What the Fiscal Cliff Could Mean for Families

As a result of the Recession, millions of people lost jobs and the poverty rate in the United States rose sharply. People who had been living comfortably were laid off and suddenly became impoverished, and those who were already struggling to make ends meet saw resources becoming even more scarce. While the country continues to slowly recover from the recession, the level of families in need continues to exceed the supports available to meet those needs through the safety-net.  Even for those who qualify for housing vouchers, waiting lists can be years long, as is the case in Washington, DC., where the average wait for a two-bedroom apartment is at least 22 years; children in some households become adults by the time they come off the waiting list, and many families never receive housing support at all. Adding to the burden, food stamps are hardly sufficient to cover the actual cost of meals, especially in urban areas where the cost of living is high. The average benefit amount an individual receives with food stamps is $4.46 a day, but in Washington D.C. an individual’s average total food cost for the day is $10.23.

However, as we’ve mentioned in previous posts, programs for low-income individuals are not just money taken from the government, but money put back in to the economy: food stamps provide states with more revenue and create jobs, and the Earned Income Tax Credit encourages work and is largely lauded as the most successful anti-poverty program.

In addition, health programs such as Medicaid and the Children’s Health Insurance Program are valuable because their coverage of screening and other prevention services reduce the likelihood that people will develop more debilitating and costly health problems in the future—chronic diseases and illnesses that cost the United States billions of dollars each year in missed days at work and lost productivity.

In the current negotiations in Congress on how to prevent the “fiscal cliff”, it is vital that one of the principles in developing solutions be: they cannot increase poverty or income inequality. In order to preserve programs for poor and low-income families, a good balance between revenue increases and spending cuts will be necessary. Unfortunately, entitlement and other programs for low-income people are often an easy target for cuts. Although cutting entitlements may save money in the immediate future, the consequences to families and the long-term consequences to the economy will be much more costly.

There is bipartisan agreement that a total of $4 trillion in deficit reduction is needed to stabilize the debt. $1.7 trillion in savings has already been achieved, through cuts to defense and non-defense discretionary spending enacted by the Budget Control Act. Therefore, Congress now needs to decide where to find an additional $2 trillion in savings.

Important decisions to be made during this lame duck session include:

• The size and ratio of spending cuts to revenue increases
• How to cancel and replace the sequester
• What to do about tax cuts
• What the downpayment on deficit reduction will include.
• Considerations over lowering caps on non-defense discretionary spending, as established under the Budget Control Act
• How to control spending in Medicare and Medicaid
• Determinations of revenue requirements

Preserving programs for low-income individuals is a good investment—for building human capital in terms of health, training and education, for creating pathways to employment, and for reducing poverty and strengthening the middle class.

For more information on the ways that investing in families can be sound fiscal choices for states visit the Policymakers’ Corner or the Policy for Results website.

How Asset Tests Hinder the Goals of Safety Net Programs

It is common knowledge that the way to economic self-sufficiency involves having a bank account and saving your money—not only so that you can eventually buy a house or fund your children’s education, but also to have an emergency fund (enough money to cover living expenses for three months) in case of job loss, health emergencies or other unexpected costs. It is also how people get out of debt and can start building wealth.

This value, saving, is reflected in many states’ economic programs for people enrolled in the Temporary Assistance for Needy Families (TANF) program. Parenting skills classes and job readiness trainings teach the importance of having a bank account and saving money. However, this value is not always reflected in states’ policy regarding eligibility for TANF. Furthermore, the Supplemental Nutrition Assistance Program (SNAP) also has asset tests, which can be different from those for TANF, adding another layer of complexity and inconsistency.

Not only do asset tests counter one of the major goals of the TANF program, it also creates extra work for state administrators and increases the chances for payment errors. There is no federal mandate for states to adopt asset tests, but of the ones that do, they vary widely in which types of resources count toward their asset limits. These resources may include bank statements, car titles, insurance policies and other relevant documents. In some cases, applicants can self-report their assets; in others, a caseworker must verify the assets based on the submitted documents.

 A new report from the New America Foundation, State Asset Limit Reforms and Implications for Federal Policy, describes how some states have reformed their policy on asset limits in their SNAP and TANF programs. Motivated by increasing program costs, threats to program integrity, and the recognition that asset tests are a barrier to long-term self-sufficiency, many states have eliminated asset tests for TANF and/or SNAP. For example, Colorado estimated that eliminating its TANF asset test would result in additional benefits for 44 families, at a cost of $123,000. However, these costs would be offset by greater administrative efficiency; eliminating the asset test would save caseworkers 10 to 15 minutes per “case interaction”, or up to 90 minute for the five or six interactions that typically occur between a client and a caseworker in the first 45 days. The successful policy reforms in Colorado and other states can serve as a useful model for other policymakers who are considering similar changes.

While asset tests were instituted to ensure that assistance is given to the families who need it the most, research has shown that once asset tests are eliminated, program enrollment did not increase significantly. This is due in part to the fact that families that seek assistance and meet the low income requirements are generally asset poor. In addition, the money that states saved in reduced administrative costs more than made up for the slight uptick in enrollment.  

States benefited from eliminating their asset tests in several key ways:

•      Caseworkers had more time and attention for other case management duties
•        Greater administrative efficiency resulted in cost savings
•        Greater streamlining simplified the process for both families and the agency

Asset tests are an example of a policy that while likely created with good intentions, has had serious unintended consequences for families’ efforts to attain financial success. This policy exemplifies the significance of considering the unintended impact of policy on families and highlights the importance of policymaking with a results focus (ensuring that policy is well aligned with intended outcomes). Eliminating asset tests is an important policy reform that policymakers should consider as a step towards encouraging families on public assistance to move towards financial self-sufficiency.

To learn more about connecting policy to results visit PolicyforResults.org. 

Utilizing Technology to Expand Access to Safety Net Services

Yesterday the Coalition for Access and Opportunity, of which CSSP is a member, held a briefing titled “Removing Red Tape: New Strategies for Strengthening the Safety Net” in which a panel described the actions state and local governments are taking to make their safety net programs more effective and efficient. These programs include the Supplemental Nutrition Assistance Program, Medicaid, the Children’s Health Insurance Program, Temporary Assistance for Needy Families, the Child Care and Development Block Grant, and the Low-Income Home Energy Assistance Program.

