The ACA in Threes: The Good, The Bad and the Ways to Make it Better

Mar 31, 2014Richard Kirsch

With the first open enrollment period ending today, consider some successes, outrages, and bug fixes for the Affordable Care Act (ACA). Roosevelt Institute Senior Fellow Richard Kirsch will debate implementation issues and the future of the ACA with the Heritage Foundation's Robert Moffit tonight at New York University. For more information, click here.

The Good: Three Big Successes of ACA:

With the first open enrollment period ending today, consider some successes, outrages, and bug fixes for the Affordable Care Act (ACA). Roosevelt Institute Senior Fellow Richard Kirsch will debate implementation issues and the future of the ACA with the Heritage Foundation's Robert Moffit tonight at New York University. For more information, click here.

The Good: Three Big Successes of ACA:

The Affordable Care Act is saving peoples lives: Already. Like Kathy Bentzoni, a Pennsylvania school bus driver, who dropped her old insurance because it was expensive and rejecting claims because of her pre-existing conditions. After getting ACA coverage at $55 a month, she was able to seek care: “They found my hemoglobin level was 5.7, and the normal is 14. I needed a transfusion. It was due to a rare blood disorder. Where would I be without Obamacare? ER, 3 units of blood, multiple tests in the hospital and a 5-day inpatient stay without insurance? Probably dead.” Kathy was not alone in that fear – studies show that tens of thousands of people each year die because they don’t have health coverage.

Medicaid enrollment is a bigger success than expected: Not only is Medicaid enrolling people who are eligible for the first time – 4.6 million of them – but almost another 2 million more are enrolling who were eligible before, but had not applied. In the big push to get people to sign up for the ACA, many people who have been eligible in the past applied for the first time.

Seniors on Medicare are saving money, getting better care: While most seniors don’t think that the ACA has anything to do with them, it does. Last year, 37 million people on Medicare – seniors and people with disabilities – received free preventive care. Since the law was enacted, 8 million people enrolled in Medicare have saved $10 billion on prescription drugs, as the prescription “donut hole’ closes. And for the first time in 30 years, hospital readmission rates for people on Medicare are coming down, because hospitals are now penalized for pushing people out before they are ready.

The Bad: Three Outrages Against the ACA

States that have refused to expand Medicaid: In an example of partisan politics killing people, Republicans in 24 states have refused to expand Medicaid, leaving 5 million people who would be eligible for coverage without any recourse.

Koch brothers campaign to discourage young people from signing up: In an example of billionaires killing people, the Koch brothers have funded tasteless ads and campus beer parties in an attempt to keep young people from signing up for insurance on the exchanges.

Republican lies about job loss and the ACA: One advantage of the ACA is that it gives people the freedom to leave their jobs or reduce their work hours, and still be able to get affordable coverage. When the Congressional Budget Office estimated that 2.3 million American workers would gain this freedom over the next 8 years, Republicans falsely claimed that it would cost jobs. If anything, it will create jobs for people who fill in for those who take advantage of their new freedom. I thought Republicans liked freedom.

The Ways to Make it Better: Three Big Fixes for the ACA:

Allow Medicare to operate in the exchanges: The best way to bring price competition and access to virtually ever doctor and hospital in the exchanges would be to have Medicare offer a plan (without age requirements) in every exchange. This is the easiest and most effective way to bring back the public option.

Base the employer mandate on a play or payroll tax: As I’ve explained here, the best way to get rid of the convoluted system of employers paying a penalty for employees who work more than 30 yours a week, would be to have employers who don’t provide coverage pay a percentage of payroll for health care, just like employers now do for Social Security.

Lower the premiums and out-of-pocket costs: While the ACA is providing affordable coverage for millions – and will offer lower premiums than 29 million people are paying now – they are still too high for many families. And the out-of-pocket costs in the cheaper plans are way too high. The subsidies should be increased for middle-income people – funded by progressive taxes – and the high-out-of-pocket plans ended. 

Richard Kirsch is a Senior Fellow at the Roosevelt Institute, a Senior Adviser to USAction, and the author of Fighting for Our Health. He was National Campaign Manager of Health Care for America Now during the legislative battle to pass reform.

Photo of President Obama signing the Affordable Care Act copyright George Miller, via Creative Commons license.

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Higher Education Financing Needs a Better Deal Than This

Mar 31, 2014Raul Gardea

Bipartisan budget proposals seek to address the debt-burden on students, yet merely underscore the need for a drastic overhaul of post-secondary education financing.

