Deck 6: Federalism and Health Care Policy

Question 1

A Section 1115 demonstration waiver led directly to ____.

A)near universal health insurance coverage in Massachusetts
B)the expansion of home- and community-based services to elders and persons with disabilities
C)the creation of the Centers for Medicare and Medicaid Services
D)the creation of the licensing model to replace the intergovernmental bargaining model

Answer 1

near universal health insurance coverage in Massachusetts

Question 2

The Affordable Care Act creates a comprehensive regulatory regime for all private health insurance, with states ____.

A)relegated to the margins of decision making
B)in charge of all major aspects
C)having the annual opportunity to opt out
D)having control over premiums

Answer 2

relegated to the margins of decision making

Question 3

Which statement is an example of the concept of competitive federalism?

A)States vie with each other to keep their tax burdens low in order to retain and attract businesses and the affluent, which makes them reluctant to raise taxes to enhance Medicaid coverage.
B)Variations in state commitment to a formula grant program may lead to stark differences in levels of spending and number of enrollees.
C)State fiscal capacity varies causing less affluent jurisdictions to be at a disadvantage unless the federal government re-calibrates the funding formula.
D)The state of Oklahoma returned a $54 million innovator grant that the state had won to expedite the creation of an insurance exchange under the Affordable Care Act.

Answer 3

States vie with each other to keep their tax burdens low in order to retain and attract businesses and the affluent, which makes them reluctant to raise taxes to enhance Medicaid coverage.

Question 4

The Affordable Care Act encourages states to apply for "early innovator" awards to help them establish information technology systems for health insurance exchanges. This is an example of a ____.

A)project grant
B)block grant
C)formula grant
D)categorical grant

Question 5

Of particular importance in the intergovernmental lobby is the ____.

A)National Governors Association
B)National Association of Insurance Commissioners
C)National Association of Attorneys General
D)National Association of State Medicaid Directors

Question 6

Which phase in the historical progression of federalism and health policy started in the 1960s?

A)growth period
B)emergent period
C)post-reform period
D)minimalist period

Question 7

Which description best portrays the relationship between the federal government and the states in grant implementation processes?

A)Power relationships between the federal government and the states are roughly symmetrical.
B)States are typically puppets with the federal government pulling the strings.
C)The federal government compels state compliance through "command and control."
D)States frequently nullify federal laws in their role as implementing agents.

Question 8

States have been entrepreneurial in shifting Medicaid costs to the federal government by ____

A)using "free" money to apply to the state's share of the match
B)issuing state bonds to raise funds for the state's share of the match
C)using intergovernmental transfers to raise the 50% floor on the federal match
D)lending each other money temporarily to meet the state's share of the match

Question 9

The Affordable Care Act ____.

A)reverses the long-time trend to afford states more Medicaid discretion
B)greatly increases the opportunities for state Medicaid waivers
C)mandates the largest expansion of Medicaid since its inception with bipartisan support
D)converts a compulsory top-down program into a voluntary federal-state partnership

Question 10

Term limits, mechanisms of direct democracy (the initiative and referendum), and the downsizing of bureaucracies have ____.

A)undercut state governing capacity
B)greatly increased the governing capacity of states
C)provided a steady march towards greater state capacity
D)pushed state governing capacity back to the 1970s level

Question 11

Heath insurance was regulated largely at the state level until passage of the ____.

A)Employee Retirement and Income Security Act
B)McCarran-Ferguson Act
C)Consolidated Omnibus Budget Reconciliation Act
D)Health Insurance Portability and Accountability Act

Question 12

Which statement best describes the state-federal relationship regarding the insurance exchanges required by the Affordable Care Act?

A)If states fail to design and operate insurance exchanges, the federal government will step in and do so.
B)Each state is required to design and operate an insurance exchange.
C)The insurance exchanges are solely in the purview of the federal government.
D)States may delegate management of insurance exchanges to private insurers pursuant to federal regulations.

Question 13

An intergovernmental pattern that emphasizes interaction between the executive branches at the national and state levels to modify grant programs primarily through the administrative process is called ____.

A)executive federalism
B)competitive federalism
C)dual federalism
D)representational federalism

Question 14

State efforts in the 1990s to reintroduce community rating and guaranteed issue led to ____.

A)healthier individuals dropping insurance due to rising premiums
B)avoidance of high-risk individuals
C)"cherry picking" of people with fewer health problems
D)guaranteed broad access to affordable coverage

Question 15

Medicaid efforts at targeting to provide more generous grants to poorer states ____.

A)can easily be blocked in the Senate
B)are enhanced by the 50% floor on the federal match
C)are fluid and frequently improved by vote of Congress
D)are at the mercy of the General Accounting Office