In the traditional human services paradigm, consumers receive services by walking into a human service organization, meeting in person with a case worker, and either supply the caseworker with their completed forms and supporting documentation, or receive assistance from the case worker in filling them out. The case worker then determines if the consumer is eligible for the benefit. The advantage to this traditional method is that consumers receive individualized support. On the other hand, consumers have to visit multiple agencies to apply for a comprehensive package of services, they often have to wait in long lines, and they are burdened with having to take time off of work, which is risky to their employment status and earnings. In addition, this process leads to heavy administrative costs to the agency.

To address these problems, many states have utilized the Internet and sophisticated software systems and databases to simplify the way consumers access safety net services. In May the Coalition for Access and Opportunity, released a report titled “Moving to 21^st-Century Public Benefits: Emerging Options, Great Promise, and Key Challenges” which examines promising practices across states to propose a new model for modernizing the public safety net to make it easier and less burdensome for families to receive benefits. Its recommendations include changing eligibility rules and procedures to allow for more streamlined enrollment into programs and for retaining eligible individuals for longer.

These eligibility rules changes include—

• Using other programs’ findings to “deem” consumers eligible for assistance without asking one agency to replicate or revise the work already done by a different agency.
• Basing eligibility on prior-year income tax records;
• Providing continuous eligibility by disregarding short-term income fluctuations; and
• Eliminating eligibility requirements that cannot be documented based on data matches. For example, consumers could opt for standardized rather than itemized deductions or disregards, and asset tests could be eliminated for some or all consumers. 

The modernized eligibility procedures include—

• Using data matches, rather than consumer provision of information, to complete application forms and establish eligibility;
• Using electronic case records or data warehouses to serve multiple programs, so that information or documentation already received by one office can be used by others;
• “No wrong door” policies so that data received by one agency is forwarded to other agencies. This would minimize the number of agencies consumers have to physically enter, just to give the same information that they provided to other offices.
• Streamlining renewal by automatically granting continued eligibility based on data matches and by letting families provide missing information over the phone and online; and
• Default enrollment strategies that provide eligible consumers with assistance unless they affirmatively “opt out”.

The success of these policy changes will be determined by how closely policymakers pay attention to the details of their implementation and balance their priorities of saving administrative costs with increasing access to consumers.  Some areas that may require attention include:

• Increased reliance on data must be met with strong security provisions to protect consumers’ privacy.
• Shaping eligibility rules to fit available data means they might disregard factors such as housing costs or asset values, which are factors that could help focus assistance on the people with the greatest need.
• Reforms that address multiple programs need to be carefully structured so that they do not import more restrictive rules into programs that are less restrictive.
• The use of Internet- and telephone-based enrollment pathways must not completely replace the traditional in-person model.  Many low-income people have not filed federal income tax returns and may lack a data trail showing eligibility. Some people may not know how to use the technology or lack the language or literacy skills needed for online applications. Still others may not have access to computers, which is especially a concern for rural and frontier locales. 

Utilizing technology has in some cases led to a dramatic increase in enrollment among those who are eligible, which suggests that the change was successful and merits the consideration of program modernization in other states. However, in the excitement to take advantage of technology to streamline enrollment and minimize administrative costs, it will be important for policymakers to do a thorough assessment of the needs of the low-income populations in their state or district. It is critical that in an effort to better serve low-income families that states do not implement policy and programs that may lead to some consumers falling through the cracks.  Considering the usability and accessibility of technology by different sub-populations is a critical aspect of ensuring that streamlining access leads to the best outcomes for poor and low-income families.

Alternatives to Confining Youth in Solitary

October is National Youth Justice Awareness Month, and the Campaign for Youth Justice is taking the opportunity to educate the public about youth incarcerated in the adult criminal justice system. Even though the ideas behind laws for sentencing and incarcerating children as adults have been debunked, there are still 250,000 youth on an annual basis in the United States that are tried, sentence or incarcerated as adults. A particularly disturbing aspect of housing youth in adult facilities is that they can be subject to solitary confinement, which has more profound negative impact on youth than on adults.

A new report from the ACLU and Human Rights Watch, “Growing Up Locked Down: Youth in Solitary Confinement in Jails and Prisons Across the United States,” is based on interviews and correspondence with more than 125 youth in 19 states who spent time in solitary confinement while under age 18.

The bare social and physical environment makes youth feel doomed and abandoned, or in some cases, suicidal, and can lead to serious physical and emotional consequences. Youth in solitary confinement describe cutting themselves with staples or razors, hallucinations, losing control of themselves, or losing touch with reality. They talk about only being allowed to exercise in small metal cages, alone, a few times a week; about being prevented from going to school or participating in any activity that promotes growth or change. Oftentimes they are denied visitation from family and relatives.

Experts assert that youth are psychologically unable to handle solitary confinement with the resilience of an adult. And, because they are still developing, traumatic experiences like solitary confinement may have a profound effect on their chance to rehabilitate and grow. Solitary confinement can exacerbate, or make more likely, short and long-term mental health problems. The most common deprivation that accompanies solitary confinement, denial of physical exercise, is physically harmful to adolescents’ health and well-being.

Youth can be guilty of crimes with significant consequences for victims, their families, and their communities. The state has a duty to ensure accountability for serious crimes, and to protect the public. But states also have special responsibilities not to treat youth in ways that can permanently harm their development and rehabilitation. Fortunately, there is a way to accomplish both public safety and the safety of the youth who have committed crimes.

Solitary confinement is costly, ineffective, and harmful with consequences for both the youth and the general public. Youth who have experienced solitary confinement return to their communities with psychological damage, social deprivation, and the deprivation of essential services such as mental health counseling and education. This puts them at an increased risk to commit more crimes that will reinvolve them with the justice system, and puts them at a disadvantage for acquiring stable employment.

