To illustrate both the complexity of the state government bureaucracy and the politics that often surround supposedly politically neutral bureaucracies, consider the reorganization of the Texas public health bureaucracy in 2003. The reorganization and consolidation of two separate executive departments, Public Health and Human Services, was set in motion by a bill approved by the 78th legislature in spring 2003. Signed into law by Governor Perry in June 2003, House Bill (HB) 2292 ordered the consolidation of twelve health and human services agencies and functions into five new agencies. The law also consolidated all related policymaking authority under the Executive Commissioner of the Texas Health and Human Services Commission (HHSC), in effect centralizing authority within this broad area of the public administration.
The law also mandated the creation and probable privatization of up to four call centers used to answer questions on eligibility and to enroll people for Temporary Assistance for Needy Families (TANF), Food Stamps, Medicaid, and the Children's Health Insurance Program (CHIP). These functions had been performed by more than 11,000 state workers at over 1,000 Texas Department of Human Services (DHS) offices around the state.
A previous effort by the state to reorganize its public health and human services departments, and to outsource the work performed by its call center employees, failed in a political collision between state and federal authorities. In 1995 the legislature voted to contract private companies - including Lockheed Martin, IBM, Electronic Data Systems, and Andersen Consulting - to answer eligibility and enrollment inquiries for its various social programs.
Since much of the money used to fund the social services in question comes from federal sources, the state sought the approval of agencies within the U.S. Department of Health and Human Services (HHS). HHS, in turn, was under strong pressure to reject the Texas proposal. The main source of this pressure was labor unions, particularly AFSCME (American Federation of State, County, and Municipal Employees), which represents approximately 1.3 million workers across the country. HHS began deliberating on the Texas plan in June 1996, and after several months sent state officials a letter saying it could not "provide a final decision at this time." A second letter sent in March 1997 warned Texas officials that proceeding with the privatization plan might jeopardize federal funds. [1] The reorganization effort fizzled in the face of this warning.
Fast-forward to 2003. Interest groups, labor unions, and private corporations were similarly divided over the new design for public health reorganization represented by HB 2292. But this time around, other interested parties - especially the governor - got involved.
In addition to mandating the massive consolidation of state public health and human services agencies in ways that fundamentally affected the delivery of services, the law also changed how public policy in this area is developed and whether the public has the opportunity for input on policy changes. The reorganization of agencies and programs under the 2003 law instituted a significant centralization of power in the Health and Human Services Commission. The governor also gained influence through the power to appoint the executive commissioner and deputy commissioners. Under the new structure the governing boards of the four new and consolidated agencies were to be replaced with advisory councils with no rulemaking authority, depriving these agencies of a critical source of distributed power and flexibility in the bureaucracy.
This new agency structure represented a massive shift in the control and political use of the single biggest area of state administration - public health and human services - with an annual budget of some 27.8 billion in fiscal year 2007, 37.5 percent of total state expenditures.
According to the Center for Public Policy Priorities, a think tank critical of the plan, the reorganization provisions of HB 2292 went far beyond simple reorganization. "These changes raise the concern that customer service may deteriorate and HHS policy decisions will become less open to the public - in particular, the advocates who look out for the interests of the people these programs serve - and more subject to political considerations." [2] Advocates of the plan, however, continued to claim that the reorganization promised to increase efficiency and cost effectiveness. Debate over the 2003 legislation continued through the following legislative session in 2005. More systematic review awaits the sunset review of the Health and Human Services cluster of departments, which is scheduled for the 2006-2007 cycle. The Sunset process is discussed in upcoming sections.
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1 Judith Havemann, link: "Welfare Reform Incorporated: Social Policy Going Private.
2 Center for Public Policy Priorities, link: "HB 2292 Update: HHS Reorganization." [Accessed February 26, 2004.]
