Author Archives: afscme

Flurry of Laws Enacted on Women’s Access to Health Care

Source: Christine Vestal, Stateline, July 24, 2017

As Washington moved to reduce federal funding for women’s health this year, adversaries in the war over affordable birth control and other women’s health services shifted the battleground to state capitals — resulting in a spate of new laws that both expand and contract women’s access to care.

It happened quickly in Iowa. In May, then-Gov. Terry Branstad, a Republican, signed a bill defunding Planned Parenthood. Medicaid dollars stopped flowing to the group July 1, and four of the state’s Planned Parenthood clinics closed within a week.

That left nearly 15,000 women in small communities without access to reproductive health services, including cancer screenings, birth control, testing for and treatment of sexually transmitted diseases, and annual checkups. ….

….In December, President Barack Obama signed a Health and Human Services rule clarifying that states could not block funding to health care providers for purely political reasons. But that policy was quickly reversed when Trump took office…..

…..At the same time, Republicans in Congress repeatedly have called for elimination of the roughly $300 million federal grant program known as Title X that funds Planned Parenthood and other local family planning clinics.

And in May, a leaked Health and Human Services proposal revealed that the Trump administration intends to undo a provision in the federal health law that requires nearly all employers to include coverage of all forms of contraception in their employee health plans. If the proposal takes effect, it would make it easy for employers to opt out of coverage of contraception for religious or moral reasons…..

For U.S. State And Local Governments, The Resilient But Shallow Expansion Complicates Budget Management

Source: S&P Global Ratings, Credit Conditions, July 24, 2017
(subscription required)

When it comes to the outlook for economic growth, U.S. state and local governments can expect the now long but shallow expansion to persist, according to S&P Global Ratings’ updated forecast. Considering GDP, the broadest measure, the pace of the expansion is likely to remain subdued, with growth of 2.2% in 2017 and 2.3% in 2018. On a more positive note, the estimated probability of a recession within the next 12 months was lowered in the forecast to 15% to 20% from 20% to 25%. The adjustment reflects that the risk of a federal policy mishap appears to have receded a bit. Putting it all together: the forecast suggests that a relatively benign if somewhat uninspired economic backdrop is taking shape for fiscal year 2018, which began on July 1 for most local governments and 46 states.

Various measures of economic sentiment, such as business confidence, that were decidedly upbeat after the 2016 presidential election, have begun falling into alignment with the “hard” data indicators. And with unemployment at a low 4.4%, state and local governments can expect the monthly pace of job creation to slow. The economic forecast no longer assumes Congress and the administration will enact a public infrastructure-spending bill. Without the potential bump in growth from a federal infrastructure package, the forecast for 2017 GDP growth was lowered to 2.2% from 2.3%. Crucially for the municipal sector, we continue to expect solutions to the problem of deferred maintenance and inadequate capacity in public infrastructure will depend heavily on strategies developed at the state and local government levels.

Overview:

  • Economic growth, as measured by real GDP, will increase at a subdued 2.2% in 2017 and 2.3% in 2018;
  • The risk of a recession within the next 12 months has fallen to 15% to 20% from 20% to 25%;
  • There will be no federally funded public infrastructure package this year or next;
  • and The Mountain region will have the fastest growing economy while the Mid-Atlantic will be slowest.
  • H.R. 1628, Better Care Reconciliation Act of 2017

    Source: Congressional Budget Office, Cost Estimate, July 26, 2017

    From the summary:
    Selected provisions of an amendment in the nature of a substitute (ERN17500), as requested by the Democratic staff of the Senate Committee on Finance and the Senate Committee on Health, Education, Labor, and Pensions hr1628selectedprovisions.pdf View Document 107.21 KB Summary Three tables: Table 1. Estimate of the direct spending and revenue effects of selected provisions from H.R. 1628 Table 2. Estimate of the net budgetary effects of the insurance coverage provisions of selected provisions from H.R. 1628 Table 3. Effects of selected provisions from H.R. 1628 on health insurance coverage for people under age 65

    Related:
    H.R. 1628, American Health Care Act of 2017
    Source: Congressional Budget Office, Cost Estimate, June 26, 2017

    The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have completed an estimate of the direct spending and revenue effects of the Better Care Reconciliation Act of 2017, a Senate amendment in the nature of a substitute to H.R. 1628. CBO and JCT estimate that enacting this legislation would reduce the cumulative federal deficit over the 2017-2026 period by $321 billion. That amount is $202 billion more than the estimated net savings for the version of H.R. 1628 that was passed by the House of Representatives. The Senate bill would increase the number of people who are uninsured by 22 million in 2026 relative to the number under current law, slightly fewer than the increase in the number of uninsured estimated for the House-passed legislation. By 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law. Following the overview, this document provides details about the major provisions of this legislation, the estimated costs to the federal government, the basis for the estimate, and other related information, including a comparison with CBO’s estimate for the House passed act.

