Federalism, Crisis, and Public Policies: A New Pattern of Intergovernmental Relations Post-Bolsonaro in Brazil’s Health Policy?

Several studies on federalism and public policy aim to analyze intergovernmental relations and the role of federal and subnational governments in policy processes across various federal countries. These studies assess the extent of centralization and decentralization in a range of public policies. In Brazil, over the past 30 years, healthcare policy has followed a model that combines shared responsibilities and strong national coordination. This model serves as the cornerstone of Brazil's healthcare system. Leadership within the system, anchored in the Ministry of Health, had historically been consistent in the last decades. However, during Bolsonaro’s administration, especially during the public health crisis, significant changes were identified: state and municipal executive authorities assumed a central role due to the federal government’s inability to unify and coordinate efforts. At this critical juncture, the federal government made unilateral decisions, without dialogue with subnational governments, leaving them to lead the pandemic response without national coordination . From this perspective, we ask: was the new pattern of intergovernmental relations established under Bolsonaro’s government reversed with the change in administration? Seeking to contribute to the scholarly debate on changes in federal dynamics, this article explores the intergovernmental relations between the federal government and subnational governments at the national arena through the analysis of the role of subnational governments in the national health policy process in Brazil. To conduct the research, data will be collected through semi-structured interviews with actors from the federal government and representatives of intergovernmental arenas that include federal and subnational governments. This paper argues that the changes in the pattern of intergovernmental relations in health policy during the crisis persisted in the subsequent period. Even though no formal alterations were conducted in the federative arrangement, the pattern of intergovernmental relations have, in practice, changed with new dynamics of interaction between the federal government and subnational governments.