The Shriver Brief : Poverty Law Commentary & Insights : Sargent Shriver National Center on Poverty Law : Affordable Housing, Healthcare Reform

Over the past 20 years, electronic deposit and electronic benefit transfers (EBT) have replaced paper checks for the delivery of public assistance benefits. EBT systems deliver government benefits by allowing recipients to use a plastic card to access their benefits through ATMs and point of sale (POS) devices located in select retail outlets.

One reason that EBT systems have become so popular is that states have found that they can save millions of dollars by "outsourcing" the provision of these benefits to big financial firms. In fact, JP Morgan is the largest processor of food stamp benefits in the United States.

JP Morgan has contracted to provide food stamp debit cards in 26 states and the District of Columbia. JP Morgan is paid for each case that it handles, so that means that the more Americans that go on food stamps, the more profits JP Morgan makes. Considering the fact that the number of Americans on food stamps has exploded from 26 million in 2007 to 43 million today, one can only imagine how much JP Morgan's profits in this area have soared.

J.P. Morgan also provides unemployment insurance benefit debit cards in seven states which is ironic since it, along with other big Wall Street banks, was a major contributor to the financial collapse that lead to tens of thousands of Americans becoming unemployed. 

It seems grossly unjust that the very Wall Street financial institutions that caused the recession and received bailouts from the U.S. government and tax dollars during the financial crisis are now making money off the recession and their victims again – low income families and taxpayers. Moreover, one of the programs that was on the chopping block during the debt debate was the food stamp program. In other words, Congress was prepared to cut food assistance to families, but did not even bother examining whether big banks’ profits from administering food stamp program benefits should be cut.

As part of the recent Wall Street reform, the Consumer Financial Protection Bureau (CFPB) was created by the Dodd-Frank Wall Street Reform and Consumer Protection Act. The CFPB, which became operational on July 21^st, is now the sole federal agency focused on consumer protections. Among its responsibilities is supervision and enforcement with respect to the laws over providers of consumer financial products and services. As such, one of its early efforts should be to review the practice of continuing to allow financial institutions to profit off the very consumers they helped to defraud and deplete their assets in the first place.

To learn more about the CFPB visit its website.

To learn more about issues surrounding the electronic payment of public benefits you can view the Shriver Center’s webinar, The Next Frontier: in Public Assistance: Electronic Payment Cards.

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The United Nations (UN) has affirmed that maternal health care is an international human right – a right of all women, regardless of their race, ethnicity, income, or citizenship status. In its landmark decision on the case Alyne da Silva Pimentel v. Brazil, the United Nations Committee on the Elimination of Discrimination Against Women established that governments have an obligation to guarantee that all women in their country have access to adequate and timely maternal health care, including emergency services, even if the government outsources health care to private institutions.

The 1979 Convention on the Elimination of All Forms of Discrimination Against Women established that governments must ensure that women receive appropriate prenatal and postnatal services (Article 12), but a maternal death case had never been brought before the UN. In 2007, the Center for Reproductive Rights brought a case against Brazil before the UN committee, and this month this first ever case involving maternal death was decided by an international human rights body. The case involved the 2002 death of a 28-year-old Afro-Brazilian woman who died in her sixth month of pregnancy from preventable complications because of misdiagnosis and delayed treatment. The UN Committee concluded that Brazil had violated the international human rights of women through discriminatory maternal health practices made clear by its history of inequitably distributing maternal health care facilities across regions, a practice that ultimately resulted in Ms. Pimentel’s untimely and preventable death. The decision signals a commitment by the UN to uphold women’s rights to maternal health services and reaffirmed that it is a human right to receive appropriate, adequate, and timely maternal health care.

The case laid bare the stark injustice women and girls face in seeking quality health care in Brazil and around the world. The inequitable distribution of maternal health care facilities in Brazil led to disproportionately low concentrations of adequate maternal health in low-income areas and areas with high concentrations of people of color. Although Brazil’s overall maternal death rate has decreased – recent numbers place it at 58 per 100,000 live births – significant disparities remain along the lines of race, economic status, and region.  

Unfortunately, Brazil is not alone in having starkly disparate maternal death rates based on race. In the United States, African American women, regardless of income, are four times more likely than white women to die of pregnancy-related complications (page 1). This has resulted in an overall maternal death rate for African American women of 26.5 per 100,000 live births (table 34) and rates as high as 83.6 per 100,000 live births in New York City (page 4). Indeed, the U.S. women most likely to die of pregnancy-related complications are low-income women of color.  

