Inside the Autonomous State: Programmatic Elites in the Reform of French Health Policy

This article combines the methods of institutionalist analysis and the sociology of elites to look inside the black box of the French state. We identify key groups of policymakers in the social policy sector and track both their policy preferences and the results of their efforts from the mid‐1980s through the late 1990s. Our conclusion is that budgetary and ideological challenges to existing policies led to the consolidation within the Ministry of Social Affairs of what we label a “programmatic elite,” whose influence derived less from the positions held by its members than from the coherence and applicability of its state‐centered policy model. The competition for legitimate authority between such programmatic elites, we conclude, is an important but often overlooked endogenous source of policy change in situations of institutional stability.