Bipartisan budget proposals seek to address the debt-burden on students, yet merely underscore the need for a drastic overhaul of post-secondary education financing.

The White House’s latest proposal for easing student-debt is a noble but ultimately bankrupt effort, which misses the forest for the trees. The plan includes an expansion of income-based repayment (IBR), makes the American Opportunity Tax Credit permanent past the current 2017 cut off, and places a cap on loan forgiveness for public sector workers. Yet like most college affordability proposals that have come out of Washington, the current plan offers Band-Aid “reforms” that fail to cut to the heart of the structural problems in how we finance higher education. Instead of trying to fix the debt, the conversation should center on solving why students should need to take out such massive debt in the first place, a discussion few in Washington are eager to have.

A common critique of debt forgiveness is that such policies encourage students to take on a heavier financial burden and leads to schools hiking tuition to compensate. On paper, tuition deferral methods like IBR coupled with loan forgiveness are sound. This method shifts the costs from the individual to the taxpayer, as they should if we still value higher education as a public good. Currently, students who demonstrate need can enroll in “Public Sector Loan Forgiveness” (PSLF) which is an IBR plan that forgives debt after ten years of public sector or non-profit employment. The new proposal lifts the needs-based eligibility requirement to allow larger numbers of individuals to sign up, but places a $57,500 cap on forgiveness for public sector workers and requires payments for twenty-five years instead of ten for any amount over that.

Yet despite the White House’s claim that the proposal provides a “safeguard against raising tuition at high-cost institutions,” there is little reason to believe that will be the case. If the school has already been paid, and taxpayers will foot the bill in twenty-five years as the proposal stipulates, what incentive would there be for colleges to keep tuition low? Since schools have nothing at stake, it is likely that they will continue to increase tuition without regard for what happens to graduates. Students who may have considered serving their communities by pursuing careers as, say, public interest lawyers, relying on the promise of loan forgiveness after ten years are now having the rug pulled out from under them.  A quarter-century of indebtedness is simply absurd to imagine.

Republicans have also weighed in on higher education spending through their tax code reform proposals. They include repealing or consolidating various credits into a permanent American Opportunity Tax Credit, taxing PSLF, and repealing several tax breaks for students, among several other proposals. While this legislation will likely go nowhere as it is, several of these items could linger for a while and undoubtedly worm their way into more digestible, passable bills.

All this back and forth about restoring the promise of higher education hides the urgent need for a massive overhaul of the way the U.S. finances post-secondary education, something that Washington seems unwilling to do. Thinking back to the hopefulness of 2009 now seems like a lifetime ago. That year appeared to signal a turning point in history: a return to a strong, activist, solutions-oriented federal government. The 111th Congress was the most productive Congress in a generation. Certain sectors of the economy appear to be correcting course, with health care costs dropping and financial markets rising again. Yet the cost of a college education, an issue that President Obama is supposedly obsessed with, has continued to increase during this tenure. As his presidency winds down, it’s easy to feel like the window for passing any kind of comprehensive reform has shut. A large segment of our generation is chronically underemployed.  Students continue getting fleeced as the federal government hands out mortgages and lends to banks at lower interest rates. 41% of student loan holders are behind on their payments. Sen. Elizabeth Warren says government should not profit off the backs of students. As one of the few consistent voices advocating for this issue, she must get lonely.

Just as income inequality has become part of the national dialogue through grassroots efforts, reeling in higher education costs is something that requires broader strokes. Local efforts like the Kalamazoo Promise or San Francisco’s Kindergarten to College must be commended for expanding college access to students who might otherwise be shut out. But these programs assume higher education will remain exorbitantly expensive. Rather than trapping students in a debtor’s prison for twenty-five years, policymakers should be deep-diving into an audit of bloated university president and administrative pay, intercollegiate athletic subsidies, and educational outcomes per tuition dollar, among other things. During election years, the Obama White House tends to revisit its college affordability agenda, and this time is no different. But even without re-election to worry about, we have yet to see this administration truly go big on this issue. As campaign season heats up, access to an affordable higher education should be a bigger part of the conversation and indeed, must be a part of any serious policy agenda.

Raul Gardea is the Roosevelt Institute | Campus Network's Senior Fellow for Education.

