Let’s Take Politics Out of Healthcare

by Erik Randolph | Feb 19, 2021

Let’s Take Politics Out of Healthcare

The federal government’s surprise move against Georgia

In a raw political move, the Centers for Medicaid & Medicare Services (CMS) removed the approval of Georgia’s Pathways to Coverage, labeling the program as “pending.”

Despite the fact that the COVID-19 vaccine rollout is consuming the resources and attention of the Governor’s office and the Department of Community Health, CMS gave Georgia only 30 days to respond before the federal government might eviscerate the program. In its February 12 letter, CMS targeted the program’s work or other community engagement components and also threatened “review” of other provisions of the program.

This move by the new administration in Washington, D.C., appears to be unprecedented. Finally secured last fall, the approval was part of an administrative process, which included time for public comments, that took years to develop.

Pathways to Coverage serves non-disabled adults below the poverty line. It is a critical component of Georgia’s plan to reduce the number of uninsured and make healthcare coverage more affordable, without sacrificing quality of care or causing other serious drawbacks associated with a traditional Medicaid expansion. It is based on the idea of not keeping these adults below the poverty line but moving them above it.

The Success Sequence provides an outline of how to reverse the cycle of poverty in our communities. GCO uses this as a framework for much of our work.

Let’s focus on helping people instead

Pathways to Coverage is really about helping people. Readers might want to check out my prior blog on this program as well as some of our published research on fixing the healthcare system.

The so-called Affordable Care Act (ACA) has caused havoc for Georgians when it comes to healthcare coverage and costs. The rate of healthcare price increases did not abate but accelerated. As we reported before, our own data analysis confirmed other research by showing that for individual markets, “Georgians suffered average price increases of 70.7% for Bronze plans, 77.3% for Silver plans, and 70.4% for Gold plans” over five years.

We also found that prior to the ACA, the median cost for a health insurance plan on the individual market for a family of four was $5,386 per year. But within six years, the cost varied from $17,550 to $26,081, depending on the level of the plan.

The bulk of Georgia’s uninsured problem lies not below the poverty line, but above it. Therefore, Pathways to Coverage necessarily links to Georgia’s Reinsurance Program designed to drive down costs in the individual markets. The test of the demonstration project will be to see how well Georgia can move people out of poverty into situations where they have better opportunities and more resources for health coverage, such as coverage through affordable individual markets or, better yet, employer-based coverage.

America has one of the world’s best and most innovative healthcare systems, if you have insurance to afford it. By far, employer-based and private insurance provides the best coverage. Medicaid has among the worst healthcare outcomes, can trap families in poverty (as we and others have demonstrated), and can be an obstacle in moving to the much-better private coverage. Incentivizing people to improve their circumstances is an important strategy that this demonstration project hopes to prove.

The Spirit of the Law

The new administration in Washington might feel like they are doing the right thing by attempting to strongarm states like Georgia into Medicaid expansion. However, this action raises concerns.

First, the question of whether the federal government can mandate states to expand Medicaid was already settled in the negative by a seven-to-two U.S. Supreme Court ruling. Second, removing a critical component of this demonstration project will not likely accomplish expansion but, if followed through, will compromise the effectiveness of the project. Third, it goes against the whole purpose of demonstration projects.

Pathways to Coverage is an approved—and hopefully remains so—Section 1115 waiver to Medicaid rules, which is found in the Social Security Act. In enacting this section of the law, Congress acknowledged that a one-size-fits-all approach dictated by the federal government is not always the best way to solve our public policy challenges.

Congress acknowledged this principle again when it enacted Section 1332 of the Affordable Care Act that allows states to come up with alternative plans in coordination with Section 1115 waivers. Georgia took advantage of both these provisions of law in developing its healthcare strategy.

Finally, demonstration projects allow states to experiment with what works best. Without experimentation, we hinder our ability to discover better ways to run public programs for the benefit of people.

What’s next

The best overall resolution would be for CMS to reinstate the approval and allow the demonstration to move forward. CMS will monitor the project, of course, but it must let it play out to see if the project will demonstrate a better way. Georgia has a vested interest in making it work. If not, Georgia could choose to modify or abandon the project. Besides, the federal government will have the opportunity to review the results when the waiver comes up for renewal.

