MLPP Blog: Factually Speaking

A Michigan where all kids thrive

Added April 21st, 2017 by Alicia Guevara Warren | Email This Entry Email This Entry
Alicia Guevara Warren

I am a self-described data and policy wonk, which suits me well as the Kids Count in Michigan Director. But my work is equally informed by growing up as a kid in Michigan and now being a mom of a young child myself. And as both a parent and a child advocate, I can’t help but wonder about the type of place we are creating for our kids and our future.

My daughter’s childhood experience and that of her friends seems to be so different from the one I had. In addition to the anecdotal evidence and stories we hear, we also have data, charts and numbers that show us how kids are doing in our home state.

The 2017 Kids Count in Michigan Data Book, an annual report reviewing several measures of child well-being in the state and its communities, was released this week. It shows that while there have been some improvements since 2008 and recent policy wins for kids and families, there are still a lot of areas that should be concerning to everyone. Many kids in Michigan are struggling, and the numbers show that some kids face significant challenges based on where they live, their race or ethnicity and how much money their families make.

2017_Health-and-Safety_WebWhile most families with low incomes are not more likely to abuse or neglect their children, living in poverty causes many hardships that can impact a caregiver’s ability to provide basic needs. According to the 2017 Kids Count in Michigan Data Book, there was over a 51 percent increase in the rate of children confirmed as victims of abuse or neglect from 2009 to 2015 with over 80 percent of incidences due to neglect. This means that there was a failure to provide adequate food, clothing, shelter or medical care or that the child’s health or welfare was at risk.

For example, a single-parent working two jobs has difficulty affording safe and quality child care, so is forced to leave an eight-year-old child at home while he or she works to keep food on the table and a roof over their heads. Another example is a family who doesn’t have access to affordable housing and may be living in substandard conditions, or even a car, if a family shelter space is unavailable.

Some other key data findings from the report include:

  • Working a full-time, minimum wage job leaves a parent with a family of three $1,657 below poverty each year;
  • Nearly 20 percent of mothers report smoking during pregnancy, with higher rates in rural communities;
  • 31 percent of mothers did not receive adequate prenatal care throughout their pregnancy;
  • About 10 percent of children in Michigan are impacted by parental incarceration;
  • On average, monthly child care consumed 38 percent of 2016 minimum wage earnings; and
  • Nearly 17 percent of Michigan children live in high-poverty neighborhoods—but the rate is 55 percent for African-American kids and 29 percent for Latino children.

Adverse childhood experiences (ACEs) and toxic stress, such as poverty and abuse or neglect, have profound impacts on short- and long-term well-being. The data show that some kids face significant challenges based on where they live, their race or ethnicity and how much money their families make. This is not right. If we are to truly improve outcomes for all kids, then policies must be crafted with the goal of achieving equity and targeted to help those who need it the most. Systematic reforms should include elimination of barriers that often result in inequitable outcomes.

From improving prenatal care, making quality child care more accessible and investing in education at all levels to changing how kids are treated in our justice system, our new report outlines solutions that can move us towards this goal to help all kids in Michigan thrive. Now it’s up for Michigan lawmakers to act on them to improve child well-being in their communities and around the state.

— Alicia Guevara Warren

On Tax Day, don’t mess with taxes

Added April 18th, 2017 by Rachel Richards | Email This Entry Email This Entry
Rachel Richards

Over spring break, my son needed to use books by a specific author for homework. Not having any of these books, my family jumped in the car, drove on our newly-paved street, passed the local fire department and stopped at the public library to see if any of these books were available. Without even thinking, we used or saw services provided by our taxes in the less than 10 minute drive.

I think about all of the amazing services taxes provide us. They provide us good public schools, vibrant communities, safe and drivable streets, public safety, parks, libraries, a trained workforce and so much more.

However, there are lawmakers who are trying to cut or eliminate our state income tax. And while paying less in taxes sounds like a good idea, what any income tax cut does is provide a big break to Michigan’s wealthiest taxpayers while providing little to our residents who need it most. Additionally, an income tax cut won’t change what residents do with their money, as the impact would be felt in small amounts throughout the year as workers receive their paychecks instead of in lump-sum payments. A $260 payment is more noticeable than $10 more in each of your paychecks.

