Administrative Policy Changes Research Articles

The Transaction Costs of the Administrative Presidency: Evidence From a Trump-Era Clean Water Act Enforcement Reduction

Over the last two decades, political polarization has gridlocked federal congressional capacity to meet environmental regulatory demands. As a result, presidential authority has expanded to overcome this legislative impediment leading to a new era of “administrative presidency.” In this new era, presidents have increasingly used their administrative authority to meet politically driven environmental goals. Yet, we still know little about how federal-level executive political actions impact the outcomes and operations of local regulatory environmental systems. This study fills this scholarly void by empirically testing the effect of a federal COVID-19 Clean Water Act (CWA) enforcement reduction on Safe Drinking Water Act (SDWA) implementation outcomes for local community water systems (CWSs) sourcing from surface waters (SWs). Using a framework grounded in transaction cost federalism, we argue that a politically motivated executive reduction in federal CWA enforcement is associated with poor local SDWA implementation outcomes. We test this assumption with a differences-in-differences econometric approach using data drawn from the federal Safe Drinking Water Information System database. Our findings suggest that the CWA enforcement reduction resulted in an over 50% increase in SDWA health violations by CWSs sourcing from SWs. The implications of this study extend to U.S. water policy and environmental federalism, highlighting the need for better coordination between the CWA and SDWA and the potential risks associated with relying on broadened executive actions to drive U.S. environmental policy. Further research is warranted to understand the consequences of administrative policy changes on U.S. environmental governance.

Simplification of Supplemental Nutrition Assistance Program Recertification Processes and Association With Uninterrupted Access to Benefits Among Participants With Young Children

In the Supplemental Nutrition Assistance Program (SNAP), families may temporarily lose benefits for which they are still eligible because of administrative issues. This lapse in benefits, referred to as churning, increases the risk of food insecurity for families, which is linked with poorer health. To examine the rate of churning among SNAP participants with young children and evaluate the association of administrative policy changes with churning risk. A cross-sectional study of recertifications among 9735 SNAP-participating households with at least 1 child younger than 6 years from May to November 2019 tested whether there were sociodemographic differences in churning risk. An interrupted time series analysis of recertifications among 70 799 households from January 1, 2014, to December 31, 2019, tested whether state-level administrative policy changes were associated with churning risk. Data were analyzed between February and November 2021. Three Massachusetts SNAP administrative policy changes. Churn episodes, defined as losing SNAP benefits after a deadline for eligibility recertification followed by receiving benefits again within 30 days, measured using state SNAP administrative data. In 2019, a total of 9752 recertification events occurred among 9735 households (3841 [39.4%] Hispanic, 2138 [21.9%] non-Hispanic Black, and 3533 [36.2%] White) with at least 1 child younger than 6 years participating in SNAP. Of these households, 3984 (40.9%) experienced SNAP churning for a period of 1 to 30 days because of missed recertification forms in any given month. Churning was more common among Hispanic households (by 3.9 percentage points; 95% CI, 1.2-6.6 percentage points) than non-Hispanic White households and more common among households with more than 1 child younger than 6 years (by 5.6 percentage points; 95% CI, 3.0-8.1 percentage points) compared with smaller households. Among households that churned, non-Hispanic White households lost a mean of $10.51 (95% CI, $10.16-$10.86) in benefits per household member, and non-Hispanic Black households lost an additional $1.10 (95% CI, $0.47-$1.74) per household member. On implementation of a task-based, first-available-caseworker model, mean churn episode length was significantly shorter immediately on introduction of the model (-0.30 days per each month after the policy change; 95% CI, -0.52 to -0.07 days) and over time (-0.23 days per each month after the policy change; 95% CI, -0.26 to -0.20 days). At the addition of a second policy change to expand participants' access to simplified reporting requirements, a decrease was seen in the trend in the probability of a churn episode by -0.74 percentage points per month (95% CI, -0.87 to -0.62 percentage points). A third policy to expand online services for submitting recertification paperwork was not associated with a change in churn risk over time. Churning in SNAP is common among households with young children and is disproportionately experienced by Black and Hispanic households and lower-income households. Administrative changes to simplify caseworkers' workloads and streamline eligibility reporting for participants may reduce churn.

Colonoscopy Following COVID-19 Delays in Procedures: Risk Stratification for Procedures Is Critical.

Colonoscopy Following COVID-19 Delays in Procedures: Risk Stratification for Procedures Is Critical.

Impact of COVID-19 Pandemic on Cancer Surgical Services-AIIMS, New Delhi Experience.

