Boost work: Keep Medicaid accessible

Complicating Iowans’ ability to get checkups and the medications they need will not improve workforce participation.

Iowa’s Medicaid program carries two major purposes. First, Medicaid provides medical care for the elderly; in fact, 44 percent of Medicaid spending goes for long-term services and supports for seniors.[1] About half of Iowa nursing home residents benefit from Medicaid.[2]

Second, Medicaid covers thousands of Iowans working in low-wage jobs with no health insurance benefits and to thousands of others who have a disability that prevents them from working. Nearly half of all Medicaid recipients in Iowa are children.[3]

The data show that Medicaid is an important work support. Most non-elderly adult Medicaid enrollees in Iowa work — 72 percent — and 87 percent live in a working family.[4]

Among Medicaid enrollees in Iowa, larger shares of African-American and Latino enrollees are working than whites. One-third of Iowa working Medicaid enrollees work in smaller companies, which likely do not provide employer-sponsored insurance. It might surprise Iowans to know the largest group of Iowa workers receiving Medicaid work in elementary and secondary schools.[5]

Imposing new requirements for Medicaid would complicate health-care access for low-wage workers, children, veterans, older Iowans and Iowans with disabilities. It would not improve workforce participation.

Contrary to some political claims, studies in case after case show the main impact of extra Medicaid requirements is not better jobs,[6] but disenrollment in Medicaid, worse health outcomes, less access to care, and financial insecurity.[7] Rather than promoting good health that is important for employment and productivity, added Medicaid eligibility requirements undermine the goal of encouraging work.

If policy makers’ goal is to increase workforce participation, more practical approaches exist in expanding the state Earned Income Tax Credit and Child Care Assistance eligibility.

Not only do new Medicaid requirements fail to encourage work, but they make sustaining coverage difficult for people who are exempt from work, such as Iowans with disabilities, who may face obstacles in documentation and verification. Workers with variable hours, particularly in food service, retail, and seasonal jobs, could face similar issues.

Many working Medicaid enrollees work full time, but their low annual wages still quality them for Medicaid.[8] Rural communities rely heavily on Medicaid; disenrollment could harm rural hospitals and restrict access to care for children, the elderly, and veterans.[9]

It makes no sense to restrict access to health care for Iowans who are working or are exempt due to age or disability status.

 

[1] Steve Eiken, Kate Sredl, Brian Burwell & Angie Amos, “Medicaid Expenditures for Long-Term Services and Supports in FY 2016.” Table 31. Iowa LTSS Percentage Trends. https://www.medicaid.gov/medicaid/ltss/downloads/reports-and-evaluations/ltssexpenditures2016.pdf

[2] Kaiser Family Foundation, “Medicaid’s Role in Nursing Home Care.” Table 1: Medicaid’s Role in Nursing Home Care, by State.  June 2017. https://www.kff.org/infographic/medicaids-role-in-nursing-home-care/

[3] American Community Survey, “Health Insurance Coverage Status and type of Coverage by State and Age for All People: 2017.” Table H105. September 2018. U.S. Census Bureau. https://www.census.gov/data/tables/time-series/demo/income-poverty/cps-hi.html

[4] Rachel Garfield, Robin Rudowitz, & Anthony Damico, “Understanding the Intersection of Medicaid and Work.” January 2018. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/understanding-the-intersection-of-medicaid-and-work/

[5] Ibid.

[6] LaDonna Pavetti, “Work Requirements Don’t Cut Poverty, Evidence Shows.” June 2016. Center on Budget and Policy Priorities.  https://www.cbpp.org/research/poverty-and-inequality/work-requirements-dont-cut-poverty-evidence-shows

[7] Hannah Katch, “Medicaid Work Requirements Will Harm Families, Including Workers.” February 2018. Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/medicaid-work-requirements-will-harm-families-including-workers

[8] Ibid.

[9] Center on Budget and Policy Priorities, “How Medicaid Work Requirements Will Harm Rural Residents – And Communities.” August 2018. https://www.cbpp.org/research/health/how-medicaid-work-requirements-will-harm-rural-residents-and-communities

 

Natalie Veldhouse is a research associate for the nonpartisan Iowa Policy Project. nveldhouse@iowapolicyproject.org

Long way to King’s goal

Persistent segregation, plus deindustrialization and declining in job quality across the region, has created stark and sustained obstacles to equal opportunity and equal outcomes.

As we mark Martin Luther King Day, it is also worth underscoring just how far we need to travel — in Iowa and in the nation — to achieve Dr. King’s aspirations of true and substantive racial equality.

Nationally, the last half-century has seen some progress in African-American educational attainment, wages, and incomes. But gains on other fronts — including home ownership, wealth, unemployment, and incarceration — have been elusive.