The Upside of Taxes

The Upside of Taxes

While most Michigan taxpayers would not see a significant impact on their pocketbook, even a small cut will significantly impact our ability to provide the things that Michigan residents rely on and need. Eliminating the state income tax without a replacement could cost the state nearly $10 billion, and even a small 0.1 percentage point reduction (from 4.25% to 4.15%) could cost the state more than $250 million on a full-year basis. And the income tax helps fund our schools, our colleges and universities, clean water, roads, and all of the good things that government provides us.

It’s been said that Michigan needs a game-changer. Cutting taxes won’t do this. We know this because we’ve done it before.

  • In the 2011 tax shift, Michigan cut business taxes by about $1.6 billion, and now net business taxes only provide about 2% of our total state-sourced revenues.
  • The state has started phasing out personal property taxes, which were paid by businesses to local governments, schools and libraries, and required the state to reimburse them for their lost revenues.
  • The state is also implementing a sales tax exemption for the value of a trade-in when buying a vehicle.

And many bills are introduced and enacted that cut or eliminate taxes on specific items or for specific entities, so much so that our state and local tax revenue as a percent of personal income has dropped 12% between 2004 (10.48%) and 2014 (9.22%).

So instead of more tax cuts, Michigan should look at investing in the things that Michigan residents, communities and businesses rely on. Perhaps this will truly change the game.

So as we mark Tax Day today, don’t despair! Remember that paying taxes is what helps make Michigan great. (And if you haven’t yet done your taxes and need help, you might qualify for some free tax help. Go to http://michiganfreetaxhelp.org/ to find out.)

— Rachel Richards

Making sure all kids have access to healthcare

Added April 10th, 2017 by Julie Cassidy | Email This Entry Email This Entry
Julie Cassidy

When Dorothy Gale clicked her heels together and repeated “There’s no place like home” in The Wizard of Oz, she thought of her family’s farm in Kansas. Although “home” looks different to each of us, we all need a familiar place that anchors us in the world, a place to live, sleep, eat and play. We also need a medical home—a model of integrated healthcare delivery involving a collaborative relationship between a patient and a team of providers, with primary care as the cornerstone.

snip of doctor and childFor those of us without magical slippers, particularly families facing financial hardship, getting to a medical home isn’t easy. A lack of transportation is a big hurdle, especially as many areas of the state are experiencing a shortage of primary care providers. The healthcare system is complex and confusing. Some people feel intimidated talking to medical staff due to barriers in language, culture and education, and some parents may avoid doctors out of fear of judgment about their parenting skills or living situations.

On the other side of the equation, primary care providers are overburdened. In the current medical practice environment, many doctors simply don’t have the time or resources to fully understand the challenges financially stressed families face in navigating the system and adhering to medical advice, or to go beyond their core responsibilities to more effectively serve this particular population.

Fortunately, Michigan has its very own Glinda the Good Witch to guide children from families with low incomes to a medical home. It’s called the Michigan Children’s Health Access Program (MI-CHAP) and it’s administered by the Michigan Association of United Ways. Through strategies employed at the family, provider and system levels, MI-CHAP aims to improve the health of Medicaid-enrolled children, improve the quality of and access to medical homes, lower healthcare costs by reducing emergency department visits and hospitalizations among children on Medicaid, and promote innovation through virtual delivery of program model components statewide.

Currently, there are nine CHAP teams covering 26 counties, including Macomb County and Wayne County. Local teams work in their communities to improve access to primary care and address other factors that affect health outside of the doctor’s office. The teams provide critical services that often complement the work of Medicaid health plans and local health departments, including:

  • Assistance finding and engaging with a medical home;
  • Education regarding when and how to utilize medical care;
  • Transportation assistance for medical appointments;
  • Assistance in navigating the behavioral health system;
  • Disease-specific education regarding asthma, obesity and other conditions;
  • Home visits to increase access to health services;
  • Translation services; and
  • Connection to community resources to address a wide variety of needs such as food, housing, and utility assistance.

Childhood health status sets the stage for health status throughout a person’s life. Programs that enhance children’s access to the basic services and education necessary for good health make a difference in the lives of individual kids and the healthcare system as a whole. Through engagement with families, providers and communities, MI-CHAP is doing transformative work to make Michigan a good home for everyone.