COVID pandemic has impacted cancer care delivery and cancer surgical services globally. There is an urgent need to study the extent of the impact of COVID on cancer surgery and individual institutional response and strategies adopted to counter the adverse impact. A review of administrative and clinical policy changes adopted at the tertiary cancer center to combat COVID pandemic and resume cancer surgical services were performed. A retrospective comparative analysis of cancer out-patient census during COVID pandemic affected year and the preceding normal year along with cancer surgery data audit for the same periods was performed to assess the impact of the pandemic on cancer surgery. In addition, COVID infection rates among cancer surgery patients and healthcare workers were evaluated. There was approximately a 50% reduction in cancer outpatient registrations during COVID pandemic affected year. A trend of increasing footfalls was noted with decreasing COVID intensity and opening of lockdowns. There was a 33% reduction in major elective surgery and a 41% reduction in emergency surgery performed during the COVID period. As far as cancer surgeries are concerned, there was a 12–50% reduction in volumes involving different subsites. Overall COVID positivity rates among cancer surgery patients was low (8.17%), and approximately 30% of healthcare workers involved in cancer surgery were tested positive for COVID during the study period. Results of the current study indicate a significant impact of COVID pandemic on cancer surgical services. There was a significant impact on outpatient visits and cancer surgery volumes. However, a multidisciplinary-coordinated team approach, effective administrative and policy implementation, adoption of revised surgical safety and anesthesia protocols, COVID screening, and testing protocols facilitated resumption of cancer surgical services without adverse impact on surgical outcomes.

Emergency intubation practices in a tertiary teaching hospital in Jakarta, Indonesia: A prospective observational study.

Intubation is an important competency for emergency doctors. Emergency patients are often unstable, with undifferentiated conditions. There is little time to prepare these patients prior to intubation and so ED intubation may differ from intubation in intensive care units and operating theatres. The present study aims to describe the characteristics of emergency intubation after an administrative policy change within a tertiary teaching hospital in Jakarta, allowing non-anaesthetists to perform intubation in the ED. Prospective data were collected regarding patients of all age groups who were intubated at the ED of Cipto Mangunkusumo General Hospital, Jakarta, from February 2018 to January 2019. Patient characteristics, intubation attempts, medications used, complications, and disposition were recorded in a self-reported airway registry based on the Australian and New Zealand Emergency Department Airway Registry (ANZEDAR) form. During the 12-month study period, 231 patients, or 41.5% of ED intubated patients were enrolled in the study, and there were 268 intubation attempts on these enrolled patients. The first-pass success rate was 207 out of 231 patients, or 89.6%, with anaesthetist (88.9%), better than emergency doctors (55.4%). Complications were reported in 51 patients, or 22.0%, with desaturation and hypotension being the most common. Thirty-three patients, or 14.3%, died in the ED before being transferred to another unit. The first-pass success rate is comparable with international data. Non-anaesthetic physicians must improve their experience to achieve a favourable success rate. The data on complications highlight the need for improvement in Indonesian ED intubation practices.

The Trump Administration's Policy Changes on China and Their Destructive Ramifications for US-China Relations

The Trump Administration's Policy Changes on China and Their Destructive Ramifications for US-China Relations

Identifying spatial heterogeneity in vaccination coverage in Michigan from 2008–2018: Evaluating the impact of a 2015 policy change on measles risk

Background: In 2000, endemic measles was declared eliminated in the US. However, a proliferation of anti-vaccination sentiment over the last decade has led to measles’ re-emergence, with 2019 experiencing the most measles cases in the US since 1992. Rising rates of non-medical exemptions (NMEs) and low vaccination coverage in the state of Michigan prompted an administrative vaccine policy change in 2015, mandating that parents attend an in-person vaccine education session prior to obtaining a non-medical exemption waiver. Despite the enactment of this policy, Michigan experienced a large measles outbreak in 2019. Methods and materials: This study used school-level data from the Michigan Department of Health and Human Services from 2008–2018. School addresses were geocoded in ARCGIS and up-to-date vaccination and NME waiver rates were aggregated at the school district, county, and state level for kindergarten and seventh grade, when mandatory vaccinations are assessed. Spatial lag regression models were used to assess risk factors while accounting for spatial autocorrelation. Results: The statewide vaccine waiver rate increased from 2008–2014, reaching a high of 5.84%, which fell to 3.58% in 2015 after the enactment of Michigan's new policy. However, since 2015, waiver rates have again been steadily increasing, reaching 4.54% in 2018. Up-to-date vaccination rates among kindergarteners were consistently below herd immunity thresholds from 2009–2018. There was significant geographic heterogeneity at the county level, where NME rates reached a high of 19.5% in 2013, corresponding to county-level vaccination coverage of 76%. While overall NME rates decreased in 2015 after the policy change, this change was heterogeneous across the state, with persistent county-level clusters of high exemption rates remaining. Conclusion: Despite Michigan's 2015 policy change, from 2008-2018, waiver rates remained high enough to allow measles to circulate and cause outbreaks. State-wide average estimates showed a reduction in waiver rates after this policy change, yet finer-scale data at the county- and school-level show wide variability obscured by this aggregation. Recent research has shown the potential for such pockets of low vaccination coverage to contribute to disease outbreaks, and thus these clusters present a risk of continued disease transmission and future outbreaks in Michigan.

