Administrative Responsiveness to the Disadvantaged: The Case of Children’s Health Insurance

Issues of administrative responsiveness to the disadvantaged (as distinct from formal policy responsiveness) possess important implications for American democracy. In this regard, the administrative practices that facilitate or impede enrollment, or take-up, in social programs deserve attention. This study focuses on two means-tested programs in the context of American federalism, Medicaid and the State Children’s Health Insurance Program. Based on an in-depth analysis of seventeen states, we develop an index of administrative responsiveness to the disadvantaged related to take-up. We then explore some possible sources of variation in responsiveness rooted in the task environment, political ideology, good government culture and practice, and signals from political principals. Our findings point to the need to refine and expand upon existing explanations of state variation in social programs. Among other things, this study suggests the political importance of international (not interstate) population mobility and gubernatorial leadership (rather than bureaucratic autonomy) in shaping administrative responsiveness to the disadvantaged. It also points to the need for a contingent approach in examining whether the greater presence of racial minorities tends to depress such responsiveness. Students of American politics and pluralism have long emphasized that certain groups face power deficits. As E. E. Schattschneider (1960, 35) observed over four decades ago, ‘‘The flaw in the pluralist heaven is that the heavenly chorus sings with a strong upper-class accent.’’ Analysts note that lower-income citizens often lack the money, time, information, skill, and organizational connections to participate effectively in the political process. Their voting participation rates tend to be lower than those of the more affluent. Moreover, the ‘‘social constructions’’ of disadvantaged citizens are often negative, further vitiating the willingness of politicians to reach out to them (e.g., Schneider and Ingram 1993; Winston We gratefully acknowledge a grant from the Robert Wood Johnson Foundation, which made this research possible. Others also helped. Kristy Ellis and Reneé Sturm of the University at Albany provided important staff support. Courtney Burke, Irene Lurie, Lawrence Mead, Samuel Thompson, and anonymous reviewers provided useful comments on earlier drafts. Neither the foundation nor these individuals necessarily agree with our conclusions. Address correspondence to Frank Thompson at [email protected]. doi:10.1093/jopart/mui056 a The Author 2005. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected]. Journal of Public Administration Research and Theory Advance Access published September 15, 2005