Zoé Hamstead
In 2010 the Affordable Care Act was passed into law amidst a great deal of controversy, marked by numerous lawsuits that were filed in the wake of its adoption. While many of these lawsuits have been resolved and courts have more or less upheld the act, one issue which has not been definitively settled is to what extent religious freedom may exempt employers from particular health care provisions – namely, the coverage of birth control for women. Some religious employers believe that some forms of birth control constitute abortion and any action that increases access to such services constitutes immoral behavior. As part of a broader and in many ways controversial policy framework involving multiple actors, we can examine the policy-making process of the birth control coverage policy in reference to the stages model of policymaking and its criticisms.
Beginning with Harold Lasswell in 1971, public policy scientists have proposed variations of the stages model of policymaking to describe the public policy decision-making process. With its emphasis on process, this model theorized a problem-oriented approach to decision-making, which helped to distinguish public policy science from political science and economics (Munger, 2000). Within this framework, in stage one a “decision-maker” would identify the “problem,” in this case, perhaps a lack of access to birth control. In stage two, decision criteria, such as the maintenance of religious freedom and/or comprehensive health care provision for the uninsured, are selected. Stage three would involve selecting and weighing alternatives, including 1) altogether excluding birth control from the menu of health care services that employers must provide, 2) requiring the provision of birth control from all employers regardless of religious mission, or 3) exempting some but not all employers. In step four, a decision-maker would consider policy constraints, such as further lawsuits and political backlash. Step five would involve implementation and studying the effects of the policy. How many women wanted to, but were unable to receive benefits? How many women paid out of pocket for birth control? What effects did the policy have on employers? Though a defining theoretical framework, this rational-comprehensive approach has been criticized for being oversimplified, disjointed, unempirical and a generally inadequate description of the reality of decision-making.
Other approaches to studying decision-making view the processes as an incremental, “muddling through.” Lindblom (1959) argues that most non-technical, large-scale decision making happens through a process in which values and policies are selected simultaneously; goals and means are not distinct; good policy is defined by consensus across different values systems; and in which theory is rarely utilized. Under conditions of bounded rationality, decision-makers have limited time, limited resources, limited information and ill-defined problems. In the best case scenario, these conditions lead to satisficing as opposed to optimizing values; in the worst case they lead to the sacrifice of social justice for convenience (Forester, 1984).
Under Lindblom’s successive limited comparisons model, the choice to value religious freedom more than affordable access to birth control is inseparable from the choice of the policy. Although a decision-maker may [somehow] abstractly value access to health care more than any other goal, the ultimate choice to exempt some employers due to feasibility constraints constitutes an implicit value weighting. Success of the policy is judged based on whether women’s rights advocates, religious groups and health care advocates, among others, will encourage constituents to vote for democrats, stop waging lawsuits, and be otherwise appeased. Under conditions of unequal power distribution among these groups, some groups may shape the policy more than others.
A major limitation of the incremental decision-making framework is that the role of a broader policy context may be ignored (Etzioni, 1967). Specific policies of the Affordable Care Act are made in the context of broader policy concepts such as the separation between church and state and the Roe v. Wade decision, which set a legal precedence for disallowing most restrictions on abortion in the U.S. Without the Roe v. Wade legal precedence, would the Obama administration have attempted a health care provision that some religious groups consider akin to providing abortion? Without precedence for the protection of religious freedom, would Hobby Lobby have considered waging a law suit against the federal government? The administration’s current policy proposal is that insurance companies will cover health benefits of birth control in cases where non-profit religious employers object to its use. While in some sense this is an incremental decision made to strike a compromise among opposing groups, in another sense the proposal is an elaboration on more fundamental decisions that, while being continuously debated and revised, do in some sense provide an overall direction for the evolution of policy. In enacting particular requirements of the Affordable Care Act, federal policy-makers need to not only consider the extent to which the goals of the act are met and how the process is structurally distorted, but also how these policies relate to the evolution of fundamental decisions which can influence future incremental decisions.
Etzioni, A. (1967). Mixed-Scanning: A “Third” Approach to Decision-Making. Public Administration Review, 27(5), 385–392.
Forester, J. (1984). Bounded Rationality and the Politics of Muddling Through. Public Administration Review, 44(1), 23–31.
Lindblom, B. C. E. (1959). The Science of Muddling Through. Public Administration Review, 19(2), 79–88.
Munger, M. C. (2000). Analyzing Policy: Choices, Conflicts and Practices. W.W. Norton & Company, Inc.
