When the Safety Net’s Ripped, the Babies Will Fall … and the Rest of the Family Too

February 17, 2015

In less than eight months, some 6,000 families in the District of Columbia will have no cash income whatever, unless the parents can land jobs PDQ. Most probably won’t because they would have if they could have.

The families I’m referring to have participated in the Temporary Assistance for Needy Families program for a lifetime total of 60 or more months. The benefits they’ve received have been, at best, extremely low — $428 a month for a parent with two children.

But their benefits have already been slashed. Our three-person TANF family facing a cut-off now receives $152 a month. Is this what a parent would choose over paying work of any legal kind, assuming s/he’s got someone to care for the kids?

Of course not. The parents who’ve perforce depended on TANF for a long time or recurrently often have what are euphemistically called severe barriers to work, e.g., debilitating physical and/or mental health problems, domestic violence trauma, functional illiteracy.

The District’s TANF program will count time spent receiving services to help overcome such barriers as compliance with its work activity requirements. But it won’t stop the clock ticking toward the cut-off date, except for the relatively few  parents who’ve been shifted out of TANF into a locally-funded program.

Most parents used to be placed in programs designed to get them into the workforce quickly, regardless of their needs and skills. No real attention to whether they could stay in the workforce. Most didn’t, as even the District’s short-term tracking showed.

Then the Department of Human Services revamped the TANF program, providing for individualized assessments and a range of services, including more diverse education and job training options. But time spent in the flawed program still counts toward the 60 months.

And parents who were deemed work-ready, either initially or after some “barrier-removal” services, had to wait for job training because the budget didn’t fund enough slots. Again, the clock kept ticking.

Now Mayor Bowser and the DC Council can let these very poor parents and their children fall into utter destitution or decide that the 60-month limit is, at the very least, too rigid, if not a bad idea altogether.

When they consider the options, as one hopes they will, they should recall that the Council hastily adopted the time limit as part of a budget-gap closing package that then-Chairman Vincent Gray pushed through shortly before he became mayor.

At least some Councilmembers — and we the public — were sold a bill of goods when a less draconian version of the benefits cut-off surfaced in the original gap-closing bill. DHS called it a measure “to more closely align with federal policy.”

But, as I said at the time, nothing in federal policy compels states or the District to cut — let alone end — TANF benefits at the end of five years. The rules only prohibit the use of federal funds to help pay for them.

And not altogether. States and the District may use federal funds to extend benefits for up to 20% of their average monthly caseload based on “hardship or domestic violence.” About 20 states do, in one form or another. The District has taken a pass. It exempts parents from their regular work requirements, but it keeps the clock running. And, as I already said, it set the clock to start when TANF families first enrolled.

So more than 6,100 families lost a portion of their benefits with virtually no warning — and little or no chance to first improve their employment prospects through the new, improved assessment and referral process.

Many would still have faced high barriers — not only those I’ve mentioned, but others that some states count as “hardship,” e.g., the need to care for a chronically ill or severely disabled child.

And then there’s that barrier confronting all local job seekers who don’t have a college degree. Last year, 19% of District residents without a high school diploma couldn’t find work, even part-time. The unemployment rate for those with, but no more was only 1% lower.

So we’ve undoubtedly got TANF parents who’ve been putting in their required work activity hours searching for a job, but to no avail. Yet we’re about to punish them — and their children — further by cutting off their benefits.

The DC Fiscal Policy Institute’s recommendations to the Mayor and Council include a temporary, renewable benefits extension for parents up against the time limit when they can’t find a job that offers enough hours for them to make ends meet.

Some other parents should get extensions too, it says — those who aren’t yet work-ready, for example, and those with the kinds of significant barriers I cited above. It also recommends extensions when families will otherwise suffer “serious hardship,” e.g., homelessness.

One can make lots of arguments, moral and pragmatic, for protecting families from the benefits reductions and cut-offs they face under the current law.

Among the most pressing of both sorts is what’s providing to be an unprecedented homeless family crisis. Stingy TANF benefits help explain it — as, of course, do the even stingier benefits the 60-month families are getting.

