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America needs help building a more perfect union, again? “Scarcity changes how we think”

The current Republican victory either threatens healthcare access success or saves the day.  Perhaps it depends on what ideas you have to form an opinion on the matter.  Thousands of people inherit political and controversial opinions from their parents or grandparents.  But this is not our grandparent’s America.   Leadership today, and ideas to formulate solutions to our society’s most vexing social and economic challenges, must be as innovative as the ideas our forefathers forged to build our constitution.  They broke new ground to form a more perfect union.

America needs help in being more perfect today.  We need new ideas to help us support new social investments to address our collective responsibility to make sure that our form of government, and the leaders we put in charge, keep a fair balance regarding the social contract that makes us the greatest nation on earth.  Perhaps reading the current book “Scarcity: Why Having Too Little Means So Much,” by Mullainathan and Sharif, could help?

Jus about a year ago an important book was published regarding scarcity.  We were all probably a bit busy, so it did not cross our minds.  Interestingly, the book is about the very social and psychological reality that caused many of us to miss the opportunity.   We just don’t seem to have enough time in the day to do the things we need to do to make our life more manageable, more simple and, perhaps, more enjoyable.  Without mentioning the dated and overused thought model, “Maslow’s hierarchy of needs,” we are reminded of a person’s lack of efficacy when overwhelmed by environmental stimuli that dictate how we feel and perhaps what we do.  Such is the case in this important book on the effects on our minds and how our mind works when confronted by daily challenges.  The mind, the book’s thesis goes, has limits (“bandwidth”), and its focus is bound by our fixation on what matters among the many things coming at us.  The book is important for public health, healthcare services and health education, for example, because it gives us a less pejorative and judgmental way to look at people misbehaving.  Especially behaving in ways that seem irrational, or worse, lazy or undeserving, to us. Perhaps as health professionals, funders, planner and policy makers, we are distanced from the daily lives and realities of those confronted with our well intentioned helping systems and recommendations.   It can be daunting and frustrating.   This book may give us  hope.

Mullainathan and Sharif elaborate on a conception of the haves and the have nots that is nuanced, insightful and perhaps more pragmatic than any construct we have heretofore seen; Yes, in the war on poverty.  To be sure, decades have passed since our last great poverty reform (PRWORA, 1996 or Bill Clinton’s Welfare Reform Law).  We now have the ACA reform (Barak Obama’s Law).  This second salvo on our nation’s efforts to address the needs of the “have nots” is once again putting the poor under the looking glass.  Back in the 90s version we were looking at people, being helped, being too lazy and needing to be made to work while getting help in order to get off of the government dole.  Millions of people were thrown off of the welfare rolls and when it was all said and done a Government Accounting Office (GAO) report declared that the majority of people remaining on the rolls were ill and not employable.  This was an important report, by “objective” pundits representing the federal government; and you would think that would have been enough to usher in healthcare reform to address the urgent plight of this government policy defined and “vetted” group.  It wasn’t.

Perhaps due to our national political discourse and the focus on levels of unemployment that could not longer be explained by the “lazy people on welfare” phenomenon, the nation began to focus on working people, many who were not faring much better than people on welfare.  The struggling middle class and the “deserving working poor” became the popular political constituency.  The increasingly divided electorate called for new issue that could wedge open the door to a new group that could tip the electoral balance.  This need fueled to drive for an electoral strategy focus on new votes and created the conditions and demand for strategies promising to move this demographic to the polls.  Enter today’s healthcare reform scenario.

Perhaps this is why healthcare reform remains a political fight with uncertainties and future possibilities for failure.  Just as the end of the PRWORA’s success, in throwing the poor of the welfare rolls, may now echo the present reality where we will have disrupted thousands of families’ lives, only to throw them off the insurance rolls.

