Is New Orleans ‘Better’ After Katrina? Depends Who You Ask.

In August 2015, New Orleans’ University Medical Center opened its doors for its first patient. Before being damaged in Hurricane Katrina, it had been known as Charity Hospital—a place where all of the city’s residents could seek care regardless of ability to pay. But after the storm, the entire Charity health care system—the only state-run, state-wide public hospital system in the U.S.—was disassembled in favor of a system of privately run hospitals. This rapid move toward privatization has come to define the post-disaster city.

Although more than a decade has passed since Hurricane Katrina hit the Gulf Coast, there is a stark discrepancy between those who can access the resources they need to rebuild their communities—the relatively affluent—and those who cannot. This has been fueled in large part by a market-based approach to recovery, which considers economic recovery more important than restoring social services. And when privatization comes at the expense of public goods, it’s the poor who pay the price.

For example, the Department of Housing and Urban Development’s rebuilding program paid homeowners based on the market value of their houses rather than on the cost of repair. This left many black working-class homeowners unable to rebuild their homes, because they lived in areas with lower market values—a result, in part, of discrimination past and present. The limited resources to rebuild, combined with the dramatic reduction in public housing—many large public housing developments were shuttered—have fueled the city’s affordable housing crisis.

Public schools met a similar fate. After the storm the city eliminated jobs for 7,000 teachers, who were dismissed without pay. The city also began moving towards a charter-based school system—a model based on market-driven ideas of choice, efficiency, lack of centralized oversight, and limited union control. This switch pushed many of the city’s most disadvantaged students out of high performing schools through a process known as “creaming” that is designed to inflate test scores.

The force of a global economy

Why has funding for disaster recovery shifted away from supporting citizens’ and communities’ needs, and towards models that favor privatization of public services? The answer lies in the shifting nature of the global economy.

Beginning in the 1970s, the deregulation of finance, transportation, and the environment—as well as the loosening of trade barriers—increased the flow of goods and jobs across national borders. This shifted manufacturing out of the U.S., and created pressure to compete globally for ports, shipping, finance centers, and tourism, as well as other high-end service industries such as the medical industry—areas in which New Orleans has historically played a significant role.

This shift happened on a city level too, and it fundamentally changed the relationship between local governments and their citizens. Governments have moved from public management to entrepreneurship, with an emphasis on increasing the economic standing of their city. Since the focus following a disaster is on restoring economic growth, the decision-making process for post-disaster cities—such as New Orleans after Hurricane Katrina or the greater New York region after Hurricane Sandy—often increases inequality of access and delivery to much needed public services, such as health care, affordable subsidized housing, and public schools.

A vulnerable health care system

In New Orleans, the health care system is perhaps one of the clearest examples of how this harms the city’s poorest residents. As the main trauma hospital, New Orleans Charity Hospital should have been a key component in recovery efforts. Though it was damaged during the storm, the National Guard had cleaned and restored the hospital so that it was able to receive patients within a few weeks. However, state and local officials chose to keep it shuttered. Instead, they opened an interim hospital and continued with plans to build a new hospital complex that would require razing nearly 70 acres of a national historic district.

For state officials, Hurricane Katrina presented an opportunity. As early as 1991, a strategic plan from the Louisiana Health Care Authority showed that officials who oversaw the state hospital system had been looking for ways to get out of the business of “charity,” and to move away from the two-tiered system that left the Charity hospitals serving most of the state’s uninsured. This was raised again in the early 2000s after Louisiana State University took over management of the hospital, when a report commissioned by LSU argued that the proportion of low income patients the hospital was serving was hampering its financial stability. But as long as Charity Hospital remained open and serving predominantly indigent patients, it would be hard to justify the expense of constructing a new building.

The damage sustained during Katrina provided the justification and funds for a new building with a new name. This was shown most pointedly in the fight over FEMA funds to repair the hospital—FEMA initially estimated repairs would cost $23 million, but the state and LSU fought for nearly $500 million to fund the hospital’s full replacement. When asked for comment, representatives from LSU said “planning for a replacement hospital was well underway with appropriated state funding from the Louisiana Legislature.” LSU had received $1.8 million for a master plan study in 2003 and was seeking funding for a move before Katrina. But even after Katrina, the state only offered $300 million towards construction of the 1.2 billion dollar hospital.

For ten years, Charity Hospital remained shuttered while the new building, now renamed University Medical Center, was constructed. Officials hoped to build a public-private partnered “destination” hospital that would be the lynchpin in the larger effort to transform the medical corridor into an economic engine for the city, though a leaked draft study challenged the hospital’s financial footing, particularly in light of the changing federal health care rules. This same report did note the successful effort to rebrand the hospital.

