Constituent Voice: A Key Tool for More Effective Administration of Government Programs

Executive Summary

 Responsive social programs are a North Star of good governance. In the context of a dynamic and sometimes volatile economy, well-run government programs can protect against precarity and deprivation while supporting economic mobility and paving the way towards greater opportunity. This is the promise of well-designed and effectively administered social policies. Unfortunately, the current reality falls far short of that promise. This failing does not stem from (grossly overstated) government waste or abuse. In fact, given the scale and needs of the populations they serve, major government programs like Medicare and Medicaid are more effective[1] and less costly[2] than private sector alternatives. While there are certainly ways that social programs can create cost savings,[3] it is an even higher priority that government be responsive to the needs of the people it serves. In a context where government waste (real and imagined) is weaponized within partisan politics[4], it is easy to forget that creating, sustaining, and administering social programs in ways that make people’s lives better is a central purpose of government. Indeed, the core functions of government revolve around ensuring “a minimum standard of living, a modicum of protection against the losses that result from the ebb and flow of the economy, and the resources for social mobility.”[5]

This white paper makes the case that effectively fulfilling these fundamental government responsibilities requires the robust and systematic centering of the voices of the denizens who most rely on public social programs.[6] Under the current structure of administering social programs, those with the most at stake are rarely the critical drivers of decision-making and reform. Because the most salient users of government programs are resource poor, the programs that serve them are widely stigmatized[7], our wider political culture depicts them as undeserving[8], and it is common to presume them incapable of being active participants in governance. The convergence of these social and political biases dampens the voice and power of policy constituents—the people most in need of government support.

This paper uses qualitative evidence to highlight the insights of social policy beneficiaries and to make the case that government agencies can cultivate more responsive, effective, and democracy-enhancing social programs by more consistently and thoughtfully engaging the people they serve. The takeaways offered here are based on in-depth research interviews with 260 enrollees and 31 agency staff of Medicaid, SNAP, (Supplemental Nutrition Assistance Program), and WIC (Special Supplemental Program for Women, Infant, and Children) programs. These interviews lasted up to an hour and tackled a wide range of topics related to experiences with social programs. Through analyses of interviewee perspectives, this paper demonstrates the importance of government responsiveness and surfaces a range of concrete perspectives on how to improve the functioning of government programs both for the people who use them and the administrators who implement them. 

What Responsive Government Means and Why It Matters

 Government agencies cannot respond to needs that they are unaware of. While objective information like income is important for certifying eligibility for government support, the perspectives of the people who are using social programs are essential to responsive government. Even if everyone who is eligible for a government program based on objective criteria (like income) were enrolled, that program could still fail to address the needs it was designed to meet. Enrollment might not translate to benefit access, the nature or quality of benefits might not be adequate, or experiences accessing and making use of benefits might prove prohibitively burdensome. These and other barriers to effective social programs are impossible to sufficiently identify, understand, or change without input and influence from the people who must overcome them. Indeed, research[9] suggests that frontline workers in government agencies are more apt to reduce the demands placed on the people they serve when those people are able to communicate their experiences and burdens. For government agencies seeking to operate more effectively, incorporating and responding to the input of program users is both logical and ethical. It is logical because experiential feedback is a straightforward mechanism for identifying consistent and emerging problems in the complex processes of administering government programs. It is ethical because including the voices of the people who are affected by programs in the processes of changing and improving those programs buttresses vital building blocks of democracy, such as fairness and shared power.

Notwithstanding such rationale, robust inclusion of program users into the administrative processes that shape government programs is not the norm. Moreover, even when feedback from program beneficiaries is solicited, systematic use of that input to enable influence is sporadic at best. Government social programs do not adequately incorporate the experiential knowledge of the people they are supposed to help. This oversight is not driven by malicious intent. As I have engaged hundreds of government officials over the last several years, I have found the opposite: many administrative leaders and frontline workers want to help the people they serve. Despite these stated desires, agency bureaucrats often have scant incentives to follow-through on such intentions, limited resources to devote to the task, and insufficient institutional mechanisms for facilitating outreach to policy beneficiaries or acting in response to their concerns.

