Reframing the racial disparities issue for state governments

Although racial and ethnic disparities in health have been on the federal government's agenda since 1985, no policy reforms have significantly reduced disparities. The question arises whether states can effectively address this issue without waiting for solutions from the national government. The purpose of this article is to propose ways of reframing the disparities issue that might give state policy makers more leverage and might strengthen political will to address the issue. I suggest a moral frame based on a concept of distributive justice in which medical care must be distributed according to need. I explain the rationales for such a frame and consider its strategic advantages and disadvantages. In the last section, I suggest some policies based on this framing that are within the power of state legislatures.     

Grants and cooperative agreements to state and local governments, universities, hospitals, and other non-profit organizations--USDA. Interim final rule

This interim final rule amendment is issued to implement the Single Audit Act Amendments of 1996 (Public Law 104-156, 110 Stat. 1396) and the June 24, 1997, revision of OMB Circular A-133, "Audits of States, Local Governments, and Non-Profit Organizations" and to replace the existing audit requirements that are superseded by Public Law 104-156 and the revised A-133.     

A proposal to regulate the manner of tobacco advertising

If the U.S. is to achieve the goal of reducing the initiation of smoking among adolescents, it must implement a system of tobacco advertising regulation as one component of a comprehensive prevention program. This paper proposes a system of advertising regulation which is grounded in the relevant legal, information processing, and media effects theories.     

横向地方政府间政策协调路径分析

横向地方政府政策协调是地方关系整合的基础.有效的制度机制既可以促进地方合作不断深入,又可以使地方合作日趋合理.笔者认为,从政策制定、政策执行到政策监控与评估等政策过程环节,政策协调内容各有侧重.而统一市场体系、多元主体参与以及权力制衡的管理体系,则贯穿横向地方政策协调过程始终.     

The FDA may not regulate tobacco products as "drugs" or as "medical devices"

Professor Richard Merrill contends that the Federal Food, Drug, and Cosmetic Act does not grant the FDA regulatory authority over cigarettes and smokeless tobacco products. The fact that Congress did not expressly deny the FDA regulatory authority over tobacco cannot, Professor Merrill argues, be used to infer such authority. This inference is particularly inappropriate in the case of tobacco regulation, he maintains, because there is compelling evidence that Congress had no intention of delegating this authority to the FDA. He is unpersuaded that presidential approval legally sanctions the FDA's claim of authority by granting it a superficial political legitimacy. Finally, he reminds us of the FDA's own repeated denials of jurisdiction over tobacco products, and he recalls the numerous times that Congress passed legislation directed at tobacco without granting the FDA any role in its regulation. Professor Merrill's Essay, like the other pieces in this volume, was written after the United States District Court for the Middle District of North Carolina decided Coyne Beahm v. FDA, but before a three judge panel of the United States Court of Appeals for the Fourth Circuit reversed that decision in Brown & Williamson Tobacco Corp. v. FDA. In Coyne Beahm, the District Court held that the Federal Food, Drug, and Cosmetic Act authorized the FDA to regulate tobacco products, but not tobacco advertising. The Fourth Circuit rejected the District Court's jurisdictional ruling and invalidated the FDA's regulations in their entirety. The Clinton Administration has since requested an en banc rehearing before the Fourth Circuit.     

Transferring NBS technology to small manufacturers through state and local centers

Transferring research results from federal laboratories to small, local industries poses major conceptual as well as practical difficulties. To address the problem, this paper provides a model of a technology-transfer system in which a federal laboratory—the National Bureau of Standards's Automated Manufacturing Research Facility—is linked to small manufacturers through state-and community-based technology centers, where the various instituions in the system are matched along dimensions of (a) level of government, (b) stage in cycle of innovation, (C) education of prototypical worker, and (d) nature of capital-revenue base.     

Effectiveness of state mandates to maintain local government health services for the poor

State governments have used several types of mandates to assure that local governments fulfill state-defined responsibilities, including public health care for the poor. This article reports the findings of a study of procedural public-participation mandates and financial sanctions imposed by California to hold counties to their obligations to provide indigent health care. An inventory of the laws' implementation in all California counties found noncompliance by some counties, although all counties complied after a state Health Services Department unit was established to monitor the counties and provide them with state aid. Case studies in eight counties identified factors that influenced the effectiveness of the laws in modifying or reversing county proposals to close county hospitals or reduce other health services. Policy guidelines are suggested for states that want to develop mandates to enforce indigent-care responsibilities of local governments.     

