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

This post is part of a weekly “Did You Know” blog series that highlights important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health. 

Did you know that the Affordable Care Act requires large-scale restaurants and vending machines to display nutritional information at the point of purchase for consumers?

An important but mostly overlooked measure in the Affordable Care Act’s effort to combat obesity rates and bring down health care costs in the United States is likely to be noticed by consumers all over the country when it goes into effect later this year. The health reform law mandates chain restaurants with 20 or more locations to display the calorie content of standard items sold on the menu board or table menus, and to make other nutritional information, like fat, cholesterol, and fiber content, available in written form upon request. This new rule also pertains to vendors with at least 20 vending machines across the country. These vendors will have to make the calorie content of the foods sold visible to consumers at the point of purchase. Because this rule applies only to large-scale restaurants and vendors, small business owners with fewer than 20 locations will not be affected.

The goal is to make information available to consumers so they can make healthier choices when eating away from home. Studies show that consumers are increasingly getting more and more of their diets from food outside the home, from restaurants, fast food chains, and vending machines. Americans report spending almost half of their food budgets on away-from-home foods, and most parents report feeding their families restaurant-prepared meals at least once or twice a week. But American consumers know little about the nutritional value of the food they are consuming when eating out, and most tend to underestimate the number of calories and fat content in away-from-home foods. I like to think of myself as a fairly knowledgeable consumer, but I was shocked last week when I discovered that the sandwich I had ordered had over 1,000 calories—had I known the nutritional facts when I ordered, I definitely would have changed my dinner plans!

With obesity and other diet-related chronic health conditions like Type 2 diabetes and heart disease at alarming levels and on the rise in our country (two out of every three adults and one out of every three children in the U.S. are overweight or obese), nutrition and public health advocates believe that disclosing the caloric and nutritional value of foods served at restaurants and available in vending machines will help consumers make better choices about the food they eat away from home. Experts say that it is hard to tell how much nutrition labeling will affect individual consumer choice, and that more research needs to be done on this topic. However, studies show that, after nutrition labeling became mandatory for packaged foods sold in grocery stores, the demand for healthier cheeses tripled and the demand for fat-modified cookies increased 15 percent. The American Dietetic Association agrees, even small individual changes in food choice multiplied by millions of consumers can make a significant impact on public health and help improve the food supply by consumer demand. And it can bring down health care costs, both at the individual and national level, by preventing unnecessary and costly chronic health conditions often exacerbated by obesity.

While the impact of this legislation seems difficult to predict, who can argue with the notion that knowledge is power for American consumers?

For more information about the importance of nutrition in your diet and educational resources, visit the American Dietetic Association online.

For more on how the Affordable Care Act is working to combat obesity and other chronic health conditions, visit healthreform.gov. 

Interested in an in-person presentation on how health reform is rolling out in Illinois and what it means for individuals? Are you a direct service provider or advocate for vulnerable populations and interested in how the Affordable Care Act will impact the population you serve? Rachel Gielau, health policy expert at the Shriver Center, is giving free in-person presentations to Illinois audiences on how health reform is affecting individual and families in Illinois. Contact Rachel Gielau at 312-368-1154 to set up a presentation for your organization!

This blog post was coauthored by Rachel Gielau.

• Email This
• Print
• Comments
• Trackbacks

Governor Pat Quinn released his proposed budget for Fiscal Year 2013 on February 22. The Governor will now work with the General Assembly to craft a budget that can gain a majority of votes in both chambers by the May 31 deadline. Low-income people and their advocates have much at stake, and perhaps more to lose, than in any previous session of the legislature. 

There is a lot to be concerned about in the Governor’s proposed budget. Most troubling is his call for $2.7 billion in unspecified cuts to the Medicaid program. Such savings cannot be achieved without doing severe harm to health care for the poor. We’ll have much more to say about this in a future post. 

The proposed budget also includes major cuts to the child care assistance program, home visiting programs, community care programs, and emergency and transitional housing. Also it would reduce lifetime eligibility for the Temporary Assistance for Needy Families (TANF) program from five to three years. 

On the plus side, the proposed budget would significantly increase funding for the Preschool for All and TANF programs. 

The Heartland Alliance has issued this release, which gives an excellent description of the threats posed to poor people by the proposed state budget.

• Email This
• Print
• Comments
• Trackbacks

The number of people in poverty has risen to unparalleled levels. According the most recent Census Bureau data, there were 46.2 million Americans living in poverty in 2010, up from 43.6 million in 2009 (an increase of 2.6 million). In other words, more than one in six Americans were poor in 2010. This is the highest number since the Census Bureau began gathering data 52 years ago, superseding last year’s all-time high.

What has been the legislative response of the United States Congress to the increase in poverty? Virtually nothing. Only one bill that will reduce poverty—legislation that will expand job opportunities and training for veterans—passed the Senate and House and was signed into law by the President in 2011.

The Shriver Center’s 2011 Poverty Scorecard, released today, rates every member of Congress on how they voted on anti-poverty legislation. In consultation with national anti-poverty experts in 20 different fields, we identified the 18 House votes and 11 Senate votes that were the most significant votes to people in poverty in 2011. The 2011 Congressional Poverty Scorecard includes a thorough summary of each vote we scored that describes the measure that was voted on and why it was important in fighting poverty. 

In past years, almost every vote important to people in poverty concerned a legislative initiative that would fight poverty. In contrast, most of the votes in 2011 that were of the greatest significance to people in poverty were votes against legislation that would have made poverty even worse.

Several votes would have eliminated programs that people in poverty rely on, including national health reform, legal services, school-based health centers, the McGovern-Dole international food program, and three important foreclosure relief and neighborhood stabilization programs.

Other votes were on sweeping proposals that affected a wide array of anti-poverty programs. These included proposals to dismantle the Medicare program, undermine the structure of Medicaid and the Supplemental Nutrition Assistance Programs (formerly Food Stamps), enshrine a balanced budget requirement and other ruinous fiscal principles in the U.S. Constitution, and substantially cut funding for Pell Grants for higher education, employment and training programs, the WIC nutrition program for pregnant women and young children, and mental health and substance abuse program.

