Governor’s metrics still raise questions

Iowa’s social distancing policy appears to be hostage to an unexplained and backward-looking indicator for hospitalizations.

(UPDATED, APRIL 16)

The latest “metrics” from the Governor’s office once again raise serious questions. A few days ago it seemed clear that two or three of the state’s six regions would very soon reach the magic number 10, at which point shelter-in-place is considered justified by the Governor and the Iowa Department of Public Health, according to their guidelines. Instead, as of April 15, regions 1 and 6 remained stuck at 8 and 9, respectively, and region 5 had fallen to 8. Why? Because the hospitalization rate score, which by deduction must have been at 3 for all 6 regions just a week ago, was suddenly downgraded to 1 in two regions, and 2 in two others.

Today, April 16, things changed again. Lo and behold, Region 6 made it to 10. And in fact the Governor followed through with something akin to shelter in place, with most kinds of gatherings limited to families, not groups of 10 or fewer. No additional business closures were announced, however. Meanwhile, Region 5 jumped two points with new outbreaks at two more nursing homes, but then lost a point because the hospitalization score apparently was lowered again, without any explanation. So it remains at 9, even though it is maxed out on all criteria except hospitalizations.

No explanation of the hospitalization score has been forthcoming beyond the vague definition in the “Guidance” memo unearthed by Zachary Smith of the Iowa City Press-Citizen last week. That memo defines it thus: “Percent of identified cases requiring hospitalization.” Is the numerator the cumulative total of all cases in Iowa that required hospitalization at some point, or just cases in the last 14 days, or just current hospitalizations as of the most recent day? Is the numerator cumulative cases, cases in the last 14 days, or something else? We don’t know, and no hospitalization rate by this measure has been reported even statewide, nor does the newly launched dashboard contain any hospitalization data at the county or regional level.

Total cases of COVID-19 continue to rise, as do current hospitalizations. So in the face of a rising number of Iowans currently with a severe enough case of the virus to be hospitalized, why does the hospitalization score decline, lessening the supposed need for shelter in place? Why is the percent relevant in the first place? Surely the total number of persons hospitalized for the virus is the single most important indicator, since it signifies not only the number of Iowans seriously affected by the virus, but the potential strain on hospital resources.

A forecast of this number is the crucial indicator in the widely known forecasting models by epidemiologists at the University of Washington and elsewhere. But in Iowa, we still do not have a forecast, and social distancing policy appears now to be hostage to an unexplained and backward-looking indicator. If that percentage continues to be low, or to fall, despite daily increases in cases, deaths, and hospitalizations, we may not see another region get to the magic number of 10.

Peter Fisher is research director for the nonpartisan Iowa Policy Project in Iowa City.

pfisher@iowapolicyproject.org

Sheltering the data in place

One thing is clear: transparency has been sadly lacking, and for no apparent reason.

Governor Kim Reynolds over the past few weeks has moved incrementally to close more kinds of businesses, to the point where Iowa’s restrictions now resemble those of states that have a blanket statewide “shelter in place” order. Significant distinctions remain: a proper and comprehensive shelter in place order closes all businesses except those specified as essential, leaving no ambiguities and loopholes, and comes with clear and enforceable restrictions on travel and social activities.

The governor continues to assert that her recommendations are driven by the same four metrics that have guided her since the beginning and that only recently became partly public information due to efforts by the press. We provided a thorough analysis of that guidance several days ago. On Tuesday, we finally learned about one of those metrics: There are three long-term care facilities with a sufficient number of COVID-19 cases to be classified as a facility with an outbreak.

We now know enough to construct the point system in spite of stonewalling by the Governor’s Office.

The first of the four measures — percent of population age 65 or over — can be found from census data. The second — cases per 100,000 population — can be calculated because the number of cases has been released by IDPH by county. The third — outbreaks at care facilities — is now known, with locations, because of a question at a press conference.

That leaves the fourth — hospitalizations as a percent of cases — that is unknown by county or region because the governor still refuses to release the data. But we know the total score by region because it shows up on the maps that are intermittently released at press conferences (but remain unavailable on the IDPH website). Thus by subtraction we can determine that all four regions must be at the highest level, a 3, on the hospitalization rate score.

From here on out, the only thing that can change is the cases per 100,000 population and the number of care facility outbreaks. Region 5 is already at the maximum on the cases measure, and regions 1 and 6 will likely get there soon, leaving all three regions with a score of 9, 1 short of 10, the number that supposedly triggers shelter in place. So those regions, covering a large majority of the state’s population and COVID-19 cases, can get to 10 only with another outbreak at a care facility.