But there are still families who’ve managed to stay housed, at least for awhile — by doubling-up (or tripling-up) with other low-income families, for example, or by contributing to the household expenses of a hospitable friend of relative.

These arrangements are by no means ideal for the children, since housing instability of any sort tends to harm them — and in ways that have lasting effects. But they’re better for them than living in the DC General shelter — or on the streets when it’s not cold enough for them to get in.

And they’re better than the cut-offs for the District’s budget too, though I’d like to think our policymakers will take a broader view of their responsibilities when they decide whether to extend a lifeline to at-risk TANF families.

 

 

 

 


House GOP Puts Disabled Workers at Needless Risk

January 26, 2015

Seems when minds are made up, they won’t be confused by facts. Consider, for example, Senator (and Presidential-hopeful) Rand Paul (R-KY) on the subject of SSDI (Social Security Disability Insurance).

“[W]hen you look like me and hop out of your truck, you shouldn’t be getting your disability check. Over half the people on disability are either anxious or their back hurts. Join the club.”

Blogger Steve Benen refutes Paul’s “over half” and the barely-submerged allegation of fraud with hard data from the Social Security Administration’s Inspector General, which, as he says, are basically the same as findings by the Government Accountability Office.

What’s so depressing is that we’ve been round this barn over and over again. Someone — an NPR reporter, for example, or a Fox News talking head — asserts that a lot of SSDI recipients could work if they wanted to, but instead have managed to get disability benefits based on “squishy” diagnoses or out-in-out fraud.

Analysts, advocates and responsible bloggers cite data showing, among other things, how stringent SSDI eligibility standards are, how few recipients can work at all, let alone ever earn enough to support themselves again, and how modest the benefits are — far too low for someone to choose them over gainful work.

Rebecca Vallas, whose post I linked to above, has written substantially the same thing so often I believe she could probably do it in her sleep.

What’s even more depressing is that the House Republican majority has now put SSDI recipients in unnecessary peril, relying, it seems, on the oft-debunked claims.

As I’ve written before, the trust fund that helps pay for SSDI benefits will run out of reserves in 2016. This has long been expected. And it has nothing to do with freeloaders, fraudsters or the difficulties jobless workers have had finding new employment due to the Great Recession.

Instead, the number of SSDI beneficiaries has grown in part because baby boomers are getting to the age where disabilities become more common and in part because more women are working — and working enough — to qualify.

A third factor — ironic in this context — is that Congress raised the eligibility age for full retirement benefits to help stave off a shortfall in the Old Age and Survivors Insurance trust fund, i.e., the one intended to ensure those benefits get paid in full.

In ordinary times, Congress would simply shift some payroll taxes that go to the OASI trust fund to the DI trust fund. It’s made such shifts 11 times — sometimes in one direction, sometimes the other.

Doing that now to protect disability benefits would have little effect on the OASI trust fund. It would merely run out of reserves one year earlier, while the DI trust fund would have enough to pay full benefits until the same year — this assuming Congress adopted the Social Security actuaries’ solvency scheme.

None of this matters a whit to Congressman Tom Reed (R-NY), who cosponsored a change in the House rules that effectively prevents any such shoring up of what he calls “a failing federal program.” You see how these unfounded attacks take hold in receptive minds?

No one, I think, questions the need to ensure that the OASI trust fund doesn’t run dry in about 20 years. But the long-term solution for both trust funds, which Reed claims he wants to force, will surely not emerge as law before 2016.

So the House rule, in effect, sets the stage for SSDI benefit cuts estimated at 19% in less than two years. These benefits now average $1,165 a month — less than $200 above the poverty level for a one-person household. Benefits for disabled workers’ spouses and children are far less.

Not surprising then that 44% of younger SSDI recipients, i.e., those 31-49 years old, are poor or near-poor, mostly the former. These are hardly people who can afford to lose close to a fifth of what’s probably their only source of cash income. And they’re many years away from eligibility for retirement benefits — even the reduced benefits they could get at 62.

