Federal Programs to Expire: The Case of Health Planning

Abstract

This is a study of how a major federal program met its demise. In 1986 Congress passed legislation which ended federal involvement in health planning, repealing the 1974 National Health Planning and Resources Development Act. This unusual action, ending (at least for now) over 20 years of federal involvement in health planning, was precipitated by changes in the policy-relevant environment and the arrival of new actors into the issue network. Federal activity in health facilities planning actually began with the 1946 Hill-Burton Act, which provided financial assistance for hospital construction and expansion. The major federal effort got underway in 1967 with the Partnership for Health Act, which set up a network of Comprehensive Health Planning Agencies (CHPAs). Both of those acts, along with the Regional Medical Program (P. L. 89-239), expired in 1974 and were replaced by the Health Planning and Resources Development Act (P. L. 93-641). The new program replaced CHPAs with Health Systems Agencies (HSAs) and created a new emphasis on cost containment by mandating state adoption of certificate-of-need (CON) laws. It was the major piece of federal legislation in health policy until the 1983 enactment of a prospective payment system (PPS) based on diagnosis related groups (DRGs). Its demise, then, should not have surprised many, and actually it was considered overdue by most actors in the issue network. How a program with 20 years of momentum could die offers new insights into the workings of government in an era of restrained budgets.