The Use of Administrative Discretion in Implementing the State Children's Health Insurance Program

States have exercised administrative discretion in at leastsix different ways during the intergovernmental implementationof the State Children's Health Insurance Program (CHIP) provisionof the Balanced Budget Act of 1997. States have used this flexibilityto determine when to submit their plans and when to put theCHIP program into effect. After describing the problem of uninsuredchildren in America and the politics of program adoption, multivariateanalysis is used to attempt to answer the following question:Why have some states moved more quickly than others to get plansfor introducing CHIP submitted, approved, and implemented? Thenature and extent of a relationship between a state's economic,political, and health-need characteristics, on the one hand,and the timing of submission and implementation, on the other,are examined.     

The implications of the emerging disproportionate policy perspective for the new policy design studies

This paper articulates the disproportionate policy perspective and uses it to mount four challenges for the new policy design orientation. First, in contrast to the new policy design thinking, disproportionate policy options may be systematically designed, and at times, successfully implemented. Second, in contrast to the new policy design thinking, there are certain conditions under which policymakers may tend to develop effective response, with cost considerations becoming only secondary in importance if at all (read, policy overreaction), or cost-conscious response, with effectiveness considerations becoming only secondary in importance if at all (read, policy underreaction). Third, in contrast to the new policy design thinking, disproportionate policy options may be designed for purposes other than implementation (e.g., to be used as signaling devices or as context-setters). Fourth, in contrast to new policy design thinking, there are certain conditions under which the emotional arena of policy may be equally, if not more, important than the substantive one. The paper concludes that so far the literature on new policy design has not responded to the emergence of the disproportionate policy perspective, but a robust research agenda awaits those answering this paper’s call for action.     

The Birth and Growth of the Social Insurance State: Explaining Old Age and Medical Insurance Across Countries

We examine the factors leading to creation and growth ofnational Old-Age Insurance (OAI) and Health Insurance schemes.None of the theories we test fit the data very well. There isweak evidence that the probability of adopting a systemdeclines in a country's wealth and in the ethnic heterogeneityof its population. Catholic countries are more likely tocreate earnings-related OAI systems. The growth of OAIspending since 1960 has varied considerably across countries,with fast growth in countries emerging from dictatorship andnon-English speaking countries. We conclude that socialinsurance can be politically expedient for many differentreasons.     

The state of the welfare state: German social policy between macroeconomic retrenchment and microeconomic recalibration

Multiparty Government: The Politics of Coalition in Europe. By Michael Laver and Norman Schofield. Oxford: Oxford University Press, 1990. Pp. vii + 308. 32 figures, 26 tables. £35. ISBN 0–19–827292–8.

Minority Government and Majority Rule. By Kaare Strom. Cambridge: Cambridge University Press, 1990. Pp. vii + 293. £25. ISBN 0521–37431–6.

Small Parties in Western Europe. Edited by Ferdinand Müller‐Rommel and Geoffrey Pridham. London: Sage Publications, 1991. Pp.240. £28.50. ISBN 0–8039–8261–5.

Legislatures. Oxford Readings in Politics and Government Series. Edited by Philip Norton. Oxford: Clarendon Press. Pp. ix + 336. £27.50 (hardback); £8.95 (paperback). ISBN 0–19–827582‐X and 827581–1.

Advances in the Spatial Theory of Voting. By Jamese Enelow and Melvin J. Hinich. Cambridge: Cambridge University Press, 1990. £27.50. ISBN 0–521–35284–3.

Political and Economic Encyclopaedia of Western Europe. Edited by Frances Nicholson. Longman Current Affairs, Harlow, 1990. Pp. 411. ISBN 0–582–06848–7.

World Guide to Environmental Issues and Organizations. Edited by Peter Brackley. Longman Current Affairs, Harlow, 1990. Pp.386. £75. ISBN 0–582–06270–5.

Portugal: O Sistema Político e Constitutional 1974–1987. Edited by Mario Baptista Coelho. Lisbon: Instituto de Ciéncias Sociais 1989. Pp. 1044. £15.

The Regions and European Integration. Edited by R. Leonardi and R.Y. Nanetti. London: PinterPublishers 1991. Pp. vi+200. £27.50 (hardback). ISBN0–86187–149–9.

Extremismus und Demokratie. Uwe Backes and Eckhard Jesse, Bonn, Bouvier Verlag, 1990. Pp.vi + 472; 13 tables, 10 documents. DM38 (hardback). ISBN 3–416–02255–6.