Fortunately, this is not how things have to be. When the decisionmakers tasked with operating government programs devote time and resources to understanding the perspectives of the people and communities they seek to support, the knowledge they gain can improve the way government works. The path to more effective, efficient government is not a scorched earth campaign of indiscriminate slashing and cutting, it is a person-centered commitment to learning from those with the deepest knowledge of programs and their consequences. Such an approach can be applied across levels of governments (national, state, local) and in a variety of policy contexts. In fact, much of the data that forms the basis of this paper was collected in partnership with Medicaid, SNAP, and WIC agency officials. We partnered with agencies to ensure that what we learned from the people most affected by government could play a role in improving it. We met regularly with state officials, sharing our findings with them in real time, so that the experiences and perspectives of the everyday people included in our research could directly inform ongoing decisions and processes.

Research-practice partnerships like this are only one of many ways to embed the voices and experiences of policy beneficiaries into the decision-making processes to facilitate responsiveness and accountability. Other strategies include robust and influential advisory councils that center those who are otherwise least powerful in government processes, systematic and well-institutionalized feedback collection practices, consistent and effectual public meetings, and more. These practices point to a set of core principles for cultivating responsive, democracy-enhancing public programs:

1. Remove the burden to initiate feedback from the beneficiary
2. Create multiple pathways
3. Ensure a real path of influence
4. Communicate early and often

This paper draws on the knowledge of policy beneficiaries to motivate and justify these principles, showing why they are critical imperatives for anyone seeking to make government work better for the people who most acutely rely on it.

 

Government Programs Neglect Constituent Voices

The neglect of voice within processes of administering government programs is salient to the people who use those programs. In a recent research study funded by the Robert Wood John Foundation[10], I partnered with Carolyn Barnes[11], a researcher at the University of Chicago, to conduct in-depth interviews with people receiving Medicaid, SNAP, and WIC benefits, as well as people working in agencies administering those benefits. This white paper draws on 291 of these interviews.[12] By capturing the perspectives of the people who directly experience social programs, we demonstrate the logic and value of centering those who have the most at stake within administrative processes.

Our study involved asking research interviewees about their experiences with key social programs and their thoughts on how to improve those programs. One of the questions we asked interviewees was whether they had any influence or say over anything that happened with public programs they relied on. The answers to this question were overwhelmingly negative. Instead of beneficiaries believing they have any influence over programs, many instead believed that political elites are the only ones who have power. This suggests (as reflected in scholarly research)[13] that a lack of voice within administrative contexts can inform views of government, politics, and democracy. Such sentiments were prevalent among interviewees across a wide range of backgrounds (racial/ethnic) and locales (urban/rural). To underscore the extent and depth of these perspectives, consider these viewpoints articulated by research participants:

• “They don’t include us in those decisions [about the program]. That’s only the politicians who’ve never been on public assistance [who] make those choices.”
• “Absolutely not [I don’t have influence over the program]. Absolutely not. It is such a disrespectful system. I’ve never been asked my opinion…I don’t think we have a damn say.”
• “Our voice don’t really get heard.”
• “I don’t think we have a say on how they run the program. No, not at all.”
• “They never really ask you your opinion… No, ma’am.”
• “I feel like people who have never had to be on government assistance at all…probably shouldn’t be making decisions for people like that when they don’t understand and wouldn’t know.”
• “[They don’t ask us] because the government don’t care about nobody. As long as you vote for them, what else do they care about?”
• “I feel as though the government feel as though being that they giving it to us, then we don’t have a say over it. You take what you get.”
• “No, we don’t have a say, but I wish we did because…if all of us need to get a little [help], I think we should have a say in it.”
• “…do I think anybody listens? No, they don’t talk to us. Because if nothing else, I should be able to report that doctor, that dentist that didn’t clean my teeth… This is our tax dollars. Most of us have worked. I’ve worked in this country since I was 14. I’m 61 …And people that are on Medicaid aren’t less than. Even if I wasn’t on Medicaid or never had to use it a day in my life, I know that these people are not less than. Why are they treated like less than? So no, they don’t talk to us. That would be in an ideal world. That would be perfect…”
• “…the people that’s using these benefits, of course, their opinions matter because they are the ones that has to use it. So, if they want to please the people, I believe they have to listen to the opinions of others, and if something is not going right, that the issue will be fixed.”
• “No, we don’t have a say, but I wish we did …I think we should have a say in it. I think we should matter. We still got to eat…”
• “I think that we should have a say in how the program should be run because the program is for us.”

