How One White Mayor Wants to Heal the Racial Divide

In 2005, Hurricane Katrina struck the Gulf Coast as one of the worst storms in U.S. history. The Category Three hurricane killed 1,833 Americans across five states and caused an estimated $108 billion in property damage. It also laid bare the deep impacts of decades of segregation and institutionalized racism in the South.

The brunt of the devastation fell on the region’s low-income and minority residents, many of whom remain displaced to this day. In New Orleans, for instance, heavily African-American neighborhoods, such as the flood-prone Lower Ninth Ward, were wiped out while affluent white neighborhoods further inland were spared.

Many progressives hoped that the gross inequities exposed by Katrina would spur broad national action on racial equity, but progress has been disappointingly slow. An April 2019 poll by the Pew Research Center, for instance, found that 76 percent of black Americans say they’ve experienced discrimination or unfair treatment. And a stunning 58 percent of Americans think race relations are “generally bad”—with 69 percent think things are getting worse.

For former New Orleans Mayor Mitch Landrieu, the lessons of Katrina remain unfinished business that the nation needs to tackle.

Read more via Washington Monthly…

Still Missing: The Women Wonks

In August 2018, Mexico’s Ministry of Health convened a high-profile conference on the benefits of breastfeeding. It was part of a long-standing effort to boost the nation’s breastfeeding rate, among the lowest in Latin America. But what drew the most attention was a photo of the keynote panel: six dour men—presumably incapable of lactating themselves—arrayed under a banner reading “Uniendo esfuerzos por la Lactancia Maternal,” Spanish for “Joining Forces for Breastfeeding.” The photo sparked viral outrage on social media and instantly established the event as a prime example of all-male panels—also known as “manels,” “colloqui-hims,” or “him-posiums.” 

I first wrote about the preponderance of testosterone at think tank panels and policy events—particularly
in Washington—in a 2012 Washington Monthly article titled “Where Are the Women Wonks?” The imbalance is about more than appearances. “Without greater representation from women, maybe it’s not such a surprise that so many of the policy debates in Washington seem to be missing half the picture,” I wrote at the time.

Read more at Washington Monthly.

Are blue-collar white women Trump’s red wall?

Despite a nonstop onslaught of fresh and damning revelations about his misconduct in office, President Donald Trump has so far maintained his core supporters’ loyalty. As of the start of this week, Trump’s average approval rating holds at 42 percent—only slightly less than the share of Americans opposing the inquiry into his impeachment.

But for Democrats desperate to oust the president, either by impeachment or the ballot, breaching this “red wall” of support (if, in fact, it can be breached) is a matter of utmost importance. Democrats face two key questions: who are Trump’s most stalwart defenders, and can they be persuaded to abandon him?

New research suggests an answer to the first of these queries. It’s a group that Democrats should—and could—be winning over: blue-collar white women. While Democrats made crucial gains among these voters in the 2018 election, these women may now be rallying to Trump’s defense.

Continue reading at Washington Monthly.

Health care’s biggest problem is getting worse

Many liberals and a growing number of Democratic presidential candidates have embraced a bold idea for reforming America’s broken healthcare system. The idea most in vogue—and the most debated—throughout the 2020 election has been to abolish private insurance in favor of a government-run national system, otherwise known as “Medicare for All.” Advocates of “single-payer” generally blame rapacious insurers as the principal villains of the current system, responsible for sky-high premiums and out-of-pocket expenses. Replacing for-profit insurance companies with a government program, the logic goes, would bring lower costs and coverage to everyone

But this singular focus on insurers means that the presidential hopefuls are neglecting an even bigger problem with far-reaching consequences for millions of Americans: the dominance of hospital monopolies in a growing number of health care markets nationwide.

Monopolies, in general, mean bad news for consumers. Health care is no exception. Mounting evidence shows that hospital consolidation exacerbates the system’s worst failings, bringing higher prices, fewer choices, and lower quality care to patients. And it’s only getting worse.

Continue reading at Washington Monthly.

How 2020 Democrats are missing the message on the economy

The 2020 Democratic primary has seen no shortage of big, ambitious ideas—the nationalization of health care via “Medicare for All,” free college, free child care, and the cancellation of student debt, just to name a few.

But there’s one big idea still missing: how to fix the stark and growing disparities between the parts of the country that are prospering and those that are falling behind. Regional inequality is perhaps the greatest challenge to America’s economic and political future, but 2020 candidates have yet to tackle, let alone acknowledge, the problem. It’s an omission that could have long-term substantive consequences for Democrats.

Since President Donald Trump took office in 2016, numerous analyses have pointed to a widening gulf—political, economic and demographic—between red and blue America. On the one hand are the rising fortunes of educated, urban Democratic districts. On the other is the steep decline of formerly industrial, Republican districts in rural America and the heartland.

