Geiger Gibson Capstone Fellowship in Health Policy & Leadership

Merle Cunningham MD MPHProgram Director

Capstone Fellowship ProgramSpring 2015

• Welcome & Program Overview

• Webinar Series• Onsite Sessions

Merle Cunningham MD MPH, Program Director

Pre-Capstone Webinar Series 2015

1. Executive Branch Role in Health Policy ( 3/24 3-

4 pm) -Merle Cunningham, GW2. Legislative Branch Role in Health Policy (3/31 3-4 pm)

-Dan Hawkins, NACHC3. Judicial Branch Role in Health Policy (4/6 3-4

pm) -Sara Rosenbaum, GW4. Role of Advocacy (4/14 3-4 pm)

-Amanda Pears Kelly, NACHC

Capstone Onsite Sessions 2015• Day 1 (4/20)

– AM at GW- Start at 8:30– PM on Capitol Hill (Metro travel)– Eve: Group Dinner (near GW)

• Day 2 (4/21)– AM at NACHC, Bethesda MD (Metro travel)– PM at HRSA, Rockville MD (Metro travel)– Eve: Free

• Day 3 (4/22)– AM & PM at GW-Adjourn at 4

The Executive Branch Role in Health Policy

Slide set adapted from Sara Wilensky, JD, PhD, Department of Health Policy

Merle Cunningham, MD MPH

Session Overview

• Federalism in Health Policy• Federal Level: Executive Branch• State Level Roles

Reading: ”State & Federal Roles in Health Care: Rationales for Allocating Responsibilities.” Chapter 2 in Holahan, Wiener and Weil’s Federalism & Health Policy. Washington DC: Urban Institute Press.

2003.

FederalismDefinition: allocation of powers and responsibilities between the States and the national government

• Key Issues– Who pays for a public service?– Who decides best /most efficient way to deliver the

services?

• Key Factors– Nature of the problem (local or national)– Effect of political pressures

Federalism in Health Policy• Arguments for Federal supremacy

– Health care requires national perspective– State autonomy may deny selected access– Federal government has necessary resources

• Arguments for State supremacy– Some programs work better if decentralized– One size does not fit all

• Examples:– Medicare vs. Medicaid – Marketplace/Health Insurance Exchanges

Executive Branch Components

• The President• White House Staff & Offices• Administrative Agencies

– Departments (Cabinet level)– Agencies

Key Federal Health Players

• Agencies (Direct healthcare roles)– DHHS (e.g. HRSA, CMS, CDC,, SAMHSA, AHRQ,

NIH, FDA, ONCHIT)

• Agencies (Indirect healthcare roles)– Defense (Tri-Care: Military Health Service) – VA (Veterans Health Administration) – USDA (e.g. WIC, Food Stamps)– Education (Health Ed Curriculum, School Health)

Key Executive PowersWhite House:• Sets National Agenda & Priorities• Issues Executive Orders• Works with Congress: Statutes & Budgets• Veto power if needed

Agencies:• Issue regulations within statutes (e.g. PINs, PALs)• Manage programs: grants, contracts (e.g. NCAs)• Provide oversight and monitoring to assure compliance

with statutes and regulations (e.g. UDS, OSV)

• Bureau Primary Health Care (BPHC)• Maternal & Child Health Bureau (MCH)• HIV/AIDS Bureau (HAB)• Bureau of Health Workforce• Other Offices

HRSA

Bureau of Primary Health Care

Administers Health Center programs • Policies: Policy Information Notices (PINs)

and Program Assistance Letters (PALs)• Program requirements, grants management• Technical assistance & training via NCAs• Reporting requirements: e.g. UDS data• FTCA Deeming

State Government Policy Roles Executive (Governor), Legislative, Judicial Branches

– State constitutions set authority & structure

– Basis: state sovereignty, commerce clause • Typical Health Care Players

– Health Department, Mental Health Department – State Medicaid Office– State Offices: licensing & regulation of health

professionals, facilities, insurance plans, etc.

• Complex relationships with Federal Agencies

• Key components of the Federal Executive Branch that relate to health policy with respect to health centers

• State level analogs of executive branches and health policy roles

Session Recap

Questions?

Open discussion