In addition to making poverty worse, some of the proposals would have exacerbated the 30-year trend of growing income inequality in the United States. In particular, the Ryan budget proposal approved in the House but rejected in the Senate would have made massive cuts in federal programs, most of which would have fallen on the poor, with all of the resulting savings used to provide additional tax breaks for the wealthy.

The Poverty Scorecard is a powerful tool that advocates, media, and citizens can use to evaluate the performance of their elected representatives. Each Senator and House member is assigned a letter grade, A+ through F-, based on their overall voting performance. Members who did not vote on enough bills were not graded. In total, we graded 431 of 435 Representatives and all 100 Senators. Readers are encouraged to examine their representatives’ voting records, as well as other data available in the Poverty Scorecard, to learn more about what Congress did, and did not do, to combat poverty in 2011.

• Email This
• Print
• Comments
• Trackbacks

Congress has recently reached a compromise on a measure to extend federal unemployment insurance benefits through the end of the year, which will keep 3.3 million long-term unemployed individuals from losing a critical lifeline. Without the compromise, 166,700 unemployed workers in Illinois would lose their unemployment benefits, which for most is the only way to provide for their families still struggling in the weak economy. Yet, even though the economy has seen recent sustained growth and a slight decline in the overall unemployment rate, long-term unemployment (unemployment lasting for 27 weeks or more) still accounts for 42.5% of all unemployment in the United States. And Congress’ agreement is indeed a compromise between proponents and opponents. The agreement unfortunately also reduces the maximum duration of benefits available in states with high unemployment from 99 weeks to 73 weeks. For the long-term unemployed, the deal is bittersweet.

A report from the Pew Fiscal Analysis Initiative found that the challenge of long-term unemployment is persistent, which makes the extension of federal benefits even more critical. The number of workers who were out of work for at least a year nearly doubled after the official end of the recession—from 16% (2.5 million) to 31.8% (4.4 million) nationally between 2009 and 2011. States typically provide around 26 weeks of regular benefits (though many states provide less or have recently reduced the number of weeks available, as Illinois did by passing legislation last spring that reduced the total number of weeks of benefits available to 25 weeks), but in the current economic climate it often takes the unemployed far longer to find a job. Currently, jobless workers endure an average 40.8 weeks, or nearly 10 months, of job searching. For each new job opening, there are over four unemployed people.

With the odds of getting a job in the current weak economy stacked against the unemployed, federal extended benefits are monumentally important to lending individuals and families an economic lifeline while staying attached to the workforce. The nation saw the labor force participation rate (the proportion of all working-age adults who are either employed or seeking employment) decline to just 64% by the end of 2011, the lowest percentage since 1985. A decrease in the labor force participation rate such as this can in part be attributed to unemployed people giving up on their job searches, which has the net effect of pushing down the official unemployment rate since only those who are actively looking for work are counted as unemployed. The long-term unemployed may be more likely to give up on their job searches and run the risk of dropping out of the labor force completely, as the longer these individuals remain unemployed the more likely they will become “unemployable” because of atrophied work and job search skills, or dispirited by the stigma of being out of work for months or even years on end.

Unemployment insurance not only ensures that unemployed workers and their families can continue living their daily lives and meeting their basic needs, but also stirs much-needed economic activity when recipients spend their benefits at local businesses, which allows local businesses to grow and create jobs. A study by the Labor Department found that, in the depths of the recession, regular, state-funded unemployment benefits boosted employment by 1 million jobs and an additional 750,000 jobs by federal emergency unemployment benefits. The country cannot afford to lose federal unemployment benefits while the economy is still underperforming and the recovery has only begun to regain steam.

Furthermore, policymakers should not lose sight of the purpose of unemployment insurance and how it has historically functioned to benefit the economy. Misguided attacks on unemployment insurance from House Republicans (such as proposals to limit eligibility for benefits, like requiring claimants to have at least a high school diploma or GED or requiring claimants to pass drug tests in order to obtain benefits) played a significant role in the compromise. These proposals were a gross injustice to unemployed workers who lost their jobs through no fault of their own. It is unfair to workers to assume a prevalence of drug use among unemployment insurance claimants when there is no evidence, and furthermore blames unemployed workers for their joblessness in an economic climate created beyond their control.

In fact, current data tell us that the scope of long-term unemployment is widespread across demographic lines, affecting millions of workers regardless of age, education level, and occupation. Thirty-four percent of unemployed workers with a bachelor’s degree in the third quarter of 2011 had been out of work for a year or longer, compared to nearly 38 percent of jobless high school graduates and approximately 39 percent of unemployed workers without a high school diploma. Whether having a certain level of education is required for a job or not, long-term unemployment affects all industries—more than 20% percent of unemployed workers in every industry had been out of work for a year or longer in 2011. What’s more, older workers who have worked hard throughout their lives may be getting hit the hardest—almost half of all unemployed workers older than 55 had been out of work for at least a year in 2011.

The compromise, which also includes an extension of the payroll tax cut, is likely to pass both the House and Senate before Congress goes on recess this weekend, and includes some drug testing provisions on workers who lost their jobs because of refusal to take an employer’s drug test. While these concessions are unfortunate, extending federal unemployment insurance benefits must be accomplished prior to the recess. It is an important step in the right direction towards fixing our economy and putting people back to work. Nonetheless, we have much more work to do, including increasing education and training opportunities for jobless workers, in order to combat long-term unemployment and its ramifications for families and communities.

• Email This
• Print
• Comments
• Trackbacks

This post is part of a weekly “Did You Know” blog series that highlights important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health. 

Did you know that February is American Heart Month, and that the Affordable Care Act is already working to save lives and save money by improving our heart health?

With an emphasis on effective preventive health measures, the Affordable Care Act has set in motion a comprehensive strategy to improve health and cut costs of treating chronic disease. Part of that strategy includes a targeted effort towards reducing the prevalence, severity, and costs of heart disease.

