Detailed Contents

List of Acronyms and Initials xii

List of Web Sites xviii

Preface xxi

1 Health and Health Policy 1

Health Defined 1

Health Policy Defined 6

Forms of Health Policies 9

Categories of Health Policies 21

The Connection Between Health Policy and Health 24

Health Policy in the States 25

The Role and Importance of Policy Competency in the Pursuit of Health 28

Summary 29

Discussion Questions 30

2 Impact of Health Policy 33

Health Policy and Health Determinants 35

Health Policy and Individuals, Organizations, and Interest Groups 54

Summary 70

Discussion Questions 71

3 Context and Process of Health Policymaking 75

The Context of Health Policymaking: The Political Marketplace 76

Demanders and Suppliers of Health Policies 81

Interplay Among Demanders and Suppliers in the Political

Marketplace 95

A Conceptual Model of the Public Policymaking Process 107

Summary 120

Discussion Questions 121

4 Policy Competency 125

Organization Design to Support Policy Competency 128

Analyzing Public Policy Environments 132

Influencing Public Policy Environments 144

The Human Element in Analyzing and Influencing Public Policy Environments 152 iX

Summary 157

Discussion Questions 158

5 Policy Formulation: Agenda Setting 161

Overview of the Policy Formulation Phase 161

Agenda Setting 163

Interest Group Involvement in Agenda Setting 176

The Influential Role of Chief Executives in Agenda Setting 193

The Nature of the Health Policy Agenda 197

Summary 199

Discussion Questions 199

6 Policy Formulation: Development of Legislation 203

The Choreography of Legislation Development 205

Originating and Drafting Legislative Proposals 206

Introducing and Referring Proposed Legislation to Committees 210

House or Senate Floor Action on Proposed Legislation 219

Conference Committee Actions on Proposed Legislation 220

Presidential Action on Proposed Legislation 222

Legislation Development for the Federal Budget 222

Legislation Development for the State Budgets 230

From Formulation to Implementation 235

Summary 236

Discussion Questions 236

7 Policy Implementation: Rulemaking 239

Responsibility for Policy Implementation 242

Rulemaking: The Beginning of Implementation 251

Summary 266

Discussion Questions 267

8 Policy Implementation: Operation 269

The Impact of a Policy's Design or Construction on Its Own

Operation 269

The Impact of Implementing Organizations and Their Managers on Implementation 273

Summary 301

Discussion Questions 301

9 Policy Modification 303

Distinguishing Policy Modification from Policy Initiation 304

Policymaking Is a Cyclical Process 306

Incrementalism in Policymaking 308

The Mechanics of the Modification Phase 310

The Medicare Program: A Long History of Policy Modification in Practice 317

Key Structural Features of Policy Modification 329

Conclusion 350

Summary 350

Discussion Questions 350

Appendix A: Overview of Medicare 355

Appendix B: Overview of Medicaid 367

Appendix C: Briefly Annotated Chronological List of Selected

U.S. Federal Laws Pertaining to Health 379

Index 419

About the Author 439

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