Small group insurance reform: how are state programs measuring up?

In the past decade, states have responded to the health insurance needs of small businesses by launching a number of reforms. According to authors Michael Morrisey and Gail Jensen, more than 30 states have implemented "bare-bones" policies that seek to make minimum-benefit, affordable coverage available to small employers. Almost all states have enacted legislation modifying the underwriting practices that insurers may use with respect to such things as pre-existing conditions and occupational exclusions. Other states have provided tax or employer subsidies. But despite the efforts of the states, the authors found the state policies have had little success. Drawing from a survey found that the few employers who were aware of the programs found them to be unappealing. In discovering what doesn't work, the authors are able to suggest remedies for the states' small group insurance ills, such as offering long-term instead of short-term subsidies.     

Die Qualität von demokratischen Regimen. Zur Erklärung der politischen Performanz in Italien und Indien durch Robert Putnam und Patrick Heller

Long-term processes of democratization have brought about a great number of states with democratic regimes. Therefore, political sociology has to focus in its research on the determinants of the quality of democracies. This article compares two theoretical perspectives: first, Robert Putnam’s attempt to explain the political performance in the Italian regions by the strength of their civil society and their social capital and secondly, Patrick Heller’s study about the Indian state of Kerala, which underlines much more the importance of the mobilization and organization of the lower classes and the functioning of the state apparatus. An empirical analysis of the determinants of the social development of the 15 largest Indian states and further studies in political sociology indicate a greater plausibility of Heller’s approach. Therefore, Putnam’s core concepts of social capital and civil society are reconstructed in a concluding theoretical discussion so that a connection to Heller’s theses and to other fields of research in the social sciences becomes possible.     

The Changing Property Tax in the West: State Centralization of Local Finances

Diminished local government autonomy and increased fiscal centralization in the hands of state government are the consequences of the restrictions on the local property tax imposed in the western states in the past twenty years. While the trend is a national one, it is more evident in the West than in other regions. Statewide voter initiatives account for some of the restrictions, particularly the more severe ones, but legislatures and governors also impose these limitations. In tracing the recent course of the centralization of local finance, this article details the property tax restrictions adopted in individual western states, examines the initiative and conventional legislative sources of these actions, and provides quantitative and qualitative evidence for the centralization thesis. In many western states the property tax has lost much of its local character, becoming in large part a fiscal and political tool for state policymakers.     

State health reform: Effects on labor markets and economic activity

Individual states are actively weighing health care reform proposals and their potential impacts on many levels, including states' own economies. This article considers the effects on state economies of two instruments of health reform: employer mandates and cost containment. The literature suggests that an employer mandate will reduce employees' wages in the long run. In the short run, however, to compensate for the costs associated with mandated health care insurance for their employees, firms may raise their prices to consumers, reduce the number of employees or allow a drop in profit margins. By increasing health care spending and the number of insured persons, mandates would also increase states' levels of economic activity. Though cost containment may dampen the stimulative effects of expanded coverage, resources not spent on health care as a result of effective cost containment might be redistributed to other sectors in a state's economy.     

The economic impact of state restrictions on abortion: parental consent and notification laws and Medicaid funding restrictions.

State-legislative support for liberalized abortion policies, the availability of abortion providers, and actual abortion rates vary widely across states. This article uses national data to examine the impact of the following three major, enforceable state abortion restrictions as of 1988 on the access to and use of abortion services: state restrictions on Medicaid financing of abortions for low-income women (36 states), state requirements for parental consent or parental notification for minors to obtain abortions (11 states), and state restrictions on insurance coverage of abortion for public employees (8 states). The impact of state abortion restrictions is becoming an increasingly important policy issue as the number and types of restrictions which can be enforced in the US increase rapidly. The Supreme Court in Webster v. Reproductive Health Services (1989) upheld a Missouri law banning abortions in public hospitals and the involvement of public employees in the performance of abortions; states via this ruling may also enforce mandatory testing for viability after a specified point in the pregnancy. The Supreme Court then in Planned Parenthood of Southeastern Pennsylvania v. Casey (1992) effectively ruled that states can enforce a 24-hour waiting period and a state-prescribed talk on abortion for women seeking abortion. Analysis of the data found that there are significantly fewer hospitals, clinics, and private physicians' offices providing abortions in states with parental consent or notification laws. Moreover the rate of minors' abortions per 1000 teen pregnancies is 16% lower, and the rate of minors' abortions per 1000 women aged 15-19 is 25% lower in states with such laws compared to states without the laws. Data from abortion clinics and referral services in Massachusetts, Minnesota, and Rhode Island suggest that 20-55% of minors are going to court instead of informing their parents. 35% of minors who contacted a clinic in Massachusetts and 49% in Rhode Island went out of state for abortions. As for Medicaid restrictions, there are significantly fewer hospitals, clinics, and private physicians' offices providing abortions in states which restrict funding of abortions as compared to states which do not. State restrictions on insurance coverage of abortion for public employees do not appear to be associated with statistically significant differences in abortion rates or abortion availability.     

