The Impact of Program Design on Enrollment in State Children's Health Insurance Programs

The success of State Children's Health Insurance Programs (SCHIP) in expanding insurance coverage among low‐income children varies considerably across states. Scholars have looked to different program characteristics to explain this variation, but have arrived at disparate conclusions regarding the impact of one of the most significant design choices—the decision to create a new program or to pursue increased child health insurance rates through an expansion of the existing Medicaid program. This study suggests that understanding the impact of programmatic choices requires a more careful consideration of the mechanisms through which these different program designs might influence enrollment than has been offered in previous research. Employing a multilevel governance framework, it suggests that there is a hitherto unexplored indirect impact, where design choices influence administrative behavior, which in turn influences enrollment success in SCHIP programs. It is important to understand the effect of administrative design choices because this is one of the key areas in which states exercise discretion in the implementation of many federal programs.     

Treatment or Placebo: Are State Programs Decreasing the Proportion of Uninsured?

Currently there are over 45 million Americans without health insurance. Recent growth in Medicaid and State Children's Health Insurance Program (SCHIP) enrollment of children has filled in the sizable gap created by decreased employer‐sponsored insurance since 2000. While the share of children who are uninsured actually decreased between 2000 and 2003, little progress was made in expanding public insurance to adults. As a result, advocates and policymakers at the federal and state level are searching for approaches to deal with the growing number of the uninsured. Conservatives advocate encouraging individuals to buy private insurance while liberals advocate the provision of health coverage through publicly financed health care. Using a 50‐state multilevel individual growth model, this study estimates the net effect of two state approaches in terms of reducing the uninsured: tax incentives (the conservative approach) and direct‐coverage programs (the liberal approach). The results suggest that these approaches have not achieved the results that many advocates had suggested. In the case of tax incentives, the results suggest that states with tax incentives experience increases in the rate of the uninsured. In the case of direct‐coverage programs, results suggest that states receive no relief in the number of uninsured individuals. Finally, the analysis suggests that the efforts originating at the federal level are most successful. These programs are a continuation of the incremental approach policymakers in America have taken to address the problem of the uninsured, rather than taking steps toward a truly comprehensive solution.     

Performance Goal Achievement in Fiscal Federalism: The Influence of State Partisan Environments and Regulatory Regimes

With tight budgets and hyper‐partisan interactions within and between the states and federal government, attention is being paid to the implementation of federal programs. This is particularly important because, as the recently implemented American Recovery and Reinvestment Act suggests, state administrators are often the implementers of federal policy. This study integrates the fiscal federalism literature with that on implementation and bureaucratic response to examine the effect that within‐state factors have on the degree of performance goal achievement in federally funded, state implemented programs. The findings suggest that, when implementing federal programs, state administrators face conflicting political incentive structures and policy‐specific capacity and capability deficits that influence their motivation and ability to achieve performance goals.     

Multilevel Instruments for Infrastructure Investment: Evaluating State Revolving Funds for Water

In recent decades, the federal government has introduced complex, multilevel state‐operated revolving loan fund programs as an instrument for promoting state and local investment in national infrastructure priorities while limiting direct federal involvement in implementation. A federally funded state revolving fund (SRF) program combines features of a categorical matching grant to states and a subsidized loan program to localities, both of which should lower the effective price of infrastructure investment and therefore promote higher levels of infrastructure investment. However, little evidence exists to date on whether these programs stimulate new subnational spending or instead displace spending that would have occurred otherwise. We evaluate the stimulus effects of SRFs by examining the two largest such programs, the Clean Water and the Drinking Water SRF Programs. Analyzing 17 years of state‐level panel data, we find evidence that the flow of federal funds to states under the SRF programs stimulates new local investment in wastewater infrastructure, but not in drinking water infrastructure. In discussing several possible explanations for these divergent results, we argue for further research that emphasizes the intergovernmental features of this financing tool.     