Heart disease, like other chronic diseases plaguing our country, is costly, life threatening, and often preventable. And, heart disease is increasingly prevalent and expensive to treat. According to the Million Hearts initiative, one out of every three people in the United States suffers from some form of heart disease, which includes severe chest pain, heart attacks, heart failure, and stroke. Heart disease claims more lives yearly than all forms of cancer, lower respiratory diseases, and accidents combined. This devastating chronic health condition kills 2,200 people every day in the U.S., and costs our country $444 billion every year in health care costs and lost economic productivity.

Fortunately, as we celebrate American Heart Month this year, we have some compelling reasons to be optimistic about the health of our hearts. One reason for optimism is that heart disease is largely preventable. By shifting our focus to preventing diseases before they occur, we save money and, more importantly, save lives. For many, it can be as easy as talking to your doctor yearly, keeping your blood pressure and cholesterol levels under control, and living a healthy lifestyle. However, we recognize there are barriers to this kind of healthy living for some. After all, if people don’t have access to things like basic medical care or healthy foods, knowing how to prevent heart disease may not be enough. These barriers need to be addressed in tandem with education efforts about preventive health. 

And this is where another reason for optimism comes in—the Affordable Care Act. The ACA is effectively shifting the focus in the United States from treating costly diseases to preventing them. The ACA is also changing the way health insurance companies do business so that obtaining coverage is fair and affordable for everybody. The ACA requires insurers to provide a number of preventive services free of cost sharing for many consumers, including screenings for obesity, blood pressure, and cholesterol levels; counseling on the use of daily aspirin to reduce the risk of stroke; and counseling on weight loss and a healthy diet, among others.  

The health reform law also increases access to affordable and fair health coverage by expanding the Medicaid program to include an additional 16 million people, and by providing tax credits and subsidies to eligible families to offset the cost of health insurance. In addition, the ACA bans many bad practices that kept many people with chronic illnesses uninsured and without access to necessary medical care. For example, insurance companies are no longer allowed to place lifetime or annual limits on coverage or deny people health insurance based on a preexisting condition. 

Finally, in a bold and unprecedented effort to prevent one million heart attacks and strokes in five years, the ACA put in motion the Million Hearts initiative. The Million Hearts initiative will focus on “improving access to effective care; improving the quality of care for the ABCS (aspirin therapy, blood pressure control, cholesterol management, and smoking cessation); focusing clinical attention on the prevention of heart attack and stroke; activating the public to lead a heart-healthy lifestyle; and improving the prescription of and adherence to appropriate medications for the ABCS. To learn more, visit Million Hearts online.

And this isn’t all that the ACA does to help people with heart disease get access to the medical care they need. To learn about other ways the Affordable Care Act is making a positive impact on the lives of people living with heart disease, visit the American Heart Association on the web

Interested in an in-person presentation on how health reform is rolling out in Illinois and what it means for individuals? Are you a direct service provider or advocate for vulnerable populations and interested in how the Affordable Care Act will impact the population you serve? Rachel Gielau, health policy expert at the Shriver Center, is giving free in-person presentations to Illinois audiences on how health reform is affecting individual and families in Illinois. Contact Rachel Gielau at 312-368-1154 to set up a presentation for your organization!

This blog post was coauthored by Rachel Gielau.

• Email This
• Print
• Comments
• Trackbacks

Great news for anyone who has ever struggled to understand exactly what their health insurance covers, what conditions apply, and how much they will owe for medical care! (And isn’t that everyone?)

Health insurance is notoriously difficult to comprehend. Luckily, one of the many positive benefits of the Affordable Care Act is the requirement that insurers disclose certain facts in easily comprehensible language. Consumers overwhelmingly like this component of the law. In fact, this provision is the most popular piece of the entire ACA.

Starting in September of this year, insurance companies will be required to provide easily understandable summaries of the coverage they issue and the terms they use, making shopping for and using your insurance much easier. They will also have to use uniform language in describing their plans, making it easier for consumers to compare the benefits offered by each plan. “All consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,” said HHS Secretary Kathleen Sebelius. “This will give them a new edge in deciding which plan will best suit their needs and those of their families or employees.” Of course, the “edge” is that it actually levels the playing field between consumers and insurers by putting everyone on the same page. 

This aspect of the ACA ensures that consumers will be able to better understand their coverage and compare plans. Insurers will have to issue a six-page document that discloses what benefits are actually provided by the insurance; additionally, the document will provide examples of common medical situations (childbirth, chronic disease management, outpatient surgery, etc.) and explain how much coverage the insurance provides in each example. Insurers will also provide a dictionary of common insurance lingo, such as “deductible” and “co-insurance.” Worried you’ll miss something in the fine print? No more tiny restrictions and warnings at the bottom of the last page—the law literally bans fine print by mandating all writing must be in at least 12-point font! 

While information about insurance coverage was difficult to find in the past, the new law will mandate that it is available before purchase to allow comparisons when the coverage is up for renewal, if the policy changes, or any other time the consumer wants. In addition, the glossary will be publicly displayed on www.HealthCare.gov, www.cciio.cms.gov, and www.dol.gov/ebsa/healthreform.

This piece of the ACA will increase consumer knowledge and allow consumers to efficiently and effectively compare coverage from different insurers. Providing the facts about insurance policies will let consumers avoid surprises in coverage gaps and pick coverage that works best for them.  

• Email This
• Print
• Comments
• Trackbacks

Tax refunds may look a little different this season in some states. Instead of issuing paper checks, a number of states will require that taxpayers receive their refunds either through direct deposit or, for those who are unbanked, prepaid debit cards. While the use of direct deposit and debit cards may save states money by cutting down on printing and mailing costs, taxpayers may wind up paying more in the long run.

Most states currently offer direct deposit, and some, including Illinois and South Carolina, encourage electronic payment of refunds but still offer to mail checks to those who want them or to those who do not have bank accounts. Increasingly, however, states have stopped mailing tax refund checks in favor of electronic transfers and prepaid cards. Oklahoma, Louisiana, Georgia, and Connecticut are among these states.