Among the few people who expressed feeling like they had a voice, most positive sentiments were framed as aspirational rather than based on actual experiences. For example, one person noted: “I’d like to think that the way that I vote when it comes to voting time…I hope that helps where it needs to be helped.” Along similar lines, another beneficiary averred that “if more people would come together in a unity and start going to their state representative, it would make more of a change.” Some optimistic perspectives were more specific, noting the positive potential of processes that allow beneficiaries to offer feedback useful for identifying and fixing recurrent problems in government systems:

“I believe we should be able to have a say … I think everyone should be able to have a say so. Because we need to get our voices heard and we can get our point across as well. Like sometimes when, I would say, ‘we’re having issues with our cards’ or anything I feel like we should be able to say ‘hey you guys need to be able to fix your system’ so that families out here are [not] going homeless or going hungry because our cards are messed up…believe we should be able to talk to them and they fix certain things.”

Beyond such hopes, only a small number of people discussed concrete experiences entailing their voices being incorporated into administrative processes.

The Limits of Current Practices

Among the handful of policy beneficiaries that highlighted mechanisms for constituent voice, most expressed skepticism that revolved around effectiveness and follow-through. Here are a few exemplars from SNAP and WIC beneficiaries:

• “We do say stuff. I don’t think they take it into consideration. They do listen to our complaints…but I don’t think they really do much about it.”
• “I did fill out a survey and I know they had a couple of listening sessions I couldn’t attend…it seems like they are interested in input from WIC participants. But if they’re actually going to use it, I don’t know.”
• “I mean, you always free to get feedback or your opinion that things is not going right, but they have their own set of rules…”

Interviews with program staff gave us additional, complementary perspectives on agency efforts to be responsive to constituent input. As frontline workers, the staff are the very people tasked with gathering such input. When we asked them whether and how beneficiaries have the ability to influence programs, they pointed to surveys, information gathered through phone calls, and physical “suggestion boxes” where program users can leave feedback. They also (less commonly) mentioned community meetings as well as more adversarial procedural processes such as administrative fair hearings. Altogether, program staff noted numerous available pathways for beneficiaries to speak up. For example, a case worker in Pennsylvania noted that,

We also have a Tell Me Box where they can tell anything that they would like changed or that they would like to do…whatever it is that they want. They can tell, or they can just come straight up to someone and ask to speak to the head coordinator that’s there for the day. And they usually get with them within the hour.

Another agency worker in Kentucky describes more formal processes of complaining of when beneficiaries believe something was done incorrectly or improperly:

There’s the ombudsman office. I don’t have that number memorized, but I do keep it on a sticky note near my computer. Usually, if it is something that’s pretty bad, like, a worker was really rude to them, or their case was just failed on multiple steps in the process. Even if I fix it, I will advise them to go ahead and call the ombudsman and make a report. And that will be investigated by someone else at a later date…There’s also hearings where they can file for a hearing if they believe that their case was acted on incorrectly, or that our decision was wrong…After somebody files for that…someone to represent the agency will be picked. And if I’m picked, what happens is I go in, and investigate the case. I look at it from application to the very end of whether it was discontinued or if it’s still ongoing…And just look at every step along the way, every piece of information returned, read through case notes. And if I don’t see where there’s any agency error, then I just compile proof and submit it. And then usually I’ll try to call the client and explain what went on. And if they still would like to continue with the hearing, then what we do is we go to a hearing officer and we both explain our side.

The most mentioned mechanism was phone calls made by beneficiaries who seek to talk about problems or needs. It is the job of agency staff to handle these issues personally or to direct them to the appropriate supervisor. In these ways, workers underscored their attempts to embed responsiveness into agency processes. Nevertheless, most of the pathways they pointed to involved action initiated and driven by program beneficiaries. The people using Medicaid, SNAP, and WIC must make phone calls, request fair hearings, leave suggestions, ask to speak to a supervisor, and so forth. Amid whatever may be going on in their lives, they must figure out who to call, what to say, and how to say it. They even participate in adversarial and sometimes biased[14] administrative hearings where caseworkers present evidence against them. This status quo places the onus on the people receiving benefits. One beneficiary astutely noted the imbalances generated by this approach:

“I can [have a say in how the program is run]—if I have an issue, I can address it. But if other people have an issue, they don’t address it. They’re not going to get the help that they need…”

This observation— that more assertive, more informed, or higher capacity individuals are more likely to be heard because they speak up, while others may not be—points to the lack of systematic, agency driven processes of collecting and aggregating feedback.

