DC Labor Laws on the Books, But Weak or No Enforcement

March 23, 2015

“The law is on the books. Enforce it.” I heard my then-boss, U.S. Civil Rights Commission Chairman Arthur Flemming, say this over and over again when the Reagan administration was insisting that Congress had to change major federal civil rights laws if it wanted them enforced as they’d always been.

Even with the best will in the world, however, an agency can’t ensure laws achieve what they’re supposed to if it doesn’t have enough money for staff. This seems to be in the case in the District of Columbia, judging from several Fair Budget Coalition recommendations.

FBC is again recommending additional funds to “implement and enforce” the District’s existing worker protection laws — a total of $3 million for the upcoming fiscal year.

Somewhat over half would pay for more staff and administrative law judges to enforce compliance with the District’s minimum wage increase and expanded paid sick leave laws, plus some others intended to prevent wage theft, e.g., denying earned overtime pay.

But a modest $292,000 would support steps that must be taken before enforcement can kick in. As things stand now, two laws — the Protecting Pregnant Workers Fairness Act and the Unemployed Workers Anti-Discrimination Act — are basically still just words in electronic files.

The former requires employers to provide reasonable accommodations for workers whose ability to perform their assigned tasks is limited by pregnancy, childbirth, related medical conditions or breastfeeding. No more denying pregnant workers enough bathroom breaks, demanding that they continue lifting heavy packages when their doctors have cautioned against that, etc.

The latter seeks to prevent jobless workers from remaining jobless just because that’s what they are.

The pregnant workers’ legislation is quite new. The timeframe for our Congressional overlords to disapprove it, which they didn’t, expired long about last Thanksgiving Day. But the prohibition against refusing to hire — or consider hiring — someone because s/he’s unemployed cleared the Congressional review period at the end of May 2012.

Yet the Office of Human Rights, which has responsibility for enforcing it, hasn’t proposed rules — let alone published final rules — to spell out what employers can and can’t do and how workers can seek remedies when they believe employers have done what they shouldn’t.

Its website doesn’t even acknowledge the law. Yet only OHR can enforce it because it denies workers the right to seek remedies through lawsuits.

Not the agency’s fault that it’s done nothing. The law conditioned implementation on “the inclusion of its fiscal effect in an approved budget and financial plan.” The Chief Financial Officer determined that the budget couldn’t cover it. That, however, was three years ago. So there’s been plenty of time to fill the gap.

This isn’t the first time the DC Council has passed progressive legislation and then neglected to make sure it was achieving its intent.

Back in 2010, the District’s auditor found that the Department of Employment Services hadn’t monitored publicly-financed projects to ensure that contractors filled at least 51% of new jobs created with District residents, as the First Source Act requires. Left to their own devices, most didn’t.

More to the point perhaps, DOES hadn’t issued final rules for the District’s Living Wage Act, which the Council passed in 2006. Nor did it get around to proposing rules for the amended law until after the auditor reported such findings as she’d been able to make — a time lag of at least a year, maybe more.

The Fenty administration told the auditor that it hadn’t moved forward because a provision in the original living wage law conditioned implementation and enforcement on annual appropriations. No appropriations forthcoming. So it’s likely that some unknown number of D.C. workers were underpaid.

Perhaps still are. The final rules provide for no enforcement unless workers or their representatives file formal complaints of violations. The burden is apparently on them, not DOES to monitor, investigate, document and so forth.

We everyday District residents read of laws the Council has passed to increase employment of our fellow residents, boost their wages and protect them from egregiously unfair treatment.

So it’s distressing that we have to learn from FBC — and ultimately from the Employment Justice Center, which proposed the labor law recommendations — that the responsible agencies aren’t fully and effectively enforcing the laws on the books.

Well, we know now. And so do the Mayor and DC Councilmembers. We have fine advocates here in the District, but I still wish we had Flemming pounding the table now.

 


Did I Pay My Fair Share of Income Taxes?

March 19, 2015

Here we are again approaching the deadline for filing income tax returns. I’ve just finished an all-day session with my tax software and miscellaneous 1099s, receipts, cancelled checks and the like. Now I ask myself whether I paid my fair share.

