Tuesday, November 17, 2009

Morrison Memo: Debate over insurance reform is healthy

The contentious debate over health insurance isn’t unique to Congress, it’s occurring on a daily basis all across the nation and in Arizona:

To the worker with no health-care benefits: “Should I pay the light bill or go the doctor’s to check on this nagging cough?”

To the unemployed worker: “Should I continue to pay COBRA or apply that dollar amount to my late house payment?”

To the union worker: “Should I consider striking or just be happy to have a job with benefits and accept the fact I have to pay more for my health insurance?”

Too many Americans are living without health insurance.

How many? Estimates vary, but the Census Bureau’s annual report released in September puts the figure at 46.3 million Americans in 2008. The actual number is likely higher since it does not include the hundreds of thousands of layoffs this year that resulted in loss of employer-provided insurance.

Arizona has one of the highest levels of residents without health insurance – almost 20%, or one in five residents, as noted in the 2009 report, Truth and Consequences: Gambling, Shifting and Hoping in Arizona Health Care.

By and large it’s not the very poor doing without insurance, since many are eligible for Arizona Health Care Cost Containment System (AHCCCS) coverage, Arizona’s version of Medicaid. No, it’s your working-class neighbor – if not yourself – who’s living without coverage. Eight out of 10 Arizonans without insurance are in households where one or more members works at least part time, according to the Truth and Consequences report, prepared by Morrison Institute for Public Policy. And as more full-time employees get laid off, along with the disappearance of dependable paychecks so go their employer-provided health care coverage.

The high cost of COBRA (Consolidated Omnibus Budget Reconciliation Act) prevents many unemployed Arizonans from purchasing the federal government’s stop-gap insurance program, which was never intended to provide long-term coverage.

In Arizona, where average unemployment insurance benefits are $937 a month, the average family COBRA premium is $1,084 – or 116% of UI income, according to a 2009 study by Families USA, a national organization for health care consumers.

In response to the worst recession of our time, the federal stimulus package reduces the COBRA premium for recently unemployed workers so they pay just 35 percent of the usual amount – but only for up to 9 months, at which time COBRA can again charge 102 percent of the premium the employee and employer collectively were playing for insurance.

With their inherent and colossal complexities, health care reform and cost containment are two issues we’ve ignored for too long, and understandably may be a bitter pill for some to swallow all at once. But a fiery debate in the Senate to find the right prescription for the ailing nation is preferred to the daily debate too many Americans face: Groceries or health care.

Tuesday, November 3, 2009

The 'new face' of homelessness

MORRISON INSTITUTE BLOG

By Kristin Borns, Senior Policy Analyst

On my way back from lunch one afternoon recently, a kind, clearly homeless man; torn, dirty clothes, skin the deepest shade of brown from having been in the sun constantly, asked if I wouldn’t mind sharing my leftovers. Just one of the everyday encounters with the struggling homeless population that happens in any downtown. This is who Arizonans think about when they think about “helping the homeless”, and they’d be right – but only in part.

The face of homelessness is changing nationwide and in Arizona. Now, more than ever before, homelessness is affecting professionals out of work, single parents, and families - the fastest growing group of homeless, according to the Department of Economic Security (DES).

DES provides an annual point-in-time count of individuals experiencing homelessness in Arizona, and in January of this year, approximately 50% of those individuals who were sheltered were in families. This is a jump from 2007, where only 37% were in families. Additionally, school districts statewide are reporting increases in homeless students as well as students accessing the free and reduced lunch program. In October, Mesa Public Schools reported an increase of 400 homeless students over the last three years. As the recession continues, and more Arizonans lose their jobs, the realities of poverty, hunger, and homelessness become more acute.

Service providers also are seeing clients they’ve never seen before. In fact, in a recent news interview, the spokesman for St. Mary’s food bank noted they are now seeing people coming in for services who last year were providing donations.

Yet, even with this tacit recognition of the increase in need, lawmakers are looking to make even more cuts to adjust a current-year budget that is $2 billion short. Some suggested impact scenarios put forth by state agencies include the Department of Housing’s complete elimination of the Homeless Prevention Program, which could result in 2,000 households now facing eviction or foreclosure; the Department of Economic Security’s reduction of TANF (Temporary Assistance for Needy Families) cash benefits for families in poverty; and perhaps most frightening, the elimination of the KidsCare insurance program, resulting in 47,000 low-income children losing coverage. Nothing can spiral a family into financial ruin like an uncovered health emergency.