The governor on the one hand argues that we already have the equivalent of shelter in place, and at the same time the metric that she says still guides her decisions shows that shelter in place is not yet warranted anywhere in the state. Has that metric really been used thus far, and in what way? How do you get from the metrics to a list of particular additional businesses to close? What will happen when a region reaches 10? Will the governor order more stringent measures in just that region? Or will the whole thing be scrapped once a proper forecasting model is developed that meets with her approval?

One thing is clear: transparency has been sadly lacking, and for no apparent reason.

Peter Fisher is research director of the nonpartisan Iowa Policy Project.

pfisher@iowapolicyproject.org

Too soon to consider recovery?

Even economists point the immediate focus to public health — and keep recovery in the wider view.

What is needed in a pandemic is for citizens to stay home, and for public policy to assure access to unemployment insurance and health care, and push support to the health system.

Economists such as former Labor Secretary Robert Reich are making these points — that limiting the spread of the coronavirus is the top priority to save lives.[1] When even economists are pressing the point about public health, our leaders should pay attention. Now is not the time to talk about being “open for business” prematurely, as President Trump once suggested we do by Easter.

That is not to say a public health spotlight precludes steps in the coming weeks and months to set up recovery when that can be the main focus.

Now, jobs remain in critical services in hospitals and electric stations, and some in construction. Factories where people stand next to each other on a production line have different social distancing from workers who build things in the open air. We could expand more of the latter jobs right now where the materials are at hand.

Good examples: Wind turbines and solar installations and the power lines that connect them to the electric grid. Right now we could be constructing clean energy facilities that can be producing electricity in six months or a year when we all want demand to expand. It is an opportune moment to think ahead and start replacing older coal production plants, which have their own health problems.

Public policy has a role here. Just before the Iowa legislators recessed because of the COVID-19 pandemic, they passed — and Governor Kim Reynolds signed — a bill to stabilize the solar industry. It would do this by setting the price for the next seven years for the electricity that MidAmerican and Alliant buy from homeowners and businesses.[2]

Another step the Legislature could take is lifting the limit on the tax credit for businesses and homeowners when they install solar.

The annual amount that could be taken on the credit was not fully used in the first year, but in all years since 2013 installations exceeded the cap, now at $5 million per year, pushing installations completed later in the year to a waitlist.[3] The tax credit eventually comes but not until at least a year later. While an installation completed today will get a federal tax credit when taxes are filed in April 2021, the Iowa tax credit will not happen until 2022 or later.

Why make these Iowa investors wait? Extending the total amount eligible for the credit from $5 million to perhaps $20 million would further stimulate the construction of solar panels just when the economy needs the jobs.

There also is a federal role, as the amount of that credit for both solar and wind is phasing out. This would be a good time to stop the phaseout for the next several years. Tax credits of electric cars could also be enhanced.

COVID-19 has slammed the economy. We need to think about when we will recover but also how we will recover. Jobs in clean energy have been on a growth curve that can be re-established quickly. And these jobs are creating a new energy system that will help us with the next crisis, climate change.

Most agree we should follow science to confront the pandemic. We should also follow the science to prepare for the next crisis — climate change.

David Osterberg is an economist and lead environmental researcher at the nonpartisan Iowa Policy Project in Iowa City. Contact: dosterberg@iowapolicyproject.org.

A version of this column also ran in the April 1 Quad-City Times.

 

 

 

 

[1] MSNBC interview, March 17, 2020. https://www.msnbc.com/the-beat-with-ari/watch/-our-economy-is-shutting-down-clinton-wh-veteran-pushes-lives-over-dollars-in-covid-19-crisis-80868933847

[2] O. Kay Henderson. Iowa House and Senate give solar bill unanimous support. Radio Iowa March 4, 2020. https://www.radioiowa.com/2020/03/04/iowa-house-and-senate-give-solar-bill-unanimous-support/

[3] Iowa Department of Revenue. Solar Energy System Tax Credit Annual Report for 2019. https://www.legis.iowa.gov/docs/publications/DF/1126111.pdf

Churchill’s words for Iowa’s future

Iowans should take this opportunity to build a stronger, more resilient state that is forward facing and not just rebuilding what came before.

“Never let a good crisis go to waste” — Winston Churchill.

Mass government spending and social distancing nearly everywhere is a response to the COVID-19 outbreak in the United States. Perhaps we, like Winston Churchill, writing during World War II, might find a silver lining.

