Learning from the States? Federalism and National Health Policy


Carol S. Weissert is the LeRoy Collins Eminent Scholar Chair and Professor of Political Science at Florida State University. She has published extensively in federalism and intergovernmental relations and health policy. She is the editor of Publius: The Journal of Federalism and received APSA’s 2008 Donald Stone Award for federalism and intergovernmental scholarship.
E-mail: cweissert@fsu.edu

Daniel Scheller is a doctoral candidate in the Department of Political Science at Florida State University. He earned a master’s degree in political science from Florida State University and attended Hanover College for his undergraduate studies.
E-mail: dss05d@fsu.edu


In its 1993 report, the Winter Commission gave direction to the federal government in the area of health policy and Medicaid: lead, follow, or get out of the way. This article examines how the federal government responded to that advice, specifically asking what has happened in the allocation of responsibility in health policies between 1993 and 2006. In short, unlike the suggestion that there be a better-defined direction in federal–state policy assignments in health, the ensuing years have resulted in more of the same. The authors examine what has happened, particularly focusing on vertical diffusion—where the states have acted first—and on the role of policy learning in federal decision making. They find little recognition of policy learning in recent federal health laws—even in areas in which state experience was extensive. The federal government is leading in some health policies—but it is leading without learning.