ABSTRACT
This chapter describes the reader a sense for what is entailed in the implementation of statutes of great scope and complexity, such as the Medicare and Medicaid acts of 1997. It introduces the concept of implementation as an important element in understanding and evaluating the policy process. As background to the legislative implementation and initial establishment of SCHIP it is important to recall some history. Child health might seem a relatively uncontroversial, nonpartisan issue. The Medicare data base has over 2,000,000 lines of instruction. Nancy-Ann deParle, the HCFA administrator who inherited the vast implementation project from her predecessor, Bruce Vladeck, recalled a meeting of the Executive Council that she attended with Vladeck to review a thirty-page draft from the Ways and Means Committee listing the various changes in the new legislation. Most difficult regulations, even with expedited procedures, typically take from eighteen months to two years. Medicaid led the way for Medicare—an unusual provenance with at least one significant side-effect.
