State Medicaid reform under Section 1115 demonstration authority

Given the complexity of federal Medicaid law and the limitations it imposes on state flexibility, it is likely that states will continue to ask the Secretary to grant waivers under Section 1115 to allow them to pursue new approaches to health care reform. The results of currently operational Section 1115 projects involving statewide managed care systems will be useful in evaluating the Medicaid reform measures currently under discussion in other states and at the federal level. In particular, the ability of the states to control Medicaid and indigent care costs and to utilize federal dollars more efficiently should prove important in evaluating a block grant approach to federal Medicaid funding. Moreover, Section 1115 project results that bear on the sufficiency of various Medicaid capitation rate methodologies will also be of value as more states expand the use of managed care arrangements for their Medicaid populations.     

Legislating Crime Policy from the White House: Presidential Success with Congress in the Passage of Federal Crime Control Policy

Previous research has found that presidents, in general, have the power to influence congress in the passage of federal crime control policy. What has not been fully explored is whether presidential supported bills are more likely to influence congress to pass federal crime control bills. Therefore, this study draws upon the theory that presidents influence congress to test the hypothesis that president supported legislation on crime will achieve greater success in congress than non-supported bills. Analysis of legislative, presidential and congressional data from 1946 through 1996 suggests support for the theory that presidential supported bills are 2.8 times more likely (or 185% more likely) to become law.     

Adoption of retrospective Medicare maximization billing practices by state Medicaid home care programs

Home care services funded by Medicare and Medicaid grew rapidly throughout most of the 1990s. During this period some state Medicaid programs transferred costs for home care claims to the Medicare program to reduce their liability and increase beneficiary access to Medicare coverage. This article reports the findings of the first national study of these Medicare maximization billing practices for home care services. Primary data were collected to determine which states conduct retrospective Medicare billing practices and the amounts recovered from Medicare. Our analysis indicates that seven states recovered as much as dollar 265 million from Medicare in state and federal dollars during the 1990s. Ratios of recovered expenditures-to-costs incurred for retrospective billing practices conducted in Connecticut, New York, and Massachusetts are between 5:1 and 7:1. While retrospective billing practices may aid states in reducing Medicaid outlays and potentially help dual Medicare beneficiaries gain coverage for their home care claims, they increase Medicare expenditures for home care at a time of concern for the long-term financial viability of Medicare and illustrate the need for reforming our national long-term care financing policy.     

Los Congresos Estatales y la Política Federal en México: state legislatures and federal policymaking in Mexico

The Mexican Constitution, in the Poder Legislativo, grants state legislatures the authority to introduce legislation (iniciativas de ley) in the federal congress. In this paper the authors examine this powerful mechanism through which the Mexican state legislatures can directly influence policymaking at the federal level. Using a new data set of state-led initiatives, this work: describes the frequency with which iniciativas are introduced; describes the substance, timing, and final disposition of these state-led initiatives; and explains which factors affect the probability of presenting a state-led initiative. The authors find that party competition and partisan divisions at the state and federal levels play a significant role in the use of iniciativas de los congresos estatales. The authors’ study of this peculiar authority granted to the Mexican states contributes to the rich discussion of the changing role of the states in the era of Mexico’s nuevo federalismo.     

Bicameralism and Geographic Politics: Allocating Funds in the House and Senate

Because they represent different kinds of constituencies—states versus parts of states—senators and House members have different incentives in constructing federal distributive programs. In order to claim credit for providing particularized benefits, House members need to use policy tools—earmarks and narrow categorical programs—that target funds to their constituencies. Senators, by contrast, are able to claim credit for the large formula grants that distribute the bulk of intergovernmental grant money. Examining House‐Senate interactions in one of the largest distributive programs, federal aid to states for surface transportation, I show that the different bases of representation in the House and Senate structure the chambers' preferences on distributive programs and affect the outcomes of interchamber conflicts.     

A Peek into a Future Filled with Climate Change Regulation

The recent federal presidential election and Democratic majority in Congress assure that federal legislation to address climate change will be enacted. The nature and extent of future federal climate change regulation cannot be predicted. But, climate change regulation will be in our future. In the absence of federal regulation, regional associations and states have taken action on their own to reduce carbon emissions and address climate change. The Western Climate Initiative (WCI) is a regional association that is developing a detailed climate change program. New Jersey is one of the states which has passed, and is now implementing, legislation to address climate change. By evaluating the WCI and New Jersey activities regarding climate change, one can develop an understanding of the major issues, some possible options for dealing with those issues, and the impact climate change regulation will have on the economy, energy issues, and everyday living.     

