The ACA and Community Health Centers

In March of 2010 Congress passed, and the president signed, the Affordable Care Act (ACA). Provisions of the ACA reform the health insurance industry and expand coverage to more Americans. However, with this change, there will be an increased need for community health care centers and a well-trained health care workforce. A new issue brief by the Kaiser Commission on Medicaid and the Uninsured addresses the opportunities and challenges presented by health reform for community health centers. The brief, Community Health Centers: Opportunities and Challenges of Health Reform, states that health reform is going to usher-in important changes to the American health care system and that community health centers will be central to providing care to millions of Americans, particularly those in underserved areas.

The brief is a useful tool for policymakers because it includes information on the way that provisions of the health care law intersect with the role of community health centers. This information is important in considering the opportunities for states that are available through the Affordable Care Act. For example, the ACA includes several provisions aimed at expanding the health care workforce in order to ensure that people have access to health care in addition to health insurance. Some of the strategies to accomplish this include increasing funding aimed at the National Health Services Corps and funding for community-based training programs. States considering new workforce development strategies that also have areas with health access concerns would certainly benefit from considering this opportunity.

Other intersections between the ACA and community health centers include:

• Increased funding for health centers
• Insurance expansion
• Medicare payment reform
• Delivery system reform

The brief includes detailed information on the way that community health centers will play a key role in these, as well as other, aspects of comprehensive health care.

For more on funding opportunities available through health reform.

For more on creating jobs through community health centers visit our Financing Community Change blog.

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Candidate's Corner- New on PolicyforResults.org!

In difficult economic times, policymakers need effective approaches that improve the lives of children and families. The Center for the Study of Social Policy (CSSP) has developed a series of briefs to help policymakers make the best decisions for children and families as safety nets are strained by the newly unemployed and tax revenues are sluggish.

These briefs on Candidate’s Corner concentrate on how to set a state’s economy in the right direction through responsible investments in family economic success, healthy child development, education and training. They emphasize policies that are economical or supported through federal funding.
Visit the Candidate's Corner to learn more.

Report: “State Approaches to School Readiness Assessment”

How do states assess school readiness? The methodology behind education statistics is particularly relevant during election season (see the Maryland Governor's Race).The National Conference of State Legislatures released an updated technical report in August, “State Approaches to School Readiness Assessment,” that closely examines states’ approaches to readiness assessments. Such a report is significant because of the correlation between kindergarten success and positive adult outcomes.

The NCSL classifies readiness as a child’s: physical well-being, social and emotional development, approach to learning, language development, cognition and general knowledge. Findings in these categories enable states to track gains among the kindergarten population, compare readiness across districts, and connect readiness data to later school performance or backwards to early learning programs. Cross-state analysis is limited due to varied approaches throughout the United States.

Only 26 states perform readiness assessments and four of those do not require assessment of all kindergarten students. Minnesota conducts a cost-efficient sampling process, while Arizona, Kansas, North Carolina, North Dakota, and Tennessee do not specify a particular instrument by which the data is collected. States like Minnesota and Maryland use a state-created instrument to perform analysis of students. The NCSL report states that, “Ideally, evaluation of the complicated set of skills and behaviors that comprise ‘school readiness’ would use multiple assessment methods.”

Inconsistencies among data make it difficult to improve programs and services for early learning based upon the information. The NCSL report notes that there will soon be a renewed federal emphasis on these data systems that will result in increased focus on readiness evaluations. Nevertheless, changes in school readiness assessments must maintain some universal consistency while accounting for regional and state differences.

For more on Ensuring Children are Healthy and Prepared to Succeed in School.

The 2009 Poverty Numbers

On Thursday the Census Bureau released the 2009 data on poverty and income. It was disheartening, though not a surprise, to see that the poverty rate in the United States rose in 2009 while median income fell. Not surprising in part because from December 2008 to December 2009 unemployment rose from 7.4 percent to 10.0 percent; contributing to the staggering 1.1 percent jump in the poverty rate.

However, even with one of the highest recorded increases in the poverty rate, the numbers were not as bad as some predicted. This is due in part to government safety-net programs. Several initiatives provided cash transfers and kept some Americans from falling below the poverty line. Social Security supported the elderly; whose poverty declined. While unemployment insurance and major transfers made through ARRA supported non-elderly adults. It is also important to note that while substantial stimulus dollars went to support low-income families, those benefit programs provide in-kind assistance and were therefore not captured in the poverty data.

While safety-net programs might have moderated the effects of the recession for some, the severity of the increase in poverty should be taken very seriously by policymakers. At a time when 20.7 percent of American children are living in poverty it is important for policymakers to consider what strategies are working to moderate the impact of the recession on families, and which are not. Whether the program provides in-kind benefits or cash assistance it is critical to evaluate the way that saftey-net programs are helping those in the greatest need in a time of extreme economic hardship.

The poverty numbers also suggested that while the recession is impacting people across the country, it has been experienced in different ways and to differing degrees.

• The poverty rate for those who have only a high school education or less rose by 1.2 percent, while for those with a college degree the increase was significantly less at 0.4 percent.

• Male householders experienced a 3.1 percent increase in poverty, female householders experienced a 1.2 percent increase, and married couples experienced an increase of 0.3 percent.

Understanding how communities are being most effected and why will help policymakers create safety-net programs that will meet family and community needs. The Census Bureau’s proposed supplemental poverty measure will hopefully be a new tool in understanding poverty and lead to improved strategies for serving those most in need. In the meantime, Isabel Sawhill at Brookings suggests strengthening the safety-net for as long as it takes to get the unemployment rate back to a reasonable level. She suggests that this will not only support families but will also aid in the recovery by allowing families to maintain their purchasing power, helping to create jobs.