Oklahoma recently introduced the Tax Refund Card, which will be administered by MasterCard. Although the state claims that the card is a safe, convenient, and secure alternative to the traditional refund checks, many Oklahoma taxpayers are unhappy with the decision due to the card’s ATM fees and a $1.50 inactivity fee. Free withdrawals are available at any MoneyPass ATM network, but this network has limited locations, forcing consumers to use other networks that charge fees. Additionally, due to limits on ATM withdrawal amounts, taxpayers may have to make multiple withdrawals, thereby incurring multiple fees.

Both Louisiana and Connecticut have contracts with Chase to offer a similar tax refund debit card. In 2011, over one million Connecticut residents received tax refunds, while 45% of Connecticut taxpayers received paper checks. This year, this 45% will be receiving prepaid debit cards and paying hefty fees to access their money. 

An estimated 7.7%, or over 9 million Americans, are unbanked and therefore, do not have the option of direct deposit. Their only option will be such prepaid tax refund cards and the fees associated with them. One solution to this problem would be for states to create BankOn initiatives, which offer the unbanked the opportunity to open low-cost accounts  at mainstream financial institutions. These include so-called “second chance” accounts that provide those who have had an account closed in the past a second chance to open a new account. By starting BankOn programs, states have the opportunity to not only save the costs associated with paper refund checks, but also to provide their unbanked residents with a chance to enter the mainstream financial market. Ultimately, such access will enable residents to save more at tax time and build assets for the long term. Instead of taking a narrow view solely focused on cost containment, states need to expand their focus to include creating asset building opportunities for their residents that, in the long term, will prove even more lucrative for states. 

This blog post was coauthored by Alison Terkel.

• Email This
• Print
• Comments
• Trackbacks

During the recent economic downturn, many American families became food insecure, meaning they had limited or uncertain access to enough nutritious food for an active, healthy life. In 2010, 40.3 million people received monthly benefits through the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps), up from 33.7 million people in 2009 and more than double the number of food stamp recipients in 2002. Participation in school meal programs also increased, and 32 million children now participate in school meal programs each day. Food insecurity is especially troublesome among older adults, given the population’s particular health and medical needs. From 2001 to 2009, the number of older Americans at risk of hunger increased by 79 percent.

The increasing prevalence of food insecurity in America has prompted Clearinghouse Review: Journal of Poverty Law and Policy to choose it as its 2012 special issue topic. Every year, the Review devotes one issue to exploration of a single topic; last year’s special issue focused on applying a human rights lens to poverty law practice, and the 2010 special issue discussed climate change and green jobs.

Helping low-income people increase their access to food through benefits programs such as SNAP, the Women, Infants, and Children Program (WIC), and the Child and Adult Care Food Program (CACPF) has long been a traditional strength of the legal services community, and Clearinghouse Review has published many articles on these topics. Recently, the Review has published articles exploring whether states should require identification requirements for SNAP participants, the use of SNAP benefits at fast-food chains, and low-income college students’ eligibility for SNAP benefits.

However, the nature of food insecurity is evolving, as are the federal and state programs that address the problem. Assisting clients with SNAP benefits has become a moving target for legal services attorneys, who are trying to help more clients get benefits in the face of state budget cutbacks that cause delays in processing times and reduce compliance with federal legal deadlines. Children, the elderly, immigrants, and people living with disabilities all face additional challenges when trying to access nutritious food through SNAP and other programs.

As the number of food-insecure Americans grows, it will not be enough for only those legal services attorneys specializing in benefits to confront the hunger problem. To end hunger in America, advocates from many disciplines—health, education, economic development, and housing, to name a few—will need to focus on food. Moreover, it will not be sufficient for these advocates to understand the changing landscape of federal and state benefit programs. To understand why so many communities are unable to secure nutritious food for all of their members, advocates need to take a close look at the communities themselves. Many low-income communities have become “food deserts” with limited access to nutritious foods. These neighborhoods also contain few safe spaces for physical activity, which has contributed to a dramatic rise in obesity over the past decade. Low-income families are also affected by food’s production, distribution, and consumption, both as workers and consumers.

The good news is that, across the country, advocates and community leaders are developing new approaches to food insecurity. Not only are they using traditional antipoverty programs in new ways, they are helping low-income people access nutritious food through farmers’ markets, community gardens, and fresh food financing initiatives. Lawyers are dismantling state-level barriers to national food programs, helping communities rezone to have more green space, incorporating the concept of a “human right to food” into their arguments, and ensuring that, as the delivery of benefits is modernized through the use of new technologies, vulnerable clients’ ability to access benefits is not compromised.. Food banks are collaborating with unexpected partners to make sure that nutritious food does not spoil before it reaches consumers. In its 2012 special issue, Clearinghouse Review hopes to showcase dynamic and diverse solutions to food insecurity from across the country so that advocates can share their expertise with one another and design new solutions to food insecurity.

If you are interested in learning more about Clearinghouse Review’s 2012 special issue, please contact Staff Attorney-Legal Editor Michele Host. The editorial team welcomes suggestions regarding topics and authors. If you or your organization is interested in sponsoring the 2012 special issue, contact Brendan Short.

• Email This
• Print
• Comments (1)
• Trackbacks

This post is part of a weekly “Did You Know” blog series that highlights important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health. 

The Affordable Care Act (ACA) will bring down the cost of health care by improving peoples’ health. A prime example is the ACA’s comprehensive approach to diabetes.

According to the National Diabetes Information Clearinghouse, diabetes affects around 25.8 million people today, which is 8.3 percent of our population. If left untreated, diabetes can spiral into a long list of serious complications. It is the leading cause of kidney failure, responsible for most new cases of blindness for people under 75 years old, and the number one reason for non-accident-related foot and leg amputations for adults. In 2007, diabetes claimed enough lives to rank as the seventh leading cause of death in America.

