But what have you done for me lately?

An astounding number of people have no idea what their government does for them — even as they benefit from government programs.

Source: Suzanne Mettler, "Reconstituting the Submerged State: The Challenges of Social Policy Reform in the Obama Era," via Sara Robinson, Campaign for America's Future

This NYTimes blog post is interesting enough, but what really caught my attention was a table from a recent academic political science paper that has made its way from liberal bloggers to a former Reagan economic advisor.

An astounding number of people have no idea what their government does for them, even as they benefit from government programs.

 

Posted by Andrew Cannon, Research Associate

Unfunded Mandates? Not Quite, Governor

What is clear is that the mandates in the Affordable Care Act are not “unfunded.” Though Iowa will be required to cover a small portion of the costs of the Medicaid expansion, this hardly qualifies as “shackl[ing] Iowa taxpayers.”

Andrew Cannon photo
Andrew Cannon

This week, Governor Branstad signed Iowa on to a multistate lawsuit challenging health care reform. In his statement announcing that Iowa would join the suit, Governor Branstad said the health reform law would “shackle Iowa taxpayers for billions in unfunded mandates.”

You may be wondering what “unfunded mandates” he’s referring to. So am I.

He might be talking about the individual responsibility requirement, since that is the provision that is being challenged in the lawsuit. Section 1501 of the Affordable Care Act requires all individuals to maintain health insurance coverage or face a tax penalty (with exemptions for those with religious oppositions or with financial difficulties).

But the individual mandate is not “unfunded;” indeed, it is largely funded by the federal government. Individuals and families earning up to 400 percent of the federal poverty level  ($88,200 for a family of four) are eligible for premium assistance. The vast majority of Iowa’s uninsured, approaching 300,000 Iowans, will be covered by the Affordable Care Act’s expansion of Medicaid. After the Medicaid expansion, the majority of the remaining Iowans will be eligible for the health insurance premium tax credits. Only about 27,400 Iowans earned more than 400 percent of the FPL ($88,200 for a family of four) and were uninsured, on average, from 2008 to 2010.

On the other hand, Governor Branstad could have been referring to the expansion of Medicaid as an “unfunded mandate.” As noted above, the Affordable Care Act vastly expands the Medicaid program, allowing all individuals with income below 133 percent of FPL ($29,326 for a family of four) to enroll. Medicaid is jointly financed by the states and the federal government, with the feds picking up the lion’s share of the tab. In normal times, the federal government pays for around 63 percent of the Medicaid program in Iowa; in recent years, that has been increased to around 71 percent, thanks to the federal Recovery Act.

But unlike traditional Medicaid, which comprises a large portion of the state’s budget, the Medicaid expansion will be almost entirely funded by the federal government. In other words, no unfunded mandate here, either. During the first three years, (2014-2016) the costs of expansion will be fully covered by the federal government. In subsequent years, the federal government’s share of the expansion costs will decrease, but not by much. In 2020 and beyond, Iowa will only be paying for 10 percent of the cost of the Medicaid expansion.

The fate of the lawsuit (and thus reform) is unclear, at this point, though experts and administration officials alike are confident that health reform will survive the legal challenges. Given the diverse rulings to date, the challenge will likely be resolved by the Supreme Court.

What is clear, however, is that the mandates in the Affordable Care Act are not “unfunded.” Though Iowa will be required to cover a small portion of the costs of the Medicaid expansion, this hardly qualifies as “shackl[ing] Iowa taxpayers.”

Posted by Andrew Cannon, Research Associate

Robbing the hungry tomorrow to help the sick today?

Deficit demagogues make points in Congress, but miss the point about good recovery policy.

Andrew Cannon, research associate
Andrew Cannon

Should we rob the hungry tomorrow to help the sick today?

Economic recovery efforts should be aiding both — and other vulnerable populations — and neither at the expense of the other.

Congress is showing renewed interest in passing an extension of the temporary increase in the federal government’s share of Medicaid financing.