Even when agencies create mechanisms for gathering feedback, via surveys for example, it is not clear whether and how that information is used. One beneficiary who is also a staff member lamented having little knowledge about who had influence over program guidelines and suspected that the people making the decisions were not the ones with the most relevant experience:

I think we’d all like to know [who makes the decisions]. Truly…I work at the place. We’d love to know who decides these things… like with disability claims. Gosh, we’d love to know who decides those… I guess they’re a bunch of dudes in Washington that decide. Dudettes? I would say, definitely people who have never lived in poverty. That would be a given.

Again and again, in hundreds of interviews with program beneficiaries and staff across all kinds of agencies (large and small, urban and rural), we heard three common themes: (1) policy beneficiaries are scarcely heard (2) the mechanisms for gathering feedback often require the users of programs to initiate and drive processes (3) even when feedback is gathered, the pathways towards using it to improve program implementation are unclear. All of this adds up to the systematic exclusion of input from the very people who are most vulnerable to harm in the face of program errors, malfunctions, and oversights.

 

Highlighting Solutions from Those Closest to the Problem

The reality is that many administrative agencies are ill-equipped to gather and incorporate feedback from their key constituents. This makes for a missed opportunity to foster more effective governance. It is also an ethical shortcoming that undermines the compelling maxim, “nothing about us, without us,”[15] a popular rallying cry of the disability rights and other social movements, that emphasizes the fundamental importance of participation by the people most affected by a process.  As indicated in the abovementioned interview excerpts, inattentiveness to the voices of the people with the most at stake undercuts trust in government and calls into question the legitimacy of administrative decision making. Moreover, firsthand experience with programs generates knowledge that agencies and governments could employ to improve policy design and implementation, and ultimately to make lives better for the people policies are intended to help.

To illustrate this, the sections to follow highlight some of the learnings culled from our research interviews. I emphasize the insights that policy constituents offer regarding reducing administrative burden, reconsidering case management practices, improving bureaucratic interactions, and using technology. Beneficiaries may not know the nuts and bolts of how to implement such changes—and not every suggestion they offer is feasible or optimal. But in the larger scheme of things, they have concrete experiences and incisive ideas that can inform administrative decision-making in ways that improve outcomes, reinforce democratic inclusion, and build much needed trust between government and citizens.[16]

 

Reducing Administrative Burden

Many of the people we interviewed described burdens they faced when accessing government programs: long hold times on the phone, complex recertification processes, difficulty figuring out who to talk to and how to reach them, and much more. Administrative burdens are the unnecessary hardships that people face when they attempt to use public services. Such difficulties purvey inequality[17] and are aptly dubbed as “policymaking by other means.”[18] People who use government programs can describe administrative burdens in detail. They also offer concrete suggestions on how burdens can be addressed and reduced. Here are a few examples:

• “They’re really hard to get a hold of when I call…I understand that they’re busy and everything, but –it’s hard.”
• “I believe they should have… a [better] message center, because…the call center is kind of always busy. The line’s always busy. Sometimes it is hard to get through to them, so it can get frustrating. Because they already close at 5:00 and the typical person sometimes gets off at 5:00 and some people like myself, work later. “
• “Why does [the application] take 16 pages and why is it –it’s busy work for caseworkers too, because why did we have to do that every year or six months? You have the information. You should be able, with technology, to go there, click a button that says everything’s the same or I got a new job.”

Importantly, the extent and nature of administrative burdens vary across programs based on policy design and implementation[19]. Medicaid beneficiaries noted that a common source of administrative burden stemmed from the learning and redemption costs associated with figuring out how to identify benefits and providers and navigate the complexity of coverage across health plans and providers.[20] For example, understanding what medications can be covered, which physicians will accept Medicaid patients, and what additional resources were available (e.g., transportation) was difficult for Medicaid beneficiaries to discern. One Kentucky woman likened this to an “easter egg hunt,” saying:

“one thing that they don’t do is—there are all these secrets, I guess, perks with each branch of whoever your MCO is for different Medicaid programs. I feel like they should inform the people of what these are, rather than it being an easter egg hunt of trying to find out.”