“Scarcity captures us because it is important, worthy of our attention, but we cannot fully choose when our minds will be riveted. We focus on scarcity even when we do not want to. We think about that impending project not only when we sit down to work on it but also when we are at home trying to help our child with her homework. The same automatic capture that helps us focus becomes a burden in the rest of life. Because we are preoccupied by scarcity, because our minds constantly return to it, we have less mind to give to the rest of life.”

via Scarcity changes how we think – Salon.com.

Filed under: Behavioral Health Outcomes, Blogosphere, Children and Poverty, Congressional Activity, consumers, Health Policy, Healthcare Reform, Policy ThinkShop Comments on other media platforms

Find out how your state is doing on ACA implementation. Health Policy Center at the Urban Institute | Independent research for better health policy

One of the most important differences between states in their ACA implementation experience is each state’s policy perspective on the social safety net.  Some states tend to be more liberal regarding healthcare.  Others see all safety net issues the same–they don’t want to pay for them and they certainly don’t want to expand them.  The details of how each state is faring and the comparison between various states you may be interested in follows …

The Policy ThinkShop facilitates your access to the complete Policy Brief update on state comparisons of ACA implementation at:

http://www.urban.org/uploadedpdf/413129-Eligibility-for-Assistance-and-Projected-Changes-in-Coverage-Under-the-ACA-Variation-Across-States.pdf

 

“The authors estimate that in 2014, 56 percent of the uninsured became eligible for financial assistance with health insurance coverage through Medicaid, CHIP, or subsidized marketplace coverage.  In states that expanded Medicaid eligibility, 68 percent of the uninsured became eligible for assistance, compared with only 44 percent in states that did not.  Because of this difference in eligibility, the ACA is projected to reduce the number of uninsured people by 56 percent in states that expanded Medicaid, compared with only 34 percent in states that did not.  The authors also provide estimates of what would happen if states that have not yet expanded Medicaid were to do so. Read more …”

More via Health Policy Center at the Urban Institute | Independent research for better health policy.

Filed under: ACA and Medicaid, Blogosphere, Children and Poverty, consumers, Health Literacy, Health Policy, Healthcare Reform

Addressing Deep and Persistent Poverty: A Framework for Philanthropic Planning and Investment

Given the last decade of a deep and lingering economic downturn, mortgage failures, Wall Street scandals and scams that brought much misfortune to the otherwise fortunate, poverty is no longer a controversial topic that afflicts the few and shakes the policy corridors of Washington.  The new poverty, according to most experts, affects families and children, the hard to employ and many struggling families who face their at home kids’ college loan bills without the benefit of Jr.’s paycheck.

Perhaps now is a good “quiet and tranquil” time to study the issue of the less fortunate without the cacophony of stakeholder voices drowning out reason.  Perhaps now that Occupy this and that has all but disappeared, the issue of poverty can occupy the voices of reason …

To be sure, the JPB foundation and the Urban Institute have recently partnered to produce an intelligent overview and analytical tools for looking, not only at poverty, but at what they term “deep poverty.”

The Policy ThinkShop provides you with the following link at an article to peruse the issue or the following downloadable report which will give you a deeper look at the deep poverty issue:

http://www.urban.org/UploadedPDF/412983-addressing-deep-poverty.pdf

“The JPB Foundation engaged the Urban Institute to provide background on the problem of deep and persistent poverty in the United States. This paper summarizes the history of US antipoverty policies, synthesizes existing knowledge about poverty and deep poverty, and presents a framework for understanding the complex and multi-faceted landscape of antipoverty efforts today. It also draws on interviews with over 30 experts, philanthropists, and thought leaders in the field to review and distill the most current thinking about promising strategies for tackling deep and persistent poverty. Drawing on these facts and insights, we present a series of questions and choices that any foundation wishing to invest in this area would be well-advised to consider.”

More via Addressing Deep and Persistent Poverty: A Framework for Philanthropic Planning and Investment.

Filed under: ACA and Medicaid, access to education, Blogosphere, Children and Poverty, Data Trends - American Demographics and Public Opinion, Demographic Change, Feminization of Poverty, Medicaid Expansion, News, Public Policy

The Middle Class Is Steadily Eroding. Just Ask the Business World. – NYTimes.com

The business world is always selling us something.  And thank God!  

