2. 16 Domestic Policy Keystone/Getty Images A.J. SISCO/UPI/Landov
Oil drilling has been a major industry in the U.S. since the 1800s. It is an industry that needs government regulation for health, safety, environmental, and monopolistic reasons, but it is also a powerful industry that has fiercely resisted government regulation. In fact, some elected officials made their personal fortunes in the oil industry.
Keystone/Getty Images
A.J. SISCO/UPI/Landov

3. 16 Learning Objectives Trace the stages of the policy-making process.
When we talk about public policy, we are referring to an intentional course of action or inaction that the government follows when dealing with a problem or an issue of concern. When we talk specifically about domestic policy, we mean the range of governmental programs that affect citizens within a country. In this chapter we'll be discussing domestic policy in the United States with an emphasis on health, education, energy and environmental policy.
Trace the stages of the policy-making process.
16.1
Describe health policy in the United States.
16.2

4. 16 Learning Objectives Outline education policy in the United States.
16.3
Explain energy and environmental policy in the United States.
16.4

5. 16
Learning Objectives
Assess the ongoing challenges in U.S. domestic policy.
16.5

6. Roots of Domestic Policy in the United States
16.1
Roots of Domestic Policy in the United States
Since the beginning, our policy-making process has been decentralized. Policy-making powers are shared by Congress, the president, the courts, and the states. Not until the 1930s and the New Deal did the federal government take a more active role in broad policy-making. From that point on, the federal government continued to expand its role in domestic policy.
In this section, we will look at the evolution of key domestic policy issues and the structure of the policy-making process itself.
The Evolution of Health Care Policy
The Evolution of Education Policy
The Evolution of Energy and Environmental Policy
A Model of the Policy-Making Process

7. The Evolution of Health Care Policy
16.1
The Evolution of Health Care Policy
National Marine Service (1798)
First federal health care service
New Deal efforts
Opposed by the American Medical Association
President Bill Clinton
Universal Health Coverage defeated
Number of uninsured rose dramatically
President Barack Obama
Patient Protection and Affordable Care Act
The very first time the federal government waded into health care was in 1798, when it created the National Marine Service to help care for sick sailors. Serious talk about national health care insurance didn't happen until the New Deal, when it was opposed by the American Medical Association.
President Bill Clinton tried to launch universal health insurance during his first term in the 1990s, but it failed to take hold. The issue stayed off the table for the next 15 years, during which time more and more Americans became uninsured.
President Barack Obama succeeded in getting the Patient Protection and Affordable Care Act passed, and it survived a major court challenge in 2012.

8. The Evolution of Education Policy
16.1
The Evolution of Education Policy
Post-Revolutionary War
Legitimizing democratic institutions through education
Immigration Era
Assimilation via education
Brown v. Board of Education (1954)
Ended segregation of public schools
Outcome and Standards-Based Education
No Child Left Behind
Race to the Top
Our history of education policy goes all the way back to the Revolutionary War. The founding fathers, especially Benjamin Franklin, saw the benefits of using education to legitimize our new democratic institutions. And when waves of immigrants began arriving on American shores, education policy was seen as an efficient way to assimilate new Americans.
In 1954, in Brown v. Board of Education, the U.S. Supreme Court ordered an end to school segregation. And in the earliest part of the twenty-first century, education policy reform evolved from outcome-based education to standards-based education in the form of No Child Left Behind and Race to the Top.

9. Who was John Dewey? 16.1 Sylvia Salmi/Bettmann/CORBIS
John Dewey was an influential education reform advocate of the late 19th and early 20th centuries. He advocated active and experiential learning. He also created the numeric Dewey Decimal system for organizing books uniformly throughout the United States.
Sylvia Salmi/Bettmann/CORBIS

10. 16.1 How did Title IX Change Education? Rich Barnes/CALSP/AP Images
Title IX of the Education Amendments of 1972 greatly expanded educational and athletic opportunities for women. As a result of these gender equity requirements, women's lacrosse is one of the fastest growing collegiate sports.
Rich Barnes/CALSP/AP Images

