The United States’ healthcare system is regulated on federal and private levels, and policy-making processes are distributed to multiple state and local administrations. Consequently, the regulations can be complicated, slow to establish, lobbied in political or business interests, and be duplicated on different governmental levels. (Bodenheimer & Grumbach, 2020). The fragmentation caused by the states’ ability to pass their policies is beneficial when a local problem requires an urgent legislative solution; however, it is a massive obstacle to developing a strong public health infrastructure. After the Affordable Care Act (ACA) passage in 2010, regions developed their insurance programs based on the insurance marketplaces allowed by the ACA. For instance, the New Jersey Health Insurance Market Preservation Act requires tax residents to get the coverage, duplicating the ACA’s initiatives. This paper aims to explore the two similar health care regulations passed on different levels, discuss the implications of federalism, and identify how the government should be involved in policy-making.
The New Jersey Health Insurance Market Preservation Act enabled the state to develop the Get Covered program to enroll the residents to receive basic insurance. Although the ACA established the regulations for getting the coverage on federal levels, the government had to allow local policy-making due to the high autonomy of many regions (Bodenheimer & Grumbach, 2020). New Jersey’s program and insurance policies duplicate the national insurance legislation, making the state’s financing system benefit from the residents’ payments. Get Covered offers the taxpayers to qualify for receiving local government’s support for essential health services, similar to the national Medicaid program (Get Covered NJ, n. d.). Although the ACA aimed to enforce the public influence on healthcare, the duplicative state-wide initiatives provided an additional opportunity for private insurance and financing for the industry.
The duplication of the ACA regulation by New Jersey’s Get Covered program is beneficial because it enables the state to address local issues without involving federal forces and finances. Moreover, the socioeconomic conditions vary among citizens, and having similar policies on two levels is an advantage because it provides an individual with the choice for the most appropriate coverage (Olfson et al., 2020). The disadvantage of the regulations’ duplication is the difficulty of taking emergency actions, such as the COVID-19 aid measures, because the usefulness of financial and implementation is unclear. If a particular government’s intervention and funding are appropriate for a poorer state, it might not work for a wealthier one, and that inequality exists in health insurance, making it difficult to build effective strategies. Furthermore, Sparer (2020) claims that “strong national standards are critical to preventing partisan politics from trumping the health policy process” (p. 490). Indeed, the existence of public and private regulation, federalism in which states share powers with the national government result in various lobbying and disruption opportunities.
The individual-mandated health insurance model has existed in the United States for a long time, and the ACA passage enforced the government’s role in regulating the industry. However, the policy-making processes are aimed to solve the states’ local problems rather than improve the system in general. Furthermore, the United States’ federalism is unique and results in the demand for developing a complex health care financing system with universal and flexible regulations applicable for the regions (France, 2008). For example, continuing education for nurses is vital nationwide, yet there is no government regulation on providing equal opportunities for all states to enforce their healthcare workforce. The federal government must be involved in the policy-making for the issues that affect most citizens, while their participation is not mandatory if a state deals with their specific challenges.
The United States’ federalism affects the health care industry where the public and private financing, insurance programs, and regulations combined. Consequently, the policy-making process becomes complex and requires assessment if the national government’s intervention is necessary. The states’ programs, such as New Jersey’s Get Covered, duplicate the ACA for making the insurance regulations more beneficial for addressing local challenges, and the minimized participation of federal representatives is valuable.