Geiger Gibson Capstone in Community Health Policy Leadership

Geiger Gibson Capstone in Community Health Policy & Leadership Webinar Series – Fall 2013 (Tues 3 -4 pm ET) 1. Executive Branch 10/1 -Merle Cunningham 2. Legislative Branch 10/8 -Dan Hawkins 3. Judicial Branch-10/15 -Sara Rosenbaum 4. Advocacy Role-10/22 -Amanda Pears Kelly Merle Cunningham MD MPH, Capstone Program Director

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

Learning Objectives At the end of this session, participants will be able to: 1. Better understand the role of key components of the Federal Executive Branch that relate to health policy & health centers 2. Better appreciate the role of key state and local government players and their relationships with Federal agencies 3. Better understand some of the issues related to Federal-State collaboration

Session Overview • • Federalism Federal level: Executive Branch State and local (county/city) level Examples of Federal-State collaboration Reading: ”State & Federal Roles in Health Care: Rationales for Allocating Responsibilities. ” Chpt 2 in Holahan, Wiener and Weil’s Federalism & Health Policy. Washington DC: Urban Institute Press. 2003.

Federalism • Definition – Shared sovereignty among levels of government • Key Issues – Who pays for a public service? – Where is it most efficient to allocate provision & payment for public services? • What level of government should deliver the service? – – – Distribution of costs & benefits Nature of the problem (local or national) Best delivery level Effect of political pressures Ideology vs pragmatism

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

Executive Branch Components • The President • White House Staff & Offices • Administrative Agencies – Departments (Cabinet level) – Agencies – Sub-agencies/divisions/centers

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

Key Powers White House: • Sets national agenda & highlights priorities • Issues Executive Orders/Presidential Directives • Interacts with legislative process: laws & budgets • Veto power if needed Agencies: • Issue/promulgate regulations within statutes (PINs, PALs) – e. g. Administrative procedures, guidance, reporting, etc. • Manage programs: grants, contracts • Provide oversight and monitoring to assure compliance with statutes and regulations

HHS Organizational Chart

Bureau of Primary Health Care Administers Health Center programs • Policies: Policy Information Notices (PINs) and Program Assistance Letters (PALs) • Program requirements, grants management • Technical assistance & training via NCAs • Reporting requirements: e. g. UDS data, ARRA • FTCA Deeming

State Government • Generally same structure as Federal – Executive (Governor), legislative, judicial branches – State constitutions, authority & structure of branches vary – 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 – Wide variation among States & agencies (e. g. CMS, CDC, SA)

Local Government (County or City) • Local Public Health Agencies: – – Created by referendum or legislation Part of state network with shared responsibilities Usually formed and managed by local government May share oversight or directly operate health services • Typical Players/Structures (integration variable) – County/city health departments – County/city mental health/substance abuse departments – County/city Medicaid/welfare offices

Federal-State-Local Collaboration • Childhood & Adolescent life cycles – Early childhood development – Immunization registries -Asthma -Obesity • Women’s Health life cycles – Family planning & prenatal care (reproductive health) – Screening & prevention (breast & cervical CA, HTN) • Adult life cycles – Diabetes – Heart disease – Depression -Obesity -Cancer -HIV AIDS

Questions? Open discussion