Low-Income Children Could Be Worse Off After Health Care Reform

Last Wednesday, hundreds of concerned citizens answered the Children’s Defense Fund’s call to join a “stroller brigade” to the U.S. Capitol. Other brigades strolled in at least 16 communities across the U.S.

These brigades were to demonstrate grassroots support for “comprehensive, affordable, accessible health care for all children, no matter where they live.” This is by no means an inevitable result of federal health care reform.

CDF warns that the health care reform bills Congress is debating give short shrift to the needs of millions of uninsured and under-insured poor and near-poor children. They could, in fact, leave many worse off than they are now.

CDF and the “champions for children” it’s organized want Congress to do three things.

1. Guarantee all children access to the full range of health benefits they need, i.e., the early and periodic screening, prevention, diagnosis and treatment (EPSPDT) services children can get under Medicaid. There are four related concerns here.

• Only some children enrolled in the State Children’s Health Insurance Program (SCHIP) get comparable benefits because states can offer more limited coverage.
• Under the bills now pending, children whose families purchase insurance through the newly-created exchange will not be covered for all EPSPDT services.
• These children will eventually include those enrolled in SCHIP. The bill the House will vote on would sunset the program in 2013. The final Senate bill will probably extend it to 2019. But even before then, SCHIP children will be shifted to the exchange if a state runs out of funds for the program.
• Premiums and out-of-pocket costs in exchange plans will be higher than what families pay under SCHIP. As a study for First Focus shows, the difference could be as great as 33%.

2. Eliminate the unjust lottery of geography. Here again, the problem is that SCHIP benefits and eligibility vary from state to state. In some states, SCHIP is structured as an expansion of Medicaid, thus ensuring EPSPDT benefits. Other states have separate, more limited programs. Twenty-two states permit enrollment of children up to 300% of the federal poverty line. The eligibility cap in the remainder is lower.

So what CHN wants in the final health care reform package is mandatory coverage under SCHIP for all children under 300% of the FPL, federal funding to ensure states can enroll all eligible children and, I infer, a nationwide benefits standard comparable to EPSPDT. It also wants SCHIP retained until the alternative can be shown to provide coverage at least as good.

3. Address bureaucratic barriers that keep children eligible for Medicaid or SCHIP from getting the care they’re entitled to. CHN says that complex application and enrollment processes and frequent renewal requirements now keep about two-thirds of eligible children out of these programs. It wants Congress to require a simple, streamlined process.

Those of us who didn’t stroll can support CHN’s agenda by signing on to its letter to Members of Congress.

As Washington Post columnist Harold Meyerson observes, “children–most particularly, children of non-affluent parents–have no clout whatever in the political process.” They depend on us and venerable champions for children like CHN.

Federal Funding For DC Homeless Housing Program At Risk

President Obama’s proposed Fiscal Year 2010 budget included $19.2 million for the District of Columbia’s permanent supportive housing program. Whether the District actually gets this funding hinges on what happens in the Senate.

The House of Representatives adopted the President’s recommendation in its version of the Financial Services and General Administration Appropriations Act–the bill that includes federal funding for the District. The Senate Appropriation’s Committee didn’t.

I’ve been told that the appropriations bill will be folded into a more comprehensive bill comprising all the appropriations that the Congress hasn’t already sent to the President. So the hope now is that leaders of the House subcommittee for the District’s appropriation insist on the provision and their Senate counterparts agree.

SOME (So Others Might Eat) has posted a letter we can e-mail to urge these leaders to agree to the $19.2 million. It’s a quick, easy way to join our voices to those of PSH providers, their clients, advocacy organizations and other concerned citizens.

The funding would enable the District to move forward with its efforts to transition from an emergency shelter-based system to a system that provides long-term affordable housing and an array of services to those in greatest need–individuals and families who’ve been homeless for a long time or repeatedly over the years. Without the funding, the program will stall because its local funding was cut to help balance the D.C. budget.

The permanent supportive housing model is widely viewed as a cost-effective approach to helping homeless people who face complex challenges, e.g., very low (or no) income, mental illness, substance abuse, etc. The theory is that once they’re in a safe, stable environment, they’re more receptive to services that help them regain control over their lives and greater self-sufficiency. And, of course, it’s easier to coordinate these services and deliver them for however long needed.

The District has already moved more than 500 individuals and 70 families off the streets and out of emergency shelters into permanent supportive housing. The Department of Human Services says that the $19.2 million would allow it to extend the program to 400 more individuals and 150 more families. As in other communities, the investment should pay off in reduced shelter, medical care and other safety net costs.

It’s no substitute for urgently-needed funding for other homeless services. But it would reduce pressure on these services and offer chronically homeless people a better chance for a better life.

Transparency In DC Has a Long Way To Go

We’re hearing a lot these days about transparency and open government.

President Obama launched his administration with a memorandum committing to “an unprecedented level of openness in government.” Transparency, it says, “promotes accountability and information for citizens about what their Government is doing.”

Here in the District of Columbia, Councilmember Mary Cheh, Chair of the Committee on Government Operations and the Environment, held a roundtable on the issue a couple of weeks ago. She too was interested in processes for citizens to gain information, in the interests of “open government in the District.”