Political Loyalty and Public Service in West Germany: The 1972 Decree against Radicals and its Consequences. Gerard Braunthal, Amherst, University of Massachusetts Press, 1990. Pp.xvi + 249, £18.40 (hardback). ISBN 0–87023–707–1.

Britain's Future in Europe. By Michael Franklin with Marc Wilkie. London: RIIA/Pinter, 1990. Pp.viii + 133. £19.50 (hardback); £7.95 (paperback). ISBN 0–86187–046–8 and 047–6.

European Competition Policy. Edited by Peter Montagnon. London: RIIA/ Pinter, 1990. Pp. vii + 135. £19.50 (hardback); £7.95 (paperback). ISBN 0–86187–885‐X.

The Technical Challenges and Opportunities of a United Europe. Edited by Michael Steinberg. London: Pinter, 1990. Pp.195. £30 (hardback). ISBN 0–86187–344–2.

Public Policy in Northern Ireland: Adoption or Adaptation? Edited by M. E. H. Connolly and S. Loughlin. Policy Research Institute, 1990. Pp.335. ISBN 1–870654–10–2.

Interpreting Northern Ireland. By John Whyte. Oxford: Clarendon Press, 1990. Pp.xii + 308. £35. ISBN 0–19–827848–9.

The Future of Northern Ireland. Edited by John McGarry and Brendan O'Leary. Oxford: Clarendon Press, 1990. Pp.xx + 376. £40. ISBN 0–19–827329–0.     

The effects of the National School Lunch Program on education and health

This paper estimates the effects of participating in the National School Lunch Program in the middle of the 20th century on adult health outcomes and educational attainment. I utilize an instrumental variables strategy that exploits a change in the formula used by the federal government to allocate funding to the states. Identification is achieved by the fact that different birth cohorts were exposed to different degrees to the original formula and the new formula, along with the fact that the change of the formula affected states differentially by per capita income. Participation in the program as a child appears to have few long‐run effects on health, but the effects on educational attainment are sizable. These results may suggest that subsidized lunches induced children to attend school but displaced food consumption from other sources. Alternatively, the program may have had short‐run health effects that dissipated over time but that facilitated higher educational attainment. © 2010 by the Association for Public Policy Analysis and Management.     

养老保险改革的自反性与福利国家平等危机——罗桑瓦隆对福利国家正当性的透视

2020年,法国通过了《法国全民退休金改革法案》,试图整合"碎片化"的养老保险制度,但引发了激烈对抗,法国养老保险制度改革陷入自反性困境。罗桑瓦隆认为,社会保险产生于资本主义的第一次平等危机,即通过再分配减少身份特权不平等,在"无知之幕"下实现个体相似性平等。后工业化社会的到来使"无知之幕"被撕开,差异性成为平等的新内涵。法国养老保险制度改革冲突的实质是逐渐显性化的差异性特质与普遍性制度要求之间的矛盾,即福利国家遭遇的第二次平等危机。而差异性平等的实现无法再单纯依赖再分配,需要以关系平等重塑福利国家的正当性。     

Usable information for policy: An appraisal of the U.S. Global Change Research Program

The U.S. Global Change Research Program (USGCRP) was established in law in 1990 (P.L. 101–606) with a mandate to provide policymakers with usable information. The law gave a White House Committee on Earth and Environmental Sciences (CEES) responsibility to implement the program with respect to its policy mandate. In 1994 CEES was replaced, in part, because it failed to provide usable information. This article, documenting the development of the program's policy mandate and CEES implementation of the USGCRP, finds a performance shortfall. The shortfall is attributed to a breakdown in the legislative process, participant perspectives, and the structure of post-World War II science policy. The purpose of the article is to explain the CEES performance shortfall in hope that its successor can improve USGCRP performance with respect to its legal mandate based upon the lessons of experience.     