The latest to highlight this trend is a new report from Mark Muro and Jacob Whiton of the Brookings Institution, which underscores how deep this schism has become over the past 10 years.

Continue reading at Washington Monthly.

High on Pot Taxes

Originally published in Governing, September 2019

Visit the online menu of marijuana producer <rØØ7>, and you’ll glimpse the blossoming world of artisanal pot—a burgeoning industry made possible by states’ momentum toward legalization. Strains like Sweet and Sour Cindy offer “an earthy mix of grape, apricot and chocolate undertones,” while Millennium Kush consists of “tropical notes” and a “citrus aroma.” “We’re really about trying to promote wellness, whether it’s a straight medical use or de-stressing or whatever else,” says President Kris Krane of 4Front Ventures, <rØØ7>’s parent company.

Krane’s business is booming. He’ll be operating at least 15 stores in seven states by years’ end. Meanwhile, states are hoping his good fortune benefits their coffers as well. Legalization advocates have promised big potential tax revenues from pot sales. In Illinois, which legalized marijuana in June, a study predicted yearly revenues as high as $676 million. Early legalizer Colorado has reaped a windfall of more than $1 billion in total collections since 2014.

Nevertheless, states shouldn’t assume a guaranteed jackpot for their budgets. California collected $82 million in its first six months of sales, falling far short of projected revenues of $185 million. In Massachusetts, revenue officials projecting $63 million in taxes by June 2018 had collected a paltry $5.9 million as of that March. Even in Colorado, revenues may have plateaued, according to a market analysis commissioned by the Colorado Department of Revenue.

Why these disappointments? In California and Massachusetts, regulatory snafus delayed the licensing of stores and, consequently, tax collections. Massachusetts, for instance, had just nine licensed stores three months after legalization, while California had only 620 licensed stores statewide as of April 2019 (a tiny number considering the state’s estimated annual pot production of 14 million pounds).

While smarter regulation could help boost revenues, it can’t change pot’s shifting economics. Most of the nine states where recreational sales are currently legal impose excise taxes based on price, along with general sales taxes. (One exception is Alaska, which taxes retail sales by the ounce.) Sales and excise taxes work well when pot is relatively expensive, but as marijuana cultivation moves out of the shadows and into industrial-scale production, “you’re going to see the price come down and your taxes going down with it,” says marijuana tax policy expert Pat Oglesby.

In Colorado, for instance, the state’s market analysis reports that retail prices for cannabis fell 62 percent from 2014 to 2017. In Oregon, marijuana can now be had for as little as $60 an ounce, compared to $350 on the illegal market, according to Karen O’Keefe of the Marijuana Policy Project.

One way to grow revenues is to increase demand, but encouraging more pot consumption is hardly good public policy. As more states legalize, counting on out-of-state sales is also less viable. Colorado’s “cannabis tourism” accounts for less than 10 percent of sales. States could raise the tax rate or shift to taxing by weight—but face bitter industry opposition. “You can only wring so much out of this industry before you choke it,” says National Cannabis Industry Association spokesman Morgan Fox.

State-owned pot shops are still another option. They’re a long shot, but tax lawyer Oglesby favors them. “It’s like the government liquor store,” he says. “They can adjust the price immediately, they’re very good about keeping kids away, and they can keep the price where they want it.”

Cannabis Corner, in Stevenson, Wash., is so far the nation’s only city-owned pot store. Launched in 2015, the store expects sales of about $1.1 million this year.

But even with maximized revenue, pot taxes will likely only account for about 1 percent of overall state budgets, according to the Institute on Taxation and Economic Policy. The $266 million Colorado collected in 2018, for instance, pales next to the state’s $15 billion in total revenues and $32 billion budget.

The bottom line: States should legalize for public health and safety, not the money. Plugging budget holes with pot? It’s, well, a pipe dream.

The Precollege Racket

Via Washington Monthly

Among the thousands of personal appeals on the crowdfunding site GoFundMe, you’ll find a 2017 campaign for a young woman named Kirstin, a then high school junior with wavy light brown hair, hazel eyes, and a smile that hints at suppressed excitement.

“Kirstin’s Invited to Stanford!” the page, created by Kirstin’s aunt, declares. “My 16-year-old niece has been offered a once-in-a-lifetime opportunity. After working hard her entire school career to achieve a goal, she has done it!”

Kirstin, it turns out, was not admitted as an undergraduate, but was raising funds for an “Intensive Law & Trial” summer program offered on the Stanford University campus. Tuition for the ten-day program runs to $4,095, not including airfare and pocket money. “Stanford, one of the most prestigious law schools in the country, is impressed enough with her to have invited her to this program in Palo Alto, California this summer,” the post continues. “Her extended family is trying hard to raise the deposit of $800.00 by week’s end so this opportunity does not slip through her fingers.”