 

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The Contraceptive Mandate Finally Leads America Out of the Victorian Era

Mar 31, 2014Ellen CheslerAndrea Flynn

The Affordable Care Act demonstrates an affirmative, proactive step from government for women's access to reproductive health care, but conservatives are bent on moving backwards.

The Affordable Care Act demonstrates an affirmative, proactive step from government for women's access to reproductive health care, but conservatives are bent on moving backwards.

Contraception should be understood as a fundamental right of American women and a necessary foundation of human security. If that seems controversial, consider this: 99 percent of American women approve of birth control and the vast majority use it over many years of their lives. These women deserve and must continue to demand insurance coverage for the method of their choice, without qualification. That’s why the contraceptive mandate in the Affordable Care Act (ACA) is so important and potentially transformative. For the first time ever, all health insurance plans, whether paid for privately or with public subsidies, are required to cover all FDA approved contraceptives at no additional cost.

Family planning is essential to securing the health and rights of women, but it is also the foundation of sound economic and social policy. Tragically, however, U.S. subsidized family planning programs currently serve just over half of those in need.

The stakes are especially high for poor women, who cannot afford the high costs of the most reliable and desirable methods and experience much higher rates of early and unwanted pregnancy as a result. Single women in poverty head a growing percentage of U.S. households. In “Breaking the Cycle of Poverty: Expanding Access to Family Planning,” a new white paper released today by the Roosevelt Institute, we argue that addressing their needs, and opening up opportunities to them and their children, will require multiple policy interventions, but none can work if women are denied the right and the agency to make, and act on, well-informed decisions about their own bodies.

Decades of social science research demonstrate that access to reliable and affordable family planning methods promotes responsible decision-making and reduces unwanted pregnancy and abortion. It allows women to pursue educational and employment opportunities that strengthen their families and their communities. A majority of women who participated in a recent study by the Guttmacher Institute, for example, report that birth control enables them to support themselves financially, complete their education, and get or keep a job. Other recent studies also show that providing family planning services at no cost results in more effective contraceptive use, decreased rates of unintended pregnancy, and dramatic declines in abortion rates.

Many American conservatives, however, reject these claims. They blame single mothers for America’s rising tide of poverty and inequality, not the other way around. They insist that access to sexual and reproductive health information and services exacerbates social problems by promoting promiscuity and unintended pregnancy, when in fact, the exact opposite is true. They promote abstinence-education and marriage promotion programs that have been tried before and been discredited, because they simply do not work.

This conflict was front and center last week as the U.S. Supreme Court heard 90 riveting minutes of argument in Sebelius v Hobby Lobby Stores, Inc. and Conestoga Wood Specialties Corp. v Sebelius, a pair of cases brought by two privately held corporations owned by Christian conservatives. The owners claim that the ACA violates the religious freedom of employers forced to cover the costs of contraception. Much of the testimony turned on technical questions of whether corporations, as opposed to the individuals who own them, legitimately have rights to assert in this instance, and whether they may impose those rights on employees who don’t share their views. There were also important matters of scientific integrity at stake, with the plaintiffs claiming that Intrauterine Devices (IUDs) and morning-after pills constitute methods of abortion, despite overwhelming medical agreement and numerous reputable scientific studies showing that, like everyday birth control pills, they only act to prevent conception.

All but lost in the court’s conversation were larger concerns about the health and well-being of women and families – and of our society as a whole. The Supreme Court hearing comes in the wake of more than three years of persistent attacks by extreme conservative lawmakers who have already decimated publicly subsidized services in states across the country and left many low-income women without access to basic family planning and to other critical reproductive and maternal health care services.

As legal scholar and policy analyst Dorothy Roberts observed, “when access to health care is denied, it’s the most marginalized women in this country and around the world who suffer the most—women of color, poor and low-wage workers, lesbian and trans women, women with disabilities... And this case has far-reaching consequences for their equal rights. Birth control is good health care, period.”

Today, by government estimates, more than 27 million American women already benefit from the ACA’s contraceptive mandate, and 20 million more will enjoy expanded coverage when the law is fully implemented. Yet even by these optimistic assessments, many low-income women will continue to fall through insurance gaps, partly thanks to a 2012 Supreme Court ruling that enables states to opt-out of Medicaid expansion mandated by the ACA. More than 3.5 million – two-thirds of poor black and single mothers, and more than half of low-wage workers – will be left without insurance in those states.