To borrow from a former President, it depends on what the meaning of “fair” is. Like most people, I suppose, I believe it begins with paying more than filers with lower incomes. Like most, but not all people. We mustn’t forget the flat tax folks, who’d consider our tax system fair if everybody paid the same share of his/her income.

I’m pretty sure I paid more than people with considerably lower incomes, but I doubt that translates into my fair share. I’ll tell you some of the reasons why because they speak to what seem to me dubious preferences built into the federal tax code.

First off, I paid a lower percent of my income than people who earned the same amount by working. That’s because I benefited from the preferential rate for both capital gains on assets held for more than a year and qualified dividends, i.e., those that meet specific criteria, as most paid to shareholders in U.S. corporations do.

Defenders of the rate claim, among other things, that it’s an incentive to invest — thus grows our economy, creates jobs, etc. This seems to me pretty lame. What would I do with the money instead? Spend it all, which itself would grow the economy? Put it under my mattress? In a savings account, where it would lose purchasing power because the interest rate is usually lower than the inflation rate?

Defenders also claim the money has already been taxed, either as corporate profits or as income earned by working. For me, the latter isn’t altogether true — at least, not in the sense that I would be taxed twice. I have as much investment income as I do because I was a beneficiary of trusts established by my grandmother and younger sister.

I sold some of the stocks I inherited last year and others in earlier years. I didn’t pay taxes on anything close to the difference between purchase and sale prices — the usual basis for capital gains. Instead, I paid only the market value the stocks had gained since the trusts passed them along to me.

So the total profit was far greater than the taxed amount because the value of the stocks was “stepped up” to the dates when my grandmother and sister died. Nobody paid taxes on the value gained before then. I can’t see what’s fair about that.

But it’s not exactly a loophole, as President Obama has termed it. It’s a feature, not a bug in the estate tax — and ardently defended.

What then about the income taxes I pay to the District of Columbia? The District has a fairly progressive income tax structure. But the tax itself is based on the federal, both adjusted gross income and itemized deductions.

So the break for capital gains and dividends carries over. Likewise, the hidden capital gains break due to the stepped-up basis. I thus benefit twice over.

I don’t want any misunderstanding here. I’m not — and never was — one of those CEOs or hedge fund managers whose compensation packages are artfully structured to minimize what they owe Uncle Sam.

I’m a fairly ordinary middle-class person, born to middle-class parents, one of whom had a parent who actually bootstrapped his way off the streets of New York. Wouldn’t have those trust assets without him.

I understand that the tax code can’t be rejiggered to compensate for the advantages I’ve had because I chose my parents wisely. But that doesn’t mean it should pass those advantages along by preferential rates and the like.

The tax code, after all, is how our federal, state and local governments raise revenues for all the programs and services that compensate for disadvantages — from pre-birth through adulthood — that make it so difficult for people born poor and near-poor to live in reasonable comfort and security.

The Institute on Tax and Economic Policy says that a “fair tax system is one that asks citizens to contribute to the cost of government services based on their ability to pay.” I’m inclined to go further because so many critical services don’t cost enough now.

All but 14 of more than 150 federal programs that are supposed to serve the needs of low-income people — and in some cases, others too — have less in real dollars this year than they had in 2010. About a third have effectively been cut by at least 15%.

This argues for an end to sequestration, i.e., the spending caps Congress passed as a fallback, thinking (wrongly) that the members appointed to the so-called supercommittee would come up with a more sensible deficit reduction plan.

Such a plan would surely include measures to raise more revenues from individuals who have the ability to pay, as well as corporations that now have — and exercise — the ability to pay less than nothing.

Two Republican Senators — Marco Rubio and Mike Lee — have instead come up with a plan of sorts that would, among other things, altogether eliminate the capital gains, dividends and estate taxes.

If you think the tax code is unfair now, as I do, just imagine how more unfair it might be. And how much more unfair our country would be, since the Rubio-Lee plan would cause the deficit to skyrocket.

