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By Michael Doonan

American Federalism in perform is a massive contribution to our knowing of latest well-being coverage in the United States. continually a massive subject, the difficulty holds specified forex at the present time given the prominence of health and wellbeing care in modern-day political and monetary panorama. Michael Doonan presents a distinct point of view on American federalism and U.S. health and wellbeing coverage in explaining how intergovernmental kinfolk form public  Read more...

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States that chose to create their own programs had flexibility to devise plans that operated more like private sector plans and less like Medicaid. However, they still had to adhere to certain federal standards with respect to administration, eligibility, benefits, cost sharing, reporting requirements, and protections against fraud. The benefit compromise, while allowing state plans to operate more like private sector plans, nevertheless required comprehensive benefits. Further, a number of benefits were specifically required and others explicitly prohibited.

22 The rule also required parents who dropped children from their health insurance coverage to wait six months before enrolling them in the CHIP program in order to discourage them from dropping their private insurance to join the CHIP program. States were also restricted by a host of other laws and court rulings. 24 Further, eligibility based on residency requirements was limited by the Supreme Court decision in Shapiro v. Thompson, which prohibited waiting periods on new arrivals to the state.

The rulemaking process was an ongoing political struggle to clarify ambiguity in the statute, and it even added provisions, like the patient’s bill of rights, that were not in the statute. Again, a very different program could have emerged if the rule were written by a different administration with different priorities. In this way, presidential elections directly influence how programs are ultimately shaped and structured. If CHIP rules had been written during the George W. Bush administration, states would have been given more power—for example, to limit benefit plans.

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