Policymaking for
Children’s Issues[1]
by
Sally S. Cohen and Alice Sardell
Children are a unique group politically. Although they lack political resources of their own, others often use them as powerful symbols in political rhetoric (Gutterman, 2002). An examination of policymaking for children can thus be a rich source of thinking about representation and the development of public policy. Several political scientists have analyzed policymaking for children as part of social movements (Imig, 1996, 2001), historical analyses of social policies for women and children (Skocpol, 1992; Skocpol & Dickert, 2001), or scholarship in a specific children’s policy area (Cohen, 2001; Gormley, 1995; Sardell, 1991; Sardell & Johnson, 1998). But few have analyzed the recent history of children’s issues across policy domains. Our work is unique in spanning two areas, child health and child care, and in its attempts to draw general conclusions about policymaking for children.
The findings presented in this paper are based on two
separate longitudinal studies of children’s issues from the 1970s through the
1990s. One study focused on child care and the other on children’s health
policy. We identify common themes in both studies so as to enhance our
understanding of the policy processes in which children are target populations.
Methods, Frameworks, and Overview
of Cases
Methods and
Frameworks
Each study used a multi-case approach and was based on an extensive review of government documents and semi-structured interviews with key informants. Combined, the investigators interviewed approximately 175 policy actors. The child care study is completed (Cohen, 2001). The study of children’s health policy, still in process, analyzes six cases of child health policy from 1977 to 1997.[2] This paper draws upon three of those cases, each of which addresses children’s health insurance.
Both
studies independently focused on the interactions among political structures
and institutions (i.e., Congress and the executive branch) and organized interests
in shaping policy outcomes. Both studies also analyzed policy communities,
conceptualized as networks of experts in a given policy area (in and outside of
government) who relate professionally to one another on the basis of their
specialization.
Both the child health and child care studies
used Baumgartner and Jones’s (1995) model of punctuated equilibrium to describe
how periods of relative stability in policymaking were followed by major
junctures of rapid policy change. Both studies also used the advocacy coalition
framework (Sabatier, 1988) for understanding how coalitions interacted in the
policy process and influenced policy outcomes. In addition, the child health
study used Kingdon’s (1995) model of agenda-setting.
Overview of Cases
Each study had a different mix of cases, reflecting their
different research questions. The child health policy data encompass three
cases related to health insurance coverage for children. The child care
research analyzed three key periods of child care policymaking ending in 1971,
1990, and 1996, respectively.
Child
health cases. The first child health case examines the
expansions of the Medicaid program during the 1980s. Medicaid, enacted as Title
XIX of the Social Security Act of 1965, is a major source of public financing
for children’s health services. In the early 1980s, federal funding for
Medicaid was cut as part of the Reagan Administration’s efforts to reduce
funding for social programs and return decision-making to the states. Congress
enacted a series of incremental changes in the Medicaid program each year
between 1984 and 1987, and 1989 to 1990. These reforms greatly increased the
number of eligible pregnant women and children and separated eligibility for
Medicaid from welfare (Sardell, 1991). A broad
coalition of children’s advocacy groups, professional associations, health
policy groups, religious organizations and state officials, including the
National Governors Association (NGA), pushed for the Medicaid expansions.
However, by the end of the decade, the NGA opposed further eligibility
expansions, arguing that states could not afford the growing costs of the
Medicaid program.
The second child health case analyzes efforts by the governors to change
Medicaid from a federal entitlement program to a block grant to the states. The
1994 election of a Congress dominated by conservative Republicans, who
advocated for a diminished federal presence in social policies, strengthened
the governors’ influence in federal policymaking. In 1995, and again the next
year, the NGA proposed to reform Medicaid by making it a block grant to states
and thus end Medicaid as a federal
entitlement for those deemed eligible. Although Congress passed the governors’
proposal, President Clinton first vetoed it and the next year threatened a veto
(Sardell & Johnson, 1998). Nonetheless, the
governors’ call to replace Medicaid with a block grant had an important
influence on the 1997 law to subsidize health insurance for uninsured children.
