Recently I wrote here about the changing political and policy climate around Medicaid expansion and Dr. Liane Wong followed up with an overview of the role of child advocates in working around the same issue, highlighting a report by the David and Lucile Packard Foundation. Dr. Wong’s piece reminded me of some basic theory any first year public policy student learns, that of “policy windows of opportunity.” The currently fast-shifting debate in states around Medicaid expansion is a really nice illustration of just what this phrase means.
At the most basic, a window of opportunity in the policy world is when some change – either internal or external – shifts the current landscape and results in a new chance for change to happen on a particular policy issue. In the Medicaid expansion debate, recent influential studies have quantified the costs to states of not expanding coverage, politically influential hospitals are widely recognizing the non-expansion costs to their bottom lines and successful approval of several conservative state plans to expand Medicaid are three factors that have all combined to open a new policy window. So, with these changed circumstances comes a new chance to make policy change.
There is one other crucial element to this policy window idea however that is easy to forget. This is the fact that just because a window is open doesn’t mean anything will actually fly through it. Some actor or combination of actors in the policy world needs to push the change. And here is where the role of advocates for children and health care comes into the picture. As the Packard Foundation report summarized by Dr. Wong demonstrates, when a policy window of opportunity opens up, well-established and respected state health and child advocacy groups can be ready to play this role.
Successfully taking advantage of a new policy window of opportunity isn’t easy or guaranteed. The difficulty or uncertainty inherent in any debate around policy, especially change that is politically charged, introduces substantial barriers even when change is possible. Therefore, the stronger, better-informed, better-prepared, and better-positioned policy actor is one who can best take advantage of change. And none of those characteristics comes without a great deal of hard and sometimes frustrating work well before new opportunities are presented. In the case with an issue like Medicaid expansion, these groups are the ones with substantial published products and a historically strong presence among the media and policymakers.
In the end, the policy window of opportunity idea is pretty simple. Circumstances may change and opportunities may arise but it is still necessary to have committed and smart people to make policy change happen.
