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The policymaking process in the United States: The Executive Branch

The policymaking process in the United States: The Executive Branch. Sara Wilensky, JD, PhD. Session Overview. Executive Branch Administrative Agencies Role of State and Local governments Federalism. Learning Objectives. At the end of this session, participants will be able to:

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The policymaking process in the United States: The Executive Branch

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  1. The policymaking process in the United States: The Executive Branch Sara Wilensky, JD, PhD

  2. Session Overview • Executive Branch • Administrative Agencies • Role of State and Local governments • Federalism

  3. Learning Objectives At the end of this session, participants will be able to: • Broadly understand the role of the Federal Executive Branch with respect to health care & CHCs • Appreciate the role of State and Local government related to health care & CHCs  

  4. Federal Executive Branch • Key Players • President • White House Staff • Administrative Agencies • Departments • Agencies • Sub-agencies/divisions/centers

  5. Federal Executive Branch • Key Powers • Agenda setting • Private persuasion • Fundraising • Budget process • Interact with legislative process • Veto • Executive Orders/Presidential Directives • Constituents?

  6. Federal Executive Branch • Administrative Agencies • Part of Executive Branch • Under President’s authority • Key Power • To issue/promulgate regulations • Administrative Procedures Act • Proper scope • Political constraints • Constituents?

  7. HHS Organizational Chart

  8. Bureau of Primary Health Care • Administers Health Center program • Policies announced through Policy Information Notices (PINs) and Program Assistance Letters (PALs) • Technical Assistance • Information about program requirements, applying for grants, and operating health centers • UDS data • FTCA deeming

  9. State Government • Generally same structure as federal • Executive, legislative, judicial branches • State constitutions vary • Authority and structure of each branch varies by state • Data, cooperation challenges • Traditional focal point of health care • 10th amendment • Complex relationship with federal government • Varying levels of federal intervention over time

  10. State Government • Key Powers • Police powers • Poor Law descendents • Create state health departments and agencies • Tax and spend • Licensing and regulation (providers, insurance) • Create sub-units • Delegate power • Home rule

  11. Local Government • Local Public Health Agencies (LPHA) • Created by referendum or legislation resolution • Defined by state law • Part of state network, shared responsibility • Common Structures • Usually formed and managed by local gov’t • May share oversight of local agency • May directly operate local agency • Counties are primary sub-unit • 75% LPHAs on county level

  12. Intergovernmental Relations • How various levels of gov’t work together • None has absolute authority or autonomy • Trickle down: Fed State Local • Types of revenue • Direct expenditures • Intergovernmental revenues • Intergovernmental assistance • Mandates

  13. Federalism • Defined • Shared sovereignty among levels of government • Key issues • Who pays for a public service? • Correspondence principle • What level of government should deliver the service? • Distribution of costs and benefits • Nature of the problem (local or national) • Best delivery level • Effect of political pressures • Pragmatism

  14. Federalism in Health Policy • Arguments for federal primacy • Health care requires national perspective • State autonomy leads to “race to the bottom” • Federal government has necessary resources • Others? • Arguments for state primacy • Laboratories for democracy • Some programs work better if decentralized • One size does not fit all • Others?

  15. Questions?

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