The third child health case examines the 1997 enactment of the State Children’s Health Insurance Program (SCHIP). In August of that year, President Clinton signed two laws that included a total of $48 billion to fund a new federal-state children's health insurance program for ten years. The program was widely hailed as the largest federal investment in children’s health services since the enactment of Medicaid. The swift enactment of SCHIP was partly due to the entrepreneurial activity of Senators Edward Kennedy (D-MA) and Orrin Hatch (R-UT) who in partnership with the Children’s Defense Fund (CDF) proposed and advanced a block grant to states for children’s health insurance.
Child care cases. In 1971 Congress passed the Comprehensive
Child Care Development Act, which proposed the establishment of a universal,
comprehensive, and voluntary child care program, based on Head Start. The bill generated considerable controversy over the issue
of prime sponsorship--which level of government and what size local entity
would be eligible to administer the child care programs. But arguments over the
administrative components of the bill paled in comparison to the ideological
conflicts that the bill sparked. Critics of child care legislation rallied
against what they considered the wrongful involvement of the State in the
rearing of children. In December 1971, Nixon vetoed the child care legislation
(Public Papers of the Presidents of the
U.S., 1972) allegedly to show support for his conservative constituents
(Cohen, 2001; Steiner, 1976).
The next major juncture in child care policymaking was in
1990, when Congress enacted landmark legislation creating the Child Care and
Development Block Grant (CCDBG).3 The
bill, first introduced in 1987, had bipartisan support and featured a child
care block grant to states for low-income working families. However,
conservatives, governors, and several religious groups opposed the bill’s
language on federal child care standards and its restrictions on federal
funding of religiously-affiliated providers. Conservatives also preferred
helping low-income working families with children through tax credits.
Ultimately, members of Congress and the Bush administration brokered a deal
that created the CCDBG and packaged it with expansions of the earned income tax
credit as part of the 1990 reconciliation act.
In 1996, under welfare reform legislation, Congress
reauthorized and restructured the child care block grant. Both sides of the
aisle agreed to consolidate seven major federal child care programs under the
CCDBG, but disagreed about funding levels, health and safety standards, and how
to exempt mothers with young children from work requirements. Eventually,
compromises were reached on these issues and child care advocates succeeded in
getting Congress to increase funding for child care by $22 billion over seven
years.
Common Characteristics of Child Care and Child Health
Policymaking
Both the child care and child health policy arenas were
characterized by failed efforts to enact major legislation before the 1980s,
followed by successful enactment of important legislation by 1990. This was
partly because each policy arena benefited from a renewed interest in
children’s issues during the 1980s. Both the child care and child health policy
communities were characterized by major advocacy coalitions, which featured CDF
as the lead organization. In both policy areas, the NGA and the US Catholic
Conference played major roles, while mainstream women’s organizations were not
consistently involved. In both child
care and child health, enactment of major new legislation created a critical
policy juncture. The growth of the right in American politics was significant
in both areas. Finally, both areas reveal important themes about the social
construction of children in the policy process.
Both child health and child care legislation were on the
governmental agenda during the 1970s and faced conservative opposition,
although for slightly different reasons. Conservatives opposed a federal child
care program because of their fear that it would usurp women’s rightful role in
child-rearing. During the late 1970s, the Carter Administration, supported by
children’s advocacy groups, sought to convince Congress to expand Medicaid
eligibility and services for pregnant women and children. Their efforts failed partly because of
opposition from conservative legislators and controversies over anti-abortion
amendments added to the Medicaid funding bill (Rosenbaum 1988).
The early to mid-1980s witnessed a renewed interest in children’s
issues. The economic recession of the 1980s exacerbated the economic
plight of low-income working families with children (Levy, 1984). In response to Reagan Administration cutbacks in children’s
services and programs, activists in the child care and child health policy
communities drew attention to the needs of children and their families (Imig, 1996; Kimmich, 1985). Their
work was facilitated by the establishment of several new congressional panels
that focused on children’s issues.