In the meantime, the city suffered the gutting of a trauma center and psychiatric care facility after one of the most traumatic social disasters. Psychiatric patients who had been served at Charity ended up in the local jail— notorious for human rights abuses—in higher rates. When community members questioned why Charity could not be reopened to serve the population as a hospital for the future (at meetings the author attended in Spring of 2011 on Charity’s reuse, as well as meetings on the process of expropriating houses in the new hospital’s footprint)—as a study suggested could be done for a much lower cost—board members replied that the Charity facility “does not meet the programmatic requirements for the LSU hospital moving forward.” LSU declined to comment on this conversation, but stated that “it was well documented that Charity Hospital was no longer an appropriate building for health care.”

Remaking our cities

It’s worth asking: In what image are cities remade after disasters? Public schools and the Charity system were in need of funds and a system-wide overhaul before the storm, but a narrow view of how to fix these pre-existing problems moved both towards privatization.

Much of the national conversation after Hurricane Katrina focused on the inequalities of class and race that made New Orleanians vulnerable before the storm. But throughout the recovery effort that vulnerability has not changed for many of the city’s poorest—a particularly dangerous risk as cities face more disasters, more often, as a result of climate change. Shifts in formerly public institutions often to private and non-profit oversight did not increase access as much as they removed decision-making from public oversight, and changed the nature of public participation in these key institutions.

If cities are going to be prepared for the future and foster sustainable communities, they should seriously question whether a healthy business environment is more important that the health of its citizens. Now, Louisiana is faced yet again with another long recovery from massive flooding. It also has new leadership, which has placed the health care of its citizens as a primary concern.  Hopefully, we will see something new emerge from the waters.



Coaching Parents Reaps Huge Benefits for Kids in Poverty. Why Don’t We Do More of It?

Last week the Census Bureau released new data that showed one of the largest single-year declines in poverty in almost 50 years. This is certainly news to celebrate, but it’s important to remember that poverty for some groups—particularly young children—persists at unacceptable rates. Nationwide, more than 1 out of every 5 infants and toddlers lives in poverty. For children of color, the numbers are even worse: 30% of Hispanic children, and nearly 40% of African American children under the age of four live in poverty.

This has serious consequences, both for the individual children and for the country as a whole. The infant and toddler years are a critical time period for child development, and they can shape a person’s outcomes for the rest of their lives.  And since our country is growing more diverse every year—the majority of young children are now children of color—the soaring poverty rates among children from diverse backgrounds is risking our long-term economic stability.

Home visiting programs, which connect families with trained professionals who help create healthy and safe home environments, are proven to directly address many of the harmful impacts of poverty before the effects take hold. The benefits are dramatic—families who voluntarily participate in these programs have improved child and maternal health, increased school readiness, prevented child abuse and neglect, and reduced participation in the juvenile justice system.

Here’s how it works

When parents bring their baby home from the hospital, they don’t come with a handbook. Home visiting aims to be the next best thing, by connecting parents and families with professionals—who may be nurses, social workers, or other trained parent educators—in their own homes through regular visits. Home visitors partner with parents to develop strong parenting skills, ensure child and family safety, and access other community resources and social services.

The services families receive during a home visit can vary depending on the specific needs of the family. A home visitor may work with a new mom to help her understand the importance of breastfeeding, or how praising a child can reinforce positive behavior. They may screen for signs of child abuse and neglect or domestic violence, and refer families to other health and social services. Home visitors will also help parents to set goals for the future—they might work together to develop a plan to go back to school, look for a job, or identify safe and reliable child care.

The results are impressive

Home visiting programs have been proven to benefit everything from child and maternal health, to increasing school readiness, to reducing child abuse and neglect. In 2014, 70% of federal home visiting program grantees saw reductions in the rate of tobacco, alcohol, and illicit drug use among enrolled mothers.  Similarly, 79% of grantees saw an increase in the household income of families participating in home visiting, and 76% saw an increase the rate at which women and families are screened for domestic violence.

These programs are so effective that they end up saving taxpayers money in the long-run. For example, improved health among participating families can lead to Medicaid savings by reducing health care costs, and improved school readiness can boost a child’s academic achievement later in life and lower participation rates in special education. In fact, for every dollar invested in these programs, we see a return of up to $5.70 in reduced federal and state costs and social benefits.

But it doesn’t reach enough people

Home visiting only reaches a small portion of families living in poverty. In 2015, 145,500 children and parents—less than 10% of families in poverty across the US—received federally-funded home visits. Even when home visiting services are available, many of the people who would benefit are unaware that they exist or unfamiliar with how they work.