— Julie Cassidy

Advocacy works—Two months, two big battles, two big wins

Added April 6th, 2017 by Gilda Z. Jacobs | Email This Entry Email This Entry
Gilda Z. Jacobs

From the First Tuesday newsletter
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We did it … again! I may be sounding like a broken record, but at least we’re stuck on a good song. For the second month in a row, I get to use this column to celebrate a big win and thank you for all you did to make it possible. The efforts to replace the Affordable Care Act (ACA) have hit a major wall, and President Donald Trump and Speaker Paul Ryan are shelving the American Health Care Act (AHCA) that would have harmed millions of Michiganians.

In their haste and partisan vigor, federal elected officials made a few significant missteps. They underestimated how “complicated” healthcare is and how effective the Affordable Care Act has been overall, especially with the Healthy Michigan Plan here in our state. Most importantly, they underestimated the power people have beyond the election process.

Congress&HealthCareThe strategy for defending the ACA and protecting the related Healthy Michigan Plan was simple. First, arm people with information. Right out of the gate, we put together a fact sheet and blog outlining all the good the Affordable Care Act has done for Michigan residents. Economist and Board Chair Charles Ballard connected universal healthcare to our conscience, our quality of life and our economy.

We quickly analyzed alternative healthcare plans and shared our findings on their flaws. This included outlining the devastation proposed block grants or per capita caps on Medicaid would cause in Michigan and exposing the real potential impact of the AHCA: 24 million fewer people with health insurance, $880 billion in cuts to Medicaid, and $600 billion in tax cuts for the wealthy and big insurance and drug companies. And we made sure that this information was on the airwaves and in front of readers the week of the expected vote.

The next step was to engage and mobilize people into advocacy. We knew that the ACA had touched many lives and was important to many organizations, and that the more we could combine our efforts, the stronger we’d be. That’s why we were proud to be a part of the Protect MI Care Coalition, a diverse group of organizations and individuals working together to ensure all Michigan residents have access to high-quality, affordable health insurance.

Through the coalition, we worked to get the people involved who would be most affected by a repeal or replacement of the ACA. We helped gather the stories of real people who have benefited from the ACA, even those whose very lives were saved, and shared them with the media and elected officials. And we joined in an online advocacy effort that enabled people to email and call their U.S. Representatives and U.S. Senators to tell them to oppose the AHCA.

Similar efforts were undertaken by our various public policy partners at the national level and organizations similar to the League in other states. Collectively, those advocacy efforts worked!

The strong public opposition and political friction ground the bill’s progress to a halt. Despite the push from the President and pressure from the House Speaker, and despite their party having the majority, the bill did not have enough votes. When the bill’s supporters courted moderates, they lost conservatives. And when they courted conservatives, they lost moderates. This sunk the AHCA, but it also showed that Republicans in Congress will face a similar challenge with any other healthcare bill that significantly undermines or undoes the ACA.

That doesn’t mean they won’t try. This threat remains imminent and new discussions are already underway. But I hope you feel as empowered as ever that advocacy does work and that you can make a difference. We are lucky to have passionate and determined people like you on our side. The League will keep fighting and I know you will too. And together, we can keep winning.

— Gilda Z. Jacobs

Are we really concerned about the children?

Added April 5th, 2017 by Pat Sorenson | Email This Entry Email This Entry
Pat Sorenson

I think I would be hard-pressed to find a state lawmaker who did not care about children and the well-being of the next generation. Many are parents and grandparents, so they feel that concern at the most personal level. They want the best for their family—good schools, safe communities, access to healthy food and the best medical care.

Their dreams for their children are shared by most parents in the state, including those who struggle to support their children on low-wage jobs, can’t find or afford safe and high-quality child care, don’t have reliable transportation to get to work, or send their children to schools that are not prepared to meet their needs.

Despite Lansing rhetoric about supporting children, many are suffering—in part because of state policies and budgets that have at best not aggressively addressed the antecedents of poverty, and at their worst have forced more children into deeper poverty.

BB League recommendations graph 2Michigan has for many years disinvested in basic income assistance programs for families struggling to find and keep work. Since 2007, state lawmakers have restricted eligibility for public assistance through more stringent lifetime limits, toughened sanctions (including stopping benefits for a whole family if one child is truant), and imposed an asset test for food assistance. And, with virtually no increases in the monthly income assistance available to eligible families (currently a maximum of $492/month for a family of three), children are living in deeper and deeper poverty.

