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Article
What Is Federalism in Healthcare For?
by Abbe R. Gluck & Nicole Huberfeld
The Affordable Care Act (ACA) offers a window into modern American federalism—and modern American nationalism—in action. The ACA’s federalism is defined not by separation between state and federal, but rather by a national structure that invites state-led implementation. As it turns out, that structure was only a starting point for a remarkably dynamic and adaptive…
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"description": "The Affordable Care Act (ACA) offers a window into modern American federalismu2014and modern American nationalismu2014in action. The ACAu2019s federalism is defined not by separation between state and federal, but rather by a national structure that invites state-led implementation. As it turns out, that structure was only a starting point for a remarkably dynamic and adaptive implementation process that has generated new state-federal arrangements. States move back and forth between different structural models vis-u00e0-vis the federal government; internal state politics produce different state choices; states copy, compete, and cooperate with each other; and negotiation with federal counterparts is a near constant. These characteristics have endured through the change in presidential administration.rnrnThis Article presents the results of a study that tracked the details of the ACAu2019s federalism- related implementation from 2012 to 2017. Among the questions that motivated the project: Does the ACA actually effectuate u201cfederalism,u201d and what are federalismu2019s key attributes when entwined with national statutory implementation? A federal law on the scale of the ACA presented a rare opportunity to investigate implementation from a statuteu2019s very beginning and to provide the concrete detail often wanting in federalism scholarship.rnrnThe findings deconstruct assumptions about federalism made by theorists of all stripes, from formalist to modern. Federalismu2019s commonly invoked attributesu2014including autonomy, cooperation, experimentation, and variationu2014have not been dependent on any particular architecture of either state-federal separation or entanglement, even though theorists typically call on u201cfederalismu201d to produce them. Instead, these attributes have been generated in ACA implementation across virtually every kind of governance modelu2014that is, regardless whether states expand Medicaid; get waivers; or operate their own insurance exchanges or let the federal government do it for them. This makes it extraordinarily challenging to measure which structural arrangements are most u201cfederalist,u201d especially because the various federalism attributes are not always present together.rnrnThe study also uncovers major theoretical difficulties when it comes to healthcare: Without a clear conception of the U.S. healthcare systemu2019s goals, how can we know which structural arrangements serve it best, much less whether they are working? If healthcare federalism is a mechanism to produce particular policy outcomes, we should determine whether locating a particular facet of healthcare design in the states versus the federal government positively affects, for example, healthcare cost, access, or quality. If, instead, healthcare federalism serves structural aims regardless of policy endsu2014for instance, reserving power to states in the interest of sovereignty or checks and balancesu2014we should examine whether it does in fact accomplish those goals, and we should justify why those goals outweigh the moral concerns that animate health policy. The ACA did not cause this conceptual confusion, but it retained and built on a fragmented healthcare landscape that already was riddled with structural and moral compromises.rnrnThis does not mean that federalism is an empty concept or that it does not exist in the ACA. Federalism scholars tend to argue for particular structural arrangements based on prior goals and values. The ACAu2019s architecture challenges whether any of these goals and values are unique to federalism or any particular expression of it. At the same time, the ACAu2019s implementation is clearly a story about state leverage, intrastate democracy, and state policy autonomy within, not apart from, a national statutory scheme. Its implementation illustrates how federalism is a proxy for many ideas and challenges us to ask what we are really fighting over, or seeking, when we invoke the concept in healthcare and beyond.rnrn* Abbe R. Gluck is Professor of Law and Faculty Director of the Solomon Center for Health Law and Policy, Yale Law School; Nicole Huberfeld is Professor of Health Law, Ethics & Human Rights, Boston University School of Public Health, Professor of Law, Boston University School of Law.",
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Article
The States’ Interest in Federal Procedure
by Diego A. Zambrano
Recent changes to federal procedure have alarmed state governments. In a series of cases decided in the past ten years, the U.S. Supreme Court has restructured basic procedural doctrines on personal jurisdiction, class actions, and pleading, among others. To signal their concern, dozens of state attorneys general have written amicus briefs in twelve out of…
