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Papers by Frank Thompson

Research paper thumbnail of The Administrative Presidency, Waivers, and the Affordable Care Act

Journal of Health Politics, Policy and Law, 2020

Within the American system of shared power among institutions, the executive branch has played an... more Within the American system of shared power among institutions, the executive branch has played an increasingly prominent policy role relative to Congress. The vast administrative discretion wielded by the executive branch has elevated the power of the president. Republican and Democratic presidents alike have employed an arsenal of administrative tools to pursue their policy goals: high-level appointments, administrative rule making, executive orders, proclamations, memoranda, guidance documents, directives, dear colleague letters, signing statements, reorganizations, funding decisions, and more. Presidents Obama and Trump employed most of these tools in an effort to shape the implementation and outcomes of the Affordable Care Act (ACA) during its first decade. This article focuses on the Obama and Trump administrations' use of comprehensive waivers to shape ACA implementation. The Obama administration had mixed success using waivers to convince Republican states to expand Medic...

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Research paper thumbnail of Trump and the Affordable Care Act: Congressional Repeal Efforts, Executive Federalism, and Program Durability

Publius: The Journal of Federalism, 2018

This article assesses the politics and partial success of Congress in repealing the Affordable Ca... more This article assesses the politics and partial success of Congress in repealing the Affordable Care Act (ACA), known as Obamacare, with particular attention to lobbying by governors. Most Republican governors behaved as members of a vertical partisan coalition supporting the national party rather than defending insurance coverage in their states. But the activities of a significant minority of these governors impeded ACA retrenchment. We also examine the role of executive federalism, highlighting how state responses to Trump administrative initiatives affected ACA durability. The Trump administration drew on waivers, executive orders, funding decisions, administrative rules, the social media, and other executive branch tools to sabotage the health insurance exchanges and undercut Medicaid. As of 2018, the Trump administration actions had contributed to some erosion in exchange coverage, but far less than many had anticipated. The degree to which Medicaid waivers encouraged by the Trump administration will precipitate enrollment declines in that program remains to be seen.

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Research paper thumbnail of Federalism and the Growth of Self-Directed Long-Term Services and Supports

Public Policy & Aging Report, 2016

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Research paper thumbnail of The Safety Net At The Crossroads? Whither Medicaid DSH

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Research paper thumbnail of Health Care Policy

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Research paper thumbnail of An Examination Of Medicaid Delivery System Reform Incentive Payment Initiatives Under Way In Six States

Health affairs (Project Hope), 2015

Medicaid waivers for Delivery System Reform Incentive Payment (DSRIP) seek to hold hospitals and ... more Medicaid waivers for Delivery System Reform Incentive Payment (DSRIP) seek to hold hospitals and other providers accountable for measureable improvements in health care delivery. We explore the policy context giving rise to these waivers in six states, with particular attention to the interplay among the financial needs of hospitals; the rise of managed care; and federal interest in replacing an "unconditional" Medicaid funding stream, the upper payment limit, with one rooted in pay-for-performance. Key characteristics of these main DSRIP waivers are compared with a particular focus on the establishment of project menus, performance metrics, and pay-for-performance processes. Concluding sections discuss the potential and limits of the waivers as vehicles for health care reform. The long-term durability and impact of DSRIP remains unclear. But federal and state officials have made considerable headway in planning and otherwise laying the groundwork for it.

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Research paper thumbnail of Medicaid Waivers and Tenancy Supports for Individuals Experiencing Homelessness: Implementation Challenges in Four States

The Milbank Quarterly, 2021

Policy Points Medicaid policymakers have a growing interest in addressing homelessness as a socia... more Policy Points Medicaid policymakers have a growing interest in addressing homelessness as a social determinant of health and driver of the potentially avoidable use of expensive medical services. Drawing on extensive document reviews and in‐depth interviews in four early‐adopter states, we examined the implementation of Medicaid's Section 1115 demonstration waivers to test strategies to finance tenancy support services for persons experiencing or at risk of homelessness. ContextThe Affordable Care Act extended Medicaid eligibility to large numbers of individuals experiencing or at risk of homelessness. This legislative development and the growing recognition of homelessness as a significant social determinant of health have encouraged advocates and policymakers to seek new ways to use Medicaid to provide housing supports.MethodsWe conducted 28 semistructured interviews with 36 stakeholders in four states. The stakeholders were government administrators, health care providers, no...

