Warning: House Budget Bills Bad for Your Health, Unless You’re Rich

April 4, 2016

Picking up where I left off, the House Budget Committee isn’t the only one working on radical spending cuts for health care. Two other House Committees have also passed bills to dismantle the Affordable Care Act.

Ways and Means Jacks Up Health Insurance Costs

House Ways and Means recently approved three “commonsense” measures that make no sense unless the only thing you care about is slashing federal spending.

They include a bill that would probably deter people from purchasing health insurance on an exchange — a Republican insurance of sorts in case the umpty-umpth effort to repeal the ACA fails.

It would uncap the dollar limits on what people who get subsidies must repay if they underestimate their income when they choose a health insurance plan.

As things stand now, individuals and families with incomes below 400% of the federal poverty line must repay only a portion of the extra they’ve received as so-called advanced tax credits, i.e., funds deducted from what they themselves must pay for their insurance.

The lower their income bracket, the less their repayment. So, for example, a poor or near-poor family would have to repay, at most, $600. Kill the caps and the clawbacks would be much larger for people who can ill afford them.

These aren’t people who tried to game the system. They had to ballpark what they expected to earn during the course of a year. That’s hard for most of us, as Families USA explains.

It’s especially hard for a low-wage worker with one of those many jobs that require more and fewer hours week to week — or even day to day. Equally hard for workers whose income consists largely of tips.

These workers — and some with steadier incomes — might well choose to pay the penalty for going without insurance, rather than face the prospects of an uncapped clawback. The former for a single person is only $695 this year.

All told, as many as a quarter of a million people would make this choice, the Joint Committee on Taxation has estimated. They’d be counting on the good health they enjoy, thus leaving mostly sicker people in the pool that companies offering insurance on an exchange must cover.

So premiums go up. More people drop out. Companies’ per person costs to up more. At least some of them decide to drop out of the exchange market. And the ACA dies, though not so swiftly as by repeal.

Energy and Commerce Targets Children and State Prison Budgets

The House Energy and Commerce Committee rolls back two other provisions in the ACA, each targeted to health care for a specific vulnerable population.

A bill it recently passed would repeal the higher federal match the law provided — and Congress extended — for the Children’s Health Insurance Program.

The District of Columbia and all states but Arizona have either a separate CHIP program or the equivalent within their Medicaid program. They’d lose a total of more than $3 billion a year if Congress extends CHIP funding again.

So as with the Medicaid block grant, one would expect at least some of the 30 that have expanded coverage beyond the required minimum to pare back.

Victims here would be immigrant children who came to the country legally or got authority to stay, but less than five years ago — the “waiting period” Congress established at the same time it ended welfare as we knew it.

The Energy and Commerce bill would take a direct bite out of Medicaid too. It would deny states their current federal match for health care low-income prisoners receive in hospitals and other in-patient facilities beyond the prison walls.

States can claim the match if they’ve expanded their Medicaid programs, as the ACA envisioned, and helped prisoners enroll — necessary steps because adults who weren’t severely disabled or aged generally didn’t qualify for Medicaid before.

The match covers all offsite healthcare costs for the newly-qualified now and will cover most indefinitely. So states stand to lose a lot of money, but a long-standing Supreme Court ruling would require them to still provide health care inmates need.

States would still get a match — whatever the base Medicaid law provides. So the lower match, in and of itself, would still make enrolling inmates better than not. But most will return to their communities. And many have chronic health problems.

States would have to pay an ever-greater share of treatment costs, unless they retrenched eligibility and/or covered services for a broader swathe of their residents, because that’s how the block grant achieves such eye-popping federal savings.

We don’t know whether states would seek comparable savings of their own. But we know enough to know they could achieve such savings only at the expense of beneficiaries.

If they left their Medicaid programs intact, they’d have to cut funding for other critical needs or raise taxes — an unpalatable choice, to say the least, that other pieces of the House budget plan would foist on them anyway.

Not a happy prospect for poor and near-poor people. And so another way that House Republicans’ bills should bear a warning like the one on cigarettes.



