Wednesday, November 4, 2015

Wednesday, November 4, 2015

Healthcare challenges ahead; Coming together on criminal justice reform; Middle aged white Americans dying at higher rates and; Safety net programs don’t cost too much

Healthcare challenges ahead
The Advocate’s editorial board is warning both candidates for governor that whoever wins Louisiana’s top job in November will inherit a Medicaid and health care mess. Medicaid costs for long term care provided in nursing homes are going up, and Gov. Bobby Jindal’s public private partnership scheme to replace the charity hospital system is under-financed:


Whatever way you slice it, we’ve got a to-do list of three items for the new governor and Legislature in January. One is that the costs of operating the public hospitals isn’t sufficiently covered in the state budget. Who is surprised, given the Jindal record? Another is that we’ve tried to limit costs by using a combination of public hospitals and among the lowest Medicaid income standards in the country. The privatized hospital contracts are under strain because a huge number of our citizens are working at low-wage jobs without insurance, hurting the workforce and individuals in pain. And we’ve refused as a state to take advantage of higher reimbursements if we raise the income standards under the Affordable Care Act. Finally, we might be able to better control costs by imposing stricter “managed care” requirements on providers, but the political pushback on that is going to be substantial for a new administration in office. It’s a mess that Democrat John Bel Edwards or Republican David Vitter will inherit.


Coming together on criminal justice reform

In a letter to Times-Picayune, LBP Board Chair Matt Bailey looks at the possibilities for criminal justice reform and says momentum is building across political lines for reducing Louisiana’s shameful incarceration rate. He points to a summit being held in New Orleans sponsored by the conservative Koch organization that features a diverse list of participants, including the Democratic governor of Delaware and the Republican governor of Arkansas.

Despite the cynicism of today’s politics, criminal justice reform is ripe for collaboration and progress. In the last Louisiana legislative session, Rep. Walt Leger’s bill establishing a task force to study incarceration reduction passed almost unanimously. The stakeholders appointed to the task force will review criminal justice data and suggest strategies to reduce the prison population and recidivism. Such smart reforms will enable nonviolent offenders to transition back to productive citizenship more quickly. Louisiana’s business community has likewise realized the importance of reform. Smart on Crime Louisiana, supported by the Committee of 100 and others, is a campaign working to emphasize rehabilitation over long jail sentences. As the initiative indicates, sensible reforms would not only save taxpayer dollars but also would strengthen families and communities. Despite the good news, questions remain for those attending the summit and others concerned about criminal justice reform. Will our politics support or hinder the reform efforts that enjoy support by conservatives and progressives alike?


Middle aged white Americans dying at higher rates

Poorly-educated, middle-aged white Americans are dying at an alarmingly high rate, according to a new study by a pair of Princeton economists. The culprit isn’t heart disease or diabetes, but rather is driven by suicide, alcoholic liver disease and overdoses of heroin and prescription opioids. Gina Kolata of the New York Times has more:


The people who are, slowly or quickly, killing themselves are the people who thought, in the 60s and 70s, that if they did what their parents did they too would get job security, pensions, and a decent lifestyle. They concluded that taken together, suicides, drugs and alcohol explained the overall increase in deaths. The effect was largely confined to people with a high school education or less. In that group, death rates rose by 22 percent while they actually fell for those with a college education. It is not clear why only middle-aged whites had such a rise in their mortality rates. Dr. Meara and Dr. Skinner, in their commentary, considered a variety of explanations — including a pronounced racial difference in the prescription of opioid drugs and their misuse, and a more pessimistic outlook among whites about their financial futures — but say they cannot fully account for the effect.


Safety net programs don’t cost too much
Testifying to the House Ways and Means Committee, Center on Budget and Policy Priorities  President Robert Greenstein said the cost of safety-net programs are not the cause of America’s budget problems:


Some policymakers, pundits, and others assume that means-tested programs in general are expanding rapidly and exploding in cost.  Budget data from the Congressional Budget Office (CBO) show that this is not the case; a very different picture emerges once one looks at means-tested programs outside health care. Total federal spending for programs outside health care that are focused on people with low or modest incomes (hereafter referred to as “low-income programs”) peaked at 2.9 percent of gross domestic product (GDP) in 2010 but has declined as a share of GDP since then and continues to do so.  It stood at 2.3 percent of GDP in 2015.  And, of particular note, it is projected to decline to 1.9 percent of GDP in 2020 and 1.7 percent of GDP in 2025 — levels that are significantly below the average for the past 40 years…Similarly, if we look at spending on low-income programs as a share of the budget, federal expenditures for low-income programs outside health care averaged 11.2 percent of federal non-interest spending over the four decades from 1975-2014, and climbed to 13 percent of spending in 2010.  But these costs are slated to fall to 10.4 percent of the budget in 2020 and 9.0 percent in 2025 — well below their average share over the past 40 years, and in fact, the lowest share since 1970.


Number of the Day
134 – Increase in the mortality rate per 100,000 people for whites 45 to 54 years old with no more than a high school education from 1999 to 2014. (Source: The New York Times)