March 3, 2023
Dear Interested Readers,
Three Steps Backwards; Where you live makes difference!
Most of us realize that when Congress failed to extend the Child Tax Credit at the end of 2021 millions of children that had been briefly lifted out of poverty had an economic rug pulled out from under them. In February 2022, NPR reported that 3.7 million children had lost their temporary relief from severe want. The article was based on an analysis from the Center on Poverty & Social Policy at Columbia University. The NPR report begins:
Since the monthly payments from the expanded Child Tax Credit expired at the end of 2021, nearly 3.7 million more children are in poverty, according to a new study from Columbia University.
In the span of just one month, from December 2021 and January 2022, the monthly child poverty rate increased from 12.1% to 17%, the highest rate seen since the end of 2020. Black and Latino children experienced even higher increases in poverty, with 5.9% and 7.1% increases, respectively.
The Biden Administration’s response to the COVID pandemic accomplished something that many progressives had wanted to try for years. For more than sixty years progressive economists and social scientists had advocated for various forms of a universal basic income. COVID presented us with an unexpected opportunity for a large-scale experiment to test some theories about the benefit of giving families cash to spend as they needed to care for their families.
There had been many small experiments in a variety of places here and abroad that were designed to test whether some form of universal basic income might lift some people out of poverty. The question was whether or not this form of public support would make people more welfare dependent or be used by its recipients as a step out of poverty toward economic security and improved opportunities including employment and better health.
The Robert Wood Johnson Foundation has determined that there is little doubt that the innovative monthly payment methodology of the COVID Child Tax credit has shown improvements in the quality of life and well-being of its recipients. For a program that lasted about a year, the evidence from multiple sources seems to suggest that although it was expensive, if it had continued it would have been shown to be a cost-effective expense that would have ultimately reduced the cost of healthcare and reduced poverty leading to less crime, less domestic abuse, and would have improved the opportunity for a better life of millions of today’s children which would have likely improved the economic status of future generations.
Most “welfare programs” are attacked by conservatives as disincentives for personal responsibility. It’s easy to remember Ronald Reagan’s rants against “welfare queens.” The reality is that “government” handouts to the homeowning middle class, small businesses, and large corporations through grants and tax credits constitute much larger parts of state and federal budgets than programs to lift children and their families out of poverty. The mortgage tax credit, the avenue for wealth building for the middle class, even after revisions in the Trump tax relief bill for the wealthy, costs the federal government $70 billion a year, but few people consider it to be “welfare.”
The Robert Wood Johnson Foundation article that I referenced above was published before the COVID Child Tax Credit was allowed to expire. Its authors presented the history of support to impoverished children and explained why the COVID Tax Credit was so effective in improving health while it reduced poverty. They wrote:
Some research demonstrates that exposure to stressors such as food insecurity, substandard housing, and income volatility can lead to poorer health. The Child Tax Credit began modestly in 1998 as a $400 per child tax credit and could only be used to offset federal income taxes, which very few families having low incomes owe. [That made it more of a boon for the middle class than those in poverty who had little taxable income.] Eligibility expansion over the years and increases in the credit amounts allowed more families with children to receive the Child Tax Credit. However, an estimated 27 million children still lived in families that did not receive the full Child Tax Credit because they earned too little. The American Rescue Plan Act of 2021 made several temporary changes to the Child Tax Credit as part of a larger package of reforms supporting economic recovery from the COVID-19 pandemic. [Poor families got monthly checks based on the ages of their children, not their taxable income.]
Low- and middle-income families with children benefit from two related tax credits: the Earned Income Tax Credit (EITC) and the Child Tax Credit. Enacted in 1975, EITC has a much more developed evidence base. [The EITC has become controversial. It has been popular with politicians on both sides of the aisle and is considered by some as our most popular and effective public assistance program for working-poor families. It has long been criticized for its inability to help many poor families and children.] A strong body of evidence shows that children who live in poverty face a lifetime of disadvantages—including differences in young children’s brain development and low birthweight—a primary risk factor for infant deaths and worse health later in life. Research has shown that EITC correlates to a reduction in low birth weight, a decrease in risky behaviors such as smoking, and an increase in prenatal care.
Increasing income through tax credits has also been shown to improve home environments, nutrition, and educational and economic attainment. Making the full credit available as a tax refund in 2021 allowed the lowest-income families to receive average benefits on par with those received by middle-income families. It also made the credit more equitable, as Black and Hispanic children are more likely to be left out of the credit’s full benefits than children who are White.