THE WRONG WAY TO MANDALAY: THE MASSACHUSETTS SELECTIVE PURCHASING ACT AND THE CONSTITUTION

The United States cannot and should not approach the world as fifty states and thousands of municipalities who embark on setting their own foreign policy whenever it suits them. ¹
It's a core principle of democracy that the federal government should not intrude on state powers to spend local tax dollars unless there's an overwhelming federal interest at stake. ²     

Leading the health policy orchestra: the need for an intergovernmental partnership

The past decade provides a useful window through which to examine whether states are likely to provide health care leadership. During this era, states were given increased discretion to set health care policy, they had the financial resources to encourage innovation, and their administrative capacity was at its strongest ever. Despite the favorable conditions, however, states were reluctant to spend their own funds on programs for the uninsured, their efforts to make private insurance more affordable for the small business community were disappointing, and their efforts to regulate the managed care industry fell short. At the same time, though, the most promising innovations over the past decade were in programs financed primarily with federal dollars, administered primarily by state officials, and advanced by an intergovernmental partnership in which administrators at different levels of government prod each other to try and do more. This sort of intergovernmental partnership provides the best model for innovative health policy leadership.     

Cost principles for nonprofit organizations--Office of Management and Budget. Notice

This notice offers interested parties an opportunity to comment on a proposed revision to Circular A-122, "Cost Principles for Nonprofit Organizations." The proposed revision establishes special provisions for costs related to political advocacy. Similar revisions are being simultaneously proposed for civilian and defense contractors through appropriate actions by the Department of Defense, NASA and GSA, the three agencies with authority to issue procurement regulations. The purpose of these proposals is to ensure that federal tax dollars are not used, directly or indirectly, for the support of political advocacy. Over the past 25 years, the volume of federal activity conducted through grantees and contractors has dramatically grown. Sound management of federal grants and contracts has correspondingly gained in importance. The responsibility of the President through OMB to improve the management of the executive branch of government with a view to efficient and economical service, and to fulfill other statutory and constitutional responsibilities, extends to issues of grant and contract management no less than to issues of direct federal activity.     

Medicaid myths: trends in Medicaid expenditures and the prospects for reform

Medicaid expenditures, which had reached more than +32 billion by 1981, have grown substantially throughout the program's history. As a result, the conventional wisdom is that Medicaid expenditures represent a significant public-policy problem. Using other measures, however, it can be shown that the program is much less of a problem than it appears to be. By 1981, spending for Medicaid represented only 12.7 percent of total state spending and had contributed only 14.2 percent to the overall growth in state expenditures since 1965. Moreover, considering only the funds which states raise from in-state sources, the median share of state budgets accounted for by Medicaid was just 5.6 percent, and only 7 states spent as much as 9 percent of their own money on the program. These figures suggest that the marginal reductions in Medicaid expenditures which would result from typical program changes are likely to be so small that rational state officials might be unwilling to incur the political opposition of powerful provider groups or the resistance of large state bureaucracies by proposing substantial reforms. The major exceptions are the few states with very large programs where even small proportional savings would amount to millions of dollars. We conclude that, given its present federal-state form and the current distribution of expenditures, it is unlikely that major reforms will be enacted because the stakes are too small for most states and the federal interest is too diffused.     

Enrolling children in public insurance: SCHIP, Medicaid, and state implementation

The Balanced Budget Act of 1997 established federal grants to the states to create the State Children's Health Insurance Program (SCHIP). This presented the states with a number of implementation choices concerning administrative models for the new programs, as well as choices about eligibility standards, enrollment simplification, crowd-out, and cost sharing requirements. At the same time, the states were also implementing welfare reform. We describe the most important of these implementation choices, and using data from the Current Population Survey, we estimate the impacts of state policy on enrollment in this multiprogram environment. The results indicate that SCHIP programs that are administered as Medicaid expansions are more successful than either separate SCHIP plans or combination programs in enrolling children. States that remove asset tests and implement presumptive eligibility and self-declaration of income have higher enrollment levels. Continuous eligibility and adoption of mail-in applications have no effect on overall enrollment. Waiting periods and premiums reduce enrollment. Stringent welfare reform reduces children's enrollment, despite federal policy that was intended to protect children from the consequences of welfare reform. The negative impacts of a number of these policy reforms substantially reduce enrollment, potentially offsetting the more favorable impacts of other policy choices. We estimate that if all states adopted the policy options that facilitate program use, enrollment for children with family incomes less than 200 percent of the poverty line could be raised from the current rate of 42 percent to 58 percent.     

