1. Implementation as Policy A Policy Regime Perspective
Peter J. May
University of Washington

2. Three Things to Remember
Policy designs do much more than set forth courses of action
Implementation is about much more than putting policies in place
Experiences with policies establish feedback processes that shape policy legitimacy, coherence, and durability

3. How the Readings Fit In Policy Feedback
Policy designs – notions about design and implementation
P. May “Policy Design and Implementation”
Policy regimes – expanded notions about implementation and politics
P. May & A. Jochim “Policy Regime Perspectives”
P. May, “Implementation Failures Revisited”
Policy Feedback
D Moynihan and J Soss, “Policy Feedback …”
D Moynihan, P Herd, and H Harvey, “Administrative Burden…”

4. What is Policy Design? Policies (usually) contain: Intentions (goals),
Means (instruments),
Implementation structures -- including third parties,
Designation of resources
Policies also:
Explicitly or implicitly target groups for benefits or burdens,
Set signals – labeling of policy, language to communicate goals, who is deserving, signaling of how tough to be

5. Consider an Example
American Patient Protection and Affordable Care Act of 2010 – “Obamacare”
Main goals are to provide protections and access to health care for many who otherwise would not have health care
Design elements:
Insurance based market system for health care
Subsidies for those who cannot afford health insurance, along with expanded access to low-income care
Strong state role (in theory) with health exchanges
Health care mandate – all must participate (with various exceptions) through employers or individual policies

6. What Happened?
Contentious politics of enactment carried into implementation – Supreme Court cases over individual mandate and federal exchange
Many states chose not to develop state run insurance exchanges, and others chose not to expand low income health care
Choices of plans had more limited of options, with many not able to keep their current insurance (despite promises they could)
Major problems with federal and state websites for enrollment crashing, wrong information, etc
Lots of adjustments in deadlines, more exemptions, to address many glitches
Nonetheless, some 7 million plus enrolled by the original deadline .. Many more since then

10. The Traditional Implementation Perspective
Rush to get this done – “expedited implementation” -- overly ambitious
Under-estimated commitment of intermediaries (particularly states), despite federal incentives
Confusion among insurance providers (other intermediaries)
Woefully under-estimated technological issues, contracting, staffing for websites
Lots of confusion over deadlines, processes, and what could be expected
In short, “a mess”

12. Potential Design Improvements
Implementation prospects are enhanced by:
Provisions that build the capacity of intermediates to carry out policies
Funding, education and training, and technical assistance
Provisions that build commitment of intermediates to carry out policies
Publicity about policy goals, cost-sharing & other incentives, joint planning for implementation
Provisions that signal and reinforce desired courses of action
Oversight, publicity about successful experiences

13. Research about Policy Design and Implementation
How does policy design affect implementation? – the preceding and more!
How do designs vary? Why?
Understanding components of policy design – attention to mixes of policy tools
Attention to different types of implementation structures – networks, NGOs, etc.

14. Toward a Broader Depiction of Implementation – Regime Perspectives
Implementation not simply a technocratic or managerial activity; fundamentally tasks of policy and political problem solving
Given this, need to consider how politics enters more – differing political environments and forces
And, need to consider how actions during implementation reinforce or undermine policy commitments

15. Policy Regime Perspectives Focus Attention on:
Ideas – shared commitments (glue of the regime)
Institutional Arrangements – structuring of authority, attention, information and organizational relationships
Interests – constituencies that provide support or opposition (energy behind the regime)

16. Obamacare in Regime Terms

17. Considering Implementation From a Regime Perspective
Shifts analytic attention to:
Ideational uptake – Are the core ideas understood and embraced?
Interest support – Are the interests mobilized? Is conflict high?
Institutional capacity – Does the institutional design channel attention and resources towards the purpose of the regime?

18. For Obamacare Ideational uptake – Interest support –
Lots of confusion, especially among the public about what they gain from Obamacare
Interest support –
Failed to marshal much support, resistance outweighed support -- insurance and drug companies did not rally support
Institutional capacity –
A key source of regime weakness, partly due to the patchwork design and compromises made to gain enactment

23. Consequences
Obamacare fell short in political terms as much as in policy terms:
Undermined by a lack of a strong shared purpose among different intermediaries – states, insurance industry, others
No real constituency for “affordable care” – more felt lost out than gained, those who gained had little voice
Institutional mistrust – competence of Obama administration called into question

24. Sets in Place Negative Feedbacks
Negative perceptions outweigh positive ones (though relatively few want to dismantle it) -- perceptions of burdens rather than benefits
Negative press coverage outweighs positive press coverage
Political benefits for Democrats are limited – unlike other major social welfare reforms

25. These in Turn Undermine
Sense of legitimacy of the policy – further undermined by court challenges
Coherence of the policy – consistency in delivery
Potential durability of the policy – leading to pressures for reform (and less realistic ones for dismantling it)

26. Restating What Regime Perspectives Provide
Descriptive lens – conceptual map of forces involved in addressing policy problems – a policy regime
Analytic lens – understanding of feedback processes that shape policy legitimacy, coherence, and durability

27. Traditional Implementation vs. Regime Perspectives

28. Future Research Directions for Policy Regimes
Emergence – What conditions foster the development of policy regimes?
Strength – What contributes to the strength of regimes?
Durability – What affects the life span of a given regime?

29. Revisiting Implementation
Traditional implementation perspectives:
How policies are carried out
Politics as obstacles to effective implementation
Regime perspectives:
Politics as central, can be a positive force (e.g., mobilization of supportive constituencies)
Reinvigorates implementation as evolution of policies – how efforts to address problems take new forms over time
Explicitly incorporates policy feedback
Reminds us of the role of policies as governing instruments