The ACLU’s report describes a number of better policies that policymakers could implement as alternatives to solitary confinement. Youth can be better managed in facilities designed to meet their unique needs, staffed with specially trained personnel, and organized to encourage positive behaviors. Another useful step would be to conduct a review of laws, policies and practices that result in youth being held in solitary confinement to get a better sense of what would be necessary to end this practice.

Of course, the most effective way to reduce youth being held in solitary confinement would be to keep youth entirely out of adult detention facilities. Never housing youth in adult facilities will both help better rehabilitate adolescents and better ensure the safety of our communities. For more details, visit the Policy For Results website on policies that can reduce juvenile detention. Rather than continuing a practice like solitary confinement, which does much harm and no good, policymakers can reform the juvenile justice system so that youth are guaranteed the ability to grow, be rehabilitated, and reenter society successfully.

Sign up on policyforresults.org for updates on results-based public policy strategies for preventing juvenile delinquency and ensuring quality juvenile justice services – coming soon!

Not Mentioned at the Debates: Poverty, and the Case for Maintaining and Strengthening the Safety Net

Last night, at the first Presidential debate, we heard the candidates focus their remarks on how they would help the middle class. Unfortunately, moderator Jim Lehrer did not ask a question about how the candidates would alleviate poverty, and they did not talk specifically about what they would do to help Americans in the lowest income bracket.

What should have been conveyed to the American people is how crucial it is to maintain the federal safety net, or “the floor below which you cannot fall” as President Obama referred to it last night. A large component of this “floor” is Social Security, which the candidates spoke about in reference to seniors, but not nearly as much about how it helps low-income people. In addition to Social Security, two other important components of the safety net are refundable tax credits and food assistance.

As the 2011 poverty data from the US Census revealed, policies such as the Earned Income Tax Credit (EITC) and the Supplemental Nutrition Assistance Program (SNAP) have kept millions of Americans out of poverty. Yet there are still 46 million Americans in poverty, 16 million of whom are children—an alarming 1 in 5 children. In order to begin to assist more of the 46 million poor people in this country, the safety net needs to be expanded—not capped, converted to a block grant or eliminated altogether.

As the Center for Budget and Policy Priorities showed, making cuts to SNAP would cause millions of people to lose their benefit, which could be devastating considering the current economic hardship experienced by so many families.

The federal deficit was a major point of contention at the debate last night, so it is of worthy note that not only does SNAP address a serious need among Americans experiencing food hardship and food insecurity, it also stimulates the economy. According to an analysis by the Food Research and Action Center (FRAC):

• Nearly 1 in 5 people in the U.S. didn’t have enough money to purchase food they need for themselves and their families in the first six months of 2012.
• More than 50.1 million Americans lived in households that struggled against hunger in 2011.
• Each federally funded dollar of SNAP benefits generates nearly double that in economic activity, because people are using the money to purchase food.
• Increased SNAP participation can increase state revenues. For example, in California each dollar of SNAP benefits frees up an estimated 45 cents more recipients spend on taxable goods, yielding additional tax revenues for the state.

In 2011, SNAP was responsible for lifting 3.9 million Americans (1.7 million children) out of poverty.

Another critical component of the safety net, refundable tax credits, were responsible for lifting an additional 9.2 million Americans (4.9 million children) out of poverty in 2010. These tax credits include:

• EITC kept 6.3 million Americans out of poverty (500,000 due to improvements brought via the American Recovery and Reinvestment Act).
• The Child Tax Credit (CTC) kept 2.6 million Americans out of poverty (1 million due to ARRA improvements).

ARRA was able to expand these crucial tax credits for low-income families by creating a new tier for larger families, and by providing marriage penalty relief. Unfortunately, as part of the large bundle of expiring financial policies constituting the looming “fiscal cliff”, the ARRA improvements are set to expire at the end of 2012. Without the Child Tax Credit, a single mother with two children working full-time at minimum wage would lose $1,545 annually. In order to prevent millions of families from facing additional financial burden, policymakers at the federal and state level should consider options that would expand EITC and CTC or consider the development of state compliments where they are not currently in place.

As the New York Times discussed, the Presidential candidates hold starkly different views of the role and scope of government in American society. However, both the data and history have shown that specific policy changes related to strengthening the safety net not only help American families by keeping them out of poverty, but also benefit the economy. Policymakers can lead by strengthening the policies and programs that serve the needs of low-income and poor families as well as strengthen the country’s economic circumstances.  Luckily for us, it is possible to do both.

African-American Youth are More Exposed to Alcohol Ads

In a new study released today from the Johns Hopkins School of Public Health, researchers found that African-American youth are exposed to more alcohol advertisements than youth of other races. The director of the Center on Alcohol Marketing and Youth at Johns Hopkins, David Jernigan, PhD said this outcome is a result of two key phenomena: 1) brands are specifically targeting African-American audiences and 2) African-American media habits make them more vulnerable to alcohol advertising in general because of higher levels of media consumption. Because of the devastating effects that underage drinking can cause, it is important for policymakers to protect youth from excessive exposure to alcohol and to prevent youth from developing an alcohol-related substance use disorder.

The study found that certain brands, channels and formats overexpose African-American youth to alcohol ads.

• In magazines, they saw 32% more alcohol ads than all youth.
• On television, they were exposed to 17% more ads per capita than all youth, including 20% more exposure to distilled spirits ads.
• On the radio, they heard 32% more advertising for distilled spirits.

Alcohol is the most widely used drug among African-American youth; more than tobacco and far more than marijuana. This study is significant because it is well established in research that the more young people are exposed to alcohol advertising and marketing, the more likely they are to start drinking. If they are already drinking, they are more likely to drink more heavily.

Despite their disproportionate exposure to alcohol ads, African-American youth actually drink less than youths of other racial groups, which researchers attribute to factors such as poverty, social norms and religion. However, this research is still significant because African-Americans who do drink suffer more serious consequences because they tend to have less access to health care, substance abuse treatment, live in poorer neighborhoods and are incarcerated more frequently. Alcohol consumption is also linked to the three leading causes of death among African-American youth-homicide, suicide and accidental injury.

Although the study could name specific magazines, alcohol brands, and television stations that overexposed African-American youth, the study could not prove the intent of the alcohol industry to target African-American youth.