Compared to other industrialized countries, however, all women in America have high maternal death rates. With an overall maternal death rate of 12.7 per 100,000 live births (table 34), the United States ranks 50^th in the world. This is an embarrassingly low rank for a country that spends the most money on health care in the world and the largest percentage of its health care costs on maternal health. To put this in perspective, a woman in the United States, regardless of race or income, is three times more likely to die in childbirth than a woman in Spain, and five times more likely to die in childbirth than a woman in Greece (page 1).

For the United States, the problem is not necessarily quality of health care, but rather access to it. Federal and state governments have programs in place to serve pregnant women and provide them with appropriate care. Many low-income pregnant women, regardless of race, age, or citizenship status are eligible for Medicaid, which allows women to receive health coverage for pre-natal and post-natal medical treatment. Indeed 42 percent of all births are covered by Medicaid, and no woman in active labor can be turned away from a hospital because of her ability to pay. Many women, however still face barriers to receiving adequate health care under Medicaid, such as transportation concerns, inflexible appointment hours, and difficulty taking time off work. Doctors, too, may be unwilling or unable to take Medicaid because of the low fees and high costs involved (page 5).    

The Patient Protection and Affordable Care Act moves the right to health care forward by requiring insurers to provide some preventive services for women at no cost, such as well-women visits, and expanding Medicaid coverage. These provisions will mean that thousands more pregnant women will receive the health care they need. But estimates indicate that thousands more women will still be in need. Many women who will now qualify for Medicaid will still face barriers in receiving quality maternal care. With the Alyne da Silva Pimentel v. Brazil decision, the UN has reinforced that maternal health care is a fundamental human right. The United States must reaffirm its commitment to women and help lead the way to lower the unacceptably high rate of preventable maternal deaths within its own borders by ending discriminatory practices and ensuring quality maternal health care for all women.

This post was coauthored by Hannah Green.

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Accumulating savings and building assets is the precursor to going from just getting by to getting ahead. Unfortunately federal and state public benefit programs actually discourage and penalize applicants and recipients who try to save and become economically mobile. 

Most states impose both income and asset or resource tests to ensure that benefit programs serve only those who truly need them. Income and asset tests vary from program to program and from state to state, and few caseworkers, not to mention applicants or recipients, completely understand what is allowed and what is not.

In terms of public policy, asset tests send the wrong message—that having assets is a bad thing. Specifically, asset limits lower the net worth of potentially eligible low-income individuals and families and discourage savings, thus serving as a barrier to financial security and upward mobility. Imposing and administering asset tests to a group largely without assets is also a waste of state resources that could be better spent on expanding benefit amounts. Finally, asset tests are unfair in that they often treat similar types of assets differently. All states, for instance, exclude defined benefit retirement savings, but most do not exclude 401(k) plans or individual retirement accounts (IRAs), even though all are retirement savings. For these reasons, there is a growing push, through legislation or administrative rule changes, on both the federal and state level, to eliminate asset tests completely, raise the amount of permissible assets, and/or expand the categories of excluded assets. 

On the federal level, the United States Department of Agriculture recently issued proposed rules to exclude retirement and education accounts from countable resources under the Supplemental Nutrition Assistance (SNAP) program. Asset tests under the federal Supplemental Security Income (SSI) program have also been targeted for reform. Like most public benefit programs, SSI is limited to those who have no more than $2,000 in assets for an individual and $3,000 for a couple. All resources deemed accessible to an individual, including defined-contribution retirement accounts, such as 401(k)s and IRAs are counted. To address this situation, the proposed federal SSI Savers Act of 2011 would increase asset limits from $2,000 (single) and $3,000 (married) to $5,000 and $7,500 respectively, index those limits to inflation and for recipients younger than 65, and exclude retirement accounts, education savings, and individual development accounts from counting against the limit.

In terms of state initiatives, states have the authority to reform asset rules in state-administered assistance programs, including Temporary Assistance for Needy Families (TANF), SNAP, Medicaid, and the state’s children’s health insurance program (SCHIP), to make the rules simple, efficient, and fair, and to encourage saving and asset building. Thus, states may set their own asset limits, exempt categories of assets, or eliminate asset limits altogether, and an increasing number of states have utilized this authority. 