Conservative opposition to contraception is not new. As we observe in our paper, the U.S. controversy over family planning dates back to Victorian-era laws that first defined contraception as obscene and outlawed its use. Those laws carried the name of Anthony Comstock, an evangelical Christian who led a nearly 50-year crusade to root out sin and rid the country of pornography, contraceptives, and other allegedly “vile” materials that he believed promoted immorality. Sound familiar?

It took nearly a century for the U.S. Supreme Court to reverse course and guarantee American women the right to use contraception under the constitutional doctrine of privacy first enunciated in 1965. The ACA promises us even more. It places an affirmative, positive obligation on government to provide women the resources to realize our rights. The question before us is simple: Do we turn back the clock and allow a new Comstockery to prevail, or do we move ahead into the 21st century by defending the full promise of the Affordable Care Act’s contraceptive mandate?

Read Ellen and Andrea's paper, "Breaking the Cycle of Poverty: Expanding Access to Family Planning," here.

Ellen Chesler is a Senior Fellow at the Roosevelt Institute and author of Woman of Valor: Margaret Sanger and the Birth Control Movement in America.

Andrea Flynn is a Fellow at the Roosevelt Institute. She researches and writes about access to reproductive health care in the United States. You can follow her on Twitter @dreaflynn.

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Breaking the Cycle of Poverty: Expanding Access to Family Planning

Mar 31, 2014

Download the paper by Ellen Chesler and Andrea Flynn.

Download the paper by Ellen Chesler and Andrea Flynn.

Poverty shapes the lives of an increasing number of American women and their families and has many consequences, including high rates of unintended pregnancy. Conservatives, eager to further dismantle federal programs and defeat the new Affordable Care Act (ACA), have recently rekindled the idea that marriage promotion will reverse rising rates of poverty, unintended pregnancy, and single parenthood. To the contrary, addressing the root causes of poverty requires multiple interventions and far more generous government programs across a range of issues, particularly the expansion of reproductive health and family planning information, care, and services. This paper reviews the recent literature on women’s poverty and health and argues that accessible and high quality family planning services for poor women remain an essential component of poverty reduction. It also looks back at the history of policy debates over this question in the hope of finding a path toward renewed bi-partisan consensus.
 
Key Arguments:
  • Family planning is a fundamental right of women and the foundation of human security.
  • Single women in poverty head a growing percentage of U. S.  households. Addressing their needs requires multiple policy interventions, but none can work if women are denied the agency to make – and act on – well-informed reproductive health decisions.
  • U.S. subsidized family planning programs meet only 54 percent of national need. The ACA will help bridge the gap, although its promise is threatened by legal challenges to the contraceptive mandate. Women deserve insurance coverage for the contraceptive method of their choice, without qualification. 
  • Many low-income women will fall through insurance gaps. Every state should expand Medicaid. The federal government should lift Medicaid’s five-year eligibility requirement for documented immigrants and increase Title X funding to address increased demand for services.
  • We can learn from history. Research since the 1970 adoption of Title X illustrates that access to improved family planning methods promotes responsible decision-making and reduces unwanted pregnancy and abortion. By contrast, abstinence-until marriage and marriage promotion programs advanced by conservatives have failed and been discredited. 

Read "Breaking the Cycle of Poverty: Expanding Access to Family Planning," by Roosevelt Institute Senior Fellow Ellen Chesler and Fellow Andrea Flynn.

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Insurance Pays for Health Care. Who’s Providing It?

Mar 28, 2014Rachel Goldfarb

Public funds for family planning services are essential to ensuring people have somewhere to access health care, not just the insurance to pay for it.

Public funds for family planning services are essential to ensuring people have somewhere to access health care, not just the insurance to pay for it.

As if somehow the case still needs to be made that family planning deserves federal funding (and apparently the case does need to be made), last week a panel of researchers, advocates, and family planning providers spoke at a Congressional briefing on the topic “The Publicly Funded Family Planning Network: An Essential Partner in the New Health Care Environment.” Among the panelists was Roosevelt Institute Fellow Andrea Flynn. She and the others explained how Title X, the only federally funded family planning program, fits into the health care landscape now so dramatically changed by the Affordable Care Act. On the heels of Flynn’s white paper on this topic, last Thursday’s panel marked the next step in Roosevelt’s approach to research and policy discussions – namely, to get ideas up and out to those, like the Congressional staffers who attended the briefing, that can convert them into action.

