A&O Network Blog

May 21, 2013

Today, 27 percent of New Mexico’s families are living in “asset poverty,” which means they don't have the savings necessary to live at the poverty level for three months if they lost their income. The nonprofit organization Community Action Agency of Southern NM is working to end poverty through strategies that develop assets. It has been demonstrated that families achieve greater economic security when they are able to turn cash into a solid future. Over the course of the next several months, national leaders will come together with local leaders in New Mexico and imagine a new future--a future that opens the door to economic security in all communities.

A series of Think Tank discussions started by the NM Assets Consortium lead agency Prosperity Works was held Spring 2013 in Albuquerque, New Mexico. Representatives from CAASNM, Opportunity to Assets, First Nations Development Institute, New Mexico in Depth, The Aspen Institute, and New Mexico Educators Federal Credit Union are among the national and community leaders who took part in the recent discussion on ‘Accessible, Affordable, and Applicable Financial Products’ that just took place on May 16th- 17th.

Prosperity Works President and CEO, Ona Porter, commented, “Designing a system that provides avenues for savings over the life span is essential to the economic security of New Mexico’s households.” Porter adds, “We’re bringing in leaders and scholars from around the nation to offer insight on ending poverty in New Mexico, we hope to learn from their experience. Not to replicate their models but to create opportunities applicable for our state.”

Rodolfo Acosta, CAASNM’s Asset Development Director, explains one of CAASNM’s programs: “Individual Development Accounts (IDAs) introduce unbanked and underbanked low-income individuals to the main financial mainstream while providing them with access to conventional financial products that eliminate their reliance on predatory loans. IDAs are perceived as low-risk instruments whose benefits outweigh their costs and thus encourage low-income individuals to build long-term savings and achieve financial stability.” CAASNM has successfully managed IDA’s for the past 6 years and helped 156 families build their assets through this high-impact program.*

Learn more at www.caasnm.org , or www.facebook.com/CAAsouthernNM

About CAASNM

Community Action Agency of Southern New Mexico (CAASNM) is a 501 c(3) non-profit serving the communities of southern New Mexico. Since 1965, CAASNM has helped low income individuals build a better future for themselves and their families through high-impact programs that build self-reliance. Ongoing services include asset development, computer literacy, tax preparation, childcare nutrition services, benefits screening, and state medical insurance enrollment.

Contact person(s): Rodolfo Acosta

Phone Number: 575-527-8799 Ext. 136

Ohio legislators have taken Medicaid expansion out of the budget, but keep talking about it. That’s good, because expanding Medicaid would be good for Ohio and good for Ohioans. In this issue brief, we look at studies of Medicaid quality.

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Medicaid helps Ohioans gain access to doctors

A national study found uninsured people have much greater difficulty gaining access to needed care than those with Medicaid.[1] The 2008 Ohio family health survey found that in Ohio, uninsured people were three times as likely to report lack of needed care than those with Medicaid coverage; the same share reported delays in obtaining the care they needed. [2]

Preventive care can improve lives

Medicaid provides access to preventive and regular care, which reduces suffering and death rates of chronic illness. Not only can screenings and precautionary steps often prevent onset of disease (e.g., breast cancer, diabetes, and cardiovascular disease) but early diagnosis and treatment can significantly increase chances of leading a healthy and productive life. A study of Medicaid patients found expansions of Medicaid eligibility in three states were associated with a significant decrease in mortality during a 5-year follow-up period, as compared with neighboring states without Medicaid expansions. Mortality reductions were greatest among adults between the ages of 35 and 64 years, minorities, and residents of poor counties.[3] The estimated decrease in mortality was 6.1 percent.[4]

Preventive care is long term, but provides short-term benefits too

A recent, limited study of Oregon’s expansion of Medicaid coverage sheds light on the potential beneficial effects of Medicaid expansion, particularly with mental illness. Even on a short-term (two-year) basis, access to Medicaid was found to increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.[5] These benefits occurred with no negative effects, such as increases in emergency-room use.