Promotion of tobacco products: issues and policy options

During the past year, several prominent voluntary health organizations and professional medical associations have called for a ban on all forms of promotion of tobacco products. The proposal raises complex issues, ranging from determination of the effects of tobacco promotion to assessment of the constitutionality of banning advertising of a legal product. We identify the issues that underlie the concern of health professionals, review evidence addressing these issues, and describe and discuss frequently mentioned policy options, especially the ban proposal.     

Loans to state and local development companies--Small Business Administration. Proposed rulemaking

SBA proposes to amend 13 CFR 108.503--4(c) to limit SBA participation with tax-exempt financing under the program authorized by section 503 of the Small Business Investment Act, 15 U.S.C. 697. Under the proposed rule, SBA would participate in the financing of a project which is also financed by tax-exempt obligations provided the repayment of the proceeds of SBA guaranteed financing is not subordinate to the repayment of the tax-exempt financing. This amendment would be in accordance with existing Federal policy which prohibits Federal agencies from directly or indirectly providing a guarantee to tax-exempt obligations.     

Further amendments to general regulations of the Food and Drug Administration to incorporate tobacco products. Final rule

The Food and Drug Administration (FDA) is amending certain of its general regulations to include tobacco products, where appropriate, in light of FDA's authority to regulate these products under the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act). With these amendments, tobacco products are subject to the same general requirements that apply to other FDA-regulated products.     

Exemption from federal preemption of state and local cigarette and smokeless tobacco requirements; revocation. Food and Drug Administration, HHS. Final rule

The Food and Drug Administration (FDA) is revoking its regulation governing the exemption from Federal preemption of State and local medical device requirements for the sale and distribution of cigarettes and smokeless tobacco to children and adolescents. This action is being taken in response to the Supreme Court Decision of March 21, 2000, in which the court held that Congress has not given FDA the authority to regulate tobacco products as customarily marketed. On March 31, 2000, FDA removed its regulations restricting the sale and distribution of cigarettes and smokeless tobacco to children and adolescents. Because these regulations are not in effect, the State requirements are not preempted. Therefore, FDA is revoking its regulations exempting the State and local requirements from preemption. This rule is also adding a regulation that was inadvertently removed in a previous document.     

Consultation with state and local officiaLs prior to awarding community health center grants--PHS. Notice

Section 1923 of the Public Health Service (PHS) Act (42 U.S.C. 300y-2) requires that if a State does not apply for a Primary Care Block Grant under section 1924 of the PHS Act (42 U.S.C. 300y-3), or does not qualify for such a grant, the Secretary of Health and Human Services will use those funds not allotted to States participating in the block grant to make grants under section 330 of the PHS Act (42 U.S.C. 254c) to individual community health centers (CHCs). Section 1923 also requires that the Secretary consult with the chief executive officer of the State and with appropriate local officials before making such grants for community health centers in a State. This notice describes the manner in which the Health Resources and Services Administration (HRSA) will fulfill the requirement for consultation. In addition, it solicits comments from local officials regarding CHCs in their areas.     

Consultations with state and local officials prior to awarding community health center grants--HRSA. Notice

Section 1923 of the Public Health Service (PHS) Act (42 U.S.C. 300y-2) requires that if a State does not apply for a Primary Care Block Grant under section 1924 of the PHS Act (42 U.S.C. 300y-3), or does not qualify for such a grant, a Secretary of Health and Human Services will use those funds not allotted to States participating in the block grant to make grants under section 330 of the PHS Act (42 U.S.C. 254c) to individual community health centers (CHCs). Section 1923 also requires that the Secretary consult with the chief executive officer of the State and with appropriate local officials before making such grants for community health centers in a State. This notice describes the manner in which the Health Resources and Services Administration (HRSA) will fulfill the requirement for consultation. In addition, it solicits comments from local officials regarding CHCs in their areas. A State may elect to supply comments under the system established in accordance with 45 CFR Part 100, "Intergovernmental Review of the Department of Health and Human Services Programs and Activities." (See 48 FR 29188, June 24, 1983.)