Some background: when Title X was signed into law in 1970, it was intended to ensure that more Americans had access to family planning services, including birth control, because of rising concerns about population growth and poverty. Title X funds patient services, staff salaries, infrastructure, and supplies at clinics across the country. The law had strong bipartisan support – Democrats worked alongside Congressman George H. W. Bush and President Richard Nixon to pass it. And it is pretty effective: according to Flynn, the program today provides care to 4.7 million individuals annually. From 1980 to 2000, Title X-funded clinics provided women with 54.4 million breast exams and 57.3 million Pap tests and prevented an estimated 20 million unintended pregnancies. It’s also cost effective: Flynn notes that in 2008 alone, services provided at Title X-supported clinics accounted for $3.4 billion in savings.

Opponents of federal family planning clinics argue that with full implementation of the Affordable Care Act, the need for funding will drop off. No, said Clare Coleman, President and CEO of the National Family Planning and Reproductive Health Association. Insurance, she pointed out, isn’t the same as access to care. Patients still need providers. Amanda Dennis of Ibis Reproductive Health, based in Cambridge, highlighted an Ibis study conducted after health care reform went into effect in Massachusetts, that found many women took their new insurance straight to Title X-funded clinics for family planning services. Patient numbers actually increased at these clinics and so did the number of insured patients. Women like the care they get at Title X clinics; having insurance doesn’t mean they want to switch providers.

The panel confirmed Flynn’s major conclusions on Title X: the Affordable Care Act doesn’t guarantee every American will be insured at all times, so there remains a need for publicly funded care providers. More federal funding for the Title X family planning network will be essential to ensure women can access reproductive health care. And Coleman drove home another invaluable point as we work on health care access: the Affordable Care Act creates a massive shift in the way many Americans actually go about getting their health care. As a child growing up with insurance, I had an annual physical that was scheduled months in advance, and my mom picked up our prescriptions at the pharmacy. Americans who grow up uninsured have a different experience. They go to public clinics, where they can expect long waits, and when they leave, they go with prescribed medication in hand, obtained at the on-site dispensary.

In other words, signing up for health insurance on healthcare.gov won’t on its own teach anyone how to use insurance. That will take a generational shift. Besides which, you don’t get health care from your insurance – you get health care from your doctor, and cover the costs with insurance. That’s why Title X clinics must remain an option. Public funding for family planning does increase access to providers. Advocates: keep driving this point home to legislators!

Rachel Goldfarb is the Communications Associate at the Roosevelt Institute.

 

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The Role of Labor Market Regulation in Rebuilding Economic Opportunity in the U.S.

Mar 25, 2014

Download the paper (PDF) by Annette Bernhardt

Download the paper (PDF) by Annette Bernhardt

At the start of the 21st century, millions of Americans face a daunting labor market that, absent coherent and sustained policy intervention, will very likely provide them with fewer career opportunities and less economic security than their parents enjoyed. While globalization is often blamed for the deterioration in labor standards, it is domestic service industries where the low-wage problem is most acute. One of the key drivers of precariousness in these sectors is employers’ growing evasion and violation of both legal and normative standards, facilitated by the withdrawal of government’s hand in the labor market. Myriad factors describe this new world of work: the weakening of employment and labor laws; under-resourced enforcement of a host of regulations; production chains that mask legal accountability; the exclusion of groups of workers from legal protection; and a dysfunctional immigration policy. To reinvigorate labor market regulation opportunity, government should: establish a strong floor of labor standards; vigorously enforce that floor; and build a base of good jobs on top of that floor.

Key Arguments:

  • The days of business self-regulation are long gone, or never existed in today’s low-wage industries; therefore, government’s hand must be visible again. 
  • Labor market regulation should play a central role in the U.S. policy response to rising inequality, via three main strategies:
    • strengthening the floor of labor standards (wages, health and safety, and right to organize chief among them);
    • vigorously enforcing that floor (and holding employers accountable for the working conditions they control, whether directly or indirectly); and 
    • leveraging government contracting and grants to build a base of good jobs on top of that floor. 
  • In the current political climate, winning change at the national level will require ratcheting up from state and local policy campaigns to federal reform.

Read "The Role of Labor Market Regulation in Rebuilding Economic Opportunity in the U.S.," by Roosevelt Institute Fellow Annette Bernhardt.

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Daily Digest - March 25: Organizing Towards Shared Prosperity

Mar 25, 2014Rachel Goldfarb

Click here to receive the Daily Digest via email.

