#administrativeburden

On drug tests for SNAP: “Such changes - even when they exist only as policy proposals - reinforce the notion that the poor must be closely policed in the use of public funds, more so than other beneficiaries of tax dollars. We do not demand drug tests of homeowners taking a mortgage deduction”

Love this book @donmoyn @pamela_herd

criteria. The feder burdens, or to delegate the capacity toy oug or administrative burdens, or to delegate the capacity to do som states. If state oversight of other welfare programs is any guide, the result would be to constrain what individuals could purchase and layer more conditionality on the receipt of benefits. Such changes. even when they exist only as policy proposals - reinforce the notion that the poor must be closely policed in the use of public funds, more so than other beneficiaries of tax dollars. We do not demand drug tests of homeowners taking a mortgage deduction, students receiv- ing subsidized loans, or corporate employees provided with tax subsidies. The recent history of SNAP therefore illustrates the fragility of a urely technocratic approach to burdens. Political support is needed to reduce burdens. Administrative burdens, once discovered and liminated, are not necessarily gone forever. Instead, policymakers

Replied in thread

**Jack Iwashyna** @iwashyna@critcare.social · Jan 4, 2023

Jan 4, 2023

@eduglaze @lakens

really interesting to think through the power / trust implications of actually operationalizing this -- as well as the #AdministrativeBurden

**Jack Iwashyna** @iwashyna@critcare.social · Dec 31, 2022

Dec 31, 2022

Hey friends, if you have been enjoying my notes on #HerdMoynihan’s lovely book #AdministrativeBurden under those hashtags, it appears Prof @pamela_herd is #OnHere, too

ADMINISTRATIVE BURDEN POLICYMAKING BY OTHER MEANS PAMELA HERD AND DONALD P. MOYNIHAN

**Jack Iwashyna** @iwashyna@critcare.social · Dec 30, 2022

Dec 30, 2022

“A major lesson from the rollout of the ACA is that the success or failure of big policy changes depends on administrative burdens”

THE AFFORDABLE CARE ACT 119

A major lesson from the rollout of the ACA is that the success or failure of big policy changes depends on administrative burdens. The actions of proponents and opponents of Obamacare support this view. Proponents, realizing the program's complexity, reduced bur- dens by educating the public about the program and making it as easy as possible for people to enroll. Opponents sought to create admin- istrative burdens to undermine program enrollment. For both sides, the stakes were clear. Administrative burdens were seen as a key to either guaranteeing the long-term viability of the law, or ensuring its unpopularity and ultimate failure.

Continued thread

**Jack Iwashyna** @iwashyna@critcare.social · Dec 30, 2022

Dec 30, 2022

I had somehow forgotten about this shitfuckery

“Michigan proposed to limit #WorkRequirements to counties with low unemployment, exempting those with higher unemployment. As a result, res- idents in high-unemployment cities that fall in low unemployment counties-such as Detroit and Flint-would be subject to the new requirements”

In some instances, new documentation requirements seemed designed to fall harder on some people more than others. Michigan proposed to limit work requirements to counties with low unemploy- ment, exempting those with higher unemployment.» As a result, res- idents in high-unemployment cities that fall in low unemployment counties-such as Detroit and Flint--would be subject to the new requirements. A higher proportion of blacks live in such cities. Even as they face unemployment rates similar or worse than predomi- nantly white residents in rural counties, they face more demanding burdens.78

**Jack Iwashyna** @iwashyna@critcare.social · Dec 30, 2022

Dec 30, 2022

#HerdMoynihan #administrativeBurden #obamacare #sabotge

So much rage

“New HHS promotional materials fea- tured videos of people explaining how the ACA had harmed them.”

“People will be required to upload the necessary docs mentation to verify their [#WorkRequirement] activities. But 30 percent of low-income adults most likely to be on Medicaid report they never use a computer, 28 percent say they do not use the internet, and 41 percent do not use email”

burdens lot harts" tons to limit competition for commissions,40 Partisan politics also played a role. Those ideologically opposed to the ACA saw undermin- ing outreach as a way to hobble Obamacare. The insurance commis- sioner in Georgia spelled out this approach: "Let me tell you what we're doing. Everything in our power to be an obstructionist. We have passed a law that says that a Navigator, which is a position in that exchange, has to be licensed by our Department of Insurance. The Obamacare law says that we cannot require them to be an insur- ance agent, so we said fine, we'll just require them to be a licensed Navigator. So, we're going to make up the test, and basically you take the insurance agent test, you erase the name, you write 'Navigator test' on it."41

