The fierce national debate over health care reform includes deep divisions over the appropriate roles of the federal and state governments. For example, while Sen Bernie Sanders (I-VT) calls for expanding the federal Medicare program to cover all Americans, the Trump administration pushes for the states to have far greater authority. However, according to Michael Sparer, JD, Ph.D., chair of health policy and management at the Columbia Mailman School of Public Health, the Affordable Care Act (ACA) points towards a more effective inter-governmental partnership, one in which the states have significant policy and administrative discretion, bounded by strong national standards designed to limit unacceptable inequities.
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