Healthcare Administrative Burden as Community Power Suppressant

• In Event: Administrative Frictions in US Health Insurance: Evidence on Coverage Loss, Claim Denials, and Eligibility Churn

Abstract

Over the last decade, public policy researchers have used the concept of “administrative burden” to explore “individual’s experience of policy implementation as onerous” (Burden et al., 2012; Moynihan et al., 2013, p. 498). In contrast to prior research on red tape and street-level bureaucracy, analyses of administrative burden shift focus onto the lived experiences and costs of navigating state bureaucracy (Moynihan et al., 2015). Recent work has also extended the concept to describe patient interactions with the U.S. healthcare and insurance bureaucracies (Kyle et al., 2025; Kyle & Frakt, 2021). Studies argue that heightened administrative burden can influence a variety of negative outcomes for individuals, including loss of access and underutilization of services (Christensen et al., 2020; Daigneault & Macé, 2020; Moynihan et al., 2013), higher out of pocket costs (Kuye et al., 2013), and loss of trust in civic institutions (Bell et al., 2024). Furthermore, research illustrates that burdens are unevenly distributed onto some groups along lines of power, with disproportionate burdens falling on people of color, women, low-income groups, and those living with disabilities (Blume, 2023; Herd et al., 2023; Ray et al., 2023). What has been less studied is how administrative burdens are not just shaped by power but also impact community power. Extending recent work on interpersonal and networked impacts of burdens (Amerikaner et al., 2025; Sackett & Lareau, 2023), this descriptive project asked two questions: How do administrative burdens impact communities? Furthermore, how do those impacts make it more difficult for communities to wield power and challenge the status quo? To answer these questions, we draw on qualitative data from 46 original focus groups covering lived experiences of healthcare system and policy failures. All focus groups were conducted as part of a community research project grounded in partnerships with state-level health advocacy groups; 16 of the focus groups were conducted by partners on state-specific healthcare system and policy obstacles. Using grounded theory coding, we found that administrative burdens result in community power costs, a combination of lost ways of knowing with lost opportunities to mobilize for institutional accountability. We identify knowledge, capacity, relationship, and institution losses as four core examples of community power costs. These costs are united in limiting the ability of communities to organize as collectives and provide policy feedback that can produce change.We close our analysis by suggesting a community power research agenda for administrative burden scholars. Future research in this area can open several related doors. These include further identifying and characterizing community power costs, empirically measuring such incurred costs and their downstream outcomes; and comparing differences in community power costs based on state policy variations. These lines of inquiry can strengthen the orientation of future administrative burdens research towards social change and challenging the structural disempowerment of marginalized communities.

Author

• Bailey Flynn, Cornell University
  Presenting Author