Monique Morrissey at the Economic Policy Institute views the House rule as “largely symbolic,” since a simple majority can overturn it. And indeed it may if the benefit cuts become an immediate reality — in an election year too, she adds.

But in the meantime, the Republicans have leverage for any of a range of Social Security “reforms.” Morrissey notes recent references to such old warhorses as raising the retirement age (again), replacing social insurance altogether with private investment accounts and/or further means testing — perhaps a phase-out to zero for high-income seniors.

Will seniors, workers who hope they’ll live to be and organizations representing them take kindly to any of these? Faced with the possibilities, will they be told that the only alternative is to keep those other folks from draining the trust fund, as Morrissey predicts?

We’ve already got framing that pits the old against the young. Last thing we need is a spin-off into a conflict between the legitimate needs of seniors and those of younger people with severe disabilities.

And as I, joining many others, have said, it’s wholly unnecessary.

UPDATE: Shortly after I posted this, I came, somewhat belatedly, upon a post by Josh Marshall, the top dog at Talking Points Memo. He foresees the sort of conflict I refer to and calls it a deliberate “plan to set different classes of Social Security recipients against each other in a zero sum for scarce dollars when in fact the scarcity is manufactured.”


New Hunger Crisis Looms

January 15, 2015

Approximately 1 million low-income — mostly very poor — people may soon have little or nothing to eat, except what charitable organizations can provide. This isn’t one of those crises we read about in some far-off country devastated by drought, locusts or internal warfare. It’s right here in the U.S. and the result of policy choices.

The 1 million or so people will lose their SNAP (food stamp) benefits in 2016. They’ve done nothing wrong, except to be between the ages of 18 and 50 and to have neither a certified disability that prevents them from working nor a family member who depends on them for care.

As I’ve written before, these so-called able-bodied adults without dependents are generally limited to three months of SNAP benefits within any three-year period unless they’re working at least half time or participating in a job training or workfare program, i.e., an arrangement whereby they work, usually for a public agency, in exchange for their benefits.

The law that sets this limit allows state to request a waiver, either for the state as a whole or for specific areas, when the unemployment rate is extraordinarily high.

The Recovery Act temporarily suspended the time limit nationwide through September 2010. Most states and the District of Columbia asked for and got waivers after that. But the waivers are already disappearing — in some cases, because Republican governors chose not to ask for them.

“We should not be giving able-bodied individuals a handout,” says Maine Governor LePage, voicing what one suspects is a common view among his counterparts.

Now unemployment rates in most parts of the country are dropping to the point where states will have, at most, waivers for some deeply depressed areas, even if they’re not hostile to the concept.

This doesn’t mean that the ABAWDs can find jobs if they just try hard enough, however. As the Center on Budget and Policy Priorities reports, about half have only a high school diploma or the equivalent — and a quarter have neither.

They may still land low-paying service sector jobs. But these won’t necessarily ensure 20 hours a week on a regular basis.

Some will have a hard time getting any job at all. In a county in Ohio that lost its waiver because Governor John Kasich decided to narrowly target his request, more than 34% of ABAWDs has a criminal record — a high barrier to employment, as we know.

The problem goes well beyond dim job prospects because the end of a waiver doesn’t mean that ABAWDs can continue receiving SNAP benefits if they comply with the alternative work requirements.

In fact, as CBPP explains, it’s misleading to call the job training/workfare alternatives work requirements because they’re quite different from the work requirements we’re familiar with in the Temporary Assistance for Needy Families program.

Though parents in TANF are generally required to participate in a work preparation program if they’re not actually working, they’re not penalized with a benefits loss if there’s no space for them in an appropriate program. Nor are they penalized if they’re actively looking for a job, but haven’t yet found one.

By contrast, states have no obligation to ensure that at-risk ABAWDs can get into a work preparation or workfare program. They generally don’t, CBPP reports. This is in part because SNAP education and training funds fall short of the need. But it’s also because states tend to give preference to other SNAP recipients, e.g., parents with dependent children.