Ohio Medicaid gets high marks

The relative strength of Ohio’s program is shown by a 50-state study released in early May 2013. The report compared the quality of hospital care between patients with Medicaid and those with private insurance by studying three medical conditions. While it found substantial variation in Medicaid outcomes across the states, the report found only small overall differences between Medicaid and private pay. For Ohio, the study found no difference between Medicaid and private pay for two conditions and only a 1 percentage point difference for the third. The study found that Ohio’s scores were always above the national Medicaid average.[6]

Medicaid expansion offers public health benefits

The public health benefits of expanded Medicaid translate directly to public safety and security. Access to care reduces the spread of disease by providing a cure or reducing infectiousness. For example, continuous and comprehensive treatment of HIV not only improves the health of the individual, but also reduces the likelihood of transmitting the virus by 96 percent.[7]

Medicaid expansion protects health care access in rural areas

The federal Affordable Care Act incrementally reduces federal payments to hospitals (known as disproportionate share hospital funds, or DSH), anticipating that increased access to both Medicaid and private insurance will reduce the amount of uncompensated care that hospitals provide.[8] Thus, hospitals in states with limited Medicaid coverage will face severe deficits as they continue to treat a high volume of uninsured patients. Without federal reimbursements for this care, hospitals will pass costs onto covered private-insurance patients; small hospitals (e.g., in rural areas) will not be able to offset these costs, and may be forced to close, leaving entire communities without access to care.[9] According to a new rule governing the funding of DSH published by the Center for Medicare and Medicaid, our state’s safety net hospitals could face more than $23.4 million in cuts in 2014 to DSH funds. The cuts will grow deeper in the years that follow; by 2018, DSH cuts will total 40 percent nationally.[10]

Resources

[1] Nakela Cook et al. “Access to Specialty Care and Medical Care Services in Community Health Centers.” Health Affairs. Volume 26, no 5 (2007): 1459-1468 http://content.healthaffairs.org/content/26/5/1459/T2.large.jpg.

[2] William Hayes, Testimony to the Ohio Senate Subcommittee on Medicaid Finance, May 7, 2013 at http://bit.ly/10uhmlv.

[3] Dr. Benjamin D. Sommers, Dr. Katherine Baicker & Dr. Arnold M. Epstein, Mortality and access to care among adults after state Medicaid expansion,” The New England Journal of Medicine (September 13, 2012) at http://bit.ly/LTcBeF.

[4] “Our estimate of a 6.1% reduction in the relative risk of death among adults is similar to the 8.5% and 5.1% population-level reductions in infant and child mortality, respectively, as estimated in analyses of Medicaid expansions in the 1980s. Our results correspond to 2,840 deaths prevented per year in states with Medicaid expansions, in which 500,000 adults acquired coverage. This finding suggests that 176 additional adults would need to be covered by Medicaid in order to prevent 1 death per year.” – see Sommers, Baicker & Epstein, Op.Cit.

[5] Dr. Katherine Baicker et.al, The Oregon Experiment: Effects of Medicaid on Clinical Outcomes, The New England Journal of Medicine (May 2, 2013) at http://bit.ly/11CbFcw.

[6] William Hayes, Op.Cit., (drawing on Joel S. Weissman, Christine Vogeli, and Douglas E. Levy. “The Quality of Hospital Care for Medicaid and Private Pay Patients.” Medical Care. May 2013; 51:389-395.)

[7] Myron S. Cohen et al, Prevention of HIV-1 Infection with Early Antiretroviral Therapy, The New England Journal of Medicine (August 11, 2011) at www.nejm.org/doi/full/10.1056/NEJMoa1105243.

[8] Hospitals are required by law to stabilize any patient in need, regardless of ability to pay.

[9] Harvard Law School Center for Health Law & Policy Innovation, Expanding Medicaid under the Affordable Care Act: Where do States Stand Today? at http://hvrd.me/QEndow.

[10] Centers for Medicare and Medicaid Services, Details for: Medicaid state disproportionate share hospital allotment reductions proposed rule http://go.cms.gov/17XSLvF.

The House Chairman of Appropriations’ letter to education leaders this week pitting education against expanding Medicaid omits a number of important facts in a way that is misleading to readers and presents a false choice between two of our state’s most critical priorities.

In reality, accepting the federal funds that have already been allocated to our state to cover more of Mississippi’s working families through Medicaid is a great deal for the state of Mississippi. It will help our economy, our state finances, and people’s health, and it will not take tax dollars from our schools.

