California Policy Research Articles

Using an Alliance of Independent Health Consumer Assistance Centers to Change Public Policy in California

The complexity of the U.S. health care system has created many obstacles for individuals and families trying to gain access to health insurance and health care services. With a multitude of payers and provider organizations, health consumers must navigate complex arrangements that vary by payer, community, and employer. This report describes the Health Consumer Alliance (HCA), an innovative collaboration of legal service organizations in California that combines individual assistance with broad advocacy work. Specifically, this paper highlights HCA's role in addressing systemic health care access issues that underlie many of the problems that health consumers face. In a 5-year period, the HCA assisted more than 60,000 individuals with problems related to obtaining access to care and health insurance coverage. The HCA used the information gained from this individual assistance to address both local and statewide policy issues by pooling the technical and political resources of individual health consumer centers (HCC) and their partners. The HCA has improved access to health care for many individuals beyond its client base by protecting indigent health services, expanding eligibility for public programs, and preserving the safety net for California's low-income population. The HCA model can be example of how information from individual consumer problems can be addressed at a broader level to reach and impact systemic change.

Using an Alliance of Independent Health Consumer Assistance Centers to Change Public Policy in California

Problem: The complexity of the U.S. health care system has created many obstacles for individuals and families trying to gain access to health insurance and health care services. With a multitude of payers and provider organizations, health consumers must navigate complex arrangements that vary by payer, community, and employer.

ASSESSING SUSTAINABLE DEVELOPMENT GAPS BETWEEN THE STATE AND LOCAL JURISDICTIONS

State mandates and guidelines significantly influence local land use planning; however few studies have been conducted to empirically detect the gaps in sustainable environmental planning between the state and local jurisdictions. This paper analyses the California Governor's Environmental Goals and Policy Report (EGPR) and 116 local comprehensive land use plans to develop a set of measurable indicators to detect gaps in local planning efforts to incorporate state goals and policies. Descriptive results indicate that the local jurisdictions reached approximately half of the state's sustainable environmental planning goals. The major gaps existed in some region-wide, global-wide, long-term, cumulative, and strategically critical environmental elements. Regression results further highlight the major factors that significantly influenced local jurisdictions' environmental planning abilities. Six policy recommendations are provided to reduce these gaps.

Policy-driven tobacco control

BackgroundSince the passage of Proposition 99, California's comprehensive tobacco control programme has benefited from a localised policy adoption process that allows for the innovation and diffusion of strong local tobacco...

Faulting and Public Policy in California: The Evolution of the Alquist-Priolo Earthquake Fault Zoning Act

The Alquist-Priolo Earthquake Fault Zoning Act of 1972, as amended, is a legislative child of the San Fernando earthquake of February 9, 1971. Over time, investigatory or design criteria, methods, guidelines, and restrictions are overtaken by improvements in scientific knowledge, exploration and design methods, and construction techniques. Many design professionals now think that the time has come to again review the investigation and design requirements developed under the Alquist-Priolo Act in light of current knowledge and capabilities, and their concerns led us to this conference. The Alquist-Priolo Act has been amended several times, and regulations developed under it have also evolved with the times. Currently, a Technical Advisory Committee to the State Mining and Geology Board9s Geohazards Committee is reviewing progress in fault assessment as well as the design philosophy inherent in the language of the Alquist-Priolo Act and the regulations promulgated pursuant to it. The intended effect of the Alquist-Priolo Act with regard to protecting public health, safety, and well-being is not by the language of the Act limited to life safety alone. The effectiveness of the Act should be measured by its effects in mitigating life safety threats, bodily harm, structural performance, and the societal costs of earthquakes.

