Children’s Health Insurance Program: A Case Study in Policy Implementation

Abstract

The Children's Health Insurance Program (CHIP) is the lynchpin of President Clinton's efforts to obtain universal health care coverage. Created by the Balanced Budget Act of 1997, CHIP provides health insurance coverage to low-income children who are ineligible for Medicaid. Implementation of this program, however, is intricate, complex, and problematic. CHIP is a joint federal-state initiative crosscutting a host of regulatory agencies' jurisdictional boundaries. Policy implementation, the third component of the policy process, hangs in delicate balance based on interagency cooperation, state compliance, and negotiations with policy actors. The authors use Ripley's model to analyze CHIP's implementation through five functional activities: resource acquisition, interpretation, planning and organizing, providing benefits and services, and use of coercion. They illustrate the role of political and organizational influences in implementation, dynamics that are integral to policymakers' ability to create, sustain, and evaluate successful public programs.

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