House Budget Plan Endangers Health of Low-Income People

March 31, 2016

When I drafted my post on the House Budget Committee’s plan, I discovered that its impacts on affordable health care had too many interlocking parts to fit. So here, as promised, is a followup.

I’ve already mentioned the not-new plan to convert Medicaid to a block grant. But there is something new — a work requirement. State flexibility notwithstanding, able-bodied adults couldn’t qualify unless they were gainfully employed, actively seeking work or participating in a job training program.

Now, this may sound reasonable. But it isn’t — for three reasons. Two we’re already familiar with from the plight of able-bodied adults without dependents who will soon lose their SNAP (food stamp) benefits.

There aren’t enough jobs they can qualify for. There aren’t enough slots in training programs for all the jobless either. And states have no obligation to provide them. No evidence they’d have to for Medicaid — or get any funds for training, as they can with SNAP.

The third reason calls for a look beyond the block grant. The House budget plan would (surprise!) repeal the Affordable Care Act.

This would, among many things, deny a growing number of states and the District of Columbia the federal funds they counted on to cover a large share of the costs they incur because they expanded their Medicaid programs.

They’d lose a total of about $2.1 trillion over the upcoming 10 years. So it’s reasonable to expect they’d revert to their pre-ACA eligibility standards — or something much like. Basically, this would mean that the work requirement would apply to only very poor pregnant women and parents.

Studies of families in the Temporary Assistance for Needy Families program tell us that many of those parents face formidably high barriers to work — some that are also barriers to regular participation in a job training program. Seems they’d go hungry.

Many Medicaid recipients do work, however. Those with incomes at or above 100% of the federal poverty line could buy health insurance on an exchange — if the ACA were still intact. But without it, they’d have no subsidy to help pay the costs.

Other House committees have already passed bills within the framework of the Budget Committee’s attack on the ACA. So yet one more post to come on how key House Republicans would save money at the expense of their constituents’ health, the states they represent or both.


DC Mayor Leaves TANF Families Dangling Near Bottom of a Cliff

March 28, 2016

Mayor Bowser said, in her State of the District address, that she would ask the DC Council to raise the local minimum wage to $15 an hour. She wants to “make sure that more families … can earn a decent wage … [s]o that when their time on TANF has ended, they can afford to stay in the District of Columbia.”

Meanwhile, a reform of some sort “will keep families working their plans from falling off a cliff.” This, I take it, refers to families headed by parents who are putting in the required number of hours on their required work preparation and/or job search activities.

The Mayor’s proposed budget quashes whatever hope her speech raised. It would, once again, just push back the benefits cut-off for families who’ve participated in TANF for 60 months or more.

Better than pushing them out of the program six months from now. But they’d still receive only the drastically lower cash aid intended to lead up to the cut-off — perhaps with a very small adjustment to compensate for inflation.

A family of three now receives $156 a month — $1.71 per person, per day. Seems to me they’re already pretty near the bottom of that cliff.

One could understand the cut-off delay if the notion of extending benefits indefinitely for some at-risk families were altogether new such that experts in the Human Services Department had to start developing a proposal from scratch.

If they had no precedents in other states to look at, instead of those in forty-four. If the notion of preserving benefits for all the 13,600 or so children who’d get only a temporary reprieve had never crossed the Mayor’s radar screen before.

If no research had found that children in extreme poverty suffer irreparable damages that put them at extremely high risk for a lifetime of poverty.

The Mayor knows, as do many of you, that the Council already has a pending bill that would qualify families for extensions if cutting off their TANF benefits would leave them penniless — or in less dire cases, short of enough wage income to cover their basic needs.

The same bill would extend a lifeline to all children, even those whose parents didn’t qualify. And it would restore the cash benefits they and reprieved parents would receive if not up against the time limit.

That’s hardly enough to live on, even with other safety net benefits, but a whole lot better than what the Mayor intends. Our family of three would have $288 more a month — and could look forward to an increase next year, if still not earning enough to boost it over the income cut-off.

Strengthening the safety net, as the bill proposes, would cost roughly $30 million during the upcoming year — $20 million more than the Mayor’s kick-the-can-down-the-road-again approach.