• website. othe What dare was modeled on an approach that enjoyed binaries gator Program was modeled on an approach that enjoyed bipartisan support: the State Health Insurance Assistance program. Indeed, this program had been in place since 1990 and was a key way the George W. Bush administration pursued outreach when it added prescription drug benefits to Medicare. By contrast, navigators had to worry they might face personal attack from conservative social media. For exam- ple, the Kansas Watchdog published a story online about a navigator, including her name and picture, attacking her for a past bankruptcy and resulting arrest warrant -ironically for unpaid medical bills due to a hospital stay.45

serve con The election of President Trump further accelerated declines in support. Since 2017, the federal government substantially curbed outreach. The Trump administration quickly canceled spending on advertising immediately following the inauguration, affecting the final weeks of enrollment in January of 2016. He then cut the ACA outreach budget by 90 percent. New HHS promotional materials fea- tured videos of people explaining how the ACA had harmed them. HHS told its own regional staff to no longer participate in enrollment events designed to reach the public. They also cut ACA promotional partnerships with organizations that had direct access to potential beneficiaries, such as companies whose low wage employees might be eligible, faith-based organizations, and medical groups. Finally, HHS ended contracts with private firms that provided in-person assistance for enrollees, and cut the Navigator Program budget by about 40 per- cent, Nonetheless, the federalist system has partially undermined wen states such as Cali-

The challenge is documenting this partic- ipation. Ten regional workforce boards are tasked with monitoring Compliance. People will be required to upload the necessary docs mentation to verify their activities. But 30 percent of low-income adults most likely to be on Medicaid report they never use a computer, 28 percent say they do not use the internet, and 41 percent do not use email.74 It is unrealistic to expect that such a population will have the technological literacy to navigate online documentation processes.

Sarah and Matt Burress offer an example of the difficulties involved. The Medicaid coverage they gained after Matt started his lawn care business was crucial: his glaucoma would have led to blindness with- out treatment. But the informal, irregular, and seasonal nature of his work does not align well with new documentation requirements. Sarah noted, "Do his clients have to say, 'Yeah, he mowed my grass this week?' Part of it feels like they're trying to catch you, by buryins people in paperwork and making it a huge inconvenience the case is not atypical. Bill Wagner, who manages primary care clinics

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**Jack Iwashyna** @iwashyna@critcare.social · Dec 29, 2022

Do I read this tonight or will it make me too mad to sleep?

FALSE CLAIMS AND TARGETED BURDENS THE CASE OF ABORTION RESTRICTIONS

Chapter 3

74 | ADMINISTRATIVE BURDEN

Table 3.1 Burdens Targeted at Women Seeking Abortions

State Policy Limitations prohibiting private insurance (eleven states) Documenting rape, incest, or risk to life to use health insurance Waiting periods (twenty-seven states) Potential Costs Learning costs to understand what is covered, compliance costs via out-of-pocket spending Psychological and compliance costs for women to document these conditions Compliance cost for both women and providers arising from additional appointments Compliance cost for women who have to go to a more expensive setting for an abortion Abortions after a specific point in the pregnancy must be performed in a hospital (nineteen states) Physician must be physically present to administer medical abortion (nineteen states) Mandatory scripted counseling (eighteen states) Required ultrasounds (twenty-six states) Parental notification (thirty-seven states) Source: Guttmacher Institute 2017. Compliance cost for both women and providers arising from additional appointments Psychological costs for women and potential learning costs if given incorrect information; psychological costs for providers Psychological costs on women, compliance and psychological cost for providers Psychological costs on women, compliance cost on provider seeking permission

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**Jack Iwashyna** @iwashyna@critcare.social · Dec 29, 2022

The #HerdMoynihan #AdministrativeBurden chapter on #Voting reviews an enormous amount of data and has these handy tables!

“Contemplating how burdens matters to the basic right of voting recalls William Faulkner's observation that "The past is never dead. It isn't even past." The history of burdens in the post-Reconstruction South holds striking parallels with the present. “

Table 2.1 Comparing Burdens in Pre- Voting Rights Era and Today Pre-Voting Rights Act Era Learning costs Knowledge of requirements, substantive and esoteric information requested (such as details of the U.S. Constitution) as part of a literacy test; costs higher if administrators chose not to share information about registration Compliance costs Poll taxes; requirements to bring documenta- tion of status, witnesses, extra time, and financial costs resulting from delays imposed by discretionary requests of local officials Psychological costs Stress of registering and voting because of overt discrimination, stresses of participating in rigged literacy tests; concerns about intimidation and violent retribution Source: Authors' compilation. Today Knowledge of registration policies, documenta- tion required and deadlines, polling place location Time and effort to travel to register and vote; providing appropriate documentation Concerns about validity of ID historyofatons 1