11. Evolution of Energy and Environmental Policy
16.1
Industrialization and Conservation
Abundant coal and oil
Teddy Roosevelt and the U.S. Forest Service
Environmental Protection
Rachel Carson's Silent Spring, Earth Day 1970
Oil Dependency
OAPEC and OPEC
Speed limits, fuel efficiency standards
Climate change concerns
Greenhouse gases and global warming
Early on in our history, concerns about the environment were related to industrialization and "laissez-faire" attitudes toward business and private property. Conservation efforts were led by President Theodore Roosevelt, who created the U.S Forest Service, national parks, and other preserves. The burning of fossil fuels resulted in environmental damage, and the focus shifted to environmental protection. Rachel Carson's book Silent Spring and the first Earth Day in 1970 are examples of that shift in thinking.
About same time, however, the United State was becoming increasingly dependent on foreign oil sources. Groups like the Organization of Arab Petroleum Exporting Countries (OAPEC) and the Organization of Petroleum Exporting Countries (OPEC) began raising their prices, which led to U.S. policies such as speed limits and fuel efficiency standards for cars.
Today, our energy and environmental policy focus is shifting more and more to climate change concerns, which include greenhouse gases caused by the burning of fossil fuels and their impact on global warming.

12. A Model of the Policy-Making Process
16.1
A Model of the Policy-Making Process
Several theories exist to explain the development of public policy. The elite theory, as you can imagine, suggests that the elites make the policy and the masses follow. Bureaucratic theory claims that the organizations that make up the bureaucracy are in charge of theory. Interest group theory says that policy is set by competing interests and pluralist theory claims that no single group can ever be fully in control of policy.
Regardless of theory, however, we can observe five different stages of the policy-making process.
The process begins with agenda setting. Agenda setting involves deciding which issues will be discussed and addressed. Policy formation is a period in which actual, proposed courses of action are suggested and written.
Policy adoption is simple approval of any given policy. Adoption is followed by
policy implementation, which is the carrying out of the policies. The last stage is policy evaluation, in which political actors assess how well a given policy seemed to work.
Agenda Setting
Deciding which issues to discuss
Policy Formulation
Crafting of proposed courses of action
Policy Adoption
Approval of a policy proposal
Policy Implementation
Process of carrying out public policies
Policy Evaluation
Did policy achieve its goals?

13. 16.1 FIGURE 16.1 What Are the Stages of the Public Policy Process?
One of the best ways to understand public policy is to examine the process by which policies are made. Although there are many unique characteristics of policy making at the various levels of government, certain commonalities define the process from which public policies emerge. In the figure, the public policy process is broken down into five steps. Each step has distinguishing features, but it is important to remember that the steps often merge into one another in a less distinct manner.

14. 16.1 How Does Government Identify Public Policy Problems?
Public policy problems are circumstances that can be addressed by government action. One example is disaster relief. During and after Hurricane Katrina, the New Orleans Centre housed thousands of people displaced by the storm in appalling circumstances never before seen on such a massive basis in the United States.
Bill Haber/AP Images

15. 16.1
16.1 Throughout our history, education has been viewed by political actors as a means to:
What have you learned so far about the history of public policy?
Legitimize democratic institutions
Facilitate assimilation
Ensure equality
All of the above

16. 16.1
16.1 Throughout our history, education has been viewed by political actors as a means to:
Education has been viewed by political leaders as a means to all these ends throughout our history.
Legitimize democratic institutions
Facilitate assimilation
Ensure equality
All of the above

17. Health Policy Today 16.2 Medicare Medicaid Health Insurance
Today millions of people receive medical care through various offices and medical centers of the Department of Veterans Affairs and the Indian Health Service. Since the 1960s we have also introduced health care programs for the elderly and the poor, Medicare and Medicaid, and in 2012 Congress approved the Patient Protection and Affordable Care Act. This expanded the federal government's role in providing health insurance.
In this section, we will look at the current state of public and private health insurance in the United States.
Medicare
Medicaid
Health Insurance
Public Health

18. Medicare 16.2 Created in 1965 People 65 and older Part A Part B Part C
Covers hospitalization
Part B
Optional; covers doctor’s visits, outpatient services
Part C
Medicare Advantage, covers gaps
Part D
Optional drug benefit
Medicare, as we just noted, was passed in It covers people who are 65 and over or disabled. Medicare is divided into four parts.
Part A covers 80% of hospitalization costs. Part B, which is optional, covers part of the cost of doctor's visits, x-rays, and other outpatient and diagnostic services.
Part C, which is called Medicare Advantage, is administered by private insurance companies. Subscribers pay a premium for insurance intended to fill gaps in coverage in regular Medicare. Finally, there is Medicare Part D, which is an optional drug benefit that went into effect in 2006.