We know what would happen to programs for low-income people then. We need only look around our communities to see what’s happened already.

 

 


Not Nearly Enough Housing Affordable for Lowest-Income Renters, Nationwide and in DC

March 16, 2015

Nearly a quarter of renter households nationwide fell into the extremely low-income category in 2013, i.e., had incomes at or below 30% of the median for the area they lived in, according to a new National Low Income Housing Coalition report.

Three quarters of these 10.3 million or so households paid at least half their income for rent and basic utilities. This is one measure of the shortage of affordable rental housing in our country — only 31 units affordable and available to rent for every 100 ELI households.

The gap was much greater for the subset of households NLIHC classifies as deeply low-income, i.e. those with incomes no greater than 15% of their area’s median. Only 17 affordable, available units for every 100 of them, making for a shortage of 3.4 million units.

All but 5% of the DLI households paid more than half their income for rent, plus utilities. These, recall, are households that somehow scraped up the money. We don’t have a reliable figure for those who were homeless because they couldn’t.

Surprisingly, at least to me, the figures for the District are somewhat better. But they still confirm the need for more affordable housing, especially for the very lowest-income residents.

And perhaps the figures are overly rosy because, as I’ve written before, the area the District belongs to for affordability calculations includes some very well-off nearby communities.

With that caveat, here’s what NLIHC reports. In 2013:

  • The District had 40 affordable, available units for every 100 ELI households, making for a total shortage 32,752.
  • For every 100 DLI households, only 34 units were affordable and available — a shortage of 21,038.
  • All but 35% of ELI households and 26% of DLI households paid at least half their income for rent, plus utilities.

These figures, recall, are more than a year old. We’ve had condo conversions, out-in-out apartment house demolitions and subsidized housing losses since. Rents have risen, sometimes quite a lot, even for tenants supposedly protected by the District’s rent control laws.

The figures are nevertheless timely because the Mayor and her people are deep into developing the proposed budget for the upcoming fiscal year. As the DC Fiscal Policy Institute reports, they’ve got to close a $200 million gap between projected revenues and the funds needed to sustain existing programs and services.

Any significantly larger investment to create and preserve affordable housing would widen the gap the Mayor would have to close because the District’s budget must, by law, balance every year.

A wider gap likewise if she — or alternatively, the DC Council — opts for greater investments in housing vouchers — either those that subsidize affordable housing operations or those that enable ELI/DLI households to rent at market rates or both, as the Fair Budget Coalition has recommended.

And again a wider gap if our policymakers boost funding for short-shot assistance that would enable some of those households to catch up on overdue rent or move to a cheaper place, if they can find it.

DCFPI recommends that the Mayor use some of the funds left over from last fiscal year, but they can’t be used for investments that involve multi-year commitments. So it also recommends that she “find ways to raise revenues.” This, I take it, is a tactful way to broach the subject of tax increases.

It’s hard to see how the District will significantly reduce homelessness without them. Because, however complex and diverse the root causes, homelessness for each individual and family reflects their inability to pay for rent, plus the bills for lighting, heating and the like.

Every one of the ELI and DLI households that’s paying over half its income for rent, plus utilities is at high risk of homelessness. Investments in affordable housing for them will pay off in lower costs in other areas — including, but not limited to shelter.

That’s not the only reason the Mayor and Council should make affordable housing a priority — preservation, first and foremost, but creation to replace lost units too.

We have the diversity of our community to consider. We’ve got the well-being and future prospects of children who suffer not only from homelessness, but from unstable housing — and from the stresses their parents experience as they try to earn enough and juggle the bills to keep them somehow housed.

If tax increases are needed, I’ll willingly pay my share. I’d like to think that others whose incomes are well above the ELI/DLI maximums will do so too.

NOTE: As I put the finishing touches on this post, DCFPI issued its own meaty report on “DC’s vanishing affordable housing.” The report includes a number of recommendations for policies to reverse the trends it documents. Highly recommended.


Why Worry Now About Time-Limited Refundable Tax Credit Expansions?