There is a sense of national unity or purpose, an outpouring of selfless action by medical professionals, and a renewed sense of national urgency to “Wash your damn hands!” What is intriguing to me is the number of individuals who — if they are still working — are suddenly shifted to a work from home situation and the follow-on effects that this has had.

While not all the “dolphins returning to the canals of Venice videos” are real (sorry!), the reduction of air pollution and greenhouse gas (GHG) emissions in China are observable and documented.[1] European cities are seeing similar reductions in GHG emissions and air pollution. A similar impact may soon be seen in the United States as “shelter in place” directives, which cut driving and factory production, take hold across the nation. The economic slowdown from the spread of COVID-19 could lead to a 9 percent reduction of emissions from the sector that is the largest GHG generator across the nation.

The transportation sector is the largest source of GHG emissions nationwide, and nearly one-third of all miles driven are for commuting purposes.[2] While only 5 percent of Americans regularly work from home today,[3] the Bureau of Labor believes that nearly one-third of Americans could do so.[4] Winston Churchill might ask: How can this be made sustainable?

From recent personal experience, working from home, especially if your partner also is now working from home, requires very few things — a comfy chair, a tub of salted pretzels, and high-speed internet. I am fortunate that I live in an area with access to broadband, but many Iowans find broadband access prohibitively expensive or lack access at any price. My own family members who live in rural areas of Iowa have experienced broadband access problems.

This disparity is well known to Governor Kim Reynolds’ office, which has encouraged the growth of broadband throughout the state through a grants program.[5] Even with this support, much of Iowa remains in a broadband desert, without access to the high-speed internet that allows for teleworking options for Iowans. The blue-shaded areas in the map below indicate areas lacking 25-megabit-per second download speed and 3-megabit upload speed, known as 25/3 broadband, in June 2018.[6]

Similarly lacking in quality are Iowa roads. The American Society of Civil Engineers gives Iowa an overall grade of “C,” with an even lower grade of D+ and D for our bridges and dams.[7] This is also not a new phenomenon, and the old joke of the Midwest having two sessions, winter and construction, points to the constant state of improvements we often find.

With these poor infrastructure grades in mind, how do we make the crisis of COVID-19 not go to waste? The federal government is passing legislation and considering more policy to provide needed financial support for workers, businesses, and the states.

While funds must first go to supporting those who have lost their jobs and for healthcare, infrastructure programs are also a way to quickly inject money into local economies once the crisis has subsided. We can even ensure some workers stay employed as we increase infrastructure construction during these economic lean times.

How? We can super-charge telecommunications investments by the state, either directly or via low-interest loans and grants to existing telecommunication firms. We can use the available public right-of-way that exists on local and state roads to lay fiber for broadband communication capacity across the state while also jump-starting road and bridge repair projects.

When telecom companies are given loans or grants, they should come with price caps to ensure that broadband service extensions are actually used by the rural public. Roads should be rebuilt with an eye less toward peak commuting travel, but more realistic travel demands in a world with expanded telecommuting and reduced motorist traffic.

In short, Iowans should take this opportunity to build a stronger, more resilient state that is forward facing and not just rebuilding what came before. And, they should ensure that fair and prevailing wages are paid for all construction contracts.

This time is one full of heartbreak for families directly affected by COVID-19 and anxiety for those wondering if and when their own family will fall ill. Industries are struggling and the economy may be grinding to a halt by the swift application of painful, but necessary, distancing efforts.

But within these trying times is an opportunity to respond with the future in mind. Like Churchill said, we should not let this crisis go to waste.

 

[1] https://www.politico.com/news/2020/03/13/climate-advocates-hit-political-turbulence-127649

[2] https://www.fhwa.dot.gov/policy/2015cpr/chap1.cfm

[3] https://www.cnbc.com/2019/10/13/people-who-work-from-home-earn-more-than-those-who-commuteheres-why.html

[4] https://www.bls.gov/news.release/flex2.t01.htm

[5] https://ocio.iowa.gov/broadband

[6] https://ocio.iowa.gov/broadband-availability-map-version-2

[7] https://www.infrastructurereportcard.org/wp-content/uploads/2016/10/ASCE_Brochure-IOWA2019.pdf

Joseph Wilensky is a Master’s Degree candidate in the University of Iowa School of Urban and Regional Planning. He has been an intern at the Iowa Policy Project during the 2019-20 school year.

Lesson from the Recovery Act

The 2009 Recovery Act offered a good example of how state fiscal relief, in addition to the temporary boost in Medicaid funding, can aid in recovery from economic problems caused by the current health emergency in the United States.

