Medicaid Section 1115 Waivers: Shifting Health Care Reform to the States

This article focuses on recent developments in state Medicaidprograms and the role ojSection 1115 waivers in this process.The evidence presented here demonstrates quite clearly thatthe states are using Section 1115 waivers to experiment witha broad range of innovative health-care service delivery, reimbursement,and eligibility concepts. This has allowed the states to reconfiguretheir Medicaid systems. More important, perhaps, the use ofSection 1115 waivers has also increased the role ofof the statesin the American health-care policy process.     

Welfare policy: The administrative frontier

The process of national welfare reform has been overtaken by local reform as states implement experimental programs under federal waivers. Most of these initiatives attempt to enforce work or otherwise control the lives of the dependent in return for support. Research, which traditionally stressed the social and economic aspects of welfare or poverty, must be reoriented to address the administrative issues raised by the emerging paternalism. A combination of field interviewing and analyses of reporting data can track implementation and connect program operations to outcomes. Such research assesses program performance less definitively than experimental trials do but is more useful to operators and more relevant to current program goals. The frontiers of welfare research, like welfare policy, are institutional.     

The State of American Federalism, 1993-1994

National political energies in 1993–1994 were focusedon major initiatives promised by the Clinton administrationduring the 1992 presidential campaign, especially health-carereform and crime. From the perspective of the states, federalgovernment action in these (and other) policy areas raised seriousquestions about preemption and mandates. The administration'sofficial pronouncements on federalism have suggested a strategyof decongestion and decentralization. Thus far, its actionshave fallen short of empowerment, taking instead the path ofregulatory waivers. Frustrated with the federal government,states and localities continued to engage in policy experimentation.     

Interstate Competition and Welfare Policy

In 1996, the federal government terminated the Aid to Familieswith Dependent Children (AFDC) program and replaced it withthe Temporary Assistance for Needy Families program (TANF).Many powers once held by the federal government are now beingused by state governments. Will welfare assistance be redesignedand expanded or will states "race to the bottom?" This issueis investigated by examining state welfare policy choices duringthe latter years of AFDC(1976–1994). Because each stateunder AFDC had the authority to set the level of its welfareguarantee for families that had no income, it is possible toestimate the effects of interstate competition on AFDC guaranteelevels. By estimating a spatial autocorrelation coefficientwhile controlling for theoretically relevant variables and statefixed effects, this study finds evidence that states are sensitiveto the welfare policies of their competitors.     

The Consequences of Shifting Control: Federal and State Distribution of Small Cities CDBG Funds in Four Southern States

Following the shift of the Small Cities Community DevelopmentBlock Grant program in 1982 from federal to state control, foursouthern states—Alabama, Georgia, Louisiana, and NorthCarolina—adopted policies intended to reduce, if not eliminate,the federal emphasis on housing rehabilitation and other activitiesthat benefit lower income groups. These states now emphasizepublic works projects, which benefit a broader spectrum of thepopulation, as well as policies designed to spread funds broadlyacross communities. As a result, the share of funds going tosmaller communities has increased substantially. States alsoappear to be allocating fewer funds to poorer communities thandid federal officials, although to date the difference is notsubstantial.     

Money and Mandates: The Politics of Intergovernmental Conflict

The federal government's relationship with the states dependsin part on the level of federal aid and the number of federalmandates. Environmental policy, with less federal aid and moremandates, differs from education policy and health policy. Thevolume of intergovernmental litigation is heavier and rhetoricalreferences to intergovernmental partnerships by agency headsare more common in environmental policy. Waivers are more commonin education policy and health policy, but that appears to bea function of congressional policies largely barring environmentalpolicy waivers. Federal judges are more supportive of the federalgovernment's position on environmental protection and educationthan its position on health care. Overall, federal funding andmandates appear to have an impact on state governments, federalbureaucrats, and federal judges.     

State Executive Orders: Nuance in Restrictions,Revealing Suspensions,and Decisions to Enforce

In the absence of a large-scale federal response to the COVID-19 pandemic, state and local elected officials have enacted executive orders that include restrictions on public liberties as well as the suspension of rules and regulations. While these restrictive policy actions have received extensive media attention, the suspensions, including regulatory rollbacks, waivers, and extensions, are lesser known. This Viewpoint essay offers insight from a working database that captures the nuance and variation across restrictions, suspensions, and enforcement mechanisms being utilized at the state level.     

