American Federalism and Health Policy Spillovers: Insights from the Opioid Crisis

Robert J McGrath

Publius: The Journal of Federalism, 2025, vol. 55, issue 3, 477-511

Abstract: This article examines how federalism shapes US public health crisis responses, emphasizing that policy divergence across states creates negative spillovers that undermine effectiveness. It develops a framework arguing that policy congruence among neighboring states is key to health outcomes. Applying this to opioid mortality (2009–2016), the study finds that states aligning regulations—such as Prescription Drug Monitoring Programs—experience fewer cross-border opioid flows and lower mortality. By focusing on horizontal policy diffusion rather than federal mandates, this research shows how federalism can enhance coordination under certain conditions. These findings refine our understanding of state sovereignty, policy diffusion, and health outcomes, suggesting that shared policies help mitigate the pitfalls of fragmented governance.

Keywords: Health Policy; state politics; policy Implementation; opioid (search for similar items in EconPapers)
Date: 2025
References: Add references at CitEc
Citations:

Downloads: (external link)
http://hdl.handle.net/10.1093/publius/pjaf021 (application/pdf)
Access to full text is restricted to subscribers.

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:oup:publus:v:55:y:2025:i:3:p:477-511.

Ordering information: This journal article can be ordered from
https://academic.oup.com/journals

Access Statistics for this article

Publius: The Journal of Federalism is currently edited by Paul Nolette and Philip Rocco

More articles in Publius: The Journal of Federalism from CSF Associates Inc. Oxford University Press, Great Clarendon Street, Oxford OX2 6DP, UK.
Bibliographic data for series maintained by Oxford University Press ().