One of the most important developments was the establishment of the House Select Committee on Children, Youth and Families in 1983. The Committee’s purpose was to examine data and explore issues related to the status of children and families and to engage members across the ideological spectrum. On the other side of the Capitol, Senators Christopher Dodd (D-CT) and Arlen Spector (R-PA) formed the Senate Children’s Caucus. Other important public and private entities created in the early 1980s facilitated the promotion of child health and child care issues on public and governmental agendas.
Children’s
Advocacy Coalitions
Policy communities may have one or more “advocacy coalitions,” defined as networks of individuals from different institutional positions “who share a particular belief system” or set of basic values about the role of government, have similar perceptions about the nature of problems, and coordinate activity over time (Sabatier, 1988, p. 139). Competing advocacy coalitions with different belief systems may co-exist within the policy community, or one advocacy coalition may dominate. The dominant coalition may be fragmented at various junctures. Both the child health and child care policy communities had a dominant advocacy coalition that changed over time because of conflicts over aspects of pending legislation.
Major child health coalition. During the 1980s, members of the child health policy community could be considered a dominant advocacy coalition because they shared the view that the health status of low income children could be improved by providing comprehensive, integrated community based health care. They also all agreed that the federal government should have a major role in financing and facilitating the provision of services. It was a coalition in which, “Everyone viewed Medicaid as the legislative vehicle for effecting policy change that addressed children’s access to health care” (Sonosky & Rosenbaum, 2001, p.99).
The NGA ceased to be part of this dominant advocacy coalition when it withdrew its support for further federal mandated expansions of Medicaid at the end of the 1980s. It directly opposed the core values of that coalition when it acted as a policy entrepreneur in 1995 and 1996, advocating for a Medicaid block grant to the states as a replacement for the individual federal entitlement to Medicaid.
By the early 1990s, the dominant child health advocacy coalition divided over whether Medicaid expansion should continue to be the vehicle for expanding coverage of uninsured children. In 1996, the CDF and Senator Kennedy, a longtime child health advocate, claimed that given the control of Congress by conservative Republicans, further Medicaid expansions were not feasible. Kennedy and CDF proposed block grants to the states to subsidize private health insurance coverage for low-income children. Others within the advocacy coalition viewed the CDF-Kennedy proposal as potentially weakening Medicaid and threatening the stability of children’s coverage. They supported bills that Senators John Chafee (R-RI) and John D. Rockefeller (D-WV) introduced, which would have further expanded Medicaid. By mid-1997, with the child health policy community split over how to expand coverage for children, the chair of the Senate Finance Committee, Senator William Roth (R-DE), crafted a compromise that allowed states to either expand Medicaid or establish a separate program to cover uninsured children (Nather, 1997). This provision was retained in the final legislation negotiated by President Clinton and the Republican congressional leadership.
Major
child care coalition. Since the late 1960s, one dominant advocacy
coalition has strived to increase the federal government’s investment in child
care. Its members have a commitment to increasing access to affordable and good
quality child care, especially for low-income families. The enormous increase
in federal funding for the child care block grant over the past decade,
reaching over $4 billion by 2001, is largely attributable to the efforts of
this dominant advocacy coalition.
Between 1971 and the mid-1980s, much changed within the
dominant child care advocacy coalition. Under CDF’s
leadership, it grew from a coalition of about 20 organizations in the early
1970s to more than 100 by the late 1980s. Many new organizations that lobbied
for child care were formed in the 1970s and early 1980s. Furthermore, the
proportion of women in the paid labor force with young children steadily
climbed, reaching 65 % by 1988 (U.S. House of Representatives, 2000).
In 1986, the organizations in support of a new federal
child care program formed the Alliance for Better Child Care. With input from
congressional staff, the Alliance drafted the Act for Better Child Care (ABC).
Senators Dodd and Representative Dale Kildee (D-MI) introduced the Act in 1987.
