Policy Alternatives, Budget & Causes

• Alternatives are different policy options considered to address a problem.
• Policymakers assess alternatives based on feasibility, effectiveness, and political support.
• The range of alternatives is shaped by experts, interest groups, and political institutions.
• The U.S. debates how to address rising prescription drug costs, and alternatives include allowing Medicare to negotiate prices, implementing price caps, or increasing transparency in pharmaceutical pricing.

Budgetary Conditions

• Budgetary conditions are the financial constraints and priorities that influence policymaking.
• A strong budget can support new initiatives, while deficits may limit policy options.
• Budget considerations often determine whether an issue is addressed or ignored.
• The Biden administration’s push for expanded child tax credits was limited by budgetary conditions, as lawmakers weighed the impact on the federal deficit.

Causes

• Causes are explanations for why a problem exists.
• How a problem’s cause is defined shapes the policy solutions proposed.
• Framing obesity as an issue of personal responsibility versus food industry regulation leads to different policies.
• Policymakers debate the causes of gun violence – whether it stems from mental health issues, access to firearms, or socio-economic conditions.
• The causes identified influences policy solutions, for example, mental health funding versus stricter gun laws.

Categories

• Categories describe the way issues are grouped influencing how they are understood and addressed.
• Policymakers may categorize problems based on urgency, affected populations, or policy domains (e.g., “economic issues,” “healthcare crises”).
• Categories shape funding decisions and policy frameworks.
• During COVID-19 relief efforts, Congress categorized essential workers differently across industries, determining eligibility for hazard pay and vaccine priority.

Civil Servants

• Civil servants, also called career civil servants and public servants, are government employees who implement policy and provide continuity in governance.
• Unlike political appointees, they typically remain in their positions across different administrations.
• Examples include agency staff, policy analysts, and regulatory officials.
• CDC’s career scientists played a key role in developing COVID-19 guidelines, regardless of the administration in power.

Congress

• Congress is the bicameral body (House of Representatives & Senate) responsible for making federal laws.
• It plays a key role in agenda-setting, policy formulation, and budget allocation.
• Congress influences policy through legislation, oversight, and hearings.
• Congress passed the Inflation Reduction Act, which included climate policy measures and prescription drug price reforms.

Comparisons

• Comparisons involve the use of analogous situations or case studies to evaluate policy options.
• Policymakers compare different countries, historical precedents, or state-level policies to inform decisions.
• Healthcare models across nations are compared to propose U.S. reforms when debating a public option during the Affordable Care Act discussions.

Conditions

• Conditions are situations that exist in society but are not yet framed as problems needing policy action.
• Problems arise when conditions are recognized as solvable and politically relevant.
• Climate change was long seen as a condition before it became a policy problem.
• The high cost of insulin existed for years as a condition but became a policy problem when public outcry and legislative efforts framed it as an issue that required government intervention.

Counting

• Counting describes the use of data to quantify issues and justify policy decisions.
• Counting can highlight trends, demonstrate urgency, or define eligibility for programs.
• The number of uninsured individuals influences healthcare policy debates.
• Census data showed an increase in uninsured Americans, prompting calls for healthcare reform.

Crises

• Crises are sudden, urgent events that demand immediate policy responses.
• Crises can push issues onto the policy agenda that were previously ignored.
• The COVID-19 pandemic led to emergency healthcare policies and economic relief measures.
• The 2008 financial crisis led to the creation of the Dodd-Frank Act, aimed at increasing financial regulation to prevent future economic collapses.

Decision Agenda

• Decision agenda refers to a subset of the policy agenda where an issue rises to the level of active decision-making (e.g., legislation, executive action).
• Issues reach the decision agenda through political pressure, public demand, or focusing events.
• A proposed gun control bill reaching a vote in Congress is an example.
• After the overturning of Roe v. Wade, some states placed abortion rights on their decision agendas, leading to state-level legislation expanding or restricting access.

Decision Memo

• Decision memo defines a document that outlines a policy problem, presents options, and recommends a course of action.
• Decision memos are used within government agencies and organizations to guide decision-makers.
• They typically include background information, costs, risks, and expected outcomes.
• A White House memo to the President outlined policy options on student loan forgiveness, detailing legal risks, political implications, and potential economic effects.

Feedback

• Feedback is information gathered from past policy implementation that influences future decisions.
• Feedback can come from evaluations, audits, public reactions, or unintended consequences of policies.
• Feedback from patients on Medicaid expansion informs future healthcare reforms.
• Data for Medicaid expansion in early-adopting states showed improved health outcomes and lower uninsured rates, influencing other states to expand their programs.