As if that weren’t enough, the law that sets the time limit doesn’t recognize job searches as a qualifying activity. So there’s really nothing that unemployed (and underemployed) ABAWDs can do to retain the generally modest, but crucial SNAP benefits they’ve gotten.

Unimaginable that the majority who lose their benefits can scrape up the money to feed themselves, as CBPP’s brief clearly shows. Their gross incomes average 19% of the federal poverty line — about $2,217 for a single person this year.

About 82% live in households with total incomes below half the FPL — less than $11,925 per year for a four-person household. How will people as poor as this make up for the loss of nutrition assistance averaging $150-$200 a month?

Congress could extend a lifeline to ABAWDs. It could, for example, change the so-called work requirement so that states would have to offer either a job or a slot in a job training or workfare program.

It could include job searches as qualifying work activities. It could at least stretch the time limit to six months — the average amount of time childless adults received SNAP benefits before they were time-limited.

It could increase federal funding for the basic SNAP employment and training grants — currently just $90 million a year.

Is this Congress going to do any of these things? A rhetorical question. So, CBPP says, states should give community groups and service providers advance warning.

Food banks and the programs they help supply surely should know that they’re likely to face even more — and more frequent — requests for free groceries and/or meals. CBPP cites other providers likely to face increased needs for services — or in the case of healthcare clinics, effects on patients they’re already serving.

Advance warning is, of course, better than surprise. But what the nonprofits can do with the heads-up is a question mark. It’s not as if they’ve stayed silent on their needs for private donations, as many of us with email accounts can testify.

Those of us with the wherewithal can hearken such requests. But as Bread for the World’s president said some time ago, “[W]e cannot ‘food-bank’ our way out of hunger…. [W]e need to change the politics.”

The impending plight of ABAWDs cries out for that. But who in the Republican leadership on Capitol Hill is listening?

 


DC TANF Families Face Benefits Cut-Offs With Dim Prospects for Steady Work

December 8, 2014

In early 2012, the D.C. Department of Human Services launched a redesigned Temporary Assistance for Needy Families program. As with TANF programs nationwide, it aimed to move very poor parents with children toward self-sufficiency, i.e., work that pays enough to support the family — or at the very least, too much to make them still eligible for TANF.

Now we have an in-depth, though partial view of the results. A recently-completed review of the TANF employment component found, among other things, that fewer than half the target group of parents who, with help, had found jobs were still employed.

But even this finding overstates the self-sufficiency prospects for the more than 6,000 families who may soon have no cash income whatever because the DC Council set a retroactive 60-month lifetime limit on benefits in late 2010 and a phase-out schedule ending in total cut-offs next October.

About the Review

The Office of the District of Columbia Auditor analyzed data and other information that DHS provided, with a view toward providing the basis for some conclusions about the outcome of what it refers to as the TANF Employment Program.

The program consists of two related types of services — work readiness and job placement. Both are provided by contractors. Work readiness contractors, as the term suggests, are supposed to help parents strengthen their qualifications for paying work.

But they are responsible for helping the parents find jobs as well. This is the only thing the job placement contracts are supposed to do because the parents assigned to them have been deemed ready to work.

The auditors focused only on parents who had received TANF benefits for more than 60 months because these were the parents whom DC Council Human Services Committee Chairman Jim Graham asked about.

They looked at data collected over about 32 months — from the time the new employment program began, in February 2012, to October 24, 2014. Graham wanted results by early November.

So the auditors were up against a tight timeframe. As a result, they’re careful to say, they didn’t verify what they got from DHS, as they ordinarily would.

Jobs of Any Sort for Fewer Than Half

Though the two types of employment services differ in scope, they’re both intended to get TANF  parents into — or back into — the workforce and earning enough to no longer qualify for TANF. For a family of three, that would have been anything over $588 a month in 2012-13, assuming no other income.

The auditors report that about 49% of parents referred to an employment services contractor got a job — 6,145 out of 12,463. Only about 38% got jobs that could have provided steady, full-time work.

