The Delegated Welfare State

Why are so many American social programs delegated to private actors? And what are the consequences for efficiency, accountability, and the well-being of beneficiaries? The Delegated Welfare State examines the development of the American welfare state through the lens of delegation: how policymakers have avoided direct governmental provision of benefits and services, turning to non-state actors for the governance of social programs. Utilizing case studies of Medicare and the 2009-10 health care reform, Morgan and Campbell argue that the prevalence of delegated governance reflects the powerful role of interest groups in American politics, the dominance of Congress in social policymaking, and deep contradictions in American public opinion. Americans want both social programs and small government, leaving policy makers in a bind. Contracting out public programs to non-state actors masks the role of the state and enlists private allies who push for passage. Although delegated governance has been politically expedient, enabling the growth of government programs in an anti-government political climate, it raises questions about fraud, abuse, administrative effectiveness, and accountability. In probing both the causes and consequences of delegated governance, The Delegated Welfare State offers a novel interpretation of both American social welfare politics and the nature of the American state.

Kimberly J. Morgan is Associate Professor of Political Science at George Washington University. Andrea Louise Campbell is Associate Professor of Political Science at Massachusetts Institute of Technology.

Chapter One. Introduction The Concept of Delegated Governance The Case Study of Medicare The Methodology and Organization of This Book Chapter Two. Exploring the Delegated Welfare State Conceptualizing the Delegated Welfare State What Does the Delegated Welfare State Look Like? A Cross-National Perspective on Delegated Governance Why Did the Delegated Welfare State Emerge in the US? Does It Matter How Social Programs Are Administered? Conclusion Chapter Three. Medicare and the Delegated Welfare State in the Post-War Era The Emergence of the Delegated Welfare State Delegating the Governance of Medicare Conclusion Chapter Four. The Rise of the Market Reform Movement The Complex Politics of Welfare State Privatization The Free Market Movement in Health Care The Politics of Marketization Conclusion Chapter Five. Crafting the Medicare Modernization Act of 2003 Delegated Governance in the MMA The Political Context: Polarization, Electoral Competition, and Partisan Conflict Program Design: The Turn to Delegated Governance Passing the MMA in 2003 The Politics of Delegated Governance Chapter Six. Administering the Delegated Welfare State The Cases of Medicare and the 2003 Medicare Modernization Act Delegated Governance in Traditional Medicare: A Mixed Picture Creating a Social Welfare Marketplace: The 2003 MMA Conclusion Chapter Seven. The Delegated Welfare State and Policy Feedbacks The Feedbacks That Haven't Happened (Yet) The Feedbacks that Did Happen: Public Demobilization and Issue Preemption Conclusion Chapter Eight. Citizens, Consumers, and the Market Model Consumers and the Requirements of the Market Model Senior Consumers and Part D Decisionmaking Part D Effectiveness and Senior Welfare: Mixed Evidence Vulnerable Populations and Redistribution Issues Conclusion Chapter Nine. Conclusion: Delegated Governance, Past, Present, and Future Implications for Thinking about the American State The 2009-2010 Health Care Debate: A Fight about Governance Appendix A. Data Sources Interviews MMA Panel Survey Wisconsin Advertising Project Data Appendix B. Supplementary Tables