Stepping Out of Bounds: The Over-Prosecution of Recreational Athletes in Light of DFSNZ v XYZ

DFSNZ v XYZ presents a worrying precedent for anti-doping law. That case arose after New Zealand's anti-doping enforcement body, Drug Free Sport New Zealand (DFSNZ), expanded its jurisdiction over recreational athletes. It did so by internal administrative decision and without notice. This action was upheld in DFSNZ v XYZ by a majority of the Sports Tribunal resulting in an unsuspecting recreational golfer being banned for one year. The decision upheld DFSNZ's extension of onerous obligations and invasive testing powers designed for elite athletes to the large proportion of ordinary New Zealanders who partake in recreational sport. This article critiques the XYZ decision on two bases: (a) DFSNZ's illegitimate expansion of its jurisdiction to recreational athletes by mere administrative policy change; and (b) the pitfalls of extending a regime designed for elite athletes to recreational athletes. The World Anti-Doping Agency (WADA) has developed a new World Anti-Doping Code which will come into force in January 2021. The 2021 Code creates a new two-tiered system which treats "athletes" and "recreational athletes" differently. This article analyses the new Code and critiques its shortcomings with regards to defining the Code's jurisdiction and ensuring a proportionate response to doping in recreational sport. WADA's new code is a step in the right direction but fails to go far enough to align with the participation, health and education objectives of recreational sport.

Stepping Out of Bounds: The Over-Prosecution of Recreational Athletes in the Light of DFSNZ v XYZ

DFSNZ v XYZ presents a worrying precedent for anti-doping law. That case arose after New Zealand's anti-doping enforcement body, Drug Free Sport New Zealand (DFSNZ), expanded its jurisdiction over athletes. It did so by internal administrative decision and without notice. This action was upheld in DFSNZ v XYZ by a majority of the Sports Tribunal resulting in an unsuspecting golfer being banned for one year. The decision upheld DFSNZ's extension of onerous obligations and invasive testing powers designed for elite to the large proportion of ordinary New Zealanders who partake in sport. This article critiques the XYZ decision on two bases: (a) DFSNZ's illegitimate expansion of its jurisdiction to by mere administrative policy change; and (b) the pitfalls of extending a regime designed for elite to athletes. The World Anti-Doping Agency (WADA) has developed a new World Anti- Doping Code which will come into force in January 2021. The 2021 Code creates a new two-tiered system which treats and recreational athletes differently. This article analyses the new Code and critiques its shortcomings with regards to defining the Code's jurisdiction and ensuring a proportionate response to doping in sport. WADA's new Code is a step in the right direction but fails to go far enough to align with the participation, health and education objectives of sport.

The Tethered President: Consistency and Contingency in Administrative Law

The law governing administrative agency policy change and checking unjustified inconsistency is rooted in a web of intertwined doctrine. The Supreme Court’s 2016 opinion in Encino Motorcars modestly recast that doctrine to emphasize that the agency pursuing a change cannot leave “unexplained inconsistency” or neglect to address past relevant “underlying facts,” but reaffirmed its central stable precepts. Nonetheless, radically different views about broad, unaccountable, and rapid agency power to make policy changes have been articulated by current Supreme Court Justice Neil Gorsuch, when on the appellate bench, and agencies pursuing deregulatory policy shifts under the leadership of President Donald J. Trump. This article analyzes the mutually reinforcing strands of this body of law, shows the errors underpinning these policy change power claims, and explains how the “contingencies” underlying an initial policy action must always be engaged by a later advocate of policy change. Statutory language constrains while usually leaving room for change, but facts and past agency reasoning unavoidably must be engaged to surmount the sturdy core requirements of consistency doctrine. Recent efforts to overcome or recast consistency doctrine seek greater room for politics and presidential influence and downplay agency obligations to provide rational explanation and engage with regulatory contingencies. Due to the balanced interests protected by consistency doctrine, this article argues that such a doctrinal reworking is unlikely and would be unwise.