The ethos of sovereignty: A critical appraisal

Taking as its starting point the commonly held claim about the obscurity of the concept of sovereignty, the article first identifies a fundamental paradox between the classical Westphalian notion of state sovereignty and human rights. In the rhetoric of international politics, attempts to establish the responsibility of states to respect human rights and fundamental freedoms within their jurisdictions are often countered with claims referring to the “sovereign equality” of all states and the subsequent principle of non-intervention. The article suggests that in a more contemporary understanding of sovereignty the responsibility of a state to respect human rights and fundamental freedoms is seen as a constituent ingredient of the state itself. The chapter continues to elaborate how this change has come about. The classical notion of sovereignty is illustrated through a reading of Bodin’s Six Books of the Commonwealth (1576). In Bodin’s world, sovereignty is a constitutive element of the state, and the possibility of a multitude of sovereign entities in a global world logically denying the possibility of any “supra-national” normative framework is still a minor consideration. This possibility is only worked out with the emergence of international law. In both classics such as Emmerich de Vattel’s The Law of Nations (1758) and more contemporary treatises such as Lassa Oppenheim’s International Law (1905), state sovereignty has become conditional to recognition by other sovereign states and a subsequent membership in the “family of nations.” The conditional membership in the “family of nations” involves a contradiction: a sovereign state must act in a “dignified” manner, it must use its sovereignty with “restraint” by respecting the human rights and fundamental freedoms of its citizens, i.e., it must employ its sovereignty in a non-sovereign way. This restriction of sovereignty, addressed as “ethical sovereignty,” becomes a constitutive element in a post-Westphalian state and a central ingredient in the contemporary doctrine of humanitarian intervention. The article further criticizes the various uses (and abuses) of “ethical sovereignty” in the regulation of “failing” and “rogue” states and concludes by identifying its general political dangers. Finally, with reference to Jacques Derrida’s Rogues (2003), the article suggests a more radical reappraisal of the concept of sovereignty. It is a fact that sovereignty is a term used without any well-recognised meaning except that of supreme authority. Under these circumstances those who do not want to interfere in a mere scholastic controversy must cling to the facts of life and the practical, though abnormal and illogical, condition of affairs.¹ —Lassa Oppenheim But to invoke the concept of national sovereignty as in itself a decisional factor is to fall back on a word which has an emotive quality lacking meaningful specific content. It is to substitute pride for reason.² —Eli Lauterpacht     

The Federal Role in State Fiscal Stress

This article examines the extent to which the federal government'spolicies were responsible for the fiscal stress experiencedby most state governments in the early 1990s. Federal policieshave contributed considerably to recent state fiscal stress,particularly through the Medicaid program—the fastestgrowing part of state budgets—and the recession, whichdepressed revenue and increased welfare and Medicaid spending.Federal aid reductions have not been an important source ofrecent state fiscal stress. The real value of per capita federalaid other than for welfare programs fell considerably in the1980s, but the reductions were much greater for local governmentsthan for states. The largest reductions were in the early 1980s.Federal policies have affected state finances in several otherways—through tax policy, unfunded mandates, and the federalfailure to cope effectively with problems like health and poverty.Federal court rulings have also caused budget problems (as havestate court decisions). In some respects, state fiscal problemsare not a federal responsibility. Rising school enrollments,new corrections policies, and inelastic tax systems have createdfiscal stress for many states. Excessive state spending in the1980s has contributed to recent fiscal problems in some states,but not generally.     

Federalism and the Safety Net: Delinkage and Participation Rates

Since the enactment of welfare reform legislation in 1996, thefederal government and the states have emphasized putting theneedy to work and reducing caseloads. Simultaneously, however,national policymakers delinked eligibility for cash assistancefrom eligibility for other safety-net benefits. Contrary tostated policy, though, this delinkage has led to declining participationin the case of Food Stamps and health-insurance programs forlow-income children. We highlight four factors that states mustshape if they are to narrow this gap between policy promiseand program performance by fostering higher participation. Weshow how our focus intersects with enduring questions of Americanfederalism—the level of state commitment to redistributiveprograms, their capacity to implement these programs effectively,and the degree to which states can augment governing capacityby becoming more genuine laboratories of democracy.     