First, if the Mississippi legislature expands Medicaid, it will not cost the state a single dime for the first three years, because the federal government will pay 100 percent of the medical services costs and new revenue generated from expansion will cover the administrative costs. Down the line, the state will have to pay for a small share – 10 percent – but the federal government will continue to foot the rest of the bill, bringing millions of dollars into our economy each year while making our economy more healthy and productive.

Even paying for this very small part of the expansion won’t take money from our schools, because expanding Medicaid will actually save Mississippi money in other ways. That’s because insuring low-wage working people through Medicaid will allow the state to curb other health care spending, which is currently being used in an inefficient way.

If working Mississippians can get preventative care through Medicaid before they get sick, they can avoid costly emergency room visits and reduce hospitals stays, two of the most expensive forms of health care. Regular care that helps a patient manage a chronic illness can also save money in the long run.

For example, Mississippi has one of the highest per capita concentrations of leg amputations in the country because of untreated or unmanaged diabetes. In a number of cases, the condition goes untreated because individuals don’t have insurance. An amputation requires a hospital stay, and it increases the likelihood that the patient will leave work and turn to government disability assistance. With consistent, preventative care through Medicaid expansion, this costly situation can be avoided, saving the state money and keeping our workforce healthier.

Second, if the state doesn’t expand Medicaid, it will need to spend more money in other ways. Hospitals throughout the state – including those that receive state support – are facing massive funding cuts. The cuts include reductions in federal payments to hospitals that treat high numbers of people without insurance, known as Disproportionate Share Hospital Payments or DSH payments. The DSH payment cuts come on top of other cuts that hospitals are facing as a result of federal laws.

During the legislative session, one hospital administrator explained to lawmakers that his hospital had already laid off workers and was planning to reduce the wages of nurses. Another administrator warned of having to cut mental health services. If hospitals are unable to provide mental health services, people in need will undoubtedly turn or be turned to other taxpayer funded mental health and public safety institutions, which in turn will require more state funds to deal with the influx.

Third, the letter implies that the state must choose between funding Medicaid and education, but the reality is that this decision is part of a complex series of spending and tax decisions that reflect the lawmakers’ priorities. During the legislative session, our lawmakers passed a number of tax breaks for corporations – many with unknown price tags - making it impossible for the legislature to understand how much those tax breaks would take away from education and health care investments. Such tax breaks are unlikely to have the same positive economic impact as Medicaid expansion, which will bring in over $1 billion in federal funds to the state and increase employment by over 9,000 jobs as early as 2017, according to the Mississippi Institutions for Higher Learning.

Finally, there is no question that education and health are inextricably connected. When parents have health insurance, their children are more likely to get the health care that they need. A sick child will have a hard time learning and succeeding in school, and will likely be less productive as an adult. Medicaid expansion is yet another way that we can ensure that Mississippi’s children arrive at school everyday ready to learn and succeed.

The bottom line is Mississippi needs an educated and healthy workforce. Both are top priorities and to suggest any differently presents a false choice. Medicaid expansion will help our economy and make people healthier. Turning our backs on that opportunity would be a huge mistake.

Author: Ed Sivak, Director

If you are newer to the microfinance field, CRA might not mean anything to you but it is integral to our work. CRA, which stands for the Community Reinvestment Act (1977), is a landmark federal law that requires federally regulated depository institutions (aka national banks) to meet credit needs in all communities where they operate, including low-income communities. One way banks comply with the regulation is by investing in microfinance institutions like Opportunity Fund that specialize in extending credit to low-income borrowers. Those investments and donations are critical for us to serve our clients. To quote our CEO Eric Weaver: “There is no question that we would not have been able to accomplish what we have without a strong, and strongly enforced, Community Reinvestment Act.”

Right now, this law is poised for its second major reform after 35 years of existence. It is time. Given the seismic shifts in the way banks do business (mobile banking, branchless banks etc.) CRA desperately needs to catch up. Along with many partners across the country, Opportunity Fund is pushing for some important (but fairly technical) changes to how CRA is interpreted and enforced. These changes will ensure that banks meet the credit needs of all borrowers in the community, regardless of which side of the tracks those people happen to be from.

