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 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/ pm) -Sara Rosenbaum, GWU 4. Role of Advocacy (3/ 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 Slide set adapted from Sara Wilensky, JD, PhD, Department of Health Policy Merle Cunningham, MD MPH

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

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)

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

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

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 Session Recap

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).