New Resources on the Recession’s Impact on Health Care

The recession has forced more than 7 million people out of jobs, and millions more are now under-employed. Many of those workers and their families have lost their health insurance, and others who still work full time have also seen their health care benefits eliminated or cut back.

In May and June of this year, the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured sent a team of researchers to four American cities, including Beloit, to learn more about the effect of the recession on health care coverage and health itself. In each community they interviewed employers and safety net providers, and also conducted focus groups with people who had lost their jobs.

Based on those focus groups and interviews, Kaiser prepared a new report, “Rising Health Pressures in an Economic Recession.” It is accompanied by a 9-minute video, “On the Edge: Health Care in the Recession,” which is a powerful statement about the severe strains on the health care system and on the recently unemployed as a consequence of the recession.

Four key findings emerged from the study:
• The recession highlights wide gaps in the nation’s health care system.
• The uninsured and under-insured delay and forgo important health care due to cost.
• More and better efforts are needed to connect families with assistance programs.
• The safety-net is critical but cannot fill the coverage gaps.

The video could help enrich community discussions on health reform. The section about Beloit emphasizes the dramatic increase in uncompensated care being provided and the degree to which people affected by the recession are putting off needed health care until problems become severe. Both of these trends contribute to the skyrocketing cost of health insurance premiums. This underscores the importance of maintaining Wisconsin’s excellent and cost-effective health care safety net, and the need to promote outreach activities geared to families who are newly eligible for health coverage through BadgerCare Plus but may not know that they qualify or how to apply.

To obtain a copy of the DVD, contact Robin Sidel of the Kaiser Family Foundation communications staff.

Federal Law Offers Opportunities to Improve BadgerCare Plus

A top priority of President Obama and Congress this year was extending and improving the Children’s Health Insurance Program (CHIP). That legislation was approved in early February, and the President promptly signed the CHIP Reauthorization Act (CHIPRA).

The new law gives states increased funding and new policy options that should enable Wisconsin not only to protect the BadgerCare Plus program, but also to move even closer to the goal of making quality health care accessible to all children in the state.

One promising aspect of CHIPRA is the performance bonus funding for states that make policy improvements and have had large enrollment increases among lower income children, whose coverage is financed with Medicaid funds rather than CHIP funding. Wisconsin could potentially get several million dollars of bonus funding in the 2009-11 biennium, but needs to meet 5 of 8 standards for improving enrollment and retention of eligible children, and the state doesn’t currently meet 5 standards.

WCCF has prepared a policy brief that summarizes the standards for getting bonus funding, as well as many of the other significant opportunities created by CHIPRA. It describes the status of those options in Wisconsin and identifies questions that need to be answered before firm decisions can be made about some of the options.

In many issue areas, the states need guidance from federal officials about how the CHIPRA options and bonus funding standards are going to be interpreted. As we learn more about the law’s interpretation and the state’s implementation plans, we will keep updating this document. With that in mind, we would love to hear other opinions about the pros and cons of the various CHIPRA options. After you've reviewed our policy brief, please share with us your comments and suggestions. (Send to jpeacock@wccf.org.)

Gallup Reports Sharp Increase in Uninsured Wisconsin Adults

Survey data released by Gallup yesterday highlight the importance of health care reform. Gallup reported an increase in the number of uninsured adults nationwide from 14.8% in 2008 to 16.2% in the first six months of 2009.

According to the Gallup figures, Wisconsin is still doing considerably better than the national average, but not as much better as I would have expected. The Gallup survey, which interviewed almost 4,000 Wisconsin residents in the first half of this year, found that the percentage of uninsured adults in our state grew from 10.9% in 2008 to 12.6% in 2009. Wisconsin has the 12th lowest percent of uninsured adults in 2009, which is about the same as last year (when WI was tied for 11th lowest).

The relative ranking is somewhat surprising and disappointing because the most current Census Bureau data (for 2006 and 2007) showed Wisconsin to have the third lowest number of uninsured residents during that 2-year period. Also, the implementation of BadgerCare Plus in 2008 significantly improved coverage for children and also for low-income parents.

