State Policy Capacity and Leadership for Health Reform

April 10, 2017 | Pierre-Gerlier Forest, W. David Helms

What does it take in terms of staff, leadership, and resources to plan and implement new policies?  The Affordable Care Act (ACA) may have been the largest and most complex piece of social policy legislation passed by Congress since Medicaid and Medicare—and it will not be the last.  A new report by Pierre-Gerlier Forest and W. David Helms examines state health policy capacity and leadership—and is especially important given the continuing debate about changes to the ACA and improving health care delivery in the United States.

Regardless of the policy positions they take, executive and legislative branch state policymakers need to make decisions that are right for their constituents and implement those decisions effectively and efficiently.

The experience of state health policy leaders who were involved in implementing sweeping changes to the ACA—in the commercial health insurance market and options regarding insurance exchanges and Medicaid eligibility—provides important lessons for policymakers tasked with planning and implementing comprehensive programs.

The authors use a combination of surveys and interviews to capture the experience of state leaders who were involved in changes to the ACA.  Their examination of how state leaders made and implemented policy decisions provides a unique opportunity to assess the resources needed and processes used by decision makers.  The report identifies key capacities that are essential to policymaking—and the outstanding needs that remain.