Search “pre-college” on GoFundMe.com and you’ll find dozens of similar campaigns from hopeful students dazzled by the allure of two weeks on an elite campus. “Going to the Summer @ Brown PreCollege Program would give me a preview of what life would be like if I attend the school of my dreams,” reads a 2018 campaign by Benjina, from Newark, New Jersey. “This program will give me the experience of a lifetime,” writes Yakeleen, a high schooler from Tucson, Arizona, hoping to raise $2,200 to attend Harvard’s pre-college program. “Coming from a low income background while being a first generation student, this is a grand oppurtunity [sic] I intend on taking advantage of.”

These posts reflect the growing trend of summer “pre-college” programs at the nation’s most prestigious universities.

Continue reading at Washington Monthly…

Anti-Fluoride Activism Is Bad, and Not Just for Public Health

Originally published in Governing, July 2019.

In 1901, a Colorado Springs dentist named Frederick McKay noticed many of his patients had peculiarly mottled brown teeth — but far fewer cavities than the norm. The cause, Dr. McKay determined after years of investigation, was high levels of natural fluoride in the town’s water. His discovery eventually led to the widespread fluoridation of public water systems across America and a dramatic decline in tooth decay over the past 70 years.

Numerous studies have shown the protective effects of adding fluoride to water, especially for kids, and the Centers for Disease Control and Prevention hails community water fluoridation as one of the 20th century’s top 10 public health achievements. State and local budgets have benefited too, thanks to lower public expenditures for dental care.

Unfortunately, a significant number of localities are now undoing their investments in fluoridation, thanks to a small but vocal minority of anti-fluoride activists using pseudo-science to trump data. The result has been the spread of misinformation about fluoride’s benefits, as well as higher costs for both taxpayers and families.

According to the anti-fluoridation Fluoride Action Network (FAN), more than 200 communities in the United States and Canada have rejected public water fluoridation since 2010, from small towns such as Sheridan, Wyo., to bigger jurisdictions such as Bucks County, Pa. In Portland, Ore., residents have voted down fluoridation four times since 1956, most recently in 2013. In 2018, at least 13 communities put water fluoridation on the ballot, while many other localities debated the issue at the city council level without a public vote.

Like anti-vaccinators, anti-fluoride activists rely on spurious medical research to argue fluoridation’s hazards. FAN, for instance, blames fluoride in water for everything from cancer to diabetes to low IQ to, ironically enough, tooth decay. “I’ve got a list as long as your arm of different claims,” says dentist Johnny Johnson, president of the pro-fluoride American Fluoridation Society. None of these claims, however, is backed up by valid science or facts.

One thing that is backed up by facts? Fluoridation saves money — for consumers as well as governments. A 2016 Health Affairs study estimated the nation’s net savings from fluoridation to be nearly $6.5 billion a year from avoided dental costs. Conversely, ending fluoridation can be costly. One study in New York found that residents in non-fluoridated counties were 33 percent more likely to undergo dental procedures, while a Louisiana study found that Medicaid-eligible kids in non-fluoridated communities were three times more likely to get dental treatment than kids in fluoridated areas and at twice the cost.

Dentist David Logan witnessed these impacts firsthand in Juneau, Alaska, where voters ended fluoridation in 2006. The immediate effect, he says, was an increase in cavities among his adult patients, “specifically in older adults where the root surface gets exposed.” Today, his colleagues are seeing many more cavities in kids and at “levels they haven’t seen before in their practicing career.”

All of this is expensive. Logan, now executive director of the Alaska Dental Society, notes that simple fillings cost about $175 in his community, while crowns cost upward of $500. “It’s a very significant amount,” he says, “especially when that cost is disproportionately borne by the public through Medicaid.”

A 2018 study of Juneau’s Medicaid records found that since the end of fluoridation, Juneau’s kids undergo one more cavity-related dental treatment per year than before, at a cost of $300 per child on average. The study also found the highest costs among children under 7, who’ve had no exposure to fluoridated water.

Logan is hopeful this study will help bring fluoride back to Juneau. But he admits he was badly outgunned 12 years ago by the opposition. “You don’t have to have facts. All you need is something sexy to say,” he says. “We had people with lots of letters after their names, but we didn’t put a face on it and got crushed.”

Next time, he says, he’ll be ready, as should all localities where anti-fluoride activists have made a stand. At stake is not just the integrity of science but public budgets and public health.