The proposed extension, however, could come at a steep price. To offset the cost of extending the Medicaid increase, Congress is looking at reducing Supplemental Nutrition Assistance Program, or SNAP (formerly known as food stamps) by $6.7 billion.

Deficit demagogues may be making points in Congress, but they miss the point about good recovery policy.

It’s no secret that the federal budget deficit has grown over the past decade. But the long-term deficit is primarily due to a few select causes: the Bush tax cuts of 2001 and 2003 that heavily favored the highest earners, the deficit-financed wars in Iraq and Afghanistan, and the dip in tax revenues due to the recession.

Recession recovery efforts, such as the Recovery and Reinvestment Act of 2009, which included the original increase in federal Medicaid payments, add a negligible amount to the long-term deficit, while providing immediate benefits to the most vulnerable Americans and stimulating the economy. An analysis of Recovery Act provisions by Mark Zandi, chief economist at Moody’s Economy and former economic adviser to Sen. John McCain’s presidential campaign, estimated that every federal dollar invested in SNAP generates $1.74 of economic activity.

Congress will need to address deficit concerns. But doing so at the expense of the most vulnerable Americans doesn’t make sense fiscally, morally or economically.

Posted by Andrew Cannon, Research Associate

Medicare ‘Advantage’? Private carve-outs cost more

Private carve-outs such as Medicare Advantage drive up costs.

Bad policy should be bad politics.

Nevertheless, a group of members of Congress recently persisted in promoting a wasteful private-sector subsidy that undermines the highly successful Medicare program.

The Iowa Hospital Association, in a recent Twitter post, noted the letter from 58 House members against President Obama’s nomination of Dr. Donald Berwick to head the Center for Medicaid and Medicare Services. The letter claims that health reform could jeopardize so-called “Medicare Advantage” programs.

Public vs pvt insuranceWe can only hope.

As shown in the graph at right, public-sector health insurance provides better bang for the buck than private  insurance.

Moreover, specifically with regard to Medicare Advantage, substantial evidence and expert analysis has demonstrated the parasitic effects of such programs on traditional Medicare.

See an excellent primer that breaks down the problems with Medicare Advantage plans and why it is that these private carve-outs from Medicare drive up costs and make it more difficult to serve Americans who depend on Medicare.

Posted by Mike Owen, Assistant Director

High stakes for Iowa in Congress’ decisions

Understanding these benefits and the consequences of losing them needs to be paramount in congressional decisions about temporary, targeted extensions of ARRA funding.

Andrew Cannon, research associate
Andrew Cannon

Today’s New York Times discusses a problem faced by 30 states — including Iowa.

State budgets have been put together assuming the extension of an increased reimbursement for Medicaid, a smart move for economic recovery and a necessary move to help states deal with the increased demands in a severe economic recession.

For Iowa, the loss of those dollars would cause a Medicaid deficit of almost $120 million, according to the nonpartisan Legislative Services Agency.

When building the state’s 2011 fiscal year budget this spring, Iowa lawmakers assumed the federal government would extend a temporary increase in its share of Medicaid financing. The American Recovery and Reinvestment Act of 2009 (ARRA) temporarily increased the Federal Medical Assistance Percentages (FMAP), the portion of Medicaid financed by the federal government. That increase, however, expires in December 2010, right in the middle of Iowa’s fiscal year. Iowa and many other states expected this financing to continue as these needs have not subsided.

So far, however, Congress has not acted. Without an extension, Iowa faces a shortfall that at some point will need to be addressed, with cuts in services that could come both in and outside the Medicaid program. Either way, a cut would be bad for the economy, which has benefited from the infusion of federal dollars. Pennsylvania Governor Edward Rendell, in fact, warns in the New York Times story today that in his state, the cuts “would  actually kill everything the stimulus has done.” His concern is warranted.