The rest got placed in jobs that were either part-time or “temporary/seasonal” — the latter presumably referring to temporary or on-and-off jobs during periods of high-volume business like the holiday shopping season.

Wide Pay Range, Including Less Than Minimum Wage

While working, the parents got paid an average of $10.58 an hour — more than the District’s minimum wage, but less than its living wage, which is now $13.60 an hour and was less during the two prior years the audit covered.

The average masks a wide disparity in pay rates. A relative few jobs paid in the $21-$50 an hour range. A far greater number — nearly 1,590 — reportedly paid less than the District’s minimum wage.

The auditors suggested (not in the report) that contractors may have reported the minimum cash wage parents got when placed in jobs that employers chose to pay at the tip-credit wage rate.

But the District’s tip credit wage is lower than most of the subminimum wages indicated. DHS perhaps could explain, but hasn’t, though I asked.

Steady Work for Very Few

As of mid-October, 2,976 TANF parents were employed — about 48% of those who’d been placed. Only 770 remained in the jobs were they’d been placed for more than six months.

We see a drop-off beginning at the end of the first month. (The auditors don’t report a figure for parents who lost their jobs or quit sooner.) Their figures do, however, show that 835 parents didn’t have their jobs any more by the time the fourth month rolled round.

Whether they’d been placed in other jobs is an open question. Indeed, the job tenure figures may not tell the whole story.

DHS informed the auditors that an estimated 3,076 “customers” in the 60-month-and-over group had left the program — a majority, it said, because they began earning too much to remain eligible. No supporting data provided.

And the agency doesn’t know whether “customers” who did earn more than the minimal maximum for eligibility remained employed — let alone how gainfully — because it doesn’t track families once they leave the program.

More Knowns and Unknowns

First off, we should recall that the auditors focused solely on parents who’d been in the District’s TANF program for quite a long time — or had cycled in and out for even longer. Results for parents who had recourse to TANF because of some singular, temporary setback might be different.

On the other hand, the parents in the sample didn’t include those whom DHS had identified as having significant, ongoing health and/or personal barriers to work, e.g., alcoholism or drug addiction, PTSD due to domestic violence.

About 60% of the rest weren’t immediately work-ready, according to the agency’s assessments. It assigned them to contractors for further education and/or development of marketable skills. Fewer than 10% completed their programs.

Does this mean they were hustled into jobs they couldn’t keep because contractors get a bonus for placements? Or did they themselves get desperate because their very low benefits had shrunk — and were soon to disappear?

Did the fact they had to scramble every day to find a place for their family to spend the night — or some used clothing for their kids — make it just too hard to satisfy the work readiness requirements and, more importantly, their employers’ expectations?

Do we need a thoroughgoing, independent assessment of the TANF employment program? Sure does seem that way.


DC TANF Families Far Below Poverty Line, Even With Uncut Benefits

November 20, 2014

Shortly before the election, Washington Post reporter Rachel Weiner observed that none of the mayoral candidates had even mentioned “a dramatic change in the city’s welfare program that could drag many poor families into further distress.”

She was referring to the District’s decision to phase out Temporary Assistance for Needy Families benefits to families who’ve received them for a lifetime total of five years. The DC Council suspended the phase-out after the first cut — and for good reasons, as Weiner indicates.

But the cuts have gone forward again. They’re likely to leave more than 6,000 families with no cash assistance whatever come next September — unless the Council and soon-to-be Mayor Bowser agree to change the law.

But what about families whose benefits haven’t been cut? Not much of a safety net for them, as the Center on Budget and Policy Priorities’ recent state-by-state update on the benefits shows.

CBPP looks at the maximum cash benefit a single parent with two children can receive. That was $428 in the District when the Center did its analysis.

A provision in the latest Budget Control Act, i.e., the package of legislation that’s paired with the budget proper, provides for a cost-of-living adjustment this fiscal year, based on the Consumer Price Index.

That, I’m told, will boost benefits by 1.5% — just making up for what our three-person family’s benefit lost in value due to inflation during the July 2013-14 period.