Demographic Changes in Radiology Residency Positions 1980–2007: The Divergence Between California and the Rest of the United States

The objective of our study was to show the disparity in the expansion of radiology residency training slots over the past 27 years between California and the rest of the United States and to relate that divergent distribution to regional differences in medical school enrollment as a precursor and state-based per capita ratios of population to radiologist trainees as a consequence. Radiology positions were obtained from the annual editions of the American Medical Association's Graduate Medical Educational Directory. Population data were recorded from U.S. censuses for 1980, 1990, 2000, and 2007. Medical school matriculant data were provided by the American Association of Medical Colleges. The numbers of radiologists in practice were provided by the American College of Radiology. From 1980 to 2007, the U.S. population increased by 35%, predominantly in the South (52%) and West (65%). At the same time, the number of medical school matriculants remained relatively constant. Simultaneously diagnostic radiology positions increased by 55%, rising from 1980 to 1993, declining until 2001, and rising again since then. The greatest increases in radiology residency positions were observed in the Northeast and South, and the least increase was seen in the West. The greatest discrepancy between concomitant population growth and radiology resident positions occurred in California where training slots increased by 17% while population grew by 54%. Since 1980, a disparity between population growth and radiology residency position growth has been sustained between the West and the rest of the country. This disparity is a consequence of California's policy of restricting medical school enrollment and radiology residency positions despite continual population growth.

Minding the Climate Gap: Environmental Health and Equity Implications of Climate Change Mitigation Policies in California

Abstract Analyses on the equity issues associated with climate change and the mitigation strategies that aim to attenuate it tend to focus on the international scale. These analyses tend to cite de...

Best in Show? Climate and Environmental Justice Policy in California

Abstract In this article, we outline the important role that environmental justice organizations played in the development of AB 32, California's landmark climate change legislation (AB 32) in ensuring that a wide range of environmental justice ideas were incorporated into policy. We distinguish between the formal elements contained in the legislation and the discursive impacts, particularly in relation to public health concerns and about cap and trade and market mechanisms. Drawing from interviews, public documents, and legislative archives, we document the process by which these diverse environmental justice elements were incorporated into AB 32 to ask a seemingly simple question. Is California really “best in show” when it comes to climate and environmental justice policy? The complex politics involved in the drafting and passage of the legislation show to what extent environmental justice organizations played in AB 32's passage. We then argue that understanding the contentiousness in how AB 32 was dra...

Environmental Nonprofit Campaigns and State Competition: Influences on Climate Policy in California

Over the past 20 years, the US Federal Government has been considered to be intransigent in its response to climate change by many commentators and not-for-profit environmental advocacy organizations (nonprofits). An enduring source of pressure on the US Government has been nonprofit campaigns operating at both a state and federal level. Six US environmental nonprofits representing a diversity of resources and prominence were selected for an in-depth examination of their climate-focused campaigns. Given the resistance at the federal level, these nonprofits have undertaken state-focused campaigns to achieve adequate climate policy development. This research examined some climate campaigns in California by the selected nonprofits that have supported, enhanced, and influenced the Californian Government's efforts to address climate change. The campaigns have gained leverage from existing state competition for economic advancement and political leadership on issues of public concern. In addition, they appear to have benefited from a high level of environmental awareness in the community, a history of progressive environmental legislation, Governor Schwarzenegger's use of climate change to differentiate his political leadership, and strong public trust of nonprofits. Recent climate-related political pledges and legislative changes at a federal level are convergent with the nonprofit-influenced, state-level developments.

City Adoption of Environmentally Sustainable Policies in California's Central Valley

Problem: Sustainability remains “the current object of planning's fascination,” as Campbell described it in 1996, but it is unclear what causes local governments to adopt environmentally sustainable policies and whether they are effective once adopted. Purpose: The goal of this article is to explain why communities adopt environmentally sustainable policies. Methods: We develop an environmental policy sustainability index for 100 incorporated cities in California's Central Valley using a combination of survey and archival data. We then use regression and cluster analyses to test which independent variables expressing three theoretical perspectives (Tiebout's public goods development model, Peterson's fiscal capacity model, and Logan and Molotch's interest group/growth machine model) are best at explaining this index. Results and conclusions: The results suggest that sustainable policies are more likely to occur in cities with better fiscal health and whose residents are of higher socioeconomic status. These findings raise important questions about the relationship between developed and developing cities that were not raised in previous studies, which focused only on major metropolitan areas in the United States. Takeaway for practice: Our results suggest that small, less-developed cities will need substantial technical, financial, and planning assistance to move toward greater sustainability. Many medium-sized, more developed cities may also need technical assistance, but are otherwise capable of becoming more environmentally sustainable. Any new policies should not discourage the largest cities from continuing to pursue their current sustainability activities, but should pass the lessons they have learned along to smaller cities to help them change to more sustainable development trajectories. Research support: This research was supported by NSF Grant 0350817.