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Research paper thumbnail of Chapter 7. Safety-Net Hospitals at the Crossroads: Whither Medicaid DSH?

The Health Care Safety Net in a Post-Reform World

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Research paper thumbnail of The Administrative Presidency and Fractious Federalism: The Case of Obamacare

Publius: The Journal of Federalism, 2014

Growing executive branch discretion in the U.S. separation-of-powers system has elevated the impo... more Growing executive branch discretion in the U.S. separation-of-powers system has elevated the importance of the administrative presidency. However, research on this topic has paid scant attention to federal policies that rely on the states to implement them. We seek to advance knowledge of the administrative presidency under conditions of fractious federalism by examining the nature and efficacy of the Obama administration’s efforts to secure state cooperation in implementing the Affordable Care Act (ACA). This law sought to assure that nearly all Americans would have health insurance. Despite strong partisan, ideological pressures on Republican policy makers in the states to refrain from implementing the ACA, the Obama administration has had some initial success in overcoming their resistance. Waivers have been a particularly valuable presidential tool.

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Research paper thumbnail of Executive Federalism and Medicaid Demonstration Waivers: Implications for Policy and Democratic Process

Journal of Health Politics Policy and Law, 2007

Executive federalism emphasizes collaboration between the executive branches at the national and ... more Executive federalism emphasizes collaboration between the executive branches at the national and state levels to transform grant programs through the implementation process. In this regard, Medicaid demonstration waivers loomed large during the presidencies of Bill Clinton and George W. Bush. This article docu- ments and compares the volume and substance of section 1115 Medicaid waiver activ- ity under the two

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Research paper thumbnail of Public Administration: Challenges, Choices, Consequences

Journal of Policy Analysis and Management, 1992

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Research paper thumbnail of Health Care Politics and Policy in New York State

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Research paper thumbnail of Health Care Politics and Policy in New York State

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Research paper thumbnail of Minority Groups in Public Bureaucracies: Are Passive and Active Representation Linked?

Administration & Society, 1976

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Research paper thumbnail of The Safety Net At The Crossroads? Whither Medicaid DSH

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Research paper thumbnail of The Administrative Presidency, Waivers, and the Affordable Care Act

Journal of Health Politics, Policy and Law, 2020

Within the American system of shared power among institutions, the executive branch has played an... more Within the American system of shared power among institutions, the executive branch has played an increasingly prominent policy role relative to Congress. The vast administrative discretion wielded by the executive branch has elevated the power of the president. Republican and Democratic presidents alike have employed an arsenal of administrative tools to pursue their policy goals: high-level appointments, administrative rule making, executive orders, proclamations, memoranda, guidance documents, directives, dear colleague letters, signing statements, reorganizations, funding decisions, and more. Presidents Obama and Trump employed most of these tools in an effort to shape the implementation and outcomes of the Affordable Care Act (ACA) during its first decade. This article focuses on the Obama and Trump administrations' use of comprehensive waivers to shape ACA implementation. The Obama administration had mixed success using waivers to convince Republican states to expand Medic...

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Research paper thumbnail of Trump and the Affordable Care Act: Congressional Repeal Efforts, Executive Federalism, and Program Durability

Publius: The Journal of Federalism, 2018

This article assesses the politics and partial success of Congress in repealing the Affordable Ca... more This article assesses the politics and partial success of Congress in repealing the Affordable Care Act (ACA), known as Obamacare, with particular attention to lobbying by governors. Most Republican governors behaved as members of a vertical partisan coalition supporting the national party rather than defending insurance coverage in their states. But the activities of a significant minority of these governors impeded ACA retrenchment. We also examine the role of executive federalism, highlighting how state responses to Trump administrative initiatives affected ACA durability. The Trump administration drew on waivers, executive orders, funding decisions, administrative rules, the social media, and other executive branch tools to sabotage the health insurance exchanges and undercut Medicaid. As of 2018, the Trump administration actions had contributed to some erosion in exchange coverage, but far less than many had anticipated. The degree to which Medicaid waivers encouraged by the Trump administration will precipitate enrollment declines in that program remains to be seen.

