ObamaCare and the Federalism Framework


ObamaCareand the Federalism Framework

ObamaCareand the Federalism Framework

Federalismin the American case is the system of government where thesovereignty in the country is divided between the devolved politicalunits (states) and the central government. To understand thepracticality federalism, it is imperative to explore federal policiesthat cut across the country and touches the two levels of government.The most appropriate and central policy in the united states is theAffordable Health Care Act of 2010, also known as the ObamaCareMedicaid.

Commonlycalled the ObamaCare, the policy’s primary purpose is to expand theMedicaid to all the people in the country, especially those who havelow income and do not have medical insurance. The act is purposed toachieve this by increasing the affordability and the quality ofhealth insurance, expanding health insurance coverage and cut downthe cost of health care (Bodenheimer &amp Grumbach, 2012). Among themain benefits of the act is to allow people who were locked out ofhealth insurance to health insurance coverage. Therefore, the policywill solve the problem of affording health care for people who cannotservice the private health insurance policies.

Historyand the Federalism Framework

Thefederalism policy has a history that dates back to 1989. According toMarcovici(2013), the policy was championed by the conservative economists, butdid not succeed the opposition of the democrats. However, in 1993,Bill Clinton agreed with the republicans to adopt a health insuranceplan for children called the SCHIP, “StateChildren`s Health Insurance Program (Marcovici, 2013). By 2006, theidea had created a large support, leading to the establishment ofObamaCare acts that became the foundation of the policy after passinginto law in 2010.

Thepolicy of the ObamaCare Medicaid directly related to the federalismaspect of governance. This is because the policy relates to both thecentral government and the devolved state governments. Theimplementation of the policy involves the compliance of the statesand the federal governments to the act passed in 2010. In addition,the history of the ObamaCare policy raised the issues with thesupport of the health care bill as some state representatives in theSenate supported the policy while others opposed the act.

Prosand Cons and Evaluation

Whilethe act had a mixed feeling among the Americans, the policy has boththe pros and cons in relation to the implementation debates that theprovisions raise. One of the pros that the act raised is that ofaffordability of health care policy and health care access. Accordingto U.S. Department of Health and Human Services (2015), the policyintroduces affordable health to Americans who cannot afford healthcare insurance policies. This advantage can be examined from two mainperspectives the policy effectiveness and policy consistency. Fromthe perspective of effectiveness, the policy has been effective inmaking health care insurance affordable. This is because the premiumspaid on the policy are low and obligates employers to pay for theemployees (U.S. Department of Health &amp Human Services, 2015). Interms of consistency, the policy has yet to be fully implemented asthe implementation period ranges from 2010 to 2020.

Asa consequence of affordable health care, the policy has an advantageof increasing the coverage of Medicaid through access to healthinsurance. The policy allows the people who were previous blockedfrom medical cover to access and afford a health policy (Blumenthal,2014).In addition, the policy led to increase in the number of people undera health care insurance policy. From the perspective ofeffectiveness, this policy has succeeded in the expansion of theaccess to healthcare by increasing the numbers of people covered.According to Blumenthal(2014),about 20 million people had achieved the purpose of the policy byhaving a health insurance policy by May of 2014. However, under theconsistency perspective, the policy has faced the challenges ofimplementation due to opposition by some states and labor unions.

Despitethe advantages, the policy has a disadvantage of causing disruptionof the existing policies leading due to an increase in the demand forhealth care. The implementation of the ObamaCare policy will cause anincrease in the demand for health care among the public hospitals,leading to an overflow to the private hospitals in the states(Bodenheimer &amp Grumbach, 2012). This will cause a challenge inthe efficiency and effectiveness of the service offered in thestates, especially those that are not well organized to handle such ademand.

Fromespecially the perspective of effectiveness, this disadvantage is avalid concern since the service delivery in public hospitals will bedisrupted as people will shift to private hospitals in the states(Bodenheimer &amp Grumbach, 2012). From a consistency perspective,the disadvantage of the policy shows a challenge in thesustainability of public hospitals in the states due to reducedrevenues as people shift to private health institutions.


TheObamaCare health policy aims at achieving affordable health carethrough the provision of accessible and affordable health careinsurance. By allowing as many people as possible to enroll toaffordable health care policies, ObamaCare introduces a perfectexample of a policy that cuts across the national government and thestate governments. Therefore, the ObamaCare is an illustration of thesuccesses and challenges experienced when implementing policies thatcuts across the constitutional framework of federalism.


&nbspBlumenthalD, Collins SR (2014).&nbsp&quotHealthcare coverage under the Affordable Care Act–a progress report.&quot.&nbspNEngl J Med&nbsp371&nbsp(3):275–81.

Bodenheimer,T.&amp Grumbach K. (2012). UnderstandingHealth Policy: A Clinical Approach.New Edition. San Francisco: McGraw-Hill

Marcovici,M. (2013). TheObamacare Case: Where the new healthcare system will lead us.New York: BoD, Books on Demand

U.S.Department of Health &amp Human Services, (2015). Howthe Health Care Law Benefits YouRetrieved From,&lthttp://www.healthcare.gov/law/information-for-you/benefits.html&gtMarch 11, 2014