At least three states, Ohio, Louisiana, and Virginia, have eliminated asset tests entirely in their TANF programs. Ohio was the first state to abolish asset limits in TANF; it did so in 1997. Although Ohio budget analysts predicted a small increase in the TANF caseload as a result of eliminating the asset test, no caseload increase or political fallout occurred. In 2003, Virginia adopted administrative rules that eliminated asset limits in the TANF and family and child medical programs, evaluated only liquid assets in the Food Stamp Program, and eliminated the TANF lump-sum rule, which made recipients ineligible for cash assistance after receiving a lump-sum payment such as retroactive SSI benefits or a personal injury settlement. Even more states have eliminated asset limits in their SNAP and Medicaid programs.

Several states that have not eliminated asset tests have nonetheless reformed their asset rules by increasing the amount of cash resources that recipients are permitted to have and by exempting certain forms of assets entirely. In 2005, Illinois excluded retirement accounts from asset tests in TANF and General Assistance. In 2006, Colorado passed legislation that raised TANF asset limits from $2,000 to $15,000 and exempted retirement, education, and health savings accounts and one vehicle per household. California passed a law exempting retirement and educational accounts from consideration as assets for recipients (but not applicants) in CalWORKs (California Work Opportunity and Responsibility to Kids, the state’s TANF program) and recently introduced a bill to exclude the value of a licensed motor vehicle from consideration when determining or re-determining CalWORKs eligibility.

Abolishing asset limits sends a clear message that saving and building assets are encouraged. While complete elimination of asset rules may not always be politically feasible, advocates can pursue substantially raising asset ceilings and exempting additional categories of assets, with the ultimate goal of removing them entirely at a later date.

For more information about reforming asset limits read the Shriver Center’s article on “Reforming State Rules on Asset Limits: How to Remove Barriers to Saving and Asset Accumulation in Public Benefit Programs,” in the March-April 2007 issue of Clearinghouse Review.

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American poverty lawyers of all specialties often hesitate before using international human rights arguments and publications in their daily work, and for good reason: the American bench has a decidedly mixed track record when it comes to citing international human rights as persuasive authority. But the 2011-2012 report on progress of the world’s women by U.N. Women, the United Nations’ organization for gender equality and women’s empowerment, is a valuable tool for women’s advocates trying to incorporate human rights standards into their practice. Progress of the World’s Women: In Pursuit of Justice, makes it clear that international human rights publications can provide advocates with useful arguments, information, models, and contacts for future collaborations—bolstering advocates’ work even if international human rights are never explicitly mentioned in the courtroom.

Appropriately enough for lawyers, U.N. Women’s new report focuses on the impact that laws and justice systems have on women and girls around the world. The authors scrutinize legal barriers that women have to face, as well as the innovative ways that advocates are devising to rip them down. This document can be a helpful resource in several respects:

• The report discusses The Convention on the Elimination of All forms of Discrimination against Women at great length and incorporates the convention into its discussion of women’s issues. Although the United States has only signed, not ratified, this treaty, it has been ratified by 186 U.N. Member States and is often recognized as persuasive by American judges. The report prompts advocates to think about using the convention in new ways.
• Each chapter of the report explores justice-related topics as well as monumental cases that have changed women’s lives, and each section is illustrated by statistics and studies that advocates can refer to in briefs or policy campaigns. For example, the first chapter, Legal Frameworks, discusses women’s struggle to achieve equal pay for equal work, noting that “[b]ased on available information from 83 countries, the ILO reports that women are generally paid between 10 and 30 percent less than men.” This upsetting statistic could be useful for women’s advocates working on equal pay issues; similarly helpful statistics are omnipresent throughout the report.
• Whether discussing noteworthy cases, legal pluralism, or violence against women, the U.N. Women report constantly refers to organizations and government entities that are working to improve justice for the world’s women. Reading the U.N. report can provide advocates with new models for their own work, as well as potential allies in other jurisdictions.

For more information on how to incorporate human rights arguments into your practice, watch out for the 2011 Special Issue of Clearinghouse Review: Journal of Poverty Law and Policy, which will be available in October. In this year’s special issue, authors from the University of Pennsylvania’s Transnational Legal Clinic, The Opportunity Agenda, Columbia University’s Human Rights Institute, The Shriver Center, Coalition of Immokalee Workers, Northeastern University’s Program on Human Rights and the Global Economy, the National Law Center on Homelessness and Poverty, the Legal Assistance Foundation of Metropolitan Chicago, and California Rural Legal Assistance, as well as two Australian public interest organizations—the Federation of Community Legal Centres and the Public Interest Clearing House—will discuss new and innovative ways for legal services lawyers to use international human rights to advance justice and equal opportunity at home.

