Medicaid Spending Dynamics: Implications for Cost Control Strategies

Because of the Medicaid program's high cost and rapid growth, state governments see it as an attractive target for cost-control strategies. The usual ways that budgeters contain spending do not work well on the Medicaid program. Cutting the Medicaid budget is likely to have unintended consequences for state revenues and spending. States can best cope with Medicaid's cost by developing a system-wide strategy of meeting their citizens' health and human-service needs.     

Policy Expansion in Local Government Environmental Policy Making

Relatively little is known about when, why, and how some jurisdictions “double down” on policy priorities, rapidly adopting multiple measures tackling the same issue. Rapid policy expansion can emerge in fast‐evolving, uncertain, and contested policy arenas in which pressures for policy making are not satisfied, and even may be strengthened, by initial policy innovation. This article analyzes local government policy making on high‐volume hydraulic fracturing by New York State municipalities from 2008 to 2012. Policy path dependence, peer influence, and policy design appear to play a critical role in determining whether public officials respond to these pressures with policy expansion. Initial policy innovations can open windows for policy participants to secure additional measures that strengthen or enlarge the scope of action. Public officials and stakeholders seeking particular policy outcomes should take a long view of the policy process while simultaneously remaining alert for opportunities afforded by pressurized policy dilemmas.     

A threat-centered theory of policy entrepreneurship

Policy Sciences - We know relatively little about the conditions that encourage people to jump into the political fray as policy entrepreneurs, advocates who devote substantial time, energy, and...     

Three faces of justice: Competing ethical paradigms in forensic psychiatry

Respect for justice has traditionally been an essential principle of health care ethics. However, many bioethical accounts of justice focus only on distributive justice, and how resources for health care should be allocated. In this article, I will argue that the practice of forensic mental health care requires clinicians to engage with justice in three additional and different ways: justice as liberty and fairness; retributive justice and protection of the vulnerable; and justice as the promotion of virtue. I will argue that British forensic psychiatry favours retributive and protective justice; in contrast to a libertarian approach to forensic practice in the United States. I discuss how respect for justice as support for virtue complements therapeutic work with offenders, which aims at the development of pro‐social character. I will conclude that without respect for justice as virtue, there is a danger that clinical forensic psychiatry risks doing harm to patients and bringing the profession into disrepute.     

Determinants of Pro‐Fracking Measure Adoption by New York Southern Tier Municipalities

New York municipalities passed more than 60 measures promoting high‐volume hydraulic fracturing (HVHF), 2008–12. These policies and resolutions signaled to state officials that municipalities desired HVHF's promised economic benefits and were anxious for an end to the state's HVHF moratorium. They also may be evidence of municipalities proactively preparing for a drilling boom. Why did some jurisdictions adopt these measures while others did not? While scholarship suggests that policy adoption is facilitated when jurisdictions and citizens possess more resources, capacity appears to have a negative or negligible impact on pro‐HVHF action. Such action appears more likely when local actors anticipate HVHF's potential gains but have not previously experienced substantial drilling, perceive that the industry could be viable locally, and can access relevant policy examples. Some lessons from conventional adoption scholarship may not apply when policies are symbolic, advocacy may be elite‐driven, and mimicry is an important diffusion mechanism.