19. Medicaid 16.2 Created in 1965 Must meet eligibility requirements
For people poor and disabled
Must meet eligibility requirements
Low-income
National and state government
Federal block grants cover 50–75%
66 million Americans covered in 2014
More than $400 billion
Medicaid was created at the same time as Medicare. Medicaid provides health insurance coverage for the poor and disabled. Recipients must meet eligibility requirements, such as showing that their income is below a certain level.
Medicare is a joint venture between the national and state governments. Federal block grants that cover 50 to 75% of Medicaid costs are given to the states, who must come up with the remaining funding themselves. States have considerable latitude in setting eligibility requirements and providing coverage. Some states do not cover all citizens who meet eligibility criteria. In 2014, 66 million Americans were covered by Medicaid, at a cost of more than $400 billion.

20. Health Insurance 16.2 Rising Costs Health care per capita costs
Technology advances
Americans living longer
Health care per capita costs
1970 $356 per capita
2013 $9,349 per capita
10 percent of Americans account for 63 percent of all health care costs
Patient Protection and Affordable Care Act
Ensures access to either private insurance or government-run exchanges
State have challenged the program
No discussion about health care policy can avoid talk of rising costs. The causes of these cost increases range from advances in technology to increased lifespans to lack of government regulation.
How significant are the increases? Consider this: In 1970, the average amount each American spent on health care was just $356. By 2013, however, that number had spiked to $9,349, an increase that far exceeds inflationary costs.
But not everyone spends the same amount. Ten percent of Americans account for 63 percent of all health care costs. The Patient Protection and Affordable Care Act was meant, among other things, to help stabilize those costs by ensuring access to either private insurance or government-run exchanges. It still faces challenges from several states.

21. 16.2 FIGURE 16.2 Where Do American Health Expenditures Go?
Physicians and hospital care constitute a majority of health care expenditures. However, prescription drug and nursing home costs are rapidly rising.
Source: Kaiser Family Foundation,

22. Public Health 16.2 Tools to protect public health Medical Research
The government also plays a role managing the spread of infectious and chronic disease through immunizations, education, advertisements and regulations.
Since 2006, for example, the vaccine Gardasil has been available to prevent human papillomavirus, a sexually transmitted disease that can cause cervical cancer. But debate has raged over whether parents should be required to vaccinate their children. Some parents have argued it will encourage sexual activity by giving young people a false sense of security.
That debate rages on, but most Americans support the government's role in funding medical research through the National Institutes of Health. Maybe that research will find new ways to combat obesity, which continues to work its way to the number one slot on the public health policy agenda. An estimated two-thirds of American adults and one-third of American children are overweight or obese, an epidemic that costs $190.2 billion a year.
Tools to protect public health
Immunizations, education, advertisements, regulation
Gardasil debate
Medical Research
National Institutes of Health
Obesity
Public health priority: 2/3 of adults and 1/3 of children are overweight or obese

23. 16.2 How Does the Government Promote Public Health?
A 2012 New York City proposal called for a ban on the sale of large sodas in city restaurants, theaters, and sporting venues. As part of Obama's health care reform, restaurants with 20 or more locations now have to provide nutritional information on menus, including calories and calories from fat.
Richard Drew/AP Images

24. 16.2 TABLE 16.1 What do Americans think about health insurance reform?
What would your answers be to the questions in this survey?
SOURCE: Data from Gallup, National adults, July 9–12, 2012.

25. 16.2
16.2 Which part of Medicare is optional and covers doctor's visits and other outpatient services?
Let's see what you have retained from our discussion of the complex provisions of Medicare.
Medicare Part A
Medicare Part B
Medicare Part C
Medicare Part D

26. 16.2
16.2 Which part of Medicare is optional and covers doctor's visits and other outpatient services?
Medicare Part B is optional and covers part of the costs of doctor's visits, x-rays and other outpatient and diagnostic serves.
Medicare Part A
Medicare Part B
Medicare Part C
Medicare Part D

27. Education Policy Today
16.3
Education Policy Today
While states and local governments handle the lion's share of public education policy and practice, the federal government plays a role a well. Much of that is indirect, such as funding of research grants and student loan assistance. But national policy can and does provide states with incentives to improve education. In this section we will look at key national policies such as No Child Left Behind.
The No Child Left Behind Act
Federal Aid to Higher Education