The dilemmas of incrementalism: logical and political constraints in the design of health insurance reforms.

Health care reform became a premier issue on the U.S. policy agenda in the 1990s. While the comprehensive proposal put forth by President Clinton failed, states and the federal government successfully pursued a variety of lesser initiatives. This article focuses on a set of reforms intended to make private health insurance more accessible and affordable to individuals and workers in small firms. It outlines the key arguments made by experts to justify stronger regulation of health insurance and the options and difficult tradeoffs that must be considered in policy design. It then examines the scope and strength of legislation adopted by 45 states and the federal government from 1990 to 1996. The substantial variation in state policies demonstrates that even though insurance market reform was the one issue that commanded nearly universal support in the health care debate, few design features were universally accepted by those who crafted the reforms. The article concludes by assessing the pattern of state and federal action. The reforms represent some progress on nominal access to insurance but little progress on the affordability of insurance for individuals and small groups. Few of the reforms present a serious challenge to existing practices and interests of the insurance industry. This pattern of policy design reflects the logical and political constraints of incrementalism. In a system where insurance coverage is voluntary, changes to increase access for one group tend to increase costs and thereby decrease access for another segment of the population. In addition, because incremental reforms will not attract sustained attention and support from the general public, it is politically difficult to impose substantial new regulation on a powerful industry.     

The politics of action on AIDS: a case study of Uganda

This article examines the political dimensions of Uganda's progress in bringing a generalised HIV/AIDS epidemic under control. The article documents the history of the political processes involved in Uganda's battle against HIV/AIDS and analyses the complexities of presidential action and the relation between action at the level of the state and that taken within societal organisations. By the mid‐1980s, Uganda was experiencing a full‐blown epidemic, the virulence of which was connected with social dislocation and insecurity related to economic crisis and war. Political authorities faced the same challenge as other regimes experiencing the onslaught of AIDS in Africa. The epidemiological characteristics of HIV and AIDS—transmission through heterosexual activities, with a long gestation period, affecting people in the prime of their productive life—meant that action required wide‐reaching changes in sexual behaviour, and the educational activities to achieve this, as well as relatively complex systems to monitor the virus and control medical practices (blood supplies, injection practices, mitigating drug delivery). The centralist character of the Museveni regime was crucial not only to mobilising state organisations and foreign aid resources, but also to ensuring significant involvement from non‐state associations and religious authorities. The Ugandan experience demonstrates that there is a tension between the requirements for systematic action that a strong public authority can deliver and the need to disseminate information requiring a degree of democratic openness. The President was able to forge a coalition behind an HIV/AIDS campaign in part because the virus largely ignored the privileges of wealth and political power. With the development of antiretroviral therapy and the access that the wealthy can gain to these drugs, this basis for the broadest possible coalition to fight HIV/AIDS may be weakened in the future. Copyright © 2004 John Wiley & Sons, Ltd.     

Before There Was Enron,There Was Orange County: A Study of Local Government Financial‐Oversight Committees

Recent financial scandals in some of America's largest corporations have prompted popular speculation that a similar crisis may occur within the public sector and, therefore, that government and nonprofit organizations should be required to adopt financial oversight practices similar to those that are mandated of publicly‐traded corporations in the Sarbanes‐Oxley Act of 2002. One of those mandated practices—the use of financial‐oversight committees—is already a common practice in public organizations, though little is known about its effectiveness. This study uses a national sample of local governments to examine whether financial‐oversight committees improve financial control and strengthen stakeholder confidence in financial reporting. The findings provide preliminary support for the use of financial‐oversight committees as an effective tool to improve financial accountability in local government.     