The family will still have an income at about 26% of the federal poverty line. And it will be considerably worse off than three-person families were when TANF began.

Adjusting for inflation, the maximum benefit for our D.C. family has lost about a third of its real-dollar value. Losses were smaller in more than half the states.

And, as we all know, the cost of living here is higher than in most places. CBPP provides just one measure — the gap between the maximum TANF benefit for three-person families and the fair market rents the U.S. Department of Housing and Urban Development set for a modest two-bedroom apartment.

The pre-COLA maximum benefit for our D.C. family is 29.1% of the FMR for the apartment. In other words, the family couldn’t come anywhere near to paying for it, even if it spent its entire benefit on rent.

This is true for families in every state, but the rent shortfall is greater than the District’s in only two — Mississippi and Tennessee. Not, I suppose, states the District would choose as benchmarks.

Rankings of this sort aren’t nearly as relevant as the measures of how woefully inadequate TANF benefits are — and how more woefully in adequate they’ve become over time.

So far as housing is concerned, the maximum for our D.C. family would have covered nearly 44% of the FMR in 2000 — still a very large shortfall, but smaller because the benefit was worth more and rents in our area hadn’t skyrocketed.

Now, it’s true that some TANF families in the District have more cash income than the maximum benefit indicates because our local program exempts a fair amount of earned income when setting benefit levels.

Also true, however, as indicated above, that many families are receiving far less than the maximum. The phase-out alone has left some three-person families with as little as $152 a month.

Most, if not all of the families, however, receive a separate cash-equivalent benefit from SNAP (the food stamp program). Yet the cash value of SNAP benefits still leaves TANF families far below the poverty line.

CBPP shows this by combining the average monthly SNAP benefit for TANF families with the maximum the three-person family can get from TANF. With the two benefits, so defined, our D.C. TANF family was at 54.4% of the FPL in July.

But, says CBPP, this is probably an overstatement for many families because the average SNAP benefit it calculated assumes housing, plus utility costs high enough to qualify families for the maximum.

No such costs for the families in the DC General shelter, most of whom depend on TANF benefits. And lower costs, if any that families can claim if they’re doubled-up with accommodating friends or relatives.

There could be fewer homeless families if the District substantially increased TANF benefits now, as originally proposed, and modified the phase-out to preserve benefits for families who’d otherwise become destitute, even though the parents had done everything they were told to.

These could include families with a parent who’s working, but not able to earn enough to support herself and her kids and those with a parent who isn’t working because jobs she could qualify for are just too scarce.

And then perhaps there are parents who didn’t do everything they were told to because they couldn’t, e.g., those with certain intellectual disabilities or PTSD that caseworkers had failed to identify.

But such exemptions would still leave some families subject to phased-out benefits that would sink them even deeper in poverty than they already are — and less likely to achieve the self-sufficiency that TANF is supposed to promote.

How can you focus on preparing for — or seeking — work when you’re trying to figure out where you and your kids will spend the night or how you’ll feed them now that you’ve run through your monthly SNAP benefit?

Problems even for parents who are still within the rigid time limit now.

 


How Low-Income Americans Live (and Whether They Live) Depends on Where They Live

November 3, 2014

TalkPoverty.org recently hosted an online panel discussion on policy solutions to the economic insecurity — and downright poverty — that the latest Census figures confirm.

Toward the end of the discussion, the moderator asked panelists for their views on the “political environment” for their solutions. None saw more than the remotest chance of positive action by Congress. All noted good things happening at state and local levels — and expressed hopes for more.

There’s a flip side to these good things. They aren’t happening everywhere. And they almost surely won’t. We have a sort of inequality that’s not much talked about — the markedly unequal opportunities and safety-net supports for low-income people, depending on where they live.

Nothing new about this, of course. I’m moved to remark on it by an analysis the Urban Institute published the same day as the panel discussion.

The Institute looks at what will happen to poor and near-poor uninsured adults in the 23 states that haven’t expanded their Medicaid programs, as the Affordable Care Act required, until the Supreme Court said it couldn’t.