Failure to reinstate the approval will likely result in a legal struggle before the courts. Who knows how long such a legal process will take? Instead of using our resources and time to bicker before the courts, we should apply them to seek out the best ways to improve people’s lives.

*Erik Randolph is Director of Research at the Georgia Center for Opportunity. This blog reflects his opinion and not necessarily that of the Georgia Center for Opportunity.

Reflections of a Newlywed

by Joyce Mayberry | Feb 16, 2021

Reflections of a Newlywed

Reflections of a Newlywed: Lessons Learned From One Year Of Marriage

A little more than a year ago you all reached out to my husband, Harold, and me on our exciting new journey as a married couple. We are so grateful for all of the wisdom that you shared with us.

Since we have been married a year now, and as an ode to National Marriage Week, I thought you may be wondering how we are doing. We are doing great!

Here are just a few of the nuggets of wisdom passed onto us, which we really relied on this first year:

Overcome stressors in your marriage by making your marriage a priority
Never criticize your marriage in public and keep your marriage off of social media
Be intentional about serving in your marriage
Pray together
Never end an apology with “but”
Life is going to happen no matter what’s going on, so share these things with your partner.

“We are bringing you along with in a new life together. And, we’re going to be learning along the way.”

The gift of this advice was timely and helped us overcome unforeseen challenges that arrived after the wedding.

I have only shared this with a small group of people, however, shortly after we were married, Harold suffered a stroke. It was traumatic for us both. I thought to myself, “we just got together, Lord please don’t take him from me.” We had a tough hill to climb, but we were both strong mentally and we leaned on each other to get through it. Now that Harold is a lot better, he said he drew his strength from us, and we both realized it made us stronger.

What did we learn from all of this:

1) We learned that mental support is needed just as much as medical support. It’s like a diet without exercise..

2) We learned well-being as a couple is also just as important as it is for individuals.

3) We also learned that community and a social network helps you get through it all.

Our community provided us with strong advice and principles which we continue to integrate into our marriage. We talk a lot about community at Georgia Center for Opportunity, which is why we think it is important for you to experience community in our Family Life Education classes. In these classes we equip and empower you with the knowledge and skills that help you to become resilient.

As Harold and I continue our marital journey, we hope these words of wisdom will help improve the quality of all of your relationships. For those looking for a little extra nudge, The Family Life Classes are available along with our Healthy@Home, and Thriving Together series on our website.

Is it time for voting rights reform for felons?

by David Bass | Feb 11, 2021

Is it time for voting rights reform for felons?

Coming off the contentious 2020 election, the issue of voting rights has been in the news lately. That is likely why, this year, there is a renewed push among some lawmakers in the Georgia legislature to reform voting-rights laws for those convicted of a felony.

This issue is central to our mission here at the Georgia Center for Opportunity (GCO). For well over a decade now, GCO has advocated for criminal justice reforms that help returning citizens create a new life—through joining the workforce, caring for their loved ones, and becoming productive members of society once again. Voting rights are part of that.

Here’s where Georgia law currently stands: Those with a felony on their record automatically have their voting rights restored once they complete their sentence, which includes serving all parole and probationary periods and paying all outstanding fines, fees, and restitution. They are also eligible to vote if they have First Offender status and that status has not been revoked.

“Just coming out of incarceration period, you feel like you have no opportunity. You feel like there are no options. I don’t have any options.”

Understanding the challenge of voting rights for felons

The goal of voting rights laws for those with a criminal record should be moving them in the quickest way possible to becoming positive, contributing members of society again. Once the individual has fully paid his or her debt to society, it makes perfect sense—and is in the best sense “just”—to reinstate their voting rights.

At the same time, there are good reasons for restricting felons from voting until the end of their sentences. Society has an obligation to prevent people who have demonstrated impaired ability to make good decisions from voting. That’s why we don’t let children or the mentally ill vote.

