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首页> 外文期刊>Journal of health services research & policy >Medicaid waivers and negotiated federalism in the US: is there relevance to other federal systems?
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Medicaid waivers and negotiated federalism in the US: is there relevance to other federal systems?

机译：医疗补助豁免和谈判美国的联邦主义：与其他联邦系统有关吗？

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Medicaid waivers have been a principal tool of innovation in health policy in the US since at least the mid 1970s. As Republicans seek to give the states more flexibility in their implementation and management of both Medicaid and the Affordable Care Act or its replacement, waiver authority is likely to be one of the key work arounds for avoiding political barriers in the US Senate. While block-granting Medicaid may require 60 senate votes, waiver authority already exists in both Medicaid law and the Affordable Care Act. Waivers also have great potential for application in other federal nations. Yet there is no theory to explain the way the application and review process evolves or the factors likely to shape the outcome. After a discussion of the theoretical underpinnings of what we call ‘negotiated federalism’, we apply it to examples of Medicaid waivers to see if the theory’s key elements – politics, party congruence, leverage, credit taking and experience – offer a useful perspective on this federal–state interaction so important to health policy.
机译：自20世纪70年代中期，医疗补助豁免是美国卫生政策创新的主要工具。随着共和党人寻求向各国提供更大的灵活性，在医疗补助和实惠的护理法案或其更换的情况下，豁免权可能是避免美国参议院政治壁垒的关键工作之一。虽然阻止药事提案可能需要60名参议员投票，但医学补助法和经济实惠的护理法案已经存在豁免权。豁免在其他联邦国家的申请也有很大的潜力。然而，没有理论解释申请和审查流程的发展方式或可能塑造结果的因素。在讨论我们所谓的“谈判联邦制”的理论下的基础之后，我们将其应用于医疗补助豁免的例子，看看理论的关键要素 - 政治，党的同时，杠杆，信用卡和经验 - 提供了一个有用的视角联邦国家对健康政策这么重要。

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