BLM, the Administrative Presidency, and Policy Shifts: Policy Tools Affecting Oil and Gas Operations

AbstractThis paper addresses change in oil and gas policies pushed by the U.S. Bureau of Land Management (BLM) during the administrations of Presidents George W. Bush and Barack Obama. Administrative policy changes occurred not only because of election outcomes and the emergence of new governing coalitions but BLM's selective utilization of policy tools such as rulemaking, planning, environmental impact analyses, and the use of discretionary authority to increase or relax enforcement decisions. The data reveal that BLM put more emphasis on the use of discretionary authority to limit environmental inspections and to limit environmental reviews of proposed drilling projects under Bush while agency officials gave priority to adopting new planning procedures to allow greater stakeholder input under Obama as well as increasing the number of environmental inspections.

Putin’s Russia: The State-Building Strategy

Today state-building processes go on in many parts of the world. In this article I look at Russia’s political development through the prism of state-building, with a focus on Putin’s state-building strategy and the factors that have made its realization possible. I argue that throughout the duration of his reign Putin distinguished himself as a vigorous and effective state-builder with a clearly defined state-building strategy. The paper examines his three-staged strategy: the weakening of Yeltsin’s “ruling coalition” and the accumulation of resources; administrative reforms and policy changes; nation-building.

Quasi-experiments to establish causal effects of HIV care and treatment and to improve the cascade of care.

Purpose of reviewRandomized, population-representative trials of clinical interventions are rare. Quasi-experiments have been used successfully to generate causal evidence on the cascade of HIV care in a broad range of real-world settings.Recent findingsQuasi-experiments exploit exogenous, or quasi-random, variation occurring naturally in the world or because of an administrative rule or policy change to estimate causal effects. Well designed quasi-experiments have greater internal validity than typical observational research designs. At the same time, quasi-experiments may also have potential for greater external validity than experiments and can be implemented when randomized clinical trials are infeasible or unethical. Quasi-experimental studies have established the causal effects of HIV testing and initiation of antiretroviral therapy on health, economic outcomes and sexual behaviors, as well as indirect effects on other community members. Recent quasi-experiments have evaluated specific interventions to improve patient performance in the cascade of care, providing causal evidence to optimize clinical management of HIV.SummaryQuasi-experiments have generated important data on the real-world impacts of HIV testing and treatment and on interventions to improve the cascade of care. With the growth in large-scale clinical and administrative data, quasi-experiments enable rigorous evaluation of policies implemented in real-world settings.

Ethical issues in telecom licensing: liberalization of Indian telecom

The big business houses of the country and many multinational corporations had foreseen huge opportunity in deregulation and consequential opening up of telecommunication service sector in India. The telecom operating licenses in India were granted to private sector by the government starting from midnineties of the last century. The political executives as well as civil servants had lot of discretionary powers in granting of these licenses and making subsequent change in them. A nexus has always been alluded to in popular press between politicians, businessmen and civil servants to the detriment of public good. There has been scope in granting of favors to the operators in matter of telecom policy and licensing. This paper describes the stages of telecom liberalization in India, the industry administrative structure and various policy and licensing changes affected by the government and consequential allegation of corruption and undue favors given to private operators. The paper goes on to describe the various institutions which probe and punish ethical misconducts and certain corrective steps undertaken by the government to bring in transparency and fair play in matter of allocation of spectrum and granting of telecom licenses.

A Mixed-Methods Approach to Investigating the Adoption of Evidence-Based Pain Practices in Nursing Homes

This mixed methods study examined perceived facilitators and obstacles to adopting evidence-based pain management protocols vis-a-vis documented practice changes that were measured using a chart audit tool. This analysis used data from a subgroup of four nursing homes that participated in a clinical trial. Focus group interviews with staff yielded qualitative data about perceived factors that affected their willingness and ability to use the protocols. Chart audits determined whether pain assessment and management practices changed over time in light of these reported facilitators and barriers. Reported facilitators included administrative support, staff consistency, and policy and procedure changes. Barriers were staff attitudes, regulatory issues, and provider mistrust of nurses' judgment. Overall, staff reported improvements in pain practices. These reports were corroborated by modest but significant increases in adherence to recommended practices. Change in clinical practice is complex and requires attention to both structural and process aspects of care.

Failed calibration of anesthesia machine due to look-alike oxygen sensors.