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Wealth and assets are the building blocks of economic stability and mobility. Higher levels of wealth also benefit society as a whole. Unfortunately, wealth inequality in the United States is not only wide but growing — the wealthiest tenth of American households possess almost three-quarters of the country’s total net worth. The racial wealth gap is even worse. In less than a generation (from 1984 to 2007), the racial wealth gap has more than quadrupled, mostly as a result of rising white wealth. In terms of household net worth, for every dollar owned by a white household Latinos own twelve cents and African-American families own only ten cents.   In fact, the median net wealth of white households is 20 times that of black households and 18 times that of Hispanic households. These lopsided wealth ratios are the largest since the government began publishing this data a quarter century ago and roughly twice the size of the ratios that prevailed among these groups for the prior to the Great Recession.

Early evidence is that the great recession has already significantly increased the racial wealth gap because of catastrophic losses in wealth amongst minorities. A recent report by the Pew Research Center estimates that from 2005 to 2009 the racial wealth gap doubled – so that median white families currently have as much as 20 times the wealth of black families, and 18 times the wealth of Hispanic families. These racial wealth disparities will rise further as the after-effects of the Great Recession continue. Although the recession affected all U.S. households’ wealth, through unemployment, falling stock prices, and huge losses in home values, it affected minorities more. In fact, the foreclosure crisis has caused “the greatest loss of wealth for people of color in modern U.S. history.”

In order to understand the persistence of this discrepancy, one needs to examine the country’s historical and current discriminatory practices and policies. Even when characteristics such as income, education, and other demographics are equal, minorities continue to have less wealth than similarly situated whites. Historically, legal, or de jure, discrimination, both by the government and by private actors, increased the racial wealth gap and created the opportunity for whites to build assets at the expense of minorities. Additionally, and perhaps more importantly, other facially neutral policies of the U.S. government racialized wealth acquisition, including the government’s promotion of white land acquisition, home ownership, retirement, and education, without explicitly delineating opportunities along the lines of race. Today, although racial discrimination is no longer legal, de facto discrimination still exists in terms of government and social priorities, principles, social norms, and the actions of individuals. Housing discrimination, unequal educational systems, disparate treatment in the realm of criminal justice, and disparate employment opportunities all continue the current advantages that whites enjoy.

Two critical public policy strategies in reducing this gap is identifying and eradicating current discriminatory government policies, whether de jure or de facto, and assisting racial minorities in developing assets. As advocates in the asset building field have explained, “public policies have and continue to play a major role in creating and sustaining the racial wealth gap, and they must play a role in closing it.”

At the moment, however, the federal government is actually exacerbating the racial wealth gap.  Instead of subsidizing wealth creation mostly for the wealthy, the federal government must switch to supporting asset-building strategies for those who need it most. In 2009, the United States spent nearly $400 billion on asset building policies. These subsidies, however, overwhelmingly go to those who already have significant wealth. For example, those earning more than $160,000 received an average of $5,109 in tax breaks per taxpayer, while those earning less than $19,000 received an average of only $5 in tax credits in 2009. Shifting the government’s expenditures toward facilitating the asset-building of the poor and minorities would help alleviate the legacy of racial inequality and provide needed fiscal stimulus.

Multifaceted public policies and strategies to help individuals build their own assets are also needed. Specifically, we must identify strategies to (1) promote savings, (2) increase access to mainstream credit, and (3) improve and increase financial education. Only by acknowledging that the same social system that has, and continues, to foster the accumulation of private wealth for many whites while denying it to blacks and redirecting this focus will we, as a society, begin to decrease the wealth gap that has racially divided this country for centuries.

To read more about the causes of the racial wealth gap and asset building policy solutions to bridge this gap read the “Eliminating the Racial Wealth Gap: The Asset Perspective,” featured in the July-August 2011 issue of Clearinghouse Review.

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First the good news: last week’s agreement to raise the debt ceiling averted a catastrophic default on U.S. obligations that would have triggered a worldwide financial crisis. Now the bad news: the Budget Control Act of 2011 will immediately result in deep cuts to vital programs for vulnerable populations and will likely result in even greater cuts in the future, without balancing those cuts with increases in revenue. Indeed, it does not provide for any increase in revenue at all. Below is a summary of the main points of the accord, with analysis of what the resolution of this crisis bodes for the future.

