Week 11 Discussion Questions
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Feb 20, 2024
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Week 11 Discussion Leader Questions: Chamari Shunda
Learning from the States? Federalism and National Health Policy
1. What policies did the federal government accede to states? Why?
2. How does instrumental policy learning connect to vertical diffusion?
Is an area in which more work can and should be done. Understanding why some areas? -in our case, SCHIP and HIPAA- are more relevant to learning by federal policy makers than others would be an important next step. The
3. When do we expect to see national policy follow state leadership, and when do we expect to see national policy provide leadership?
Returning to the Winter Commission terminology, we expect to see that when there is substantial state experience, national policy will follow state experiences.
When the states are encouraging national leadership and when there is minimal state experience, we expect to see national policy provide leadership.
4. Why was HIPAA such a major concern when enaction ERISA?
One of the intergovernmental issues of concern during the debate over HIPAA was the Employee Retirement Income Security Act of 1974 (ERISA), which preempts state regulation of health insurance provided by large companies that self-insure. 5. Why is the FDA and pharmaceutical industry against importing medication from other
countries?
6. What was added to the Homeland Security Appropriations Bill?
Finally, in the 109th Congress, language was added to the Homeland Security Appropriations Bill (P.L. 109 295) that allowed individual citizens to buy prescriptions from Canada without facing repercussions from the border control.
7. Why were states angry about Medicare Part D?
The states were angry and surprised because the provision came very late in the process and without airing in either the House or the Senate bills.
8. What were the findings and recommendations of the IoM report?
In this report, the IoM estimated that the number of preventable adverse medical events leading to death was between 44,000 and 98,000.
The IoM report made a series of recommendations calling for a nationwide mandatory reporting system to collect information from states about adverse events, a new federal agency to convene states to share information and expertise,
and funding for states so they could establish or adapt their error reporting systems to collect standardized information and con duct follow-up action.
1.
What is commonly referred to as the “managed care bill of rights?”
Most prominent in this category are medical malpractice and the regulation of managed care entities (commonly called the "managed care bill of rights").
2.
Schneider and Ingram (1988) noted that policy designs were often what?
Schneider and Ingram (1988) noted that policy designs were often copied, borrowed, or "pinched" from similar policies in other locales.
3.
In what year did the Winter Commission Report take place?
1993
4.
From 1993-2006 how many laws were signed into place?
17 laws were signed.
5.
Name one of those laws?
HIPPA
6.
With HIPAA what did the federal government strip states of?
Less well known are its far-reaching intergovernmental provisions, which brought
the federal government into insurance regulation for the first time, stripping states
of their long-held authority over insurance markets. 7.
In Table 2. Under State Participation in Congressional Hearings by Health Issue what percentage of State Officials in House Hearings involved medical errors?
5%
The Fourth Face of Federalism
1.
What is the Comprehensive Employment and Training Act?
CETA allows recipients, mostly large cities,' wide discretion in establishing their own manpower training and public service employment programs.
2.
What services were CETA and CD expected to pay for?
The two programs were to pay for a wide variety of services: job training, public service jobs, housing rehabilitation, downtown economic development, and many more.
3.
What four factors shaped the assortment of administrative agencies?
First, Richmond city officials wanted to avoid building the programs permanently into the city's bureaucracy.
Second, previous federal programs had created a large and powerful constituency for continued community-level funding. As one manpower official explained about CETA:
i.
First, when CETA started, there was very heavy emphasis [from the Department of Labor] on the fact that we had to do business with the people who had been doing business before with the feds. ii.
Second, the nature of city politics dictated that we had to keep these people happy.!
The changing nature of Richmond politics also deeply affected these organizational decisions.
i.
As CD and CETA arrived in Richmond, the city was in the midst of a dramatic change in community power. ii.
A shift from at-large to district representation on the city council gave blacks their first city council majority, and they elected one of their number as the city's first black mayor. iii.
Before the change, the white council majority had no desire to jeopardize an already precarious position by antagonizing black community leaders with a change in funding strategy. iv.
Moreover, after the blacks gained the majority, their one-vote edge left no room for dissension. v.
Particularly in the CETA program, the community-based organizations were enjoying support that made a dramatic reorganization unthinkable.