The New Deal Launched Unions as Key to Building Middle Class (Next New Deal)

Click here to receive the Daily Digest via email.

The New Deal Launched Unions as Key to Building Middle Class (Next New Deal)

In the first of a series of posts summarizing his new report, which explores possibilities for labor-organizing reform, Roosevelt Institute Senior Fellow Richard Kirsch looks at the history of union organizing as a source of shared prosperity.

The Next Health-Care Debate (WaPo)

The Affordable Care Act's success will prove that government is indispensable in fighting widespread inequality, writes E.J. Dionne, who sources Roosevelt Institute Fellow Mike Konczal's work on why charity can't tackle the problem.

The U.S. Cities Where the Poor Are Most Segregated From Everyone Else (The Atlantic Cities)

Noting that "moral cynicism" is among the corrosive "neighborhood effects" of grinding poverty, Richard Florida looks at the data concerning the segregation and concentration poor people, which is greater in large, dense metro areas and where wages are higher.  

Freelancers Piece Together a Living in the Temp Economy (NYT)

Planning for the future in an age of job insecurity is nearly impossible, writes Adriene Hill. She reports on a Las Vegas woman who knows her current assortment of appearance-based gigs can't last forever.

Forces of Divergence (The New Yorker)

John Cassidy reviews Thomas Pikkety's Capital in the Twenty-first Century, which considers the swing back towards capital accumulation over wages in today's economy. Cassidy deems it a must-read for anyone interested in inequality.

The NLRB Must Restore Democracy in Chattanooga (Truthout)

John Logan calls on the National Labor Relations Board to overturn the recent United Auto Workers vote in Tennessee, because otherwise the NLRB will set a precedent that accepts outside interference.

The Law That Could Sink Birth Control Coverage (MSNBC)

In the context of today's Supreme Court hearing on the contraception mandate in the Affordable Care Act, Adam Serwer and Irin Carmon explain the history of the 1993 Religious Freedom Restoration Act.

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Daily Digest - March 24: Public Financing: Compromise Won't Fix Corruption

Mar 24, 2014Rachel Goldfarb

Click here to receive the Daily Digest via email.

A Promise Cuomo Can Keep (Albany Times Union)

Roosevelt Institute Senior Fellow Jonathan Soros and Frederick A.O. Schwartz call on New York's Governor Cuomo to avoid compromise on public campaign financing where concessions just extend a corrupt status quo.

Click here to receive the Daily Digest via email.

A Promise Cuomo Can Keep (Albany Times Union)

Roosevelt Institute Senior Fellow Jonathan Soros and Frederick A.O. Schwartz call on New York's Governor Cuomo to avoid compromise on public campaign financing where concessions just extend a corrupt status quo.

The Tea Party and Wall Street Might Not Be Best Friends Forever, But They Are for Now (TNR)

Tea Party Republicans in Congress insist that the financial crisis was all government's fault, says Roosevelt Institute Fellow Mike Konczal. That narrative, and the corresponding legislative agenda, couldn't make Wall Street happier.

Why Charity Can’t Replace the Safety Net (Slate)

Jordan Weissmann praises Mike Konczal's recent piece in Democracy Journal, emphasizing that charity can't replace government aid during recessions. Charitable donations drop just when need rises.

All Economics Is Local (NYT)

Raising the local minimum wage is an effective step towards reducing inequality, say Michael Reich and Ken Jacobs. Moreover, their research shows that low-income industries can absorb the increase and benefit from greater employee retention. 

Payday Lending: The Loans with 350% Interest and a Grip on America (The Guardian)

David Dayen explains the vast regulatory conundrum of these predatory loans. He lays out how state and national regulators, Congress, and the Justice Department are working side-by-side, but often a step behind lenders.

The End of Jobs? (In These Times)

Sarah Jaffe argues that under our current system, the shrinking of secure full-time work increases inequality. Instead, we could restructure our economy to push for a universal basic income and shorter working hours.

New on Next New Deal

Memo to Congress: Family Planning Needs More Funding

In her remarks at a Congressional briefing last week, Roosevelt Institute Fellow Andrea Flynn explains why publicly funded family planning needs to expand as the Affordable Care Act is implemented. 

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Memo to Congress: Family Planning Needs More Funding

Mar 21, 2014Andrea Flynn

On Thursday, March 20, Roosevelt Institute Fellow Andrea Flynn joined the National Family Planning and Reproductive Health Association for a briefing on "The Publicly Funded Family Planning Network: An Essential Partner in the New Health Care Environment." Her prepared remarks are below.