Focusing Events

• Focusing events describes major occurrences that draw public and political attention to an issue.
• These can be natural disasters, economic downturns, scandals, or acts of terrorism.
• School shootings increase momentum for gun control debates. The Sandy Hook shooting acted as a focusing event, intensifying the push for gun control legislation.

Framing

• Framing is the way an issue is presented to shape perceptions and influence policy responses.
• Framing can emphasize urgency, blame, or solutions.
• Examples of framing include presenting homelessness as a public safety issue versus a housing affordability issue, which leads to different policy responses.
• Climate change can be framed differently by different groups: some present it as a national security threat, others as an economic opportunity, and some as a scientific issue requiring urgent intervention.

Ideas and Interests

• Policy choices result from the interaction of ideas (beliefs, ideologies), interests (stakeholders, lobbying groups), and institutions (government structures, rules).
• The Affordable Care Act reflected a mix of progressive ideas (universal coverage), interest group influence (insurance industry compromises), and institutional constraints (Congressional negotiations).

Indicators

• Indicators are data used to measure problems and track trends.
• Routine indicators include ongoing data collection on mortality or causes of death, total health expenditures, and rates of obesity
• Non-routine indicators include “one-off” numbers that draw attention to problems, such as think tank reports, academic studies, specific events or disasters, and shocking studies on opioid deaths.
• Policymakers use indicators to assess policy needs and effectiveness.

Interest Groups

• Interest groups are organizations that advocate for specific policy positions.
• They can include business associations, unions, advocacy groups, and think tanks.
• Influence policymaking through lobbying, funding campaigns, and public awareness campaigns.
• The NRA lobbies against firearm regulations, while Planned Parenthood advocates for reproductive rights.

Non-Problems

• Non-problems are issues that are not recognized as problems by policymakers or the public.
• They can be ignored due to lack of political will, perceived insignificance, or competing priorities.
• Some issues may be deliberately FRAMED as non-problems to avoid policy action.
• Physician Burnout is often viewed as an individual or workplace issue rather than a systemic policy problem requiring federal intervention.

Norms and Baselines, Cut Points

• Norms and Baselines are Standards or expectations used to evaluate policies or problems, they Establish what is considered “normal” and influence whether something is seen as needing change.
• The Federal Poverty Level (FPL) is a baseline used to determine Medicaid eligibility.
• Cut Points: Decision thresholds that determine when an issue moves from being acceptable to requiring action.
• A policy debate might focus on cut points, like whether to expand eligibility from 138% of FPL to 200%.

Numbers

• Numbers refers to quantitative data used in policymaking to define problems, justify actions, or shape public perception.
• Numbers can be manipulated to support particular policy positions, such as emphasizing large figures to create urgency.
• Policymakers use numbers to frame issues as more or less significant.
• Uninsured rates, such as the fact that 30 million Americans lack health insurance, can be used to argue for policy changes like expanding the ACA or implementing a public option.

Omission

• Omission is the act of leaving something out of policy discussions, analysis, or decisions.
• Omission can be intentional (to downplay an issue) or unintentional (due to lack of information or oversight).
• Omission plays a role in problem definition – what is left out can be just as influential as what is needed.
• Mental Health Parity. Critics argue that the omission of stronger mental health funding leaves gaps in care, even though the ACA expanded healthcare access.

Orphan Drug Act

• The Orphan Drug Act is a 1983 U.S. law designed to encourage pharmaceutical companies to develop treatments for rare diseases.
• Provides incentives like tax credits, grants, and exclusive marketing rights for orphan drugs.
• The act shows how policy can be crafted to address issues that might otherwise be ignored due to market failures.
• The Orphan Drug Act led to the development of drugs for diseases like cystic fibrosis, which would otherwise be unprofitable to research.

Participants

• Participants are individuals or groups involved in policymaking, for example, elected officials, bureaucrats, interest groups, and the media.
• Participant resources are assets that influence policy influence, such as expertise, funding, political connections, and credibility
• The AMA has significant participant resources (money, lobbying power) to influence healthcare legislation, whereas smaller patient advocacy groups may struggle to gain attention.

Policy

• Policy includes a consciously chosen course of action or inaction, a general purpose/desired state of affairs, and a chosen course of action or statement of intent.
• Policy can be formal (laws, regulations) or informal (guidelines, recommendations).
• Medicare-for-All would be a policy decision to provide universal health insurance, while choosing not to expand Medicaid is also a policy decision.

Policy Agenda

• Policy agenda is the set of issues that receive serious attention from policymakers at a given time.
• It's influenced by political climate, public opinion, media coverage, and policy entrepreneurs.
• Gun control may be on the policy agenda after a mass shooting, but whether it moves forward depends on political will.