Another woman wondered about the truth of a rumor she heard about transportation assistance—an important benefit within the Medicaid program—because she was never formally made aware of it:

“I do take my son to Louisville every six months because he has to see [a specialist] there. And I did hear from someone that there was some kind of program that you could apply for like assistance with gas, money… and I don’t know if that’s true. But I’ve never, to my knowledge, received anything from them saying, ‘oh hey, you can do this for your trip to Louisville.’”

Alternatively, WIC beneficiaries expressed contrasting perspectives given WIC’s more robust practices of providing people with a range of information and ensuring that they are accessing as much help as possible.:

when I was pregnant, they helped me— when I was telling them that I was thinking about getting doula services, they gave me information on that. Breastfeeding stuff, they gave me information on that because I had mastitis twice. They helped me with that. They’ve helped me with different things. For example, early last year when I was having the trouble with the money and stuff, they helped me do rental assistance and stuff like that. So, they’re really helpful.

Most generally, this underscores an opportunity for garnering insights through comparison across programs based on input from people with experiential knowledge.

 

Reconsidering Case Management Practices

Both staff and beneficiaries discussed challenges with case management practices. For example, numerous SNAP and Medicaid staff in Kentucky noted that a single case is often managed by multiple people, with calls routed to the first available person. This might make sense from an efficiency or coordination perspective, enabling agencies to secure timely responses by operating in a sort of triage mode. But both staff and beneficiaries pointed to the downsides of this approach.

For staff, a fast but cursory telephone response protocol that prioritizes fielding a high volume of calls over responding intensively to any single case is disorienting—akin to beginning in the middle of a book and trying to figure out the plot. It also means that staff spend most of their time certifying eligibility and processing administrative details but have little substantive ability to help. Instead, they refer clients to others for more extended follow-up. This leaves agency workers feeling like they are not responsive to the acute needs of beneficiaries, an outcome they find frustrating for themselves and deleterious for their clients. One agency staff person describes the dynamic this way:

We just refer them…which makes it a little challenging because they want an answer right there. I wish we could have something else because I feel like they need something right there and then, an answer right away. They’re desperate. You know what I mean? Desperate moms. Like, my God, I need help right now. I don’t want to call a number and go through an automated system and leave a message. I’m sure that’s not what they want to do.

For beneficiaries, the triage approach feels impersonal and alienating. It means that they often do not talk to the same person twice and there is no single person who understands the nuances of their situation. For people with complex or long histories with a program, this leads to explaining the same thing over and over. And much like the “telephone game,” it sometimes proliferates misconstrued information, mixed signals, and conflicting directives.

More tailored or specialized case management may not be possible in every case or feasible on a wide scale. But the insights of both staff and beneficiaries suggest that for people with complex cases and frequent needs, consistent interaction with a smaller subset of workers could greatly improve user experiences. The positive experiences of WIC beneficiaries, who do have dedicated case workers, reinforce this insight:

I usually have the same person and she’s always really nice. I ask questions. I guess referring back to our last time that we talked—because my daughter had gut problems from her being a preemie, switching over from breast milk to formula and stuff. She asked questions about, is it still the same? Do you need help with this and that?…they’re really helpful. 

 

Bureaucratic Interactions

Beneficiaries and staff report wide variation in the nature and quality of interactions between (1) front line workers and program beneficiaries, and (2) between frontline workers and upper management. These differences map to greater or less staff satisfaction, with implications for how agency organizational cultures trickle down to beneficiary experiences. More toxic organizational cultures can lead to higher turnover, less transparency, and more stress—all of which can translate into negative interactions for program beneficiaries who interact with strained front-line workers. This can hinder access and increase burdens. For example, some agency workers have managers that understand themselves as “the chief servant leader” and foster mission-centric, supportive environments. Others, however, are characterized by strained communication with upper management. Such stressors on the administrative side spillover into negative bureaucratic interactions between frontline workers and program constituents, leading beneficiaries to suggest that agencies,

Increase awareness about being empathetic and compassionate towards people seeking resources…I think people need to be treated or should be treated with respect. I tend to—I feel we’re all equal, and connected, and treat people like I want to be treated. People shouldn’t be in a customer service-oriented role if they can’t.