She chooses instead to give more than half the total to businesses through another cut in the franchise tax and to the beneficiaries of estates, which would have no tax levied until the value, after deductions exceeded $2 million.*

The Council triggered these tax cuts — and possibly others — in its latest budget-related legislation, but she could have asked it to defer them.

I have nothing like the expertise to say where else Bowser and her budget experts could have found the funds needed for the TANF extensions. But they’re surely somewhere in that $13.4 billion budget.

I realize I’m not giving the Mayor credit for a number of fine budget proposals — $13.1 million to move the plan to end homelessness forward, for example, another $100 million commitment to help finance construction and/or preservation of affordable housing, further investments in public education. And so on.

But I can’t get over her decision to leave nearly 6,600 poor families hanging by a thread when she has such a clear, justifiable alternative. And I don’t think Councilmembers should go along when they could, at least in this respect, make the budget live up to its billing as “a fair shot.”

* Current law exempts assets that pass directly to surviving spouses and/or charitable organizations. So the larger tax break wouldn’t benefit them. It would benefit other heirs if either or both received some of the assets because the taxable value doesn’t include them.

UPDATE: I’ve just seen the Chief Financial Officer’s (unpublished) cost estimate for the short-term reprieve. He puts it at $11.6 million, based on an estimated 6,200 families and no cost-of-living adjustment, as I had thought there might be.

What’s New (and Not) in the House Budget Committee Plan

March 24, 2016

I feel sorry for progressive analysts and advocates whose main business is the federal budget and related issues because they again have to swat down pernicious proposals and misleading justifications.

I myself am tired of blogging on the retreads we see in the proposed House budget resolution — the immediate occasion of my pity and exasperation that I suspect is shared.

So what’s new? A few things that would devastate programs for low-income people, as well as some not new.

Vast Spending Cuts

The Washington Post has repeatedly reported that the House budget plan would cut spending by $30 billion over two years to offset what last year’s budget deal allows above the caps originally set for the upcoming fiscal year.

This is doubly misleading, though not, I think, intentionally. First off, the deal has already offset that $30 billion, though the savings reach the total over a longer period of time. Second, the plan would actually cut spending by $6.5 trillion during the next 10 years, the usual window for budget-related estimates.

The massive cut isn’t new. Nor the justification for it. The plan, like its recent predecessors aims to balance the federal budget, without raising more revenues.

It would, in fact, raise less than likely now because it would eliminate taxes on all profits corporations claim to earn overseas and the Alternative Minimum Tax collected from well-off individual filers who benefit from the lower capital gains tax rate, plus diverse deductions and credits.

Where the “Savings” Would Come From

The House Budget Committee finds roughly a sixth of its savings in discretionary programs, i.e., those that depend on annual appropriations. Most are subject to the caps, while only a few others are.

The plan provides for spending up to the somewhat higher caps agreed to for the upcoming fiscal year. But it doubles down in the years following, while boosting spending on defense even more than the budget tables show.

Spending on non-defense discretionary programs would fall by about $1 trillion below the current caps, according to a Center on Budget and Policy Priorities estimate.

These programs include a wide variety that serve low-income people’s immediate needs, e.g., affordable housing and child care, help with home heating bills. Others offer them or their children opportunities to improve their earnings prospects, e.g., job training, work-study for college students.

Most have already lost real-dollar value since the year before Congress passed the law that imposed the caps, as the Coalition on Human Needs shows.

A much bigger chunk of the savings would come from changes in mandatory programs, i.e., those the federal government must spend enough on to provide full benefits authorized by laws other than a budget.

What’s not new is a sketch of sorts for partially privatizing Medicare. Likewise proposals to convert Medicaid and SNAP (the food stamp program) to block grants.

The former would reduce federal spending by more than $1 trillion, the latter by $125 billion — nearly a third during the block grant’s first four years. Another $25 billion or so saved by not-new proposals House Republicans tried to get into the latest version of the Farm Bill.

The block-granting impacts are self-evident, as they’ve always been. Either states would have to use significantly more of their own funds to sustain the same benefits to the same groups now eligible or they’d have to cut benefits, deny them to some or a combination of both.

What’s sort of new is the re-branding. The undermined programs wouldn’t be block grants, but rather state flexibility funds, the more palatable term the House Budget Committee adopted last year.