Regrettably, Iowa (and its upper Midwestern neighbors) remain among the starkest settings for racial inequality across a number of dimensions. Historically, Midwestern and rustbelt metropolitan areas have always been among the segregated places to live. Indeed black-white segregation in Iowa’s metro areas has persisted across the last generation and — in the Iowa City metro — has actually worsened since 1990. This, coupled, with the sustained impact of deindustrialization and declining in job quality across the region, has created stark and sustained obstacles to equal opportunity and equal outcomes.

The result is a jarring juxtaposition: While Midwestern metros (Des Moines, Madison, Minneapolis) typically crowd the “best places to live” lists, they are also among the very worst places to live for African-Americans. In one recent analysis, ranking the states by an index of racial inequality, Iowa and its immediate neighbors (Wisconsin, Minnesota, South Dakota, and Illinois) were the top (worst) five states.

Below, I have calculated Iowa’s position (rank among the states) across five key dimensions. For poverty, income, unemployment, and homeowners I used the Census Bureau’s 2013-2017 American Community Survey (pooling five years of data, given the size of the African-American sample in Iowa, provides a more reliable estimate); for rates of incarceration, I rely on the ongoing work of the Sentencing Project.

Here are the results:

1.  Although Iowa’s unemployment rate is low, the white-black gap is persistent. At 7.2 percent, the African-American unemployment rate is more than double the rate (3.2 percent) for white Iowans (2013-17). We are one of 16 states to reach this dubious threshold; the ratio of white-to-black employment in Iowa is the eighth worst in the country.

2.  African-American household median income in Iowa ($30,505) is barely half white household income. On this measure, we rank seventh worst in the country.

3.  On poverty, the disparity is even starker. The African-American poverty rate in Iowa (34.1 percent) is more than triple the white poverty rate (10.0 percent). We rank sixth worst in the country.

4.  Almost three quarters (74.1 percent) of white Iowan heads of households own their homes, almost triple the rate (27 percent) for black heads of household. On this metric, Iowa has the seventh worst disparity in the country.

5.  One of every 17 black men in Iowa are in prison, a rate of incarceration that is the third worst (behind only Vermont and Oklahoma) in the country. The ratio of black-white incarceration in Iowa is 11.1: 1 (for every white adult in prison there are 11.1 black adults in prison), again ranking third worst (behind Wisconsin and New Jersey).

Colin Gordon is senior research consultant for the nonpartisan Iowa Policy Project. A professor of history at the University of Iowa, Gordon also has authored IPP’s State of Working Iowa reports. Contact: cgordonipp@gmail.com

Ag Gag: Never a good idea

Restoring Iowans’ rights with the strikedown of Iowa’s “ag-gag” law is an important step forward. Next, someone needs to test the Iowa law reducing neighbors’ rights to sue big hog facilities.

pigs-matrixThe Iowa Legislature and our former governor just got a spanking by the courts. The “ag-gag” law they created in 2012 is unconstitutional because it violates free speech.

As Trish Mehaffey reported last week in the Cedar Rapids Gazette, the law “threatened up to a year in jail for those individuals who use undercover means or provide false identities to document or report on activities in the agricultural animal facilities.” In other words, the law — now overturned — had criminalized actions by a whistle blower.

Another law passed and signed in 2017 needs similar testing by the courts. This one restricted nuisance suits by neighbors against large animal production facilities, as IPP reported in March 2017.

The source of both laws was the ag industry, which has successfully lobbied legislators to avoid better approaches to livestock production, with scare tactics about the survival of the industry. Their claims are nonsense.

For evidence, look to Denmark — like Iowa, a big and thriving producer of hogs, but with many more restrictions. Rather than making it a crime to report on abuse of animals, Denmark requires that:

“All Danish pigs are produced within independently monitored assurance schemes, which also require a monthly visit by the local veterinarian. In addition, the Danish authorities run an annual programme of ‘unannounced’ visits to ensure that all welfare legislation is being complied with.” [1]

In other words, whistleblowing would be encouraged.

Denmark has other rules in its promotion of a strong industry that considers animal welfare and protection of human health:

  • Required “showering systems for all pigs over 20kg weight to enable them to regulate their body temperature in hot weather.
  • A 2015 ban on the use of fully slatted flooring systems allows pigs a more comfortable lying area. [2]
  • Reducing antibiotic use in all animals by 49 percent from 1994 through 2016, while production of food animals actually increased by 15 percent. [3] The U.S. Food and Drug Administration has only a voluntary program to reduce antibiotic use in animal agriculture and this effort has yet to show decreases in total amount of antimicrobials. [4]

In Iowa, ways have been shown to raise hogs other than in confinements that are outside the public eye or contrary to neighbors’ concerns. Hoop houses offer one such alternative. Among environmental advantages, hoop houses remove one problem because manure produced is mixed with straw or other materials. That manure can be applied to land with much less danger of running off into streams, a problem with liquid manure from confinements.