For more strategies on Family Economic Success.

More from our blog: a primer on poverty measurement and the Census instruments used.

National Neighborhood Alliance Launched

The Center for the Study of Social Policy, United Neighborhood Centers of America, Harlem Children's Zone and PolicyLink are joining with several other leading organizations in launching the National Neighborhood Alliance. The National Neighborhood Alliance is a voluntary collaboration of national, state and local organizations that are supporting work in communities of concentrated poverty.

Starting in October, the Alliance will begin holding a series of regular, monthly conference calls to share information about work in, or support of, these communities. The calls will also serve as a forum for sharing information on advocacy efforts.The National Neighborhood Alliance is open to any interested national, state or local nonprofit organization, philanthropic organization, or for-profit organization involved in neighborhood-based work. Membership is free. Adding your organization to the list is simple. Just email Patrick Lester at plester@unca.org. The original founding organizations are:

• Alliance for Children and Families
• America’s Promise Alliance
• The Bridgespan Group
• Center for the Study of Social Policy
• Child Trends
• Coalition for Community Schools
• Enterprise Community Partners
• Harlem Children’s Zone
• Local Initiatives Support Corporation
• National Congress of American Indians
• PolicyLink
• Promise Neighborhoods Research Consortium
• Results Leadership Group, LLC
• The Rural School and Community Trust
• The Skillman Foundation
• Social Solutions
• United Neighborhood Centers of America
• United Way Worldwide
• YMCA of the USA

By Patrick Lester, crossposted from Building Neighborhoods.

The Benefits of Expanding Pre-K Programs

Pre-K attendance increases graduation rates, improves standardized test scores, and reduces the possibility of grade repetition. The Montgomery County Public School System’s (MD.) implementation of a Pre-K program across the entire county has resulted in similar improvements. The report, Lessons in Early Learning: Building an Integrated Pre-K-12 System in Montgomery County Schools, highlights the success that the local and federally funded Pre-K education program has had on closing achievement gaps between racial and ethnic groups.

The study found that 90% of Pre-K students in Montgomery County entered first grade with essential early literacy skills and 77% went on to later attend college. Education experts are now focused on expanding Pre-K programs to school districts throughout the United States. The Pew Center’s report on National Pre-K-12 reform explores the possibility of replicating the program through the reauthorization process of the Elementary and Secondary Education Act (ESEA). In order for the strategy to come to fruition, the reauthorization must allocate funding from federal, state, and local resources to early learning programs. Pre-K advocates believe that successes in Montgomery County will play an important role in affecting change among early learning programs across the United States.

For more information on Ensuring Children are Healthy and Prepared to Succeed in School.

For a previous blog on Pre-K programming.

Virginia's Geriatric Prison

At the end of 2009, state and federal correctional authorities had jurisdiction over 1,613,656 prisoners. This level of incarceration, which is the highest in our nation's history, has resulted in financial burdens and tough questions. How do correctional systems cater to elderly inmates and how will correctional systems evolve to meet the needs of an aging prison population? The article, “Caregiving Behind Bars: Correctional Officer Reports of Disability in Geriatric Prisoners,” concludes that correctional systems are not adequately prepared to properly treat geriatric prisoners.

A recent story in The Washington Post summarizes the experiences of inmates at Deerfield Correctional Center, Virginia’s only geriatric prison. The cost of housing an inmate at the 1,000 bed facility runs about $28,000 per year, in comparison to $19,000 at a medium security prison in Virginia. The geriatric facility provides services that are in high demand as evidenced by its long waitlist.

Such demand, particularly in Virginia, is partially related to the fact that the state maintains the lowest parole rate in the nation. In the near future, states will have to consider how they can better meet the needs of elderly prisoners and facilitate transitions to the community among those individuals that are released to reduce pressure on correctional systems. Louisiana recently rejected a measure that would have changed parole laws for elderly prisoners, while the Texas State Parole Board considers medical recommendations.

For a previous blog on reentry initiatives.

This Week: Annual Release of Poverty Numbers

The Census Bureau has announced the official dates for the annual release of their data on poverty, income and health insurance coverage. On Thursday, September 16th, the Census will release the 2009 data from the Current Population Survey (CPS) and on Tuesday, September 28th, the Census will release the results from the American Community Survey (ACS).

The ACS is the largest household survey in the United States and offers broad, comprehensive information on social, economic, and housing data. The ACS is designed to provide information at various geographic and community levels. The CPS is a detailed questionnaire and serves as the source of information used to produce the official annual estimate of poverty, as well as to estimate a number of other socioeconomic and demographic characteristics, including income, health insurance coverage, school enrollment, marital status, and family structure. The Census Bureau provides a detailed table that summarizes the key differences between the two instruments.

Most experts expect that when the data is released this month that the poverty rate will have increased in 2009, particularly for child poverty, due to the recession and the growth in unemployment. The Brookings Institution is holding its’ eighth annual briefing, Poverty and Income in 2009: A Look at the New Census Data and What the Numbers Mean, to discuss the new data and its’ implications for families and policymakers. Ron Haskins, Rebecca Blank, Wade Horn, Nicholas Eberstadt, and Avis Jones-DeWeever will provide expert insight on the significance of the new figures.

For policymakers, this data serves as a great tool to combine with knowledge of community specific needs. Combining the official data with research and community-specific information can assist policymakers in crafting policy that will best serve those in need of support during this recession.

For more on Family Economic Success.

For more on Financing Community Change work that can support efforts in your community.

To register for the Brookings Institution event, Poverty and Income in 2009: A Look at the New Census Data and What the Numbers Mean