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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：至少自20世纪70年代中期以来，医疗补助豁免一直是美国卫生政策创新的主要工具。随着共和党人寻求让各州在实施和管理医疗补助和平价医疗法案（Affordable Care Act）或其替代方案时具有更大的灵活性，豁免权可能是避免美国参议院政治障碍的关键解决办法之一。虽然整体批准医疗补助可能需要参议院60票，但在医疗补助法和平价医疗法案中已经存在豁免权限。豁免在其他联邦国家也有很大的应用潜力。然而，目前还没有理论来解释申请和审查过程的演变方式，或者可能影响结果的因素。在讨论了我们所说的“协商联邦制”的理论基础之后，我们将其应用于医疗补助豁免的例子，以查看该理论的关键要素——政治、政党一致性、杠杆、信贷和经验——是否为这种对卫生政策如此重要的联邦-州互动提供了有用的视角。

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