Unfunded Mandates Research Articles

Reality, Teaching, and the Four Researchers

The 112th meeting of the Association of American Medical Colleges (AAMC) was held November 2–7, 2001, in Washington, DC. The theme for the meeting was “Facing the Future,” yet there appeared to be considerable time and concern devoted to the realities of the present. The first plenary session, “The Cost of Compliance: Dollars, Time, and Faculty Morale,” caught the mood of the gathering with a careful analysis of the current costs to academic medical centers of the unfunded mandates for compliance. Russel E. Kaufman, MD, vice dean for education and academic affairs at Duke University School of Medicine, Durham, NC, presented his overview of the cost of compliance in research. Kaufman noted that the cost of the institutional review board at Duke, including record keeping, personnel, and time for protocol development and review of protocols, exceeded $12 million in supporting the medical school–wide research endeavor. Kaufman outlined a study done at Duke in which compliance costs were shown to increase at a rate exceeding that of any other research costs. He warned specifically about the Federal False Claims Act and the unknown potential fiscal effects of the privacy protection rules now pending implementation. Mark E. Erath, a partner in Healthcare Consulting Practice at PricewaterhouseCoopers LLP, San Francisco, Calif, presented the results of a study done by that firm documenting the cost of compliance for clinical healthcare. Erath reported that the Center for Medicare and Medicaid Services (CMS) code is now larger than the Internal Revenue Service code. At one phase in reviewing the data from his study, he noted that the time spent documenting clinical activities equaled the time spent actually performing the clinical activities. Erath suggested that breakthrough changes are required if the system is to survive financially. Primary among these changes that Erath suggested are three initiatives: (a) Unfunded mandates must be carefully examined, (b) the workforce supply crisis must be solved, and (c) the CMS and American public must eventually deal with the demand crisis for medical services. Erath’s study of the cost of compliance to healthcare is available from PricewaterhouseCoopers. This sobering dose of reality was followed by a session about the physician payment situation. The CMS update on the physician payment resulted in a 5.4% decrease in payment per work relative value unit. The 2002 relative value unit payment has declined to $36.23 compared with the 2001 value of more than $38.00. Of equal concern is the decrease in the technical component payment for radiologists of about 5%. This makes the overall “hit” for radiology departments about 11% for the year 2002. The AAMC and other professional organizations are working diligently to mitigate the effect of the suggested reductions. The general impression was that the best we could ever come away with is to reinstate the 2001 payment scale. The most likely scenario was that the reductions recommended by the CMS would stand. George F. Sheldon, MD, the Zack D. Owens Distinguished Professor of Surgery and chairman of surgery at the University of North Carolina, Chapel Hill, delivered an analysis of the 21st century workforce in medicine. Sheldon predicted a major upcoming physician shortage. Sheldon showed demographic data for medical resource that suggested a crucial shortage of physicians and, in particular, specialty trained physicians, is likely to develop during the next 10 years. We in radiology can certainly resonate with that opinion. Sheldon suggested a workforce study group for graduate medical education (GME) whose tasks would include documentation of the need to increase class size in the nation’s medical schools and support of an increase in the size of GME training Acad Radiol 2002; 9:834–836

From Revenue Sharing to Deficit Sharing: General Revenue Sharing and Cities. Bruce A. WallinThe Politics of Unfunded Mandates: Whither Federalism?. Paul I. Posner

From Revenue Sharing to Deficit Sharing: General Revenue Sharing and Cities. Bruce A. WallinThe Politics of Unfunded Mandates: Whither Federalism?. Paul I. Posner

STATE URBAN POLICY: “New” Federalism In Virginia, New Jersey and Florida

The recent rediscovery of federalism has left the nation's governors with expanded responsibility and limited federal support. In return, they were promised greater fiscal flexibility, a real partnership in program design, and protection from unfunded mandates. However, states seem unwilling to offer the same guarantees to their cities that they sought from the federal government, even as they expand city responsibilities and limit state aid. This paper explores the extent to which Virginia, New Jersey and Florida have provided the fiscal flexibility and partnership, except in the area of economic development, but the diminished fiscal capacity of some distressed communities relative to their suburban counterparts render them unable to benefit from such efforts.

The Impact of Unfunded Environmental Mandates When Environmental Quality and Timber are Produced Jointly

A number of different aspects of environmental quality are produced jointly with timber. Unfunded environmental mandates whose costs are borne strictly by the private landowner lead to reduced production of both timber and environmental quality relative to the quantity of both that would be produced in the absence of such policies. That is, acting without regard to environmental consequences, private landowners produce more environmental quality (as a byproduct of producing timber) than they do when unfunded policy mandates result in de facto partial takings for which they are not compensated.

