Executive federalism emphasizes collaboration between the executive branches at the national and state levels to transform grant programs through the implementation process. In this regard, Medicaid demonstration waivers loomed large during the presidencies of Bill Clinton and George W. Bush. This article documents and compares the volume and substance of section 1115 Medicaid waiver activity under the two presidencies. From the perspective of policy performance, Medicaid demonstration waivers provide modest support for the view that states serve as laboratories for policy learning in the health care arena. More broadly, the waivers have not yielded a major solution to the problem of the uninsured and are unlikely to do so. At the same time, they have not (as some have suggested) been a subterranean force for the erosion of Medicaid. To the contrary, these waivers have often enhanced health services for low-income people; above all, they have helped preserve Medicaid as an entitlement by undercutting support for those seeking to convert the program into a block grant. From the perspective of the democratic process, we find that Congress has been a more significant player in shaping waivers than the executive federalism model suggests. While the decision processes surrounding Medicaid waivers often fall short of democratic standards with respect to transparency and opportunities for public input, they still compare favorably to certain alternatives.

This review offers a synthesis and critical assessment of the reinvention movement in the United States. Focusing on the work of David Osborne, the National Performance Review, and the Winter Commission, it describes the key themes that define this movement and then assesses them from two major perspectives. The first perspective probes whether reinvention ideology provides a plausible prescription for improving the efficiency and effectiveness of public agencies. The second focuses on the implications of reinvention for accountability and related democratic concerns. The degree to which reinvention ideas appear to be taking root at the various levels of the federal system also receives attention. The authors conclude that the reinvention movement should not be dismissed as the latest fad, but rather as the fount of several plausible hypotheses that should be tested further. They also suggest that the American political system will place major, although not necessarily insurmountable, barriers in the way of sustaining reinvention.

Do minority civil servants actively represent the minority community more than white officials do ? Many observers express doubts. Clearly, there are formidable barriers to nonwhite civil servants acting as representatives of their racial groups. Nonetheless, existing evidence suggests that nonwhite officials do serve in this capacity under certain circumstances. A major task for students of public administration is to specify what these circumstances are. The author notes several societal and job related factors which increase prospects that minority officials will actively represent their racial communities.

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