Policymakers may not even know or understand the size and need of this new community. Without this understanding, it is impossible to know what long-term impact cuts alone are going to have. Serving those who are experiencing homelessness has always been complex. Even the notions of who those experiencing homelessness in downtown are likely to miss the nuances and needs of the individual I encountered during that lunchtime.

HUD releases an annual report on homelessness nationally, and in the report for 2008, released last July, it was noted that families were more likely than other groups to have been housed the night prior to experiencing homelessness, often staying with family or friends. As families experience lost jobs and incomes, they are exploring other options, with homelessness being the last stop. Even more so now than before, policymakers defining the need and possible consequences of choices is complicated, since preconceptions of those experiencing homelessness do not apply in this new normal.

Our neighbors and friends are the new face of the recession.

Monday, November 2, 2009

Arizona's Public Behavioral Health System: Critical Issues for Critical Times

Arizona's Public Behavioral Health System: Critical Issues for Critical Times prepared jointly by ASU’s Center for Applied Behavior Health Policy and Morrison Institute for Public Policy, notes that Arizona’s billion-dollar public behavioral health system, which serves 150,000 ill residents and their families, is inadequately staffed and struggling under budget cuts and the demands of a 28-year-old class-action law suit.

Among the findings of the report:

35% of Arizona adults with serious mental illness do not qualify for AHCCCS/Medicaid, primarily because they are working poor and uninsured, and thus are at risk for inadequate treatment
Funds for housing and food to support patients’ recovery are essential, yet are not provided to even patients covered by AHCCCS/Medicaid because they are not considered "medically necessary"
Budget pressures put Arizonans at risk through cuts to crisis services, which not only avert suicides and drug overdoses, but provide vital assistance to local hospitals and local law enforcement officials.
The report’s release comes just weeks after Governor Jan Brewer’s October 9th call for a major reorganization of the statewide system.

Friday, October 30, 2009

Morrison Memo: Voting as a barometer for civic engagement

Morrison Memo

While the information age and social media have created a multitude of new forums for civic engagement and political rambling, voter turnout remains a critical indicator of the health of our democracy. So just how representative is our political system?

At the national level, the 2008 presidential election was hailed as mobilizing youth and minority voters. According to the U.S. Census, voter turnout increased by 5 million and turnout among voters ages 18 to 24 increased from 47% in 2004 to 49% in 2008.

For minorities, voting rates for African Americans, Asians, and Hispanics each increased by approximately 4 percentage points from 2004 to 2008. Women (66%) continued to vote at a higher rate than men (62%), although this doesn’t reflect a statistically significant change from voting rates in 2004.

What about Arizona?

Arizona has seen an increase in presidential election turnout since 1980, but a decrease in turnout for gubernatorial elections over the same period. During the period 1980 to 2008, the average gap between Arizona and U.S. voter turnout was 6.2% for presidential elections and 2.5% for non-presidential elections.

One discouraging trend is the fact that the percentage of Arizona’s voting age population that is eligible to vote has decreased substantially from 1980-2008. In 1980, 96% of Arizona’s voting age population was eligible to vote compared to only 85% of the voting age population in 2008. Nationally, the decrease has been less significant, from 97% in 1980 to 92% in 2008. For Arizona, this can be attributed to largely to an increase in non-citizen residents and partly to an increase in ineligible felons.

According to Pew Hispanic Research Center, Arizona’s Hispanic population is the sixth largest in the nation (nearly 1.8 million in 2008), but only 37% of Arizona Latinos are eligible to vote. This figure largely reflects the number of Hispanics who are non-citizens (both documented and undocumented). It also reflects the relative youthfulness of Arizona’s Hispanic population. Based on 2008 American Community Survey data, 26.2% of Hispanics in Arizona are under 18 years of age.

Among those Hispanics who are eligible to vote, turnout may increase if the educational attainment gap were closed. Twenty-eight percent of Latino eligible voters in Arizona have not completed high school and studies suggest that this educational disadvantage could make them less likely to turnout on Election Day.

