Implementation as PolicyA Policy Regime Perspective

Peter J. May

University of Washington

Three Things to Remember

Policy designs do much more than set forth courses of action

Implementation is about much more than putting policies in place

Experiences with policies establish feedback processes that shape policy legitimacy, coherence, and durability

How the Readings Fit In

Policy designs – notions about design and implementation P. May “Policy Design and Implementation”

Policy regimes – expanded notions about implementation and politics P. May & A. Jochim “Policy Regime Perspectives” P. May, “Implementation Failures Revisited”

Policy Feedback D Moynihan and J Soss, “Policy Feedback …” D Moynihan, P Herd, and H Harvey, “Administrative

Burden…”

What is Policy Design?

Consider an Example

American Patient Protection and American Patient Protection and Affordable Care Act of 2010 – Affordable Care Act of 2010 – “Obamacare”“Obamacare”

Main goals are to provide protections and access to health Main goals are to provide protections and access to health care for many who otherwise would not have health carecare for many who otherwise would not have health care

Design elements:Design elements: Insurance based market system for health careInsurance based market system for health care Subsidies for those who cannot afford health insurance, Subsidies for those who cannot afford health insurance,

along with expanded access to low-income carealong with expanded access to low-income care Strong state role (in theory) with health exchangesStrong state role (in theory) with health exchanges Health care mandate – all must participate (with various Health care mandate – all must participate (with various

exceptions) through employers or individual policiesexceptions) through employers or individual policies

What Happened? Contentious politics of enactment carried into Contentious politics of enactment carried into

implementation – Supreme Court cases over implementation – Supreme Court cases over individual mandate and federal exchange individual mandate and federal exchange

Many states chose not to develop state run Many states chose not to develop state run insurance exchanges, and others chose not to insurance exchanges, and others chose not to expand low income health careexpand low income health care

Choices of plans had more limited of options, Choices of plans had more limited of options, with many not able to keep their current with many not able to keep their current insurance (despite promises they could)insurance (despite promises they could)

Major problems with federal and state websites Major problems with federal and state websites for enrollment crashing, wrong information, etc for enrollment crashing, wrong information, etc

Lots of adjustments in deadlines, more Lots of adjustments in deadlines, more exemptions, to address many glitchesexemptions, to address many glitches

Nonetheless, some 7 million plus enrolled by Nonetheless, some 7 million plus enrolled by the original deadline .. Many more since thenthe original deadline .. Many more since then

The Traditional Implementation Perspective

Rush to get this done – “expedited Rush to get this done – “expedited implementation” -- overly ambitious implementation” -- overly ambitious

Under-estimated commitment of intermediaries Under-estimated commitment of intermediaries (particularly states), despite federal incentives (particularly states), despite federal incentives

Confusion among insurance providers (other Confusion among insurance providers (other intermediaries)intermediaries)

Woefully under-estimated technological issues, Woefully under-estimated technological issues, contracting, staffing for websitescontracting, staffing for websites

Lots of confusion over deadlines, processes, Lots of confusion over deadlines, processes, and what could be expectedand what could be expected

In short, “a mess” In short, “a mess”

Potential Design Improvements

Implementation prospects are enhanced by: Provisions that build the capacity of

intermediates to carry out policies Funding, education and training, and technical

assistance

Provisions that build commitment of intermediates to carry out policies

Publicity about policy goals, cost-sharing & other incentives, joint planning for implementation

Provisions that signal and reinforce desired courses of action

Oversight, publicity about successful experiences

Research about Policy Design and Implementation

How does policy design affect implementation? – the preceding and more!

How do designs vary? Why? Understanding components of policy

design – attention to mixes of policy tools

Attention to different types of implementation structures – networks, NGOs, etc.

Toward a Broader Depiction of Implementation – Regime Perspectives

Implementation not simply a technocratic or managerial activity; fundamentally tasks of policy and political problem solving

Given this, need to consider how politics enters more – differing political environments and forces

And, need to consider how actions during implementation reinforce or undermine policy commitments

Policy Regime PerspectivesFocus Attention on:

Ideas – shared commitments (glue of the regime)

Institutional Arrangements – structuring of authority, attention, information and organizational relationships

Interests – constituencies that provide support or opposition (energy behind the regime)

Obamacare in Regime Terms

Considering ImplementationFrom a Regime Perspective

Shifts analytic attention to: Ideational uptake – Are the core ideas

understood and embraced? Interest support – Are the interests

mobilized? Is conflict high? Institutional capacity – Does the

institutional design channel attention and resources towards the purpose of the regime?

For Obamacare

Ideational uptake – Lots of confusion, especially among the public

about what they gain from Obamacare Interest support –

Failed to marshal much support, resistance outweighed support -- insurance and drug companies did not rally support

Institutional capacity – A key source of regime weakness, partly due

to the patchwork design and compromises made to gain enactment

ConsequencesObamacare fell short in political terms as much as in policy terms:

Undermined by a lack of a strong shared purpose among different intermediaries – states, insurance industry, others

No real constituency for “affordable care” – more felt lost out than gained, those who gained had little voice

Institutional mistrust – competence of Obama administration called into question

Sets in Place Negative Feedbacks Negative perceptions outweigh

positive ones (though relatively few want to dismantle it) -- perceptions of burdens rather than benefits

Negative press coverage outweighs positive press coverage

Political benefits for Democrats are limited – unlike other major social welfare reforms

These in Turn Undermine Sense of legitimacy of the policy –

further undermined by court challenges

Coherence of the policy – consistency in delivery

Potential durability of the policy – leading to pressures for reform (and less realistic ones for dismantling it)

Restating What Regime Perspectives Provide

Descriptive lens – conceptual map of forces involved in addressing policy problems – a policy regime

Analytic lens – understanding of feedback processes that shape policy legitimacy, coherence, and durability

Traditional Implementation vs. Regime Perspectives

Future Research Directionsfor Policy Regimes

Emergence – What conditions foster the development of policy regimes?

Strength – What contributes to the strength of regimes?

Durability – What affects the life span of a given regime?

Revisiting Implementation

Traditional implementation perspectives: How policies are carried out Politics as obstacles to effective implementation

Regime perspectives: Politics as central, can be a positive force (e.g.,

mobilization of supportive constituencies) Reinvigorates implementation as evolution of policies

– how efforts to address problems take new forms over time

Explicitly incorporates policy feedback

Reminds us of the role of policies as governing instruments