Internal rifts among the Alliance’s many
members delayed advancement of the ABC bill. Many women’s and educational
organizations opposed its final language on funding of religiously-affiliated
providers. In particular, language on vouchers for federally financed child
care threatened these organizations’ longstanding commitments to upholding
separation of church and state.
After the 1990 enactment of the CCDBG, the
Alliance for Better Child Care slowly dissipated. In the mid-1990s, many of its
members reconvened under CDF’s leadership and
successfully lobbied Congress for both annual increases in appropriations for
the CCDBG in the 1990s and its reauthorization in 1996.
For both child care and child health, CDF took the lead in developing legislative strategies, working the media, and coordinating the efforts of a broad array of organizations. It was the center of the dominant advocacy coalition in both policy communities. In synthesizing data from both research projects, we look inside the “black box” of CDF and identify nuances of its work.
Within CDF, we distinguish between Edelman’s role as a
“political entrepreneur” and lead staffers who functioned as “policy
entrepreneurs.” Edelman relied on rhetoric that emphasized the moral
responsibility that American society has for its children. She combined a
“liberal” “language of rights” with a religiously-based
“language of good” in her appeals for support of children’s needs
(Marlow, 1995, pp.163-165). As discussions of morality in social policy, framed
in religious terms by the Right, have become central in American political
debate, Edelman is a singular representative of the use of religiously-based
moral rhetoric on the Left (Marlow, 1995).
As CDF’s financial resources grew
in the 1980s, it was uniquely able to lead other nonprofit organizations
concerned with both child care and child health. CDF has developed grassroots
networks in all 50 states, which enables it to identify advocates across the
country, keep them informed through electronic updates, and teach them advocacy
strategies. CDF also has field offices in nine states and an extensive network
of faith-based communities.
The policy implications of CDF’s dominance are somewhat hard to discern. It does mean that issues such as child care and child health are often framed according to CDF’s legislative and organizational agendas, which might not emphasize perspectives that are priorities for other groups. For child health and child care, this often created divisions within the dominant advocacy coalition.
The National
Governors Association and the U.S. Catholic Conference
Both child
care and health insurance involved policy disputes about the role of federal
authority vs. state autonomy. Thus, state level actors, particularly the NGA,
were important in determining political outcomes at key junctures. As described
above, the governors had a pivotal role in the three cases involving children’s
health insurance. Their influence
increased markedly with the 1994 election, when a Republican majority
supporting a diminished federal role and increased state authority came to
power. Similarly, the governors were influential in opposing the 1971 child
care bill because of its potential to diminish their role in administering
child care programs. They successfully defeated proposals for federal child
care standards in the late 1980s, and their calls for increases in child care
funding were important in 1996 (Cohen, 2001).
Another major actor in both child health and child care was
the United States Catholic Conference (USCC). During the 1980s, lobbyists for
the Catholic Church enlisted “pro-life” legislators, such as Representative
Henry Hyde (R-IL), to become part of the coalition supporting the Medicaid expansions.
The 1980s expansions were made possible by an agreement among CDF, the USCC,
and key congressional staff to separate child health issues from abortion
(Rosenbaum, 1988, pp.25-36). In the case of child care, in the late 1980s the USCC successfully fought
for child care vouchers and the loosening of restrictions placed on
religiously-affiliated providers under the original version of the Act for
Better Child Care. Its support was crucial for obtaining votes among members of
both parties.
Enigmatic Role of Women’s Organizations
In both the child care and child
health cases, the role of women’s groups was complicated. They did not assume
leadership roles in the dominant advocacy coalitions for either child care or
child health. This was particularly puzzling for child care, since policymakers
and advocates frequently referred to the growing number of women in the paid
workforce as a major impetus for federal support of child care programs. The
only women’s organization that was a consistent partner with CDF in leading the
coalitions for both the child health and child care was the National Women’s
Law Center (NWLC).
