Congress and the Executive Branch and Health Policy
By Julie Rovner Kaister Family Foundation Published : May 28 , 2024 | Updated January 14 , 2025
The federal government is not the only place health policy is made in the U . S ., but it is by far the most influential . Of the $ 4.5 trillion the U . S . spent on health in 2022 , the federal government was responsible for roughly a third of all health services . The payment and coverage policies set for the Medicare program , in particular , often serve as a model for the private sector . Many health programs at the state and local levels are also impacted by federal health policy , either through direct spending or rules and requirements . Federal health policy is primarily guided by Congress , but carried out by the executive branch , predominantly by the Department of Health and Human Services .
The Federal Role in Health Policy
No one is “ in charge ” of the fragmented U . S . health system , but the federal government probably has the most influence , a role that has grown over the last 75 years . Today the federal government pays for care , provides it , regulates it , and sponsors biomedical research and medical training .
The federal government pays for health coverage for well over 100 million Americans through Medicare , Medicaid , the Children ’ s Health Insurance Program ( CHIP ), the Veterans ’ Health Administration , the Indian Health Service , and the Affordable Care Act ( ACA ). It also pays to help provide insurance coverage for tens of millions who are active-duty and retired military and for civilian federal workers .
Federal taxpayers also underwrite billions of dollars in health research , mainly through the National Institutes of Health ( NIH ) and the Agency for Healthcare Research and Quality ( AHRQ ).
Federal public health policy is spearheaded by the Centers for Disease Control and Prevention . Its portfolio includes tracking not just infectious disease outbreaks in the U . S . and worldwide , but also conducting and sponsoring public health research and tracking national health statistics .
The Health Resources and Services Administration ( HRSA ) funds critical health programs for underserved Americans ( including Community Health Centers ) and runs workforce education programs to bring more health services to places without enough health care providers .
Meanwhile , in addition to overseeing the nation ’ s largest health programs , the Centers for Medicare and Medicaid Services ( CMS ) also operates the federal insurance Marketplaces created by the ACA and enforces rules made by the law for private insurance policies .
While the federal government exercises significant authority over medical care and its practice and distribution , state and local governments still have key roles to play .
States oversee the licensing of health care professionals , distribution of health care resources , and regulation of health insurance plans that are not underwritten by employers themselves . State and local governments share responsibility for most public health activities and often operate safety-net
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