Dr. Jernigan recommends that alcohol marketers commit to cutting exposure to this high-risk population, but there is also a role for policymakers to play. The Prevention Resource Center outlines a number of measures policymakers can take to create policies aimed at retailers, adult providers, youth, and alcohol availability in general. A number of states have already implemented limits to the public’s exposure to alcohol ads. For example, New Hampshire bans alcohol billboards as well as any advertising of alcohol events, such as happy hours. Some states ban ads in alcohol outlets that are visible from the street.

Sign up on policyforresults.org for updates on results-based public policy strategies for preventing and treating youth substance abuse – coming soon!

Alzheimer’s Disease and the Link with Junk Food

It is already well-known that a diet high in junk food can lead to obesity, diabetes and other diseases, but there is a growing body evidence that junk food can have another effect, and this one even more debilitating: Alzheimer’s disease. With 5.4 million Americans currently affected by Alzheimer’s, unless something is done this prevalence will climb higher as Americans live longer. There is a role that policymakers can play in helping to abate this growing public health crisis, and that is by putting an emphasis on prevention: creating policies that expand children and families’ access to healthy, affordable food.

Prompted by New Scientist’s September 1 cover story on the issue, The Guardian summarized the latest research suggesting that Alzheimer’s is primarily a metabolic disease. It has long been established that people with type 2 diabetes are two to three times more likely to develop Alzheimer’s than the general population. There are also associations between Alzheimer’s and obesity and metabolic syndrome. Now some scientists are strengthening the link and have even renamed Alzheimer’s disease “type 3 diabetes” because they believe that Alzheimer’s is caused largely by the brain’s impaired response to insulin. Insulin in the brain has functions beyond glucose metabolism—it also regulates the transmission of signals between nerve cells, and affects their growth, plasticity and survival.

Anyone who has cared for a family member with Alzheimer’s can affirm how disabling this disease can be, and the stresses it can put on families. In fact, more than 15 million Americans provide unpaid care valued at $210 billion for persons with Alzheimer's and other dementias.

The cost of Alzheimer’s treatment to the state and federal government is also enormous. Average per person Medicare payments for an older person with Alzheimer’s or other dementias are nearly 3 times higher than for an older person without these conditions. Medicaid payments are 19 times higher.

Research has not reached the point where scientists can unequivocally say that poor diet is a leading cause of Alzheimer’s disease, but there is enough evidence to underscore the public health message of healthy diet. Furthermore, this becomes a policy issue because low-income communities and communities that are predominately people of color have a disproportionately low access to healthy food. To possibly prevent our children of today from developing Alzheimer’s later in their lives, it will be important to invest in widening their access to healthy, affordable foods.

For policymakers, see the Policy For Results brief on increasing access to healthy affordable foods.

New Data from the U.S. Census on Poverty, Income and Health Insurance

Earlier today the Census Bureau released the 2011 data on income, poverty and health insurance coverage. The good news is after three consecutive years of increases, neither the official poverty rate nor the number of people in poverty were statistically different from the 2010 estimates. The bad news is there is still an unacceptable poverty rate, marked income disparities by race, and a continued shift of wealth to people in the top income percentiles.

Highlights from the Census data on poverty and income:

• The 2011 official poverty rate for the nation was 15.0% and there were 46.2 million people in poverty, not statistically different from last year.
• There still persists a large income disparity among racial groups, as Blacks had a poverty rate of 27.6%, Hispanics 25.3%, Asians 12.3% and Non-Hispanics Whites 9.8%.
• Hispanics were the only ethnic group to see a change in poverty rate, which decreased from 26.5% in 2010 to 25.3% in 2011.
• The percentage of people without health insurance coverage decreased in 2011 to 15.7% from 16.3% in 2010. The number of uninsured also decreased to 48.6 million in 2011 from 50.0 million in 2010.
• There was a significant change in the share of aggregate income, as the top 5% of earners saw their share of aggregate income increase by 5.3%. Those in the second, middle, and fourth quintiles saw their share of aggregate income decrease by 1.6%, 1.9%, and 1.6%, respectively. Those in the lowest quintile saw no significant difference.
• People in the lowest quintile of income increased their percentage of year-round, full-time workers by 17.3%, which was much higher than any other income quintile.
• The percent of people in deep poverty (i.e. their income is 50% of their poverty threshold) was 6.6%--although this is not a significant change from 2010, it is important to note that 6.6% is a substantial increase from the 1967 level of 4.4%.
• Unemployment insurance benefits saved 2.3 million people (600,000 of whom were children under 18) from being poverty
• Social Security income saved 21.4 million people (1.1 million of whom were children under 18) from being in poverty
• Although the Supplemental Nutrition Assistance Program (SNAP—food stamps) and the Earned Income Tax Credit (EITC) are not counted in the poverty measure, if they were: SNAP would have decreased the poverty number by 3.9 million people (1.7 million of whom were children) and the EITC would decreased the poverty number by 5.7 million people (3.1 million of whom were children).

On health insurance:

• In 2011, the percentage of people without health insurance decreased to 15.7% from 16.3% in 2010. The number of uninsured people decreased to 48.6 million, down from 50.0 million in 2010. This is the first time in four years that the number fell.
• However, coverage levels remain below levels prior to the Great Recession. The percentage of people without coverage remains higher than in 2007, when 14.7% of the population was uninsured.
• Among adults aged 19-25, in 2011 27.7% were uninsured as compared to 29.8% in 2010. This is a decrease of 2.2%. There was not a significant change in insurance coverage for children under 19.

The poverty data released today tells us the percentage and demographic information of people in the United States that live in poverty.  However, the numbers indicate something else too: the impact that public policies have on poverty.  Public investment in policies that create jobs and support families significantly impacts whether or not people experience poverty.  In an earlier post, the Center on Budget and Policy Priorities connected the numbers on health insurance to related federal policies. They found that the decrease in the percentage of uninsured young people aged 19-26 can be explained in part because of the new provision under the Affordable Care Act that allow adult children to obtain coverage from their parents’ health insurance plan up to their 26^th birthday. Similarly, in a recent piece by Half in 10, they outline the impact of public policy choices on poverty, including information on the tax programs that were included in the Recovery Act. Furthermore, CBPP found that it is possible to reduce poverty while reducing the deficit, as the three largest three largest deficit-reduction packages of the last two decades achieved both by increasing the EITC (in 1990 and 1993), increasing SNAP (in 1993) and creating the Children’s Health Insurance Program (CHIP) (in 1997).