Labels and medications with similar appearances have the potential to harm patients and cause delays in hospital services. We report a problem involving the Maxtec MAX-1 and MAX-11 oxygen sensors which are commonly used on anesthesia machines. These oxygen sensors have nearly identical labels which resulted in inadvertent interchanging of the sensors. The incident required the replacement of a MAX-11 sensor with a MAX-1 sensor to ensure proper functioning of the anesthesia machine. Identification of these cases can educate health care professionals of potential sources of labeling errors and safety issues and can also bring about Food and Drug Administration policy changes.

Reconsidering the workplace: faculty perceptions of their work and working environments

In an effort to foreground the impact of the material environment on faculty activities, this study examines the dynamic intersections among faculty work practices, the academic workplace and professional identity. Drawing on in-depth interviews with 16 social science faculty at one public university in the United States, this study reveals the impact of the physical environment on faculty perceptions of what they do, where they work and who they are. Analysis of interview data revealed overlapping themes regarding perceptions of faculty work practices, the inability of places to contain faculty work, faculty socialization, and questions concerning the ownership and distancing of particular work types. Findings from this study point to a need for administrative policy changes to be accompanied by a respatialization of the local campus that resists tendencies toward isolating environments.

Hemoglobin Levels Triggering Erythropoiesis‐Stimulating Agent Therapy in Patients with Cancer: the Shift After United States Food and Drug Administration Policy Changes

To determine whether the hemoglobin level at which health care providers prescribed erythropoiesis-stimulating agent (ESA) therapy (trigger hemoglobin level) for their patients receiving chemotherapy was lower after the United States Food and Drug Administration (FDA) mandated a black-box warning in March 2007. Retrospective analysis. U.S. Department of Veterans Affairs Healthcare System (VA) national databases. A total of 7450 patients who were diagnosed with cancer between 2002 and 2009, were undergoing chemotherapy, and who received an ESA within 12months after their cancer diagnosis. Data were collected on patients' demographic, clinical, environmental, and treatment-related factors. After controlling for these factors, multivariable regression analyses were used to compare the trigger hemoglobin level before and after the FDA-mandated labeling change. The average trigger hemoglobin level was 0.73g/dl lower after the labeling change (95% confidence interval [CI] -0.84 to -0.63). Moreover, the decline in trigger hemoglobin levels began in mid-2006, when the average trigger hemoglobin level fell from 10.50g/dl in early 2006 (95% CI 10.36-10.63) to 9.30g/dl by late 2009 (95% CI 9.10-9.49). Even before the 2007 FDA-mandated changes in ESA product labeling, hemoglobin levels that triggered ESA treatment began declining for patients receiving cancer care within the VA. This highlights the critical importance of dissemination of postmarketing safety data to impact shifts in ESA use for anemia management.

Finnish, Norwegian, and Swedish alcohol policy after the seminal year of 2004

Aim To assess how Finland, Norway and Sweden reorganised their alcohol policies after the travellers import quotas for alcoholic beverages were abolished in 2004. Data & Methods Alcohol taxation, alcohol programs and other alcohol policy changes, as well as common alcohol policy initiatives by the Nordic Alcohol monopoly countries are examined. In addition to relevant research literature, the main sources used are public reports and documents as well as interviews with nine key informants in the field of alcohol policy. Results Finland is characterized as the country with the highest alcohol consumption and an alcohol policy that is different from the policies in Norway and Sweden. Typical for Norway, apart from an increased availability of alcoholic beverages, is an active engagement in international alcohol policy issues, whereas Sweden is characterized by big administrative alcohol policy changes, and by the rulings of the EC-court in alcohol policy matters. Conclusions Alcohol policy in Finland has not been as prioritized as in Norway and Sweden, and there has not been an active political support for restrictive social alcohol policy in Finland. Despite clear similarities, the differences in Finland's, Norway's and Sweden's alcohol policies have increased since 2004, and it has become increasingly difficult to talk about a common Nordic alcohol policy.

Wisconsinʼs Recent BadgerCare Enrollment Decline

The State Children's Health Insurance Program (SCHIP) has been intended to provide healthcare coverage to that group of children previously caught between Medicaid eligibility and adequate access to employer insurance. However, SCHIP can be implemented quite differently across the states, potentially affecting actual enrollment. We review prior studies that have attempted to dissect how the administration of SCHIP impacts enrollment, including a multivariate study by the authors that indicates presumptive eligibility, expanded parent coverage, and 12-month continuous eligibility all contribute to a reduced likelihood of being uninsured. We then detail an administrative policy change in one state, Wisconsin, that yielded unanticipated and dramatic enrollment fluctuations in its SCHIP program, BadgerCare.