It’s possible that Wisconsin’s much lower rank in the 2008 and 2009 Gallup data (compared to the earlier Census ranking) is a reflection of the sharp drop in employer-sponsored insurance in our state since 2007. However, we don’t have comparable Gallup data from 2007, and it could be that the difference between the older Census data and the more current Gallup data is a function of significant variations in the surveys. In contrast to the Census Bureau survey, Gallup focuses just on adult coverage, and it asks about point-in-time coverage (whereas the Census reports on people uninsured for a full year). Also, I suspect that Gallup asks fewer questions about whether people have public coverage (which sometimes takes multiple questions to ascertain).

New Census Bureau data for 2008 will come out on September 10. I’ve been hoping it would show that despite the recession, the total number of uninsured Wisconsin residents held fairly steady in 2008 and the number of uninsured children declined. The Gallup findings make me less optimistic about the news we will get next month.

The Gallup figures make me particularly concerned about what the Census Bureau will report for Wisconsin’s rate of uninsurance in September 2010 (for 2009 coverage). But in the meantime, the Gallup data show that even in a state like Wisconsin with relatively strong safety net programs, the recession has eroded coverage and policymakers need to redouble their efforts to make insurance accessible for everyone.

No Surprise Here - Putting Delinquents Together Can Make it Worse

Time Magazine recently published an article called Bad Crowd: Why Juvenile Detention Makes Teens Worse which takes note of a recent longitudinal study of 779 Montreal youth that adds to previous findings indicating thatinteraction between juvenile offenders often increases the odds of future offenses. The study, Iatrogenic Effect of Juvenile Justice, found that juveniles sentenced to a juvenile prison were 37 times more likely to be arrested as adults, while juveniles placed on probation, where they may interact with other offenders in group counseling or in probation officer’s waiting rooms, are 14 times more likely to be arrested as adults compared to similarly behaving juveniles that do not enter the juvenile justice system.

Taken together, these studies suggest a need for careful assessment of youthful offenders, high levels of supervision and low juvenile-to-staff ratios when juvenile offenders are placed in groups, and using highly structured programs when working with groups. Family therapy and one-on-one counseling are also recommended to prevent juveniles from interaction with other juveniles. We know more and more about what works with youthful offenders – and what doesn’t!

Conservatives Join the Debate about Life Without Parole for Juvenile Offenders

One of the emerging controversies in the juvenile justice world is whether juvenile offenders, perhaps as young as 13, should be sentenced to life without parole in adult court. As noted in a previous posting - May 13 - the Supreme Court is set to take on two such cases, challenging the appropriateness of essentially sentencing such young offenders to "die in prison." One of the major issues at hand will be whether the brain development research that helped support a ban on the imposition of the death penalty for young offenders in the Roper case should be applied to an unreviewable sentence of life in prison. The Heritage Foundation, a conservative think-tank, has taken on this issue by releasing a report titled Adult Time for Adult Crimes: Life Without Parole for Juvenile Killers and Violent Teens, in which they attempt to counter the arguments of advocates who are pushing for at least some kind of opportunity for review of such "life without parole" decisions. With the Supreme Court taking up these cases in the fall, advocates on both sides will be gearing up for this debate.

State Property Values Fall

A Wisconsin Department of Revenue report released on Friday shows that total property values in Wisconsin fell about 0.5 percent between January 1, 2008 and January 1, 2009. According to the department’s historical data, the $2.5 billion reduction is only the second decrease in total property values statewide in the last 50 years.

The value of residential property fell by 1.3 percent. A DOR press release notes that its figures are “in line with estimates from the Federal Housing Finance Agency (FHFA), which reported that Wisconsin's existing home values were nearly stable from 1st quarter 2008 to 1st quarter 2009, declining only 0.9%.” The department contrasted that Wisconsin figure with the trend in valuations nationally, which it says “dropped by an average of 7.1%.”

Manufacturing property also dropped by 1.3 percent, but the value of agricultural property grew by 1.6 percent, or $36 million, and commercial property grew by almost $2.2 billion, or 2.4 percent.