As a result of these changes, the number of children receiving income assistance through the state’s Family Independence Program (FIP) has plummeted while child poverty remains stubbornly high. Children represent nearly 8 of every 10 persons receiving FIP assistance, so any policy that restricts help to families is causing the greatest hurt to children, and especially young children.

And why is this a problem for all Michigan residents? First, investing in children is the right thing to do and it is what we expect of ourselves as residents of this state. I don’t think many of us would sleep well at night knowing that we had done something—even unintentionally—to hurt a child.

Second, it is to our mutual advantage. With our rapidly aging population, the next generation of workers and parents are the foundation for growth and stability of the state’s economy. The link between childhood poverty and a host of negative outcomes for children is undeniable and includes poor health, higher rates of disability and reduced academic achievement—all potential barriers to success in the workforce.

The governor has recommended funding in the 2018 state budget that could benefit families living in or near poverty, including continuation of the “heat and eat” policy that expands food assistance and an increase in the annual clothing allowance for families receiving FIP. The League supports those investments as a first step on a long path.

For more on the governor’s budget and the League’s priorities, see our most recent Budget Brief (link here).

— Pat Sorenson

With federal budget cuts, the sky may really be falling

Added March 31st, 2017 by Rachel Richards | Email This Entry Email This Entry
Rachel Richards

My son loves books, and one of our favorite things to do every night is read before bed. Many of the stories we choose also provide a learning experience. One of our recent favorites has been Chicken Little, which I think my son chooses to laugh at me stumbling over tongue-twisting character names. It also gives us a chance to talk about thinking rationally.

This lesson is applicable from our kids to my policy work to the highest levels of government. But when President Donald Trump released his “skinny budget” in March—despite being light on detail—the potential impact it could have on our state budget and Michigan residents was stifling. And at times, I really do feel like the sky is falling.

My fear is not unfounded. Michigan has grown increasingly reliant on federal funds. Over the past decade, while our total state budget has grown by about 29%, federal funds in our budget have grown by nearly 69%. In our current budget, federal funds provide $22.7 billion of our $54.2 billion state budget. This means that more than $4 out of every $10 provided for important programs like public education, healthcare for children and families with low wages, food assistance and road maintenance are paid for by federal dollars.

Think-the-federal-budget-does-not-matter_CROP

These federal grants do matter to our state budget. According to a recent report from the Center on Budget and Policy Priorities, federal grants to states and local governments make up nearly one-third of non-defense discretionary spending. Michigan receives 3% of total federal grants to states, and only California, New York, Texas, Florida, Georgia, Illinois, Pennsylvania and Ohio get a bigger share than Michigan. Cuts to these discretionary programs, which are already at historically low levels, would harm workers, college students, local communities and families with low- and moderate-incomes.

What’s more is that this “skinny budget” proposes to completely eliminate funding for the Low Income Home Energy Assistance Program (LIHEAP), which helps families and many seniors pay heating bills; a block grant that supports housing, community facilities and economic development; the HOME program which helps develop and repair affordable rental housing and repair homes for homeowners with low incomes; and the Community Services Block Grant, which provides anti-poverty services.

While President Trump’s budget only outlines changes in discretionary spending, changes to mandatory grants may still be forthcoming, for example block granting or putting a per capita cap on Medicaid. (While the first round of the American Health Care Act was withdrawn, you can bet that Congress will try, and try again, to repeal the Affordable Care Act and alter Medicaid funding.) Changes in these programs, including Medicaid, the Children’s Health Insurance Program (CHIP), free and reduced-priced school meals, child care assistance and other assistance for families with low incomes, would mean deep cuts to these programs as states would be unable to absorb the costs themselves. This would reduce services to those Michigan residents who really need it.

Cuts to federal grants to state and local governments, and changes in federal programs, will only mean cuts to the very Michigan residents that rely on these services. Changes will result in more potholes and unsafe bridges, fewer Michigan residents with healthcare coverage, more children going hungry, less affordable housing, more poverty and more problems, all having a long-term negative impact on our economy.

So pardon my doomsday sentiment, but states really rely on federal funds to run. And these changes would affect our state for years to come. But we can change the future. It is important for all of us to get in touch with our members of Congress and tell them the things that really matter to us as they make decisions on the federal budget that will have a direct impact on our great state.