Implementing Work Programs for Poor Men

How might work levels among low‐income men be raised, as they were for welfare mothers in the 1990s? This study expands the relevant literature on both social policy and implementation. Low‐skilled men owing child support and ex‐offenders returning from prison are already supposed to work but often fail to do so. The reasons include both the recent fall in unskilled wages and the confusion of men's lives. Existing work programs in child support and criminal justice appear promising, although evaluations are limited. A survey covering most states shows that half or more already have some men's work programs, usually on a small scale. Field research in six states suggests the political and administrative factors that shape wider implementation of these programs. Work programs should preferably be mandatory, stress work over training, and be combined with improved wage subsidies. The federal government should provide more funding and evaluations.     

The Attitudes of State Legislators and State Medicaid Policies Related to AIDS

As the Medicaid programs become increasingly important payers of AIDS-related care, state governments will face difficult policy choices in allocating limited Medicaid resources among many competing health needs. The state legislatures will play a critical role in these allocation decisions. This research presents the results of an analysis of attitudes concerning Medicaid coverage of AIDS-related care among state legislators serving on health-related committees in all 50 states. The model employed includes characteristics of the state legislators, their districts, and their states to explain the legislators' allocation choices and attitudes relating to Medicaid coverage of AIDS-related care. The relationship of these factors to the actualization of AIDS-related state policy also is examined. The model identified political ideology, party affiliation, and sex of the state legislator as the most important predictors of attitudes about AIDS-related Medicaid policies. AIDS prevalence, constituency characteristics, and legislator attitudes are the most important predictors of actual state policies.     

BLOCK GRANTS AND URBAN POLICIES: IMPLETATION AND IMPACT

In the 1970's, the federal government has made greater use of block grants to encourage subnational units to pursue national goals. Using two jurisdictions—St. Louis City and St. Louis County—and two block grant programs—Community Development and Comprehensive Employment and Training—as case studies, this essay describes how differences in local polities affects policy implementation and policy impact. The tentative conclusion is that maintaining local autonomy and achieving national goals are far from mutually compatible.     

Medicaid Expansion and the Political Fate of the Governors Who Support It

We provide evidence regarding potential policy feedback effects of healthcare reform by estimating the effect of Medicaid expansion on public support for the state actor most closely associated with responsibility for the expansion decision—the governor. The discretion granted to state governments concerning Medicaid expansion has created the potential for significant variation in mass feedback effects across the states. We are particularly interested in how these effects are influenced by the emerging racial polarization over healthcare policy, and how this may lead to different types of feedback effects that align with partisan, ideological, and racial cleavages. We estimate the impact of Medicaid expansion on gubernatorial approval, utilizing five waves of the Cooperative Congressional Election Study (2008–16). We find that on average, expansion led to a modest, yet statistically significant increase in gubernatorial approval. However, there is important variation both within and across states in the effect of expansion. Specifically, we find that governors were more likely to be rewarded for expansion by those who supported President Obama, and those who resided in states where the Medicaid recipient population is more likely to be white.     

Saints, Stalwarts, and Slackers: State Financial Contributions to Welfare Reform

Considerable literature finds that spending levels are important predictors of poverty rates, both in the American states and in western European nations. Those jurisdictions with the most generous support programs generally have lower poverty rates. This article examines state Temporary Assistance for Needy Families (TANF) spending levels in relation to national norms, the spending ability of the state as predicted by their total taxable revenue base, and the state's poverty rate. The analysis shows enormous variation in state per capita TANF spending, with many states spending far less than the national mean and their fiscal capacity. Most of the low-spending states have the fiscal ability to fund more vigorous programs but at optimal levels; some would still fall below the national mean. In return for improved funding, these states would be candidates for increased federal assistance. A few states with a high poverty rate and usually with large numbers of poor citizens are generous spenders, indicating that funding is one component of effective programs.     

U.S. Environmental Policy Implementation on Tribal Lands: Trust,Neglect, and Justice

This study investigates the implementation of U.S. environmental protection laws under American Indian tribal governance. The landmark laws of the 1970s that form the core of America's environmental policy regime made no mention of American Indian tribal lands, and the subsequent research literature on environmental policy has given them little attention. The U.S. Environmental Protection Agency has primary implementation responsibility for environmental protection laws on tribal lands, which offers a unique opportunity to study direct federal implementation apart from typical joint state–federal implementation. Further, because Indian reservations are homes to a disproportionately poor, historically subjugated racial group, analysis of environmental programs on tribal lands offers a unique perspective on environmental justice. We analyze enforcement of and compliance with the Clean Water Act (CWA) and Safe Drinking Water Act (SDWA) to compare the implementation of environmental policy on tribal lands with nontribal facilities. Analysis reveals that, compared with nontribal facilities, tribal facilities experience less rigorous CWA and SDWA enforcement and are more likely to violate these laws.     