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"description": "Recent changes to federal procedure have alarmed state governments. In a series of cases decided in the past ten years, the U.S. Supreme Court has restructured basic procedural doctrines on personal jurisdiction, class actions, and pleading, among others. To signal their concern, dozens of state attorneys general have written amicus briefs in twelve out of the eighteen major procedure cases decided by the Supreme Court since 2007, demanding that federal courts refrain from remaking longstanding principles. Some state legislatures have threatened to invalidate procedural decisions through legislation, and even state courts have joined the effortu2014one state judge claimed that a recent class action decision was u201ccontrary to every legal principle in the book, and I donu2019t care if the U.S. Supreme Court wrote it or not. Itu2019s wrong.u201d Repeatedly, the states have expressed u201calarm,u201d argued that some procedural changes are u201cdeeply insulting,u201d and called some decisions u201cabsurd,u201d even though many cases seemingly had no effect on state courts whatsoever. Why exactly are the states so interested in federal procedure?rnrnThis Article presents the first comprehensive study of the relationship between the states and federal procedure. This Article offers three contributions. First, it catalogs the statesu2019 wide array of interventions into federal procedure to show that the states have a strong interest in recent procedural changes. Second, it builds a typology that explores the multifaceted ways in which federal procedure does in fact affect the states. This review exposes federal-state cross-currents rooted in legal, economic, and political dynamics. Surprisingly, although Democrats and Republicans are squarely divided on procedural issues, this Article finds that the statesu2019 institutional interest in procedure trumps political ideologies; most state amicus briefs in this context have involved bipartisan coalitions. rnThird, this Article draws upon a wealth of federalism and administrative law scholarship to argue that scholars and federal actors should welcome the statesu2019 involvement in federal procedure. Giving the states a role would provide rich epistemic benefits, promote democratic values, and improve transparency at the Advisory Committee.rnrnrn* Harry A. Bigelow Teaching Fellow and Lecturer in Law, University of Chicago Law School.",
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Article
Reviving Federal Regions
by Yishai Blank & Issi Rosen-Zvi
More than one hundred executive departments and agencies operate through systems of regional offices strategically located around the country. Currently, these regions are misguidedly viewed as mere enforcers and implementers of central policies. We propose two alternative visions of federal regions—regions as mediators and regions as coordinators. These two visions have deep roots in the…
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"description": "More than one hundred executive departments and agencies operate through systems of regional offices strategically located around the country. Currently, these regions are misguidedly viewed as mere enforcers and implementers of central policies. We propose two alternative visions of federal regionsu2014regions as mediators and regions as coordinators. These two visions have deep roots in the rich but forgotten history of U.S. public administration. In the New Deal era, federal regions were understood as mediating entities between the central governmentu2019s centralizing efforts and regional needs and conditions. With the expansion of federal programs and agencies in the 1950s and 1960s, federal regions were gradually reconceived as vehicles for coordination among the different branches of the administration as well as between the federal government and the states. Since the 1980s, however, federal regions have been seen as part of the oversized federal government and have thus been mistrusted, their role confined to that of mere enforcers.rnrnThis Article calls for a revival of viewing federal regions as mediators and coordinators. It argues that when regions live up to their potential, they inject a much-needed dose of democracy into the bureaucracy, improve the coordination among federal departments and agencies, and serve as a powerful check on presidential overreach. Federal regions mediate between central headquarters and state and local governments. Their proximity to the states and to regulated populations and industries enables regional offices to counter the democratic deficit that plagues U.S. bureaucracy. Relatively insulated from Washington, D.C. and state partisan politics, regional officials fuse their expertise with principled politics and can avoid capitulating to the will of the President or presidential appointees. Our model of federal regions as coordinators envisions them as entities that coordinate among the different departments, agencies, states, and localities that operate within given regions.rnrnOur innovative understanding of federal regions gives rise to a promising alternative to both the centralizing, national vision and the state-centered vision of American federalism. We then propose a set of legal doctrines and principles that modify administrative law to suit the unique characteristics of federal regions. Included among these doctrines are broad subdelegation of powers to regions; greater judicial deference to regional policies and decisionmaking; and intergovernmental consultation and redelegation at the regional level.rnrn* Professors, Tel Aviv University Buchmann Faculty of Law.",
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Essay
The Challenge of the New Preemption
by Richard Briffault
The past decade has witnessed the emergence and rapid spread of a new and aggressive form of state preemption of local government action across a wide range of subjects, including among others firearms, workplace conditions, sanctuary cities, antidiscrimination laws, and environmental and public health regulation. Particularly striking are punitive measures that do not just preempt…
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Essay
Preemption and Commandeering Without Congress
by Jessica Bulman-Pozen
In a time of polarization, states may introduce salutary pluralism into an executive-dominated regime. With partisan divisions sidelining Congress, states are at once principal implementers and principal opponents of presidential policies. As polarization makes states more central to national policymaking, however, it also poses new threats to their ability to act. This Essay cautions against…
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View Current & Past Print Volumes
Recent Online Essays
SLR in the News
The Supreme Court of Michigan cites Textualism and the Fourteenth Amendment in its opinion in Citizens Protecting Michigan’s Constitution v. Secretary of State.