The bolding of the text and the bracketed comments above were my way of pointing out the unique advantage of the modifications that were introduced as part of Biden’s American Rescue Plan Act of 2021 and the shortcomings of previous programs. What we now face is further damage to poor families as the increase in SNAP benefits that were part of the response to COVID has expired as of March 1. That is not the end of the retraction of support to the poor that will be occurring. Many people were added to Medicaid during COVID and the frequent repeat cycle of redetermination for eligibility was suspended. Now those changes are also expiring. A report this week from the Kaiser News Service suggests that seven million children and young adults could lose Medicaid coverage by April 1.
In another more extensive article, the Kaiser Family Foundation estimates that before the “unwinding” of the COVID rules for Medicaid is over as many as 14 million people may lose coverage. It can’t happen fast enough to suit the likes of Sarah Huckabee Sanders, former press secretary to President Trump, and now recently elected governor of Arkansas. She plans to fast-track the unwinding in Arkansas because she doesn’t want people to get used to “government dependence.”
Medicaid was a compromise from the start. For it to pass it had to be a joint program between the states and the federal government with state investments matched by federal dollars. Medicare is an entirely federal program. Because of its design, there has been huge variability in who qualifies for Medicaid from state to state. Years ago, I read a New England Journal of Medicine article that compared the qualifying metrics for Medicaid by state. At that time to qualify for Medicaid in Arkansas your income needed to be below 17% of the Federal poverty level. That meant that in Arkansas you could earn no more than about $1500 a year a qualify for Medicaid in Arkansas. At the same time in Minnesota, you qualified if you earned less than 400 percent of the federal poverty level which was somewhere around $50,000 per year. We all know that since the Supreme Court has allowed the states to accept or reject the Medicare extension of the ACA there are still 12 states that have rejected the extension even when the federal government will pay 90% of the cost. To see a map identifying those states, click on the link. It is a reality that we are the United Unequal States of America.
The first part of the title of this letter, “Three Steps Backward; Where you live makes a difference,” refers to the end of the Child Tax Credit, the reduction in SNAP benefits, and the end of the concessions to Medicaid enrollment. The second part, “Where you live makes a difference” has heightened meaning since the Dobbs decision on abortion will be even more dramatic after the removal of the Medicaid adjustments from COVID. We all know that reproductive rights vary by state, but I am not so sure that everyone realizes how much your health and quality of life vary by where you live.
I have discovered that the University of Wisconsin Population Health Institute has developed a tool that allows you to compare the social determinants of health and quality of life between counties in America. You can also compare a county to the national average. As you might guess I have been playing with the tool.
In one comparison I have compared my current county in New Hampshire, Merrimack, with the counties where I lived in South Carolina and Texas. I lived in Richland County, South Carolina in Columbia, the state capital where there are several colleges including the state university and a medical school. In my county in New Hampshire which also includes Concord, the state capital, 13% of people have “poor or fair health.” In Richland County, South Carolina, the number jumps to 18%. I spent much of my childhood in Waco in McLennan County, Texas, which is the home of Baylor University and more recently a very popular home improvement television program that shows what a lovely place it is. McLennan County is not so healthy. 24% of its citizens have “poor or fair health.” Three other places of interest to me are Hope, Arkansas, Bill Clinton’s hometown and Laurel, Mississippi, the really nice “hometown America” that sports another popular home improvement program, and finally, the home county of Rome, Georgia in Marjorie Taylor Greene’s congressional district. The poor or fair health number for Jones County, Mississippi is 25%. In Floyd County, Georgia in Marjorie Taylor Greene’s congressional district, the number is 23%. In Hempstead County, Arkansas where Bill Clinton grew up the number is a whopping 28%.
The tool which is supported by the Robert Wood Johnson Foundation allows comparison across dozens of factors including premature death, maternal/child survival, smoking, obesity, employment, education, ratios of doctors to the population, and many others including the percentage of the population that is uninsured. It doesn’t take long for an interested person to confirm that in states where there are large uninsured populations there are fewer physicians, poorer access to mental health services, lower life expectancies, and greater inequities in all healthcare opportunities.
After looking at health and well-being in Hope, Arkansas, I realized that I had not checked my home county in Massachusetts. It was not a surprise to see that only 2% of Norfolk County residents were uninsured. The “poor or fair” health metric was only 11%. I should add that all of Massachusetts is not a healthcare Nirvana. The city of Boston is in Suffolk County and its numbers are closer to South Carolina than to its affluent neighboring counties of Middlesex (Newton, Cambridge) and Norfolk (Wellesley, Needham, Dedham). We have inequities between states, within states, between rural and urban communities, and between cities and their affluent suburbs. I fear the numbers will get worse everywhere in the wake of the loss of the COVID health benefits, which include the augmented Child Tax Credit, increased SNAP benefits, and the suspension of Medicaid eligibility reviews.
