The Districts Dime

How Health Reform Can Help District Smokers

August 6th, 2014 | by Wes Rivers

The District has been a leader in using the Affordable Care Act (ACA) to expand health insurance to nearly all of its residents. But we should not stop there. The next step is to focus on providing services to address DC’s long-standing health disparities, including those caused by tobacco use.  The District has taken advantage of some – but not all – of the ACA options to enhance tobacco treatment. The District’s next wave in health reform should include aggressively attacking tobacco use in the city. 

About one in five District adults smoke, including nearly one in three African-American adults. Residents east of the river are more likely than others to be frequent smokers. This means that tobacco use worsens health disparities across the city. 

The District has already taken advantage of two Affordable Care Act provisions to provide tobacco prevention and cessation services, especially among residents who are Medicaid eligible. 

  1. Banning private health insurers from charging tobacco users more for their health plan. The ACA allows DC and the states to ban private insurers from charging smokers more than non-smokers for their health insurance premiums. DC chose to ban rate hikes for tobacco users, as the price increases could prevent lower income residents from accessing the care they need to quit. 
  2. Expanding Medicaid coverage to include face-to-face tobacco counseling and cessation medication for pregnant women. Tobacco use during pregnancy can have serious health effects on the fetus, so the ACA mandated coverage of counseling and cessation drugs for this population. The District amended its Medicaid State Plan this year to include these services. 

8-6-14-tobacco-blog-t1But the District is not doing enough to provide Medicaid coverage for FDA-approved cessation drugs or to cover tobacco counseling services. The ACA requires state Medicaid programs to cover all seven FDA approved cessation drugs (See Table 1) for all enrollees by January 2014. DC covers only three of these drugs (nicotine gum, patch, and lozenge), which means the city is out of compliance with ACA and missing the opportunity to greatly curb preventable disease. 

The District also has the option to fund the “tobacco quit-line” – its telephone counseling service – using Medicaid dollars. The District would need to conform the quit-line with proven practices, which could lead to a more effective program and a sustainable funding stream via Medicaid.  

Improving health outcomes is not only good for tobacco users and their family and friends. It also will reap long-term healthcare cost savings. A good example is Massachusetts — which implemented comprehensive Medicaid coverage for tobacco cessation services and medication and found that every dollar invested in the cessation program resulted in $3.12 in medical savings. 

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In the DC Metropolitan Region, Black Workers Are Being Hit Especially Hard

August 5th, 2014 | by Jenny Reed

Black residents in the Washington region have a much harder time finding a job than white residents —even when they have a college degree.  And the gap in earnings between white area residents and Black and Hispanic residents is growing. This suggests that policymakers need to focus not only on improving education and training, but also on efforts to help connect residents with jobs.

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No matter the education level, Black residents in the region face far higher unemployment levels than other residents.  (See Figure.) Thisis particularly true for Black workers without a high school diploma, where one in four Black residents are unemployed, compared with fewer than 10 percent of White, non-Hispanic residents. Even Black residents with an advanced education face job challenges. The unemployment rate for Black residents with a college degree or more is 6 percent, compared with 2 percent for White residents with the same educational attainment.

Beyond these challenges, the wage gap between Black workers and White workers has risen since in recent years. In 2007, the typical Black worker earned 74 cents for every dollar the typical White worker earned. By 2012, that had fallen to just 70 cents. Hispanic workers also face a large wage gap. Hispanic residents in the region made about 73 cents for every dollar earned by the typical Black resident in 2012 and just 51 cents for every dollar earned by White, non-Hispanic residents.

It is not entirely clear why Blacks are facing a harder time in the region, but certainly discrimination and a lack of access to opportunities play a role.  A recent study in Baltimore, for example, that followed nearly 800 low-income school children for nearly 30 years found higher employment levels among White men without college degrees than Black men without college degrees. One of the reasons? Many more White men were able to secure well-paying industrial jobs due to connections from friends and family in the industry.

With many Black residents being left behind in the region, policymakers should look to solutions that can help improve access and opportunity for them.

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Strengthening Rapid Re-Housing Will Help Homeless Families Succeed

July 31st, 2014 | by Kate Coventry

One of the keys to addressing DC’s homeless crisis is to strengthen Rapid Re-Housing, DC’s program that provides short-term rental assistance and supportive services to homeless families. The District currently is developing new rules to govern this program, which is also known as the Family Re-Housing and Stabilization Program (FRSP), and three particular issues stand out. The proposed rules would require families to pay too much of their limited incomes for housing, require homeless families to find housing without any initial help, and cap housing assistance at 12 months in most cases, even though some families may need more help. 

These proposed rules run counter to best practices, and modifying them would make FRSP a more effective tool to help homeless families get out of shelter and into their own homes. 

FRSP currently requires families to spend at least 40 percent of their income on rent, with their contribution increasing over their time in the program. This is higher than the 30 percent threshold used for most federal housing programs, and it is likely to force families to cut back what they spend on food, transportation, healthcare and other necessities.[1] We recommend the District cap what families pay toward rent at 40 percent of income, with a portion of that set aside in an escrow account to pay for necessities and emergency needs. 

FRSP also currently requires families to attempt to find housing on their own, before receiving housing search assistance. Yet other communities have had success by helping families negotiate with landlords to lower rents or to address issues such as a poor credit and rental history.[2] DC families searching for their own housing have reported that landlords do not understand how the program works and thus have been reluctant to participate in it.[3] This leaves families in shelter for longer than is necessary. FRSP will be more successful if parents receive immediate housing search and negotiation assistance. 