Empirically enhanced reflections on 20 years of rape research

Using PsychInfo review of rape and sexual assault publications, the period of greatest fertility coincided with the establishment (1975) and demise (1987) of the National Center for the Prevention and Control of Rape. To document what has been learned and when, the era in which new rape concepts entered the literature is summarized and important developments highlighted. Then, new investigations that are urgently needed are elaborated. The author expresses concern that current federal investment is insufficient to sustain and expand a science workforce adequate to the tasks ahead. Since 1995, more than 1 billion US dollars have been awarded to prosecutors, law enforcement, and community agencies to assist victims of violence. In contrast, between 1996 and 2003, only 14 of 178 (7%) of investigator-initiated grants funded by the Department of Justice and the Centers for Disease Control and Prevention for violence against women had titles pairing the word sexual with assault, violence, abuse, or rape.     

Funding the Cause: How Public Interest Law Organizations Fund Their Activities and Why It Matters for Social Change

Most of the work of public interest law organizations does not make money. How do these organizations survive, given the economic realities of law practice? Drawing on survey data from a national random sample of public interest law firms, we investigate how funding models vary across public interest organizations and how funding sources affect these organizations’ activities. We find funding structures have, over time, shifted away from foundation support toward government grants. Compared to other organizations, however, conservative organizations draw significantly less of their budget from federal and state grants, and significantly more of their budget from private contributions. Conservative organizations are significantly less likely than other organizations to rely on funding that prohibits engaging in class actions, receiving attorney's fees, or lobbying. Respondents reported that funding restrictions hamper their ability to negotiate favorable settlements, bring about systemic change, and represent vulnerable client communities. We close with a comparative institutional analysis of different funding models.     

Reconsideration of the agricultural transfer model

The cooperative extension system in American agriculture is widely viewed as the paradigmatic public sector technology transfer system. Empirical evidence supports the view that research and extension are complementary inputs in increasing agricultural productivity. Cooperative extension, however, does not perceive itself as a technology transfer system; but as an informal education system. Many participants at the federal, landgrant university, or county levels in cooperative extension would not recognize their work within a technology transfer framework. Moreover, many would object to such a characterization of their work. The differences in perspective is accounted for, in part, by the fact that agricultural extension is part of the larger system of cooperative extension. This system, which encompasses agriculture, home economics, 4-H and community and rural development, requires a more encompassing framework than technology transfer to provide an integrated rationals for its program elements. Within the technology transfer framework, the roles of the different components of the system across the states are both highly variable and changing. Based on site interviews in nine states, analysis is presented of the current and prospective roles of extension specialists and county agents.     

The Politics of Appointment and the Federal Courts'Role in Regulating America: U.S. Courts of Appeals Judgeships from T.R. to F.D.R.

Historians and political scientists have noted that appointments of judges to the U.S. Courts of Appeals are not determined by senatorial courtesy alone. What has not been adequately explained is why and when a president defers to a senator's choice rather than seek to control the selection. This article attempts to understand the politics of federal appellate court appointments. The author first identifies a major change in the work of the courts of appeals during the years 1900-1945—the growth in review of the actions of newly created federal regulatory agencies. Then, by examining Justice Department files and presidential correspondence, he discoveres three patterns of appointment emerging in the same period. The patterns vary with presidential perceptions of the role of the federal government and of the courts of appeals' ability to affect accomplishment of administration goals. Appointments during the first years of the presidencies of Theodore and Franklin Roosevelt and during the Harding and Coolidge administrations were dominated by patronage concerns. Those administrations yielded to the recommendations of senators and demonstrated no interest in the policy-making potential of these courts. In the two other patterns the White House played a more active role, with senators more often deferring to the president's selection. Concerns about professionalism dominated selections in Taft's and Hoover's administrations: because they recognized the policy importance of those judgeships but saw the role of government as limited, they sought judicial craftsmen who would make policy only incrementally. Policy concerns dominated selections during Wilson's administration and the latter years of both the Roosevelts' administrations: Justice Department officials screened nominees to determine their policy orientation, because federal appellate court judgeships were perceived as crucial policy positions that could affect the president's ability to implement his reform programs.     