I concede that if you compare all of the numbers to the experience a half-century ago we have seen great progress. I will also contend that we could have done much better. I fear that the future will be characterized by a decline in our temporary achievements. I wish our politicians were as interested in improving the health of all Americans as they seem to be in preserving our right to own guns, denying our children access to the history of our national shortcomings, preserving the ability of the wealthy and corporations to avoid paying taxes and limiting the ability of regulators to protect the environment.
It’s sad to say that as we take three steps backward, a good personal strategy is to be very careful to make your home in a state and a county where life is good and complemented by good access to healthcare. It is obvious that depending on where you live there is a huge variation in outcomes. Does it really have to be that way? Is this the America that you want?
Winter Is Making A Comeback
By the end of February, winter is getting a little old. It is like an old friend who has come for dinner but stays too long. But, late winter does have some unique characteristics. The days are noticeably longer. In mid-December, the sun would set so early and fast that it was like someone suddenly turned off the lights. In late February and early March, the sun seems to take its time going down. We are beginning to have a little bit of twilight that will continue to lengthen in time until it becomes the nicest part of a long summer day.
The picture that I am using for the header for this week’s letter was taken by my youngest son while on a hike with friends in the woods near his home in Gray, Maine. This fall, he and his wife moved to Maine from a neighborhood in Brooklyn near Prospect Park. They tried hard for many years to get as close to nature as possible in Prospect Park, but finally with some reluctance gave up on the city and moved to the real woods. My daughter-in-law is now practicing family law for Pine Tree Legal Assistance, the non-profit legal aid program for the poor of Maine, and my son is one of those modern-day workers who can work from home via the Internet and live anywhere on the planet. They chose Maine where they can be close to friends from college.
There was a time when they would both have long subway rides to and from work in New York and New Jersey. Since the pandemic, his brother lives the same kind of life working from home, but he is three thousand miles away in the San Lorenzo River Valley above Santa Cruz, California. That son’s wife rides down the mountain road that follows the San Lorenzo through the redwoods to UC Santa Cruz where she is a librarian. It does not surprise me that both of these sons have gone out of their way to get closer to nature. As you know, I also found city life to feel alien to me, and I have moved out of the city to an environment that better suits my fancy and is far from the city and its traffic and light pollution. It just took me fifty years to get to where I really belong.
When I was living in metropolitan Boston, and tolerating the anxieties and inconveniences of crowds and congestion, I did not pay much attention to the angle of the sun near the end of the day in late winter. I did frequently complain that the sun was in my eyes as I drove west from the Longwood Medical Area to my home in Wellesley. In those moments the sun was a problem, and not a source of inspiration as its light is filtered through the woods. My son wrote a song to go along with his picture. The song spoke to me. So, I thought that I would share it with you as you may endure the last blasts of winter and the certain delays and anxiety that snow plus city traffic creates.
Preparing for the nightfall
They said there could be a storm
Not a twisting frightful dark thing
Maybe a nice one like before
If the wind drives home the wild things
And the road holds nothing more
I’d be fine to stay indoors
And by the way the dark looks pretty
When the night does what it’s for
You can’t catch this in the city
We couldn’t see like this before
If the wind drives home the wild things
And the road holds nothing more
I’d be fine to stay indoors
I got out of town during a snowstorm on Tuesday for a long-scheduled visit with my siblings in my mother’s hometown of Lincolnton, North Carolina. My mother was born on March 3, 1919, so today is her 104th birthday, and so my siblings and I thought it would be a good time for a long overdue in-person visit. We had a family wedding scheduled for the last weekend in March 2020 which COVID canceled. So, our last gathering was for my father’s funeral in September 2018. COVID has freed my sons from useless commutes, but it has also denied us the joy of gathering. Early spring has come to North Carolina. There are thousands of Barlett Pear trees in full bloom along the roads. The camellias and azaleas will be in full bloom soon. The temperature is in the high 60s and low 70s. Winter rarely dares to spoil March in the Carolinas.
There will only be three weeks of winter left when I return because the “Opening Day” for the Red Sox is March 30. That’s the earliest Opening Day I can remember. Perhaps the Red Sox management is planning to capitalize on the benefits of Global Warming. It may be a risk because I can remember that in March 1968, my first March in Boston, we had two snow storms of over twenty inches after March 20. You never can trust March.
What you can trust is that the afternoon sun will linger a little longer each day. My recommendation for your weekend is to try to find someplace in the wild where you might enjoy the late afternoon sun. If you live in the city you may find it in a park, or if you have the time, head out of town looking for a late afternoon hike in the woods. You could have a transcendent moment if you are in the right place and ready to enjoy a few minutes of late afternoon sun.
Be well,
Gene