Threshold Rules for Funding Environmental Mandates: Accountability and the Unfunded Mandate Reform Act

Unfunded mandates are orders imposed by higher level governments on lower-level governments without providing the funds necessary for implementation. We highlight the following trade-off associated with unfunded mandates: on the one hand, no funding creates a risk of over-regulation by the higher-level government (the accountability principle), but on the other, full funding creates a moral hazard problem whereby the lower-level government fails to minimize the cost of implementation. We examine threshold rules that simultaneously provide incentives for efficient decisions by both levels of government. We then apply the results to the Unfunded Mandate Reform Act.

U.S. fiscal policy measures: Unfunded mandates

U.S. fiscal policy measures: Unfunded mandates

The Politics of Unfunded Mandates: Whither Federalism?

The Politics of Unfunded Mandates: Whither Federalism?

Book Notes

Sanford Borins, Innovating with Integrity: How Local Heroes are Transforming American Government.Milton M. Carrow, Robert P. Churchill, and Joseph J. Cordes, Democracy, Social Values, and Public Policy.Joseph D. Davey, The Politics of Prison Expansion: Winning Elections by Waging War on Crime. WestportSherry Glied, Chronic Condition: Why Health Reform Fails.Erich Goode, Between Politics and Reason: The Drug Legalization Debate.Peter J. Haas, and J. Fred Springer, Applied Policy Research: Concepts and Cases.Rodney E. Hero, Faces of Inequality: Social Diversity in American Politics.Stuart S. Nagel, Policy Within and Across Developing Nations.Paul L. Posner, The Politics of Unfunded Mandates: Whither FederalismHoward Schuman, Charlotte Steeh, Lawrence Bobo, and Maria Krysan, Racial Attitudes in America: Trends and Interpretations (rev. ed.).Mark E. Rushefsky and Kant Patel, Politics, Power, & Policy Making: The Case of Health Care Reform in the 1990s.Donald A. Sylvan and James F. Voss (eds.), Problem Representation in Foreign Policy Decision Making.Edward P. Weber, Pluralism by the Rules: Conflict and Cooperation in Environmental Regulation.Walter A. Zelman and Robert A. Berenson, The Managed Care Blues and How to Cure Them.

The Politics of Unfunded Mandates, Whither Federalism?

This book is the first comprehensive analysis of the politics behind the use of mandates requiring state and local governments to implement federal policy. Over the last twenty-five years, during both liberal and conservative eras, federal mandates have emerged as a resilient tool for advancing the interests of both political parties. Revealing the politics that led to the policies, Paul L. Posner explores the origins of these congressional mandates, what interests and needs they satisfy, whether mandate reform initiatives can be expected to alter their use, and their implications for federalism. This book reveals how mandates have changed the way policy is formed in the United States and the fundamental relationship between the federal government and the state and local governments.

