ABSTRACT
The argument that there is a cyclical pattern of American federalism may have historical validity. Large firms have stalwartly fought to preserve Employee Retirement Income Security Act's federal preemption of state insurance regulation, and small firms have pleaded for inclusion, in order to escape the oversight of the states. “Evolving” authority to the federal government through insurance reform is inconsistent with decentralization. Among the alternative scenarios, few would advocate a weak senior/weak junior partner model of federalism on its own merits; “hobbled federalism” seems most likely to emerge as a default option in the face of national gridlock. The federal government remains actively involved in health care policy, but it ceases to be able to assert dominance over the states. In the absence of any systematic underlying framework for sorting out responsibilities, everything is up for grabs, resulting in “competitive federalism.”