To promote increased civic dialogue and informed civic action, Morrison Institute for Public Policy hosted the State of Our State conference on October 9, 2009. More than 200 community leaders and public officials participated in the inaugural event and Morrison Institute will continue to engage with citizens during a year-long series of events and publications on key issues facing the state. One desired outcome is a greater sense of connection between constituents and their representatives such that citizen voices are heard not just on election day, but throughout the legislative process.

Monday, September 21, 2009

Forum 411: "Road to Recovery: Lessons from Arizona's First Economy"

This sixth issue of the Morrison Institute for Public Policy's "Forum 411" series looks at the collapse of the economic underpinnings in Arizona of housing, employment, and financial services, and what it will take for us to recover.
The economic underpinnings in Arizona of housing, employment, and financial services have collapsed, as they have almost everywhere else around the nation, albeit deeper here than in most other states.
Arizona again must have the wisdom and willpower to rebound. But it will take more than a bold vision, although one is needed. It will take follow-through and collaboration – neither of which have been Arizona’s strong suit in recent years – as well as informed public policy based on what we’ve learned from the past, melded with what we already know about the future. In short, Arizona must prepare itself for the next economy.
For report, go to Morrison Institute's Web site at: http://MorrisonInstitute.asu.edu


Thursday, September 3, 2009

Are Arizonans Living on the Edge?

In the July 2009 AZ Views, "Arizonans On Edge ... So Why Not Involved?" there was a 30% net loss in those panelists saying they had an improved quality of life and those who said it had declined. This is the highest reported decrease since Morrison Institute started asking this question more than 10 years ago.
To read the report: http://MorrisonInstitute.asu.edu

  • How do you feel about your quality of life?
  • Is your life status threatened?
  • Are your hopeful it will improve?
  • What needs to happen for an overall and individual improvement?

Make your comment below. Please include your name and city.

Tuesday, August 11, 2009

Risk Management: Assessing Domestic Violence Suspects Arrested in Phoenix

Criminal Justice Issues of Arizona, Issue 5

Domestic violence is Phoenix’s most commonly reported violent crime, but many suspects’ cases are dismissed almost immediately after arrest, and many others are freed from jail without the supervision recommended by a standard risk-analysis. Risk Management reports these findings among others from analysis of data collected by Phoenix Municipal Court. The brief looks at more than 6,800 surveys with DV suspects collected by jail personnel between July 2006 and June 2008.
Analysis showed that 43% of DV suspects had their cases dismissed shortly after being arrested and brought to jail, and before going to court.
Another finding showed 77% of DV suspects should be supervised while on bail to ensure that they follow release guidelines, show up for court, and aren’t a danger to the community. But with screening and supervision programs cancelled for financial reasons, every year around 1,500 Phoenix DV suspects who should be supervised while on bail are not being supervised.

Read the report: http://MorrisonInstitute.asu.edu

Thursday, July 30, 2009

New Data Shows Arizonans Dissatisfied with Legislature, On Edge About Jobs and Quality of Life

Two-thirds of Arizonans who participated in the latest Arizona Indicators Panel are dissatisfied with how the Arizona Legislature is dealing with the state budget and tax issues. And of those respondents who keep close tabs on current news about the Arizona state budget, 80% disapproved of the legislature’s handling of the situation.

These new data are among the findings from a statewide panel of a representative sample of Arizonans. These and other results have just been released in a new AZ Views briefing “Arizonans on Edge…So Why Not Involved?

The panel survey tracks how Arizonans are thinking and feeling over time. AZ Views reports the data and analysis from the survey. The panel is part of Arizona Indicators, which is a project of Morrison Institute. These latest findings look at how attitudes have changed about a range of issues in the past year.

Compared with June 2008 when AZ Views reported that “Arizonans have a strong sense of job security, despite the national economic slump and the state’s budget crisis,” opinions have changed. Data from June 2009 shows that not only are Arizonans feeling insecure about their jobs, but in the past 12 months, those who said they feel “very secure” about keeping their jobs or keeping their businesses open declined by almost a third.