One explanation for the lackluster involvement of women’s
organizations in child care was that during the 1980s many feminists thought
that lobbying for child care legislation would perpetuate the incorrect
assumption that women were solely responsible for the care of children. Furthermore, in the late 1970s and early
1980s, feminist organizations focused on pay equity, nondiscrimination in the
workplace, and enactment of the Equal Rights Amendment, all of which took
priority over child care (Cohen, 2001). Finally, as mentioned above, in the
1980s many women’s organizations distanced themselves from the final child care
bill because they thought its provisions for religiously-affiliated care
threatened the Constitution’s separation of church and state. By the late
1990s, several women’s organizations, especially the National Council of Jewish
Women, resumed their lobbying for child care. They addressed their concerns
about church-state separation through other issues.
Major Policy Junctures
Both child health and child care were characterized by
critical policy junctures as described by Baumgartner and Jones (1993), which
coincided with the enactment of significant legislation. For child care, the
1990 enactment of the CCDBG began a new era in child care policy. It signaled
the acceptance of a federal presence in the child care arena, even among
conservatives who had been critical of federal involvement for decades. As a
result, the legislative battles in the years after 1990 focused on the size and
nature of the federal government’s investment in child care, not whether or not
it would be involved. The
enactment of the CCDBG, significantly altered the child care policy domain.
Similarly, the enactment of SCHIP in 1997 was a
critical juncture for child health policy. It marked the end of the twenty
years in which the expansion of Medicaid eligibility for pregnant women and
children had been the focus of children’s health activists. Since 1997, the
child health policy community, including state and federal policymakers, has
focused on the factors that promote and impede SCHIP implementation at the
state level. Enactment of SCHIP marked a reconfiguration of federal and state
relationships as they pertain to children’s issues and health care. Some
policymakers view the enactment of SCHIP as signaling the end of new federal
entitlements in health policy. Clearly, the 1997 enactment of SCHIP has created
a significant policy legacy.
Opposition from the Right
Both
child care and child health policies were affected by the growth of the
conservative and religious right political movements in the U.S. and ensuing
ideological debates over the relationship between families and the State. The
child care policy community included not just the dominant advocacy coalition,
but also those opposed to an expanded federal presence in child care. These
individuals and groups comprised the competing advocacy coalition. In the early
1970s, opposition to the federal child care program came mainly from a
loosely-knit group of individuals. By the late 1980s, opposition came from
newly formed think tanks and organizations, such as the Heritage Foundation and
the Family Research Council, and the burgeoning religious right.
Unlike their predecessors in the early 1970s who simply
opposed a federal child care program, conservative opponents in the late 1980s
offered policy alternatives such as vouchers, parental choice, and tax credits
that were eventually enacted into the final 1990 law. The compromises between
liberals and conservatives in the late 1990s have had a lasting impact on child
care policy.
By the late 1990s, the coalition opposed to a federal child
care program began to dwindle. For conservatives, other issues--such as
reducing the tax burden, eliminating the marriage penalty, and promoting school
vouchers--took priority over child care. Moreover, child care had become an
accepted component of the social policy landscape, especially given the work
requirements under the welfare reform law of 1996, which many conservatives had
advocated.
Within the child health policy community, proposals to expand Medicaid during the 1980s did not raise serious ideological controversies mainly because such proposals were framed as preventing infant mortality--a goal supported by actors across a broad ideological spectrum. Moreover, as discussed above, legislators and advocacy groups were able to reach an agreement that separated reproductive health issues from Medicaid expansion, thereby eliminating the potential for ideological conflicts related to the Medicaid bill. When the NGA later opposed further Medicaid expansions on both budgetary and ideological grounds, they found Congressional allies outside the child health policy community.
Many political observers have noted that children lack the
ability to mobilize or to vote. Low-income adults, the disabled, and even
prisoners have the potential
to vote or to protest, while
children do not. Consequently, policy entrepreneurs use the “social
construction” of children in their appeals on behalf of children.