The dual perspectives of both workers and beneficiaries helps to identify and detail the problem of disrespectful treatment of people receiving assistance, and points to the possibility that toxic organizational cultures within agencies enable such practices.

 

The Use of Technology

As the use of technology increasingly dominates the administration of social programs, beneficiaries must confront more and more technological barriers (slow and hard to navigate websites, difficulty uploading documents, problems interfacing with apps, etc.). Beneficiaries talk about the need for technology to be more user-friendly and accessible across places (urban/rural), demographics (age), and technological availability (ensuring access via mobile phones for people who do not have computers). Beneficiaries and staff also flag frustrations with outdated online systems that hinder more than they help. They report that remote options (like recertifications or applications online or on the phone) can make things easier. At the same time, they also describe the challenges of these mediums for certain populations, underscoring the importance of retaining walk-in office visits as an option, especially considering the needs of certain beneficiaries (e.g., older populations or those with more limited access to technology).  Most generally, the people we interviewed offered useful perspectives on leveraging technological communication:

• “So, if they want to use the telephone as a way of communicating with everybody, that’s not going to be efficient…So texting seems to be, in my opinion, the best way to communicate with anyone. Because then there you are, you see the message, you get the message quickly, you’re—it pops right up on your phone.”
• “I wish they were more accessible and then I guess on their end, maybe like a lighter caseload for each manager or a better way to divvy up each caseload so they don’t feel overwhelmed, and they can communicate better with clients. I also wish I could email them. Like that would be nice if they can’t, can’t call or maybe email or text. If a phone call is difficult.”
• “I [applied] on the phone, just because we didn’t have internet— we live a rural area and so internet is terrible. Whenever you do have internet it’s terrible.”
• “It’s a lot easier to do [Medicaid] over the phone because there’s no wait…I mean, there’s a wait when you call but not as long as it is if you went into the office. [The phone system] has been awesome. I like how if you call and they’re busy, you can leave your name and your number. And they’ll call you back. That makes it easy, so you don’t have to just get on the phone for a while.”

Clearly, there is no single “best” technological approach. Texting and email are easier and more convenient for some people. For others, requiring an internet connection is prohibitive. The larger point is that the attentiveness and responsiveness of administrative agencies to the barriers and vulnerabilities of beneficiaries from different places and backgrounds is just as important as the specific technology.

 

Principles of Incorporating Voice

The sections above only scratch the surface of the insights garnered from beneficiaries and staff of government programs; they are a sampling of ideas that demonstrate the value of centering the experiential knowledge of the program constituents. Most broadly, the learnings from this research underscore four core principles for incorporating voice and influence into administrative processes.

• Remove the burden to initiate feedback from the beneficiary. Current systems are set up to require immense effort on the part of beneficiaries who want to offer feedback or input to agencies. It is crucial to reorient administrative systems in ways that produce more affirmative (on the part of the agency), and readily accessible (on the part of the beneficiary) processes for incorporating and acting upon the experiential knowledge of policy beneficiaries. The particulars will vary across place and according to administrative capacity and resources, but the principle is that the primary responsibility for inviting, gathering, and using input from beneficiaries lies in the hands of the agency.
• Create multiple pathways. Mechanisms of beneficiary feedback and influence must be multiple and varied, not singular or shallow. Having in-depth research conversations with hundreds of people revealed immense heterogeneity in the needs and perspectives of beneficiaries, as well as in capacities across types of government programs. This underlines the importance of developing context sensitive mechanisms for beneficiary voice. Government agencies must be especially careful not to privilege populations with the highest capacity for engaging.[21] Instead, they must think carefully about how to incorporate the widest range of people, especially those facing the most substantial barriers to engaging. The mechanisms that facilitate the input of young mothers with children on Medicaid may not be appropriate for garnering the perspectives of elderly people with chronic illnesses. The processes for learning from beneficiaries in rural areas may be very different from those for learning from their urban counterparts. This indicates that a one-dimensional effort, such as occasional “consumer” surveys, will likely miss important populations. Instead, multiple, intentionally tailored feedback processes are an optimal strategy for the robust incorporation of beneficiary voice. Government agencies must plan thoughtfully, allocate resources, and develop the institutional capacities necessary for a multipronged approach.
• Ensure an Actual Path of Influence: None of the mechanisms for incorporating beneficiary feedback (surveys, focus groups, research-practice partnerships, community meetings, town halls, advisory groups, etc.) are meaningful or effective unless there is a process of change underlying them. Voice without influence is tokenism. Agencies must carefully consider what will happen with the feedback once they get it and ensure that it is deployed to influence agency outcomes and practices. There should be multiple, well-considered opportunities for beneficiary voices to catalyze real change. If not, it is better not to gather input at all, lest agencies expend their own time and resources, all while draining the energies of policy constituents who offered their knowledge. Establishing concrete and effective mechanisms for conveying and implementing the ideas that stem from constituent feedback is a vital step.
• Communicate Early and Often: If a tree falls in the forest and no one hears it, perhaps it did not fall. This logic applies to integrating constituent voices into administrative processes. If agencies invest the necessary time, resources. and planning into culling feedback from constituents, they must also communicate effectively and widely about what they are doing, how they are doing it, and what changes it produces. Policy beneficiaries’ pessimistic sentiments about their capacity to influence government programs can undermine their relationship with government and dilute their civic trust. Scholars have long identified the ways that experiences with government agencies can either weaken or strengthen democracy depending on how policy is designed and administered.[22] Communicating (genuine and robust) efforts to center the voices and perspectives of policy beneficiaries is one way to convey lessons to beneficiaries about the value and importance of their contributions to social and civic communities, and doing so could be an important step in buttressing democracy.