— Rachel Richards

How to think about health insurance and the Affordable Care Act

Added March 20th, 2017 by Charles Ballard | Email This Entry Email This Entry
Charles Ballard

Few laws, if any, have been the object of more misinformation, disinformation and alternative facts than the Affordable Care Act of 2010 (ACA, also known as Obamacare). Now that Congress is considering plans to dismantle the ACA, it’s more important than ever for Americans to have access to thoughtful analysis, which is what I hope to provide here.

Why Health Insurance Is a Good Thing
The first thing to say is something that may sound obvious, but which has nevertheless often been lost in the noise: Health insurance saves lives. Across the country, thousands of people are alive today who would be dead without the insurance coverage that they have received through the ACA. That’s worth saying again—thousands of Americans would be dead without the ACA.

If the ACA is rolled back, it is estimated that nearly 24 million Americans will lose their health insurance. This includes millions of people in Michigan. If that happens, every year more and more will die needlessly.

Why the United States is the Only Affluent Country without Universal Health Insurance
The second thing to say is another thing that may seem obvious, but is worth saying because the “debate” over the ACA has obscured so much: The USA is the only affluent country in which a “debate” like this is taking place. Every other affluent country in the world (including Canada, the United Kingdom, Australia, Germany, Japan and many others) has achieved a moral consensus that all residents should have full access to the healthcare system. In these countries, the moral judgment is that it is simply wrong for a society to provide full access to healthcare for some residents, but not for others. In other words, in these other countries, access to healthcare is viewed as something that should be distributed very equally.

Healthcare 2In the United States, the lack of such a consensus indicates that many are comfortable with a very unequal distribution of access to healthcare. With that very unequal distribution, those who are rich enough or lucky enough to have good health insurance have access to the best doctors and hospitals in the world. Those who aren’t so lucky are left to pray that they don’t get sick. If they get very sick, they are sometimes lucky enough to get a hospital to provide them with uncompensated care. And sometimes not.

It’s worth noting that access to healthcare is only one of several areas in which the moral consensus in the USA is different from the moral consensus in the rest of the world. For example, in the USA, household income is distributed much more unequally than in other affluent countries. For the USA to have a distribution of income as equal as that of the countries of western Europe, it would be necessary to redistribute a few trillion dollars from the top one percent to the bottom 99 percent, every year.

These differences between the USA and the other affluent countries did not arise by accident. They are the deliberate result of policies. The other countries also have more generous provisions for parental leave and child care, much lower rates of incarceration, and the list goes on and on. In one policy area after another, the political systems of the other affluent countries reflect a moral consensus to limit inequality, while the American political system reflects a moral consensus (or lack thereof) that allows a much greater degree of inequality.

The Economics of Health Insurance Markets
Although morals and ethics are central to understanding why we in America allow so many needless deaths as a result of lack of health insurance, a full assessment of the issue also requires some knowledge of the economics of health insurance. If private health insurance markets were able to provide universal coverage at a cost that everyone could afford, the problem would easily be solved.

pediatricianHowever, private insurance markets suffer from fundamental flaws. (This is not a diatribe against private markets. Private markets do an amazing job of providing all sorts of goods and services, with only a very modest amount of government regulation and oversight. But the peculiar characteristics of insurance markets are such that they don’t work nearly as well as most other markets.)

A private health insurance company makes a profit by collecting more in premiums than it pays out in claims. Thus the best of all possible worlds for a private health insurance company is to collect premiums from very healthy customers who have few illnesses, and thus generate few claims. That’s why, before the ACA, the standard business model for private health insurance companies was to deny coverage to people with pre-existing medical conditions.

If a private health insurance company were to offer coverage at rates based on community averages, and if it could not keep out the sickest people, what would happen? The sickest people would sign up, but the healthiest would not. That would leave the company with a sicker-than-average pool of customers. This is called “adverse selection,” and it’s a formula for insurance companies to go out of business.

Denial of coverage to people with pre-existing medical conditions is extremely unpopular with the public, but it is the only way for an otherwise unregulated private health insurance market to avoid collapsing from adverse selection.