收入、健康与医疗保险对老年人幸福感的影响

本文使用中国9个省、2200名55岁以上老年人的微观调查数据,主要检验了收入水平、健康状况与医疗保险对主观幸福感的影响。Ordered Logit回归分析结果表明：收入增加能够显著提高城镇老年人的主观幸福感,收入差距的影响不显著;对农村老年人而言,收入的作用不明显,而收入差距则有显著的负向影响。心理健康和城乡老年人幸福感呈高度的正相关,记忆力、日常生活自理能力等身体健康因素也具有显著的正向影响。公费医疗显著提高农村老年人的幸福感,城镇职工医疗保险和合作医疗分别对城镇和农村老年人幸福感具有积极的作用。总体上,城镇老年人的主观幸福感高于农村,东部老年人幸福感高于中部,中部高于西部。因此,增加老年人的收入水平,完善老年人医疗保险制度,并逐步协调城乡和地区经济发展,有助于从整体上提高老年人的幸福感。     

The effects of state and local antidiscrimination policies on earnings for gays and lesbians

In the last 25 years, many cities and counties, as well as a few states, have adopted policies that prohibit discrimination based on sexual orientation in private or public employment. These policies may increase earnings for gays and lesbians by decreasing discrimination in hiring, firing, promotion, or pay. This study uses data from the 1990 U.S. census to estimate the effects of these policies on individual earnings and household income. The results suggest that the policies have been adopted in places with higher earnings and that same-sex couples are more likely to live in areas that have adopted policies. However, after controlling for individual and location characteristics, the results show no evidence of a direct effect of antidiscrimination policies on average earnings or income for members of same-sex couples. Antidiscrimination policies may be more important both for a small number of individuals and as symbols of full citizenship and legitimacy for gays and lesbians.     

The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions

The U.S. population receives suboptimal levels of preventive care and has a high prevalence of risky health behaviors. One goal of the Affordable Care Act (ACA) was to increase preventive care and improve health behaviors by expanding access to health insurance. This paper estimates how the ACA‐facilitated state‐level expansions of Medicaid in 2014 affected these outcomes. Using data from the Behavioral Risk Factor Surveillance System, and a difference‐in‐differences model that compares states that did and did not expand Medicaid, we examine the impact of the expansions on preventive care (e.g., dental visits, immunizations, mammograms, cancer screenings), risky health behaviors (e.g., smoking, heavy drinking, lack of exercise, obesity), and self‐assessed health. We find that the expansions increased insurance coverage and access to care among the targeted population of low‐income childless adults. The expansions also increased use of certain forms of preventive care, but there is no evidence that they increased ex ante moral hazard (i.e., there is no evidence that risky health behaviors increased in response to health insurance coverage). The Medicaid expansions also modestly improved self‐assessed health.     

Public Health Insurance and Medical Spending: The Incidence of the ACA Medicaid Expansion

This paper examines the incidence of the cost burden associated with expanding public health insurance to low-income adults in the context of the Affordable Care Act. Using data from the Medical Expenditures Panel Survey (MEPS), I exploit exogenous variation in Medicaid eligibility rules across states, income groups and time. I find that public insurance eligibility reduced mean out-of-pocket spending by 19.6 percent among targeted households, but it did not causally increase total expenditures among beneficiaries. Rather, Medicaid expansion shifted the burden of payment from eligible households and private insurance (21.5 percent reduction) to taxpayers in the form of public insurance (46.6 percent increase). The efficiency of these public funds can be summarized by a mean Marginal Value of Public Funds of 0.70 in the full sample, 0.99 among households with at least one pre-existing condition, and 1.26 in states with an above-median number of public hospitals.     

State fiscal constraint and local overrides: a regression discontinuity design estimation of the fiscal effects

Public Choice - Despite abundant evidence regarding the influence of US state-imposed tax and expenditure limitations on local governments, the causes and consequences of local overrides remain...     

The devil may be in the details: how the characteristics of SCHIP programs affect take-up.

In this paper, we explore whether the specific design of a state's program has contributed to its success in meeting two objectives of the Children's Health Insurance Program (SCHIP): increasing the health insurance coverage of children in lower income families and doing so with a minimum reduction in their private health insurance coverage (crowd-out). In our analysis, we use two years of Current Population Survey data, 2000 and 2001, matched with detailed data on state programs. We focus on two populations: the eligible population of children, broadly defined--those living in families with incomes below 300 percent of the federal poverty line (FPL)--and a narrower group of children, those who we estimate are eligible for Medicaid or SCHIP. Unique state program characteristics in the analysis include whether the state plan covers families; whether the state uses presumptive eligibility; the number of months without private coverage that are required for eligibility; whether there is an asset test; whether a face-to-face interview is required; and specific outreach activities. Our results provide evidence that state program characteristics are significant determinants of program success.     