Anne Schneider and Helen Ingram (1993) described children
as a “dependent” group, with low political power, but a positive social image
(p.336). Children are generally seen as biologically, psychologically and
socially more vulnerable than adults. The vulnerability and innocence of
children is, in fact, the basis of moral appeals for their care. As an example,
advocates framed the expansion of Medicaid eligibility for pregnant women and
children as a solution to the problem of high infant mortality rates, an issue
with much emotional resonance (Sardell,
1991).
Children are also socially constructed as unformed and
malleable; they are not yet what they will become. Therefore, they are more
“fixable” than adults (Sardell, 1991). They have a “dual status” as existing in both
the present and the future (Mayall,1998). These dimensions of children’s uniqueness were
central to the arguments made in both the child care and child health policy
debates about the contributions that child care and child health services would
make in building a productive work force or contributing to a safer and more
literate society. During the 1980s, foundations, corporate research
organizations, and congressional agencies issued reports that described how
investments in child health and child care were cost-effective. They argued
that to compete in a new world economy, the U.S. must invest in children.
In 1997, child health advocates framed their successful effort to expand child health insurance coverage in terms of assisting hard-working, deserving families and protecting innocent children from the immoral activities of “Big Tobacco.” Their plan for expanding child health coverage relied partly on an increased tobacco tax. Thus, the primary message from the political coalition formed to support the Kennedy-Hatch proposal was that the legislation advanced a powerful good -- the health of children – while simultaneously opposing a powerful evil -- smoking by children and adolescents. Many of the ads sponsored by the coalition featured a picture of a young boy and the image of “Joe Camel” with the words underneath, “Joey vs. Joe Camel.” Knowledgeable sources noted that the framing of health insurance legislation for children in these terms made it very difficult for the Republican leadership to oppose it. This was the politics of morality writ large, with simple icons of good and evil.
Children’s
Issues in the Policy Process
Implicit in our research and findings is the notion that children are a unique target population for social policymaking. Thus, children’s advocates have used the social construction of children to appeal to certain interested publics on the basis of children’s vulnerability or innocence, or on the basis of their potential future contributions to society. But the politics of children’s issues is not simply about the effectiveness of moral appeals.
Because there is
fundamental conflict within the America polity about the relationship of
families and the State, disagreement persists over how to achieve policy goals
that may improve children’s well-being. The great
political debates surrounding children’s issues have centered on how to achieve
an acceptable balance between public and private sector responsibilities; or,
how to balance the role of government and family in caring for children and
their families. Resolving the conflicts in determining the proper balance between
family and State has historically been difficult (Cohen, 2001; Garfinkel, Hochschild & McLanahan, 1996; Michel, 2000). It has also been
intensified by the growth of the conservative and religious right since the
mid-1970s.
Another characteristic of the politics of children’s issues is that the agendas of children’s advocates were often acted upon in the shadow of other adult-centered issues. For child care, the bitter political arguments were often not about child care, per se, but rather about adult-oriented issues, such as welfare reform or the distribution of the tax burden among families with different incomes. In a similar way, children’s health had to compete for congressional attention and entrepreneurial interest in the face of health care reform efforts aimed at the whole population under the Carter and Clinton administrations. Policy entrepreneurs for children’s health positioned themselves to take advantage of opportunities for incremental reform after the failure of those efforts.
Further empirical research and analysis is needed to understand how the six cases described here compare with other issues in children’s policymaking. Such research will contribute to the development of a body of data that can be used to advance our knowledge of the policymaking process for children and social policymaking, generally.
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[1] This is a revised version of a paper that the authors presented at the 2002 meeting of the American Political Science Association, Boston, MA.
[2]
Alice Sardell is
working with Kay A. Johnson of Dartmouth Medical School on the six child health
policy cases. They gratefully acknowledge financial support for their work from
The Robert Wood Johnson Foundation Investigator Awards in Health Policy
Research Program. Sardell’s work was also funded by
the City University of New York PSC-CUNY Research Award Program.
3 Technically, 1988 was another major juncture for child care policymaking when the Family Support Act required states to offer child care to welfare participants enrolled in the federal JOBS program. It is not included here because it was not part of the ongoing effort to establish a federal child care program