Editor’s Note: This is an excerpt of a larger report from the Center on Budget and Policy Priorities (CBPP), “Immediate and Robust Policy Response Needed in Face of Grave Risks to the Economy.” It points to lessons policy makers can take regarding state fiscal relief in the American Recovery and Reinvestment Act of 2009, enacted to move recovery from the Great Recession. For the full CBPP report, click here.

Providing Additional Needed State Fiscal Relief

Given the severe threat to the economy — and the resulting threat to state finances — states will likely need additional fiscal relief beyond what (a temporary increase in the share of Medicaid costs borne by the federal government, or FMAP) … would provide. During the last recession, states faced budget shortfalls totaling about $600 billion. The Recovery Act’s FMAP provisions provided roughly $100 billion in fiscal relief — a big help, but well short of what it would have taken for states to avoid laying off teachers and other workers and cutting services in other ways that deepened the recession. Increasing the FMAP is the single most important way to get fiscal relief efficiently to states, but Congress should also enact additional emergency fiscal aid to states. We recommend that this added fiscal relief take a similar form to the Recovery Act’s State Fiscal Stabilization Fund (SFSF), which provided roughly $60 billion in fiscal aid to states.

Given the wide range of fiscal challenges states are facing, they should have significant flexibility over how to spend this aid. The SFSF required states to spend 82 percent of the aid on education, including both K-12 and higher education. A new version of the SFSF should allow states to spend a smaller percentage of the aid on education, so that states are free to best respond to the COVID-19 outbreak and its economic fallout, but still require that a substantial share be used to support state education systems. While many schools and universities will likely be closed in the next few weeks, teachers still need to be paid (to avoid hardship and further drag on the economy). And if revenues decline as sharply as expected, states will face serious difficulties in adequately supporting their schools in the coming fiscal year, when schools will be trying to make up for lost class time. Education accounts for roughly 40 percent of state spending, the single largest part of state budgets, making it very difficult for states to avoid cutting educational services when revenues decline sharply.

As under the Recovery Act, states would be required to distribute funding to schools using their existing funding formulas, which favor low-income districts, or by distributing funding directly to Title I schools (schools that serve a large number of disadvantaged students). States should also be encouraged to use the funding to increase college tuition assistance for low-income people facing a tough job market and students whose families’ ability to help pay for school has diminished. Targeting state fiscal aid to protect education systems in the coming year would benefit the nation’s economy in the longer term by improving the educational outcomes of students, many of whom are now missing weeks of school. And requiring states to distribute a substantial share of this aid to schools would help protect against some states accepting the aid and then using it instead to cut taxes. As under the Recovery Act, this new version of the SFSF should include a maintenance-of-effort provision that requires states to maintain their own education spending at current levels.

Finally, Congress should also consider certain forms of direct aid to localities, whose own budgets will also be deeply harmed. For example, Congress should consider direct aid to public transit systems, whether buses or subways, which stand to lose much of their fare revenue in coming weeks — losses that many of these systems will likely have difficulty recovering from on their own and that will further strain local budgets, risking cuts in other needed public services.

This excerpt is one small section of a CBPP report by Sharon Parrott, Aviva Aron-Dine, Michael Leachman, Chad Stone, Dottie Rosenbaum, LaDonna Pavetti, Ph.D., Peggy Bailey, Chuck Marr, and Kathleen Romig. We share it on the Iowa Policy Project blog as an example of one approach that research and experience have shown will be needed as states and local governments attempt to contribute to recovery from the current health emergency.

Time for state to act

170118_capitol_170603-4x4The Pelosi-Mnuchin stimulus package that passed the U.S. House on Friday includes many measures to protect ordinary Americans who may see lost wages or who may need to stay away from work because someone in the family needs attention.

According to The Washington Post:

“The agreement reached Friday is primarily aimed at expanding the safety net to cope with the potentially catastrophic economic impact of the coronavirus. In addition to ensuring free coronavirus testing, the plan would dramatically increase several benefits, particularly family medical leave and paid sick leave, while also bolstering unemployment insurance; spending on health insurance for the poor; and food programs for children and the elderly.”[1]

The food program expansion “nullifies existing work requirements on the food stamp program.”[2] The medical leave and family leave section will allow up to two-thirds of salary to a great number of employees including full tax credits from employment tax for self-employed individuals.[3] The federal share of Medicaid is boosted and unemployment insurance is strengthened.