Buying and selling is a huge part of our culture.  Measuring the value of what we own and what that means to us and those around us is also central to our social experience and identity.  America is about progress and the pursuit of happiness is at its very essence; we must always strive to have things and be places.  Understanding our place in the American social hierarchy  may not be as simple as counting our possessions though.  We are all Americans but we are not all equal–not even close.  Being an American is real.  But what about the so called “Middle Class”?  Have you seen it?  Do you possess a piece of it?  Are you standing in it?  If you can make a good argument that you are in it, will your children share as lofty an address?

Today’s NYTs clamors about yet another elusive metaphor that we have lived by: The Middle Class.  Illusive and metaphor because we cannot be sure if it really ever existed, at least not in all its Hollywood and public media glory.  Like the nuclear family propelled and burned into the public mind by popular TV shows like “Father Knows Best,” the middle class is a very inclusive category which most Americans strive to get into;  and yet another very important segment labors to stay above and beyond it (including today’s infamous top 1%).

For hundreds of years the extended family and agrarian life dominated gender relations, work, time and leisure.    The modern middle class and Levittowns (Levittown was the first suburb and is considered the “archetype” for America’s suburbs America’s.) are an economic creation buttressed by Hollywood and Madison Avenue cultures.  The Nuclear family of “Mom, DAD and Children,” can be similarly understood as an ideal.   Nevertheless, in perhaps a nostalgic way, today’s popular media considers the Middle Class in danger of disappearing, if nothing else, from our imaginations.  In historical terms the middle class was here for about a relative minute.  Gone so soon?

“In Manhattan, the upscale clothing retailer Barneys will replace the bankrupt discounter Loehmann’s, whose Chelsea store closes in a few weeks. Across the country, Olive Garden and Red Lobster restaurants are struggling, while fine-dining chains like Capital Grille are thriving. And at General Electric, the increase in demand for high-end dishwashers and refrigerators dwarfs sales growth of mass-market models.”

via The Middle Class Is Steadily Eroding. Just Ask the Business World. – NYTimes.com.

Filed under: access to education, Blogosphere, Children and Poverty, consumers, Culture Think, Data Trends - American Demographics and Public Opinion, Demographic Change, Economic Recession, Economic Recovery, Education Policy, Education Reform, New American Electorate, News, Parenting, Philanthropy, Policy ThinkShop Comments on other media platforms, Political Economy, propaganda and spin, Public Policy, WeSeeReason

How Will the Uninsured in New Jersey Fare Under the Affordable Care Act? | The Henry J. Kaiser Family Foundation

Read the following resource from the Kaiser Family Foundation brought to you by The Policy ThinkShop… Read the information below and then download the following fact sheet about NJ and the Affordable Care Act’s impact on poor families. Be sure to share this resource with others….

http://kaiserfamilyfoundation.files.wordpress.com/2013/12/8531-nj.pdf

The 2010 Affordable Care Act (ACA) has the potential to extend coverage to many of the 47 million nonelderly uninsured people nationwide, including the 1.3 million uninsured New Jerseyans. The ACA establishes coverage provisions across the income spectrum, with the expansion of Medicaid eligibility for adults serving as the vehicle for covering low-income individuals and premium tax credits to help people purchase insurance directly through new Health Insurance Marketplaces serving as the vehicle for covering people with moderate incomes. The June 2012 Supreme Court ruling made the Medicaid expansion optional for states, and as of December 2013, New Jersey was planning to implement the expansion in 2014. As a result, the ACA will be fully implemented in New Jersey, and almost all nonelderly uninsured, most of whom are adults, are eligible for coverage expansions. As the ACA coverage expansions are implemented and coverage changes are assessed, it is important to understand the potential scope of the law in the state.

How Does the ACA Expand Health Insurance Coverage in New Jersey?