International marriage and the state in South Korea: focusing on governmental policy

With globalization, the number of individuals traveling, working or studying abroad is rising globally, and so is the number of international marriages. However, there has been a dramatic rise in the number of ‘mail-order brides’ through matchmaking since the 1970s in the Western world and since the 1990s in several Asian countries. The so-called ‘mail-order bride’ phenomenon has become an important route for international migration, especially for gendered migration. Since official relations with China began in August 1992, the number of Korean Chinese women who came into Korea for marriage with native Korean men is about 100,000 between 1990 and 2005. The number of Japanese women who married Korean men is approximately 17,000, while the numbers of Filipino women who married Korean men is about 6000. Recently, the nationalities of these foreign wives of Korean men have expanded to include women from Vietnam, Russia, and Uzbekistan. In 2005, among a total of 250,000 foreign spouses in Korea, 160,000 of them were women. The Korean state had contributed to initiate these international marriages by importing Korean Chinese women for their unmarried rural citizens. As international marriages have become a social issue, the state tries to cope with these new issues through changing the laws and policies. Utilizing several government statistics, a nationwide questionnaire survey of nearly 1000 foreign brides with various nationalities, which was conducted in May and June 2005, and some interviewed data of foreign wives and government personnel, this paper analyzes (1) patterns and trends of marriage migration to Korea; (2) the issues and problems of foreign brides, such as their status and citizenship, economic situation, access to social security and ‘fake marriages’ issues; and (3) recent changes in governmental policies towards them. Special focus will be on what factors influenced the recent governmental action and how the ideology that ‘A married daughter is no longer a daughter ()’ is still reflected in recent policies even in today's more progressive society.     

On the scenario approach to simulation modeling for complex policy assessment and design

This paper reviews the major issues posed by scenario-based simulation modeling in the policy process, using agricultural policy as an example of a complex decision arena. Policy is seen as a process by which decision makers use the instruments under their control to approach the general goals of society. Models can help to choose instrument settings, evaluate policy options, and assess their appropriateness to a particular situation. But they cannot design policy; the interactions between policy makers and models are critical if modeling is to be useful in the policy process. Policy models must be oriented to the factors that focus and constrain judgments in the real world, as well as toward the substantive problems motivating analyses. These include the actors within the system, as well as the geographic and disciplinary contexts of the problems. Scenario-writing provides a way of ordering understanding and judgment about different phenomena to help users interact most effectively with a model and to insure that the perspectives of the model are most appropriate to the needs of the decisionmaker. It is an iterative and evolutionary process which can provide a great deal of insight into the assessment phase of policy design.     

The effects of administrative linkages on implementation: Welfare policy in Israel

This article focuses on the interaction between local-national relations and the implementation of welfare policy in Israel. It studies the administrative linkages between different levels of governmental jurisdictions involved in the implementing of certain policies of the Ministry of Welfare. It seeks to understand their impact on the original goals and programs of the national government and on actual services provided at the municipal level. These linkages include the arrangements for provision, funding, employment, regulations, and inspection. Without denying the importance of other explanations, the article emphasizes the significance of administrative linkages for understanding welfare policy and practices. In effect, the present study evaluates the extent to which the administrative linkages enable the national government to implement its policies on the one hand, and local authorities to influence national policies and programs on the other.The findings and analysis of administrative linkages suggest four conclusions. First contrary to Government policy the welfare system involving the Ministry, local municipalities and their agencies, is very inegalitarian; services are neither uniform nor adjusted to need. Second, the administrative linkages maximize local output and undermine the ability of the Ministry to implement its policies. Third, it is questionable whether the Israeli government can use its present Welfare Ministry to cope with major aspects of the problem. Fourth, it appears that the operations of the Israeli Welfare Ministry system are more similar to the federal than unitary model.     

State budget periodicity: An analysis of the determinants and the effect on state spending

Much of the public budgeting literature focuses on the institutional rules of budgeting and how those rules affect process and outcomes. This study focuses on a particularly rudimentary rule of budgeting: the length of the budget period. State budgets are dictated (constitutionally or statutorily) to recur over one-or two-year intervals. Statistical analysis of the determinants of state budget periodicity shows that the more states spend, ceteris paribus, the more likely they are to budget annually. I hypothesize that budget periodicity has the opposite effect on spending: Biennial budget states spend more, ceteris paribus, than annual budget states spend. Ordinary least squares analysis does not support the hypothesis, but with instrumental variable methods, biennial budgeting exhibits a positive and statistically significant effect on state spending.