The Substitution Approach To Intergovernmental Relations: The Case Of OSHA

Federal legislation of the last two decades has substantiallyreduced state autonomy in dealing with many regulatory issues.Participation in the implementation of these federal programsmay, however, enable states to exert some leverage over policyoutcomes. Variations in state leverage no doubt exist from oneintergovernmental grant program to the next. Substitution authoritymay be one variable accounting for this variation. Under a substitutionapproach, a federal agency cannot only sever the flow of fundsto a grantee; it can also step in and operate a program if statesfail to meet expectations or choose not to participate. Thisarticle generates more basic propositions about the substitutionapproach by analyzing its implementation under the OccupationalSafety and Health Act of 1970. The article examines the roleplayed by substitution authority in motivating the OccupationalSafety and Health Administration (OSHA) to adopt an aggressiveposture toward the states. The article then assesses whetherOSHA's aggressiveness prompted state grantees to exert considerableeffort on behalf of program goals. Finally, the implicationsof current reform proposals, which call for a sorting out offunctions between the states and the federal government, receiveattention.     

A New Measure of Policy Spending Priorities in the American States

In this paper, we develop and test a general measure of policyexpenditures in the American states. Our approach is to constructa spatial proximity model of yearly state program spending.The empirical analysis reveals that state spending patternsvary along a clear and readily-interpretable unidimensionalcontinuum which differentiates policies that provide particularizedbenefits to needy constituencies from policies that providebroader collective goods. Based upon standard evaluative criteria,the variable created from our model possesses some highly desirablecharacteristics. And, it compares favorably to other measuresof state policy activity. The net result is a yearly score foreach state which summarizes that state's spending across allmajor program areas. More generally, we believe that our variablecan be interpreted as valid and reliable representational measurementof state policy priorities. In this capacity, it could occupyan important position within models of state politics. Author's note: Many colleagues provided useful feedback on earlierversions of this paper. We particularly appreciate the excellentcomments and suggestions from Robert Erikson, Richard Fording,Kim Hill, David Lowery, Andrea McAtee, and George Rabinowitz.We would also like to thank Daniel Lewis and William Myers fortheir assistance with the data collection. The yearly statepolicy priority scores obtained from the unfolding analysis,along with the data used to create the scores, the SAS macroto carry out the unfolding procedure, and all other supplemental materialsare available on the authors’ web sites: http://polisci.msu.edu/jacobyand http://polisci.msu.edu/schneider. All these materials arealso available on the Political Analysis Web site.     

State political culture, primary frontloading, and democratic voice in presidential nominations: 1972–2000

In light of the notorious “frontloading” phenomenon in U.S. presidential nominating elections, this paper examines the relationship between state political culture and state primary scheduling, for the purpose of understanding how differences in institutionalized community values may have affected the equity with which democratic voice has been distributed in modern presidential nominations. Using stratified event history analyses of nomination campaign schedules from 1972 to 2000, we find that “moralistic” states tend to schedule primary dates earlier in the campaign season than do individualistic or (especially) traditionalistic states, particularly in states with more ideologically liberal elites. Moreover, this tendency toward frontloading among moralistic states becomes more dramatic as racial homogeneity increases relative to other states. These results disturbingly reveal that the democratic voices of racial minorities have often been muffled under the modern institution of presidential nominations.     

The Status of State Governments in Nigeria's Federalism

Nigerian states have almost completely lost their autonomy.The Babangida years and, in particular, 1991–1992, havewitnessed unprecedented reductions in states' powers. The entrenchmentof local government autonomy and the loss of some state powersto local authorities, the reduction of states' financial powersand their share of the Federation Account, as well as the decreeof a highly centralized two-party system, all have, within theframework of structural economic adjustment and the transitionto civil rule (expected to be completed in January 1993), worsenedthe position of the state governments. However, with the establishmentof civilian governance in the states and the return of constitutionalgovernment after January 1993, the state governments may reasserttheir autonomy.     

Reforming the U.S. Department of Transportation: Challenges and Opportunities of the Government Performance and Results Act for Federal-State Relations

This article examines attempts during 1993–1999 to reformthe U.S. Department of Transportation to hold it accountablefor achieving improved program results through performance measures.These attempts affected the department's relationships withCongress and the states. The political context, institutionalstructure, federal system, and separation of powers into whichthese reforms were introduced limited the course and outcomesof the reforms. For the reforms to succeed, changes need totake place in the behavior of state transportation departmentsand members of Congress. However, there are no clear incentivesfor either constituency to change its behavior. Instead, thestates' political interests in maintaining their flexibilitiesand the electoral concerns of members of Congress create incentivesthat undermine rather than enforce reform.     