What’s worse, federal funding is at risk of expiring if Congress fails to act. The Maternal, Infant, and Early Childhood Home Visiting, or MIECHV, program is the single largest funding source for home visiting—it’s the only guaranteed source of funding in all 50 states, and it provides $400 million per year to expand evidence-based programs. Since it was established in 2010, MIECHV has expanded home visiting programs so that they now reach families in every state, the District of Columbia, and 5 territories across the United States. After the original authorization ended in 2014, MIECHV received two short-term reauthorizations—the most recent of which is slated to run out at the end of September 2017.

Where do we go from here?

Without action from policymakers, the families who currently participate in the federal home visiting program may lose a critical source of support. Worse yet, millions of others will never benefit from a highly effective program. In many states, MIECHV is the only source of financial support for home visiting, and without it services would disappear.

Rather than letting a highly effective program expire, Congress should increase MIECHV funding and extend the program for a minimum of five years. That way the program will reach more of the families who need it, and states will be able to focus on providing services rather than worrying about finding sustainable funding.

As we see from last week’s Census data release, there are still too many young children and children of color bearing the burden of poverty. In the long run, this will only exacerbate inequality and harm our country’s economic outlook. Home visiting has the potential to address inequality before its effects are realized—if the program is given a chance to succeed.



Want to Reduce Domestic Violence? Treat It Like An Economic Issue.

In the world of conventional wisdom, there are “women’s issues” and there are “economic issues,” and never the twain shall meet. The right to college, economic; college sexual assault, women’s. Affordable healthcare, economic; access to abortion, women’s. Livable wages, economic; the wage gap, women’s. You can begin to see the issue: We separate the two spheres in our thinking, but in reality they’re so closely intertwined that they might as well be the same thing.

Domestic violence is a classic “women’s issue.” Although both women and men can be victims (and although both men and women can be violent) studies estimate that up to 97% of abusers are men with female partners; between 1994 and 2010, the Bureau of Justice says, 4 in 5 victims of intimate partner violence were women.

It’s easy to look at these numbers and frame domestic violence purely around sexism: If patriarchy says a man is king in his home, and if women’s lives and needs are deemed less worthy than men’s, then it follows that many heterosexual relationships descend into a nightmare of control and violence as the abuser asserts his supremacy in the most literal way possible.

But if you shift your focus just a little bit to the side, to the realm of money and work, another pattern emerges — and it may prove to be far more useful in terms of crafting policy that saves victims’ lives.

In one study, 60% of domestic violence survivors reported losing their jobs as a direct consequence of the abuse. 98% said that abuse made them worse at their jobs — they couldn’t concentrate because they’d been attacked, or were anticipating an attack when they got home. Generally, abuse victims miss work more often, come in late more often, are hospitalized for injuries more often, suffer more long-term and chronic health conditions (depression, PTSD, substance abuse), and thereby accrue more medical debt. When you add in the economic abuse present in 98% of abusive relationships—anything from sabotaging job interviews to holding a monopoly over family bank accounts to simply making sure that things like cell phone contracts are in the abuser’s name—it’s no surprise that a woman who does try to leave her abuser frequently finds that her entire financial support structure disintegrates when the relationship does. It’s for precisely this reason that the majority of homeless women are domestic violence survivors.

The division between “economic issues” and “women’s issues” is artificial.

The point of this catalogue of horrors isn’t to tell you domestic violence is bad, which (I hope to God) we can all take as a given. It’s to demonstrate that the division between “economic issues” and “women’s issues” is artificial. Money is our society’s most concrete form of power. And when we look at domestic violence through money, what we see is a power play: women are kept captive to male violence because they can’t afford to live without the men who hurt them.

That’s why it’s essential to treat domestic violence as an economic issue. It allows us to craft responses that go beyond the moral (“don’t be violent”) or even the purely gender-based (“don’t be sexist”—always good advice!) and actually alleviate specific burdens.

In Pennsylvania, for example, there are two measures on the table: One, a move to remove all cancellation fees for abuse victims who have to abruptly leave their cell-phone contracts, and give them a new phone number if requested. Two, a move to allow women who are being abused to terminate their leases without penalty. Those seem like small things, maybe even trivial—but if your abuser still has access to your phone, he may be able to see who you’re calling, or even use your GPS to find you, making stalking more possible. And you can’t “just leave” if breaking your lease will damage your credit and make it impossible for you to rent your next home and begin to rebuild your life.