The agreement raises the debt ceiling by $2.1 trillion, enough that it won’t have to be raised again until after the next presidential election in November 2012. The agreement also provides that the deficit will be reduced by more than $2 trillion over the next 10 years, with deficit reduction occurring in two steps.

Step one is a spending reduction of $900 billion over the next 10 years, accomplished with binding caps on annual appropriations bills. All of these cuts will be made to “discretionary spending”. Entitlement spending, including safety-net entitlement programs for low-income people, is exempt from being cut. In addition to the “big three” entitlement programs – Social Security, Medicare and Medicaid – other non-discretionary programs exempted from being cut include:

• child care mandatory assistance;
• child nutrition entitlement programs, e.g., school meals;
• Children’s Health Insurance Program (CHIP);
• child support enforcement and family support programs;
• Pell Grants;
• foster care and permanency programs;
• Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps);
• Supplemental Security Income (SSI);
• refundable tax credits, including the Earned income Tax Credit and Child Tax Credit; and
• Temporary Assistance for Needy Families (TANF).

Discretionary programs that are subject to the caps that will result in $900 billion in cuts over the next 10 years include:

• discretionary (non-mandatory) child care assistance;
• Head Start;
• Women, Infants and Children (WIC) nutrition program for low-income women, infants and small children;
• maternal and child health;
• Title X family planning services;
• low-income housing assistance;
• low-income energy assistance; and
• Older Americans Act congregate and home-delivered meals.

Step two is complicated. It begins with the congressional appointment of a 12-member deficit reduction super committee, with three members appointed by each legislative leader. The super-committee’s charge is to come up with a deficit-reduction package that saves at least another $1.5 trillion over the next 10 years. The super committee is free to consider all possibilities, including more cuts in discretionary spending, cuts in entitlement spending, and revenue-raising measures. If a majority of the super committee agrees on a proposal, then it will be submitted to Congress for an up-or-down vote by the end of this year.

If, as largely expected, the super committee does not reach an agreement on a deficit-reduction package -- or Congress does not approve the package or the President vetoes it -- then federal spending will automatically be reduced by $1.2 trillion over the next 10 years through a process called “sequestration.” Entitlement programs (listed above) would be exempt from cuts, and revenue would not be increased. Rather, all of the cuts would come from discretionary programs, with half of the reduction coming from domestic programs and the other half from defense spending. This would amount to a 9 percent decrease in both domestic discretionary spending and defense spending – an amount that many believe would seriously compromise national security. The cuts made by sequestration would not go into effect until January 2013.

Speaker Boehner has already announced that the U.S. House of Representatives will not approve any revenue increases that the super-committee may recommend. To understand what the impact of a “cuts only” proposal would be, it’s worth considering the deal that President Obama and Speaker Boehner recently discussed. That ultimately unsuccessful deal would have:

• raised Medicare’s eligibility age and cost-sharing charges;
• shifted significant Medicaid costs to states;
• modified cost-of-living adjustments in Social Security and other benefit programs (and in the tax code); and
• instituted other entitlement savings.

All of those steps would have saved $650-$700 billion over 10 years, representing only one-half of the cuts that the super committee will have to produce.

One other noteworthy provision in the Budget Control Act of 2011 is an agreement to allow an up-or-down vote of the House and the Senate this fall on a constitutional amendment to balance the budget, threatening to enshrine this popular but fiscally ruinous principle in the U.S. Constitution.

To sum up, the most disturbing aspect of the Budget Control Act of 2011 is that it achieves all of its savings through spending cuts despite polling that shows a large majority of Americans across all population sectors supports a balanced approach that includes increasing taxes on the wealthy and big corporations to help reduce the deficit. This cuts-only approach sets an extremely disturbing precedent for future budget and spending battles.

Second, although some of the most extreme proposals floated this year, such as a global spending cap or super-majority requirement to raise taxes or the debt ceiling, were not included in the final agreement, it does include the mandatory spending reduction mechanism of sequestration. And, while low-income entitlement programs are exempt from sequestration, discretionary programs on which low-income populations rely enjoy no such protection and are, in fact, under a direct threat to be heavily cut.

So what does the future hold? For one thing, it appears that Medicaid is now in the cross-hairs. Conservatives in Congress have consistently signaled a desire to scale-back Medicaid. They receive strong support for this agenda from conservative governors who seek the power to generate state budgetary savings if Medicaid is changed to allow them to cut the program and roll-back eligibility. It’s hard to see how any of this can be squared with implementation of the Affordable Care Act, whose health care reforms rely on expansion of the Medicaid program to insure 16 million currently uninsured people.

