RUNNING HEADER: THE POLICY PROCESS PART I

The Policy Process Part I-Childre!s Health Is"race Pro#ra$ %CHIP&

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La"ra Coolly
1
THE POLICY PROCESS PART I
Policy Process Part I-CHIP
This 0a0er 1ill 2oc"s o the 2irst three 0ortios o2 ho1 the 0rocess ta3es 0lace 1ithi
Childre!s Health Is"race Pro#ra$ %CHIP&- 2or$"latio- le#islati4e- ad i$0le$etatio
sta#e5 The 2irst sta#e o2 the 0olicy 0rocess 6e#is 1ith a o0eratioal set o2 r"les that chec3 each
sta#e ad ste0s to es"re a 0ositi4e o"tco$e5 The Uited States health care syste$ is 2re7"etly
re4ie1ed or $eas"red to s"00ort the 0olicies 2or i$0ro4e$et5 All o2 these 0rocesses ca
theoretically a22ect each cos"$er i a 0ositi4e or e#ati4e 1ay- there2ore- cosideratio shall 6e
ca"tio"sly cosidered5 It is i$0erati4e 2or each o2 these sta#es to 6e s"ccess2"l ad doi# so the
strate#y 0reseted $"st 0ro4ide i$0ortat "derstadi# #etti# 0er$itted5 All o2 these
$eas"res 1ill ca"tio"sly 6e e4al"ated thro"#ho"t the 0olicy 0rocess5 Policies are e4al"ated to
i$0ro4e the health care syste$5
Formulation Stage
5
The Ceters o2 8edicare ad 8edicaid Ser4ices %C8S& esta6lished i /9:+ %CHIP- ,.//-
(a"ary /.&5 The Childre!s Health Is"race Pro#ra$ %CHIP& 6e#a i /99; %CHIP- ,.//-
(a"ary /.&5 The CHIP 0ro#ra$ 6"d#eted thro"#h the <alace <"d#et Act o2 /99; eacted Title
==I o2 the Social Sec"rity Act5 The Clito ad$iistratio 2"ded the health is"race
co4era#e e>0asio 2or ta>0ayers %CHIP- ,.//- (a"ary /.&5 The CHIP 0ro#ra$ is s0osored 6y
Seator Ed1ard 'eedy ad Ori Hatch %CHIP- ,.//- (a"ary /.&5 The state 0ro#ra$ 6illed
a00ro>i$ately ?,. 6illio dollars 2or a 0eriod o2 /. years 2or di22eret states to co4er lo1er
ico$e childre 1ho 1ere ot eli#i6le 2or 8edicaid ad their 2a$ilies co"ld ot a22ord 0ri4ate
is"race %,./.- (a"ary ,,&5 Each state is eli#i6le 2or co$0esatio "der the Title ==I stat"te
to s"6$it 2or a00ro4al 6y the secretary the se7"eces i 1hich that state 1ill "tili@e the 2iaces
ad e>ec"te the re7"ired r"li# ad directi4e "der *,CAR Part *+; %CHIP- ,./*- (a"ary /&5
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THE POLICY PROCESS PART I
The 2irst sta#e i the 0olicy 0rocess starts 1ith the 2or$"latio that 0re0ares the sta#e 6y
ideti2yi# ad "derstadi# the cocer related to CHIP 2or o-co4ered childre ad
2a$ilies5 The 0reset circ"$staces o2 o-co4ered cos"$er de4elo0 a a00roachi#
0redictio 1ith corro6oratio to 0er$it the CHIP 0ro#ra$ to e"$erate the 0ro6le$ 1here
le#islatio occ"rs5 The lo1er ho"se or le#islati4e re4ie1ed the 0roBected 0olicy %or la1& o2 the
CHIP 0ro#ra$5 The CHIP 0ro#ra$ 1as disc"ssed 1ith the a00lica6le #ro"0 2or e#otiatio ad
2or$al decisio $ethods to 0"t ito 0lace 2or the eed o2 the local co$$"ities5 The CHIP