I’ll have more to say about the Committee’s plans for healthcare programs because the not-new proposal to repeal the Affordable Care Act and a separate effort to undermine it pose broader threats than the block grant in and of itself.

I’ll just cut to the chase here in hopes of answering a question I’m guessing is on the minds of those of you still reading what seems the same old, same old with new numbers.

Why Worth a Worry

The House Budget Committee’s plan won’t develop into next year’s budget — or the many legislative changes needed to gut the mandatory programs. It may not even pass in the House because some of the Tea Partiers feel it doesn’t cut spending enough.

If it does pass, it won’t in the Senate, even if all Republicans there vote for it because they’d need at least six Democrats to join them. Lotsa luck there.

Yet I think the analysts and advocates I pity are right to not just shrug off the plan as a waste of their energies and time. Set aside, if we can, the upcoming elections.

When state flexibility funds, attacks on the ACA and other radical spending cuts resurface year after year, they become familiar in a way that doesn’t breed contempt. They gain a sort of tolerance — as negotiable perhaps or at least due the deference we generally accord debatable propositions.

Not saying all is right with all the programs the federal government funds. But the notion that it should leave the well-being of low-income and other disadvantaged Americans to the states they live in — and whatever those states can and choose to spend — seems to me fundamentally wrong.

This is not a notion that should cease to shock just because it’s teed up year after year, with new wrinkles and rhetorical flourishes.

All told, the House budget plan would cut spending on programs for low-income people by $3.5 trillion over the next 10 years — about 40% of what’s spent now or nearly one and a half times their share of non-defense spending.

And that should shock as much as the House Republican majority’s first budget plan — the ironically entitled Path to Prosperity — did.




Will DC Policymakers Subject Children to Brain-Damaging Toxic Stress?

March 21, 2016

The DC Fiscal Policy Institute is celebrating its fifteenth year as a lead advocacy organization for low-income District of Columbia residents — and an invaluable source of research and analysis for many other advocates, including yours truly.

It highlighted the occasion by putting yet another plank in a platform that it and like-minded allies have been building for well over a year. And now they hope we’ll join them.

The plank was a series of brief presentations on why District policymakers shouldn’t cut the “lifeline” for nearly 6,600 very poor families. “The biggest issue in DCFPI’s history,” said Executive Director Ed Lazere. One can understand why.

The families, as many of you know, have reached (or exceeded) the rigid 60-month time limit the District now sets for participation in its Temporary Assistance for Needy Families program.

Most of the parents are by no means ready to find — and keep — jobs that pay enough to support them and their children. Yet they could soon lose their only source of cash income, as well as other critical benefits and services.

You who follow this blog know I’ve learned quite a bit about TANF, the time limit and why it’s so wrong-headed, thanks in large measure to DCFPI and its parent organization, the Center on Budget and Policy Priorities.

The anniversary event nevertheless gave me a better understanding of some prospective harms to the 13,600 or so children in those at-risk families. They may, in fact, already be suffering those harms.

But policy changes can, to some extent, reverse the effects — this the hopeful code to an otherwise dismaying presentation by pediatrician and child health advocate Dr. Lee Savio Beers.

The harms are results of what medical experts call toxic stress — stress that causes physiological damages because it’s acute and experienced often or for long periods of time.

Not going to delve here into the various bodily reactions to stress — partly because they’re more various and complex than I understand. (Those of you who want to can find a technical explanation in this report by the American Academy of Pediatrics.)

Basically, I gather, a perceived challenge or threat triggers the release of certain hormones and other chemicals. When they keep surging, they affect the way our bodily systems work. We become more susceptible to a range of mental and physical illnesses, for example.

But toxic stress does other damages to children, especially in their early years because it affects the way the genes they’re born with shape the way their brains develop — and don’t.

On the one hand, the part of the brain that processes stress goes into a permanent hyperactive mode. On the other hand, portions of the brain that handle functions like thinking, learning and controlling emotions remain under-developed.

And if they don’t develop when they’re supposed to, they won’t. So there’s a limited window of opportunity to avert the effects of toxic stress. The key here is whether experiences that can trigger stress are “buffered” by nurturing attention from adults.

