Introduction
Public health law is a legal mechanism that focuses on issues involving the governance and provision of medical services. The aim of the legislation is to ensure that the services are provided fairly to all persons. In the United States of America, the provision of Medicare is the mandate of both the state and the federal governments. It is provided in the form of Medicaid and Medicare. The services mainly target children, the aged, and the poor in society (Carson, Koger, Lebo, & Young, 2010). As such, there are legal mechanisms and guiding policies that are put in place to regulate the administration and management of resources and funds pooled together by the two governments. Consequently, there are common interests and conflicts between the two governments in the provision of these essential services. In this paper, the author will analyze these interests and conflicts with regard to the provision of Medicaid.
Interests and Conflicts in the Provision of Medicaid
Similarities between the Interests of the State and the Federal Governments with Regards to Medicaid
Both the state and the federal governments share some vested interests in the provision of Medicaid. The two governments are interested in the provision of quality healthcare to the citizenry (Pearson, 2005). To achieve this objective, the governments come together and pool their resources in a guided and regulated plan. The federal and state governments also attempt to increase funding to the program to improve the quality of services provided. To this end, the federal government is proposing additional funding under the Affordable Care Act (Gordon, 2014). On its part, the state governments are pushing for the adoption of budgets and policies in favor of Medicaid. Bovbjerg, Wiener, and Housman (2006) observe that citizens are entitled to Medicaid. As such, the federal and state governments share some legal obligations to provide services to all citizens who qualify for the program. As such, there are laws and policies enacted on both sides to enhance the management of the plan (Wachino, Scheider, & Rousseau, 2004).
Conflicts between the State and Federal Governments in Relation to Medicaid
Cases involving two or more parties are characterized by a wide array of issues and conflicting interests. The same applies to Medicaid. It is a fact that the program is funded by the state and federal governments, creating a shared interest. In addition, the two governments are guided by statutory provisions, such as the Conflict-Free Case Management [CFCM] (Carson et al., 2010). However, there still exist cases of conflicts between the federal and state governments. A case in point is the application and definition of administrative policies that guide the program (Gordon, 2014). Each of the two governments attempts to outdo the other by imposing its policies. In addition, the acquisition of resources and facilities poses a challenge to the two entities. To this end, there are conflicts on who should undertake the procurement of human resources and facilities (Grabowski, 2007).
Other factors that bring conflicts between the interests of the two governments include the provision and acquisition of the required skills and expertise (Esterling, 2009). Under normal circumstances, it is the state government that should provide these skills (Snyder & Rudowitz, 2015). However, when there is a lack of capacity on the part of the state authorities, conflicts arise on how the services should be acquired (Esterling, 2009). The conflicts may affect the quality of the services provided to the citizens.
The manifestation of the Interests and Conflicts between the Federal and State Governments in the Provision of Medicaid
It is a fact that both parties are committed to the funding of the Medicaid program (Pearson, 2005). To this end, funding is one of the ways through which the similarity in interests manifests itself. Other ways through which the shared interests are expressed is through the enactment and enforcement of policies and acts aimed at improving and managing Medicaid (Bovbjerg et al., 2006). According to Gordon (2014), the introduction of the CFCM is another way through which the shared interests between the federal and the state governments are made evident. The CFCM is enacted through amendment acts and regulations put in place by Congress (Gordon, 2014).
Policymaking and discharging of duties are two of the main channels through which the conflicts between the federal and the state governments are displayed (Grabowski, 2007). It is observed that in most cases, differences in political opinions affect the enactment of policies touching on Medicaid. The differences are especially evident when the state governments publicly ‘refuse’ the services of the federal government (Grabowski, 2007). The introduction of the Centre for Medicare and Medicaid Services (CMS) was meant to avert the conflicts between the two entities. According to Carson et al. (2010), CMS is meant to provide guidance with regards to the management of funds meant for Medicaid.
Analyzing the Loyalty of the Congressional Delegation in Relation to Medicaid
Congressmen are elected leaders in the House of Representatives. They are required to pass bills and laws to regulate commerce and other activities in the various jurisdictions (Bovbjerg et al., 2006). The political differences between the elected members determine the loyalty of the Congressional delegation. In most cases, the majority side tends to push for the bills that favor their side of the political divide. To this end, it is apparent that if the ruling party has a majority in the Congressional delegation, the loyalty of the members is likely to lie with the federal (Esterling, 2009). The loyalty switches to the state government if the ruling party lacks control over the delegation (Gordon, 2014).
According to Pearson (2005), the loyalty of the Congressional delegation lies with the party that has the majority in the house. Leaders will push for policies that are beneficial to their electorate. However, their loyalty, even in matters to do with Medicaid, lies with their party (Snyder & Rudowitz, 2015). It is important to note that in some cases, especially when it comes to service delivery, some leaders deviate from partisanship. The reason is that partisanship may result in electoral penalties from the constituents (Wachino et al., 2004).
Conclusion
People who cannot afford proper medical care in the US are catered for by programs put in place by the federal and state governments. Such programs include Medicaid. The plan is funded by the state and the federal governments. Provision of services calls for the procurement of facilities and personnel. To this end, the duties of the two governments are made clear by the law. However, at times, conflicts between the interests of the two governments arise. The conflicts can result from the failure to adhere to the guidelines put in place. They may also arise from political intolerance on both sides.
References
Bovbjerg, R., Wiener, J., & Housman, M. (2006). State and federal roles in healthcare.Web.
Carson, J., Koger, G., Lebo, M., & Young, E. (2010). The electoral costs of party loyalty in Congress. American Journal of Political Science, 54(3), 598-616.
Esterling, K. (2009). Does the federal government learn from the states?: Medicaid and the limits of expertise in the intergovernmental lobby. Publius, 39(1), 1-21.
Gordon, F. (2014). Conflict free case management: Themes in states working to implement new systems.Web.
Grabowski, D. (2007). Medicare and Medicaid: Conflicting incentives for long-term care. The Milbank Quarterly, 85(4), 579-610.
Pearson, K. (2005). Party discipline in the contemporary Congress: Rewarding loyalty in theory and in practice. Berkeley: University of California.
Snyder, L., & Rudowitz, R. (2015). Medicaid financing: How does it work and what are the implications?.Web.
Wachino, V., Scheider, A., & Rousseau, D. (2004). Financing the Medicaid program: The many roles of federal and state matching funds. Web.