54 | ADMINISTRATIVE BURDEN

Table 2.3 Policy Checklist to Reduce or Increase Burdens in Voting Reduce Vote by mail and mail absentee voting reduces learning and compliance costs Early voting, weekend voting, in-person absentee voting or making Election Day a holiday increases the convenience of voting Source: Authors' compilation. Increase Reducing the number of days of early voting, limiting its overlap with registration, reducing weekend voting Voter ID laws create learning and compliance burdens to acquire IDs

)/ THE RESURGENCE OF BURDENS IN VOTING | 69 Conclusion Contemplating how burdens matters to the basic right of voting recalls William Faulkner's observation that "The past is never dead. It isn't even past." The history of burdens in the post-Reconstruction South holds striking parallels with the present. Laws and procedures were adopted with clear discriminatory intent and effects. The imple- mentation of those laws, and the beliefs of bureaucrats tasked with implementation, may be just as important as the laws on the books. The empirical evidence reviewed in this chapter suggests that these central features remain salient to the experience of voting today. Contemporary election policies are motivated by race- more restric- tive laws are passed in states with higher populations of politically active black people. Some of these policies will create burdens that make it less likely that citizens will vote. And low-income and minority voters are more likely to experience these burdens relative to other groups--they are less likely to get help in terms of information or support, less likely to have a polling place close by, and are more likely to be required to prove their identity. In short, the evidence largely supports Ginsburg's vision of elec- tions. It took the strong medicine of the Voting Rights Act to end widespread discrimination. As soon as the preclearance requirements TRANS

**Jack Iwashyna** @iwashyna@critcare.social · Dec 29, 2022

I know I am quoting too much and forking the threads annoyingly, but, SO GOOD

“the generally opaque nature of #AdministrativeBurden makes them valuable as a form of policymaking by other means that substitutes for or complements more overt policy change. …

“One of the most striking examples is the use of burdens, such as unnecessary regulations for abortion providers, to prevent women's access to legal abortion”

How much of healthcare do #HerdMoynihan explain?

Fourth, we propose that the generally opaque nature of adminis- trative burdens makes them valuable as a form of policymaking by other means that substitutes for or complements more overt policy change. This point is important in an age of fierce polarization when, absent unified political control, parties look to nonlegislative ways to make policy. Indeed, administrative burdens form part of the "hidden politics" that Jacob Hacker argues have characterized battles about the role of the state in recent decades, where big policy changes have been made largely out of public view and without large formal policy choices.84 Although Hacker is most concerned that the welfare state has failed to evolve to reflect the contemporary risks individuals are vulnera- ble to, administrative burdens fits into the category of "subterranean political processes that shape ground-level policy effects, which he argues are both fundamental to understanding the evolution of governance and largely neglected.& One of the most striking examples is the use of burdens, such as unnecessary regulations for abortion providers, to prevent women's access to legal abortion.

**Jack Iwashyna** @iwashyna@critcare.social · Dec 29, 2022

.@jsussman thought you would enjoy this: on the intentional use of unbalanced quality metrics in welfare admin

Welfare policies offer a straightforward lustration of how burden, reflect articulations of competing values. As far back as the Nixon administration, welfare programs have not been designed tobalane take-up by eligible claimants with mistaken payments to indigibe beneficiaries; instead, administrative procedures have been used reduce the former in the name of the latter? Federal quality contro guidelines offered states stronger incentives to avoid overpayment rather than to enroll eligible participants.? Contemporary perfor mance evaluations of welfare programs maintain this tradition br rewarding reductions in fraud measures but neglecting beneficiary take-up.? Welfare is also a domain where the politics of race play ou with robust evidence that burdens fall disproportionately harder on black, relative to white, beneficiaries ? As we examine each polis we identify the political values that arise in debates about burdens.

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**Jack Iwashyna** @iwashyna@critcare.social · Dec 29, 2022

“The simple act of waiting communicates that the state believes that individuals' time is of little value.”

UNDERSTANDING ADMINISTRATIVE BURDEN | 27 offering few skills to enable them to move out of poverty but feel they have no choice but to participate. 46 Other aspects of citizen-state interactions can more subtly reinforce messages of power and standing. Welfare office waiting spaces tend to be systematically designed to convey certain messages to those who use them.* The simple act of waiting communicates that the state believes that individuals' time is of little value 48 Such spaces may also be characterized by few amenities, the use of security, and partitions between claimants and caseworkers, further reiterating the limited standing of the claimant. 49 Studies of welfare programs illustrate how the state may com- municate that people are unable to determine how to live their lives and must conform to externally imposed processes and directives. Qualitative accounts find that welfare claimants are acutelv aware of the disempowering effects of such processes and their relative lack of autonom. "

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**Jack Iwashyna** @iwashyna@critcare.social · Dec 29, 2022

“If behavioral economics provides a logic for why cognitive biases make small burdens a big deal, social psychology suggests that violating basic psychological needs of autonomy and respectful treatment also exacerbate burdens.”