Conversely, abuse, even if only verbal or directed at another family member, and neglect, even if only inattention, trigger stress responses. If acute and/or prolonged, they’re toxic. Links to high levels of stress caregivers experience are obvious.

So toxic stress is communicable, though it’s technically not a disease. And relieving caregivers from conditions that stress them will protect children from it — and thus from becoming toxically-stressed parents themselves.

Lots of things can acutely stress parents, of course. But having no money or safety net benefits sufficient to compensate, as they generally aren’t, stresses any parent who’s sane and sober enough to have a child in her care.

So the District has these 6,600 or so families who’ll soon have no cash income, except what they can scrape together, plus SNAP (food stamp) benefits that rarely cover a full month’s worth of groceries and Medicaid, which will still leave the parents stuck for co-pays if they and/or their children need prescription drugs.

Many of those who aren’t already homeless soon will be, since fewer than a third live in subsidized housing (not counting housing subsidized by short-term vouchers, which will surely expire while the parents still can’t afford the full rent.)

A recently-published study that I (and many others) have referred to tells us how families get along on no more than $2 a day per person. Basically, they sell whatever they can — sex, for example, their plasma or, much as they don’t want to, their SNAP benefits.

They’re in “a constant, perpetual state of crisis,” says one of the coauthors. In other words, in a state that produces toxic stress in both parents and their children.

TANF, as another panelist said, offers states and the District a lot of choices. In the next few months, the Mayor and DC Council can choose to preserve a lifeline for many of the families now at risk — and others that will reach the current 60-month limit as time goes on.

Or they can choose to expose very poor children to more acute and prolonged toxic levels of stress, as well as the everyday hardships that fuel it and the long-term consequences of those.

As I’ve written before, a bill now pending in the Council would extend benefits beyond the time limit to families headed by parents who face unusually high barriers to work, plus some others — and to all children.

This wouldn’t only relieve impending toxic stress. It would relieve stress already caused by the benefits phase-out — a state of perpetual crisis, one assumes, since a mother and two children who could soon lose what remains of their benefits are already living on less than $2 a day.

Relief because the bill would restore the benefits families would have now if the District had granted them extensions from the get go. It wouldn’t altogether undo damages already done. But the relative security families would gain could lay the groundwork for reversals because the brain can modify its own structure, especially when children are young.

What’s needed now is the broadest possible expression of constituent support. Both individuals and organizations can sign a pledge endorsing the principles the bill reflects. I hope fellow District residents will seize this opportunity.



What Federal Policymakers Have Done and Can Do About Lead Poisoning … And What We Can Do to Prod Them

March 17, 2016

Picking up where I left off. As I said, the Flint water crisis in some ways unusual, in others not. Higher percents of young children have dangerously high blood lead levels in other poor communities for example.

And these are only children who’ve been tested — some unknown fraction. Not because the irreversible damages lead in the blood can cause have only recently been known. Not because the federal government has done nothing but compile data.

It hasn’t done all it can to protect children (and adults) from lead poisoning, however. In fact, some recent decisions have probably made matters worse.

Congress could partly undo the damage, without first resolving the conflicts holding up action on next year’s budget. And with or without Congress, the administration could increase protection for millions of low-income families.

What the Federal Government Has Done (and Not)

Lead was recognized as a health hazard a long time ago. The federal government seems to have become energized in the 1970s — hence the leaded-paint ban I mentioned, plus related provisions in the Toxic Substances Control Act and the Safe Water Drinking Act.

Federal rules have required blood lead level tests and followup care for young children in Medicaid since 1989 — rules never effectively enforced, however. Congress mandated the phase-out of lead in gasoline a year later, setting 1996 as the deadline.

Congress acted again in 1992, requiring the U.S. Department of Housing and Urban Development to issue rules protecting some tenants and homeowners against leaded paint hazards.

Both the first version and the latest, issued in 1999, apply to federally-assisted housing of various sorts built before 1978, including public housing and housing subsidized by Housing Choice (formerly Section 8) vouchers.