Felons have an added strike against them in that, in addition to poor judgment, they’ve also—in many cases—expressed contempt and disregard for the laws that govern us and shouldn’t be allowed to impose laws on the rest of us until they have shown their respect for and willingness to abide by the law.

A good place to begin

So, where should we begin with reforms to voting rights for felons? A great place is also the simplest and most non-controversial: There is strong evidence that even some felons who have fully paid their debt to society face challenges in having their voting rights restored.

For example, in 2019 a representative from the Georgia Justice Project testified before a state Senate committee that there is frequently misinformation within voter registration offices, and sometimes among volunteers, about whether someone ever convicted of a felony can vote. There are also challenges with felons proving they are officially “off paper” (i.e., they have completed their probation or parole) and are now legally eligible to vote.

Let’s begin here with clearing up misunderstandings around the law on voting rights for returning citizens and ensuring that all election-related officials are applying it correctly. A big step would be for election officials to be required to accept Certificates of Sentence Completion from the Department of Community Supervision as sufficient proof that a returning citizen should be added back to the voter rolls.

Work is important, too

A central goal of the Georgia Center for Opportunity is to help returning citizens reintegrate into society. Voting rights is one aspect of reintegration, but there are others—like finding stable employment—that are far more important to improving outcomes for returning citizens.

We know that work is a key way to reduce recidivism: Research has shown that if an ex-offender can keep a job for six months or more, their likelihood of ending up back in prison drops dramatically. It also improves the odds that a returning citizen will reconnect with loved ones, especially their children, another key to preventing recidivism.

GCO’s efforts through initiatives like Hiring Well, Doing Good are making progress here, and stories like Kevin’s are inspiring.

Does the Minimum Wage Hurt or Help the Poor?

by Erik Randolph | Feb 9, 2021

Does the Minimum Wage Hurt or Help the Poor?

What economic research really tells us

Finally, we have the definitive answer on a longstanding debate on whether empirical studies show that minimum wage laws negatively impact employment.

You may have heard conflicting summaries, perhaps from economists themselves, on the economic research on this important topic. Some summarize the research to say that indeed raising the threshold of minimum wage laws comes with a cost of lost jobs, especially for poorer individuals who tend to lack experience and job skills. Others summarize the research to suggest that no such evidence can be found or there might be even slight benefits. And, still, others claim that the evidence is mixed, and you can’t conclude anything.

Last month, David Neumark—an economic research associate at the University of California, Irvine, and Peter Shirley with the Joint Committee on Government and Finance for the West Virginia Legislature—released a study that answered the question.

What does economic research tell us about the minimum wage?

In their National Bureau of Economic Research working paper, the researchers assembled what they believe to be the entire set of published empirical economic studies on the minimum wage in the United States since 1992. They did not include unpublished papers, simulations, or studies using methods considered to be less empirically rigorous.

Of the total 66 papers they identified and examined, they found that 79 percent of them showed a negative impact.

In summarizing the demographic groups most impacted by the minimum wage, the authors said the following:

There is strong and consistent evidence of negative employment effects for teens, young adults, the less-educated, and directly-affected (low-wage) workers, with the estimated elasticities generally larger for the less-educated than for teens and young adults, and larger still for directly-affected workers.

By the way, in case you don’t know, “elasticity” is simply an economic measurement of sensitivity. In this case, it refers to employment’s sensitivity to a change in the wage rate.

Interpreting the research scientifically

Some might want to spin the results to say that because 21 percent of the studies showed no adverse impact, we cannot conclude anything. Or, worse, they may argue that raising the minimum wage in this case may have some positive effects on employment.

However, this is what is known as cherry picking—a no-no when reviewing statistical evidence. We need to keep a few things in mind.

First, when reviewing statistical studies, there is always the chance you get false results. These are known in the profession as Type I or Type II errors, depending on whether you reject your null hypothesis when you shouldn’t have, or its opposite.

We have to look at the confidence level. (Not to be confused with the confidence interval or margin of error.) A 90 percent confidence level, which is usually the standard for national employment data released by the Bureau of Labor Statistics, means that 10 percent of the time, your results will be totally wrong. (That is, outside your margin of error.)