Politics

• Politics are the process of negotiation, conflict, and power struggles that determine policy decisions.
• Politics encompasses elections, interest groups, lobbying, and public debates.
• Democrats had to negotiate with centrist senators to pass the Inflation Reduction Act (2022), demonstrating political strategy.

Policy Analysis

• Policy analysis is the systematic study of policy problems and solutions.
• It involves evaluating the effectiveness, efficiency, and equity of policy options.
• Before banning menthol cigarettes, policymakers might commission a policy analysis on its impact on public health and racial disparities.

Policy Analyst

• Policy analysts is a professional who conducts policy analysis to advise governments, organizations, or interest groups.
• They use data, research, and evaluation methods to inform decision-making.
• A policy analyst at the Congressional Budget Office (CBO) might evaluate the cost of expanding Medicare before Congress votes.

Policy Memo

• Policy memo is a concise, structured document that presents policy recommendations.
• It's typically addressed to decision-makers and includes problem identification, background, policy options, and a recommended course of action.
• An example is when a White House staffer writes a policy memo outlining the benefits and risks of student loan forgiveness.

Policy Entrepreneur

• Policy entrepreneur defines an individual who actively promotes policy change by leveraging resources, networks, and political windows of opportunity.
• Policy entrepreneurs can be politicians, advocates, business leaders, or bureaucrats.
• Bernie Sanders has acted as a policy entrepreneur for Medicare-for-All, pushing the idea into mainstream debate

Political Institutions

• Political institutions are structures of government that shape policymaking, for example, Congress, the Presidency, and courts.
• They influence how decisions are made and how power is distributed.
• The Supreme Court as a political institution shaped abortion policy with Dobbs V Jackson, overturning Roe v Wade

Political Appointees

• Political appointees are individuals appointed by elected officials (e.g., the President) to executive branch positions
• They often lead federal agencies and help implement the administration’s policy agenda.
• Dr. Rochelle Walensky was appointed by Biden as CDC Director, influencing public health policy during COVID-19

Public Policy

• Public policy describes "Authoritative decisions made in the legislative, executive or judicial branches of government that are intended to direct or influence the actions, behaviors, and decisions of others"
• Public policy can also be seen as "A course of action adopted and pursued by a government, party, statesman or other individual or organization”
• Example: the Affordable Care Act is a public policy that expands access to health insurance

Public Opinion/Political Culture

• Public opinion refers to the collective attitudes and beliefs of citizens about policy issues; it's short-term and issue-specific.
• Public opinion shifted in favor of abortion rights after the Dobbs decision overturned Roe v. Wade
• Political culture refers to the broader set of values, norms, and expectations that shape political behavior and institutions; it's broad and deeply rooted.
• The U.S. has a strong political culture of individualist and limited government intervention.

Problems

• Problems are conditions that are seen as solvable, and not all problems are recognized or acted upon.
• Something must be FRAMED as solvable to gain policy attention; not all conditions are seen as problems.
• Some issues remain unaddressed due to competing priorities, political opposition, or lack of resources
• High prescription drugs costs are framed and now recognized as a problem, prompting calls for price caps

Problem Definition

• Problem definition is the process of identifying, framing, and justifying an issue as a problem requiring policy action.
• The way a problem is defined can determine which solutions are considered viable.
• Examples of problem definition are issues like understanding whether homelessness is a housing affordability problem or a mental health crisis; the framing influences policy solutions.

Simplification

• Simplification is reducing complex policy issues to understandable terms for decision-makers and the public
• Although effective, simplification Can be useful but may also distort reality by ignoring nuances.
• Medicare for all = health as a human right simplifies a complex policy into an accessible message.

Specialists

• Specialists are experts in specific policy areas (e.g., healthcare, education, economics) who provide data-driven insights.
• They are often found in think tanks, academia, government agencies, or advocacy organizations.
• Dr. Fauci was a key specialist in COVID-19 response

Status Quo

• Status quo describes the default position in policymaking and choosing not to act is itself a policy decision
• Governments may resist change due to institutional inertia, political risk, or lack of urgency.
• The filibuster in the Senate often maintains the status quo by blocking major reforms.

Symbols

• Symbols are words, images, or events that convey deeper political meaning.
• Symbols are Used to mobilize support, frame policy issues, or shape public perception, for example, the “War on Drugs” and the “climate crisis”.
• “Death panels” was a symbolic (and misleading) phrase used to oppose the ACA.

The Administration

• The Administration refers to the executive branch under a specific President or Governor.
• It includes political appointees, agencies, and executive orders that drive policy direction.
• “The Biden Administration” refers to all executive branch officials under Biden.

The President

• The President holds the highest executive authority in the U.S., with significant influence over the policy agenda
• They use executive orders, veto power, public speeches, and appointments to shape policy.
• President Obama prioritized healthcare reform, leading to the passage of the ACA