The Effect of the Affordable Care Act Medicaid Expansion on Migration

The expansion of Medicaid to low‐income nondisabled adults is a key component of the Affordable Care Act's strategy to increase health insurance coverage, but many states have chosen not to take up the expansion. As a result, for many low‐income adults, there has been stark variation across states in access to Medicaid since the expansions took effect in 2014. This study investigates whether individuals migrate in order to gain access to these benefits. Using an empirical model in the spirit of a difference‐in‐differences, this study finds that migration from non‐expansion states to expansion states did not increase in 2014 relative to migration in the reverse direction. The estimates are sufficiently precise to rule out a migration effect that would meaningfully affect the number of enrollees in expansion states, which suggests that Medicaid expansion decisions do not impose a meaningful fiscal externality on other states.     

After the fall: the impact of government regulation on church attendance in Eastern Europe, 1990–2004

Previous literature modeling the demand for religion has identified socioeconomic factors, religious human capital and religious market structure as being the fundamental determinants of the level of participation in religious services and practices. Building on the existing literature, this study analyzes the effect of government regulation and intervention on religious activity. Using religion-related data as well as demographic and economic data from 22 Eastern European countries after the fall of Communism, the existence of any form of religious restrictions is found to reduce church attendance rates.     

Networks and campaigns but not movements: collective action in the disciplining Chinese State

Popular protest, civil society organizing, and non-governmental organizations have become notable features in China’s socio-political development. A mounting body of research has documented both opening opportunity structures and remaining restrictions when it comes to collective action within the authoritarian state. However, given the wide range of definitions and interpretations that are at play in the literature, it can be difficult to distinguish between different forms of collective action and determine which actions represent actual movements. This article argues that a refocus towards the basic components that constitute movement action can provide more clarity and help explain the limitations, as well as the opportunities, that surround collective action within authoritarian states. To illustrate, the article studies the organizational growth, networking, and collective action that have occurred in connection with AIDS in China. It finds that political restrictions and other coordination challenges prevent the mobilization of actual social movements.     

Public Information and Regulatory Processes: What the Public Knows and Regulators Decide

Because bureaucratic agencies may be less transparent in their decision processes than legislatures, most states have developed processes to incorporate input from regulated communities and other parties potentially affected by regulations. Administrative agencies may encourage democratic practices to increase legitimacy and accountability of the bureaucracy and improve decision‐making processes. However, rules governing the regulatory process vary by state, with some incorporating more open practices than others. Understanding these dynamics is increasingly important, as the rulemaking process has become central to policymaking over the past several decades, with a large portion of policymaking authority delegated to administrative agencies. Drawing from regulatory documents, rulemaking comments, media coverage, and interviews with regulators in 14 regulatory decision processes across five states, this study finds that while states vary in their approach to providing access to information, there are overriding patterns that reduce the role of citizens and the overall transparency of regulatory processes.     

Which States Will Restrict Abortions? Predictions from Votes in the House of Representatives

In response to the Supreme Court's rulings in Webster v. Reproductive Services and Planned Parenthood of Southeastern Pennsylvania v. Casey, which increased the ability of states to restrict abortions, many state legislatures have reexamined their abortion policies. Several recent studies use a variety of methods to predict whether states will restrict abortion access. These studies have utilized congressional votes on abortion legislation, past state laws restricting abortions, or current attitudes by state legislators and governors. Each method has its merits and limitations. This paper uses recent votes in the states' House of Representatives pertaining to abortion issues to predict the likelihood of significant abortion restrictions. These results are compared with rankings from other recent studies.     

婚前性行为和同居观念的现状及影响因素:现代性解释框架的经验验证

本文在现代性解释框架下对我国婚前性和同居的社会态度进行了实证研究。分析数据来源于2007—2008年在上海和兰州两地进行的抽样调查(N=2200)。研究结果发现,成长于改革开放前后的人群对婚前性和同居的态度的确具有显著差异,但与西方相比仍相当保守。在影响因素方面,除了现代理性、后物质主义和个体主义价值观念的增长之外,社区文化和国家制度变迁对我国性态度变迁的影响效应不容忽视。     

Freeing money: Why have states been more willing to liberalize capital controls than trade barriers?