Federal Unfunded Mandate Reform: A First-Year Retrospective

The Unfunded Mandates Reform Act (UMRA, P.L. 104-4) was enacted in 1995 as part of the Republicans' Contract with America. The act represented a remarkable convergence of interests that had been divergent for decades. Historically, the Congress had been reluctant to restrain itself from passing the costs of new programs and policies on to the states. That reluctance grew in tandem with the federal deficit, to the dismay of the states (see Conlan, 1991; Derthick, 1992; Zimmerman, 1992; St. George, 1995; Kelly, 1995; Ray and Conlan, 1996.) Congress's ability to satisfy the demand for new programs without raising taxes or reducing federal benefits became increasingly valuable as an ever larger share of the budget went to pay interest on the national debt. Bipartisan realization that the growing federal debt was taking on greater public saliency stimulated interest and support for the Balanced Budget Amendment. Many governors were reluctant to support such an amendment however, without some protection from unfunded mandates. They were concerned that the pressure for new programs and policies would remain constant, the budgetary bite of entitlements would increase, and the requirement for balancing the budget would shift the cost of entitlements or new programs and policies to the states. At their 1995 annual association meeting, the governors made their position clear--unfunded mandates protection first. Congressional Republicans agreed, and a new antimandates coalition was born. At the same time, local governments had achieved their own remarkable convergence of interests. The major local government advocacy groups, such as the National League of Cities, the National Association of Counties, and the National Conference of Mayors, had been pursuing antimandates legislation individually for the better part of a decade. Then, in 1994, the National Conference of Mayors and the National Association of Counties engaged the Price Waterhouse firm to survey municipalities and counties on the costs of mandates. They released the survey results on the NUM Day (for National Unfunded Mandates Day), October 27, 1993. They were joined in a rally on the steps of the Capitol by the National League of Cities, the National Conference of State Legislatures, the National Governors Association, and other representatives of state and local governments (see Beam and Conlan, 1995; Conlan, Riggle, and Schwartz, 1995; Kriz, 1995). The conclusions that Price Waterhouse reached about the costs of mandates were staggering (U.S. Conference of Mayors, 1993). The firm estimated that unfunded federal mandates cost localities approximately $11.3 billion in fiscal year 1993. The report figured prominently in the debate over the Unfunded Mandates Reform Act (UMRA), although many outside observers questioned its methods and conclusions (Senate Committee on the Environment and Public Works, 1994). Still, the visibility afforded the issue of unfunded mandates as depicted in the report, when combined with a united coalition of state and local governments and an energized Republican Congress, was powerful enough to provide solid congressional support for the act. As it manifests its goals to improve the information the Congress receives about the effect of federal legislation on state, local, and tribal governments, and the private sector, and to make it more difficult for Congress to impose unfunded mandates on state and localities, the UMRA became the first promise fulfilled in the Republicans' Contract with America. This first-year retrospective examines how the UMRA has affected the legislative process. After a brief summary of the elements of Title I--the section of the law that addresses how mandates are identified and considered at the legislative stage--we examine the role of the Congressional Budget Office (CBO) in identifying mandates and calculating their costs. We then consider how that information was used by members of the 105th Congress as they deliberated five major bills that contained significant intergovernmental mandates. …

State Immunization Registries and Public Opinion: The Case of Georgia

DRAMATIC CHANGES have occurred in the intergovernmental system in the last two decades. A process that began as “shift and shaft” federalism during the Reagan years has led to a major transformation in the role and function of state governments. One benefit has been enhanced state discretion in the development and implementation of important new policies—as is illustrated by welfare reform. The downside, of course, is an increased financial burden (Hebert, Wright, and Brudney 1992) and a reduced but steady tide of unfunded mandates (Ray and Conlan 1996; Antonelli 1996). Certainly, the states have supported new and expanded activities and services. State governors have shown an unprecedented level of leadership (Pear 1995), and they have taken steps to further refine their administrative machinery (Jenks and Wright 1993). A recent report on the federal system notes that the states have launched initiatives to “overhaul their civil service, procurement, training and information systems and to revise

Rhetoric through Media

Rhetoric through Media

Judicial Review of Discount Rates Used in Regulatory Cost-Benefit Analysis

Executive orders, statutes, and precedent increasingly require cost-benefit analysis of regulations. Presidential executive orders have long required executive agencies to submit regulatory impact analyses' to the Office of Management and Budget (OMB) before issuing regulations,2 and recent federal legislation exhibits a trend toward mandatory cost-benefit analysis. For example, the Toxic Substances Control Act,3 the Federal Insecticide, Fungicide and Rodenticide Act,4 and the recent Safe Drinking Water Act Amendments5 require the Environmental Protection Agency to balance costs and benefits in regulating chemicals and pesticides. In 1995, Congress passed the Unfunded Mandates Act,6 requiring cost-benefit analysis of all significant federal regulations that require expenditures by state, local, or tribal governments.7 Additionally, Congress has proposed several bills

Environmental Consequences of Reducing the Federal Role in Transportation: Legal Framework

The Intermodal Surface Transportation Efficiency Act (ISTEA) currently provides transportation grants to states financed by the Highway and Mass Transit Trust Funds and establishes a variety of requirements that seek to make environment a key factor in transportation planning and implementation. Devolution of the federal role would make states responsible for financing highway and transit improvements and for making related policy and program decisions. Although ISTEA is not primarily an environmental law, it contains numerous provisions that take into account the environmental implications of authorized activities. In addition, federal funding can trigger requirements for “major investment study” and National Environmental Policy Act (NEPA) processes that consider environmental impacts of proposed projects and allow for public comment. Devolution could affect the number of transportation projects subject to such scrutiny, where federal funding is the sole element that “federalizes” a project enough to make major investment study or NEPA requirements apply. And, although many other federal and state laws provide environmental protection, they typically do not focus on achieving an environmentally friendly transportation system. The impacts that devolution could have on environmental protection are explored here. The environmental provisions currently in ISTEA are reviewed and the potential role of NEPA and the Unfunded Mandates Reform Act in a devolution environment is identified. Other federal or state laws that may be available to “stand in” for environmental provisions eliminated or weakened by devolution are explored, and the potential environmental impacts of a reduced federal role in transportation oversight are discussed.