March 12, 2015

Say Congress decided to preserve the expansions of the Earned Income Tax Credit and Child Tax Credit that were originally part of the Recovery Act. What would this mean for low and moderate-income working families? Citizens for Tax Justice answers.

In 2018, more than 13 million families, including about 24.8 million children would benefit by an average of $1,073 per family. They’d gain an average of $905 per child. This is only the first year the tax credits will revert to their earlier forms unless Congress acts.

CTJ provides state-by-state estimates, as well as these national estimates — and for each of the refundable tax credits, as well as the two together.

So we learn, for example, that 20,175 families in the District of Columbia, including nearly 45,000 children would benefit from the two tax credits combined. Their average gain would be slightly more than the national average — $1,093 per family. This is somewhat more than two whole weeks of pay for a full-time worker earning what will then be the minimum wage.

The expanded CTC would have the greater impact in terms of both the number of families helped and the average per child benefit, according to the estimates. This is presumably because, without the expansion, families who owe less than zero in income taxes couldn’t receive any refund at all unless their incomes were somewhere around $14,700.

But, as I noted in an earlier post, the District’s own EITC is linked to the federal, as is also the case for all but one of the 25 states with their own EITCs. So the ultimate boost to family budgets is greater than what CTJ estimates.

The flip side of all this, of course, is that a large number of family budgets would take a hit if Congress lets the refundable tax credit improvements die. And that seems thus far what Republicans have in mind.

They do rather like the notion of a child tax credit. But they would expand it up the income scale, while letting the threshold for claiming it revert to its pre-Recovery Act minimum, plus all the inflation adjustments since 2009 — and further adjustments yearly.

The bill the House passed last year, with some Democratic support, would have reduced after-tax income not only for families that couldn’t claim the refundable CTC at all, but for those with incomes as high as $40,000 a year.

President Obama’s budget would make the Recovery Act improvements permanent. The first-year cost in lost revenues would be slightly under $14 billion, CTJ says. A small fraction of the budget, but not chump change.

And, of course, the 10-year estimate we’re used to seeing is considerably higher — roughly $103.8 billion, if I’m reading the Treasury Department’s table correctly. But the President’s budget includes revenue-raisers too.

Well, the President has proposed locking in the EITC and CTC improvements before. Best he could get was an extension that will expire at the end of 2017. Many of us haven’t even filed our 2015 tax returns yet. Why should we worry about 2018 now?

The answer lies in what’s underway in our Republican-controlled Congress. On the House side, Republicans are again moving to convert time-limited tax breaks, mostly for businesses, into permanent law.

The packages they’ve already passed will cost more than $93 billion over the first 10 years. No offsets for the revenue losses, just as there weren’t last year. And there are other temp-to-perm tax breaks in the pipeline.

The more such “tax reform” we have, the slimmer the chances of saving the refundable tax credit improvements. Just look at that deficit, Republicans will say when the improvements are about to expire. Can’t possibly extend them. Next thing you know, we’d be Greece.

We need also to consider the practical politics of trying to pass a bill that does nothing by extend expanded tax breaks for lower-income families. Things being as they are, these benefits don’t stand much of a chance unless they’re packaged with others that appeal to Congress members who’ve got their eyes on wealthier constituents and/or corporate donors.

This, I think, is what top experts at the Center on Budget and Policy Priorities meant when they said, about last November’s huge tax break package, that it risked “stranding” the temporary EITC and CTC provisions that have proved so beneficial to low-income working families.

The fewer tax breaks Congress has left to extend, the fewer the “linkages” supporters can make — or perhaps one should say the fewer opportunities for horse-trading.

In another world, we wouldn’t need them. The EITC and CTC, in their current forms, have lifted more people out of poverty than any other federal benefit, except Social Security — 8.8 million last year, the Census Bureau reports.

The tax credits reward work. We’re supposed to like that. They help support families with children. We’re supposed to like that. And I believe we do, Republicans and Democrats alike, though we’ve differences between and within the parties on certain types of families.

Be that as it may, the EITC and CTC expansions are clearly endangered. We’d otherwise find them in bills that aim to make other time-limited tax measures permanent. And we certainly wouldn’t have had Republicans blaming their exclusion on the President’s immigration actions.