Read more or weigh in here

RAISE Texas Webinar - “Integrating Financial Coaching Into Your Organization’s Financial Capability Services”

June 17, 2013 10:30am - 12:00pm CST At the first RAISE Texas webinar on Financial Coaching, participants learned what financial coaching is within the financial capability field and how important this service is to the expanding Texas asset-building field. For this 2nd webinar, we want to take this conversation one step further by bringing in national and local experts to discuss how to integrate financial coaching into your organization’s current services. Join us as we continue our webinar series by registering today. We look forward to having you on the webinar. Please mark your calendars to take part in this important webinar, register today, and spread the word to your colleagues so they too can take part in this key discussion. We would like to thank the Federal Reserve Bank of Dallas for hosting this webinar and for supporting RAISE Texas’ efforts in spreading crucial resources, tools, and programs statewide.

Harris County Community Services Department has several funding oppurtunities coming up. Please visit their website at www.csd.hctx.net to find out more.

Legislators should accept federal dollars to pay for comprehensive health care coverage for Ohio’s low-income workers. Approving a budget that expands Medicaid to 153,000 low-income working women, and others, will help mothers and babies get healthier in Ohio. As a result, families, communities, and our economy will grow stronger.

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More than 153,000 Ohio women between the ages of 19 and 44 could gain health insurance coverage if Ohio expands the Medicaid program under health reform.1 Expanding Medicaid to cover these women could help lower Ohio’s infant mortality rate, shockingly high in some counties and among some communities.

When women have health coverage before becoming pregnant and between pregnancies, they are healthier during pregnancy and their babies are more likely to be healthy at birth, research shows.2 Yet thousands of low-income women do not have health coverage in Ohio. Parents with children under 19 and earning less than 90 percent of the federal poverty level are eligible for Medicaid. But parents earning more than 90 percent of poverty – just $17,577 for a family of three – are not. Workers without children are not eligible. These groups will continue to have no access to health care if the Ohio legislature does not expand Medicaid.

Figure 1 shows that people making more than the federal poverty level will get health care with subsidies that allow them to buy health insurance on the exchange in 2014. Without Medicaid expansion, young women entering the labor market at low wages and no benefits, or older women with grown children in the same employment situation, will lack health coverage in spite of national health reform. Their wages are too low to pay for coverage but too high for Medicaid.

At present in Ohio, parents earning 90 percent of poverty are eligible for Medicaid. Annual income at 90 percent of poverty is $13,959 for a single mother with one child in 2013. That mom may be working 34 hours a week at minimum wage, or 27 hours a week – the average full time work week in retail and some service sectors – at between $9 and $10 per hour. More hours or a promotion could eliminate her health coverage. Expanded Medicaid would allow her to seek more hours and higher wages so her family can escape poverty.

Infant mortality is linked to maternal health. The infant mortality rate is calculated as the number of live-born infants per thousand who die within their first year of life. The United States has one of the highest rates among developed nations (6.05 per 1,000 live births in 2011), and Ohio’s infant mortality rate exceeds that of the nation (7.9 per live birth), placing it 11th highest among the states.3 For African Americans it is 15.8 statewide, and even higher in some counties – in Ashtabula County it averaged 39.5 between 2006 and 2010. Ohio has highly prestigious health care institutions, yet in some communities, its infant mortality rates exceed those of developing nations.

Ohio has studied the issue of infant mortality for some time. The Ohio Collaborative on Infant Mortality recognizes the importance of maternal health in reducing infant mortality, as did the Ohio Infant Mortality Task Force before it. Now it’s time to do something about it. By passing Medicaid expansion, the Ohio legislature can give a Mother’s Day gift that can reduce infant mortality.

Legislators should commit to accepting $17.5 billion federal dollars between 2014 and 2022 to pay for comprehensive health care coverage for Ohio’s low-income workers. Approving a budget that expands Medicaid to those 153,000 low-income working women, and others, will help mothers and babies get healthier in Ohio. As a result, families, communities, and our economy will grow stronger.

[1] 2011 American Community Survey. “Low-income” defined as at or under 138 percent of the federal poverty line. Totals may not match sum of individual categories due to rounding.

[2] Center for Budget and Policy Priorities, “Expanding Medicaid will help both low income women and their babies,” April 17, 2013 at www.cbpp.org/files/Fact-Sheet-Impact-on-Women.pdf.

[3] Ohio Office of Health Transformation, “Reducing Infant Mortality,” (updated January 20, 2013) at http://1.usa.gov/16DEK89.

