All Policy is Local: Enacting Federal Programs at the State and Local Levels

Michael Steinberg, MPP, Staff Writer, Brief Policy Perspectives 

According to Pew Research Center, in 2014, only 20% of Americans believe that federal programs are managed well, and thus, frustration with government has become a central theme of the 2016 presidential election. However, when the federal government coordinates with state and local governments to implement certain policies and programs, it can improve individual American lives and social conditions in the United States as a whole. During the Obama administration, the federal government successfully cooperated with states and municipalities to reduce the number of uninsured individuals and the number of homeless veterans.

Both of these examples provide a potential model for future administrations to enact bipartisan, citizen-centered policies. In order to create successful policy, federal agencies and Congress must design policies and programs that incorporate the skills and perspectives of state government leaders and local municipal officials.

Medicaid Expansion: Federal and State Government

Although the Affordable Care Act is one of the most controversial bills of our generation, there is no denying that the law has decreased the number of Americans without health insurance. This is due, in part, to the provision of the bill that allows states to receive additional funding for Medicaid if they expand eligibility. Medicaid is an extremely vital program that provides health insurance to low income individuals and families. According to the Center on Budget and Policy Priorities, the program’s expansion has decreased the infant mortality rate, the number of emergency room visits, and out-of-pocket medical expenses for individuals, and it has increased the likelihood of patients seeking preventative care, treating chronic conditions, and even finishing high school.

If states agree to participate in the expansion program, the federal government provides 100% of the funds to cover individuals with incomes up to 138% of the federal poverty level until 2017.  After 2020, the federal government  will provide 90% of the funding while states will provide the other 10%. Thus far, 31 states and the District of Columbia have agreed to participate in this program, while 19 states, including more conservative states like Texas, Mississippi, Alabama, and Oklahoma, have not accepted expansion funds as of July.  In states that have adopted the program, Medicaid eligibility has increased by over 8 million people and by over 2 million people in California alone.  Furthermore, the expansion program is only expected to expand state Medicaid budgets by 2.8% over 10 years while providing coverage to 17 million more Americans.

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However, some states actively elected not to expand Medicaid, and they are losing out on the benefits of the extra funding, which is trouble for their residents. According to a 2014 Gallup study, of the 12 states with the highest uninsured rates, 8 have decided against expanding Medicaid.  This means more emergency room visits, higher costs for states, and less budget flexibility for struggling Americans. Beyond the budget benefits, the Robert Wood Johnson Foundation found that states that expanded Medicaid are seeing increased job growth as well.  

Because of the numerous societal benefits of health insurance, it is smart policy for states to expand access to Medicaid, and this means the state officials must disregard party politics and cooperate with federal partners to help their citizens.

Reducing Veteran Homelessness: Federal and Local Government

In addition to working with state governments to enact policies, the Obama administration has also worked with local governments to successfully implement policy. President Obama’s Opening Doors strategic plan and the Mayor’s Challenge to End Veteran Homelessness have reduced the number of homeless veterans in the United States by 47% since 2010 and have effectively ended veteran homelessness in two states.  Through the Mayor’s Challenge, 702 mayors, 9 governors, and 172 city and county officials have committed to ending veteran homelessness in their cities.

The federal government achieved this goal by coordinating efforts among HUD, the VA, and the Interagency Council on Homelessness to provide resources to local governments and communities’ homeless assistance programs. These resources include fact sheets, webinars, benchmark goals, and regional federal employee contacts. The materials supplied emphasize key practices in ending homelessness such as providing veterans with short-term housing, targeting permanent supportive housing to prevent chronic homelessness, providing rapid re-housing opportunities for those with unstable housing, and arranging other community services for veterans. The Interagency Council on Homelessness even recognized in a recent article that the first step to ending veteran homelessness in a community is to get the state and local leaders committed to the effort.

This program is crucial for improving communities around the country because in the long run, chronic homelessness costs the government more money than providing permanent supportive housing for the homeless.  It has also increased the use and availability of data for municipalities when identifying their homeless populations. By cooperating across different levels of government and with various stakeholders directly, the Obama Administration was able to adequately equip our local communities to reduce homelessness among our nation’s veterans. These methods should be employed to address other social issues in our country.

Conclusion

Although many voters in the United States are cynical about government effectiveness, these successful programs show government can move beyond party politics to tackle modern social issues. “Washington bureaucrats” should create partnerships with state and local governments to encourage participation in federal programs such as Medicaid expansion and the initiative to end veteran homelessness, and these partnerships can ensure that average Americans see the benefit of government in society.  When designing new laws and programs, the White House, executive agencies, and Congress must consider how to incorporate state and local governments in the implementation process, regardless of political affiliations. By working with municipal officials to enact federal programs, the Obama Administration increased the number of insured Americans, reduced the number of homeless veterans, and ultimately created successful policy.  

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