In 2010 the Affordable Care Act was passed into law amidst a great deal of controversy, marked by numerous lawsuits that were filed in the wake of its adoption. While many of these lawsuits have been resolved and courts have more or less upheld the act, one issue which has not been definitively settled is to what extent religious freedom may exempt employers from particular health care provisions – namely, the coverage of birth control for women. Some religious employers believe that some forms of birth control constitute abortion and any action that increases access to such services constitutes immoral behavior. As part of a broader and in many ways controversial policy framework involving multiple actors, we can examine the policy-making process of the birth control coverage policy in reference to the stages model of policymaking and its criticisms.
Beginning with Harold Lasswell in 1971, public policy scientists have proposed variations of the stages model of policymaking to describe the public policy decision-making process. With its emphasis on process, this model theorized a problem-oriented approach to decision-making, which helped to distinguish public policy science from political science and economics (Munger, 2000). Within this framework, in stage one a “decision-maker” would identify the “problem,” in this case, perhaps a lack of access to birth control. In stage two, decision criteria, such as the maintenance of religious freedom and/or comprehensive health care provision for the uninsured, are selected. Stage three would involve selecting and weighing alternatives, including 1) altogether excluding birth control from the menu of health care services that employers must provide, 2) requiring the provision of birth control from all employers regardless of religious mission, or 3) exempting some but not all employers. In step four, a decision-maker would consider policy constraints, such as further lawsuits and political backlash. Step five would involve implementation and studying the effects of the policy. How many women wanted to, but were unable to receive benefits? How many women paid out of pocket for birth control? What effects did the policy have on employers? Though a defining theoretical framework, this rational-comprehensive approach has been criticized for being oversimplified, disjointed, unempirical and a generally inadequate description of the reality of decision-making.
Other approaches to studying decision-making view the processes as an incremental, “muddling through.” Lindblom (1959) argues that most non-technical, large-scale decision making happens through a process in which values and policies are selected simultaneously; goals and means are not distinct; good policy is defined by consensus across different values systems; and in which theory is rarely utilized. Under conditions of bounded rationality, decision-makers have limited time, limited resources, limited information and ill-defined problems. In the best case scenario, these conditions lead to satisficing as opposed to optimizing values; in the worst case they lead to the sacrifice of social justice for convenience (Forester, 1984).
Under Lindblom’s successive limited comparisons model, the choice to value religious freedom more than affordable access to birth control is inseparable from the choice of the policy. Although a decision-maker may [somehow] abstractly value access to health care more than any other goal, the ultimate choice to exempt some employers due to feasibility constraints constitutes an implicit value weighting. Success of the policy is judged based on whether women’s rights advocates, religious groups and health care advocates, among others, will encourage constituents to vote for democrats, stop waging lawsuits, and be otherwise appeased. Under conditions of unequal power distribution among these groups, some groups may shape the policy more than others.
A major limitation of the incremental decision-making framework is that the role of a broader policy context may be ignored (Etzioni, 1967). Specific policies of the Affordable Care Act are made in the context of broader policy concepts such as the separation between church and state and the Roe v. Wade decision, which set a legal precedence for disallowing most restrictions on abortion in the U.S. Without the Roe v. Wade legal precedence, would the Obama administration have attempted a health care provision that some religious groups consider akin to providing abortion? Without precedence for the protection of religious freedom, would Hobby Lobby have considered waging a law suit against the federal government? The administration’s current policy proposal is that insurance companies will cover health benefits of birth control in cases where non-profit religious employers object to its use. While in some sense this is an incremental decision made to strike a compromise among opposing groups, in another sense the proposal is an elaboration on more fundamental decisions that, while being continuously debated and revised, do in some sense provide an overall direction for the evolution of policy. In enacting particular requirements of the Affordable Care Act, federal policy-makers need to not only consider the extent to which the goals of the act are met and how the process is structurally distorted, but also how these policies relate to the evolution of fundamental decisions which can influence future incremental decisions.
Etzioni, A. (1967). Mixed-Scanning: A “Third” Approach to Decision-Making. Public Administration Review, 27(5), 385–392.
Forester, J. (1984). Bounded Rationality and the Politics of Muddling Through. Public Administration Review, 44(1), 23–31.
Lindblom, B. C. E. (1959). The Science of Muddling Through. Public Administration Review, 19(2), 79–88.
Munger, M. C. (2000). Analyzing Policy: Choices, Conflicts and Practices. W.W. Norton & Company, Inc.
RSS Feed