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 effects of state policy design features on take-up and crowd-out rates for the State Children's Health Insurance Program.

We evaluate the effects of state policy design features on SCHIP take-up rates and on the degree to which SCHIP benefits crowd out private benefits. The results indicate overall program take-up rates of approximately 10 percent. However, there is considerable heterogeneity across states, suggesting a potential role of inter-state variation in policy design. We find that several design mechanisms have significant and substantial positive effects on take-up. For example, eliminating asset tests, offering continuous coverage, simplifying the application and renewal processes, and extending benefits to parents all have sizable and positive effects on take-up rates. Mandatory waiting periods, on the other hand, consistently reduce take-up rates. In all, inter-state differences in outreach and anti-crowd-out efforts explain roughly one-quarter of the cross-state variation in take-up rates. Concerning the crowding out of private health insurance benefits, we find that between one-quarter and one-third of the increase in public health insurance coverage for SCHIP-eligible children is offset by a decline in private health coverage. We find little evidence that the policy-induced variation in take-up is associated with a significant degree of crowd out, and no evidence that the negative effect on private coverage caused by state policy choices is any greater than the overall crowding-out effect. This suggests that states are not augmenting take-up rates by enrolling children that are relatively more likely to have private health insurance benefits.     

Reconsidering The Counter-Mobilization Hypothesis: Health Policy Lobbying In The American States

Despite its widespread use since the concept was introduced by David Truman (1951. The Governmental Process. New York: Alfred A. Knopf), counter-mobilization by organized interests has remained theoretically ambiguous and rarely studied empirically. We more fully develop the concept of short-term counter-mobilization, distinguish it from long-term counter-mobilization, specify the conditions under which we might observe short-term counter-mobilization, and test the resulting hypotheses with data on health care lobby registrations in the American states during the late 1990s. We find little evidence of short-term counter-mobilization among health interest organizations, which leads us to more fully consider several null hypotheses about the limits of strategic behavior on the part of organized interests.An earlier version of this paper was prepared for presentation at the Annual Meeting of the Midwest Political Science Association, Chicago, April 2004. This research was supported by a Robert Wood Johnson Foundation Investigator Award in Health Policy Research (ID#047727).     

Success and Failure in Environment Policy: The Role of Policy Officials

This paper reports on interviews conducted between 2010 and 2013 with senior officials involved in Australian federal environmental policies over the past 30 years. It examines whether they have a prior sense of whether an environment policy is likely to succeed and their experience of the key factors driving environment policy success. Most interviewees claimed a strong prior sense of policy outcomes, but their expression of the key factors indicating success (consultation, clear objectives, a clear mandate, and a strong evidence base) varies from the usual emphases found in the public policy literature. The research illuminates the ways in which the policy officials at times exert a greater role than that suggested by the Westminster conventions or the policy theory literature. Not emphasised in the literature, yet pivotal for success in the vexed space of environmental policy, was the self‐directed yet at times skilful policy ‘agency’ exhibited by officials.     

Health Insurance in Transition: The Health Insurance Portability and Accountability Act of 1996

The Health Insurance Portability and Accountability Act (HIPAA)of 1996 (PL. 104–191) brings the federal government fullyinto insurance regulation for the first time. Despite the Republicanmajority's rhetoric about state control, election-year politicstrumped federalism. HIPAA's immediate impact oncoverage maybe modest, but its ultimate significance is great because itcreates a template for more farreaching federal involvementin regulating insurance. HIPAA amends the Employee RetirementIncome Security Act (ERISA), the Public Health Service Act,and the Internal Revenue Code, creating a complicatedstructuredictated by efforts to avoid an unfunded mandate. The historyof insurance regulation and the activity surrounding the enactmentof PL. 104–191 suggest that HIPAA continues an incrementalprocess of transition between state insurance regulation andfederal oversight driven by recent and accelerating changesin the structure of the health-care marketplace.     

Industrial Policy and the States

The emergence of industrial policy proposals on the nationalscene raises the prospect of a greater role for the states inAmerican economic policy. Four types of industrial policy proposalsare described, each representing a distinctive strategic orientation.After describing the implied role of states in each type, weargue that state involvement is politically necessary if anyproposal is to succeed in the national policymaking arena. Weassess the four strategic proposals in light of that contentionand conclude that two of the approaches—infrastructureinvestment and subnational jurisdiction proposals—havean advantage over the better known trade policy and sectoraltargeting strategies.     