The dissemination and utilization of welfare‐to‐work experiments in state policymaking

Abstract This paper reports the results of a telephone survey of state‐level officials as to the influence of evaluations of three state welfare innovations: California's GAIN, New York's CAP, and Florida's Project Independence. The three experiments were known to those interviewed, yet they did not have dramatic, decisive effects on policymaking. However, GAIN and CAP appear to have influenced policymaking in less dramatic and more subtle respects. Much more important than empirical findings about the effects of tested programs was information about how these programs actually operated in the field along with evidence that the policies tested in welfare‐to‐work experiments were logically consistent (that is, there was no obvious reason to think that they would be unsuccessful), could clear federal waivers, and would not encounter major political resistance. © 2000 by the Association for Public Policy Analysis and Management.     

The Impact of State Debt Management on Debt Activity

This article addresses the impact that state debt management has on the debt activity of a state debt program. A quantitative measure of state debt management is developed and used in analysis of state debt activity. The study finds that states with decentralized debt management issue more long-term debt as compared to states with other forms of debt management. The study also investigates the impact other institutional variables have on state debt activity and highlights the interaction effects of these variables with the institutional debt management variable. The study finds that the effects of previously tested variables such as the number of public authorities and constitutional debt limitations on debt activity are altered if the form of debt management is considered.     

NSF's Experimental Program to Stimulate Competitive Research (EPSCoR): Subsidizing academic research or state budgets?

This cross‐state empirical study focuses on the National Science Foundation's (NSF) Experimental Program to Stimulate Competitive Research (EPSCoR) and examines its impact on the academic research and development (R&D) expenditures financed by state governments. Based on a panel of 50 states during 1979–2006, the empirical results indicate that EPSCoR, while increasing federal R&D support to EPSCoR states, crowded out financial support for academic research from the governments of EPSCoR states. About one‐third of EPSCoR funds went to subsidize state budgets. The crowd‐out effect calls for some reconsideration of EPSCoR program design in order to maintain or even increase the state government financial support for academic research activities deemed critical to academic competitiveness and economic prospects. © 2009 by the Association for Public Policy Analysis and Management.     

Perceptions of Federal Aid Impacts on State Agencies: Patterns, Trends, and Variations Across the 20th Century

American federalism is a dynamic process involving the viewsand interactions among state and national officials. Based onmultiple mail surveys of state agency heads across 75 years,this article traces the perspectives of state executives towarda core component of state–national relationships—federalaid. The time frame dates from the 1920s and covers a periodin which federal aid programs to the states grew enormously,as did state administrative establishments. There was a long-termrise in the perceived intrusiveness of federal aid as well asincreased policy distortion effects. Despite substantial fluctuationsin perceived aid impacts, there was a four-decade consistencyin the penetration of federal aid into and across the existing3,000 state agencies. Furthermore, when perceptions of nationalinfluence are combined in an index of perceived national fiscalinfluence, there was a roller coaster effect with an overallsecular "decline" in national influence since 1974.     

AT ARM'S LENGTH WITH DIRTY HANDS: TAXING THE AUSTRALIAN PUNTER

Abstract: Taxes on betting are a major source of revenue for Australian state governments. Specific taxes on the racing industry date from 1915. However, the revenue potential has only been tapped in all the states since the legalisation in the past 30 years of off-course betting through the state-run totalisator (TAB). The introduction of the TAB followed a long period when various states adopted different policies towards off-course betting, ranging from legalisation of bookmakers' betting shops to attempts at complete suppression. In tracing the history of these policies, the focus is on "implementation failure", or the many administrative pitfalls and obstacles that were experienced. These include insurmountable tax evasion by bookmakers, regulatory capture of betting boards by bookmakers and corruption of the law enforcement agencies. State governments also had to accommodate a range of conflicting interests, including the interests of the racing industry itself and the demands of the anti-gambling lobby. The TAB is shown to be a happy and convenient resolution of most, but not all, of these administrative and political dilemmas.