The Take-Home Message

While the official poverty rate did not change from last year, it is important to note that the data shows the wealth gap between rich and poor continues to increase, and the rate of people in deep poverty remains staggeringly high.

The Census data also showed a link between full time work and the leveling-off of the poverty level.  This has meaningful implications for policymakers. Continuing to focus on job creation will help to bring more people out of poverty and stable employment at a reasonable wage will ensure they stay there. However, the data also shows the immense value of safety net programs like SNAP, the EITC, unemployment insurance, and Social Security which are there to support those  who have a job but are still struggling to meet their basic needs, those who have lost their jobs and those who may be unable to work.

While budgets are tight and falling short, and while unemployment rates and poverty remain high, it is important for policymakers to continue to work on supporting the families in greatest need - all while considering the feasibility within the current economic climate. Understanding how communities are being most affected and why will help policymakers create safety-net programs that will meet family and community needs. Creating policy with a focus on results will help to do this in a way that also efficiently allocates scarce resources and improves the odds that problems will be addressed effectively.

To read CSSP's Statement on the New Poverty Data and Implications for Children and Families please click here.

For more strategies to Ensure Children Grow Up in Safe, Supportive and Economically Successful Families visit PolicyforResults.org.

More from our blog: a primer on poverty measurement and the Census instruments used.

To Block Grant Medicaid—A Potentially Heavy Burden for States

Medicaid, the federal health insurance program that largely serves low-income children, seniors and certain disabled adults, has been a vital component of the public safety net since its inception in 1965. Because children under Medicaid tend to be in poorer health than children in private insurance (they have a higher prevalence of asthma, autism, dental and vision problems, ADHD, developmental delays, depression, and seizure disorders), Medicaid’s benefits package was designed to meet the complex needs of low-income children. Early and Periodic Screening, Diagnosis and Treatment (EPSDT) has been essential to ensuring that children continue to have a routine source of care and preventive screening for oral health, vision, mental health, developmental issues, and physical health.

In the last four years, people have enrolled into Medicaid at a higher rate than previous years as a direct result of the recession. With more people out of work, they lose access to their employer-based health insurance, their families become impoverished and they then become income-eligible for Medicaid. Furthermore, Medicaid’s enrollment has increased because of the aging population and because of the steady decrease in the number of employers who offer health plans to employees.

Since the federal government pays for the majority of the share of Medicaid spending, this increase in enrollment has led to an increase in the proportion of federal spending that goes to Medicaid. Although Medicaid costs less for the federal government than Medicare and Social Security, it often becomes the target of cuts because people with low-income are an easy target. Therefore, to control for the rising costs of Medicaid and to reduce the federal deficit, there are two very different opinions on the direction that Medicaid should now take: (A) expand Medicaid eligibility while creating cost-savings elsewhere or (B) block grant Medicaid.

Under the Affordable Care Act, Medicaid’s eligibility rules are set to expand in 2014 so that childless, non-disabled adults would be able to enroll if their income was up to 133% of the federal poverty level. The costs of this expansion are offset by revenues from the excise tax on high-premium insurance plans and net savings from other coverage-related effects, such that the Affordable Care Act produces a net reduction to the federal deficit of $124 billion.

On the opposite end of the spectrum is a proposal to change Medicaid from a defined entitlement program to a block grant. With a set amount of dollars and no mandates on coverage, states would have more autonomy and flexibility to design their Medicaid program to meet the specific needs of the state. Under this proposal, to encourage more enrollment into private insurance, premium supports or a refundable tax credit would help non-disabled adults and children to enter the private insurance market. States would be encouraged to use block grant dollars to pay for home-based care for the aged and disabled, rather than more costly institutional care.

As noted by First Focus in their analysis of the US House of Representative’s Budget Committee bill (which would block grant Medicaid), a Medicaid block grant would result in a loss of $810 billion over 10 years of federal investment in the program. About $162 billion of the total would come from investment in children’s services. While it would save money for the federal government, it would also shift the burden of costs to states, which would face a difficult decision in how to respond.

According to the non-partisan Congressional Budget Office, which also analyzed the bill, “states would face significant challenges in achieving sufficient cost savings through efficiencies to mitigate the loss of federal funding.” States could: (A) maintain current service levels, in which case they would need to reduce spending in other areas or raise revenues, or (B) reduce the size of their Medicaid program.

To adjust to the decrease in contribution from the federal government, states would likely have to tighten eligibility restrictions, ration care that children receive and lower payments to providers. Considering that Medicaid reimbursement rates are already lower than the reimbursement rates under Medicare and private insurance, this might discourage doctors from accepting Medicaid patients.

Whether Medicaid expands as an entitlement or is reduced via a block grant, states will have flexibility to design innovative programming to get services to their populations; it will be critical that state policymakers carefully consider their options (through state plans, waivers, demonstration programs, etc.) to provide quality, cost-effective care to children.For more on strategies to ensure that children are healthy, please visit PolicyForResults.org.

The Nutmeg State: A policy model for health equity

Connecticut is fast becoming a leader when it comes to their policy on health equity for the state’s children and families.  The Connecticut Health Equity Initiative can serve as a model for other states in thinking about how to “enhance the capacity of local health departments in partnership with community partners and leaders to achieve health equity through a focus on the social, political, economic, and environmental conditions that affect health.” 