0ro#ra$ 1et thro"#h the 0olicy o2 acco"ta6ilities thro"#h co$$ittees ad s"6co$$ittees5
The heari# ad 2ial ste0s i the 2or$"latio 0hase tras0ire 1he the CHIP 0ro#ra$ 1as
0reseted to the e>ec"ti4e 6rach 1hich 1o"ld 6e the 0residet or #o4eror to e>ec"te ito la15
I2 the CHIP 0ro#ra$ 1as 4eto- it 1o"ld 6e ret"red to the la1$a3ers 2or a $aBority 4ote5 A2ter
the CHIP 0olicy had 0assed- it 1as 2or1arded to the e>ec"ti4e 6rach to start the i$0le$etatio
0hase5 Each state 1as o22ered a o0tio i desi#i# idi4id"al eli#i6ility 0olicies to 2ollo1 the
2ederal #"idelies %CHIP- ,./*- (a"ary /&5 Each state ca s"6$it a a00licatio 2or a 1ai4er
2ro$ C8S to icrease the CHIP 0ro#ra$ i that state 2or $e$6ershi0 #ro1th5 The 2ederal
#o4er$et is res0osi6le to 0ay ;. 0ercet o2 the CHIP 0ro#ra$C the state is res0osi6le 2or
0ayi# the re$aii# D. 0ercet %La$6re1- (5- ,..;- Ae6r"ary /&5 Each state $ay s0ed /.
0ercet o2 their 2"ds 0ro4ided 6y the 2ederal #o4er$et 2or o"treach ad other acti4ities
%La$6re1- ,..;- Ae6r"ary /&5 The social ecoo$ics o2 this 0olicy e>teded co4era#e to lo1er
ico$e 2a$ilies ad their childre- 1ho 0re4io"sly co"ld ot o6tai or 7"ali2y 2or is"race
thro"#h the state 8edicaid 0la5 Passi# this 0olicy assisted childre ad 2a$ilies stadard
health care ser4ices 2or ro"tie $atters thro"#h a 0ri$ary care 0ro4ider istead o2 headi# to the
3
THE POLICY PROCESS PART I
e$er#ecy roo$ 2or $edical eeds5 I$0le$eti# this 0la i di22eret states assisted $"lti0le
2a$ilies ad childre 1ith their health care eeds5
Legislative Stage
The CHIP 0ro#ra$ has 6ee a 3ey co$0oet as $e$6ershi0 coti"es to #ro1 2or childre
ad their 2a$ilies %Health Re2or$- ,./*- (a"ary /&5 Ehe the A22orda6le Healthcare Act
%ACA& etered ito the $ar3et0lace (a"ary /- ,./* o0ei# eroll$et- less tha hal2 o2 the
states e>0aded their $e$6ershi0 %Health Re2or$- ,./*- (a"ary /&5 State le#islat"res re4ie1ed
o4er ,-+.. 6ills related to ACA to deter$ie co4era#e 2or idi4id"als ad 2a$ilies %Health
Re2or$- ,./*- (a"ary /&5 The le#islati4e sta#e coti"es to cosider a de6ate- ar#"e- ad
e>ec"tes the la15 The secod sta#e o2 the CHIP 0rocess started 1ith the o6li#atio o2 a
4ie10oit "$6er- H5R5 re0resets a Ho"se <ill ad S5 re0resets a Seate <ill5 The the CHIP
0ro#ra$ allocated the 0ro0er "$6er- re0resetati4es ad seators that cha$0io the 0ro#ra$
ao"ci# it to the co$$ittee ad s"6co$$ittee %Healthcare re2or$- ,./*- (a"ary /&5 The
le#islati4e sta#e esta6lishes the 4al"e ad si#i2icace o2 the CHIP 0ro#ra$ as it relates to health
care iss"es 2or o-co4ered childre ad 2a$ilies added to the a#eda 2or disc"ssio5 The 0arties
i4ol4ed $"st e>cha#e date ad 6e#i a 2orecasti# sta#e o2 the CHIP 0ro#ra$5 The CHIP
0ro#ra$ $o4ed thro"#h the le#islati4e sta#e 1ith ade7"ate i2or$atio to 0rod"ce attetio 2or