Now that the debt ceiling has been raised for the time being, the next flashpoint will be the adoption of a budget for the next federal fiscal year beginning October 1. Typically, no agreement is reached by that date, and the government continues to operate based on a series of “continuing resolutions” until a full-year budget is agreed upon. If one of these continuing resolutions runs out without an agreement to extend it, then the federal government shuts down. A sizable majority of the House Republicans just demonstrated their willingness to risk a global financial cataclysm to achieve their policy ends. There is little reason to doubt that they will be willing to engage in such brinksmanship again. Indeed, they may attempt to extract even greater concessions when all that is at stake is the continued operations of the federal government, since they will feel there is less to lose in provoking a crisis. The template for resolving such a crisis, as established by this debt ceiling deal–substantial spending cuts, no revenue increases, a mandatory mechanism to enforce deficit reduction–sets a bad precedent for future policy negotiations, unless different tactics are adopted by proponents of important spending priorities for struggling Americans.

Beyond that, there are a number of events that will be occurring in the lame-duck session just after the next presidential election in November 2012. The Bush tax cuts will be expiring; the January 2013 automatic sequestration cuts (assuming no super committee agreement that becomes law), including deep cuts in national defense, will be taking effect; and the debt ceiling will have to be increased again. The battles that were just waged thus are simply the prelude for many more to come. 

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Coauthored by Rachel Gielau

On July 30th, 1965, President Johnson signed Medicaid into law. Its mission, then and now, is access to quality, affordable health care. For 46 years, Medicaid has been a lifeline to millions of America’s most vulnerable people, including low-income seniors, people with disabilities, children and their parents, and pregnant women. Today, the public health insurance program is the second largest health insurer in the United States, providing quality coverage and peace of mind to one out of five Americans.

Unfortunately, in the midst of the budget battles being fought in Washington Medicaid is under attack. Right-wing proposals like the U.S. House-passed Republican budget plan calls for debilitating cuts that would end the Medicaid program as we know it, slashing the program by about one-third and shifting costs onto states, beneficiaries and providers.

But individuals and families in Illinois depend on Medicaid!

• For 46 years, Medicaid has been the foundation of health coverage for Illinois’ most vulnerable populations. Today, more than 2.5 million Illinoisans (60 percent are children; 20 percent are elderly, blind, or disabled adults) rely on Medicaid.  
• Children depend on Medicaid! Almost 1.5 million children, or 43 percent of all kids in Illinois, rely on Medicaid for their well-child doctor visits and other health care needs. For most low-income children, Medicaid is the only source of affordable coverage available. 
• Medicaid is a lifeline! For more than 559,000 Illinois seniors and people with disabilities Medicaid provides affordable long-term and specialty care. Access to these services helps avoid the use of institutionalized care, keeping costs down and families together.

And we know that Medicaid works!

• Medicaid makes Illinoisans healthier! Medicaid has been proven to increase access to affordable health care for low-income people, which improves the health and financial stability for families everywhere.
• Because of Medicaid, low-income children in Illinois are able to get a healthy start in life. Medicaid helps Illinois children be better students and develop healthy living habits early in life. With access to well-child care, our children get the primary care they need to avoid absences from school and prevent costly chronic health conditions later in life.
• The success of public health insurance programs like Medicaid and the Children’s Health Insurance Program (CHIP—called All Kids in Illinois) has kept uninsured rates for children from spiking due to the economic recession.  
• Medicaid is more cost-effective than private health insurance! Medicaid spending per enrollee has increased at a slower rate than that of private insurance. Also, Medicaid spends less per enrollee than private insurance does. In fact, “Medicaid costs 27% less for children and 20% less for adults than private insurance.”
• Medicaid stimulates the economy and supports jobs in Illinois. Every dollar spent on Medicaid in Illinois generates matching federal funds that come back to the state, increasing economic activity and creating jobs. In 2009, Medicaid funding brought an additional $46 billion in business activity, $15.8 billion in wages, and support for 385,742 jobs to local economies in Illinois.
• While America and Illinois can take pride in Medicaid as it turns 46, the program needs and is getting 21st Century improvements.   Primary care case management, medical homes, electronic medical records, disease management, coordinated care and other initiatives aimed at improving the quality of care for Medicaid patients and controlling costs are all in effect or on the drawing board in Illinois and elsewhere. 

Medicaid just marked its 46th birthday. We think it has improved with age. And as we sing at the end of the birthday song, “Happy birthday to you—and many more.”

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