So it’s occurred to me to wonder what our leaders have in mind when they talk about transparency and openness. One clue are the focuses on new technologies and disclosure under freedom of information statutes. We see them in both the President’s directive and Cheh’s roundtable announcement.

But transparency ought to mean more than giving us access to documents our government produces. The documents ought to be clear and informative enough for us to know what our government is doing.

Back in March, I ranted on the challenges of understanding Mayor Fenty’s proposed Fiscal Year 2010 budget. They apparently bedeviled even DC Councilmembers. As Jenny Reed at DC Fiscal Policy Institute notes, the Council wound up approving a budget for the Department of Human Services without knowing it would mean a $12 million cut for homeless services.

Would they have known if they’d opened their last round of budget deliberations to the public, as community groups requested? Perhaps taking advantage of a loophole in the District’s open meeting requirements put the Council at a disadvantage.

There’s something even more important than access and clarity. It’s truthfulness. The thing that’s got me most distressed about the saga of the homeless services budget is that we’ve been treated to a stream of half-truths and evasions.

The Fenty administration repeatedly asserted that there’d been virtually no cut in this budget–this apparently because the budget, i.e., the document presented to the Council, dealt only with the proposed local appropriation. What about the federal TANF funds and general revenue funds that had been used to supplement the appropriation? Oh well, they weren’t part of the budget.

Then, when pressed, DHS Director Clarence Carter testified that TANF funds had been transferred to homeles services last year, but that there were “no additional TANF reserve dollars to make available.” More probing needed to surface the fact that the funds hadn’t just vanished. The department decided to use them for something else.

Nevertheless, Mayor Fenty told a TV interviewer that the view that the homeless services budget had been cut was “either a miscommunication or a distortment [sic] of the facts.” The reality, he said, was that a contractor overspent its budget last year and wasn’t going to get extra money this year just because of “inefficiencies.”

The contractor here is apparently the Community Partnership for the Prevention of Homelessness, which manages homeless services for the District. It’s hard to see how the Partnership–or any contractor for that matter–could actually spend more than the District provided unless it used funds from other sources. The purported overrun is instead almost surely the funds Carter testified his department had transferred.

So Fenty’s account is less than a half-truth. It’s a deliberate and harmful “distortment of the facts.” Harmful not only to the Partnership. Harmful to what’s supposed to be a democratic process.

If the Fenty administration had felt it had to cut funding for homeless services, then it should have said so straight out. The Council could have agreed to the cut, adjusted funding priorities or even done more to raise revenues. We would have had an opportunity to say what we wanted our elected representatives to do.

Our local government is bogged down in recriminations, charges and counter-charges and pervasive mistrust. The lack of transparency about homeless services is far from the only reason. But it’s a good example of how far the District has to go to be a genuinely open government and what happens when transparency falls by the wayside.

NOTE: Thanks to Mike DeBonis, a.k.a. Loose Lips, for alerting me and many others to the TV interview and for his acute comments on the Mayor’s assertions.

Let’s Not Forget Poor Rural Children

A new report from the Casey Foundation aims to widen our vision of child poverty in America. It’s called The Forgotten Fifth because one in five poor children lives in a rural community. Yet their plight is commonly overlooked by both policymakers and the general public.

That wasn’t always the case, the authors say. But, in recent years, the image of child poverty has become “an overwhelmingly urban one,” to the detriment of poor families in small, out-of-the way communities.

Here’s a sample of the wealth of facts and figures the authors bring to bear on this problem.

First off, the child poverty rate is higher in rural than in urban areas, and a higher percentage of rural children are in deep poverty, i.e. below 50% of the federal poverty threshold. As of 2007, all but one of the 51 one counties with the highest child poverty rates were rural.

Thirteen states–all in the South, lower Midwest or Southwest–have rural child poverty rates over 25%. Only 10 states that have non-metropolitan areas have rural child poverty rates under 15%.

In various respects, poor rural children suffer greater disadvantages than their urban counterparts.

• Child poverty rates are highest in counties most remote from an urban area, so access to support services is more limited.
• Rural children are exposed to all the adverse impacts of poverty for longer periods because poor rural families tend to stay poor longer than poor urban families.
• States with the highest percentages of rural poor children provide lower TANF benefits and are less likely to have their own Earned Income Tax Credit than states with the lowest percentages.
• States with the largest numbers of rural children spend considerably less per child than states with the fewest.

The Casey authors say it would cost $10 billion to lift all rural children out of poverty. Can we afford this?

Consider first the human costs of doing nothing more than we’re doing now. According to a UNICEF assessment of child well-being, children who grow up in poverty are more vulnerable to a host of problems, including poor health, learning and behavioral difficulties, academic under-achievement, early pregnancy and ultimately lower skills and aspirations, low pay and unemployment. Over the years, we could save countless children from such life-long disadvantages.

And then there’s the dollar cost. In 2007, a Center for American Progress task force estimated that persistent child poverty costs our country$500 billion a year.

Looked at this way, how can we afford not to ramp up our anti-poverty efforts? How afford not to ensure that they do a better job of addressing the particular needs of poor rural families?