Diabetes is an expensive disease to treat. Diabetics spend, on average, 2.3 times more than their healthy counterparts do on medical care each year. The United States spends $116 billion every year in direct medical care to treat diabetes and loses $58 billion in lost productivity, disability, and premature mortality due to the chronic illness, a whopping total of $174 billion annually. If trends continue, the United States could see the incidence of diabetes go from 1 in 10 adults today to 1 in 3 adults by year 2050. And the cost for treating diabetes is predicted to increase by 100 percent as soon as 2025, reaching $514 billion. But it doesn’t have to come to that. Type 2 diabetes is the most common form of the disease and is known to be triggered by obesity and lifestyle, rendering it largely preventable through healthy diet and regular exercise.

The cost of care over a lifetime for a diabetic and the risk of developing expensive complications help to explain why insurance companies have found diabetics unfavorable to insure. Yet quality health insurance is what permits sustained relationships with primary care doctors, which facilitates prevention and health maintenance. 

The ACA helps people with diabetes get the care they need at a price they can afford. For example:

• No more denial of coverage due to a preexisting condition. Prior to health reform, insurance companies could outright deny diabetics coverage simply because they were diabetic, or offer insurance but refuse to cover basic diabetes-related care. The ACA bans this discriminatory practice. The rule went into effect for children in the fall of 2010, and will go into effect for adults in 2014. To bridge the gap between now and 2014, uninsured adults with diabetes can enroll in a high-risk pool set up in each state. Illinois’s high risk pool, called IPXP, can be found online. For additional resources available to uninsured diabetics in Illinois, see the American Diabetes Association webpage.
• No more lifetime or annual limits on coverage, and no more rescissions. Insurance companies used to have free rein to place annual and lifetime limits on coverage, leaving people with chronic illnesses like diabetes afraid for the day their coverage would run out, and leaving many without access to affordable care. Insurance companies were also allowed to drop people from coverage when they came down with an illness, abandoning those who needed care the most. The ACA bans these practices.
• Medicaid expansion. In 2014, Medicaid will expand to include almost all persons at or below 133 percent of the federal poverty level. This historic expansion will bring health coverage and access to quality medical care to 16 million low-income individuals nationwide and around 700,000 here in Illinois. Given the higher risk that low-income families have for developing Type 2 diabetes, the Medicaid expansion is an important step forward to preventing and managing the chronic illness and will address both health disparities and the overall cost of the health care system.
• Tax credits and cost-sharing subsidies for low-middle income families.In 2014, individuals and families with income between 100 and 400 percent of the federal poverty level will be eligible to receive sliding scale tax credits and subsidies for cost-sharing to make coverage more affordable. This expansion of access to good insurance will improve prevention and maintenance.

Here are a few other ways the ACA is working to prevent diabetes and the serious and costly complications that go with it:

• No more co-payments for preventive health services for anybody with a “non-grandfathered” health insurance plan.The ACA establishes a set of preventive health services that must be offered free of co-payment for any person with a new plan or one that has changed significantly since the law was passed on March 23, 2010. The list includes blood pressure screening, Type 2 diabetes screening for adults with high blood pressure, obesity screening and counseling, and diet counseling for adults at higher risk of chronic disease, among others.
• The Centers for Disease Control created the National Diabetes Prevention Program. The ACA directed the Centers for Disease and Control and Prevention to implement a National Diabetes Prevention Program aimed at bringing evidence-based lifestyle-changing programs to communities across the country in an effort to prevent Type 2 diabetes. The prevention programs are centered around the goal of helping people to make modest lifestyle changes like improving their nutrition and getting at least 150 minutes of exercise in each week. The lifestyle-changing program actually reduced the risk of developing Type 2 diabetes by 58 percent over a three-year period in people who were at a heightened risk of the disease in the study. Once implemented across the country, this program could save $29.8 billion in medical costs and avert 885,000 cases of Type 2 diabetes over the course of 25 years.

The ACA’s strategies for handling diabetes are a strong example of the cost-saving, health-improving measures available under the act across the spectrum of health conditions.

For more diabetes-related information and resources, see the American Diabetes Association online. And go online to learn about how the Affordable Care Act is working to prevent the many other costly chronic health conditions prevalent in the United States.

Interested in an in-person presentation on how health reform is rolling out in Illinois and what it means for individuals? Are you a direct service provider or advocate for vulnerable populations and interested in how the Affordable Care Act will impact the population you serve? Rachel Gielau, health policy expert at the Shriver Center, is giving free in-person presentations to Illinois audiences on how health reform is affecting individual and families in Illinois. Contact Rachel Gielau at 312-368-1154 to set up a presentation for your organization!

This blog post was coauthored by Rachel Gielau.

• Email This
• Print
• Comments
• Trackbacks

America overall is more integrated than ever, and all-white neighborhoods are virtually extinct. Gentrification, immigration, migration to the suburbs, and the tearing down of public housing all have contributed to desegregation over the past decade. However, there are still areas of the country that remain highly segregated.

According to a recent report by the Manhattan Institute for Policy Research, although Chicago has seen the second largest decrease in segregation among the ten biggest cities, next only to Houston, Texas, it is still the most racially segregated city in America.

The study uses census data and two key measures to discuss segregation. First the report examines “isolation,” which measures the tendency of members of a racial group to dominate a neighborhood. The report also measures “dissimilarity,” which is the evenness of the distribution of two racial groups across an area. Chicago’s difficulty lies in the fact that it has historically isolated African-American neighborhoods that are very rarely integrated because, unlike other neighborhoods, they are not experiencing population growth or the influx of new housing.

While segregation may be decreasing since its peak in the 1960s, racial income and asset inequality still persists and is actually growing. According to a recent Pew Study, the median wealth of white households is 20 times that of black households and 18 times that of Hispanic households. This is the largest racial wealth gap since the government began publishing the data 25 years ago. In fact, the gap has doubled since the 2008 recession. Prior to the recession, in 2005, Hispanics had $18,359 in net worth (assets minus debts), African-Americans had $12,124, and whites had $134,992. After the recession, the net worth for Hispanics and African-Americans fell dramatically, while white families were left unscathed. In 2009, the average white family had $113,149 in net worth compared to $6,325 for Hispanics and $5,677 for African-Americans.