Finally, the District proposes limiting FRSP assistance to 12 months except for families experiencing “extraordinary circumstances.” Yet the National Alliance to End Homelessness (NAEH) recommends against using a hard time limit and notes that programs must be “flexible enough to permit extensions if best efforts fail or another crisis occurs.”[4] NAEH also recommends that Rapid Re-Housing programs take into account each family’s individual circumstances as well as community conditions such as high unemployment. DCFPI recommends that the District adopt this approach—individualizing the length of the subsidy to each client’s circumstances. 

Together, these changes will lead to a stronger program, allowing more families to succeed.                  

To see DCFPI’s full comments, click here.

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[1] Joint Center for Housing Studies at Harvard University, “The State of the Nation’s Housing,” 2011, http://www.jchs.harvard.edu/sites/jchs.harvard.edu/files/son2011_housing_challenges.pdf

[2] Core Components of Rapid Re-Housing. Endorsed by USICH, NAEH, HUD, and VA. http://www.endhomelessness.org/page/-/files/RRH.pdf

[3] Weiner, Aaron. Where Are D.C.’s Homeless Families Living Now That D.C. Doesn’t Have to House Them? Washington City Paper. May 21, 2014. http://www.washingtoncitypaper.com/blogs/housingcomplex/2014/05/21/spring-fever/

[4] Rapid Re-Housing: Creating Programs that Work. National Alliance to End Homelessness. July 2009. http://b.3cdn.net/naeh/adc8b82e3d49a50252_7dm6bk8te.pdf

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Wondering What Made It Into Next Year’s Budget For Health and Education? Check Out Our Toolkits.

July 30th, 2014 | by Wes Rivers and Soumya Bhat

The city may be in the midst of its summer slowdown, but DCFPI wants to make sure you are up to date on what to expect in the DC budget for next year. Today, we’ll give you a summary of what’s in store for two of the biggest parts of the DC budget, health and education, from DCFPI’s budget toolkit. We’ll cover more issue areas, and provide an analysis of the entire budget, before long. 

Health Care in DC’s FY 2015 Budget 

The District plans to spend $3.5 billion in local and federal funding on health care funding next year.  That is a 6 percent increase after adjusting for inflation. The budget includes: 

  • Continued Growth in Medicaid Program. The Department of Health Care Finance – which administers Medicaid – represents 85 percent of the growth in healthcare expenditures. This reflects higher per-person costs in the Medicaid managed care program and a 3 percent growth in enrollment.
  • Greater Local Investment in Public Health Programs for Children.  The FY 2015 budget invests new local funds in Home Visiting – which supports health and cognitive development for children under age five ­– to replace expiring federal funds. The budget also expands school-based mental health to six additional schools. Still, fewer than half of all schools (DCPS and charter) will have a mental health professional.
  • A New Funding Mechanism to Sustain the DC Health Exchange. Federal funds have been covering the costs to operate the District’s exchange, DC Health Link, but next year the city will have to pay those costs. So the DC Council established a dedicated, local tax to fund the exchange’s $29 million budget. 

Education in DC’s FY 2015 Budget

The city will spend $1.9 billion in local funds on education next fiscal year, a 6 percent increase after adjusting for inflation. That includes:7-30-14-toolkits-blog-f1

  • Changes to the School Funding Formula. The budget increases base per-pupil funding by 2 percent for both DC Public Schools and Public Charter Schools. It also increases amounts provided for students in adult and alternative education, English language learners, and special education students.
  • New At-Risk Funding. The budget adds $81 million for 36,000 at-risk students across both sectors. Summer school will also be funded by this amount. DCPS plans to use new funds to add staff and supports for middle grades, and to extend the school day at up to 52 schools, among other initiatives. But teachers have approved a longer school day at only a handful of schools, and it is not clear at this time what will happen at the others.
  • Investments in Early Childhood Education. The budget adds $4 million to build DC’s system for rating and improving the quality of early childhood programs. Another $5.2 million is included to support additional child care slots for infants and toddlers.

Keep checking back with the District’s Dime for more toolkit updates this summer!

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Four Quick Facts on DC’s Economy and Its Impact on Residents

July 29th, 2014 | by Jessica Fulton

Amidst the ups and downs of the DC economy in recent years – the Great Recession that may seem to some like a distant memory, the ongoing gentrification in more and more communities – some key stories emerge. DC is becoming a more expensive place to live, yet many residents live in poverty, unemployment is higher than before the recession started, and growth in wages has largely been confined to the top earners. These are key findings from the DC Fiscal Policy Institute’s “Quick Facts” on the DC economy. Here are four points that we think are especially important.7-29-14-quickfacts-f1

  1. Poverty affects one in five DC residents. For a family of three, that means living on less than $19,090 a year. Children under the age of 18 are much more likely to live below the poverty level than adults. And one in four black DC residents and one in five Hispanic DC residents live in poverty compared with under one in 10 white non-Hispanic residents. Read about poverty in DC. 
  2. DC’s unemployment rate remains higher than before the recession. For many of DC’s residents, the economy has improved. But the District’s recovery has been uneven, and many groups–including minorities, young residents, and residents without college degrees — face far higher unemployment rates than before the recession began. Read more about unemployment in DC.
  3. The wages of low-wage DC workers have barely changed over the past thirty years, while wages for top earners have increased substantially. Wages have fallen for all but DC’s most educated residents, and wage inequality is now at the highest level on record. Read more about DC’s wages.7-29-14-quickfacts-f2
  4. Consumers spent 42 percent more for everyday goods and services in 2013 than they did in 2000. The Consumer Price Index (commonly known as inflation) is a measure of the average change over time in the cost of typical goods and services. These cost increases show why increases need to be made to income through services like Temporary Assistance for Needy Families or through the minimum wage. Read more about the Consumer Price Index. 

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