Question 1

A Section 1115 demonstration waiver led directly to ____.

Accepted Answer

The Section 1115 demonstration waiver allowed Massachusetts to implement its own health care reform in 2006, which included an individual mandate for insurance coverage and the creation of the Massachusetts Health Connector. This led to near universal health insurance coverage in the state.

Question 2

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

Accepted Answer

The Affordable Care Act (ACA) significantly increased federal oversight and standards for health insurance, limiting the role of states primarily to implementation and enforcement, thus relegating them to the margins of decision-making in many aspects of health insurance regulation.

Question 3

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

Accepted Answer

This statement exemplifies competitive federalism as it highlights how states compete with one another to attract businesses and the wealthy by keeping their tax burdens low, which in turn can hinder efforts to invest in programs such as Medicaid.

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 ____.

Accepted Answer

This is an example of a project grant, which provides funding for specific projects or activities that align with the goals and objectives of the grant program.

Question 5

Of particular importance in the intergovernmental lobby is the ____.

Accepted Answer

The National Governors Association is a prominent intergovernmental lobby that represents the interests of governors from all 50 states and territories. It has significant influence in shaping national policies and legislation that affect state governments. The other organizations listed also play important roles in intergovernmental lobbying, but the National Governors Association is widely regarded as the most powerful and effective.

Question 6

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

Accepted Answer

The growth period in the historical progression of federalism and health policy started in the 1960s, marked by significant expansions in health policy and federal involvement, including the establishment of Medicare and Medicaid.

Question 7

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

Accepted Answer

Power relationships between the federal government and the states in grant implementation processes are roughly symmetrical. While the federal government provides funding and sets general guidelines, the states retain some discretion in how to implement the grant programs within their boundaries. This means that states can negotiate with the federal government on certain aspects of the grant implementation, making the relationship between the two roughly symmetrical.

Question 8

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

Accepted Answer

States have used creative financing mechanisms, such as using "free" money from other sources, to cover their share of Medicaid costs, effectively shifting more of the financial burden to the federal government.

Question 9

The Affordable Care Act ____.

Accepted Answer

The Affordable Care Act (ACA) reverses the trend of giving states more discretion over Medicaid by setting federal standards for Medicaid expansion, thus reducing the level of discretion states had previously.

Question 10

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

Accepted Answer

Term limits, mechanisms of direct democracy, and downsizing of bureaucracies have led to a decrease in the experience and expertise of elected officials and government employees, as well as a lack of continuity in policies and programs. This has resulted in a reduction in state governing capacity.

Question 11

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

Accepted Answer

The Employee Retirement and Income Security Act of 1974 (ERISA) established federal regulations for employee benefit plans, including health insurance, and preempts much of state law in this area.

Question 12

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

Accepted Answer

The Affordable Care Act does require each state to establish its own insurance exchange, but if a state does not do so, the federal government will step in and run the exchange for that state. This creates a partnership between the federal and state governments where the state has the option to take the lead or defer to the federal government. Additionally, states may also 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 ____.

Accepted Answer

Executive federalism emphasizes interaction between the executive branches at the national and state levels to modify grant programs primarily through the administrative process. Competitive federalism emphasizes competition between states to attract businesses and investment. Dual federalism emphasizes clear distinctions and separation of powers between the national and state governments. Representational federalism is not a commonly used term in political science.

Question 14

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

Accepted Answer

Community rating and guaranteed issue policies in the 1990s often led to healthier individuals dropping their insurance coverage due to rising premiums. These policies aimed to make insurance more accessible and fair by preventing insurers from setting premiums based on health status or denying coverage for pre-existing conditions. However, without a mandate for everyone to purchase insurance, healthier individuals, who assessed themselves as less likely to need medical care, were more inclined to forgo coverage, leading to a sicker and more expensive insurance pool. This, in turn, drove up premiums further, exacerbating the issue.

Question 15

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

Accepted Answer

The answer of Medicaid efforts at targeting to provide more...

Quiz 6: Federalism and Health Care Policy