A Supreme Court of Texas decision cites in its reasoning Torts and Estates: Remedying Wrongful Interference with Inheritance.
A Time Magazine story about sexual harassment law cites the Open Statement from the #MeToo and the Future of Sexual Harassment Law symposium.
Justice Thomas cites Who Are “Officers of the United States”? in his concurring opinions in Lucia v. Securities and Exchange Commission and in Ortiz v. United States.
An ABC News story about legal issues regarding asylum seekers at the U.S. border cites Refugee Roulette: Disparities in Asylum Adjudication.
Justice Sotomayor cites Statutory Interpretation From the Inside—An Empirical Study of Congressional Drafting, Delegation and the Canons: Part I in her concurring opinion in Digital Realty Trust, Inc. v. Somers.
Featured Topic in the Law
Article
Constitutional Administration
by Ilan Wurman
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Administrative law rests on two fictions. The first, the nondelegation doctrine, imagines that Congress does not delegate legislative power to agencies. The second, which flows from the first, is that the administrative state thus exercises only executive power, even if that power sometimes looks legislative or judicial. These fictions are required by a formalist reading of the Constitution, whose Vesting Clauses permit only Congress to make law and the President only to execute the law. This formalist reading requires us to accept as a matter of practice unconstitutional delegation and the resulting violation of the separation of powers, while pretending as a matter of doctrine that no violation occurs.
rnThis Article argues that we ought to accept the delegation of legislative power as a matter of doctrine because doing so can help remedy the undermining of the separation of powers. Accepting delegation as a matter of doctrine allows us to delineate the legislative, executive, and judicial components of administration and to empower each constitutional branch of government over the component corresponding to its own constitutional function. With this insight, for example, a legislative veto of the administrationu2019s legislative acts is constitutional.
rnThis Article seeks to make one functionalist move (accepting delegation) in order to deploy formalist tools to restore some semblance of the original constitutional scheme of separate powers. It seeks to take both formalism, which has served merely to mask the administrative stateu2019s unconstitutional foundations, and functionalism, which has failed to offer any limiting principles to modern administrative practices, more seriously than modern scholars and doctrine do. A functionalist approach to delegation allows us to deploy formalismu2014but an honest formalismu2014to the separation of powers.