8531 - NJ Figure 1

Historically, Medicaid had gaps in coverage for adults because eligibility was restricted to specific categories of low-income individuals, such as children, their parents, pregnant women, the elderly, or individuals with disabilities. In most states, adults without dependent children were ineligible for Medicaid, regardless of their income, and income limits for parents were very low—often below half the poverty level.1 The ACA aimed to fill in these gaps by extending Medicaid to nearly all nonelderly adults with incomes at or below 138% of poverty (about $32,500 for a family of four in 2013).  Thus, as of January 2014, Medicaid eligibility in New Jersey covers almost all nonelderly adults up to 138% of poverty, as shown by the dark blue shading in Figure 1. All states previously expanded eligibility for children to higher levels than adults through Medicaid and the Children’s Health Insurance Program (CHIP), and in New Jersey, children with family incomes up to 355% of poverty (about $83,600 for a family of four) are eligible for Medicaid or CHIP. As was the case before the ACA, undocumented immigrants remain ineligible to enroll in Medicaid, and recent lawfully residing immigrants are subject to certain Medicaid eligibility restrictions.2

Under the ACA, people with incomes between 100% and 400% of poverty may be eligible for premium tax credits when they purchase coverage in a Marketplace. The amount of the tax credit is based on income and the cost of insurance, and tax credits are only available to people who are not eligible for other coverage, such as Medicaid/CHIP, Medicare, or employer coverage, and who are citizens or lawfully-present immigrants. Thus, the effective lower income limit for tax credits in New Jersey is 355% of poverty for children and 138% of poverty for adults, as indicated by the bright blue shading in Figure 1 Citizens and lawfully-present immigrants with incomes above 400% of poverty can purchase unsubsidized coverage through the Marketplace.

How Many Uninsured New Jerseyans Are Eligible for Assistance Under the ACA?

8531 - NJ Figure 2

With New Jersey deciding to implement the Medicaid expansion, over six in ten (63%) uninsured nonelderly people in the state are eligible for financial assistance to gain coverage through either Medicaid or the Marketplaces (Figure 2). Given the income distribution of the uninsured in the state, the main pathway for coverage is Medicaid, with over a third (37%) of uninsured New Jerseyans eligible for either Medicaid or CHIP as of 2014. While some of these people (such as eligible children) are eligible under pathways in place before the ACA, most adults are newly-eligible through the ACA expansion.  About a quarter (26%) of all uninsured people in New Jersey are eligible for premium tax credits to help them purchase coverage in the Marketplace.

Other uninsured New Jerseyans may gain coverage under the ACA but will not receive direct financial assistance. These people include the 19 percent with incomes too high to be eligible for premium tax subsidies or who have an affordable offer of coverage through their employer. Some of these people are still able to purchase unsubsidized coverage in the Marketplace, which may be more affordable or more comprehensive than the coverage they could obtain on their own through the individual market. Lastly, the approximately 18 percent of uninsured people in New Jersey who are undocumented immigrants are ineligible for financial assistance under the ACA and barred from purchasing coverage through the Marketplaces. This group is likely to remain uninsured, though they will still have a need for health care services.

via How Will the Uninsured in New Jersey Fare Under the Affordable Care Act? | The Henry J. Kaiser Family Foundation.

Filed under: ACA and Medicaid, Blogosphere, Children and Poverty, consumers, Health Literacy, Health Policy, Healthcare Reform

What’s So Bad About Income Inequality?

Adam Smith played an important part in our understanding of how society affects the evolution of civil society and business.  As mathematics and reason improved economic theory through the development of rational choice theory, econometrics and mathematical modeling, economists took an important role at the governance table of most democracies.

