The Structure
It is no surprise that although healthcare wasn't specifically thought of when our founding fathers built the structure of government, what they did still has a strong impact of healthcare today. Federalism, for example, plays a huge role. Federalism refers to the division of power between the central government and the states government. In most cases, federalism serves us good and protects us from one government being too powerful. However, when it comes to healthcare it makes things difficult. Not all states are on the same page with healthcare so when a healthcare act gets passed it's up to the states how far they want to go with the matter and this can result in the act being ultimately unsuccessful. For example, in the beginning of 2017, states were expected to take on the Obamacare medicaid expansion. In 2012, Supreme court gave states the right to not participate and that's exactly what 27 states did. With more than half of states opting out the expansion, many were left uncovered. "Among adults who earn less than poverty wages in states that didn’t expand Medicaid, the uninsured rate is 36 percent, a decline of two percentage points (termed not statistically significant) from last year. That compares to a dramatic drop from 28 percent to 17 percent in states that expanded Medicaid. (huffingtonpost)" This is only one example of healthcare reforms failing due to states opting out. With different views coming from different states, it's hard to come to an agreement. Even when mandatory acts are passed, States fight against it and usually are able to decide. This is because it's protected in our Constitution and although, it's intentions are nothing but good, it makes moving forward difficult.