28. The No Child Left Behind Act
16.3
The No Child Left Behind Act
Accountability
Standardized tests, report cards, reorganization
Flexibility
Schools can tailor expenditures to meet their needs
Proven methods for quality outcomes
Best practices
School Choice
Vouchers for private or other public schools
Charter schools
In 2002, Congress passed the bipartisan No Child Left Behind Act, which has four key tenets. First is accountability. Students are given a battery of standardized tests each year, which are then used to calculate a "grade" for the school. Schools that have a low grade must provide additional services such as extended hours or tutoring, and they can be forced to reorganize if they fail to improve.
Second, No Child Left Behind provides for flexibility in spending, so schools can focus on areas that would meet the specific needs of their students. Next, schools must use proven methods to produce so-called "quality outcomes" in children.
Finally, and perhaps most controversial, is the school choice component. Parents of children enrolled in failing schools can move their children, possibly with the use of a voucher to pay for private school. Charter schools, which are semi-public, also give parents additional choice.

29. 16.3 What Are Charter Schools? Chris Hondros/Getty Images
Charter schools are semipublic institutions that are run by universities, nonprofits, or corporations. Many charter schools, such as Harlem Success Academy, seen here, have achieved outstanding results in traditionally underprivileged communities.
Chris Hondros/Getty Images

30. Federal Aid to Higher Education
16.3
Federal Aid to Higher Education
Federal government policies tend to provide indirect support of higher education through research grants and financial assistance to students. The federal government also funds the U.S. Military Academy, U.S. Naval Academy, the U.S. Air Force Academy, the U.S. Coast Guard Academy, and the U.S. Merchant Marine Academy.
But the biggest topic in higher education policy in recent years has been access and student loan debt. Students graduate from college with an average debt of $23,000 even though the federal government spends more than $140 billion each year on grants and loans.
To help out, the federal government passed the College Cost Reduction and Access Act. Among other things, the act fixed interest rates for federally subsidized Stafford loans, and allowed new borrowers to cap their repayments at 10 percent of their total income, with the balance forgiven after 20 years.
Research grants and financial assistance to students
Military academies
Access to college
Student debt load
Grants
College Cost Reduction and Access Grant
Stafford fixed interest rate
Repayments capped at 10% of income

31. 16.3
16.3 No Child Left Behind can force schools to reorganize under which of its four tenets
What have you learned about education policy? Please answer this question on the No Child Left Behind Act.
Accountability
Flexibility
Proven methods of outcomes
School choice
None of the above

32. 16.3
16.3 No Child Left Behind can force schools to reorganize under which of its four tenets
Under the accountability section of No Child Left Behind, schools can be forced to reorganized if they fail to improve following a poor report card grade.
Accountability
Flexibility
Proven methods of outcomes
School choice
None of the above

33. Energy and Environmental Policy Today
16.4
Energy and Environmental Policy Today
Energy and environmental policy are linked. The demand for cheap and abundant sources of energy can have serious environmental impacts, such as climate change. In this section we will learn how balancing energy needs, regulation costs, and the need to address climate change has proven very difficult and left us without serious policy reform.
Energy Policy
Environmental Policy
Climate Change

34. Energy Policy 16.4 President Obama's budget Oil and other fossil fuels
"All of the above" approach encourages development of alternative energies
Oil and other fossil fuels
U.S. has 2 percent of world's oils reserves but consumes 20 percent of the world's oil
Natural gas extraction
Problems with groundwater contamination
Consumption
Energy efficiency requirements for cars, buildings
You may have heard President Barack Obama speak about the need to develop more clean and renewable sources of energy. His budget recommendations included $27.2 billion for an "all of the above" approach to developing clean technologies and incentives. This is important, for the United States has just 2 percent of the world's oil reserves but consumes 20 percent of the world's oil.
Problems have arisen in areas that have explored natural gas extraction. Groundwater contamination caused by this so-called "fracking" led Vermont to become the first state to ban it.
Given the strain on energy resources, federal energy policy has also focused on consumption in the form of energy efficiency requirements for cars and buildings, for example.

35. 16.4 FIGURE 16.3 Where Do U.S. Oil Imports Come From?
American oil imports come from sources around the globe. Although the largest percentages come from the Middle East and Africa, significant proportions also come from South America, Mexico, and Canada.
Source: U.S. Energy Information Administration, Office of Senator Richard Lugar, lugar.senate.gov/energy/graphs/oilimport.html.