Conclusion

This paper has focused on administrative changes that can foster a more responsive, democratic approach to engaging people who rely on government programs. Though it may seem narrow, wonky, or insufficient to focus on administrative improvements, there is strategic value to this emphasis. In a starkly polarized partisan context, many legislative paths to improving government social programs are currently infeasible. While building power in communities is especially vital in the medium to long term,[23] it is also critical to consider short term administrative interventions that strengthen democracy by facilitating more responsive government. This paper has precisely such an emphasis. Still, given the focus on voice, it would be remiss to omit mention of the many suggestions for change offered by policy beneficiaries that are not amenable to administrative solutions. Many of the interviewees in the study also made the case for policy and structural changes. Most common among these suggestions was a widespread insistence on more generous benefits for a wider range of people and better support for agency workers. Consider these suggestions from beneficiaries talking about the insufficiency of income limits for eligibility, as well as sentiments from agency workers talking about underfunded agencies, respectively:

• “There’s a couple things I would change with the program. Like the income limit…Considering the cost of everything now has gone up so high. It’s hard” (beneficiary).
• “I think that the SNAP income limits should be higher, especially with how expensive things are now. Rent has gone up. Groceries have gone up. Gas has gone up. And if people— you know, people need to eat, so if they’re going to be able to eat, I think those benefits limits need to be higher” (beneficiary).
• “Now, for a family the size of mine, which I’ve just had the two kids at home, my gross income falls within the income limits to receive benefits that I provide for my client” (agency worker).
• “The resources that I’m talking about is that we are down like several, several case workers and supervisors. So, we are working on very limited staff right now…resources are not available, and they don’t seem like in a talking mood to try to fix that (agency worker).

These and many other insights from policy beneficiaries and agency workers make it clear that increasing funding for social programs and deepening capacity for government agencies are pivotal issues that legislatures should take up, advocates should take on, and organizers should build power to address.[24] But alongside addressing these fundamental issues—and in the immediate term—agency leaders, policymakers, and other actors who shape the implementation of public programs, can leverage maximal administrative capacity to facilitate responsive, democracy-enhancing governance.

 

References

[1] The Commonwealth Fund. (2017). New Report: Medicaid Provides Equal – or Better – Quality Health Insurance Coverage Than Private Plans as Well as More Financial Protection. Online at:

https://www.commonwealthfund.org/press-release/2017/new-report-medicaid-provides-equal-or-better-quality-health-insurance-coverage.

[2] Yun, J., Oehlman, Kathryn., Johansen, M. (2018). Per Visit Emergency Department Expenditures by Insurance Type, 1996 – 2015. Health Affairs, vol. 37, pp.1109-1114.

[3] U.S. Government Accountability Office. (2023). Government Efficiency and Effectiveness: Opportunities to Reduce Fragmentation, Overlap, and Duplication and Achieve Billions of Dollars in Financial Benefits. Online at: https://www.gao.gov/products/gao-23-106864.