Intergovernmental Relations and Productivity

How have the efforts to coordinate the actions of federal, state, and local governments adjusted to the iterative shifting of responsibilities among levels of governments? The efficiency and effectiveness of intergovernmental interactions have been challenged by current constraints. Using the hypothetical Reinvent, Inc., the following example illustrates the constraints currently affecting the productivity of intergovernmental interactions. At Reinvent, Inc., three profit center executives -- A, B, and C -- have specific authority, responsibilities, and resources at their disposal. The nature of Reinvent, Inc.'s business requires that the executives coordinate the work of their profit centers. Initially, Executive A provided funds and directives to Executives B and C to assist in accomplishing their profit centers' work. Executives B and C were in a subordinate role to Executive A due to their economic dependence. The owners of Reinvent, Inc. recently directed Executive A to reduce funds to Executives B and C. As they have sought and obtained other sources of funds, Executives B and C have become more economically dependent on Executive A. Although the economic relationship has changed, the owners directed Executive A to retain and assert more authority over Executives B and C by increasing the directions, and the requirements, expectations, and the responsibilities of Executives B and C. The three executives communicate regularly to adjust the coordination of their work as each change is instituted. This example portrays current intergovernmental relations, with Executive A representing public administrators in the federal government, and Executives B and C representing public administrators in state and local government (Wright, 19990; ACIR, 1996). Ideally, for intergovernmental relations to have high productivity, the authority, purposes, responsibilities, and resources of federal, state, and local governments would be clearly delineated and stable. Given that less than ideal circumstances exist, the following discussion identifies coping strategies that should be or are being used to enhance the productivity of intergovernmental relations. Continuous Awareness of Current Capacities Awareness of three-year and five-year trends is informative, but it is increasingly important for governments at all three levels to monitor the nearer term in order to capture unanticipated changes that will spike demand for public services. Public organizations at each level can individually and collectively determine on an ongoing basis what their unique and current strengths are and assess what each can realistically accomplish. The following discussion of the unique strengths of the three levels of government is directed to that end. At the federal level, comprehensive knowledge is avoidable from which overall trends a-nd statistics can be derived. The resources are also comprehensive, enabling the broadest range of activities to be supported. Through these resources, the federal. government has the greatest capacity to function as a change agent using regulation and unfunded mandates or by tying funding to planning, performance measurement, civil service, or other requirements (Hatry, 1989). The federal government has also served as a trendsetter for other government units with regard to public employees through the passage of civil service reforms (Henry, 1992). State and county governments are confronted by a smaller range of competing interests than the federal government. Regional interests are both more specialized and more unified than at the federal level. For example, states have specific industries such as farming, oil, or aeronautics instead of the full spectrum of industries that compete for favor at the federal level. State and county governments have narrower tax bases than the federal government and, without the extensive public-good obligations like defense, they can focus these resources on issues and problems unique to their region. …

The politics of "Drive-through deliveries": putting early postpartum discharge on the legislative agenda.

Since May 25, 1995, twenty-nine states have adopted "early discharge" legislation or comparable regulations, mandating insurers to cover minimum postpartum hospital stays. The topic of early discharge moved onto the agenda with notable speed, despite a lack of empirical evidence to support either those insurers who reduced the postpartum length of stay for mothers and babies or the new statutes that protected their right to longer stays. The new laws' simplicity and low cost as unfunded mandates accounted for much of their appeal, as did the symbolic power of the issue to doctors and patients, frustrated by managed care. Emotional constituent anecdotes, unsupported by definitive research findings, also influenced legislators.