    H.R. 1628: The American Health Care Act (AHCA)
    Source: Annie L. Mach, Congressional Research Service, CRS Report, R44785, May 4, 2017

    ….This report contains three tables that, together, provide an overview of all the AHCA provisions. Table 1 includes provisions that apply to the private health insurance market, Table 2 includes provisions that affect the Medicaid program, and Table 3 includes provisions related to public health and taxes. Each table contains a column identifying whether the AHCA provision is related to an ACA provision (e.g., whether it repeals an ACA-related provision). In addition to the three tables, the report includes more detailed summaries of each AHCA provision, and two graphics showing the effective dates of AHCA provisions. Figure 1 covers AHCA provisions related to the private health insurance market, public health, and taxes. Figure 2 covers AHCA provisions related to the Medicaid program…..

    H.R. 1628, American Health Care Act of 2017
    Source: Congressional Budget Office, Cost Estimate, May 24, 2017

    From the summary:
    CBO and the staff of the Joint Committee on Taxation (JCT) estimate that enacting the legislation—which would repeal or modify many provisions of the Affordable Care Act—would reduce federal deficits by $119 billion over the coming decade.

    CBO and JCT estimate that in 2018, 14 million more people would be uninsured under the legislation than under current law. After additional changes to subsidies for insurance purchased in the nongroup market and to the Medicaid program took effect, the increase in the number of uninsured people would rise to 19 million in 2020 and then to 23 million in 2026.

    The gig economy is nothing new – it was standard practice in the 18th century

    Source: Tawny Paul, The Conversation, July 18, 2017

    ….. While it might seem that long-established ways of working are being disrupted, history shows us that the one person, one career model is a relatively recent phenomenon. Prior to industrialisation in the 19th century, most people worked multiple jobs to piece together a living. Looking to the past uncovers some of the challenges, benefits and consequences of a gig economy. ….

    Capping Medicaid: How Per Capita Caps Would Affect Long-Term Services & Supports and Home Care Jobs

    Source: LeadingAge and Community Catalyst – Center for Consumer Engagement in Health Innovation, June 2017

    The American Health Care Act (AHCA) – passed by House Republicans in May, and currently under consideration in the Senate – would dramatically change Medicaid’s financing structure. Currently, Medicaid operates as a federal-state partnership where each pays a percentage of Medicaid’s costs and federal financial support increases with need. Under the per capita cap system proposed in the AHCA, the federal government would provide states with an aggregate amount of funding based on the number and category of eligible beneficiaries in the state, with nominal differences in the amount per beneficiary category. The proposed per capita cap system would adjust for overall population growth, but would not account for other relevant factors affecting Medicaid expenditures, such as changes in health care needs or costs. The Congressional Budget Office estimates that this change in the financing structure along with other changes proposed in the AHCA would cut $834 billion from the Medicaid program. States would likely have to account for the decreased funding by cutting benefits, cutting payments to providers, changing eligibility requirements, and/or adding to program waiting lists.

    A per capita cap system would have serious implications for people receiving long-term services and supports (LTSS) – including millions of older adults with functional and cognitive impairments. LTSS include a range of typically non-medical services designed to help individuals perform activities of daily living such as bathing, dressing and eating. Medicaid is the primary payer for LTSS so reductions in Medicaid funds would have serious consequences for people receiving LTSS.

    States provide LTSS both in the community and in institutional settings. Per capita caps would cause a shift away from home and community based services (HCBS) toward institutional care such as nursing homes. This is because providing LTSS services through HCBS is optional under Medicaid rules while institutional care is mandatory. HCBS varies by state but generally includes home health services and other services such as adult day care.

    This brief provides information on some of the factors that would affect states’ abilities to provide LTSS in a per capita cap system. Additionally, we look at a portion of the labor force that provides LTSS – home health aides and personal care aides specifically – and predict that across the United States, between 305,000 and 713,000 home health aides and personal care aides would lose their jobs if the proposed per capita cap system in the AHCA were to be implemented.

    How a job acquires a gender (and less authority if it’s female)

    Source: Sarah Thebaud, Laura Doering, The Conversation, July 23, 2017

    ….When men direct others, they’re often assumed to be assertive and competent. But when women direct others, they’re often disliked and labeled abrasive or bossy.