the 0olicy$a3ers to add to the a#eda ad a00ro4e the 0ro#ra$5 The 6ill is added to the a#eda
to 6e deter$ied ad a00ro4ed5 The 0ertiet #ro"0 Seate- state ca6iet associates- ad
Co#ress re4ie1ed ad e>ec"ted 2ro$ the a#eda the CHIP 0ro0osal5 A2ter the cocl"sio o2
the a#eda- 6e#is the 0olicy 2or$"latio5 The e4al"atio 0rocess de2ies the sta#e 1here
deli6eratios- disc"ssios- de6ates- ad B"sti2icatios are co$0leted to s"00ort the e1 CHIP
0olicy5 Le#islatio is a e>tra ste0 to or#ai@e as it relates to the co$$"ity ho1 the CHIP
0olicy 1ill a22ect the local $ar3et5 This sta#e is a 3ey ele$et 1hich 0ro4ides the 0olicy i the
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THE POLICY PROCESS PART I
re4ie1- $eets the criteria ad 0la i$0le$eted5 Clearly ideti2y the scale ad #oals o2 the
CHIP 0olicy thro"#h the 0rocess sta#e 1ill 6e o2 4al"e5 The s"6co$$ittees 1ill hear e4idece
e4al"ate the CHIP 0ro#ra$ ad ho1 it s"00orts the 6ill5 The s"6co$$ittees $ay cha#e the
CHIP 0ro#ra$ holdi# aother sessio 2or ay cha#es ad re0ort cha#es to the co$$ittee
0rior to sedi# the 6ill to the Seate or Ho"se5 The co$$ittee is res0osi6le to re0ort the
CHIP 0ro#ra$ i2 ay 2"rther actio re7"ires attetio5
Implementation Stage
The i$0le$etatio 0rocess is i$0ortat as 0lai#- i4esti#ati#- ad de6ati# re$ai
cosidered 6e2ore the CHIP 0ro#ra$ 1as i$0le$eted5 The third sta#e assesses the CHIP
0ro#ra$ 2or the i$0le$etatio 0hase5 This sta#e de0eds o three ele$ets5 Airst- the
0residet or local #o4er$et state o22icials recei4ed the CHIP 0olicy to deter$ie the
acce0tace5 The a#ecy has the ca0a6ilities to hadle s0eci2ic 0olicy s"ch as CHIP5 Secodly-
le#islatio recei4ed the 2la1less co0y o2 the CHIP 0ro#ra$ i$0le$eted5 The #o4eri# 6ech
held le#islators res0osi6le 2or clear ad 0recise $eas o2 the CHIP 0olicy 6ei# 0reseted5 I2
the 6ech does ot 2eel- the i2or$atio is a00ro0riate they co"ld ha4e cacelled the
i$0le$etatio 0olicy 2or CHIP5 Aially- the reso"rces to achie4e the CHIP 0ro#ra$ $"st ot
ca"se disr"0tio o2 0roced"res to achie4e the 2ial 0rocess 6et1ee the or#ai@atios5 The
details o the ti$elie o2 the CHIP 0ro#ra$ ad res0osi6ility o2 the state #eerated thro"#h
e4idece ad e22ecti4eess5 This ste0 is cr"cial as the #o4er$et 2"ds the CHIP 0ro#ra$ ad
s0eds i$$ese a$o"ts o2 $oey to s"ccess2"lly i$0le$et the 0ro#ra$ to 6e s"ccess2"l5
5
THE POLICY PROCESS PART I
Conclusion
The CHIP 0ro#ra$ 1et ito e22ecti4e i /99;- 0ro4idi# co4era#e to "is"red childre
ad their 2a$ilies %CHIP- ,.//- (a"ary /.&5 The #o4er$et dis0layed ho1 0assi# the CHIP
0ro#ra$ thro"#h the 0olicy 0rocess ste0s ta3es 0lace5 Each sta#e is i$0ortat to 2ollo1 the
0rocesses to es"re i$0ro4e$ets are s"ccess2"l as sho1 1ith the CHIP 0ro#ra$5 The
2or$"latio sta#e 0re0ares ad deli4ers the 6ac3#ro"d o2 the CHIP 0ro#ra$ 0reseted to the