On Thursday, March 20, Roosevelt Institute Fellow Andrea Flynn joined the National Family Planning and Reproductive Health Association for a briefing on "The Publicly Funded Family Planning Network: An Essential Partner in the New Health Care Environment." Her prepared remarks are below.

The Affordable Care Act represents an historic investment in the health of American women and girls. It has already improved the lives of millions of Americans and will make health care accessible for many more as rollout continues. Fulfilling the promise of the ACA, however, depends on the continued support of existing programs, such as Title X, which must remain as pillars of the country’s public health infrastructure.

For more than 40 years, Title X has provided critical medical care to low-income women, immigrant women, and young women across the country.  Some have suggested that the ACA’s expanded coverage of women’s health care will obviate the need for Title X. In fact, the opposite is true. Title X will play a number of important functions in the coming years.

First, Title X will support a network of qualified family planning and reproductive health care providers who will deliver care and services to the growing ranks of insured. Clinics funded by Title X will become an even more critical building block of our nation's health system. Even when individuals obtain coverage, many will continue to choose publicly funded clinics as their main source of care. As one of my colleagues here will further explain, during the four years following the implementation of Massachusetts’ health care reform patients continued to rely on Title X centers even after they gained insurance coverage. 

Women who are already fully insured will also continue to rely on Title X clinics because they can access care with complete confidence. Issues such as intimate partner violence and religious beliefs of employers, family members, and partners, cause many women to circumvent their insurance plans when accessing family planning services. Sadly, these concerns will persist regardless of the coverage status of American women.

Second, Title X will guarantee family planning access to those still uninsured. The ACA was intended to provide a path to health insurance for most Americans. However, because of the Supreme Court’s decision to allow states to opt-out of Medicaid expansion, fewer uninsured Americans will gain coverage than originally planned.  As Clare mentioned,  today, 22 states are still refusing to expand Medicaid, leaving more than 3.5 million low-income women without coverage. As a result, two-thirds of poor black and single mothers, and more than half of uninsured, low-wage workers, remain without coverage. Title X clinics will continue to be a trusted place of care for these women.

Moreover, even in states that participate in Medicaid expansion, many low-income individuals may still remain uninsured. Estimates suggest that between 25-35 percent of those eligible for Medicaid still do not know it, and are failing to enroll.  Many immigrants will also remain uninsured, given the federal 5-year eligibility requirement for Medicaid. And millions of others will churn among coverage plans. One study estimates that up to 29 million people under age 65 will be forced to change coverage systems from one year to the next. Individuals who fall into these categories will rely on the Title X network for quality, affordable, and confidential care.

Third, and equally important, Title X will continue to set a comprehensive standard of care for family planning and reproductive health services.

Finally, Title X clinics are a primary and trusted point of entry into the health system. Six in ten women who receive services at a publicly funded family-planning center consider it their primary source of medical care. As such, the Title X network will continue to play an important role in ACA outreach and enrollment efforts to ensure that health coverage is realized by as many Americans as possible.

Title X is particularly important given the health challenges facing many women in the United States. However, current funding for U.S. public family planning programs extends care and services to just over half of the women in need. Per capita, the United States spends two and a half times more on health care than other developed countries, yet Americans overall have less access to services and experience worse health outcomes. The United States reports among the highest rates of teen birth, unintended pregnancy, and maternal and infant mortality of any industrialized country. Almost half of all U.S. pregnancies – approximately 3.2 million annually – are unintended. Poor women, women of color, and immigrant women bear a disproportionate burden in this regard. They are also more likely to experience chronic disease, maternal mortality and have a lower life expectancy than women with higher incomes.

Unintended pregnancy and teen pregnancy remain persistent issues in the United States, ones that Title X has been tackling for decades. Unintended pregnancies have a number of larger health implications. Women who have unintended pregnancies are more likely to develop complications and face worse outcomes themselves and for their infants. They often receive inadequate prenatal care, and the care they do receive begins later in pregnancy. Research has shown that pregnancies that occur in rapid succession pose additional risks for both mother and child.