Public Policies for Overcoming the Flaws of Private Health Insurance Markets: The Simple and the Complicated
If we want people with pre-existing conditions to have health insurance, two public policy approaches are available. The simple method is to have a “single-payer” system in which everyone is covered. This simple method is used in Medicare, which pays for health insurance for all elderly Americans. Medicare is not perfect, but it does effectively solve the problem of adverse selection for elderly Americans—the elderly are covered automatically.

medical1-150x150If we were to extend Medicare to the non-elderly population, a system of “Medicare for All” would achieve universal health insurance coverage, and would thus overcome the problem of adverse selection. Everyone would be covered.

An added advantage of Medicare for All is that it would lead to a dramatic reduction in administrative costs. The healthcare “system” in the United States is a crazy-quilt hodge-podge of Medicare, Medicaid, various types of private insurance, and a separate system for veterans, each with its own rules and forms. As a result, the United States spends far more on administration than any other country. If we had a single, unified system, we would save hundreds of billions of dollars per year by reducing the cost of administering the system.

The complicated way to expand health insurance coverage is to continue to rely on private insurance companies, but to add some major tweaks to the system. The first tweak would be to prohibit the insurance companies from denying coverage to those with pre-existing conditions. But that, by itself, would push the system into a death spiral of adverse selection. The sickest would sign up; the healthiest would not; the companies would go out of business.

Thus if we desire to move toward universal coverage, while still working within the framework of a private market for health insurance, it isn’t enough to prohibit companies from denying coverage. It’s also urgently necessary to get more healthy people into the risk pool. The way to get more healthy people to sign up for coverage is to offer a set of subsidies for acquiring insurance, and/or penalties for not doing so.

Enter President Barack Obama. When he took office in 2009, along with Democratic majorities in both Houses of Congress, the levers of power in Washington were in the hands of people who were committed to pushing toward more equal access to healthcare. They faced a choice between the simple method (Medicare for All) and the complicated method (prohibition of denial of coverage, combined with taxes and subsidies).

They chose the complicated method: The Affordable Care Act prohibits insurance companies from denying coverage to those with pre-existing conditions, which is extremely popular. And then, in an effort to avoid an adverse-selection spiral, the ACA also has a complicated system of taxes and subsidies, which are unpopular.

Why did President Obama and the congressional Democrats choose the complicated method? The answer has nothing to do with the economic advantages and disadvantages of the simple method and the complicated method. It has everything to do with the political fact that health insurance companies have tremendous power. The simple approach of Medicare for All would cut out the insurance companies. President Obama and the Congressional Democrats reached the conclusion that insurance companies had enough power to block the simple method, which left the complicated method as the only option for increasing access to healthcare.

Evaluation of the Affordable Care Act
What can we say about how well the ACA has performed? In my view, the ACA is a significant improvement on what we had before. Its biggest achievement, of course, is that the number of Americans with health insurance has increased by about 20 million, including about 1 million in Michigan; as mentioned above, some of these people are alive today because of the ACA.

Emergency room 2Unfortunately, the ACA has not done as much as it might have done. One problem is that the decision to take part in the Medicaid expansion, which is an important part of the ACA, was left up to the states. Many states decided not to participate, even though the federal government would have covered a large portion of the costs. Millions of Americans thus had to continue without health insurance, and some of them died needlessly. Fortunately, Michigan’s Governor Rick Snyder is one of the few Republican governors who had the courage to put the health of residents ahead of partisan politics.

The taxes and subsidies that are designed to shore up the private health insurance market have only been modestly successful. Some insurance companies have stopped providing coverage. This is a testament to the extraordinary stubbornness of the adverse-selection problem. Even with a very elaborate system of incentives, the ACA still has not been able to get as many healthy people into the system as it should.

Efforts to Roll Back the ACA
If the 2016 elections had been won by people who place a high priority on equal access to healthcare, the ACA probably would have been tweaked in an effort to put a further dent in the problem of adverse selection.

But power in Washington now rests in the hands of those for whom equal access to healthcare appears to be a low priority. And yet the Congressional leadership also appears to understand that it would be politically unpopular to return to a system in which insurance companies can deny coverage to those with pre-existing conditions. Thus the American Healthcare Act maintains the ACA’s prohibition on denial of coverage, but would charge more in a person has a significant lapse in coverage while weakening the parts of the ACA that were designed to prevent an adverse-selection spiral. This raises the real possibility that the problem of adverse selection could worsen.