DOR also released a report on net new construction. On a statewide basis, new construction increased property values by a net of more than $6.6 billion, or 1.3 percent, but that increase was more than offset by declining property valuations.

Among Wisconsin’s 29 largest cities, Milwaukee had the largest percentage decline in property values – almost 3.1 percent – which represents a loss in property tax base of nearly $1 billion. The largest county declines were in the two counties across the river from the Twin Cities: 5.9 percent in Pierce County and 5.4 percent in St. Croix County. On the other side of the state, Milwaukee County property values declined by 2 percent, but Manitowoc County had a 4.6 percent increase.

The differences between various communities highlight the importance of the state’s equalization aid formulas. Unfortunately, much of the equalization aid has been frozen for many years or cut, which hinders the ability of those formulas to help cushion revenue losses in the communities that have been the hardest hit.

New Strategies for Improving Foster Parent Recruitment and Retention

On Wednesday, the WI Department of Children and Families (DCF) announced the release of a new strategic plan for improving recruitment and retention of foster parents in Milwaukee County. DCF enlisted the aid of the Utah Foster Care Foundation in preparing the plan. DCF undertook the project as part of a public-private partnership with the Milwaukee-based Child Welfare Philanthropy Group, which provided the resources for the research that went into developing the strategic plan. The Recruitment and Retention Plan for Milwaukee County outlines several strategies for boosting recruitment and retention efforts, including recruiting foster and adoptive parents simultaneously, increasing foster parent payment rates, and public relations efforts aimed at improving the public perception of foster care and adoption.

The release of the plan coincides with publication in the Milwaukee Journal Sentinel of an article highlighting some of the shortcomings found by the Utah-based researchers in the performance of the Children's Service Society of Wisconsin, an agency contracted to work with foster families across the state. The article highlights a number of areas in which the agency needs to improve, starting with the fact that foster parents in Milwaukee County "do not feel valued, supported or appreciated" by the agency. The article does point out that some of the problems identified are already being addressed, and notes that the agency is doing some things well. Problems identified range from insensitivity to race and poverty to inadequate training for foster parents to computer system inadequacies.

Social and Economic Benefits of Lead Hazard Control

What if for every dollar you invested, you could be guaranteed a return of between $17 and $221 dollars? Even in financially strapped times, you’d come up with the cash, right?

Well, a new cost-benefit analysis by the Economic Policy Institute estimates that by eliminating lead exposure to young children, we could save a bundle through reduced health care costs, reduced criminal activity, increased IQ, higher lifetime earnings, increased tax revenue and less spending on special education.

Laws eliminating lead from gasoline, food, beverage cans and new house paint, among other things, have substantially reduced young children's exposure to lead. Local health initiatives and lead abatement efforts have also helped reduce lead exposure. However, lead poisoning is still a threat to many children in Wisconsin. Low-income children and children of color are particularly at risk, as they are more likely to live in older housing that contains lead-based paint. This significant inequity contributes to disparities in health and developmental outcomes based on race and economic status.

Lead poisoning is entirely preventable. Lead has no known value to the human body. Research indicates that even at very low levels there is significant brain damage to children who are exposed. Most children who are lead poisoned are exposed in their own homes from ingesting lead paint dust. Eliminating lead exposure in children’s homes makes the most sense and provides a sizable return on the investment.

You can learn more about who is lead poisoned in Wisconsin from Lead-Safe Wisconsin or the Annie E. Casey Foundation's Kids Count Data Center.

Update on Federal Early Learning Initiatives

WCCF has put together a summary of key federal early learning initiatives being deliberated in the Congress. With President Obama’s strong interest in early learning, the proposals on the table offer excellent opportunities for Wisconsin if they pass. The proposals include: the Early Learning Challenge Fund Home Visiting proposal Head Start and Early Head Start, Child Care and Development Block Grant, and Title I Pre-Kindergarten Incentive Fund. The summary describes the proposals, indicates progress in Congress, and explains the implications for Wisconsin. Our op-ed about this stuff, particularly the Early Learning Challenge Fund, has appeared or is about to appear in a few newspapers around the state, including this version in the Green Bay Press Gazette.