The U.S. teen pregnancy rate has declined dramatically over the last decade, thanks to services offered by programs like Title X. However, it is still considerably higher than in any other developed country, where rates are generally 5 to 10 births per 1,000, compared to the current U.S. rate of 29.4 per 1,000. Racial disparities are especially pronounced in relation to teen pregnancy, with teen birth rates for white women hovering around 21.8 per 1,000, while the rates for Hispanic, Black, and American Indian teens are at least twice that. Research has shown that increased access to comprehensive reproductive health information, care, and services, including a broad range of contraceptive methods, reduces rates of unplanned pregnancy among teens.

Title X has prevented these various health disparities from becoming even more troubling. With an increased investment the program could replicate its incredible results many times over, leading to significant health improvements for American women.

In times of economic uncertainty the demand for publicly funded family planning services increases. Since the 2008 financial crisis and the ensuing recession, the need for Title X has grown dramatically, while funding levels have declined or remained flat. Over the past few years the Title X budget has been cut by $40 million. To make matters worse, the anti-family planning and overall austerity sentiments that have since prevailed reduced and restricted family planning budgets in many states. There have been fewer state and federal funds for women’s health during the very time that women have also lost jobs and insurance coverage.

When Title X centers lose funding, they are forced to make cuts in three places: services and supplies, hours, and staff. As a result of funding challenges, six in ten Title X clinics have been unable to stock the most costly contraceptives, particularly long-acting reversible contraceptives (LARCs) such as the IUD and implants, methods considered highly effective and most desirable among women wanting to avoid pregnancy.

Family planning is first and foremost a matter of women’s health and rights. But it is also central to women’s economic security. The continued fragility of the U.S. economy and the recession’s devastating impact on low-income families requires an increased investment in family planning. American families, many of them now headed by single women, face enormous challenges. Access to affordable contraception enables women to pursue educational and professional opportunities that strengthen their families and their communities. The majority of women who participated in a recent Guttmacher Institute study report that birth control enables them to support themselves financially, complete their education, and get or keep a job. 

Given the tenuous state of the U.S. economy, the vulnerability of women’s health programs in the face of unrelenting political attacks, and the fraying social safety net more broadly, public funding for family planning is more critical than ever. Continued – indeed, increased – funding of Title X will maximize the impact and reach of the ACA and ensure continued quality care for those who remain uninsured.

Thank you. 

Andrea Flynn is a Fellow at the Roosevelt Institute. She researches and writes about access to reproductive health care in the United States. You can follow her on Twitter @dreaflynn.

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Daily Digest - March 20: The Safety Net - Government = ?

Mar 20, 2014Rachel Goldfarb

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The Voluntarism Fantasy (The Majority Report)

Click here to receive the Daily Digest via email.

The Voluntarism Fantasy (The Majority Report)

Sam Seder speaks with Roosevelt Institute Fellow Mike Konczal about Mike's new piece in Democracy Journal. Mike says the social safety net has always depended on the government.

The Tyranny of the On-Call Schedule: Hourly Injustice in Retail Labor (The Nation)

Michelle Chen explains the ways that retail scheduling has harmed workers' ability to plan their lives. On-call schedules mean not knowing how much you'll make or when you'll work, ever.

Journalists’ and Activists’ Strange Approach to Low-Wage Workers (WaPo)

Sarah Jaffe calls out the habit of representing low-wage workers as poor, unfortunate Others in need of our help. Any one of us could share the concerns and needs of low-wage workers.

Why Not Peg EITC Benefits to the Local Cost of Living? (PolicyShop)

David Callahan suggests President Obama could do better than simply increasing the earned income tax credit. For low-income workers living in high-cost areas, it would make a big difference.

Janet Yellen's Rookie Mistake: Speaking Too Clearly (Bloomberg Businessweek)

Janet Yellen, the new Federal Reserve Chair, needs to speak with less specificity, writes Peter Coy. Attaching a six-month timeframe to a vague written statement set off a market selloff.

The Key Question for Yellen: Is This Economy As Good As It Gets? (FiveThirtyEight)

Andrew Flowers considers the ways to measure economic potential, and what the Federal Reserve ought to do if we agree that the U.S. is still falling short.

Do We Need to Force People to Live in the Homes They Own? (Pacific Standard)

Real estate that isn't actually lived in may be a good investment, but it isn't good for a city, writes Kyle Chayka. He suggests that residency requirements could control rising rents.

New on Next New Deal

There's More to Fixing the Minimum Wage Than Just Raising It

Azi Hussain, Roosevelt Institute | Campus Network Senior Fellow for Economic Development, says that instead of tying the minimum wage to annual inflation, we should peg it to inflation over the business cycle to ensure flexibility.

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