Navigating the Social Safety Net: A State‐Level Analysis of the Relationship between Medicaid and Consumer Bankruptcy

The social safety net in the United States consists of a variety of programs administered by both federal and state governments. Although the populations served by social programs such as Medicaid and consumer bankruptcy likely overlap, policymakers tend to look at individual programs unilaterally and often fail to communicate appropriately with legislators and political leaders at differing levels of government. The result of such an incremental approach to policy reform is a fragmented social safety net system in the United States. In this study, the relationship between two social programs belonging to the larger social safety net is examined, and recommendations for policymakers are offered.     

Incomplete Sovereigns: Unpacking Patterns of Indigenous Self-Governance in the United States and Canada

ABSTRACT

In the early 1970s, both the Canadian and United States federal governments introduced modern land claim agreements as a first step forward in the states’ recognition of Indigenous goals for self-determination. Since then, both the United States and Canadian federal governments have incrementally expanded their recognition of Indigenous rights to include Indigenous goals for political self-determination. Yet, despite the fact that both countries began implementing broadly similar policies at approximately the same time, the degree to which Indigenous political and economic self-determination has been realized varies considerably both within and between the two countries. The variation in Indigenous self-governing power and authority suggests that the policy shift towards Indigenous self-determination is incomplete and has faced important barriers to implementation. This paper investigates two key aspects of this variation in Indigenous self-determination in the United States and Canada: (1) institutional histories embedded in geography, and (2) the temporal nature of policy frameworks. I argue that the full realization of Indigenous self-determination has been shaped in different ways and, ultimately, is limited by the intersection of embedded institutional legacies and federal political dynamics.     

Moderating Local Capacity: Exploring EO 12372's Intergovernmental Review Effects on Federal Grant Awards

This article asks whether the Reagan Executive Order (EO) 12372 matters for intergovernmental fiscal relations today. To address this question, federal grant receipts from programs that are, and programs that are not, covered by EO 12372 are compared by examining the differential effects of political and local administrative capacity on each. Grant receipts are examined by coding federal grant award data from 1993 to 2003 using Catalog of Federal Domestic Assistance reference numbers. In the case state, Kentucky, Area Development Districts are the regional functionaries for the state single point of contact clearinghouse, by virtue of which status they review proposals for federal funding originating in, or affecting, their districts. Since federal award decisions take clearinghouse information into account on grant programs covered by EO 12372, differences in the effects of local capacity on receipt of grants covered and not covered by the EO are expected. Methodology used in this post‐only analysis is pooled cross‐sectional time series analysis with panel corrected standard errors. Results focus attention on the differential effects of government administrative and political capacity as they apply to federal grants covered, and not covered, by the EO.     

MANDATING AS A POLICY ISSUE – THE DEFINITIONAL PROBLEM*

Mandating of state policies by agencies of the federal government and of local government policies by both state and federal agencies has emerged in recent years as an important policy issue. This conceptualization of mandating behavior offers a typology based upon (1) substantive aspects of the mandate; (2) the method by which a mandate is imposed; and (3) the mode of application. Problems associated with different types of mandates suggest multidimensional effects of intergovernmental relations on state and local policy formulation and Implementation.     

Policy Climates,Enforcement Rates,and Migrant Behavior: Is Self‐Deportation a Viable Immigration Policy?

U.S. immigration policy has been the subject of considerable debate in recent years. Previous research has focused on how temporal variation in federal policy has altered the migratory behavior of immigrants. The effect of spatial variation in enforcement remains untested. Relying on the criminological distinction between general and specific deterrence, we argue that high rates of enforcement are unlikely to encourage undocumented immigrants to self‐deport. We also examine the effects cultural and economic immigration policies adopted by the states. Previous research suggests that migrants will choose to remain in states with favorable environments, but this claim has not been directly tested. We draw on data from the Mexican Migration Project (MMP) to address these gaps. MMP data are supplemented with government data on federal enforcement obtained from Immigration and Customs Enforcement (ICE) and measures of state policy. Our findings suggest that higher rates of enforcement and the establishment of negative policy environments do not encourage undocumented immigrants to leave the United States at a higher rate than their documented counterparts do. Rather, high enforcement contexts exaggerate the differences between documented and undocumented migrant behavior, with undocumented migrants staying longer. Liberal state policies have no discernible effect.     