[4] Parker, D. (2012). Rooting out Waste, Fraud, and Abuse. Political Research Quarterly, vol. 66, no. 3, pp. 630-644, https://doi.org/10.1177/1065912912459566.

[5] Michener, J., SoRelle, M., & Thurston, C. (2022). From the Margins to the Center: A Bottom-Up Approach to Welfare State Scholarship. Perspectives on Politics, 20(1), 154-169.

[6] Michener, J., Ford, T., (2022). Engaging Voice to Support Racially Equitable Policymaking. https://www.commonwealthfund.org/blog/2022/engaging-voice-support-racially-equitable-policymaking

[7] Gilens, Martin. (1999). Why Americans Hate Welfare: Race, Media, and the Politics of Antipoverty Policy. Chicago, IL: University of Chicago Press.

[8] Katz, M. B. (2013). The Undeserving Poor: America’s Enduring Confrontation with Poverty. New York: Oxford University Press.

[9] Halling, Petersen. (2024). Frontline Employees’ Responses to Citizens’ Communication of Administrative Burdens. Public Administration Review. Vol 84, no. 6: 1017-1037.

[10] Barnes, Michener. (2022). Examining Medicaid and the Nutrition Program for Women and Children to Understand How to Design Social Policy to Achieve Health Equity. Duke Sanford Center for Child and Family Policy. https://childandfamilypolicy.duke.edu/research-item/social-policy-health-equity/

[11] Associate Professor, University of Chicago Crown Family School of Social Work. Carolyn Barnes, PhD. https://crownschool.uchicago.edu/directory/carolyn-barnes.

[12] This is a subset of the data from the larger project that includes interviews with 260 social policy beneficiaries (people who received Medicaid, WIC, or SNAP benefits) and 31 agency staff (frontline workers who administer public benefits). Over half of these interviewees (56 percent) were from Kentucky and the rest (43 percent) were from Pennsylvania. Interviewees were carefully selected to include people from a range of backgrounds in terms of geography (rural, urban, suburban), race/ethnicity (Black, Latinx, White), and age.

[13] Soss, J. (2000). Unwanted Claims: The Politics of Participation in the US welfare System. University of Michigan Press.

[14] Franklin, S. (2017). The Politics of Race, Administrative Appeals, and Medicaid Disenrollment in Tennessee. Social Sciences, 6(1), 3.

[15] UN Enable – International Day of Disabled Persons. (2004) United Nations, New York. https://www.un.org/esa/socdev/enable/iddp2004.htm

[16] Mettler, S. (2018). The Government-Citizen Disconnect. Russell Sage Foundation.

[17] Herd, P., Hoynes, H., Michener, J., Moynihan, D. (2023). Introduction: Administrative Burden as a Mechanism of Inequality in Policy Implementation. RSF: The Russell Sage Foundation Journal of the Social Sciences, 9(4), 1-30.

[18] Herd, P. Moynihan, D.P. (2018). Administrative Burden: Policymaking by Other Means. New York: Russell Sage Foundation.

[19] Barnes, C. (2023). “I Can’t Get Ahold of Them”: Perceptions of Administrative Burden and Administrative Exclusion Across SNAP, WIC, and Medicaid during the COVID-19 Pandemic; Barnes, C., Michener, J., Rains, E., (2023). “It’s Like Night and Day.”: How Bureaucratic Encounters Vary across WIC, SNAP, and Medicaid. Social Service Review, 91(1):1-40.

[20] Barnes, C. (2020). “It Takes a While to Get Used to”: The Costs of Redeeming Public Benefits. Journal of Public Administration Research and Theory, 31(2), 295-310.

[21] Gilad, S., & Assouline, M. (2022). Citizens’ choice to voice in response to administrative burdens. International Public Management Journal, 27(1), 38–59.

[22] Michener, J. (2018). Fragmented Democracy: Medicaid, Federalism, and Unequal Politics. Cambridge: Cambridge University Press.

[23] Michener, J. (2023). Policy Feedback in the Pandemic: Lessons from Three Key Policies. Roosevelt Institute. https://rooseveltinstitute.org/publications/policy-feedback-in-the-pandemic/

[24] Michener, J. (2024). Building Power for Health: The Grassroots Politics of Sustaining and Strengthening Medicaid.” Journal of Health Politics, Policy and Law.