The current deep and long recession and the troubling recovery, however, have cast some doubt on prevailing economic theories and their pundits and disciples.   Perhaps the turning points were the Enron scandal and Madoff caper because the inequality that pervades America today is not going away.  Somehow we have arrived at the moment when we are looking at values and relative differences between those who climb the ladder and those for whom there seems to be no ladder at all.  As America continues to be decided on ideological grounds and social space and social relations continue to be segregated in terms of education, access to higher paying jobs and wealth, it becomes increasingly difficult to see an American future where a large middle class supports the notion that everyone who tries hard can make it here.  That is a significant problem that is now seemingly being institutionalized as the American economy fails to create a necessarily clear and reasonable path between birth and upward mobility.

“One interpretation of the Pareto Principle, which suggests that 20% of the people own 80% of the wealth, is that there\’s no point in being angry about that inequality. Maybe the 20% is doing better than you because they went to college and you didn\’t — but that\’s not hurting you.

Dr. Deaton: I agree with the Pareto Principle, but you can be hurt by that kind of inequality, and that can happen in many different ways. If a bunch of people get extremely rich but nothing happens to your income, that\’s OK. But if they use their wealth to start buying the government, for instance, then it\’s not OK, because you don\’t get your share in the democracy anymore.

I\’ll give you an example from the U.S. right now. If you\’re a drug manufacturer and you come up with a blockbuster drug that does very well, eventually the patent runs out. Your business could let the patent run out and let the generics manufacture that drug, which is what\’s supposed to happen. But your company could also spend a lot of money lobbying Congress to get an extension of your patent. That\’s an example of blocking equality, and it hurts people. And economists have been very weak on that.

Like everyone, we economists specialize in what we do. So economists think we\’re the gods of income; we tend to think about well-being in terms of income, and we don\’t worry too much about the other things that contribute to well-being, such as health, education, or participating in a democratic society. But not having access to an important medicine doesn\’t show up as a share of GDP.

When we think about well-being, we can\’t just think about wealth. That\’s one of the things we\’ve learned from the Gallup World Poll — how important many other elements are to a person\’s satisfaction with his life.”

via What’s So Bad About Income Inequality?.

Filed under: access to education, Blogosphere, Children and Poverty, consumers, Demographic Change, Economic Recession, Economic Recovery, Education Policy, Education Reform, Job Sector, News, Political Economy, Pundits

Getting into Gear for 2014: Insights from Three States Leading the Way in Preparing for Outreach and Enrollment in the Affordable Care Act | The Henry J. Kaiser Family Foundation

Policy ThinkShop Resources to help you stay on top of today’s leading policy issues:  Healthcare Reform implementation — The Affordable Care Act

http://kaiserfamilyfoundation.files.wordpress.com/2013/09/8480-getting-into-gear-insights-from-three-states.pdf

 

“Fall 2013 will begin to usher in the key health insurance coverage expansions of the Affordable Care Act (ACA), with open enrollment in new health insurance Marketplaces beginning on October 1, 2013, and Medicaid expanding to adults in states moving forward with the ACA Medicaid expansion as of January 1, 2014. During summer 2013, with open enrollment rapidly approaching, many states were in high gear to finalize preparations for outreach and enrollment efforts to help translate these new coverage options into increased coverage for millions of currently uninsured individuals. This report provides insight into preparations in Maryland, Nevada, and Oregon -three states that have established a State-based Marketplace, are moving forward with the Medicaid expansion, and are among the states leading the way in preparing for outreach and enrollment. The findings provide an overview of where these three states are in establishing their Marketplaces; preparing for the Medicaid expansion; planning for marketing, outreach and enrollment; and establishing enrollment assistance resources. They also highlight the challenges that states have encountered and overcome, the successes they have achieved, and the key lessons that may help inform implementation efforts moving forward.”via Getting into Gear for 2014: Insights from Three States Leading the Way in Preparing for Outreach and Enrollment in the Affordable Care Act | The Henry J. Kaiser Family Foundation.

Filed under: ACA and Medicaid, Blogosphere, Children and Poverty, consumers, Health Literacy, Health Policy, Healthcare Reform, Maternal and Child Health, Medicaid, Medicaid Expansion, News, Public Health, Public Policy

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