Finally, for some of the projects, particularly in the CD program, non-city agencies were the city's only alternative.
4.
What crosscutting requirements did the federal government add to intergovernmental grant programs?
Crosscutting requirements: i.
accountability to the federal government for specific program requirements.
ii.
accountability to city officials for individual project goals. iii.
accountability to those who ultimately received the fruits of the projects-
usually the clients of the non-city agencies-for the quality of the services.
5.
What are the four layers of accountability?
The programs were thus encumbered with four layers of accountability:
o
accountability to the federal government for general, crosscutting requirements
o
accountability to the federal government for specific program requirements
o
accountability to city officials for individual project goals o
accountability to those who ultimately received the fruits of the projects-
usually the clients of the non-city agencies-for the quality of the services.
6.
What areas of expertise have local government officials had to develop because of “overhead” regulations?
Environmental reviews
Planning for equal opportunity
Fair housing
1.
What did Richard Nixon promise with New Federalism?
Richard Nixon promised a "New Federalism" of guaranteed grants, fewer federal rules, and more discretion for state and local governments on what projects could receive support.
2.
In the 1970’s the Great Societies Confrontation was mainly between what?
The Great Society's confrontation between city hall and city neighborhoods.
3.
What was this confrontation often fueled by?
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Often fueled by federal grants that bypassed city governments and were channeled directly to the neighborhoods, slowly gave way to closer (if not always pacific) ties.
4.
In CETA’s 1978 yearly review what did congress put limits on?
In the CETA program's 1978 annual renewal, Congress put limits on how long CETA participants could work and how much they could be paid.
5.
Name the city whose officials help with the article?
Richmond
6.
What did the article say about those over CETA and CD regarding accountability?
At the same time, the complicated administrative net- works that manage CETA and CD have simultaneously streamlined and muddied the problem of accountability.
7.
In the 1970’s these programs helped build the non-city groups into what?
In the 1970s, the pressures for ad- ministrative expedience and for neighborhood power gave non-city agencies a continuing but different role.
The Transformation of Governance: Globalization, Devolution, and the Role of Government
1.
What are the two effects of the transformation of government?
First, it has strained the traditional roles of all the players.
i.
For decades, we have debated privatizing and shrinking government. ii.
While the debate raged, however, we incrementally made important policy
decisions. iii.
Those decisions have rendered much of the debate moot. iv.
Government has come to rely heavily on for-profit and nonprofit organizations for delivering goods and services ranging from anti-missile systems to welfare reform. v.
It is not that these changes have obliterated the roles of Congress, the president, and the courts. vi.
State and local governments have become even livelier. vii.
Rather, these changes have layered new challenges on top of the traditional institutions and their processes.
Second, the new challenges have strained the capacity of governments—and their nongovernmental partners—to deliver high-quality public services.
2.
Why was congress’s response to the Lee problem ineffective?
There was little evidence the restructuring would solve the Lee problem—if there was a problem, and if the problem were structural within the DOE.
3.
What do analysts’ mean by globalization "is increasingly forcing us to live in an economy rather than a society”?
Some analysts have gone so far as to suggest that globalization “is increasingly forcing us to live in an economy rather than a society”—with shrinking national
political power and “with government’s role in economic affairs now deemed obsolete.”
4.
How has the internet impacted globalization?
At the core of the globalization movement, however, are lightning-fast communication systems—especially the Internet—that have developed over the last decade. The communications revolution has made it possible to spread information around the world easily and cheaply.
5.
How has the power of international organizations impacted the federal government?
First, what is the federal government’s role at a time when international organizations—formal organizations like the WTO and the United Nations; informal organizations like the NGOs and multi-national corporations—have become far stronger?
6.
What are some of the benefits of welfare reform?
Welfare reform is really a multi-faceted connection among job assessment, job training, job placement, and family support programs.
7.
How do horizontal relationships affect accountability in government?
The spread of horizontal relationships muddies that ac-countability. They replace hierarchical authority with net-works—sometimes formally constructed through contracts and other legal agreements, sometimes informally drawn through pragmatic working relationships.
1.
What has the government become reliant on for delivery of goods and services:
Government has come to rely heavily on for-profit and nonprofit organizations for
delivering goods and services. 2.
Name one of the goods and one of the services offered by these organizations.