    Our new study puts a twist on this narrative. Gender bias doesn’t merely disadvantage women, it also can disadvantage men. The reason? We don’t just stereotype men and women. We stereotype jobs. ….
    Related:
    The Effects of Gendered Occupational Roles on Men’s and Women’s Workplace Authority: Evidence from Microfinance
    Laura Doering, Sarah Thébaud, American Sociological Review, Volume 82, Issue 3, June 2017
    (subscription required)

    From the abstract:
    The gendering of occupational roles affects a variety of outcomes for workers and organizations. We examine how the gender of an initial role occupant influences the authority enjoyed by individuals who subsequently fill that role. We use data from a microfinance bank in Central America to examine how working initially with a male or female loan manager shapes borrowers’ compliance with future managers’ directives. First, we show that borrowers originally paired with female managers continue to be less compliant with subsequent managers, regardless of subsequent managers’ gender. Next, we demonstrate how compliance is shaped by the gender-typing of the role and the gender of the individual who fills that role. We find that men enjoy significantly greater compliance in male-typed roles, but male and female managers experience similar levels of compliance in female-typed roles. Further analyses reveal that these gendered patterns become especially pronounced after managers demonstrate their authority by disciplining borrowers. Overall, we show how quickly gendered expectations become inscribed into occupational roles, and we identify their lasting organizational consequences. More broadly, we suggest authority mechanisms that may contribute to the “stalled” gender revolution in the workplace.

    Public university sector mostly stable, but with pockets of stress

    Source: Moody’s, Sector In-Depth, July 17, 2017
    (subscription required)

    Public colleges and universities continue to demonstrate overall financial stability with steady enrollment, solid cash flow margins and retained financial flexibility, according to our fiscal 2016 sector medians. However, heading into 2018, revenue and expense pressures will emerge, pressuring performance for some. The challenges will mostly affect some moderate and small universities lacking the revenue diversity and brand strength of large research, or comprehensive, universities…..

    Rating changes for the 50 states from 1970

    Source: Moody’s, Sector Comment, July 21, 2017
    (subscription required)

    This report is part of a series that identifies changes in state general obligation (GO) and issuer ratings and outlooks. The report is produced on a quarterly basis with the last publication in April 2017.

    We maintain GO or equivalent issuer ratings for 48 states. Stable outlooks apply to 41 states, one has a positive outlook, and seven states have negative outlooks. Outlooks are maintained on some states that do not have GO or issuer ratings but do have ratings on other types of state debt. The data included in this report reflect rating changes by state by year, a list of all state GO or issuer ratings by category and a list of all state outlooks…..

    State and Local Pension Plans Funding Sputters in FY 2016

    Source: Jean-Pierre Aubry, Caroline V. Crawford, and Alicia H. Munnell, Center for State and Local Government Excellence, July 2017

    From the summary:
    SLGE’s annual update on the funded status of state and local pension plans outlines the challenging path that plans have been on, especially since 2009.

    Key findings:
    • Overall, public pensions are in a better position than they were immediately following the recent economic downturn;
    • The ratio of assets to liabilities for the 170 plans in the Public Plans Database decreased from 73 percent in 2015 to 72 percent in 2016, as measured by the traditional GASB standard; and from 73 percent to 68 percent, as measured by the new standard;
    • These plans, which account for the vast majority of the members and assets of state and local pension plans, have been paying more of their required contributions (92 percent) relative to recent years;
    • Payments as a percentage of payroll have increased to 18.6 percent;
    • Plans in the PPD have continued to adjust their annual investment return assumptions downward to an average of 7.6 percent in FY 2016;
    • In order to return the aggregate funded ratio above 80 percent, plan sponsors will need to increase their contribution efforts and investment returns must consistently meet or exceed expectations over a sustained, longer term.

    Comparing the Voting Electorate in 2012-2016 and Predicting 2018 Drop-off: How the Electorate has Changed Over the Years and How that Informs the 2018 Cycle

    Source: Celinda Lake and Joshua E. Ulibarri, Voter Participation Center, July 20, 2017

    As part of our ongoing efforts to understand the voting patterns of the Rising American Electorate, we’ve worked with Lake Research Partners to produce this report, which catalogues the changes in voting turnout for the Rising American Electorate between 2012 and 2016 – and makes projections for voter drop-off in 2018.

    The projections are sobering and troubling to everyone who cares about increasing participation in our great democracy. Our prediction is that 40 million Americans who voted in 2016 won’t cast a ballot in the 2018 midterms — and to make matters worse, 2/3 of those drop-off voters will be members of the Rising American Electorate. The RAE dropoff is projected to be particularly pronounced in key 2018 battleground states, such as Arizona, Nevada, Florida, and Ohio …..

    …. Add in the effects of ongoing vote suppression efforts and the implication is clear: Democracy is facing a headwind in 2018. We need to double down on voter registration, mobilization and turnout efforts, and fighting for voting rights in order to make sure that every American has the opportunity to raise their voice at the ballot box. ….