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Establishing State Health Insurance Exchanges

Anna, Bo, Talib present project proposal HT2012 , Policy Processes, Actors, and Consequences

Anna Ballance

on 18 October 2012

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Transcript of Establishing State Health Insurance Exchanges

Establishing Health Insurance Exchanges THE AFFORDABLE CARE ACT Research Design Consider funding our project in search of underlying assumptions and meaning-creations behind policy outputs in the case of the Affordable Care Act

Give us $ Understanding Micro-processes in the Implementation of the Affordable Care Act A. Ballance
T. Jabbar
B. Nylander 17.6% of US GDP spent on Health Care
21% of US budget spend directly on Health
Spending on Health Care has doubled in the last 10 years Rising Costs Key Dates for Exchanges Deadline:
Submission of plan to HHS Deadline:
Launch of exchange markets November16, 2012 January 2013 January 2014 Deadline:
National Profile Data about each state's exchange Colorado self run exchange Implementation Gap Texas decision not to create state exchange
Probably will have a nationally set up exchange How state-level bureaucrats, the governors, understand their roles as implementers ..... Christine Gregoire
Gov. Washington "Meaning is created, often within discourses that are reigned and reined in by politics and political forces-- power, interests, beliefs--or even cognition and different ways of understanding; different ways of perceiving what a task is, what language is used and therefore conveyed and translated Accessing that information using qualitative methods Cognition of the situation Interpretation of Role or Task Beliefs
Power Overall Disposition Further studies 49.9 million Americans are uninsured
16.3 % of the total population
95 million on Government Health Care Lack of Coverage Benefits of our Study New Perspectives on multi-level policy implementation
Benefit to future implementation research
Helpful to future policy reform federal-state level
Witnesses implementation process (Real Time) Research Question:
How do implementing agents' perceptions and understandings explain variances in states' actions implementing the insurance exchange markets mandated by the ACA? Actors The federal government
The states
Policy implementors What is an Exchange? Questions from class Markets for insurance
Set up by the states
Finished plan by 2013
Individual mandate Hurdles Reinforcement
Lack of public option
Political opposition Remember! Every governor-state case has it's own set of influencing conditions, from our interviews, we try to determine what those are. “The rising cost of health insurance is a significant concern for residents across the state."

“Today my signature on the Health Benefits Exchange bill makes it easier for individuals and small businesses to compare, select, and buy affordable health care coverage. The exchange will help take the guess work out of the health insurance process and will assure that consumers get what they pay for." ! Our Approach "The sub-national or provincial level of government is not subordinate to the national government but has substantial powers of its own which the national government cannot take away" (Buse et. al, 2012) Caduceus v. Asclepius Perfect Implementation implementation input output "perfect implementation" (Hood, 1976)
Performance: Success v. Failure
pessimistic discourse -- "gaps", "deficits" Federalist Context Federalism ACA -- federally-mandated; MLG
"disabled by design" (Ferman, 1990) Synthesis
Top-down -- mandate
Bottom-up -- State-level Bureaucrats (SLBs) NOT impediments Interpretative Approach (Spillane, Yanow, Coburn) Van Meter & Van Horn (1975)
Disposition of Implementors
cognition (comprehension, understanding)
direction (acceptance, neutrality, rejection)
intensity (values, beliefs, power) Discourse Interpretation Framing Structures Meaning
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