The rules, among many things, require “environmental intervention” when a single test finds 20 micrograms of lead per deciliter of blood in children under six. The intervention trigger is just a tad lower if multiple tests are conducted.

We’ve learned more about levels of lead in blood since then. Heeding the research, the Centers for Disease Control twice ratcheted down its high-risk threshold. It’s been 5 micrograms per deciliter since 2012.

But HUD’s standard remains the same. And the trigger for action, as you can see, is damage already done. Young children are like the canaries coal miners once used to alert them to hazardous gases — by keeling over.

Squeeze on Targeted Lead Poisoning Prevention Funds

You’ll recall perhaps that Congress capped spending on programs that depend on its annual choices about a year before CDC last cut its lead blood level threshold in half.

Two programs that help fund lead poisoning prevention have gotten whacked far more than the caps themselves required, as the Coalition on Human Needs reports. One is now worth 28.6% less in real dollars than the year before Congress set the caps. The other, focused specifically on children has lost 55.6%.

What will happen for the upcoming fiscal year is anybody’s guess, since neither the House nor Senate has even set spending targets for the subcommittees that develop program-specific budget proposals.

What Congress Could Do Now

Congress doesn’t have to wait until Republican leaders resolve conflicts and the subcommittees do their work. It could act swiftly to channel some money to Flint and other communities with lead in their water. Because others there are, though we don’t know how many.

A bill awaiting action in the Senate (how often do I have to write this?) would provide $170 million to support urgently needed water infrastructure improvements, plus $17.5 million to monitor lead exposure and alert the public if excessive levels are found.

An additional $30 million would supplement funding for three programs to help prevent toxic lead exposure, with a special focus on pregnant women, mothers and their children.

The money wouldn’t restore what the two I mentioned have lost since 2010. Nor the third, which funds health-related screenings as one of many services for low-income pregnant women, babies and their mothers.

But “Congress has a lot of catching up to do,” as CHN’s monthly report says. So one can hope — if one’s still capable of that these days — that more Senators will sign on to the bill and press Majority Leader Mitch McConnell for a vote.

Meanwhile, Democrats in both the House and Senate have introduced bills that would require HUD to use CDC’s blood lead level maximum as its trigger for intervention.

They would also require HUD to strengthen its risk assessment standards, which now permit just a look around the place and altogether exempt efficiency units, even if small children live there — or will.

And they’d require HUD to make it possible for a family with a young child in a subsidized housing unit to move immediately if a lead hazard is found — and the hazard has already put the child at high risk. Why HUD wouldn’t have to swift children with less lead in their blood to safety I don’t know.

HUD may have to update its rules anyway. The Shriver Center, the Health Justice Project at Loyola University Chicago and nearly 30 allies have filed a petition calling on the agency to do so. Their proposals generally resemble what the House and Senate bills mandate, but they spell it all out and add some pieces.

What We Can Do

Advocates have created opportunities for concerned individuals to support both the pending Senate bill and the rulemaking petition.

Those of you with Senators can fire off emails urging them to get on board with the bill and press for a vote. And everybody, even disenfranchised District of Columbia residents, can sign the petition to HUD.

You know that all the brouhaha about Flint and lead poisoned children will die down, as such things always do. Even friendly Congress members will turn their attention elsewhere. HUD will surely be distracted by agency leadership changes — no matter how the Presidential race nets out.

So we need to do what we can now to get as much done as feasibly can be done now.


Finding a Teachable Moment in the Flint Water Crisis

March 14, 2016

We’ve all read about the lead-laden water in Flint, Michigan. Flint is far from the only community where tests have found alarmingly high numbers of children with alarmingly high levels of lead in their blood. And water isn’t the only source — not even the most common.

Flint has prompted a spate of news reports and op-eds on toxic lead exposure, as you’ve probably noted. It’s also prompted federal-level initiatives to ramp up prevention. I’ll defer these to a separate post and deal here with the basics — many new to me and perhaps to some of you also.

Harms Excessive Lead Levels Do

When lead gets into our bodies, they distribute it to organs like our livers, kidneys and brains. They confuse it with essential nutrients and try to use it, instead of them to build and repair bones, muscles and brain connections.