These specific, practical policies are not only effective, they require policymakers to take a feminist, victim-centered approach: Talk to victims, listen for common stories, and figure out what common tactics abusers are using and precisely where debt-relief or financial aid should be applied to benefit victims best. The cell phone bill, for example, stems in part from a specific situation in which a woman’s abuser smashed her cell phone because he knew she couldn’t afford a new one, thus draining her bank account (she couldn’t stop paying the bill) and limiting her ability to reach out for help.

Annamarya Scaccia, who has reported on the Pennsylvania bills, says these smaller interventions can precede and prevent the necessity for larger ones.

“The most direct connections aren’t always the most obvious or violent,” Scaccia told me. “When an abuser wipes out your account to embarrass you at the store or when they smash your cell phone knowing you can’t afford another one, these can easily be framed by the abuser as accidents or lies, and the victim ends up looking ‘crazy’ or ‘overreacting’ (which of course has a gendered element). These smaller (so-to-speak) moments of abuse often proceed [more severe abuse].”

To be clear, cultural work is also deeply necessary. As long as women are fundamentally seen as less worthy than men, the violence they experience directly in abusive relationships will simply be repeated in other, subtler ways throughout their lives, as they move from the men who attack them to the bosses who pay them less or the male co-workers who denigrate their contributions. Needless to say, if more employers benefited from real education about how domestic violence works, and more workplaces had plans for dealing with it, fewer victims would lose their jobs.

But when we allow ourselves to move toward an understanding of domestic violence and sexism as economic issues—with all the seriousness and “real” political heft that implies—then we have both more urgency and more acuity in dealing with them. And when we include gender in our economic understanding, our policy stops being a sort of generalized “uplift” and starts providing specific and targeted aid. We can stop sifting our thinking into “real” issues and “women’s” issues, and start thinking about the ways both feminism and economic justice cohere to make real, immediate changes—which we have to do, in the end, if we want to impact sexism at all.



New Census Data Show Historic Gains on Poverty. Here’s How to Keep the Momentum Going.

Yesterday the Census Bureau released new data showing that Americans made historic gains in income, poverty reduction, and health insurance. Wonks everywhere predicted good news—but what we saw in the data went well beyond our expectations.

As antipoverty advocates, we’ve become so accustomed to poverty staying stagnant—or getting worse—since the turn of this century that we barely know how to celebrate this kind of progress properly.  So, let’s take a minute to appreciate it.

The U.S. poverty rate saw one of the largest single-year declines in almost 50 years. After years of stagnant incomes the typical American household got a raise for the first time in nearly a decade, with median household income rising more in one year than ever recorded. Meanwhile, the share of Americans without health insurance dropped to a record low, making 2015 the first time we’ve seen simultaneous improvements on all three fronts—poverty, median household income, and health insurance coverage—since 1999.

The improvements we’re marking this week didn’t happen by accident—they’re the result of policies that work. And with the wrong policy choices, we could see these important gains erased.

Take the minimum wage. State and local minimum wage increases likely played a big role in the decline in poverty and increase in income that we saw in 2015—as well as the faster wage growth among African American and Hispanic workers, and women (all of whom are disproportionately likely to be low-wage workers). They also likely helped the gender wage gap hit 80 cents for the first time ever, and led to even stronger progress on the wage gap for African American women. And in states that enacted minimum wage increases, low-wage workers saw faster wage growth than workers in states where minimum wages stayed flat.

Variation across states demonstrates the difference that policy choices make

On the health insurance front, the Affordable Care Act remains the gift that keeps on giving. The tremendous gains in coverage that we saw in 2014 and 2015 brought the nation to a record low uninsured rate of 9.1%. But here too, variation across states demonstrates the difference that policy choices make. The average share of uninsured individuals in states that hadn’t expanded Medicaid by January 2015 was 12.3%, compared to just 7.2% in states that had adopted Medicaid expansion. It is clear that the national gains would have been even stronger if 19 states weren’t still refusing to expand their Medicaid programs.

And let’s not forget the safety net. Census data released yesterday using the Supplemental Poverty Measure (SPM), an alternative measure that takes into account critical poverty-reducing investments such as nutrition assistance and tax credits for working families, reminds us how important these and other programs are to cutting poverty and mitigating hardship. According to the SPM, without Social Security nearly 27 million more Americans would have been poor in 2015—that would be an increase of more than 58% in the share of poor Americans. The Supplemental Nutrition Assistance Program protected 4.6 million Americans from poverty. And the Earned Income Tax Credit and low-income portion of the Child Tax Credit together accounted for 9.2 million fewer individuals living in poverty last year.

We’ve got to keep moving the needle in the right direction, particularly as we have yet to return to pre-recession levels of poverty and incomes. And despite strong progress on the national poverty rate, poverty among children, female-headed families, African-Americans, Hispanics, Native Americans, and people with disabilities remains dramatically higher than the overall national rate.