Ranging from anti-missile systems to welfare reform.
3.
Most citizens expect what regarding their problem?
Citizens expect their problems will be solved and tend not to care who solves them.
4.
Where was Lee working when he was arrested?
Department of Energy 5.
What secret did the US Intelligence Agency accuse the Chinese Government of gaining access?
Intelligence analysts concluded the Chinese government had captured the secrets of the W-88 warhead, America’s most advanced nuclear device.
6.
What does the EPA stand for?
Environmental Protection Agency (EPA)
7.
What role has the EPA shifted to over the years?
Shifted into the role of service purchaser (through contracts with private companies to clean up Superfund sites) and service arranger (through partnerships
with state governments).
Translating National Policy Objectives into Local Achievements across Planes of Governance and among Multiple Actors: Second-Order Devolution and Welfare Reform Implementation.
1.
Why do we reject the idea that hierarchy is an underlying organizational base for effective implementation?
2.
What are the 3 strategies we rely on to examine the confluence of policy implementation and intergovernmental relations?
First, we do not accept the common assumption of hierarchy as an underlying organizational base for effective implementation.
A second rejected assumption is the often-unstated expectation of policy “failure” as a
common feature of implementation efforts and the research that assesses those achievements.
A third approach to policy implementation that we circumvent is the case-study strategy.
3.
Who are the “street level” actors in policy implementation?
Likewise, a focus on county officials who play central roles in implementing national objectives accepts the roles of "street-level" actors in achieving policy results.
4.
Describe the two sources of data in this study.
The data comes from two sources: o
(1) survey results from mail questionnaires to county officials
o
(2) objective county characteristics.
5.
What is the image behavior relationship?
We must recognize that the people whose decisions determine the policies and actions
of nations do not respond to the "objective" facts of the situation, whatever that may mean, but to their "image" of the situation. It is what we think the world is like, not what it is really like, that determines our behavior.
6.
What is the Index of Employment Achievement?
Is based on three measures of perceived achievement that are associated with the primary goals of welfare reform. County officials were asked to indicate their county's level of achievement for the following objectives: o
(a) the promotion of personal responsibility
o
(b) the securing of workforce participation
o
(c) the reduction of welfare caseloads in their counties.
7.
What is the Quality-of-Life Index?
Is based on two measures of perceived achievement that are associated with supplementary goals of welfare reform. Survey responses measured the perceived achievement of the following:
o
(a) the reduction of family poverty
o
(b) the improvement of child well-being.
1.
What question were the writers of this article especially asking?
We specifically seek to answer the following question: what contextual, attitudinal, and administrative characteristics explain higher level(s) of perceived welfare reform accomplishments in implementing welfare reform in the local setting?
2.
Explain Devolution?
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"Devolution," in its generic sense, simply refers to the shift in duties, functions, or responsibilities from one jurisdiction to another.
3.
What act did O’Toole say was the wicked problem of policy implementation?
To explore the "wicked problem" of policy implementation (O'Toole 1989), one could
search far and wide before locating a more distinctive case than the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
4.
What state was the focus of this article?
North Carolina
5.
Explain Dillon’s Rule?
Dillon's Rule, which defines (for most American states) the fundamental legal subordination of local governments to state governmental power(s).
6.
Under the section Dependent Variables, The 1996 National and the 1997 state legislation established what?
The 1996 national and 1997 state legislation established caseload reduction and employment initiatives as the primary objectives of welfare reform.
7.
Under the section Empowerment Devolution, what two measures were used in the North Carolina counties?
The first, called Yes to Increased Authority, is included as a measure of a county's perceptions of devolved authority from the state legislation of 1997. o
Officials were asked the following: "In your judgment, has your county gained or obtained greater authority in welfare policy decisions during the past three years (1997-2000)?"
o
Respondents could answer "Yes" or "No." o
This county-level variable is coded as the percentage of respondents from that county who said "Yes" to the question about increased authority.
The second measure, Electing Status, is a dummy variable to examine the effect of the standard versus electing distinction. o
Values of one indicate electing counties. o
These variables are indicative, subjectively, and objectively, of perceived and actual devolution of authority. o
As a two-item cluster they suggest the presence (or absence) of empowerment in the hands of county officials.