The impact of Federal Alcohol and Drug Abuse block grants on state and local government substance abuse program expenditures: the role of federal oversight

Are the federal Alcohol and Drug Abuse (ADA) block grant funds substituting for or supplementing state and local government spending on substance abuse? Using panel data on state and local government substance abuse programs, this study explores the fiscal effects of the ADA block grant money and the increased enforcement (after 1989) of federal restrictions on state spending of ADA block grants. The findings here reveal that for the current period, the federal ADA grant has no statistically significant effect on state and local government substance abuse spending both before and after 1989, and the increased enforcement of federal restrictions on the ADA grants after 1989 does not change this result. An additional finding is that lagged ADA grants have had a large effect on substance abuse spending both before and after 1989--a feature of the program not considered in previous studies.     

The United States Congress and nuclear war powers: explaining legislative nonfeasance

Scholarly debate over the role of the United States Congress in approving military action has focused on the respective war powers granted the executive and legislature by the United States Constitution. Although a voluminous literature has examined the institutional and partisan politics shaping their exercise, a conspicuous lacuna concerns nuclear war powers. Despite periodic but mostly ineffective reassertions of congressional prerogatives over war, the decision to employ nuclear weapons has been left entirely to presidential discretion since 1945. Explaining this consistent refusal by Congress to rein in the ultimate presidential power and exercise co-responsibility for the most devastating form of war relies less on disputatious constitutional grounds than on three arguments about congressional dysfunctionality, legislative irresponsibility, and the relative costs of collective action by federal lawmakers on perilous national security questions.     

The Genesis of the Austrian Model of Constitutional Review of Legislation

Abstract The European model of the constitutional review of legislation, characterized by the concentration of the constitutional review power in a single constitutional court, had its origin in the Austrian Federal Constitution of 1920. This is all the more remarkable when one considers that this Constitution established at the same time a parliamentary system of government in a fairly radical form. As the author explains, this “invention” of a constitutional court is attributable to two factors. One factor is the federal aspect. The Court was conceived by the framers of the Austrian Federal Constitution of 1920 as an umpire between federal legislation and the legislation of the states or Länder. In this respect it was meant as a substitute for the principle of the priority of federal law over state or Land law. This is manifest in the initial draft of the Constitution, where actions on questions of the constitutionality of legislation could only be brought by the Federal government (against the legislation of one or another of the states or Länder) and by the State or Land governments (against federal legislation). Right from the beginning, however, the Court could examine a parliamentary act ex officio when it had to apply such an act in another proceeding. It was this power of the Court that triggered the development of constitutional review. Its exercise gradually transformed the Court into a guardian of the Constitution as a whole, in particular, the fundamental rights of citizens. The author traces this development in the context of the concept of state and law that prevailed in the late nineteenth and early twentieth century. This concept included specific restrictions on constitutional review. On the basis of a different understanding of the functions of a constitution, the Court gave up these restrictions and followed the examples of the European Court of Human Rights, the German Constitutional Court and—indirectly—the American Supreme Court.     

State services for children: an exploration of who benefits, who governs

In recent years, equity, choice, and efficiency issues in the provision of education have received much attention and analysis. Yet, in the area of other state services for children (health, protective services, day care, etc.), there has been scant concern for equity, efficiency, or choice, despite the fact that out-of-school influences can be crucial in determining in-school performance. This paper reports on work in progress that reaches the following initial conclusions: 1. In the field of children's social services, data compilation is approximately 20 years behind the state of the art for education. Basic data on services provided is not collected for submission to state or federal authorities in any standard format on a recurring basis. 2. From the limited data available, the access of children to quantity and quality in social service programs varies enormously within states. The variations are much larger than those discovered in the public financing of education even before the recent school finance reform movement (1968-1978). 3. Federal allocations to states for social service programs comprise a substantial proportion of state Title XX budgets. For several reasons, the degree of accountability for these funds is less than that for federal education grants. 4. In all three states Title XX state allocations to localities are purported to be based on need. Closer examination of the formulas, and interviews with policy makers, revealed that Title XX allocations are determined primarily by political criteria.     

The Siren’s Song: Federalism and the Cops grants

The federalization of crime control has become a focal point for criminal justice researchers. Because the federal government is limited in how it can affect crime, it often assumes the role of funding agent to state or local governments and places restrictions on the use of these monies. Generally, no consideration is given to state or local concerns. As a result, national crime control policy often becomes mired in issues of federalism. One unintended consequence is the creation of a Siren’s Song, where state and local agencies simply pursue funding dollars to expand their budgets rather than to adopt beneficial policies or make meaningful changes. This paper illustrates this point by examining the federal “100,000 Cops” initiative in one rural West Virginia jurisdiction.