According to the Center on Budget and Policy Priorities (CBPP), the Medicaid boost means an additional $240 million is available for Iowa.[4] Noted CBPP’s Jennifer Sullivan:

The House COVID-19 bill’s temporary Medicaid funding boost, if in effect for all of calendar year 2020, would deliver roughly $35 billion in immediate, needed relief to states, which will face growing costs due to the virus and a likely economic downturn. … Similar measures have been a critical part of economic stimulus packages under both Democratic and Republican administrations….

The bill, expected to pass the Senate in a few days, addresses what many expect to be a downturn in the economy caused by the pandemic reaching U.S. shores.

Responsible actions at the federal level require a state response as well. Iowa Policy Project blog posts in recent days have noted good opportunities:

First, Iowa needs improvements in the unemployment system: (1) Relax the job search requirements to enable individuals forced into unemployment by the virus to collect UI benefits; (2) Allow individuals forced to take a leave of absence to collect UI during that period; (3) Establish procedures for individuals losing a job for health safety reasons or to care for a family member with the virus to qualify for UI, and (4) Establish rules under which employers’ unemployment experience rating is not harmed by virus-related layoffs.[5]

Second, Iowans need strong Medicaid and SNAP benefits now more than ever. The safety net helps us all — not just current beneficiaries, but also those on the edge of financial security and the general economy. Any legislation, such as SF430 and HF2030, that imposes new bureaucratic hurdles for struggling Iowans not only will take food and doctor’s visits away when people need them the most, but hurt local communities as well.[6]

[1] Erica WernerMike DeBonisPaul Kane and. Jeff Stein. The Washington Post, “House passes coronavirus economic relief package with Trump’s support,” March 14, 2020. https://www.washingtonpost.com/us-policy/2020/03/13/paid-leave-democrats-trump-deal-coronavirus/
[2] Ibid

[3] H. R. 6201 Making emergency supplemental appropriations for the fiscal year ending September 30, 2020, and for other purposes. Page 93 and 103. https://docs.house.gov/billsthisweek/20200309/BILLS-116hr6201-SUS.pdf

[4] Jennifer Sullivan, Center on Budget and Policy Priorities, “Medicaid Funding Boost for States Can’t Wait,” updated March 13, 2020. https://bit.ly/3d1jPBQ

[5] Peter Fisher. IowaPolicyPoints.org blog post,Protecting workers from coronavirus impacts.” March 14, 2020.

[6] Natalie Veldhouse. IowaPolicyPoints.org blog post, “Make Iowa resilient: Strengthen supports for working families.” March 13, 2020.

osterberg_david_095115David Osterberg co-founded the Iowa Policy Project and is a researcher with the organization.

dosterberg@iowapolicyproject.org

 

Make Iowa resilient: Strengthen supports for working families

170803-healthcare-acaThe Coronavirus (COVID-19) crisis is a good time to recognize the strong public structures we have in place to protect Iowans most vulnerable to economic challenges. Two federal-state programs are ready to address times like these: Medicaid and the Supplemental Nutrition Assistance Program, or SNAP.

A health emergency is an opportunity to bolster both programs to make sure they operate as intended, mitigating the impact on Iowans while our state and local leaders do what they can to contain the spread of the virus.

These two work support programs ensure that Iowans have access to food and medical care. The accessibility and adequate funding of these programs ensure all Iowans are protected. The specific programs help those who have fallen on hard times. Making sure everyone in society gets health care reduces the transmission of disease. When schools are closed, children who get free meals need SNAP to ensure there is enough food at home. These are especially important concerns during crises.

Ironically, the integrity of these programs has been threatened recently at the federal and state levels:

  • State and federal attempts to impose additional work reporting requirements and redundant quarterly eligibility checks for benefits would kick some families off of these vital work supports.
  • Federal rule changes including time limits on benefits and eliminating efficient and streamlined processes to qualify, as well as budget cuts, all threaten the ability of SNAP to prop up workers, families and communities during an economic slowdown that may be one of the impacts of COVID-19.
  • Similarly, budget cuts and the move to block grants fly in the face of Medicaid’s stated goal to provide health care to low-income Americans especially during an economic downturn.

We need Medicaid and SNAP now more than ever. It would be a timely move for lawmakers to step back and recognize that the safety net helps us all. Iowa bills SF430 and HF2030 impose bureaucratic hurdles that will serve to take food and doctor’s visits away from Iowans.

Especially during a public health crisis, we need our leaders looking for ways to help all Iowans get ahead.

2018-NV-6w_3497(1)Natalie Veldhouse is a research associate at the nonpartisan Iowa Policy Project. nveldhouse@iowapolicyproject.org