Restoring Iowans’ rights with the strikedown of Iowa’s “ag-gag” law is an important step forward. Next, someone needs to test the Iowa law reducing neighbors’ rights to sue big hog facilities.

[1] Agriculture and Food.co.uk. Providing Information on the Danish Pig industry. Overview https://agricultureandfood.co.uk/welfare/overview

[2] Ibid.

[3] Statens Serum Institut, National Veterinary Institute, National Food Institute. “DANMAP 2016.”

[4] United States, Department of Health and Human Services, Food and Drug Administration Center for Veterinary Medicine. “Guidance for Industry #213.” December 2013, https://tinyurl.com/ybkn2uk5.

2016-osterberg_5464 David Osterberg, co-founder of the Iowa Policy Project in 2001 and a state legislator from the 1983 through 1994 sessions of the General Assembly, is the lead environmental researcher for the Iowa Policy Project. Contact: dosterberg@iowapolicyproject.org

Listen to Osterberg’s interview on this topic with Michael Devine of KVFD, 1400AM in Fort Dodge.

For starters, issues to watch in 2019

There are many issues to watch in the new Iowa legislative session. Here is a non-exhaustive list, identifying where policy changes could affect opportunity for many thousands of Iowans.

With the 2019 session of the Iowa Legislature officially underway, the Iowa Policy Project is a dependable source for quality information and analysis on Iowa’s most pressing policy challenges. IPP’s Roadmap for Opportunity project will highlight and clarify many of these challenges as they emerge. Among issues to watch:

Public funds for private schools

Vouchers or “education savings grants” stand to take more money away from public schools and add to the $66 million Iowa taxpayers pay every year to support private education. Funding for Iowa’s public schools has failed to keep up with rising costs. Underfunded schools impact student development and workforce potential. Read more in our Roadmap piece, “Strengthening public education, no new subsidies to private schools” and the accompanying backgrounder, “Taxpayer support of private education in Iowa.”

Unemployment compensation

Unemployment insurance is an important program that supports workers experiencing temporary unemployment and acts as a macroeconomic stabilizer during economic downturn.[1] Because states are granted flexibility in shaping the program, there lies potential to undermine it, as other states have recently. More to come on this issue.

Attacks on public pensions

Maintaining a strong public pension system in Iowa ensures that we are able to attract and retain quality state employees who teach our children and protect our communities. It is important that Iowa wards off attempts to restructure the Iowa Public Employees’ Retirement System (IPERS) in ways that erode retirement security. For more, read our Roadmap piece, “IPERS works to boost retirees, economy.”

Further tax cuts

During the 2018 session, legislators passed a package of tax changes that largely benefit wealthy Iowans, with 2.5 percent of Iowa earners taking nearly half of tax cuts. The current administration has signaled support for further cuts that would endanger services that promote thriving communities such as education and healthcare. Read more on “What real Iowa tax reform would look like.”

Protecting Iowans’ health

Iowa’s privatized Medicaid system continues to cut off patient care and miss payments to providers. With little hope of returning the program to state control anytime soon, we must ensure that cost savings are achieved by increasing innovation and efficiency, not by undercutting health care providers or denying services to the sick and disabled. We should also stay away from Medicaid work requirements, which lead to disenrollment and additional barriers for elderly and disabled Iowans without meaningfully improving employment.[2] For more, read out Roadmap piece, “Restoring success of Iowa Medicaid.”

As noted above, this is not an exhaustive list — only a start. Stay up to date on our analysis through Facebook, Twitter, and our email newsletter.

[1] Chad Stone and William Chen, “Introduction to Unemployment Insurance.” July 2014. Center on Budget and Policy Priorities. https://www.cbpp.org/sites/default/files/atoms/files/12-19-02ui.pdf

[2] Center for Law and Social Policy, “Medicaid Works: No Work Requirement Necessary.” December 2018. https://www.clasp.org/publications/report/brief/medicaid-works-no-work-requirement-necessary

Natalie Veldhouse is a research associate for the nonpartisan Iowa Policy Project. nveldhouse@iowapolicyproject.org

Open Letter to Grinnell College

We could not in good conscience patronize campus facilities to discuss our work to advance economic opportunity and justice for all Iowans when a serious threat to workers’ rights was being mounted in front of us.

An Open Letter to the President of Grinnell College

The Iowa Policy Project Board of Directors met Tuesday in Grinnell. This would not normally be particularly noteworthy, but circumstances are not currently normal in Grinnell.