Tom Shapiro of Brandeis University, who has studied the racial wealth gap for years, says he's concerned about the long-term impact. He thinks the wealth gap will likely grow even more, unless the economy turns around soon. Not only does the economy need a boost, but so do government policies that create barriers for minorities’ financial stability and mobility. As the Manhattan Institute’s report notes, access to credit and fair housing laws significantly contribute to a city’s segregation patterns. Government programs and policies that increase access to credit and bank accounts, as well as policies that encourage saving and diversified asset holdings will eradicate segregation. During the recession, white families, whose assets were diversified, were relatively safe compared to minority families, whose assets were mainly concentrated in the housing market, which crashed. Clearly, the racial wealth gap is still prevalent in cities across America, and there is much to be done to begin to close it. Changing government policies and creating asset building opportunities for everyone is an important first step. 

Check the Shriver Brief for more coverage on access to credit, fair housing laws and closing the racial wealth gap.

This blog post was coauthored by Alison Terkel.

• Email This
• Print
• Comments
• Trackbacks

New data show that the Affordable Care Act has already saved $2.1 billion for the 3.6 million Americans with Medicare! That comes out to be over $600 per person for Medicare beneficiaries, who are either elderly or disabled. And the savings are growing—by 2021, the average Medicare beneficiary will have saved about $4,200. People with particularly expensive prescription needs will save about $16,000 in the same 10-year period. The particular provisions at work here involve closing the prescription drug donut hole through discounts on generic and brand-name prescriptions. Medicare beneficiaries are saving on all kinds of prescriptions, with diabetes, cholesterol, asthma, and blood pressure drugs as some of the biggest categories. These drugs treat chronic conditions—making these prescriptions affordable helps people treat ongoing conditions and prevents the costly care associated with not treating chronic conditions.

Illinoisans have received higher than average benefits from the new law. Last year, over 144,000 Illinois Medicare beneficiaries saved over $96 million. That is an average saving of $667 dollars per person in 2011. That would pay more than nineteen months of CTA passes or ten months of electric bills—a significant savings. The Affordable Care Act is already making a difference in people’s lives.

• Email This
• Print
• Comments
• Trackbacks

The Centers for Disease Control and Prevention (CDC) have released the results of a 2010 comprehensive study on the prevalence of sexual violence in the U.S. The results of the National Intimate Partner and Sexual Violence Survey reveal an increase in the rate of such incidents; over 50 million people each year are estimated to be victims of some form of sexual or intimate partner violence. Sexual and intimate partner violence has become an epidemic, making it a major public health issue that will require preventative measures at both the public policy and community level. The study looks at the characteristics of sexual and intimate partner violence as well as the long-lasting effects of violence on the mental and physical health of the victims.

Several key findings from the survey highlight the increase in rates of sexual violence victimization among men, as well as an epidemic of abusive relationships among adolescents and young adults. Teen dating violence, intimate partner violence among young adults, is becoming a more prominent issue as young people struggle to form healthy relationships. February has been designated Teen Dating Violence Awareness and Prevention Month to shed light on the growing problem. 

The CDC uses expansive definitions of sexual and intimate partner violence that extend beyond rape to include other forms of sexual aggression, such as sexual coercion, unwanted sexual contact, and non-contact unwanted sexual experiences. Included in their definition of Intimate Partner Violence is sexual violence generally as well as domestic violence, psychological aggression, stalking, and control of reproductive health. The rate of violence among intimate partners is explored separately, highlighting the complexity of interpersonal relationships as they relate to violence.

Women are more likely than men to be victimized by sexual and intimate partner violence. It is estimated that in 2012, 1.3 million women reported experiencing rape—53.2 million women will be raped in their lifetime—this translates to one in five women in the U.S. Among female rape victims, over half report that the perpetrator was an intimate partner, and the majority report experiencing rape in their teenage and early adult years—30% between the ages of 11 and 17 years and 37% between the ages of 18 and 24. As mentioned, these numbers reflect a growing problem among adolescents and young adults. Many of the dynamics of intimate partner violence among teens mirror abusive adult relationships, but because of the unique nature of adolescent relationships, addressing teen dating violence requires specific measures for prevention.

In regards to other forms of sexual violence the numbers remain high for female victims: one in six women are stalked, and one in four women report experiencing severe physical violence from a partner. In recent years we have learned more about stalking and how it relates to intimate partner violence—nearly three in four stalking victims know the perpetrator. The Internet has emerged as a new medium for violence; “cyberstalking” is on the rise as a serious form of intimidation and aggression. The popularity of social networking sites has made it easier for some perpetrators to harass victims; this type of online abuse is particularly prominent among young people. While “cyberstalking” may be virtual, the consequences for victims are very real. Those victimized by stalking were more likely to report both short- and long-term physical and mental trauma—post-traumatic stress disorder, physical injuries, asthma, diabetes, etc. January has been deemed Stalking Awareness Month, an effort to inform the public of this crime and hopefully prevent it.

Although the results show a high rate of victimization among women, significant numbers of men were also shown to be victims. The survey shows that 1.2 million or one in 71 men will experience rape in their lifetime—these numbers are significant when compared with previous data on sexual violence against men. Like female rape victims, over half of men reported previously knowing the perpetrator. Men are also being victimized in other ways: one in seven men reported experiencing severe physical violence perpetrated by an intimate partner while one in nineteen men reported being stalked. These significant numbers warrant specific responses and interventions to address the needs of male victims.

Beyond gender, the study looks at the prevalence of sexual and intimate partner violence by race and ethnicity. Women of color in particular reported experiencing high rates of violence: one in five African-American and one in seven Latina women will experience rape in their lifetime. Among Native American women, over 26% were rape victims. Some of the highest numbers of sexual violence victimization were among those women who identify as multiracial, with over half (53.8%) experiencing some form of sexual violence in their lifetime. Men of color experienced sexual violence at higher rates than white men; the highest percentages were among Latino men (26.2%) and men who identified as multiracial (31.6%).

Local statistics on sexual and intimate partner violence showed that in Illinois nearly 40% of the female population and 25% of the male population will experience some type of sexual violence in their lifetime.

