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Administrative Burdens in Health Policy

JHHSA, Vol. 43 No. 1, 3-16 (2020)

The US healthcare system is enormously complex, begetting a seemingly endless array of bureaucratic obstacles that make it both costly and difficult to navigate for users. We apply the administrative burden framework to three particular aspects of health policy: the Affordable Care Act (ACA), Medicaid, and Medicare. The applications are more illustrative than definitive, intended to demonstrate that administrative burdens play a key and underappreciated role in how policies are implemented, sometimes deliberately so. The following claims arise from our framework. First, burdens are consequential – they make a difference in our lives, most obviously in terms of access to healthcare. Second, administrative burdens are distributive: some groups, like the poor, are more burdened than others. Third, burdens are a function of political and administrative choices, constructed via processes of both policy design and implementation.

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