Besides shoring up state revenues, as Iowa Fiscal Partnership reports have shown, ARRA has brought significant economic benefits to Iowa to enhance the prospects of a faster recovery. For the Medicaid match alone, IFP reported in Just What the Doctor Ordered:

Every federal dollar of economic stimulus invested in Medicaid yields about $1.68 in total output for the state of Iowa. Out of that dollar, 76 cents is returned to Iowa workers in the form of wages and salaries and incomes of small business owners.

ARRA — by providing dollars for Medicaid, unemployment insurance and food assistance — has come through with important resources for vulnerable Iowa families at a time they are most needed. At the same time, it has boosted the economy by increasing or maintaining spending by Iowans on goods and services, keeping people employed and spending their money in the economy.

Understanding these benefits and the consequences of losing them needs to be paramount in congressional decisions moving forward on temporary, targeted extensions of ARRA funding.

Posted by Andrew Cannon, Research Associate

Numbers, numbers, numbers … People!

It’s a familiar refrain in the office each month when we put together our analysis of Iowa’s latest job numbers: There sure are a lot of numbers!

That’s an understandable reaction. Too many numbers can obscure the message, something we consider in our analysis of public policy issues at the Iowa Policy Project.

So, we try to strike the right balance. How many numbers do we need to tell the story — accurately and in context?

Goodness knows these days, too many people out there will torture numbers to extremes if it helps their message. We prefer to review the numbers and then figure out what the message should be.

This month, as IPP Executive Director David Osterberg noted in his comments in our news release, “Good news is hard to find in these numbers.” There was only a 200-job loss in nonfarm jobs in August — but even that good news came with a major downward revision in the previous month’s numbers. July’s job loss, previously reported at 2,400, is now recorded at 4,400.

Iowa payroll jobs have dropped in 11 of the last 12 months
Iowa payroll jobs have dropped in 11 of the last 12 months

Furthermore, those numbers show Iowa:

  • has lost payroll jobs in 11 of the last 12 months. (See graph at right.)
  • has shown a net loss of 49,400 nonfarm jobs in that same period — 28,000 of them in manufacturing.
  • has seen its unemployment rate jump to 6.8 percent in August from 4.2 percent a year earlier (an increase of over 60 percent).

And we could go on, with lots more numbers. And as long as they help to tell the story, we will do that.

But they will only tell the story if we always keep in mind that those numbers represent people — Iowans, our friends and neighbors — and the places they can go to work and support their families.

We can’t wait until those numbers start looking better, month after month. That will make it a little easier when we look at our first draft and say, There sure are a lot of numbers!

Posted by Mike Owen, Assistant Director

Federal stimulus impacts on Iowa

Here is a look at some of the impacts of the American Recovery & Reinvestment Act in Iowa:

FMAP (Medicaid percentage increase) FY2009-11 — $550.0 million

State Fiscal Stabilization (Flexible block grant) — $ 86.0 million

Education/ Child Care:

State Fiscal Stabilization fund (education) FY2009-10$386.4 million

Title 1 (supplemental support) — $65.3 million

IDEA (special education state grants)—$120.9 million

Child Care & Development Block Grant FY2009-10 — $18.1 million

Child Support FY2009-10 — $27.2 million

Unemployment Insurance (UI):

UI Benefit Increase ($25/week) — 212,422 recipients

UI Emergency Extension to 12/09 — 27,600 new beneficiaries

Employment Services FY09:

Youth Services — $5.2 million

Dislocated Workers — $6.3 million

Adult Activities — $1.6 million

Making Work Pay Credit — 1,110,000 taxpayers

Food Stamps FY2009-13:

Benefit Increase — $161 million and 279,000 recipients

Administration — $2.7 million

Child Tax Credit (tax year 2009 — lowers threshold to make credit available to families at $3,000 earnings):

Number helped lowering $8,500 threshold — 133,000

Number helped lowering $12,550 threshold — 156,000

Emergency Shelter Grant Pgm FY091 Add’l Funds — $16.8 million and 4,500 households