Indeed, over the last number of years, public health officials, as well as policymakers, have begun to conceptualize health in much broader categories than previously considered.  A recent work edited by Howard Frumkin, Andy Dannenberg, and Richard C. Jackson entitled, Making Healthy Places, speaks to how the physical environment naturally impacts one’s health – everything from the roads we build to the parks we enjoy.  This type of thinking is concerned with social determinants of health, that is, as defined by the CDC, “the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.”  Health equity, then, is focused on making these determinants more fair for children and families who are situated in vulnerable circumstances, either socially, financially, psychologically, through the places they lives, or a combination thereof.  Connecticut uses an integrated model in attempting to shape healthier citizens, through workforce development, community engagement, and a health equity index that they created based on eight recognized social determinants and other indicators.  Through this index, residents of Connecticut can then go on the Health Equity Alliance website and map their city or county’s health equity.  This is a stirring innovation, because it allows both public health officials and policymakers to visualize health equity.  Hopefully as this tool continues to be refined there will be opportunities to see how various localities’ health equity may change over time.  What I find particularly useful for policymakers is that along with the quantitative data, the Index allows for the collection of qualitative data -- the narrative of those experiencing or witnessing health inequities.  This feature will provide officials with stories to help get the message about health equity out.  

Connecticut is doing great work when it comes to creating tools, strategies, and awareness for sophisticated knowledge and action on health equity.  Other states could and in my opinion, should be following the Nutmeg State’s lead. 

To learn more about state policies to ensure that children are healthy visit PolicyforResults.org.               

The Convergence of Health and Place-based Policy

Place governs our lives.  Our physical environments impact our behaviors, our choices, and our life outcomes.  More recently, the Obama Administration has explicitly endorsed place-based policies and increased interagency coordination in their social policy approach.  However a number of placed-based programs existed in prior administrations including, the Community Reinvestment Act, housing redevelopment through HOPE VI, Empowerment Zones, New Markets Tax Credit investments, as well as foundation-led comprehensive community initiatives and local nonprofit ventures.  Promise Neighborhoods, a program established by the Obama Administration is an addition to the list as is The Building Neighborhood Capacity Program and Choice Neighborhoods.  The question is, why focus on place, and how do place, community health and wellbeing relate?  

In the last few years, a body of research has been growing which argues for the significance of place-based investments.  Xavier Briggs, in his text, The Geography of Opportunity, shows why segregation persists and how it undermines education, job prospects, and even health and safety for millions of minorities and low-income families.  More recently, Enrico Moretti’s book, The New Geography of Jobs, speaks to how America’s economic map shows growing differences between communities and how labor and employment is causing growing geographic disparities in all aspects of our lives, from health and longevity to family stability and political engagement. 

Given this literature, a number of states and cities have begun to think about the myriad of ways in which place, essentially where people live and work, affects the health of children and families.  The program Safe Routes to School, a national partnership, has many statewide and local initiatives, including in Arizona, California, New Jersey, Illinois, and Maryland to name just a few states.  This initiative is focused on providing youth with safe streets and access to school, while simultaneously promoting active living environments for children and their families.  In Takoma Park, Maryland, Safe Routes to School has worked with local officials to improve sidewalks and trails for enhanced student safety and walkability to and from school.  Further, SRTS has hosted an annual 5K walk/run for students, as well as organizing National Walk to School Day to support health and active lifestyles early in life.

In another initiative in the Twin Cities in Minnesota, community groups, ISAIAH, TakeAction Minnesota and national community intermediary PolicyLink launched the Healthy Corridor for All Health Impact Assessment (HIA) project to understand the potential impacts of the proposed transit-oriented land use changed on the communities that live in a proposed light-rail corridor.  They conducted a Community Health Impact Assessment to assess the impacts of the rezoning proposal on community health, health inequities and underlying conditions that determine health in the area known as the Central Corridor.  This case is a great example of improved ways of looking at the affects of land-use or other place-based policies on community health.  

State policymakers concerned with providing healthy places for children and families to work and go to school – should consider these strategies.  Partnerships like Active Living by Design and Leadership for Healthy Communities provide great resources for policymakers focused on improving the places located in their jurisdictions – and by way of that the health outcomes of the families in their communities.

For results-based policy strategies to improve health outcomes for children visit PolicyforResults.org

Building Neighborhood Capacity!

Public policy that aims to create better coordinated and comprehensive approaches to address community needs can both take advantage of community strengths and reduce program redundancy.  In an economic climate that requires stretching fewer resources to meet increased need – these approaches are ever-more important.  On the national level there are several policy initiatives that are aiming to create neighborhoods of opportunity through more comprehensive place-based programs.   One such effort is the Building Neighborhood Capacity Program.

The Building Neighborhood Capacity Program (BNCP) is designed to help low-income neighborhoods build the infrastructure and resources needed to ensure families living within these communities experience better results around education, employment, safety, housing, and other key areas. The BNCP was established in 2011 as a part of the White House Neighborhood Revitalization Initiative (NRI). The BNCP is unique in that it is focused on helping communities build and further their infrastructure to be in a better position to create coordinated community approaches.  The communities that have been  chosen for this program have historically faced barriers to revitalization, such as distressed neighborhoods that may not be well-connected with institutions such as universities and hospitals, are far from economic vitality, experience high rates of crime, and may have experienced racial or class segregation that severely limits opportunities.

The goal of the BNCP is to help neighborhoods develop knowledge, skills, relationships, and organizational resources that enable residents, civic leaders, the public and private sectors and local organizations to create comprehensive neighborhood revitalization plans. The BNCP mobilizes and empowers communities to achieve what they want for their children, families, and residents through jobs and economic success, affordable housing, good education, strong families, safe neighborhoods, and health.

The Center for the Study of Social Policy (CSSP) is collaborating with the Departments of Justice, Education and Housing and Urban Development to provide technical assistance for the BNCP. CSSP will offer training to help the BNCP neighborhoods develop and begin to pursue results-driven revitalization plans. CSSP is in collaboration with the Aspen Institute Roundtable on Community Change, the Institute for Community Peace, Living Cities, and the National League of Cities.

The Communities that have been selected for the BNCP were announced today and are: Milwaukee, Wisconsin; Flint, Michigan; Memphis, Tennessee; and Fresno, California. For more information on the selection read our Investing in Community Change post.