The ‘Millionaires Tax’ And Mental Health Policy In California

Despite long-standing and widespread opposition to new taxes, in 2004 Californians approved a so-called millionaires tax, levied on those with taxable net income over $1 million. The proceeds, estimated to be $700 million to $1 billion per year, can only be spent on improving mental health services for people with or at risk of a disabling mental disorder. Progress has been made in access to services, prevention programs, supported housing, and integrating mental health with the other human services. Challenges include a complex administrative structure, a paucity of change agents, a less-than-robust oversight and accountability process, and high public expectations.

Trading the Forward Rate Puzzle

Permits to carry concealed firearms in public (CCW permits) remain controversial. A small scale natural experiment with shall-issue CCW permit policy in California, a may-issue state, is reported. During the mid-1990s, the chief of police of the Sacramento County town of Isleton issued permits to all county residents who applied and passed a standard background check. This program received national publicity. The incidence of subsequent criminal activity among 691 persons applying for CCW permits through Isleton’s program in 1995 and that in a statewide sample of 965 CCW applicants from 1993–94 were compared. Subjects were followed up for three years from their application dates. The arrest rates for violent crime among Isleton and statewide applicants were 291 and 104 per 100 000 person-years, respectively (relative risk 2.8, 95% confidence interval 0.7 to 11.2, p = 0.18). This suggests that a shall-issue policy for CCW permits may result in higher rates of violent crime among permit holders, but the results do not reach statistical significance; larger studies are needed.

California's Farmland Preservation Programs, Taxes, and Furthering the Appropriate Safeguarding of Agriculture at the Urban Fringe to Reduce Greenhouse Gas Emissions

California has long been a leader in both its attempts to preserve land devoted to agricultural production and in its approach to funding its state and local governments. Recently it has become the leader in creating a statewide policy (AB 32) to reduce the amount of greenhouse gases generated within its border. California's policy choices regarding state and local revenue reliance, farmland preservation, and reducing greenhouse gas emissions are interrelated. There is concern among environmental and agricultural stakeholders that elements of the system of state and local taxation that developed in California after Proposition 13 discourages the retention of land in agriculture, and this subsequently generates greater urban sprawl in the state. Many of these same stakeholders point to the presence of the state's three major farmland conservation programs (and other programs and multiple policies throughout different codes) as encouraging the retention of agricultural land and thus resulting in less urban sprawl in the state. The overall purpose of this paper is to examine these two claims in as unbiased a manner as academically possible and to offer an opinion on their validity. Such an opinion is necessary to offer an informed comment on the desirability of reforming the state's tax system, and/or expanding the state's system of farmland preservation, to reduce the degree of sprawl experienced in California and thus be better poised to achieve the reduction in GHGs mandated by AB 32.

Beyond technology-push and demand-pull: Lessons from California's solar policy

The scale of the technological transformation required to reduce greenhouse gas emissions to “safe” levels while minimizing economic impacts necessitates an emphasis on designing climate policy to foster, or at least not impede, environmental innovation. There is only a weak empirical base for policy-makers to stand on regarding the comparative innovation effects of various climate policy options, however. Empirical scholarship in environmental innovation is hindered by the complexity of both the innovation process and the interactions between the dual market failures of pollution and innovation that are in play, and it appears that the field would benefit from the structure provided by a common lexicon. This paper focuses on the issues related to policy categorization in this field; these issues have received little attention in the literature despite their importance to making insights gained from empirical studies generalizable. The paper reviews the origins, strengths, and weaknesses of the dominant policy typology of technology-push versus demand-pull instruments. Its primary contribution, however, is to assemble a comprehensive chronology of solar policy in California and its impacts on innovation, where known, and then use this as a basis for building a new policy categorization that takes advantage of the intuitive resonance of the dominant typology, while encompassing the broader range of policy instruments that are employed in practice in order to stimulate environmental innovation. The most noteworthy aspect of the new categorization is that it introduces a third category of environmental innovation policy instrument that focuses on improving the interface between technology suppliers and users. This reflects developments in the economics of innovation literature as well as considerable evidence in the domain of distributed solar energy technologies that opportunism by some of the actors that work at this interface can be a barrier to innovation.