Homeless Single Adults in DC Speak Out

March 9, 2015

We’ve had ample opportunity to learn about homeless families here in the District. We’ve read about the increasing number, about the District’s struggles to shelter them when it must, about its struggles to move them out of shelter into housing they may not be able to pay for when their short-term subsidies expire.

We know — and have known for some time — that conditions at DC General, the main family shelter, are awful.

But as of the latest official count, there were somewhat more homeless single men and women, i.e., those who had no children with them, than adults and children together as families. And there have been considerably more in years past. What about the singles?

A briefing last Monday provided some answers. Nothing definitive, but more than I knew before. You too perhaps.

Here then, briefly, is what we learn from the experts — the homeless men and women who spend (or formerly spent) their nights in shelters and from a social worker for Catholic Charities, which operates five shelters for singles under contract to the District.

Also, briefly, the conclusion I reached and a brand-new development that should point the way forward.

Awful physical conditions. Like DC General, most of the shelters for singles are “aged buildings,” as a former shelter resident called them. Sometimes the electricity works. Sometimes it doesn’t. Sometimes there’s heat and hot water. Sometimes not.

And, as at DC General, the singles’ shelters are reportedly infested with vermin — bed bugs in the mattresses, rats and roaches scuttling about, etc.

Bad food. Shelter residents complain of spoiled food, just as they do at DC General. There seems to be something to this. The social worker reported that staff examine the food delivered by the District’s contractor to decide whether it can be served. Sometimes not, one infers, since he spoke of going to other sources.

Not enough help getting out. Singles in the shelters say they can’t see the caseworkers who are supposed to help them develop and carry out plans to become job-ready and/or find paying work.

Some back-and-forth at the briefing about whether the caseworkers are on duty when the shelter is open — and allegations that they won’t always see clients when they are. What seems beyond dispute is that there aren’t enough of them.

Catholic Charities has one caseworker for every 100 clients. And the ratio would be higher if it didn’t use donor money to supplement the staff covered under its contract. No way that a caseworker, however diligent, could effectively assess, refer and guide that many clients.

Uncaring treatment. For the homeless and formerly homeless singles who spoke, both on the panel and from the audience, none of the above triggered as much outrage as the way shelter staff treated them.

There’s a “disconnect” about weather, one said. Shelter residents are turned out onto the streets when it’s raining. If they try to remain, someone calls the police. If it’s raining — or even snowing — when they’re lined up waiting to get in, staff still keep the doors shut until official opening time.

When it’s bitter cold, residents have a right to remain in shelter during the day — and apparently are allowed to. But they may have to sit in some sort of outer room, on uncomfortable chairs, for many hours because their regular rest areas don’t get promptly clean.

One resident spoke of waiting for eight hours — not only he, but people in wheelchairs. Desperate offers to clean their own rest areas were curtly dismissed.

It’s not only such particulars that make sheltered singles feel they’re treated like lesser beings. Staff  have a “drill sergeant mentality,” one woman said. They “bark.” She further objected to their assumption that every resident — obviously herself included — is a drug addict, an alcoholic or mentally ill.

“They need to put humanity behind what they are doing,” she concluded. “We are individuals.” One hears a plea for recognition that homeless people are as different from one another as shelter staff members know they themselves are.

Beyond that, however, a recognition of common humanity. Panelist Carol Doster, formerly homeless and now a poignant advocate, put it well. “In practice, we do not consistently afford our homeless neighbors with the level of respect, dignity … or human rights that we Americans and D.C. residents indicate we stand for.”

Or, I would add, that we would expect — and be shocked not to find — if we became homeless and had no friends or family to turn to.

Management issues. Several of the speakers called for better staff training. The remedy, I think, must be broader. The District has contracted out responsibility for the single adult shelters — ultimately to the Community Partnership to End Homelessness, which lets and manages contracts with the nonprofits that operate them, as well as with the food service providers.