Because of these reasons, the science tells us to look at all valid studies—methodologically valid, that is—and go with the preponderance of the evidence. In this case, because 79 percent of the studies show negative impact, this is the conclusion we need to go with.

When it comes to empirical studies applied to economics, there is another consideration. The design of the study must be consistent with economic reasoning.

This is harder than it sounds. For minimum wage issues, economic reasoning says that negative impacts will occur only when price floors—minimum wages in this case—exceed the market equilibrium. Absent that condition, there would be no impact, but then also no point in establishing the price floor.

This adds a level of complication that, if anything, would increase the error rate. In this case, a 21 percent error rate would be consistent with what we should expect. By the way, this is also why it’s important to do multiple empirical studies to replicate the results. You can’t rely on just one study.

If raising the minimum wage is not the answer, what is?

For advocates of the minimum wage, the empirical evidence will be disappointing. Take heart. There are better solutions out there.

The main reasons people support the idea of a minimum wage are to help wage earners keep up with inflation and to enable them to earn a decent living. In response, I suggest a three prong approach: attack inflation, promote economic growth, and improve education and job skills of the population, especially low-income workers.

Few people realize that inflation is government policy. The Federal Reserve Board of Governors has adopted an annual inflation target of 2 percent, and since the start of the pandemic the board eased its policies to allow inflation to exceed its target.

From my perspective, this inflation target is crazy. It’s a hidden tax that hits the poor the worst. My recommendation is to eliminate the inflation target with a new target so prices remain stable or decline slightly every year to match general gains in productivity.

Of course, economists are divided as ever when it comes to macro policies, and a host of them will cry that eliminating the inflation target is dangerous. They’re wrong, but I’ll save my rebuttal for another day.

“I suggest a three prong approach: attack inflation, promote economic growth, and improve education and job skills of the population, especially low-income workers.”

Second, the more the economy grows, the better it is for the labor market, increasing the demand for jobs. This is a natural and excellent way to push up wages for workers. When you have a growing economy, businesses can afford to pay their workers more—and they will do so without government cajoling them because it will be in their economic interest to do so. We only need to look at the increase in employment and wages over the several years leading up to the COVID-19 recession for evidence of how this works.

Conversely, when you have a recessionary time, like now, it is the worst time—not that there is any good time—to force businesses to pay their workers more when they can least afford it. Politicians take heed. Follow the science on this one.

There are countless stories of this in action. For example, the restaurant Boca Nova in Oakland, California, implemented dramatic changes to its pay structure after the city mandated a $12.25 minimum wage in 2015. In lieu of gratuity, the restaurant tacked 16 percent onto customers’ bills: 4 percent went directly to servers and the remaining 12 percent covered the cost of raising salaries for other workers. The results were that about 60 percent of the restaurant’s servers quit because the policy slashed their average hourly earnings by around half—from between $38 and $70 an hour to $22 to $28 an hour.

Finally, our public education systems have been failing us and our children, especially for students stuck in underperforming schools or lacking resources at home. The consequence is too many workers unable to secure higher wages in our current job market.

This last prong is where the Georgia Center for Opportunity (GCO) really shines. It is actively promoting improved education and job training. And GCO is collaborating with other nonprofits to help place people in employment with a career ladder to improve their earning capacity over time.

School closures, a job loss, and health emergencies: How the pandemic is impacting one family of a student with special needs in Georgia

by David Bass | Feb 8, 2021

School closures, a job loss, and health emergencies: How the pandemic is impacting one family of a student with special needs in Georgia

Students are missing the magic that happens in a classroom that cannot be replicated on a Zoom call

When the pandemic came home to DeKalb County in March 2020, Jennifer Sheran and her husband never expected that it would touch off a year-long stint of trials.

It all began with the public school system’s transition to online learning. A virtual classroom worked fine for Jennifer’s two older children, but her youngest son, 10-year-old Joey, has Down syndrome. Online learning is entirely unworkable for him due to his special needs.

