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Re-Figuring Federalism: Nation and State in Health Reform's Next Round

By: Lawrence D. Brown
Published: January 2009
Health reform must recognize the extensive role of states in U.S. health policy and reconcile national consistency with sub-national diversity. This paper draws lessons both from federal-state relations in Medicaid and from the experiences of three other federal countries—Canada, Germany and Switzerland. It concludes that universal health coverage is compatible with a federal system, but that the federal government needs to establish central rules of the game.