36. 16.4 FIGURE 16.4 How Does the United States Generate Electricity?
Although the percentage of American power coming from alternative fuel sources has increased in recent years, coal is still the largest source of electrical power.
Source: U.S. Energy Information Administration,

37. Environmental Policy 16.4 National Environmental Policy Act of 1969
Required environmental impact statements when the government proposed a project
Clean Air Act of 1970
Established national primary and secondary air quality standards
Clean Water Act of 1972
Goal to make all surface water "swimmable and fishable" by 1985
It may come as little surprise to hear that the need for economic recovery and the demand for reduced dependency on foreign oil has overshadowed the issue of environmental protection.
The major environmental policies we have at the federal level were passed right before and during the 1970s. The National Environmental Policy Act of 1969 required government agencies to draft an environmental impact statement when proposing a new project. That was followed the next year by the Clean Air Act of 1970, which established primary and secondary air quality standards for six air pollutants. Two years later Congress passed the Clean Water Act of 1972, which sought to make all surface water "swimmable and fishable" by 1985.

38. Climate Change 16.4 Difficulties for comprehensive federal reform
This issue of climate change is complex, both from a scientific perspective and, certainly, a policy perspective. President Barack Obama has been involved in international agreements on climate change, but scientists' inability to predict the absolute consequences of climate change make crafting and adopting federal policy difficult.
So states have answered the call. California, for example, passed a law that aims to reduce greenhouse gas emissions from cars by 30 percent before Thirteen other states have also adopted stricter emissions standards, and nine states belong to the Regional Greenhouse Gas Initiative, a cap and trade agreement. And 30 states, plus the District of Columbia have adopted mandatory Renewable Portfolio Standards, which require set amounts of energy be generated by alternative sources.
Difficulties for comprehensive federal reform
Exact impact unknown
State efforts
California
30 percent reduction in automobile emissions
Regional Greenhouse Gas Initiative (RGGI)
A cap and trade agreement among nine states
Renewable Portfolio Standards (RPS)
Require set amounts of electricity from alternative sources

39. 16.4 How can governments encourage Americans to go green?
One simple way governments have encouraged environmental consciousness is to provide citizens with incentives to purchase compact fluorescent light bulbs, shown here.
Patrick Collard/AP Images

40. 16.4 Federal environmental policy has taken a backseat lately to this.
Let's test what you have learned about environmental policy with a quick-multiple choice question on impediments to passing new policies.
Economic recovery
The need to wean the U.S. from foreign oil
Both of the above
None of the above

41. 16.4 Federal environmental policy has taken a backseat lately to this.
Our last major federal environmental policy is more than 40 years old, and current concerns about economic recovery and oil dependence continue to push environmental policies to the back burner.
Economic recovery
The need to wean the U.S. from foreign oil
Both of the above
None of the above

42. Toward Reform: Ongoing Challenges in Domestic Policy
16.5
Toward Reform: Ongoing Challenges in Domestic Policy
Why does it seem to be so difficult to create comprehensive federal policies and then fully implement them once they are adopted? Part of the complexity comes from the decentralized nature of our policymaking and implementing process. The different groups involved in calling for policy change—the elites, the bureaucrats, the interest groups— can make smooth policy making difficult. Health care costs, for example, are still rising and the quality standards for No Child Left Behind have not been fully met.
At every stage of the policy making process, from agenda setting to policy evaluation, there are both opportunities and barriers to change. Policy is often formulated in the context of uncertainty: Will these educational practices produce better results? What exactly are the impacts of climate change? Not having concrete answers to these questions can result in changes in policy implementation along the way, which can further muddy the policy waters.
And let's not forget effect of the public's attention span. Once an issue fades from public focus, its chances of being addressed in lasting policy are greatly reduced.
Policies not fully implemented or successful
Opportunities and barriers to change
Policy often formulated in context of uncertainty

43. 16.5
16.5 Which of these factors contributed to the complexity and difficulty of the policy-making process?
Please answer one final multiple-choice question for the chapter on the complexities of the policy-making process.
The decentralized structure of government
The different interests of different groups
The public's focus or lack of focus on an issue
All of the above

44. 16.5
16.5 Which of these factors contributed to the complexity and difficulty of the policy-making process?
As we just noted, all of these issues make the policy-making process complex and, at times, difficult.
The decentralized structure of government
The different interests of different groups
The public's focus or lack of focus on an issue
All of the above

45. 16
Discussion Questions
Why is the U.S. the only developed country without universal health care? Why are Americans disinclined to adopt a single-payer health care system?

46. 16 Further Review Listen to the Chapter
Study and Review the Flashcards
Study and Review the Practice Tests