Thematic Areas

Executive Authority to Reform Health

Madhu Chugh, JD, MPP

Paper Summary

Presidential power has provoked increasingly vigorous debate since the turn of this century. In recent years, scholars and lawyers have been grappling with how Congress's dictates may limit the President's Commander-in-Chief power to detain enemy combatants at Guantanamo Bay, to fight wars abroad, and to conduct intelligence activities at home. But policymakers have not yet explored the many possibilities for invoking the President's “Take Care” power to change health care policy.

This paper explores the scope and limits of President Barack Obama's ability to invoke his executive authority to reform health care. Specifically, it identifies ways the Obama Administration can use directives to: (1) expand Medicaid and SCHIP coverage through section 1115 waivers; (2) test quality initiatives through Medicare demonstration authority; (3) expand health information technology; (4) allow drug reimportation and experiment with contracting power under Medicare; (5) enhance patient protections and private coverage requirements; (6) lift coverage restrictions on Medicaid and SCHIP; and (7) build on the health insurance program for federal employees.

Consistent with the mission of the Legal Solutions in Health Reform project, this paper does not endorse a particular policy. Instead of recommending “what,” it explains “how.”

About the Author

Madhu Chugh, J.D., M.P.P., is currently clerking for Judge Thomas B. Griffith on the U.S. Court of Appeals for the District of Columbia Circuit. During the 2004 presidential election, Madhu served as Director of Health Care Policy for the Kerry-Edwards campaign. She was the Policy Director on former Governor Jeanne Shaheen's 2002 Senate campaign, and from 2001-2002, she worked on health care policy for Senator Edward Kennedy. In 1998, Madhu served as deputy communications director on Tom Vilsack's successful gubernatorial campaign in Iowa, where he was the first Democrat elected governor in more than 30 years. While maintaining her communications duties in Governor Vilsack's office, Madhu helped pass legislation that invested Iowa's share of a large tobacco settlement in creating and expanding health care programs. Madhu graduated from Yale Law School where she was a Book Reviews & Features Editor on The Yale Law Journal. She also has a master's degree in public policy from the Kennedy School at Harvard University, during which time she received the Soros Fellowship for New Americans. She majored in journalism and government at the University of Texas at Austin, graduating with honors and election to Phi Beta Kappa. During her senior year, Madhu received the university's most prestigious award, the University of Texas Outstanding Female Student of the Year.