From confrontation to the response of democratic institutions: a new post-COVID federalism?

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Abstract
This article analyzes the transformations driven by the COVID-19 pandemic in Brazilian federalism, especially in the health area, highlighting the impacts on the pattern of intergovernmental relations established over the past three decades and discussing the possible legacies for current governments. Using a specific model based on historical neo-institutionalism and articulating the concepts of critical juncture and path dependence, the study examined the dynamics of the main actors and institutions in the national health arena, emphasizing their positions, strategies, disputes, and consensus; the level of government in which they operate; and the instruments, devices, and standards issued, comparing these elements with the trajectory of the pandemic. The results show a threefold structural shift in the implementation of the health policy, in which federative coordination was exercised by state and municipal health departments and their representative entities. Meanwhile, Congress and its parliamentary caucuses assumed the formulation of policies to support subnational entities. In turn, the Supreme Federal Court took responsibility for safeguarding the autonomy of state governments in the decentralized management of the health system. Finally, the article discusses the potential impacts of this shift on federal institutions and policy coordination within the Brazilian Unified Health System (SUS) in the current government cycle.

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