It is critical for policy solutions to address issues in coordinated and comprehensive ways because that is the way that best meets the needs of families and communities.  BNCP is an example of a national effort to help communities develop the infrastructure needed to begin doing work in more coordinated ways.  State policymakers could consider similar efforts for communities in their state.  To learn more about the BNCP visit CSSP’s resource page on Building Neighborhood Capacity.  To learn more about comprehensive state policy strategies for addressing issues that impact families visit Policyforresults.org.

Communities to Students: Let us help with your massive student loan debt!

Next American City has a great article on how cities and states are attempting to attract young people to their regions through incentives tied to student loan debt repayment.  The “brain drain” of many older industrial cities has plagued these places for decades.  The article shines a spotlight on a number of state and local initiatives that aim to both reverse this hemorrhaging of young, educated people to certain cities through offering students the opportunity for help in paying off their student loans – a policy issue that is only going to become more severe over time.  

Just recently news was release that American students have racked up over $150 billion in loan debt.  Over the past decade, student loan debt has soared 275%.  This has become an epidemic.  Just think, if many students have to pay back voluminous quantities of loans it delays their being able to purchase a car, a house, various consumer items, and most importantly to save for the future.   And this all relies on the student finding a decent job following college or graduate school.  

Most notably, the New Jersey Assembly introduced a bill last month that would provide financial incentives to recent college grads who move to certain parts of the state, including Camden, Trenton and Jersey City.  The bill is entitled, the Urban Scholar Revitalization Initiative, and it would offer up to $7,000 in reimbursement for tuition fees.  The policy of the program is straightforward in that the program would be administered with New Jersey’s already existing Urban Enterprise Zone Authority, “allowing businesses that receive tax credits under the program to earn further credits for helping recruit more young people to the program.”

Not wanting to be left out, the Midwest is getting involved too.  The state of Kansas, with 50 participating counties (called Rural Opportunity Zones rather than municipalities) will waive income tax for five years and provide up to $15,000 in loan reimbursements.  By October 160 people will already have received payments as new residents of the state.  Their neighbor to the north, Nebraska is now considering a similar program; a bill is on the 2012 legislative agenda.

Whether or not these policies will be successful in revitalizing communities is yet unknown – and is somewhat controversial.  On one hand, I can see it serving a mutual good in that students are able to pay down their loans in places that are more than glad to have them.  On the other it seems that these incentives are going to many students who would have been moving to these areas anyway as most of the participants that qualified for the Kansas program had regional ties.  Further, there are a myriad of other ways in which money could be spent which focus on young persons entering the workforce, including job training, educational scholarships, and mentoring programs.  

As Sean Andrew Chen writes in the NAC article, “If the program fails, it would be yet another example of wasted money that could have gone to services such as police and education.  But if it works, it could help bring much-needed investment and serve as a future model for other struggling cities.”  My guess is that these programs might bring some young people into these places, however the larger structural issues related to brain drain and displacement will continue unabated.  It is important to not only address the symptoms but also to confront the root cause.  Comprehensive strategies to address the difficult issues facing these communities are needed, success requires it, and whether or not these incentive policies are a significant aspect of a successful strategy – remains to be seen.

The Importance of Medicaid

Medicaid is crucial in supporting low-income households in obtaining healthcare coverage and provides health insurance to nearly 60 million children and families. Since Medicaid has strict rules for eligibility, the expansion of Medicaid benefits those who had not been previously eligible for any type of affordable health coverage. Under the current eligibility requirements, state Medicaid programs must cover children under the age of 6 living in families with incomes below 133% of the federal poverty level and children ages 6-18 with family incomes below 100% of the FPL. However, states can decide whether or not to extend eligibility further. For example, states must cover children up to 18 years of age, but have the option to cover 19 and 20 year olds. In addition, states must provide coverage to pregnant women with family incomes below 133% of the FPL and parents with incomes below 50% of the FPL, but have the option to provide coverage to these groups above the minimums.

Adults who are not disabled, pregnant, or elderly, and have no minor children generally have been excluded from Medicaid.  In the past, to extend Medicaid to these adults, states had to receive a waiver and could not receive additional federal Medicaid funds for this coverage; instead, states needed to redirect existing federal Medicaid funds or create program savings to offset the cost of the coverage.  As a result, the expansion of Medicaid will cover an additional 22.3 million uninsured individuals with incomes below 138% of the FPL.

Medicaid is jointly funded by the federal government and states. To finance the expansion, the federal government will cover 100% of the states’ cost in covering newly eligible Medicaid recipients, then phase down its federal contribution to 95% between  2014 and 2019, then again to 90% in 2020. Since April 2010, California, Connecticut, Minnesota, New Jersey, Washington, and the District of Columbia have expanded Medicaid to low-income adults and have been able to cover an additional 600,000 people.  These states were able to preserve, expand, and strengthen coverage for their low-income residents.

 According to The Urban Institute, if a state does not implement the expansion, some individuals would receive federal tax credits and other subsidies instead of Medicaid; however, cost-sharing requirements would be higher. Federal tax credits and subsidies would not be available for most people with incomes below the federal poverty line, which means uninsured individuals living above poverty can receive help, but those living below poverty would not. Rejecting federal funds and refraining from the expansion could have adverse impacts on more than 27 million uninsured Americans with incomes below 138 percent of the poverty level.

For state policymakers, it is important to consider the economic and societal benefits of providing healthcare to those who currently lack access to affordable coverage and to reduce coverage disparities.  

For state policy strategies to ensure that children are healthy, visit PolicyforResults.org. 

Eliminating Food Deserts: A Policy Solution

Much has been made about food deserts over the last few years, and rightfully so.  These spaces in our cities and states are where healthy, affordable food is difficult or at times impossible to obtain.  Food deserts often correlate with low housing values and populations with marginalized SES.  Generally, the wealthier the neighborhood, the more choice its residents have for healthy eating.  Increasingly, more states and cities have been confronting the myriad of public health concerns that emerge from food deserts through a number of interesting policy solutions.  The Economic Research Service at the Department of Agriculture even has a Food Desert Locator for individuals and families to see how their neighborhood stacks up.  In this entry I will shed some light on one idea in particular that makes fresh, health, and affordable food available for children and families for who access has been lacking. 

