The government’s responsibilities concerning health care has grown over the last 100 years. After the Great Depression, Social Security was formed; and in the 1960s, Medicare and Medicaid were enacted. Federal responsibilities grew until the “New Federalism” of the 1990s increased reliance on the states for health care (Longest, 2010, pp. 30-33). Smaller, more local government can represent its citizen’s values better, and it knows the nature of its citizens’ problems. The New Federalism did not significantly change health policy; it gave the states more authority in setting policy and more flexibility in administering programs (Longest, 2010, pp. 30-33).
States and localities became the primary authorities in regard to health and welfare benefits. While the states welcome the increase in policy flexibility, the rising costs of healthcare and welfare put constraints on state budgets. As a result, states and localities are being forced to become more creative. Although Medicaid continues to place an enormous fiscal burden on states, programs like Children's Health Insurance Program (CHIP) have proven to be successful in terms of appropriately expanding benefits while reducing caseloads (Longest, 2010, pp. 30-33). States continue to serve as the primary distributors of social service benefits, but decreasing federal support, uncertain state economies, and the increasing need to provide long-term care to healthcare recipients are placing overwhelming burdens on states to maintain and expand existing programs.
The role of the states in protecting and promoting the health of the population is broad and complex, but can be described within six broad functions: (1) guardians of the public’s health, (2) purchasers of healthcare services, (3) regulators (e.g., standard setting and regulation), (4) safety net providers, (5) education, and (6) laboratories (Longest, 2010, pp. 30-33). States are the principal resource for protecting the public’s health by conducting a wide range of activities. State health agencies collect and analyze information; conduct inspections; plan; set policies and standards; carry out national and state mandates; manage and oversee environmental, educational, and personal health services; and assure access to health care for underserved residents (Longest, 2010, pp. 30-33). They are involved in resource development and respond to health hazards and crises. As guardians, states have inherent power to act to protect its citizens. States also have the power to delegate agencies with authority to carry out activities in their interest.
Each state has a health agency that is headed by a health commissioner or secretary of health and a state health officer. Organizational units within the state agencies vary, but most states have programs for vital statistics and epidemiology. However, these programs can vary in importance and in content between states. One common theme between all states is Medicaid, the nation's largest health...