Updating an outdated poverty measure

Jacqui Broughton

The U.S. Commerce Department recently announced the Census Bureau is developing a new, unofficial poverty measure to go alongside the current poverty measure.

This is a change advocates have been waiting to see for years as the current measure is far out of date.

The new measure will not replace the official measure calculated each year by the U.S. Census Bureau or the official poverty guidelines published each year by the U.S. Department of Health and Human Services, but it will be published annually along with the official measure.

The current poverty measure does not take into account the things it takes for a family to live. It only considers pre-tax cash income and is adjusted each year for inflation using the Consumer Price Index.

The current measure was developed in the 1960s and is based on the U.S. Department of Agriculture’s economy food plan. This food plan was the lowest estimate of what a family needed to feed themselves, but was not necessarily sufficient for long-term nutrition. At the time, it was estimated that the average family would spend approximately one-third of their total net income on buying food using this plan.

The supplemental measure, due to come out in the fall of 2011, is based roughly on a measure the National Academy of Sciences developed in 1995. This measure takes a lot more into account, such as:

• Assistance received from food assistance programs, housing vouchers, energy assistance and tax credits;
• foster children (the official measure only includes relatives by birth, marriage, or adoption);
• living expenses; and
• geographic differences in the cost of living.

Since this new measure looks at a lot more things, it is thought it will cause the percentage of people in poverty to go up since the amount a family must earn to not be below the poverty level will go up.

The new measure will not, however, impact program eligibility. This means, a family with income higher than the current poverty level may be in poverty by the supplemental measure, but still not qualify for assistance programs since a family will have to be even poorer to get help.

This overhaul is long overdue. While the current measure will remain the official poverty measure, it will be put in perspective by the supplemental measure. The current measure is severely outdated and fails to take into account the things that a family or individual needs to sustain a basic standard of living besides food–such as housing, utilities, clothes, and transportation.

So while the poverty rate will probably go up, this measure will give a clearer picture of what poverty really looks like in America.

-Jacqui Broughton

Health care reform — one step closer

Jan Hudson

In June 1994, the Michigan League for Human Services’ Board of Directors adopted a set of health care reform principles.

Last night’s historic House vote brought us one step closer to realizing the implementation of many of the policies and principles included in that document, which by health care reform standards, (see a brief history of health reform) is relatively new.

The Senate bill passed by the House is Senate Bill H.R. 3590 and the ensuing reconciliation bill is Reconciliation Act H.R. 4872.  Several components of the League’s health reform principles are included below with a brief explanation of how they are addressed in health reform legislation:

• Coverage for nearly all Americans. By 2019, it is projected that 95 percent of non-elderly legal residents would have insurance. The legislation expands Medicaid to all adults and children under 133 percent of the federal poverty level (FPL) and provides subsidies to families with incomes up to 400 percent FPL to purchase insurance.  In addition, caps, based on a sliding income scale, will protect low-income persons from excessive out-of-pocket costs.
• Mandated enrollment in health care coverage to spread the costs as broadly as possible.  The legislation requires most people to obtain coverage or pay a penalty, which is necessary to provide an incentive for people to secure coverage before they become ill. With nearly everyone enrolled in coverage, over time, premiums should become more affordable as they will no longer include the “extra cost” of providing care for those who are uninsured.
• Focus on disease prevention and chronic disease management.  There are numerous prevention and wellness initiatives included in the legislation.  For example, all co-payments, co-insurance and deductibles for preventive services will be eliminated for Medicare beneficiaries.
• Coverage of the full range of mental and physical health needs.  The new state-based exchanges would have to provide minimum standards for coverage and cost-sharing protections for enrollees, making sure coverage is comprehensive and affordable. Four levels of coverage will be required. Medicaid would continue to provide comprehensive coverage to all who qualify with enhanced federal subsidies for the newly eligible.
• Implement effective cost containment. The legislation takes a number of steps, particularly within Medicare, to institute efficiencies to lower cost and improve quality of care, through changes in the delivery system, and through the establishment of an independent Payment Advisory Board charged with developing proposals to slow the growth of both Medicare and private insurance spending and improving quality of care.
• Comprehensive quality management and health care outcomes.  The legislation creates a research institute to conduct comparative effectiveness research, create a value-based system for hospitals and physicians, and encourages the development of new patient-care models, to name a few.

Of key importance are the provisions in the legislation that will reform the health insurance marketplace by prohibiting lifetime limits on benefits and terminations of coverage when people become ill.  In addition, the reforms will prohibit insurers from denying coverage or charging higher premiums to persons with pre-existing conditions, or higher premiums based on gender.

The reform package gradually eliminates the Medicare Part D “doughnut hole,” the coverage gap in which beneficiaries continue to pay Part D premiums, but have no pharmacy coverage, and must fully pay for their medications.  An immediate 50 percent reduction in the cost of brand-name drugs will be available to those who reach the “doughnut hole.”

The reform package passed by the House last night will also provide subsidies to small businesses to enable them to provide coverage at a reasonable cost to their employees. They will also be able to purchase comprehensive, affordable coverage through the state-based exchanges.  Many small businesses have been unable to provide, or have been forced to drop insurance coverage due to the escalating cost of premiums.  The exchanges will provide opportunities for small business to purchase coverage with more affordable and predictable premiums.

The above information is only a small sample of the benefits included in the health care reform legislation passed by the House.  The reconciliation bill, which must now be taken up by the Senate, can be passed with a simple majority (51 votes).  Action by the Senate is expected this week.

The League and the Michigan Health Insurance Access Advisory Council are sponsoring a forum on April 23, Federal Health Care Reform: Challenges for the States.  For more information and to register, click here.

— Jan Hudson