**Jack Iwashyna** @iwashyna@critcare.social · Dec 29, 2022

“A simple definition of #AdministrativeBurden is that it is an individual’s experience of a policy’s implementation”

I find #HerdMoynihan’s articulation of “learning costs” particularly useful as an addition

individual Experience of Burdens and Effects on Citizens

A simple denition of administrative burden is that it is an india. tals experience of a policy's implementation as onerous A mos specie definition is that administrative burdens are the leaning psychological, and compliance costs that citizens experience in the interactions with government. This definition is helpful for two tea. sons. First, it distinguishes between the actions of the state and the experience of the individual. As figure 1.1 makes clear, the state can construct rules and processes that give rise to the experience of burden, but the individual experience of burden is distinct from rules and process. Second, the definition allows for variation in the expe- rience of burdens. To return to the example of the DMV, both the person who has waited twenty minutes and the person who has waited two hours have experienced burdens, but the costs imposed on the latter are greater. It may seem excessive to label twenty min- posses urdensome because it may reflect the most ficient serie possible. But allowing for variation in the degree of burden provides for greater precision, enabling us to distinguish between experienti that are more or less burdensome. To broaden the simple defnitions given, we identify broad at Wasten offarma. Be as of cos that constitute tions given, we ident be aberd

Table 1.1 The Components of Administrative Burden Learning costs Compliance costs Psychological costs Time and effort expended to learn about the program or service, ascertaining eligibility status, the nature of benefits, conditions that must be satisfied, and how to gain access Provision of information and documentation to demonstrate standing; financial costs to access services (such as fees, legal representation, travel costs); avoiding or responding to discretionary demands made by administrators Stigma arising from applying for and participating in an unpopular program; loss of autonomy that comes from intrusive administrative supervision; frustration at dealing with learning and compliance costs, unjust or unnecessary procedures; stresses that arise from uncertainty about whether a citizen can negotiate processes and compliance costs Source: Authors' compilation.

Continued thread

**Jack Iwashyna** @iwashyna@critcare.social · Dec 29, 2022

“#Nudges become an attractive mode of action when one has decided to ignore more structural shoves that influence societal inequality”

**Jack Iwashyna** @iwashyna@critcare.social · Dec 29, 2022

#HerdMoynihan note “ordeal mechanisms” as an antecedent to their concept of #AdministrativeBurden

Ping @sociology if either of them are #onHere

of burdens. Antecedents of the Concept of Administrative Burden Our framing of administrative burden as costs may imply a rational approach under which citizens weigh costs against expected bene- fits. A perspective from economics, which frames burdens as ordeal mechanisms, rests on such an approach: only those who truly derive a good deal of utility from a good or service will put up with the hassles that must be borne to receive it. Those who are not highly motivated to receive the good, such as wealthier people who value their time more highly and are unwilling to spend it negotiating burdens, will exit the process. The ordeal mechanism perspective warns us that burdens can be sO great that people will simply opt out of dealing with processes they find too onerous. But it also has limitations. For one thing, unless elected officials deliberately design administrative processes with the rationing effect of burdens in mind, such effects are an unanticipated

**Jack Iwashyna** @iwashyna@critcare.social · Dec 28, 2022

Dec 28, 2022

I had not realized the Treasury once released something entitled “Report to the Secretary on the Acquiescence of this Government in the Murder of the Jews”

risk as potencion of ment visa application form was four feet long.26 entitical choices about burdens can be amplified or undercut, administrative actors. In the case of immigrants, the pasive respons ofthe US. government was compounded by a State Departmentthe used its discretion to harden rather than relax administrative bur dens. As early as 1930, consuls in Germany were directed by the State | Department to limit the issuance of visas to no more than 10 percent of the allocated quota.? Administrative burdens became a mechanism to achieve this goal. As World War II came to a close, and the grim fate of Jews who had stayed in Germany became apparent, the Treasury Department issued a scathing attack on the U.S. government in gen- eral and the State Department in particular. In its "Report to the Sec- retary on the Acquiescence of this Government in the Murder of the Jews," the Treasury identified the power of individual administratols to obstruct immigration. For example, Breckinridge Long, assistant secretary of state, described as an anti-Semite and nativist, used his…

INTRODUCTION | 9 bureaucratic power to block a variety of efforts to help migrants. For instance, he crafted a State Department memo in 1940 guiding the obstruction of visas. Long could take such actions in the knowledge that Congress "would certainly not object to administrative devices to limit immigration."29

These political choices are present not only in extraordinary cir- cumstances. They are also present in the most mundane encounters with government that nearly all people experience.