Grinnell College is a true asset to the state of Iowa, a private college with a strong educational reputation. Our organization has enjoyed holding our board meetings on the college campus in recent years, but this week decided we could not in good conscience patronize campus facilities and chose to relocate our scheduled meeting to a nearby off-campus restaurant.

We are deeply disturbed that the college’s leadership has so far refused to honor the results of a recent election in which student workers exercised their legal right to indicate their desire to bargain collectively with their employer. We were even more deeply disturbed that December 10th, one day prior to our meeting, the college took the extreme step of attempting to deny Grinnell student workers any rights as employees, via an appeal to the National Labor Relations Board. With this move, college leaders signaled their clear intent to trigger a federal Board decision that they know could in turn strip rights from millions of college and university employees (if they also happen to be students) across the country.

The college’s position matters to us because it matters for Iowa and the nation. We cannot promote the work our organization does to encourage economic opportunity and justice for the people of our state — including the rights of workers to organize and collectively bargain — and ignore a serious threat to those rights being mounted right in front of us.

We wish the college, its students, administrators, instructors and staff the best, and hope we will be able to return to campus for our next meeting upon learning the college has reversed its position.

Mike Owen
Executive Director, Iowa Policy Project

Tuition rising: Do students approve?

As I spoke to a University of Iowa finance class this week, I wondered: Did they vote?
I showed these students data on a variety of issues, closing with the reversal from state support to tuition as the largest share of funding Iowa universities, an issue affecting most if not all of the class. Here is what it looks like for the University of Iowa:
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We have more about this in our new “Roadmap for Opportunity” series. See this two-pager.
Today, The Gazette of Cedar Rapids landed on my doorstep with a page 1 story about the Board of Regents’ plans to raise tuition 3 percent to 5 percent a year for the next five years at the UI and Iowa State University. The size of the increase will depend on new funding. An increase of at least 3 percent a year results from years of cutting.
My talk to the finance class came six days after Iowa voters retained Statehouse leadership that has forced the regents to tell families to plan on tuition increases for the next five years. The regents’ plan implicitly shows they expect more of the same from the Legislature and Governor.
I told the students that I hoped they had voted, and that they would pay attention to the impacts of public policy choices on their lives. Maybe they did, and maybe they are OK with the policy choices made, and coming.
They will be living with these impacts — student loan debt among them — long after many of us are gone. If they want something different, they will have to speak up, and they will have to do so in large numbers.
M
Mike Owen is executive director of the nonpartisan Iowa Policy Project.
mikeowen@iowapolicyproject.org

Restoring equity in tax policy — Plug tax loopholes

Iowa is out of step with the majority of states by refusing to close corporate tax loopholes. Equity demands better.

Through the years in Iowa, very few lawmakers have had the courage to take on an utter abomination in our corporate tax system: tax loopholes.

It is one thing to expressly pass a tax preference — a credit, exemption or deduction — with a specific purpose, clearly defined for all taxpayers to see and reviewed for its effectiveness. (Iowa does not provide such accountability with many such preferences, but that is for another post.)

It is quite another thing, however, to see weaknesses in your tax code exposed and exploited by large companies, and to leave those holes open for routine abuse. Welcome to Iowa.

A new report by the Center on Budget and Policy Priorities discusses this issue as part of overarching tax policy that states can use to advance racial equity and sustain services responsibly. From the report:

States can nullify a variety of tax avoidance strategies employed by large multistate corporations by adopting a reform known as “combined reporting,” which treats a parent company and its subsidiaries as one entity for state income tax purposes, thereby minimizing companies’ ability to shift income earned in a state to other states that are tax havens (like Delaware and Nevada).

The figure below shows Iowa is out of step with the majority of states on this issue. All but one of our neighboring states has a corporate income tax, and all but one of those states has combined reporting to stop companies from avoiding taxes that were originally intended by the tax code to be collected.

The Iowa Policy Project and Iowa Fiscal Partnership have been encouraging Iowans to look at this issue for many years. We made it part of our 2018 Tax Policy Kit — explaining here how Iowa could save itself tens of millions of dollars that are squandered to companies that effectively set their own tax policy. The Iowa Taxpayers Association consistently defends this break that not only burdens our state, but tilts the playing field to big, multistate corporations and against Iowa-based, Iowa-focused businesses.

Two governors, Tom Vilsack and Chet Culver, at times proposed adoption of combined reporting, but the issue — while getting some attention at the committee level — has not reached a floor vote in the House or Senate.

Iowa’s tax code needs to be fair to all residents. It needs to generate revenue to sustain services that are important to all residents, from education to water quality to law enforcement to health care. To allow corporations to set their own rules by exploiting weaknesses in the tax code defies these oft-stated Iowa values of fairness and accountability.

Posted by Mike Owen, Executive Director of the Iowa Policy Project.

mikeowen@iowapolicyproject.org