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Research paper thumbnail of Federalism and the Growth of Self-Directed Long-Term Services and Supports

Public Policy & Aging Report, 2016

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Research paper thumbnail of The Safety Net At The Crossroads? Whither Medicaid DSH

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Health Care Policy

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Research paper thumbnail of An Examination Of Medicaid Delivery System Reform Incentive Payment Initiatives Under Way In Six States

Health affairs (Project Hope), 2015

Medicaid waivers for Delivery System Reform Incentive Payment (DSRIP) seek to hold hospitals and ... more Medicaid waivers for Delivery System Reform Incentive Payment (DSRIP) seek to hold hospitals and other providers accountable for measureable improvements in health care delivery. We explore the policy context giving rise to these waivers in six states, with particular attention to the interplay among the financial needs of hospitals; the rise of managed care; and federal interest in replacing an "unconditional" Medicaid funding stream, the upper payment limit, with one rooted in pay-for-performance. Key characteristics of these main DSRIP waivers are compared with a particular focus on the establishment of project menus, performance metrics, and pay-for-performance processes. Concluding sections discuss the potential and limits of the waivers as vehicles for health care reform. The long-term durability and impact of DSRIP remains unclear. But federal and state officials have made considerable headway in planning and otherwise laying the groundwork for it.

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Research paper thumbnail of Medicaid Waivers and Tenancy Supports for Individuals Experiencing Homelessness: Implementation Challenges in Four States

The Milbank Quarterly, 2021

Policy Points Medicaid policymakers have a growing interest in addressing homelessness as a socia... more Policy Points Medicaid policymakers have a growing interest in addressing homelessness as a social determinant of health and driver of the potentially avoidable use of expensive medical services. Drawing on extensive document reviews and in‐depth interviews in four early‐adopter states, we examined the implementation of Medicaid's Section 1115 demonstration waivers to test strategies to finance tenancy support services for persons experiencing or at risk of homelessness. ContextThe Affordable Care Act extended Medicaid eligibility to large numbers of individuals experiencing or at risk of homelessness. This legislative development and the growing recognition of homelessness as a significant social determinant of health have encouraged advocates and policymakers to seek new ways to use Medicaid to provide housing supports.MethodsWe conducted 28 semistructured interviews with 36 stakeholders in four states. The stakeholders were government administrators, health care providers, no...

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Research paper thumbnail of Chapter 7. Safety-Net Hospitals at the Crossroads: Whither Medicaid DSH?

The Health Care Safety Net in a Post-Reform World

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Research paper thumbnail of The Administrative Presidency and Fractious Federalism: The Case of Obamacare

Publius: The Journal of Federalism, 2014

Growing executive branch discretion in the U.S. separation-of-powers system has elevated the impo... more Growing executive branch discretion in the U.S. separation-of-powers system has elevated the importance of the administrative presidency. However, research on this topic has paid scant attention to federal policies that rely on the states to implement them. We seek to advance knowledge of the administrative presidency under conditions of fractious federalism by examining the nature and efficacy of the Obama administration’s efforts to secure state cooperation in implementing the Affordable Care Act (ACA). This law sought to assure that nearly all Americans would have health insurance. Despite strong partisan, ideological pressures on Republican policy makers in the states to refrain from implementing the ACA, the Obama administration has had some initial success in overcoming their resistance. Waivers have been a particularly valuable presidential tool.

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Research paper thumbnail of Executive Federalism and Medicaid Demonstration Waivers: Implications for Policy and Democratic Process

Journal of Health Politics Policy and Law, 2007

Executive federalism emphasizes collaboration between the executive branches at the national and ... more Executive federalism emphasizes collaboration between the executive branches at the national and state levels to transform grant programs through the implementation process. In this regard, Medicaid demonstration waivers loomed large during the presidencies of Bill Clinton and George W. Bush. This article docu- ments and compares the volume and substance of section 1115 Medicaid waiver activ- ity under the two

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Public Administration: Challenges, Choices, Consequences

Journal of Policy Analysis and Management, 1992

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Research paper thumbnail of Health Care Politics and Policy in New York State

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Health Care Politics and Policy in New York State

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Minority Groups in Public Bureaucracies: Are Passive and Active Representation Linked?

Administration & Society, 1976

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Research paper thumbnail of The Safety Net At The Crossroads? Whither Medicaid DSH

Bookmarks Related papers MentionsView impact