The making of health policy in the United States is a complex process that involves the private and public sectors, including multiple levels of government. Five characteristics of the policy process are identified, which establish the means by which policies are formulated and which affect the nature of the policies that emerge. These characteristics include (1) the relationship of the government to the private sector; (2) the distribution of authority and responsibility within a federal system of government; (3) the relationship between policy formation and implementation; (4) a pluralistic ideology as the basis of politics; and (5) incrementalism as the strategy for reform. The article focuses on the impact on health policy of the distribution of authority and responsibility within the federal system, particularly the impact of new federalism policies as they emerged during the past decade. The effects of dual federalism, cooperative federalism, creative federalism, and new federalism are examined in relation to health policies. The article concludes with an examination of the challenge to long-established values and health policies posed by new federalism.
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