Learning-by-Doing and the Optimal Solar Policy in California

Much policy attention has been given to promote fledgling energy technologies that promise to reduce our reliance onfossilfuels. These policies often aim to correct market failures, such as environmental externalities and learning-by-doing (LBD). We examine the implications of the assumption that LBD exists, quantifying the market failure due to LBD. We develop a model of technological advancement based on LBD and environmental market failures to examine the economically efficient level of subsidies in California’s solar photovoltaic market. Under central-case parameter estimates, including nonappropriable LBD, we find that maximizing net social benefits implies a solar subsidy schedule similar in magnitude to the recently implemented California Solar Initiative. This result holds for a wide range of LBD parameters. However, with no LBD, the subsidies cannot be justified by the environmental externality alone.

Prenatal Screening for Infectious Diseases: An Analysis of Disparities and Adherence to Policy in California

Prenatal infectious diseases are a major cause of mortality and morbidity among newborns, but many are preventable with proper maternal screening and treatment. METHODS; Adherence to prenatal infectious disease screening guidelines and demographic factors that influence adherence were determined utilizing existing data on 1837 live births from 1999-2003. We found higher rates of testing for syphilis (94.54%), rubella (92.69%) and hepatitis B (94.23%) than for HIV (73.82%) and GBS (69.05%). Adherence to testing guidelines varied by both disease and maternal factors. Lack of insurance, geographic location, inadequate prenatal care and incarceration were the main maternal factors associated with lack of testing. Disease screening rates may be improved by reducing socioeconomic barriers to prenatal testing, supporting access to insurance, eliminating provider biases and providing adequate prenatal care.

Testing Incapacitation Theory

Under incapacitation theory, higher incarceration rates are expected to correlate with accelerated reductions in crime. California’s contemporary incarceration patterns offer an opportunity to analyze the validity of this theory, particularly as it applies to young people. This study focuses on California’s juvenile incarceration and crime trends during the past half century. The findings of this study fail to demonstrate reduced crime rates through higher levels of juvenile incarceration, calling deterrence and incapacitation theories into serious question as effective youth crime reduction strategies and demonstrating the urgent need for California policy makers and legislators to consider alternative theories in response to crime and sentencing.

Assessing Experience in Articulating Species Protection Policies with Land Use Policies in California

California's experience implementing species protection laws illustrates both the necessity and challenges of articulating those policies with land use policies. Species protection increasingly relies on habitat protection achieved through land use controls. However, species protection policies are not well articulated with land use policies. The causes of this separation include a conceptual divide in theoretical orientation, different approaches to uncertainty in policy implementation and inadequate policy instruments.

State innovations in affordable housing policy: Lessons from California and New Jersey

Decades of diminishing federal leadership and support for affordable housing policy have opened up a gap in public response to housing needs. Filling this gap is critical if the long‐held goal of decent (and affordable) housing for every American is to be honored and communities are to thrive. This article investigates state governments in an era of federal retreat by examining the factors associated with innovations in housing policy in California and New Jersey, two reputed leaders in state housing policy. We collected data through interviews with key informants, as well as from meetings, reports, public documents, agency records, and other secondary sources. Our analysis indicates that state innovations in housing policy are influenced by bureaucratic (internal) factors, such as funding and agency structure, and by environmental (external) factors, such as local autonomy and interest group activity. We conclude with the policy and research implications of our findings.

The transformation of mental health policy: An analysis of the mental health policy in California

The transformation of mental health policy: An analysis of the mental health policy in California