Damages to young children are especially severe. This is partly because their bodies absorb relatively more lead. And it’s more likely to get into their bodies, especially if they live in homes where the paint on the walls and/or woodwork is still lead-based.

You know how babies are. They crawl around on the floor, which may have paint dust or flecks on it. They put their hands in their mouths. They chew on things — and can reach more things to chew on as they learn to toddle.

Those first few years are when the brain does much of its development work, making connections among cells at an extraordinarily high rate.

This, if I understand correctly, is why lead in the body then can result in a range of irreversible damages, e.g., learning disabilities, attention deficit disorder, difficulties coordinating so-called small motor actions like picking up something with a finger and a thumb.

For somewhat similar reasons, babies may be born with damaged brains if their mothers have lead in their systems — or dead because their mothers miscarry.

Flint Children Just the Tip of the Iceberg

In one respect, the Flint crisis is as particular as the decisions that led to it. In another, it’s one case among many that haven’t gotten the popular media attention they deserve. Nor the rush to remedy — even belatedly, as in Michigan.

New York Times columnist Nicholas Kristof cites two communities, a state and a large part of a second where tests have found higher percents of children with dangerously high levels of lead in their blood.

The Detroit News fills in with more communities in Michigan. A reporter, also for the Times, adds Cleveland and several other cities. Vox reports 18 in Pennsylvania where a higher percent of children tested in the danger range than in Flint.

All told, well over half a million young children have blood lead levels higher than the maximum the Centers for Disease Control uses for its risk analyses, according to the Center’s (somewhat dated) estimate.

Where the Lead Comes From

Flint isn’t the only community where corrosion in publicly-owned water pipes has released lead into tap water. Some fellow District of Columbia residents will recall our own lead-infused water crisis.

The most common sources of lead poisoning in children, however, are lead-based paint in their homes and soil that’s got flakes of lead-based exterior paint in it and/or deposits of lead that was in the exhaust emitted by cars and trucks before Congress mandated a gradual phase-out of leaded gasoline.

Not an Equal Opportunity Risk

Flint is an extraordinarily poor community, with a poverty rate of 40%, according to the latest Census survey. The rate soars to nearly 71% for children under five, the highest-risk age group. The community is also predominantly black — not unrelated, one assumes, to the poverty rates.

The poverty rate in Cleveland, also predominantly black, is barely lower — and the rate for children under five somewhat over 64%. More than 17% of the young children tested there (most weren’t) had blood lead levels over the CDC high-risk threshold. Recent tests found a 26.5% toxic rate in one poor part of the city.

CDC has found high blood lead levels in relatively more black children nationwide. It (indirectly) attributes this to older housing and poverty.

But it’s not the age of the house that matters. It’s whether the house was repainted since 1978, when a federal rule banned lead in house paint — and whether the new paint still completely masks the old, if it was. Whether it’s always masked the old matters too.

Fair to assume that poor families are more likely to live in poorly-maintained buildings — and in buildings closer to highways, bus terminals and the like, which were sources of lead that’s still in the soil.

What About Race in the Place

Experts interviewed by Cleveland Plain Dealer reporters attribute the persistent risks to racism. On the one hand, red-lining policies concentrated blacks in neighborhoods then neglected, they say.

On the other hand, evidence of lead poisoning in children was shrugged off or blamed on the kids and their parents. Sound familiar? That may be history now. But Cleveland’s failures to investigate and require remedies isn’t — and not only due to funding shortages, it seems.

Congressman Dan Kildee, who represents Flint, says that race was “the single greatest determinant” of what happened there, referring, it seems, to how the governor and his people discounted residents’ complaints.

Huffington Post reporters go further, citing the waste auto factories dumped into the Flint River as one, but not the only example of environmental racism. It’s nevertheless hard to pinpoint racism when poverty seems a factor too.

“It’s not just about black lives mattering,” says a sociologist who studies impoverished communities. “Poor people’s lives don’t matter.” The water crisis, he adds, “just made everybody notice” what had been going on for a long time.

Perhaps the crisis will prove “a teachable moment for America,” as a former CDC director says. A lot of lessons for state and local officials. Some for Congress and at least one federal agency too.

Of which more shortly.




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