In addition, most panelists continue to rate the quality of life where they live as “good” or “excellent,” but they report a marked decline “in the last few years.” In 2008, more panelists reported an improved quality of life than those who said it had declined. In 2009, panelists who said “declining” outnumbered “improving” by 30%. Among those reporting the highest decline in quality of life are those who represent minority groups, are ages 45-59, or make $30,000 or less.

Yet despite concerns about declining quality of life and economic security, fewer than half of the respondents are keeping tabs on current public policy processes, including the state budget process.

Read the full version of “Arizonans On Edge” at http://MorrisonInstitute.asu.edu For more on the facts and figures behind the issues covered in AZ Views, visit Arizona Indicators at www.arizonaindicators.org

Morrison Institute is an independent and non-partisan public policy research organization at Arizona State University.

Monday, June 29, 2009

Report Reveals the High Cost of Arizonans Living Without Health

“I have a lot of friends who don’t have it (health insurance). I think they’re dealing with it like I am: Hoping we don’t get sick.”
Those are the words of Josh, 47, who suffers from hypertension and unemployment.
His story and many others are told in Truth and Consequences: Gambling, Shifting, and Hoping in Arizona Health Care, a new report by Morrison Institute for Public Policy, St. Luke’s Health Initiatives, and the L. William Seidman Research Institute at the W.P. Carey School of Business.
The report, released today, examines the true costs of so many Arizonans – almost one in five – living without health insurance.
“Health care is expensive, but the costs of poor health can be enormous,” said Arizona State University economist Kent Hill, who contributed to the report.
Treatment costs alone for chronic disease in Arizona are estimated to be $4.2 billion, or 2.3% of the gross state product. By 2023, projected costs for major chronic diseases are $99 billion, of which more than $25 billion could be avoidable.
But without health insurance, the personal stories of so many Arizonans will continue to paint a gloomy picture of lost dollars, lost potential, and lost opportunity:
· “At a public health clinic, you have to go wait in line. I try to avoid going because of cost.”
· “What if I got hurt? What’s going to happen to daughter?”
· “It’s very frustrating. Especially when you know you’re sick but you can’t get anything done about it.”
Truth and Consequences seeks to change that portrait by presenting recommendations to Arizona’s policymakers that could help the state fare better in the future so that Arizona can stop taking risks on residents’ health and health care.
Read the full report at http://morrisoninstitute.asu.edu

Monday, June 15, 2009

Arizona's second-class status for behavioral health care

Some of Arizonans’ most common and destructive illnesses—those of the brain—are failing to receive adequate treatment due to a combination of modern governmental gridlock and a centuries-old philosophythat separates the mind from the body.
That is among the findings of a new publication by Morrison Institute for Public Policy at Arizona State University.
"Arizona’s Mind-Body Problem: Mental Health Systems and Choices" is the latest issue in the Institute’s Forum 411 policy briefing series.
The eight-page report looks at why mental health care has been relegated to second-class status, resulting in markedly fewer benefits for Arizonans with private insurance and a public system that has long has been criticized as underfunded, understaffed, and highly uneven in its quality of care.
How severe is the gridlock?
Arizona’s system, which spends more than $1 billion annually, has been embroiled in a major class-action lawsuit for 28 years.
National studies have repeatedly shown that mental disorders, from phobias and panic attacks to schizophrenia, are widespread throughout the population, inflict suffering on millions of individuals and their families, and cost society billions in lost production.
Most people still shrink from the stigma of acknowledging mental problems, and most health care providers still labor under the false premise — refuted by the U.S. Surgeon General and other authorities — that problems of the mind should be dealt with separately from problems of the body.
Arizona’s Mind-Body Problem offers a range of policy choices, ranging from combating the stigma of mental illness to merging the public system with Arizona Health Care Cost Containment System (Arizona's version of Medicaid).
To read the full version of Arizona’s Mind-Body Problem, go to http://morrisoninstitute.asu.edu/
This Forum 411 on mental health is scheduled to be presented on June 17 to the Arizona Senate Committee on Healthcare and Medical Liability Reform.
Sponsored by Westcor, Forum 411 is a quarterly briefing series offering policy, business, and community leaders information on Arizona’s critical issues.
Morrison Institute is an independent and non-partisan public policy research organization based at Arizona State University as part of the College of Public Programs. The Institute is located in downtown Phoenix.