Geiger Gibson Capstone Fellowship in Health Policy Leadership

Geiger Gibson Capstone Fellowship in Health Policy & Leadership Merle Cunningham MD MPH Program Director

Capstone Fellowship Program Spring 2016 • • Welcome & Program Overview Webinar Series Onsite Sessions Executive Branch Role Merle Cunningham MD MPH, Program Director

Pre-Capstone Webinar Series 2016 1. Executive Branch Role in Health Policy ( 3/1 3 -4 pm) -Merle Cunningham, GWU 2. Legislative Branch Role in Health Policy (3/8 3 -4 pm) -Dan Hawkins, NACHC 3. Judicial Branch Role in Health Policy (3/22 12 -1 pm) -Sara Rosenbaum, GWU 4. Role of Advocacy (3/29 3 -4 pm) -Amanda Pears Kelly, NACHC

Capstone Fellowship Onsite Sessions 2016 • Day 1 (Mon - Apr 4) – AM GWU- Start at 8: 30 – PM Capitol Hill (Metro travel) – Eve: Group Dinner (near GWU) • Day 2 (Tues - Apr 5) – – – AM at NACHC, Bethesda MD (Metro travel) PM at HRSA, Rockville MD (Metro travel) Eve: Free • Day 3 (Wed – Apr 6) – AM & PM at GWU-Adjourn at 4

The Executive Branch Role in Health Policy Merle Cunningham, MD MPH Slide set adapted from Sara Wilensky, JD, Ph. D, Department of Health Policy

Session Overview • Federalism in Health Policy • Federal Level: Executive Branch • State Level Roles Reading: ”State & Federal Roles in Health Care: Rationales for Allocating Responsibilities. ” Chapter 2 in Holahan, Wiener and Weil’s Federalism & Health Policy. Washington DC: Urban Institute Press. 2003.

Federalism Definition: allocation of powers and responsibilities between the States and the national government • Key Issues – Who pays for a public service? – Who decides best / most efficient way to deliver the services? • Key Factors – Nature of the problem (local or national) – Effect of political pressures

Federalism in Health Policy • Arguments for Federal supremacy – Health care requires national perspective – State autonomy may deny selected access – Federal government has necessary resources • Arguments for State supremacy – Some programs work better if decentralized – One size does not fit all • Examples: – Medicare vs. Medicaid Expansion – Marketplace/Health Insurance Exchanges

Executive Branch Components • The President • White House Staff & Offices • Administrative Agencies – Departments (Cabinet level) – Agencies

Key Federal Health Players • Agencies (Direct healthcare roles) – DHHS (e. g. HRSA, CMS, CDC, SAMHSA, AHRQ, NIH, FDA, ONCHIT) – Defense Dept (Tri-Care: Military Health Service) – VA (Veterans Health Administration) • Agencies (Indirect healthcare roles) – USDA (e. g. WIC, Food Stamps) – Education (Health Ed Curriculum, School Health)

Key Executive Powers White House: • Sets National Agenda & Priorities • Issues Executive Orders • Works with Congress: Statutes & Budgets • Veto power if needed Agencies: • Issue regulations within statutes (e. g. PINs, PALs) • Manage programs: grants, contracts (e. g. NCAs) • Provide oversight and monitoring to assure compliance with statutes and regulations (e. g. UDS, OSV)

HRSA • • • Bureau Primary Health Care (BPHC) Maternal & Child Health Bureau (MCH) HIV/AIDS Bureau (HAB) Bureau of Health Workforce Other Offices

Bureau of Primary Health Care Administers Health Center programs • Policies: Policy Information Notices (PINs) and Program Assistance Letters (PALs) • Program requirements • Technical Assistance & Training • Reporting requirements: e. g. UDS data • FTCA Deeming

State Government Policy Roles Executive (Governor), Legislative, Judicial Branches – State constitutions set authority & structure – Basis: state sovereignty, commerce clause • Typical Health Care Players – Health Department, Mental Health Department – State Medicaid Office – State Offices: licensing & regulation of health professionals, facilities, insurance plans, etc. • Complex relationships with Federal Agencies

Session Recap • Key components of the Federal Executive Branch that relate to health policy with respect to health centers • State level analogs of executive branches and health policy roles

Open Discussion Identify and discuss a health service program with restrictions related to health policy issues set by Federal or State Executive Branch decisions (NOT related to Legislative Branch laws or Judicial Branch rulings).