Manifold problems at DC General have prompted some advocates to say that the Partnership should be replaced — at least, in its capacity as the shelter manager. Seems to me someone needs to look carefully at how it’s managing the rest of the homeless services system it’s responsible for too.

We now have the results of an audit, thanks to an inquiry from Councilmember Mary Cheh. These, at the very least, cast doubts on the Partnership’s financial practices — and controls over at the Department of Human Services.

But the issues our homeless singles experts raised call for another sort of investigation. Who, if anybody, is visiting the shelters (unannounced), examining the meals delivered, finding out how staff are trained and supervised, etc.? And who, with clout, is raising holy hell about the building systems and maintenance?

“I had an instinct that no one was minding the store sufficiently,” Cheh says. She was referring to the money matters, but we’ve got more than instinct to tell us it’s true for shelter operations as well.

 


Be Careful What You Wish For

March 5, 2015

So here I was elaborating on reasons Congress should renew funding for the Children’s Health Insurance Program. No sooner had I finished the post than the Center on Budget and Policy Priorities published a damning brief on a draft bill that would — sort of.

The draft is especially worrisome because it’s the product of the chairmen of the committees that have primary responsibility for CHIP — Senator Orrin Hatch, who heads the Senate Finance Committee, and Congressman Fred Upton, head of the House Energy and Commerce Committee.

The Hatch-Upton bill would significantly reduce federal funding for CHIP in several different ways. It would, among other things:

  • Altogether deny a federal match for the healthcare costs of children in families with incomes above 300% of the federal poverty line — currently $60,270 for a single parent with two children. Eighteen states and the District of Columbia currently cover children at this income level.
  • Use the regular Medicaid matching rate, rather than the higher CHIP rate for children whose family incomes are between 250% of the FPL and the 300% cut-off. If the law were in effect now, 27 states and the District would lose, on average, 13% of their match.
  • Repeal the higher CHIP matching rate that the Affordable Care Act established for 2016 through 2019, when CHIP would officially expire, unless renewed. So all CHIP programs would take a hit, even those that cover only lower-income children.

States and the District would have have to pick up more of the costs of covering children whose family incomes aren’t low enough to qualify them for Medicaid — and more of some of those who are because the ACA provided the higher CHIP match for children states had to shift into Medicaid.

Or rather, they would if they decided to keep their CHIP programs as they are. States could, if they chose, shift children back from Medicaid to separate CHIP programs. This, CBPP says, would probably mean less comprehensive coverage and higher out-of-pocket costs.

More generally, states could change their laws to make fewer children eligible for CHIP because the Hatch-Upton bill repeals a so-called maintenance of effort provision in the ACA that prohibits them from doing this before the end of the 2019 budget year.

States could also impose long waiting periods — up to a year — before enrolling children in CHIP. They could do this for virtually all families who’d had — or “declined an offer of” — group health insurance.

States can now require waiting periods of up to 90 days, but not for all children. They must waive the waiting period for “good cause,” e.g., if the child loses health insurance because a parent dies or can no longer get coverage through an employer-sponsored plan. Children with special healthcare needs must also be able to get CHIP coverage immediately.

Only 14 states have opted for a 90-day waiting period. Thirty-three and the District have no waiting period at all. But who knows what they’d do if faced with the funding crunch the draft bill would create?

The MOE repeal and the extended waiting period option are, of course, other, though less direct ways the Hatch-Upton bill would cut federal spending for CHIP.

Still another is by omission, rather than commission. The bill would fail to renew Express Lane Eligibility — an expiring tool that allows states to use information they’ve already collected, e.g., from SNAP (food stamp) applications, to determine eligibility for Medicaid and CHIP.

This can not only reduce administrative costs, but boost enrollment — and get children the health insurance they need quicker, according to an evaluation for the U.S. Department of Health and Human Services.

Lest we should miss the intent, the bill also repeals a provision in the current CHIP law that offers states a higher match rate for interpretation and translation services so that language barriers don’t become barriers to enrollment.

In short, as the Executive Director of Georgetown University’s Center for Children and Families says, the “proposal comes with fine print that could reverse our nation’s progress in covering kids.”