Recent trends in the Social Security Disability Insurance Program

Earlier analysis documented the rapid growth of the Disability Insurance (DI) program from 1966 to 1975; this article discusses trends since 1975. Over the decade of the 1970's, the population insured for disability increased by 34 percent, and women as a proportion of the insured population rose from 32.4 percent in 1970 to 39.1 percent in 1980, reflecting the increase in female labor-force participation. Of disabled workers receiving benefits, the proportion that were women rose from 28.4 percent in 1970 to 32.4 percent in 1979. Although inflation caused total benefit costs to rise over the entire period, the number of DI beneficiaries began to decline in 1978. Disabled-worker awards reached a peak in 1975 and fell subsequently so that the 1969 and 1981 figures are approximately equal. Relative to 1970, the fraction of awards going to women increased, the share for persons aged 50-54 rose, and the proportion received by those aged 60-64 declined. Decreased in total awards, and hence recipients, stemmed primarily from higher rates of denial at both the initial application and the reconsideration stages. Higher denials were countered by substantial rises in the number of hearings and reversals by administrative law judges (ALJ's). in 1980, only 65 percent of all awards came from initial applications, while over a fourth resulted from ALJ reversals. In future years, recent legislative changes may be expected to curtail program expansion further.     

The Failure of Success in Natural Resource Policy: Pacific Salmon Harvest Policy in New York State

Natural resource management policies like the Pacific salmon harvest policy developed by New York State often did not anticipate the extent of social, economic, and ethical concerns that would be generated, largely because the agency concentrated on biological considerations. The number of concerned stakeholders grew in proportion to both the success and failure of the initial policy. Had all participants been equally willing to recognize both the successes and the failures, development of a revised policy through group negotiations may have been possible, resulting in a cooperative mode of decision making. Instead, institutional mechanisms based on legislated process were ultimately the approach chosen for policy revision.     

The State as Architect of Political Order: Policy Dynamics in German Health Care

The focus of this article is on the state as an actor that can create, rearrange or even destroy established structures of interest representation. Through small, often almost overlooked, and sometimes even failed interventions, governmental policies create a legacy that can serve as a springboard for further political action. This policy dynamic is triggered by “architectural” activities of the state, aiming at the structure of the interest group system. This kind of policy bears the potential not only to manipulate the structure, but also the preferences and strategies of interest groups so as to overcome their veto-power. The case of German health care reform policies since the late 1970s is used to illustrate how suck a kind of governmental “design” has exerted a decisive impact on the structure of the policy field, culminating in an unexpected legislative success for the federal government.¹     

Impact of Political Structures and Informal Political Processes on Health Policy: Comparison of the United States and Canadab

A number of factors, including cultural, social, economic, political, and historical, influence policy. United States and Canada's health care systems are the conscious and subconscious outcomes of formal political structures and informal political processes. The Canadian parliamentary political system encourages centralized, organized, planned policy in health care. However, this is accomplished at the risk of leaving some individuals—physicians in this case—quite frustrated. American constitutional features, the presidential system, weak political parties, and the tireless participation of interest groups in the political process all function to discourage the formation of highly rational and efficient policy. While few special interests are ever completely satisfied with the legislation produced, seldom is any organized group completely thwarted. Therefore, it is no surprise that a tightly integrated national program of universal health insurance was not adopted by Congress in 1993–1994. Political structures and processes discourage effective, comprehensive health care reform in the United States.     

Policy Diffusion and Program Scope: Research Directions

A major omission in diffusion research is the scope of changein program adoptions. Diffusion studies focus almost exclusivelyon the rate of change, thus ignoring possible variance in thecontent of programs selected by leaders, followers, and laggards.States may adopt new programs in one area, such as state-mandatedstudent testing. While most states now have a testing policy,these policies vary in terms of the number of students subjectto examinations. Thus, the amount of program change dependson the content of each state's policy. An interstate diffusionstudy of the pattern of program adoptions ignores this variance.It is also possible that policy scope is influenced by certainaspects of the diffusion process. One possibility is that programinnovators generally select more extensive programs than followers.Similarities or differences in policy scope among adopters mayalso be related to innovation attributes (e.g., whether a newprogram is symbolic, redistributive, or administratively complex).Finally, the number of years required for interstate diffusionmay result in similarities or differences in policy content.     

Explaining Australian Economic Success: Good Policy or Good Luck?

Australia and some European countries experienced economic “miracles” in the 1990s that reversed prior poor export, employment, and fiscal performance. The miracles might provide transferable lessons about economic governance if it were true that economic governance institutions are malleable, and that actors deliberately changed those institutions in ways that contributed to the miracles. This paper analyzes Australian policy responses to see whether remediation should be attributed to pluck (intentional, strategic remediation of dysfunctional institutions to make them conform with the external environment), luck (environmental change that makes formerly dysfunctional institutions suddenly functional), or just being stuck (endogenous or path‐dependent change that brings institutions into conformity with the environment). These distinctions help establish whether actors can consciously engineer institutional change that is “off‐path.” While pluck appears to explain more than either stuck or luck in the Australian case, the analysis suggests that both off‐path behavior and policy transfer are probably rare.     

Dollars and Decisions: Fiscal Policy and Administration in the American States

Books reviewed in this article:
Glenn Beamer, Creative Politics: Taxes and Public Goods in a Federal System
David Brunori, State Tax Policy: A Political Perspective
Kurt M. Thurmaier and Katherine G. Willoughby, Policy and Politics in State Budgeting