Policy Interaction in the Provision of Unemployment Insurance and Low-Income Assistance by State Governments

In this paper we investigate empirical relationships between Unemployment Insurance (UI) and welfare policies using a unique database covering 48 states annually from 1973 through 1989. We first document substantial variation across states in UI program outcomes. Having established that UI is so variable, we explore the simultaneous interaction between UI and Aid to Families with Dependent Children (AFDC), Medicaid, and total state and local welfare spending. Our econometric results indicate substitution between the two cash assistance programs, AFDC and UI, by state governments. On the other hand, states that operate relatively generous UI programs also tend to allocate more resources to Medicaid and other in-kind, low-income assistance programs.     

Defiant Innovation: The Adoption of Medical Marijuana Laws in the American States

Diffusion research often characterizes the role of the federal government in innovation adoption as a supportive one, either increasing the likelihood of adoption or its speed. We examine the adoption of medical marijuana laws (MMLs) from 1996 to 2014 to shed light on what motivates states to adopt innovations that are in explicit defiance of federal law. Furthermore, we examine whether federal signals have any influence on the likelihood of adoption. In doing so, we utilize implementation theory to expand our understanding of how the federal government's position impacts state policy innovation adoption. We find mixed evidence for the influence of federal signals on the adoption of MMLs. The results suggest that medical marijuana policies are much more likely to be adopted in states when proponents have the political or institutional capital, rather than a medical or fiscal need. Moreover, this political capital is sufficient independent of the federal government's real or perceived position.     

Australian Federalism and Domestic Violence Policy-Making

The influence of state architecture on gender policy and politics is an emergent strand of feminist research. This paper contributes to this research by undertaking a detailed case study of one specific gender policy area – domestic violence policy – in old federation Australia. Drawing on the experiences of the past decade, it confirms earlier research findings that demonstrate that under certain conditions, federal structures can influence the development of gender policy in positive ways, such as providing opportunities for ‘venue shopping’ and policy innovation. The paper engages, too, with recent research on Australian federalism and challenges the consensus about the centralised nature of the Australian federal system by demonstrating that in the area of gender policy, states and territories are more than just the implementation arms of the Commonwealth government. Sub-national governments continue to play an important and autonomous role in policy relating to women and therefore remain central sites for advancing gender equality.     

Competitive Pressures and the Emergence of Mothers' Aid Programs in the United States

Do states compete in providing (or not providing) welfare services? Do competitive pressures shape state welfare program adoption? Even though interstate competition is viewed by some to be a ubiquitous feature of the American federal system and welfare state, there is mixed evidence as to whether such pressures have influenced cash assistance policy in the United States. Although evidence exists of competitive pressures in contemporary welfare program decisions, such pressures have not been found in examinations of early state welfare programs. To reconcile this seeming contradiction, I examine the impact of neighboring state behavior on the emergence of state Mothers’ Aid cash assistance programs during the early part of the twentieth century. Linking theory of intergovernmental competition to program diffusion, I argue that competitive pressures may play a greater role as programs evolve past the circumstances of initial adoption to decisions about program maintenance. Contrary to previous research, I find that state decisions regarding Mothers’ Aid were responsive to similar decisions in neighboring states. Further, there is evidence that women's political organizations were important to Mothers’ Aid adoption but not to how states subsequently structured those programs.     

The Influence Of States On Federal Policy Adoptions

This article examines whether stales, in the role of "laboratories of democracy," influence federal policy adoptions. Taking the recent past as the time frame, the article begins by examining major federal legislation to gauge the extern to which stale models were an influence. Following this, the focus shifts to important slate initiatives of the early 1980s, and their impact on subsequent federal legislation. The article concludes that the nature of the policy issue and the accompanying political dynamics are critical in determining whether states act as laboratories of democracy.