As you may recall, the ACA had required states to provide Medicaid coverage to non-elderly adults with incomes no greater than 133% of the federal poverty line — effectively 138% because of the way income is calculated.

The law also allows anyone in the same age bracket to purchase health insurance on an exchange if they can’t get affordable health insurance through their employer, but only if their income was at least 100% of the FPL.

What this means is that an estimated 6.3 million people have fallen into a coverage gap, being ineligible for both unexpanded Medicaid and for affordable health insurance offered on an exchange.

Needless to say (I hope) very few adults so poor can get health insurance sponsored by their employers. And there’s no way they can afford to buy it at market rates.

Their median annual income is just $9,500 — 65% of the FPL, the Institute reports. But it’s considerably lower in a number of states — 61% of the FPL in three (all Southern) and 49% in Alaska, where the median annual income for left-out residents is $7,422.

And, of course, half of the adults in the coverage gap have incomes lower, which means trying to get by on no more than $800 a month in most of the non-expansion states.

Some of these states have also done their best to limit purchases on the exchange that the federal government set up because they wouldn’t create their own.

As I’m sure you’re well aware, the exchange website isn’t altogether user-friendly. Even if it were, assessing the different plans offered and deciding which to choose wouldn’t be easy, especially if you’ve never had health insurance before.

The ACA, however, provided funds for “navigators” to inform consumers and help them through the enrollment process. And the U.S. Department of Health and Human Services established requirements to make sure they could do the job, e.g., training on a range of topics, a certification exam.

At least 13 states piled additional requirements on, according to a Health Care America Now review. Texas, for example, doubled the training hour requirements and added background checks. Can’t have ex-felons advising people on health insurance, you know.

It also requires community groups to secure liability protection, e.g., an insurance policy, for the navigators they retain and to comply with a bunch of additional rules. More costs clearly intended to hamstring the groups’ activities.

Indiana and several other states did something similar through licensing requirements that reportedly cost as much as $175 per navigator. Florida barred navigators from its public health offices.

We can see the results in the latest American Community Survey figures. In Texas 22.1% of the population had no health insurance last year. In the District of Columbia and Hawaii, just 6.7% of residents didn’t. Only Massachusetts, whose own healthcare reform gave it a jumpstart, had a lower rate.

We see similar divides in other state-level policies that affect the lives of low-income people, e.g., minimum wage rates, welfare benefits. I single the ACA pushback out because it’s so egregiously political, perverse and consequential.

Political because the state governors and/or legislative majorities want the ACA to fail — and more importantly, to ensure they don’t get beaten in the next primaries by candidates even further to the right.

Perverse in part because expanding Medicaid wouldn’t cost the states one thin dime until 2016 and only 10% of the costs of health care for the newly-eligible from 2020 forward.

Some of these costs would be offset by savings on care for people without insurance, however. So the extra states would have to spend would be a miniscule percent of what they have to spend anyway — 0.3%, on average, another Urban Institute analysis found.

And some states, the Institute concluded, would probably come out ahead. Another of its studies estimated states’ total savings at $12 billion to $19 billion a year, beginning in 2020.

We don’t need number-crunching to know that states gain nothing by deterring their residents from purchasing health insurance on an exchange. If anything, they’re stiffing their hospitals, virtually all of which must provide emergency care, whether patients can pay for it or not.

But people without health insurance generally don’t get much else by way of medical care. No routine checkups to detect so-called silent health problems like diabetes and hypertension. No screenings that can detect certain types of cancers.

Nor do people without health insurance generally have the wherewithal to follow recommendations they may get, e.g., to take prescribed medications at prescribed intervals, to get followup tests.

There’s been a lot of back-and-forth among experts over how many people will die because their states haven’t expanded Medicaid. The truth is we don’t know (yet).

But it seems as clear as day that low-income people — and some not-so-low — can look forward to longer, healthier lives in some states and will die unnecessarily in others. And if that’s not inequality, then I don’t know what is.