Balancing Risk and Finance: The Challenge of Implementing Unfunded Environmental Mandates

What impact have unfunded environmental mandates had on local governments? Carol Cimitile, Victoria Kennedy, Henry Lambright, Rosemary O'Leary, and Paul Weiland's two-pronged research studied seven local governments in New York State in 1994. First, they examined if and how these local governments prioritized risks (such as environmental and public health problems) to decide what environmental areas should have priority. Second, they examined how local governments were paying for the implementation of environmental mandates. The division of responsibility for environmental programs differs dramatically among the seven local governments studied. Common themes, however, were discovered and are discussed. The authors conclude that the problems posed by unfunded environmental mandates are the result of a number of factors including fragmentation (institutional, scientific, legal, and political), lack of information, and the rigidity of laws and regulations. They call for a national reexamination of environmental regulation. One of the first bills passed by Congress during the 1995 session and signed into law by President Clinton was P.L. 104-4 which addresses the issue of unfunded mandates. The passage of this law came on the heels of a number of other actions that called attention to a multitude of unfunded mandates being passed from the federal government to the states and from the states to localities. In 1993 and 1994, numerous resolutions were introduced in both the United States Senate and the House of Representatives to limit the passage of unfunded federal mandates. In 1993, President Clinton signed Executive Order 12875 (President Clinton, 1993) calling for a reduction in unfunded mandates. And October 27, 1993, was declared National Unfunded Mandates Day by the U.S. Conference of Mayors and the National Association of Counties. One purpose of all these actions was to call attention to the growing number of environmental mandates handed down from federal and state governments to local governments. Increasingly, the duty to implement environmental laws is falling on local governments. Environmental responsibility has shifted downward but without the needed funds to implement the programs mandated by the laws (ACIR, 1990., Fix and Kenyon, 1990; Schwartz and Peck, 1990; Zimmerman, 1992). Unfunded environmental mandates affect many of our nation's governments (DiLorenzo, 1993; U.S. Conference of Mayors/Price Waterhouse, 1993). Although much has been written on federalism and environmental policy (Fitzgerald, McCabe, and Foltz, 1988; Peretz, 1992; Tobin, 1992), little attention has been paid to the issue of how local governments are dealing with unfunded environmental mandates. The cost of federally mandated environmental programs has been estimated by the Environmental Protection Agency (EPA) to be $99 billion for 1990 alone (Pompilli et al., 1992). Yet there is little information on the impact of environmental mandates on individual local government entities. In one of the few studies on the subject, officials in Columbus, Ohio, estimated its portion of those costs to be $1 billion from 1992 to the year 2000 (Environmental Law Committee, 1991). In another study, the overall impact of environmental mandates on Anchorage, Alaska, was estimated to be $430 million from 1992 to 2000 (Municipality of Anchorage, Alaska, 1992). To gather further empirical evidence to understand better how local governments are coping with the unfunded environmental mandates facing them, we studied seven local governments in New York State. The focus of the research was two-pronged. First, we examined if and how these local governments prioritized risks (such as environmental and public health problems) in order to decide what environmental areas should have priority. Second, we examined how local governments were paying for the implementation of environmental mandates. Researchers asked the questions: Are risk and finance balanced by these local governments? …

Advisory Commission on Intergovernmental Relations in 1996: The End of an Era

On 30 September 1996 the U.S. Advisory Commission on Intergovernmental Relations (ACIR) closed its doors, ending thirty-seven years of advocacy forfederalism and intergovernmental relations. A majority of members in the Congress felt that ACIR had become irrelevant to the issues facing them and agreed that little would be lost by terminating the commission. The Clinton administration, although supportive until near the end, withdrew its'support out of displeasure with the commission's handling of the unfunded federal mandates issue. The national associations representing state and local governments were ambivalent. ACIR was no longer looked to for solutions to the nation's intergovernmental relations problems. With the exit of ACIR, the federal government's last resource for addressing broad intergovernmental issues-beyond the confines of individual programs-is gone.

Unfunded Mandates Reform Act: 1996 and Beyond

The first year of the Unfunded Mandates Reform Act was greeted with great expectations in much of the intergovernmental community. State and local governments did, in fact, realize some important victories in the Congress, both in softening the impact of new mandates and in reversing some existing ones. Viewed historically, these achievements certainly break with established trends. Yet, 1996 did not prove to be a watershed year. Significant new mandates and preemptions were passed, while state and local victories were largely achieved in modifying how new mandates were to be implemented, not in determining whether new mandates would be enacted.

Unfunded Mandates Reform Act: 1996 and Beyond

The first year of the Unfunded Mandates Reform Act was greeted with great expectations in much of the intergovernmental community. State and local governments did, in fact, realize some important victories in the Congress, both in softening the impact of new mandates and in reversing some existing ones. Viewed historically, these achievements certainly break with established trends. Yet, 1996 did not prove to be a watershed year. Significant new mandates and preemptions were passed, while state and local victories were largely achieved in modifying how new mandates were to be implemented, not in determining whether new mandates would be enacted.