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Feature
Refugee Roulette
by Jaya Ramji-Nogales, Andrew I. Schoenholtz & Philip G. Schrag
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"headline": "Disparities in Asylum Adjudication",
"description": "Addressing consistency in the application of the law, former Attorney General Robert Jackson told Congress in 1940: u201cIt is obviously repugnant to one's sense of justice that the judgment meted out . . . should depend in large part on a purely fortuitous circumstance; namely the personality of the particular judge before whom the case happens to come for disposition.u201d Yet in asylum cases, which can spell the difference between life and death, the outcome apparently depends in large measure on which government official decides the claim. In many cases, the most important moment in an asylum case is the instant in which a clerk randomly assigns an application to a particular asylum officer or immigration judge.This study analyzes databases of decisions from all four levels of the asylum adjudication process: 133,000 decisions involving nationals from eleven key countries rendered by 884 asylum officers over a seven-year period; 140,000 decisions of 225 immigration judges over a four-and-a-half-year period; 126,000 decisions of the Board of Immigration Appeals over a six-year period; and 4215 decisions of the U.S. courts of appeals during 2004 and 2005. The analysis reveals amazing disparities in grant rates, even when different adjudicators in the same office each considered large numbers of applications from nationals of the same country. For example, in one regional asylum office, 60% of the officers decided in favor of Chinese applicants at rates that deviated by more than 50% from that region's mean grant rate for Chinese applicants, with some officers granting asylum to no Chinese nationals, while other officers granted asylum in as many as 68% of their cases. Similarly, Colombian asylum applicants whose cases were adjudicated in the federal immigration court in Miami had a 5% chance of prevailing with one of that court's judges and an 88% chance of prevailing before another judge in the same building. Half of the Miami judges deviated by more than 50% from the court's mean grant rate for Colombian cases.Using cross-tabulations based on public biographies, the paper also explores correlations between sociological characteristics of individual immigration judges and their grant rates. The cross-tabulations show that the chance of winning asylum was strongly affected not only by the random assignment of a case to a particular immigration judge, but also in very large measure by the quality of an applicant's legal representation, by the gender of the immigration judge, and by the immigration judge's work experience prior to appointment.In their conclusion, the authors do not recommend enforced quota systems for asylum adjudicators, but they do make recommendations for more comprehensive training, more effective and independent appellate review, and other reforms that would further professionalize the adjudication system.",
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Response
Refugee Roulette in an Administrative Law Context
by Margaret H. Taylor
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"headline": "The Deja vu of Decisional Disparities in Agency Adjudication",
"description": "In Refugee Roulette: Disparities in Asylum Adjudication (the Asylum Study), Professors Ramji-Nogales, Schoenholtz, and Schrag provide a comprehensive analysis of new data to document decisional disparities that undermine the fairness of asylum adjudication. The Asylum Study is an empirical project of remarkable scope. It examines patterns of asylum decisions at four different adjudication levels: at the asylum office interview, in immigration court, on administrative appeal to the Board of Immigration Appeals (BIA), and on petition for review to the federal courts of appeals. At each level, the Asylum Study generates empirical findings to support what we knew mostly by anecdote-- that there are eye-popping disparities in the grant rates of asylum adjudicators that cannot be explained by the underlying merits of the cases.",
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Article
Inside Agency Statutory Interpretation
by Christopher J. Walker
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The Constitution vests all legislative powers in Congress, yet Congress grants expansive lawmaking authority to federal agencies. As positive political theorists have long explored, Congress intends for federal agencies to faithfully exercise their delegated authority, but ensuring fidelity to congressional wishes is difficult due to asymmetries in information, expertise, and preferences that complicate congressional control and oversight. Indeed, this principal-agent problem has a democratic and constitutional dimension, as the legitimacy of administrative governance may well depend on whether the unelected bureaucracy is a faithful agent of Congress. Despite the predominance of lawmaking by regulation and the decades-long application of principal-agent theory to the regulatory state, we know very little about how federal agencies interpret statutes.
rnThis Article looks inside the black box of agency statutory interpretation in the rulemaking context. The Article reports the findings of a 195-question survey of agency rule drafters at seven executive departments (Agriculture, Commerce, Energy, Homeland Security, Health and Human Services, Housing and Urban Development, and Transportation) and two independent agencies (the Federal Communications Commission and the Federal Reserve). Of the 411 officials sent the survey, 128 responded, and their answers shed considerable light on the tools and approaches they use to interpret statutes and draft regulations. The findings uncovered challenge some theories on agency interpretation while reinforcing others. As Congress, courts, and scholars gain more insight into how federal agencies use the canons, legislative history, and judicial deference doctrines in agency statutory interpretation, the relationship between Congress and federal agencies should improve, as should the judicial branchu2019s ability to monitor and faithfully constrain lawmaking by regulation.
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Back to the Top
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