One policy intervention that I have become increasingly smitten by are fresh food corner stores.  These have popped up in a number of areas and their appeal is palpable in these communities.  In Louisville, Kentucky, the Healthy in a Hurry Corner Stores started appearing in 2009; there are currently six stores operating throughout the city.  These stores stock fresh, affordable produce for residents of food deserts, essentially allowing a healthy choice to be an easy choice.  Indeed, many of those living in poor neighborhoods don’t have easy access to private transportation and so while they may want to eat healthy foods, it’s difficult for them to drive the long distances outside their neighborhood for more options.  Healthy in a Hurry Corner Stores enable good decision making through ease of use.  How were these stores funded?  In Louisville, city officials used an award of $7.9 million through a Health and Human Services Communities Putting Prevention to Work initiative, funded by the American Recovery and Reinvestment Act. 

Perhaps the leader in this healthy corner store movement is Philadelphia and the Philly organization The Food Trust.  Their Healthy Corner Store Initiative is funded through a range of support from philanthropy including the Robert Wood Johnson Foundation and state policy such as the Pennsylvania Fresh Food Financing Initiative which encourages the development of food retail in underserved Pennsylvania communities.  Through the leadership of Rep. Dwight Evans, the Fresh Food Financing Initiatives serves as a model grant and loan program stewarded by a public private partnership consisting of the Reinvestment Fund, the Food Trust, and the Greater Philadelphia Urban Affairs Coalition.  The results speak for themselves.  According to the Food Trust, “the Fresh Food Financing Initiative has provided funding for 88 fresh-food retail projects in 34 Pennsylvania counties, creating or preserving more than 5,023 jobs and improving access to healthy food for more than half a million people.”  Through the success and wide publicity of Philadelphia’s efforts, other cities are jumping on board including Chicago and Seattle.  In addition the Healthy Corner Stores Network has been created as an umbrella site for the variety of initiatives across the country.  Many in government, social policy, and public health have asked will these cities attempts at eradicating food deserts work?  My contention is whether they completely eradicate food deserts is beside the point.  Indeed, there is no silver bullet in these matters.  What they are doing is bringing healthy and affordable produce to neighborhoods in dire need of these choices.  And that is a big step in the right direction.           

To read more about the Pennsylvania Fresh Food Financing Initiative as well as the Federal Fresh Food Financing Initiative see our issue brief, Aligning Resources and Results:  How Communities and Policymakers Collaborated to Create a National Program

To learn more about what state policymakers can do to increases access to affordable healthy food read our report, in partnership with Leadership for Healthy Communities, on Preventing Childhood Obesity or click here. 

The Opportunity Gap: Schools and Equity

The news organization ProPublica is a well known nonprofit newsroom that produces investigatory journalism in the public interest.  They were the first online news source to win a Pulitzer in 2010.  One piece in particular that I would like to craft a conversation around today is their web tool entitled, The Opportunity Gap: Is Your State Providing Equal Access to Education? 

Decades after Brown v. Board, education in our country is still tied to geography.  America’s de facto education policy is simple:  If you want good public schools for your kids you move to a zip code which has good schools.  We are allowing a market-based laissez-faire system to determine if, and to the degree, our children will have access to a quality education.  Rather than being institutions of greater social and economic mobility, schools often serve as engines of the status quo.  Students who live in poor neighborhoods and attend under-resourced schools are less likely to be successful than their counterparts located in higher income communities.  This gets to the heart of the difference between the achievement gap and the opportunity gap in America.  The achievement gap puts the focus squarely on the child and their ability to achieve, whereas the opportunity gap places the focus on the contextual social, economic, and political forces that create pathways for that child to achieve.  A focus on the opportunity gap, leads to the question:  Are states providing fair and equitable access toward a quality education for all kids?

To address this question, ProPublica provides a database to access data on the opportunity gap specifically.  It then provides equal opportunity indicators such as Inexperienced Teachers, Number of AP Courses, Students who get free/reduced lunch, Students who take at least one AP course, Students who take advanced math, and compares this data with both the School District and the State.  Further, there is a breakdown of racial demographics by school, district, and state.  

I looked up my high school, Ballard High in Louisville, Kentucky.  I found, to my expectation, that Ballard had less inexperienced teachers than either the comparable district or the state in Kentucky and more AP courses offered.  A significantly lower percentage of students at Ballard received free/reduced lunch than either at the district or the state.  

ProPublica also looks at how states compare at providing high poverty and wealthier schools equal access to AP classes, chemistry, physics, advanced math, and gifted/talent classes.  States like Maryland and Kansas did poorly at achieving equitable distribution of these opportunities whereas states such as Minnesota, and Delaware did well.  

What are the takeaways for policymakers from this tool?  Well, one is for simply creating awareness.  Our schools are, essentially, a reflection of our society; a society that remains inequitable and segregated by socio-economic status.  Many policymakers know this already and, in turn, argue and attempt to craft policies toward the amelioration of the status quo, however there is a vast and growing body of research in this realm and better connecting policy to this research is critical.  For instance, for a number of years now, Maryland has been lauded for having the nation’s best public school system.  However, in examining the ProPublica database, we see that while a great public school system, the spoils of that quality is distributed relatively unequally compared to other states.  This brings up questions of how states wish to see their resources allocated and how important an equitable allocation of resources is for citizens and policymakers.

Secondly, this website changes the language and framing of the debate from “achievement gap” rhetoric to an opportunity gap.  Our educational leaders are awash in language of “leave no children behind” and the usage of metrics and ever-increasing reams of data to measure “accountability” through a variety of standardized tests.  In turn, the achievement gap has become part of our daily lexicon.  Words shape how we view the world.  Words shape how we confront challenges in our lives and our society.  In short, words matter because words lead to real action, policy shifts, and results that may benefit children and their families.  Shifting from an achievement to an opportunity framing aids in confronting the root causes of these issues rather than putting the focus on an individual child’s achievement.  If we as a society care about all our children, we should care about the pathways these kids have for opportunities rather than a more narrow definition of “achievement” based on quantitative testing.  Data tools such as ProPublica’s database now makes it easier for states to create policies around the opportunity gap and benchmark themselves against other states.  This is public interest journalism at its highest and best use.