Not only covering them, but as I earlier wrote, ensuring that they can receive the full range of healthcare services they need at affordable rates. By this measure, as well as others, the draft bill is hardly what we should wish for.


Children’s Health At Risk Without CHIP Funding, Even If They’re Insured

March 2, 2015

I came belatedly to an enlightening article on the potential end of funding for the Children’s Health Insurance Program. Learned more than I knew when I blogged about it last October.

Professor of Pediatrics Aaron Carroll, who wrote the piece, notes the concern about children who may have no health insurance whatever — about 2.2 million, according to one count. But he focuses mainly on concerns for those who will have coverage because their parents have an affordable family plan purchased on a health insurance exchange.

Or we surely hope so. As you’ve probably read, the Supreme Court has been asked to rule that the federal government can’t subsidize plans purchased on the exchange it established for people who live in states that didn’t create their own.

Many trustworthy experts think the Court won’t. But if it does, as many as five million children could wind up with no affordable health insurance, according to a friend-of-the-court brief filed by the American Academy of Pediatrics and seven other organizations engaged in healthcare services and advocacy for children.

Carroll doesn’t allude to this doomsday scenario. He instead makes several points in favor of renewing CHIP funding, even with the subsidies intact.

The first is that CHIP covers a larger portion of children’s healthcare costs — more than 90%, as compared to 70% in the mid-level silver benchmark plans the Affordable Care Act provides for.

A troublesome difference. Some parents, however, might opt for plans with rock-bottom monthly premiums, but even higher deductibles and other out-of-pockets. This could cause them to forgo needed care — for themselves and perhaps their children.

Cost aside, Carroll raises several concerns about the health care children could receive through plans available on the exchanges. They’re rooted in the fact that the plans, unlike CHIP, aren’t tailored to children’s healthcare needs.

The problem begins with the ACA itself. The law establishes essential benefits that all plans must cover, both those offered directly to individuals and those small employers can purchase. They include pediatric services, with vision and dental care specified.

For reasons known best to the U.S. Department of Health and Human Services, the rules are silent on all but the two named services. And they allow for a separate, optional dental care plan — at an additional, unsubsidized cost — rather than requiring coverage in the overall plan.

I don’t suppose I need to elaborate the potential consequences for low-income children.

More generally, the failure to specify essential pediatric services has allowed states to choose as the basis for their minimum requirements plans that exclude a variety of healthcare services for children.

Carroll cites, among others, services for children with learning disabilities and autism. He also notes gaps in services expressly required, e.g., care of congenital defects, hearing aids and implants for children whom hearing aids can’t help.

Another related variation applies to plans families may purchase. Some, Carroll says, have very narrow networks, i.e., hospitals and physicians whose services the insurance company will pay for.

They’re narrow for providers of pediatric care than care for adults — and especially narrow for providers of specialty care, he adds. The narrow-network plans tend to be cheaper. And we’ve some evidence that many purchasers don’t understand the trade-off.

So parents may learn, when it’s too late, that there’s no in-network children’s hospital or other source of affordable services from doctors trained to treat children with complex, chronic conditions.

What’s rather strange about CHIP is that the ACA extends it through Fiscal Year 2019 — and sets a higher federal match rate for states’ costs beginning in Fiscal Year 2016. Yet it gives the federal government authority to spend money on the program only through this fiscal year.

States may have some leftover funding, but it’s unlikely to last through the year. There’d still be a match for low-income children who’ve been served through Medicaid, rather than separate CHIP programs, but it could be lower. It would definitely be lower for the children states shifted into Medicaid, as the ACA required.

For the rest, there’s no assurance state exchanges would have insurance plans with benefits and cost-sharing comparable to CHIP. Carroll’s analysis suggests that many don’t now. They could, but wouldn’t have to if CHIP funding dries up.

Surely it would be irresponsible to let CHIP funding lapse and see what happens. If children’s health problems aren’t promptly and expertly diagnosed and/or don’t get appropriate treatment, no one can remedy the harms by restoring CHIP or refining the ACA later.

 


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