| Understanding the ways in which public agencies attempt to influence policy is of critical importance to policy studies and to democratic theory. Most research on bureaucratic power focuses on rulemaking and policy implementation, but bureaucrats also engage in earlier stages of the policy development process. In this dissertation, I theorize and test a previously unexplored mechanism for agency influence on policy, asking whether, and how, bureaucrats enlist the help of interest groups in attempts to influence legislation.;I focus this investigation on state Medicaid bureaucrats. Evidence from a novel survey of state-based health lobbyists in 25 states reveals that state Medicaid bureaucrats routinely conduct what I call "indirect bureaucratic lobbying." Survey data also provide preliminary support for hypotheses about the conditions that increase the likelihood of indirect bureaucratic lobbying. In particular, I find a positive effect of bureaucrat-lobbyist agreement on specific Medicaid legislation. However, the effect of policy agreement also varies according to the levels of state agency capacity and state legislative capacity, and vice versa. For example, bureaucrats are more likely to request interest group support where state agency capacity is low, as long as a minimal level of bureaucrat-lobbyist policy agreement exists. I also find that indirect bureaucratic lobbying is more likely where governors have relatively weak formal budget powers, conditional on the existence of governor-bureaucrat agreement on specific Medicaid legislation. In addition, I build on my findings about the importance of policy agreement to explore the applicability of different theories of legislative lobbying, and to ask whether we can predict bureaucratic lobbying according to the content of Medicaid legislation.;Overall, my findings have major implications for research on bureaucratic politics and on state health policy. In contrast with the conventional view of bureaucrats, I provide evidence of a specific way in which bureaucrats attempt to influence legislative decision-making, and I show that they do so regularly. This dissertation highlights the need for greater scholarly attention to bureaucrats' power, role in the policy process, and policy preferences. My findings also have practical implications for the effective dissemination and targeting of health services research evidence. |