But the big takeaway from yesterday’s data that we should all be shouting about is that we know we can make great progress in cutting poverty—if we make the right choices. Now is the time to double down on the policies we know make a difference, such as making job-creating investments in infrastructure, research, and education; raising the minimum wage and further strengthening tax credits for working families; ensuring paid leave, childcare, and fair schedules, as well as closing the gender wage gap; protecting and strengthening vital safety net programs; and removing barriers to employment for people with criminal records and their families, and workers with disabilities.

Today we should all celebrate the progress we are finally making. But tomorrow, we must use this news to inform the work we do together in the months and years ahead. Now is the time to recommit to making the right choices so that we don’t turn back.



The Federal Poverty Line is Too Damn Low

The U.S. Census Bureau’s announcement today that the number of Americans living below the poverty line fell between 2014 and 2015 is good news. But before we get too excited, it is worth noting that the federal poverty line was a meager $12,000 for a single person living alone in 2015 (and only about $24,000 for a married couple living with two children).

If your initial reaction to that is “whoa, that’s waaay too low for a person to lead a minimally decent life on in the USA,” then you’re in good company. In a recent survey conducted by the conservative American Enterprise Institute (AEI) and the Los Angeles Times, Americans were asked, “[What is the] highest annual income a family of four can have and still be considered poor by the federal government.” The average response was $32,293—an amount 34 percent higher than the current federal poverty measure.

In short, conservatives did a poll on how much income it takes to avoid poverty, and the answer they got back was more than $8,000 above the federal poverty line.

The wonks reading this might be thinking “well, if the federal government says a married couple with their two kids only needs $24,000 to live a minimally decent life, then they must have good reasons to think this is enough.”  I’m a bit wonkish myself and generally trust official government statistics—but the federal poverty measure is a big exception.

The main reason I don’t trust this approach to measuring poverty is shown in the figure below. In 1963, the poverty line for a family of four was 50% below median family income—or one-half of the income of the typical four-person family in America. Today, however, the poverty line for a family of four is 66% below median family income.

The federal poverty line is getting further away from median family income

That means to be officially counted as poor today, a family has to be much poorer compared to the typical American family than it had to be in 1963. In fact, if the federal poverty line today was set at the same place relative to median income as it was in 1963 it would be about $33,000, rather than $24,000.

The AEI survey results are not a fluke. We know from decades of evidence that the public’s understanding of the income needed to avoid poverty increases over time at a rate faster than inflation, and closer to the increases in mainstream incomes and living standards.

So why hasn’t the official poverty line been adjusted over time in a way that reflects the public’s more accurate understanding?

The reasons for this are largely political.

In the early 1960s—around the time when the Beatles were just becoming famous here—Mollie Orshansky, an employee in the Social Security Administration (SSA), developed working estimates of what it meant to be poor at that time.

The data available to Orshansky wasn’t particularly sophisticated, or even timely. For example, she based her estimates in part on a food consumption survey conducted in 1955. When the federal government started using her calculation of the poverty line in the mid-1960s, Orshansky and federal officials understood that it would need to be adjusted over the long-term for increases in mainstream living standards. The SSA “made a tentative decision early in 1968 to adjust the poverty thresholds for the higher general standard of living.”

But then two things happened that year. First, officials in the Johnson administration prohibited the SSA from making this kind of adjustment, likely in part due to concern that the updated figures would show an increase in poverty. Second, Richard Nixon was elected President.  After he took office, his budget office issued a directive making the Orshansky thresholds the “official” poverty measure, and specifying that they would be adjusted for inflation only.

There have been repeated recommendations to reform the poverty measure

In 1970, Orshansky said this decision would likely “freeze the poverty line despite changes in buying habits and changes in acceptable living standards.” There have been repeated recommendations to reform the poverty measure since then, but no President has been willing to revise the Nixon directive.

The Census Bureau has an alternative measure of poverty, the Supplemental Poverty Measure, which improves the current federal poverty measure in many respects. But even this approach puts the poverty line at about $25,000 to $26,000 for a family of four—and that’s still too low.

Here’s a better approach: dump the current official poverty measure and replace it with two different measures. One measure would be anchored to half of the typical (median) American family’s income in 2016 and then adjusted for inflation over time; the other would be set at the same level initially, but adjusted annually using the median income over a 5-year period. This way, the poverty line won’t drift away from mainstream living standards of living over time.

It’s 2016: We need a poverty measure that reflects what the public thinks is required to meet basic needs in Beyoncé America.  But instead we’re stuck in Beatlemania America—and that needs to change.