State Implementation of the Children\u27s Health Insurance Program: Analyses of Variation In Policy Adoption

This study of CHIP begins with a discussion of the comprehensive Clinton health plan and the origin of CHIP as a potential legacy of that national dialogue. While the Clinton plan did not achieve passage, its heightening of the issue of uninsurance, particularly in pediatric populations, appears to have set the tone for future reform initiatives. This study examines the complexity, program choice, and legislative and administrative timing associated with CHIP adoption within a framework based on Kingdon\u27s (1995, 92-93) problem, policy, and political streams. Four theoretical perspectives are drawn from the policy streams framework: (1) Agenda Setting; (2) Public Need; (3) Path Dependence; and (4) Socio - Political Effects. In this preliminary research study, the models are illustrative of the intricacy of the policy process. Each of the analytic models developed for the project demonstrates one primary theoretical perspective that best explains that particular component of the policy process. Complexity is most influenced by path dependence, while program choice appears to be best explained by economic growth. Higher numbers of pediatricians, derived from the socio-cultural perspective, appear to be meaningful in explaining lengthier time to approval for both legislative and administrative functions. Additionally, findings in this study suggest the potential importance of incorporating individual state policy contexts into analytic discovery. An analysis of the policy process surrounding CHIP adoption and its influences offers several benefits. First, this research contributes insight into effective health care policy implementation, particularly within the context of state policy devolution. Second, the findings from this study can inform ongoing research in theories of policy process related to the dynamics of agenda setting, the influences of public need, path dependency, and the effects of socio-political determinants. Third, implications for the development of future federal and state initiatives addressing social policy issues can be derived from this study