The rollback of the ACA also includes repeal of some of the taxes that were enacted to pay for the expansions of health insurance. The most important thing to know about the taxes slated for repeal is that they are paid almost exclusively by people with very high incomes. Thus again we see the linkage between moral attitudes toward different issues. The Congressional leadership seeks to scale back the ACA (thus leading to less equal access to healthcare), at the same time that it seeks to reduce taxes on the most affluent (thus increasing income inequality generally).

I trust it is clear that I am in favor of expanded health insurance. In fact, I would be happy if every American had health insurance, even though that would probably require increased taxes, some of which I would probably have to pay. It’s also true that I have been fortunate to work for the last 34 years for an employer that provides very good health insurance. Thus you might ask, why do I care whether anyone else gets insurance? If I have mine, why shouldn’t I just be happy about that (and if others don’t have health insurance, that’s just their tough luck)? The reason is that I am a member of a community. I am not an island unto myself; I am a citizen of the State of Michigan and the United States of America. I believe in the Biblical admonitions to feed the hungry, clothe the naked, welcome the stranger, and care for the sick. I believe that if you have done it unto one of the least of my brethren, you have done it unto me.

— Charles L. Ballard, Ph.D., League Board Chair

Facing the rhetoric about working families and child care

Added March 17th, 2017 by Pat Sorenson | Email This Entry Email This Entry
Pat Sorenson

My days of raising young children are long gone, but I remember well my biggest parenting struggle and cause of angst—finding child care that I trusted. I am not unique. Two of every three young children have working parents and many are facing the same struggle.

Virtually all parents consider their children their most precious gift, and they want child care that is safe, nurturing, consistent and reliable. They want care that can help their children take advantage of the rapid growth that happens in the earliest years—in language, emotional attachment, and social and cognitive skills.

Sadly, not enough has changed in the 25 years since I was in the child care market. Despite rhetoric about the importance of children and new scientific research about the critical window of opportunity for brain development in the earliest years of life, child care providers are still some of the most underpaid workers in our state, with wages similar to dishwashers and fast food cooks (who are also underpaid).

When my youngest son was in child care, I worried about the turnover of child care providers in his center. Just when he was getting attached and feeling comfortable with caregivers, they would leave. On one occasion I went to a downtown Lansing sandwich shop to pick up some lunch, and found one of his favorite teachers behind the counter. She told me that she missed the kids and loved the work, but couldn’t afford to stay.

BB Child Care BibsMarch_17_2017 chart 2What does this say about how we value our children? And mine is a story of someone who had the means to purchase higher-quality care. What about the many parents who do not, and are forced to rely on a patchwork of relatives, neighbors and friends who do not want to provide long-term care, or are facing health or other hardships of their own?

Despite the low wages paid to child care providers, child care is a major expense for low- and moderate-income families—exceeding the cost of housing and even college tuition. A family with poverty-level wages would need to spend virtually all its income (92%) to put two children in a high-quality child care center.

The governor has proposed an increase in funding next year for Michigan’s child care subsidy program, with the goal of raising reimbursements to providers willing to care for children from families with low incomes. This will not completely bridge the gap between our rhetoric about valuing children and the reality of the state’s child care system, but it is an important step forward—with a needed focus on the families that can least afford high-quality child care, and the children who need it most. I commend the governor for this important step and hope you will too.

— Pat Sorenson

 

Stop and listen

Added March 14th, 2017 by Jenny Kinne | Email This Entry Email This Entry
Jenny Kinne

“I just want to give up. I want to go to sleep.”

This came as a response to a simple question, asked in a room of strangers: “Tell me your life story. What is keeping you and others down in Kalamazoo?” Perhaps more heartbreaking than the response was the chorus of nodding heads and mumbles of agreement around the room.

Over the past couple of weeks, I have traveled around Kalamazoo, sitting in on community conversations and trying to understand the realities and causes of poverty in the city. The Michigan League for Public Policy is working with the Nonprofit Network to train all Kalamazoo city employees on cultural competency, the systemic causes of poverty and ways in which public servants can create pathways out of poverty.

To build this training, we had to first do a lot of listening.

stop_and_listen_by_stupideyedFor the first time in my professional life, I was instructed to wear casual clothes, no jewelry, no makeup, no purse, no cell phone, and I was told that I should simply listen. I could not take notes. I could not share my own ideas.