Physical and mental health outcomes for victims of sexual and intimate partner violence are shown to be both long term and severe. Victims surveyed report physical outcomes such as high blood pressure, persistent headaches, asthma, and diabetes. Victims were also two to three times more likely to report having poor mental health.

In order to address widespread sexual and intimate partner violence, both prevention and intervention-based approaches are necessary. There needs to be a collective response from federal, state, and local governments to crimes of sexual violence where perpetrators are held accountable and victims are given options. Last month, the U.S. Department of Justice announced a change in the federal definition of rape, a change long overdue. The new, more accurate definition will allow for better reporting of rapes and a more appropriate response to victims seeking justice. The reauthorization of the Violence Against Women Act (VAWA), currently pending in Congress, would step further in the right direction to help victims of sexual violence. Improvements to VAWA that are contained in Senator Leahy’s bill, S.1925, would build the capacity of local communities to maintain critical victim services already in place as well as increase outreach to traditionally underserved populations. Learn more about VAWA reauthorization and the list of senators not yet signed on as co-sponsors. If your senator is not yet a co-sponsor (both senators from Illinois are), please contact your senators and ask them to sign on as a co-sponsor of S.1925, the reauthorization of the Violence Against Women Act.

In addition to policy changes, there need to be changes in the way communities approach and understand sexualized violence. You can increase awareness of violence in your own community—do your part to make your voice heard.

• Email This
• Print
• Comments
• Trackbacks

The results are in: poverty is on the rise in America. Over 46 million Americans, 15% of the country’s population, are income poor. This number has grown from 1 in 5 in 2009 to 1 in 4 today. And this is actually an underestimate of the U.S. poverty level since the Census Bureau’s current method for calculating poverty is outdated. In fact, the Census Bureau recently announced a new supplemental poverty measure to help update the way it calculates poverty.

While income poverty is important, it refers only to a person’s cash flow. Asset poverty, on the other hand, focuses on net worth. Individuals who cannot get by for three months if all of their outside sources of income cease are considered asset poor. Asset poverty is, therefore, is more important than income poverty, since income poverty examines only whether people have enough to get by, whereas asset poverty examines whether they have enough to get ahead. 

This week, the Corporation for Enterprise Development (CFED) released the 2012 Assets & Opportunity Scorecard, which highlights the growing asset poverty trend. According to this report, 43%, or 127.5 million people, are asset poor. The Scorecard focuses on five areas and provides an overall ranking and grade per subject area for each state, as well as policy solutions for states to implement to improve their scores. As CFED’s State Asset Network partner for Illinois, the Shriver Center contributed data for this report.

Based on this data, Illinois ranks 32^nd in the nation with almost 13% of its population experiencing income poverty and over 26% experiencing assert poverty.

Financial Assets and Income
Illinois scored a C and ranked 29^th in the nation in terms of assets and income. The most dramatic figure ranks Illinois 42^nd in the country for bankruptcy; 6.3 per 1,000 residents have filed for bankruptcy, compared to the national average of 5.

Businesses and Jobs
Illinois also scored a C and ranked 31^st in the nation in the area of business and jobs. While the national unemployment rate is 9.6%, in Illinois it is 10.2%, ranking the state 36^th in the country. Similarly, the national underemployment rate is 16.7% versus 17.5% in Illinois, ranking it 40^th. These numbers depict the continuing struggle of those looking for work and lingering unemployment.

Housing and Homeownership
Illinois scored a D for housing and homeownership, ranking it 44^th in the nation. The state’s foreclosure rate is 7.29%, 48^th in the nation, meaning that 1 in every 498 households are in foreclosure. Forty percent of residents are also financially overburdened by their homeownership costs and another 52% are overburdened by rental costs.

Health Care
Illinois scored a C in health care and ranked 26^th in the nation. Although health care reform will provide health care coverage for more Americans, currently the poorest 20% of Illinois residents are 13.6 times more likely to be uninsured, and people of color are 2.3 times more likely to be uninsured than the rest of the nation.

Racial Wealth Gap
Nationally there has been a dramatic increase in the racial wealth gap. While 20% of white families are asset poor, over 44% of households of color in America are asset poor. In Illinois, people of color are 2.6 times more likely to be asset poor.  

Asset Building Policy Solutions
The recession may be over, but families are still reeling from the aftermath and struggling to get ahead. The U.S. income poverty level is the highest it has been in the 52 years that poverty data has been collected. It is imperative that states and the federal government begin addressing these overwhelming figures. By implementing asset building strategies, the nation will create opportunities for families to both move out of poverty and become economically upwardly mobile. The Shriver Center and its Assets Opportunity Unit will continue its efforts to ensure that these issues receive the attention that they deserve. 

For more information about the Shriver Center and its work on alleviating poverty visit Shriver’s Website and subscribe to our asset building newsletter, or follow us on Twitter and Facebook.

For a complete look at all 50 states and their scores, see the full CFED Asset and Opportunity Scorecard.

• Email This
• Print
• Comments
• Trackbacks

This post is part of a weekly “Did You Know” blog series that highlights important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health. 

Did you know that switching the focus from treating chronic illnesses to preventing the diseases will not only improve the health of individuals and families all over the country, but will also rein in health care costs and strengthen the economy?

The Affordable Care Act (ACA) is applying this logic in its fight to lower the rate of preventable chronic illnesses, produce real savings in the health care sector, and recover lost economic activity at the local, state, and national levels. And it’s doing it in the name of prevention through effective public health initiatives.

The prevalence of chronic health conditions in the United States is taking a huge toll on our citizens, our nation’s health care spending, and our workforce. More than half of the people living in the United States have at least one chronic health condition, such as heart disease, stroke, diabetes, obesity, and cancer. Chronic health conditions account for 7 out of 10 deaths in America and rack up 75% of our nation’s health care spending. The cost for treating people with type 2 diabetes, heart disease, hypertension, and stroke, alone, amounts to $238 billion each year. In 2010, the United States spent almost $2.6 trillion on health care, meaning we spent around $1.9 trillion just last year on treating and managing chronic illnesses, most of which are largely preventable. Here in Illinois, more than 6.7 million people have reported being diagnosed with a chronic health condition, costing the state $12.5 billion in annual health care expenses.

