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AbstractThe Boren Amendment is frequently cited as an example where judicial involvement markedly shaped the implementation of federal legislation. Unlike other controversial health policies, Boren was eventually rescinded by Congress. Results indicate that the Amendment was repealed because changing socioeconomic, political, and programmatic conditions combined with policy‐oriented learning to facilitate a shift in policy venue away from the judiciary toward the President and Congress. This is because during the devolutionary climate of the mid‐to‐late 1990s, both the executive and legislature proved more conducive to the policy image promulgated by state officials that the Amendment unnecessarily restricted state discretion, than the policy image promulgated by providers that without the Amendment, low reimbursement levels would compromise access and quality. Data for this analysis derive from archival documents, secondary sources, and 101 interviews with state and federal experts.

Because of the active role assumed by the courts in Medicaid nursing facility reimbursement, and because that role changed over time, federal intervention in this area provides a useful window through which to examine the role of the federal judiciary in oversight of state health policy making. Findings support the proposition that because judicial influence extends beyond program outcomes to include the organizational structure and beliefs of key stakeholder groups, the effects of case decisions, and the statutes under which they are litigation, may be deeper and longer lasting than their usefulness as a litigation tool. Findings also support the proposition that neither the executive nor the judiciary acts in isolation but instead they serve as tandem institutions guiding federal oversight of state policy making. Data for this analysis derive from archival documents, secondary sources, and 101 in-depth interviews. Adapted from the source document.

Few systematically assess the determinants of Medicaid nursing facility reimbursement. Consequently, this article examines what factors influenceprogram administrators'decisions regarding nursing facility cost report data—the basic information states use to establish payment. Whereas elected officials focus primarily on how much is spent on nursing homes, state Medicaid officials assume primary responsibility for the esoteric and highly technical dimensions that help make spending goals a reality. Findings indicate that the federal government influenced state policy by enabling provider litigation under the Boren Amendment. They also indicate that program administrators responded rationally to fiscal and economic concerns, and that states with stronger administrative capacity were better able to overcome obstacles to sustaining desired policies. Although results reveal that states with more powerful nursing home lobbies tended to implement more generous systems, they fail to reveal significant associations between cost report year and lobbying activity on behalf of the elderly.

Political scientists have long distinguished between incremental & non-incremental policymaking. In this study, I illustrate the relevance of this distinction for comparative state policy research by modeling both incremental & non-incremental change in the same policy area: Medicaid nursing facility reimbursement. I use mixed-modeling techniques to model incremental year-to-year changes in per diem rates & payments per recipient & event history analysis & ordered logit to model non-incremental comprehensive innovation in this policy area. My results indicate that federal action prompted non-incremental change in capital reimbursement policy by limiting state discretion over incremental year-to-year spending decisions. Incremental policy appears to be affected by regional diffusion, but there is no evidence of this effect for non-incremental policy. Furthermore, when a state's fiscal health declined & the demand for government services grew, it was more likely to respond by making incremental adjustments than non-incremental system overhauls. Whereas governing capacity influenced both incremental & non-incremental change, state ideology influenced only incremental change. The rate at which states pursue incremental or non-incremental policy change depends on their relative vulnerability to federal policy changes, their receptivity to neighboring state influences, & their susceptibility to internal political, economic, & programmatic conditions. Tables, References. Adapted from the source document.

AbstractPolitical scientists have long distinguished between incremental and non-incremental policymaking. In this study, I illustrate the relevance of this distinction for comparative state policy research by modeling both incremental and non-incremental change in the same policy area: Medicaid nursing facility reimbursement. I use mixed-modeling techniques to model incremental year-to-year changes in per diem rates and payments per recipient and event history analysis and ordered logit to model non-incremental comprehensive innovation in this policy area. My results indicate that federal action prompted non-incremental change in capital reimbursement policy by limiting state discretion over incremental year-to-year spending decisions. Incremental policy appears to be affected by regional diffusion, but there is no evidence of this effect for non-incremental policy. Furthermore, when a state's fiscal health declined and the demand for government services grew, it was more likely to respond by making incremental adjustments than non-incremental system overhauls. Whereas governing capacity influenced both incremental and non-incremental change, state ideology influenced only incremental change. The rate at which states pursue incremental or non-incremental policy change depends on their relative vulnerability to federal policy changes, their receptivity to neighboring state influences, and their susceptibility to internal political, economic, and programmatic conditions.

State policy adoption researchers make predictions based on states' political & socioeconomic characteristics. Some also describe relationships among states. Cross-sectional data traditionally have been used for empirical analysis, but there has been a trend in the past 10 years toward the use of longitudinal data. Although scholars have begun to supplement secondary sources with survey data, few use qualitative data to acquire a deeper understanding of the particular policy contexts being studied. The lack of qualitative analysis may be one reason why much of the literature downplays the complexity of state policy making while ignoring the role of the federal government & deemphasizing cognitive & normative processes. This article reviews the literature on comparative state policy research. The author suggests that the field would benefit from not only greater integration with other policy & organizational theory perspectives but also greater integration with qualitative methodologies. 2 Figures, 168 References. Adapted from the source document.

A review essay on a book by Richard Lynn & Tatu Vanhanen, IQ and the Wealth of Nations (Westport, CT: Praeger, 2002). 11 References.

Following the 11 Sept crashing of two airplanes into the World Trade Center (WTC) by terrorists, the US government adopted a large airline subsidy with the apparent goal of preserving essential airline services. However, economic analysis shows that it is unlikely to achieve this goal because it leaves marginal cost & marginal revenue unchanged. Thus, it is unlikely to affect the level of airline service & unlikely to maintain airline employment. In essence there was a large transfer of money to the industry for very little, if any, public benefit. A very generous victim assistance program was also adopted. No rational reason can be found for a program that assists these victims more than those killed or injured in other disasters. 4 References. Adapted from the source document.