A recent post examines wages through the lens of gender in Mississippi. Differences in wages between men and women are not the only ones that exist within the state. Mississippi’s median wage gap between white and African American workers is larger than the gap between men and women. In 2012, the median wage for white workers registered at $16.97 while the median wage for African American workers was $11.44 – a difference of $5.53.

The table looks at these 2012 wage levels for many Southern states. Wages for white and African American workers are highest in Georgia. The median wage for white workers was lowest in Arkansas and for African American workers was lowest in Mississippi.

The gap between the white and African American wage was largest in Mississippi where the median wage equaled 67% of the white wage last year. The gap means that for every $3 earned by the median or ‘middle’ white worker, an African American worker earns $2. Nationally, the median African American worker earns $3 for every $4 earned by a white worker.

In Mississippi, the median wage for African Americans has hovered around 70% of the median wage for white workers for more than two decades with little change. The trend means that wages for both groups have advanced at the same pace for 20 years, with African American workers not gaining ground on their white counterparts.

The racial wage gap has significant implications for families, children and the state’s greater prosperity. As the differences in wages earned persist, so do differences in household income and poverty levels by race. These trends are not unique to Mississippi, but the data suggest that the differences are more severe than the nation and Southern states. Being intentional about considering these racial and economic divisions in workforce development, asset development, and education policy remain critical for the economic success of the state in the future.

Author: Sarah Welker, Senior Policy Analyst

It has now been more than five years since Mississippi and the nation entered the 2007 recession. Across the country and in our state, men’s wages fell substantially from the mid-2000s to a low in 2010 (see chart). In contrast, women’s wages did not take the same dip as men’s, and in Mississippi estimates show that the median wage for women peaked in 2010. The combination of trends made it seem as though the gender wage gap was narrowing at the end of the last decade. In 2010, the median wage for women equaled 89% of the median wage for men.

However, wage data from 2011 and 2012 raises questions about whether there was a permanent narrowing of the gap, or a temporary effect from the economic constraints of the great recession. After adjusting for inflation, men’s wages are on the increase over the last two years, while women’s have fallen. In 2012, women’s wages equaled 78% of men’s – a lower percentage than 10 years before in 2002. In the U.S., women’s median wages were 82% of men’s in 2012.

For both genders the 2000s showed much slower wage progression than in the 1990s.

How do workers in Mississippi stack up against workers nationally?

In 2012, the median wage for Mississippi’s women ranked 48th among 50 states while the median wage for men ranked 42nd. Women’s wages fall behind Louisiana and Montana, and are $2.30 below the national median. Men’s wages in the state are $1.80 below men’s wages nationally (see chart).

These wage trends suggest that efforts to narrow the separation between men’s and women’s wages are still needed in Mississippi and nationally. Women make up close to half of our state’s labor force and a persistent difference in wages by gender has broad implications for families and the economic security of women.

Up Next: We’ll compare wages between different demographics in Mississippi and the South.

Author: Sarah Welker, Senior Policy Analyst

Foreclosures continue to wreak havoc in Ohio communities, according to data released from the Ohio Supreme Court. In Ohio 70,469 new households filed foreclosures in 2012. This was about the same as in 2011 (a 1.5% decrease) but was more than four times as many foreclosures as we were seeing in the mid 1990s (15,975 in 1995). Foreclosure filings peaked in Ohio in 2009 with 89,061.

Cuyahoga County continues to lead Ohio in the number of new foreclosure filings with 11,427 – a marginal 1 percent decrease from 2011. Smaller counties represented the largest percentage increases from 2011 with Adams (41 percent), Noble (38 percent), and Madison (22 percent) counties seeing the largest one-year growth

“These numbers make it very apparent that the foreclosure crisis continues to haunt Ohio,” said David Rothstein, project director for asset building at Policy Matters Ohio. Policy Matters Ohio will release a detailed analysis of the new foreclosure filings next week and an interactive map shortly.

“Clearly this small decrease in overall foreclosure filings demonstrates the increased need for foreclosure mediation and mortgage counseling,” said Mark Wiseman, director of the Consumer Law Center at Neighborhood Housing Centers of Greater Cleveland.

Housing organizations in Cleveland and Ohio share the concern about foreclosures and are available for comment. These include the Cleveland Housing Network, ESOP, Neighborhood Housing Services of Greater Cleveland, and Consumer Law Center and the Ohio Poverty Law Center.