What’s more is that the cost of chronic health conditions goes beyond the money spent on health care services. The toll these illnesses take on our workforce productivity is telling. According to the Gallup Poll, 7 out of 8, or 83 percent of American workers either have a chronic health condition or are obese. The poll estimates that this prevalence of chronic illness and obesity in our workers could be costing our economy $153 billion a year in lost productivity due to increased sick days. Other reports that take into account other chronic conditions and factors like lost productivity from workers who show up on the job while sick estimate that chronic health conditions are costing the United States more than $1 trillion each year in lost economic activity. To bring these statistics home, chronic disease plaguing Illinois’s workforce cost the state $14.3 billion in lost productivity. And the commonality of chronic disease is rapidly increasing. It is estimated that the number of Americans living with a chronic health condition will increase by 36%, or 46 million people by the year 2030, and that we could be spending $685 billion a year on medical treatment for chronic disease by 2020. Other sources estimate the total economic toll of chronic health conditions to reach $6 trillion a year by the middle of the century.

But it doesn’t have to be this way. As the CDC states, “Access to high-quality and affordable prevention measures (including screening and appropriate follow-up) are essential steps in saving lives, reducing disability and lowering costs for medical care.” And research has proven that for every dollar invested in effective prevention and public health initiatives, $5.60 is saved. The same study reveals that, if we invest $10 per person every year in effective community-based public health programs, we could save the United States more than $16 billion in just five years. 

Fortunately, the Affordable Care Act recognizes the benefits to be had from investing in smart and effective preventive and public health efforts. The ACA established the National Prevention, Health Promotion and Public Health Council within the Department of Health and Human Services (HHS), made up of secretaries from various federal departments and chaired by the Surgeon General. The Council is responsible for developing our first ever National Prevention and Health Promotion Strategy, which was released in June of 2011 and identifies four strategic directions for preventing disease and improving health nationwide. The four strategic directions are: creating healthy and safe community environments; expanding access to quality clinical and community preventive health service; empowering people to make healthy choices; and eliminating health disparities. The Council is charged with providing leadership moving forward with the National Prevention and Health Promotion Strategy.

The ACA also established a Prevention and Public Health Fund, which is administered by the Secretary of HHS, Kathleen Sebelius, and provides financial support for state and community-wide efforts to prevent disease and promote healthy lifestyles. The Fund is a 10-year, $15 billion commitment to support prevention and public health programs across the country, like the Community Transformation Grants, which fund community-level programs geared towards reducing the prevalence of chronic disease and promoting healthy lifestyles.   Already, $103 million in grant money has been issued to 61 different state and community programs across the country, reaching 120 million people.

So what does all of this mean for chronic disease in Illinois? Already, the State of Illinois has received $17.14 million out of the Prevention and Public Health Fund to support community- and state-level wellness and prevention programs aimed at preventing chronic disease and raising awareness about healthy living. For a breakdown of what programs received funding and for how much, visit HealthCare.gov online.

The Secretary of HHS will continue to issue funds for prevention and public health programs across the country to reverse the trend of chronic disease, so stay tuned as health reform continues to make a positive impact in our communities. To find out what other kinds of initiatives the Affordable Care Act has taken to increase access to preventive health measures and decrease illness in America, visit the Shriver Brief online.

Interested in an in-person presentation on how health reform is rolling out in Illinois and what it means for individuals? Are you a direct service provider or advocate for vulnerable populations and interested in how the Affordable Care Act will impact the population you serve? Rachel Gielau, health policy expert at the Shriver Center, is giving free in-person presentations to Illinois audiences on how health reform is affecting individual and families in Illinois. Contact Rachel Gielau at 312-368-1154 to set up a presentation for your organization!

This blog post was coauthored by Rachel Gielau.

• Email This
• Print
• Comments
• Trackbacks

Thanks to a certain MTV show, young parents are very much in the news, although not in the most nuanced way. The good news is that teen pregnancy has been declining; according to the National Campaign to Prevent Teen and Unplanned Pregnancy, the teen birth rate declined 44% between 1991 and 2010. Even so, according to the campaign “it is still the case that about one-third of teen girls get pregnant by age 20 and there were more than 400,000 births to teens in 2008.”

A recent Clearinghouse Review article examines problems facing a vulnerable subset of young parents: young parents who are themselves in foster care. These parents face not only the difficulties facing all young parents—lack of educational opportunity and financial stress among them—but also intense scrutiny from the social service agencies and attorneys designated as their protectors. 

The article’s authors represent young parents in foster care at New York City’s Center for Family Representation. They explore the tensions that arise when a young parent in foster care has a baby and the local child welfare agency then files a child welfare case against the young parent. In most parts of the country, when a young parent in foster care becomes a respondent in a family court case, the same child welfare agency responsible for the parent’s welfare as a foster child is responsible for proving that she is a neglectful or abusive parent.

Unsurprisingly, the child welfare agency’s double role can raise trust issues for the young parent. Because they often live in congregate placements, such as mother-child placements or maternity residences, young parents are observed more closely than parents who have the means to live independently. When court cases are filed against them, young parents often continue to work with the same agency personnel who have accused them of abusing or neglecting their children—even though those personnel may end up testifying against them in family court.

Also, because the child welfare agency has a special legal relationship with the young parent, the agency has access to her confidential medical and mental health history. Child welfare agencies sometimes include voluminous detail from young parents’ mental health histories in the initial allegations against them—even if the hospitalizations and mental health diagnoses described predate the birth of the young parents’ children by many years. Child welfare agencies almost never have this kind of access to confidential records for parents who are not in foster care, which shows how agencies can use a young parent’s foster care status to her disadvantage.

While some judges have written sympathetically about young parents who are also foster children, the courts have not found any conflict of interest inherent in child welfare agencies simultaneously taking care of a young parent as a foster child and presenting an abuse or neglect case against that young parent. Is this double role right and lawful? If not, what should child welfare agencies be doing about it?

• Email This
• Print
• Comments
• Trackbacks