0olicy$a3ers to deter$ie i2 the 0olicy 1ill coti"e thro"#h the 0rocess5 The co$$"ity
a22ected co"ld ot a22ord health care is"race "til the CHIP 0ro#ra$ 1as i$0le$eted ad
0ro4ided assistace5 This sta#e 0ro4ides s"22iciet research o the CHIP 0ro#ra$ thro"#h the
0olicy 0rocess5 The secod sta#e le#islati4e 0rocess 0re0ares the 0olicy "$6er to 6e directed
thro"#h a 0rotocol o2 co$$ittees ad s"6co$$ittees to #et the CHIP 0ro#ra$ added to the
a#eda 2or cosideratio5 The le#islatio sta#es 6ro"#ht the Ho"se ad Seate to#ether to
coti"e 1ith the CHIP 0olicy thro"#h the 0rocess sta#es5 The CHIP 0ro#ra$ 1as itrod"ced to
assist o4er1hel$i# icreases o2 "is"red childre ad 2a$ilies 1ho did ot 7"ali2y 2or
8edicaid5 The last sta#e 1hich is the i$0le$etatio 0rocess re7"ired the 0residet ad state
local #o4er$et o22icials to 0ass the CIP 0ro#ra$5 The le#islatio recei4ed a clear 0olicy to
0reset ad 0ass ito la1 the CHIP 0ro#ra$5 The 6ech co"ld ha4e cha#ed the i$0le$etatio
0olicy i ot a#reea6le or acce0ta6le5 The 2ial 0rocess o2 i$0le$etatio achie4ed the clos"re
2or the CHIP 0ro#ra$5
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THE POLICY PROCESS PART I
References
ChildreFs Health Is"race Pro#ra$ %CHIP&5 %,.//- (a"ary /.&5 Retrie4ed- 2ro$
htt0:))1115$edicaid5#o4)8edicaid-CHIP-Pro#ra$-I2or$atio)<y-To0ics)Childres-Health-
Is"race-Pro#ra$-CHIP)Childres-Health-Is"race-Pro#ra$-CHIP5ht$l
ChildreFs Health Is"race Pro#ra$ %CHIP&5 %,./.- (a"ary ,,&5 Retrie4ed- 2ro$
htt0:))1115csl5or#)research)health)childres-health-is"race-0ro#ra$-o4er4ie15as0>
8oroe- (5A5 %,..G&5 8orals ad health 0olicy5 I (5A5 8oroe- T5 (5 Lit$a H L5S5
Ro6is %Eds&- Health politics and policy %005 *9-:.&5 Cli2to Par3- N(: Del$ar Ce#a#e
Leari#5
ChildreFs Health Is"race Pro#ra$ %CHIP&5 %,./*- (a"ary /&5 Retrie4ed (a"ary /-
,./*- 2ro$ htt0:))1115csl5or#)research)health)$edicaid-ad-chi05as0>0>
Health Re2or$: ,.//-,./D State Le#islati4e Trac3i# Data6ase5 %,./*- (a"ary /&5
Retrie4ed (a"ary /- ,./*- 2ro$ htt0:))1115csl5or#)research)health)health-re2or$-data6ase-
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Rice- L5 L5 %,./.&5 State$ets o2 Po1er: Presidetial Use o2 State$ets o2
Ad$iistratio Policy ad Si#i# State$ets i the Le#islati4e Process5 Presidential Studies
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'reidler- 85 L5 %,./*&5 Health Care Policy H Politics5 Health Care Policy & Politics --
Research Starters Business- /-:5
7
THE POLICY PROCESS PART I
La$6re1- (5 %,..;- Ae6r"ary /&5 The State ChildreFs Health Is"race Pro#ra$: Past-
Preset- ad A"t"re5 5 Retrie4ed - 2ro$ htt0:))1115co$$o1ealth2"d5or#)0"6licatios)2"d-
re0orts),..;)2e6)the-state-childres-health-is"race-0ro#ra$--0ast--0reset--ad-2"t"re
8