This article investigates why advanced industrial states have chosen to dismantle their postwar capital controls during a period — the 1970s and 1980s — when they became less enthusiastic about eliminating trade restrictions. Four explanations are presented. First, the unique mobility and fungibility of money was important in both encouraging competitive deregulation pressures and making the control of financial movements difficult, each of which created differing collective action dynamics in the financial sector than existed in the trade field. Second, the US and Britain played a leading role in encouraging financial liberalization because they held distinct hegemonic interests in finance that did not exist to the same degree in the trade sector. Third, domestic coalitions of neo-liberal advocates and internationally-oriented corporate interests encountered relatively little domestic political resistance to their demands for financial liberalization because of the low domestic political visibility of international financial issues. Finally, financial liberalization and trade protectionism may in fact have been directly related: it has proven difficult for states to maintain liberal practices in finance and trade at the same time.     

Public preferences about government spending: Partisan,social, and attitudinal sources of policy differences

Although the causes and consequences of the growth of government have become the focus of increasing scholarly attention, relatively little empirical research has been done about the nature and determinants of individual fiscal preferences. The present study analyzes patterns of partisan, socioeconomic, and attitudinal differentiation in public spending preferences for a variety of government functions. Two important findings emerge from our analysis. First, attitudes about the adequacy of government spending for each of the functions considered are shown to have two dimensions—a support for spending dimension and a support for change dimension. Second, the patterns of partisan and socioeconomic cleavages about government spending are shown to vary significantly across policy domains. This fracturing of demand structures, it is argued, may be one of the root causes of the performance crisis of political institutions.     

Comment on “Does the Likely Demographics of Affordable Housing Justify NIMBYism?”

Abstract

Automated underwriting (AU) systems have become the tool of choice in mortgage lending decisions. While these systems provide significant benefits to mortgage originators and investors, questions have been raised about their impact on underserved populations. The questions focus on the relative accuracy of AU compared with manual underwriting and whether AU has increased the flow of mortgage credit to underserved consumers.

Using information from Freddie Mac's Loan Prospector AU service, we provide statistics useful in examining these issues. The data strongly support our view that AU provides substantial benefits to consumers, particularly those at the margin of the underwriting decision. We find evidence that AU systems more accurately predict default than manual underwriters do. We also find evidence that this increased accuracy results in higher borrower approval rates, especially for underserved applicants.     

Explaining variation and change in supervisory confidentiality in the European Union

Abstract

Some European Union member states’ financial regulators choose to make some of the data they routinely collect on individual banks publicly available. Others treat this data as confidential. What explains this difference? This paper considers the possible effects of crises, path-dependent legal institutions, and the design of deposit insurance schemes. At the national level, the paper focuses on contrasting German and Dutch cases. After the recent economic crisis, the Dutch released more data while the German authorities maintained strict confidentiality rules. The design of deposit insurance schemes provides a key reason why the level of secrecy varies, with the Dutch move from an ex post to an ex ante scheme where the government served as the ultimate backstop leading to questions about the accounts of individual banks while the German system favoured continued secrecy. The paper also describes the level of transparency at the EU level. Multilevel legal restrictions and bureaucratic capacity tilt EU banking union practices towards member states that treat financial supervisory data as confidential.     

Gendering the Rwanda Defence Force: A Critical Assessment

Over the past five years the Government of Rwanda has placed renewed emphasis on increasing the number of female military personnel and gender mainstreaming the Rwanda Defence Force (RDF). This article examines the efforts made by the RDF since 2007 to meet these strategic requirements and integrate women into the national security organ. It is suggested that, in spite of Rwanda's success in bringing women into the political sphere, women are still reluctant to join the military. It is argued that prevailing societal values and attitudes, conflicting narratives within official discourse about the role of women as security actors, resource constraints and the RDF's emphasis on ‘gender equality’ are barriers to achieving RDF goals. Drawing on in-depth interviews with RDF military personnel and government officials, as well as documentary research, the article first provides an overview of the Rwandan government's approach to mobilizing women to securitize the state, before examining how the RDF aims to progress the Women, Peace and Security (WPS) agenda nationally and within local communities. The article then reflects on some of the factors that are hindering the recruitment and retention of female military personnel.