 


Why Are Poverty Rates for People With Disabilities So High?

October 30, 2014

My last post tried to answer a straightforward question: How many District of Columbia residents with disabilities lived in poverty last year? The answer was about one in three, but rates were higher for children and working-age adults, especially the former.

Computing the rates is a whole lot easier than explaining why they’re so high. No source I’ve found comes close. Here’s what I’ve pieced together from federal data and other research for the nation as a whole.

Poverty As Both Cause and Effect for Children With Disabilities

The poverty rate for children with disabilities is high nationwide, though not as high as in the District, where it’s 45.5% of children old enough for the Census Bureau’s survey to have captured all the major types of disabilities they may have.

Such research as we have indicates that children are more likely to be disabled if they’re borne by poor mothers and into poor families. Inadequate nutrition, including actual hunger is a factor. Likewise inadequate health care and exposure to toxins in the environment, e.g., lead paint, pollutants in the air.

Stress itself has toxic effects on children’s physical and mental development. And living in poverty is stressful — not only because of the material hardships and instability children suffer, but because the stresses sometimes cause parents to neglect or even abuse their children — or one parent to abuse the other.

At the same time, childhood disability contributes to family poverty. Parents who would otherwise work can’t — or can’t work as much — because they need to care for their disabled child. Parents here generally means mothers, the research tells us.

Working-Age, But Not Many Working

The poverty rate for working-age adults with disabilities is somewhat easier to understand. They may be working-age, but relatively few of them are working — only 26.8% of those 16-64 last year, according to the Bureau of Labor Statistics.

About one in three were working part time — a higher percent than for their counterparts without a disability.

And both they and the full-timers may, in some cases, have gotten paid as little as a quarter an hour because some employers may legally set wages based on their own assessments of productivity.

An additional 14.7% of working-age adults with disabilities were jobless and actively looking for work — about the same percent as in 2012. The unemployment rate for their counterparts without a disability dropped to less than half this rate.

Rolling the working and looking-for-work figures together, we find that more than two-thirds of working-age adults with disabilities were not counted as part of the labor force.

How many could have worked, but became utterly discouraged by employers who wouldn’t even consider them — or who wouldn’t accommodate their disabilities, as the law requires — is an open question.

Some of the dropouts may have worked before they became disabled. If they’d worked long enough and earned enough, they might have qualified for SSDI (Social Security Disability Insurance).

But disability alone wouldn’t suffice. The Social Security Administration would have had to decide that they couldn’t earn much, if anything from work because of their disability and wouldn’t be able to for at least a year.

The benefits might — or might not — lift them over the poverty threshold. Probably wouldn’t for those whose annual earnings averaged somewhere around what a full-time, minimum wage job pays.

Adults who can’t meet the SSDI standards may instead receive Supplemental Security Income benefits if their incomes are low enough, their cash and near-cash assets small and, again, if SSA decides they’re too severely disabled to “engage in substantial gainful activity.”*

SSI lifted about 3.9 million people out of poverty last year. But their incomes couldn’t have been far below the poverty threshold without it. The maximum annual benefit for an individual was about 73% of the threshold for a single person — less, of course, for a family of any size.

Late-Onset Disabilities for Some

Presumably the poverty rate for seniors with disabilities reflects in part the fact that some incurred their disabilities long before their “golden years” — born with them, in some cases, in others early enough so that their Social Security retirement benefits are very low.

But those retirement benefits, plus SSI or draw-downs from their own retirement accounts probably explain why their poverty rate is lowest among the age groups I’ve carved out. Doesn’t mean that all those who cleared the threshold are doing fine.

As I’ve said many times, the thresholds are very low. And when the Census Bureau takes account of basic living expenses, including medical out-of-pocket costs, the District’s senior poverty rate rises to 26% — higher than the rate for any state.

Would that we had SPM rates specifically for young, old and in-between people with disabilities.

* SSI benefits are also available to children with severe disabilities if their families meet somewhat similar income and asset tests and to low-income seniors, disabled or otherwise.

 

 

 


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