For example, DeKalb is following a normal bell schedule but staying engaged on Zoom for hours on end is not working. Morning classes will sometimes go well, but by lunchtime Joey is tuned out. It is impossible to get him back online after the lunch break for specials, such as music and art, and Jennifer cannot stay tied up until 2:30pm every day. She has seen academic and social regression for her son as he has little to no interaction with peers.

Additionally, his academic growth is limited due to repetitive practice of current skills on worksheets with no new individual instruction to learn new concepts in language arts or math. As a highly visual and experiential learner, he is missing the magic that happens in a classroom that cannot be replicated on a Zoom call.

“It’s day-by-day and minute-by-minute,” Jennifer shares. “One class he is engaged and on task, and the next minute he is hiding under the bed or taking his shirt off.”

Adding fuel to the fire, Jennifer’s 25-year career in PR and corporate communications hit a speed bump in July when she lost her full-time job. Her income was a significant part of the household budget.

Normally, Jennifer would have launched a job search immediately, but the demands of online learning for Joey meant that she could only pick up a few freelance projects to try and bridge a small part of the gap in their family budget.

Today, nearly a year after DeKalb schools went virtual, Jennifer is getting so desperate that she and her husband have decided to list their home in Dunwoody and move south to Henry County, where public schools have been open for in-person instruction since September.

We’re expanding opportunities and giving new hope to children across the state. All students deserve access to high quality education options.

Good news on the horizon

Another layer of challenges hit when Jennifer’s mother had a stroke and is now in rehab. With her father already suffering from COPD and advanced kidney disease, the Sherans will be selling their home and moving in with her parents to be caregivers until they can make the permanent move to Henry County.

All schools continue to have their doors shut to in-person learning, Jennifer shares that the special needs community “is getting completely overlooked.”

“In other states and even elsewhere in Georgia, school districts make accommodations, understanding that special-needs students have a need to return back to classrooms earlier than others,” she said.

There is good news on the horizon for families like Jennifer’s: Georgia Governor Brian Kemp recently allocated $10 million in federal emergency relief dollars specifically to reimburse parents of students with special needs for education expenses incurred during the pandemic.

In Jennifer’s case, the funds would be crucial to help hire tutoring help so that she can find more work to make ends meet.

“One-size-fits-all won’t work here,” she said. “We can’t allow our special-needs students to fall even further behind. They will be more dependent on society as they transition to adults. These children are capable of so much if we give them the support they need.”

The importance of the African American family in our history

by Corey Burres | Feb 1, 2021

The importance of the African American family in our history

A focus on the contributions of the African American family

As we head into February, we at the Georgia Center for Opportunity (GCO) are proud to celebrate Black History Month and the experience of the African American community. In particular, we plan to take this month to celebrate and promote the African American family and how it has positively shaped our nation as a whole.

We believe that all communities can learn from each other. The strength and generational bond that is particularly strong within the African American family is something that should be applauded and modeled for others. African American families have had to face so much in our nation’s history—from slavery to legally sanctioned discrimination—yet there are so many stories of the triumphs and stories of these strong relationships. They inspire us all.

So this month we will feature blogs and commentary around family and the strength of the African American community. Expect to see features on Marriage Week (Feb. 7-14), the foundational principles that define family, creating an extended family for foster children, and fundamentals for a healthy marriage. These universal principles will help shape our understanding of what it means when we say “better relationships”.

The Success Sequence provides an outline of how to reverse the cycle of poverty in our communities. GCO uses this as a framework for much of our work.

Family makes us stronger

We are all stronger when we have the support base of a family that will stand by us throughout hardships. We know that the support structure and relationships formed out of strong family bonds lead to success throughout life. It is why we provide training and support to further family development in our communities. Healthy relationships and strong family bonds are a key part of the Success Sequence, a process that helps people avoid poverty and leads to meaningful work, finances, and relational lives. In short, it leads to a vibrant and thriving life.

We value the importance of listening and learning from the experiences of others. That is why throughout February we will be highlighting the strength and values of the African American family from the perspective of those in the African American community. GCO staff members will share their experiences and we will draw on the experiences of those we serve—all of this with the purpose of applauding the marriage, family, and diversity of experience