As a result, trust was established, and I heard people in a way I hadn’t before. I was humbled by their stories. Here are a few:

  • “I returned here from prison … Men get locked up and then no one is around to help take care of the kids. Everyone loses. We need jobs. I’m $57 away from being homeless.”
  • “I live in a shelter, I’m 54 and my foot is broken in three places. The doctor says my arm is bad and it won’t work anymore—may never heal. I was raised as a working man. I was raised to take care of my family … They tell me to get on disability. I’ve tried multiple times. I apply—they tell me to wait a year. I apply—they tell me to wait some more. Meanwhile, I’m on the streets, trying to take care of my kids … I’m going to do what I have to do. And if that means breaking into your house to get what I need to survive, you can’t judge me. I lost everything.”
  • “I hurt my back and have been disabled since 2002. I had to draw down unemployment but I can’t get what I need to feed my kids. I’ve worked since I was 14. I own my own home—have for 22 years. And I was told by a worker that I was living above my means and that I should sell my home. How dare she? That’s my home. I lost it. I went off. They had to call the police on me.”

Like many people around the state, these men and women are suffering, working to make ends meet, but for many reasons outside of their control are not able to keep up with life’s demands.

As a policy enthusiast, here is what I see. I see a need for criminal justice reform—investment in reentry programs and motivation for employers to hire people with criminal records. I see a need to simplify the application process for unemployment, disability and other state services. I also see the necessity of incentivizing the development of affordable and high-quality housing.

One of the core causes of poverty is most certainly inadequate and inequitable public policy, and the stories I heard in Kalamazoo have further confirmed a need for reform of key policies in Michigan.

From now on, I plan to put listening first in my work. I hope to dig deeply and empathetically into statistics to find the real people underneath. I think this is vital as we move forward, organizing for change in our state and globally, within harsh and often impersonal political environments.

— Jenny Kinne

So many health factors are beyond our control

Added March 10th, 2017 by Julie Cassidy | Email This Entry Email This Entry
Julie Cassidy

As the League’s newest analyst with a focus on the social determinants of health, I’ve been thinking a lot about my own health and how it’s affected by the larger world in which I live. The social determinants of health are the conditions in which people are born, grow, live, work and age, and include things like environment, nutrition and income.

I took my health for granted until I was diagnosed with Crohn’s disease and prescribed medication that retails for $1,400 per month. Fortunately, I have health insurance so my medication is affordable. My disease is mostly under control and I enjoy a high quality of life, which I attribute to the fact that I’m in a position to make many choices every day that allow me to maintain good health.

Because individual behavior drives much of a person’s health status, it’s easy to blame unhealthy people for failing to make the “right” choices. However, this perspective ignores that the ability to exercise choice and make healthy decisions varies drastically from person to person, often due to broader forces beyond the control of any individual.

Many social determinants of health are closely connected to household income. Financial hardship directly prevents people from obtaining high-quality medical care, and getting and staying healthy can be costly and time-consuming in ways that disproportionately affect families that are struggling to get by.

I’m fortunate to have an employer that offers paid leave time so I don’t have to worry about losing wages due to my illness. Living in a city, I’m not too concerned about a shortage of healthcare providers. As a well-educated, white, thin person, I’m not worried that my providers harbor implicit biases affecting the quality of the care I receive. I have a reliable car so I can easily get to medical appointments and the grocery store.

MI Should Eliminate SNAP Asset TestSince my diagnosis, I cook almost everything from scratch. This would be impossible without access to the fresh, healthy food available at a full-service grocery store. My parents cooked regularly when I was growing up and they taught me the basics. Even with these advantages, it’s a lot of work. If I were working multiple jobs to make ends meet, I wouldn’t have the time to cook for myself and my family in this way.

I’ve never had a problem finding safe, affordable housing or had to risk my life to keep warm. As a white person who grew up in a nearly all-white town, I’ve never worried that economic structures and social institutions shaped by years of systemic racism have literally made me sick.

Poet John Donne wrote, “No man is an island.” This is especially true when it comes to health. Our well-being is intertwined with our social connections, and virtually every aspect of public policy has health implications. In a country founded on the notion of equality of opportunity, no child should be born with his or her health destiny already written in stone.

Through our policy work, the League aims to remove systemic barriers so that all Michiganians have the freedom to choose good health. Be sure to check the blog periodically as I explore the specific social determinants of health and highlight the programs and policy solutions that can empower all people to enjoy a long, healthy life.

— Julie Cassidy

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