Continue reading at Governing

The Education Investment States Should Be Making

Originally published in Governing, May 2019

In the midst of record low unemployment, many states are nonetheless struggling with ongoing skills gaps — shortages of workers with the right skills for in-demand jobs.

At the start of 2019, according to the Department of Labor, as many as 7.3 million jobs remained unfilled. These included a substantial number of “middle-skill” jobs requiring some schooling beyond high school but not a four-year degree. They were in fields such as health care, IT, welding and truck driving. The American Trucking Associations, for instance, reported a shortage of 50,000 drivers in 2017.

One reason these gaps exist is underinvestment in career and technical education. Of the more than $139 billion in annual federal student aid spending for higher education, just $19 billion goes to career and tech ed. Students generally can’t use federal Pell Grants to fund short-term, non-college-credit training programs, such as for welding certifications and commercial drivers’ licenses. Federal dollars under programs such as the Workforce Innovation and Opportunity Act are typically limited to the lowest-income workers.

Two states, however, have programs that show how valuable occupational credentials can be. Already, these initiatives are generating big returns by raising workers’ wages, closing skills gaps and driving economic development — and at a price much cheaper than “free college,” another higher-ed funding idea that’s gained popularity in recent years.

In Virginia, the state’s New Economy Workforce Credential Grant Program covers two-thirds of the cost of a credentialing program, up to $3,000 per student. It’s a pay-for-performance model, so community colleges and other training providers don’t get paid until a student completes a class and obtains an approved credential aligned with the state’s annual “hot jobs” list. So far, about 8,000 Virginians have earned credentials through the program since its launch in 2017.

In Iowa, the Gap Tuition Assistance Program pays tuition, books and fees for lower-income students pursuing credentials from approved programs. In 2018, about 2,400 students applied, and 1,000 were accepted. The program boasts an 89 percent completion rate.

Both programs aim to reach workers who don’t qualify for federal aid. “Back in the days when a welding class was going to cost an individual $4,000, someone who was struggling to make ends meet would not come to us,” says Elizabeth Creamer, vice president of the Community College Workforce Alliance in central Virginia. “Now they can.”

Funding credential attainment has been a smart investment in these states — for workers, for businesses and for the public purse. “These are great programs for moving somebody who could be a public burden or isn’t really on track for a good career into getting the skills they need in a high-demand area,” says Jeremy Varner, administrator of the Division of Community Colleges and Workforce Preparation for the Iowa Board of Education. “It’s giving folks economic opportunity they otherwise wouldn’t have and at the same time meeting the very profound industry labor market needs that exist.”

In Iowa, which allocates about $2 million to the program annually, workers who earned a credential and found a job in a new industry increased their wages an average of 37 percent, according to the state’s analysis. Workers who moved from agriculture to manufacturing raised their wages by as much as 138 percent.

In Virginia, Creamer says her graduates see average wage increases of between 20 and 45 percent as they go on to good-paying jobs at regional powerhouses such as Amazon, Altria and DuPont. Results like these are one reason Virginia is growing its investment from $4.5 million in 2017 to a projected $13.5 million by 2020. The program has also encouraged the state’s community colleges to build better partnerships with local businesses so they can produce the talent companies need. “We’re not just training and hoping someone gets a job,” says Creamer. “We know they will.”

As Students Debts Mount, A New Form of Repayment Emerges

Originally published in Governing, March 2019

An ambitious group of seniors from Oregon’s Portland State University devised a creative plan in 2012, dubbed “Pay Forward, Pay Back,” to deal with spiraling college costs and student debt. In exchange for deferred tuition, students would contribute a chunk of their post-graduation earnings to a fund for future students, ultimately creating a self-perpetuating pool of aid passed from one generation to the next.

Unfortunately, Pay Forward, Pay Back quickly hit the wall of fiscal reality. Despite the embrace of legislators, the state’s Higher Education Coordinating Commission concluded that the deferred tuition plan was unaffordable, costing as much as $20 million a year for 20 years to benefit just 1,000 students annually.

Yet interest in new ways to finance college remains very strong, especially as average in-state tuitions at four-year public universities have roughly tripled since 1998, total student debt topped $1.5 trillion in mid-2018 and state grant aid has stayed flat.

Rather than look to public money, however, some states are exploring novel alternatives to traditional student debt, ideas that would rely on private and philanthropic financing. Of particular interest are so-called income share agreements (ISAs), which proponents argue has the sex appeal of Pay Forward, Pay Back, but poses less risk to the public purse. Six states considered ISA-related legislation in 2018, according to the Education Commission of the States. In 2019, California could launch the nation’s first statewide ISA pilot.

Perhaps the nation’s best-known ISA program so far is a private one. Purdue University’s Back a Boiler program, begun in 2016, allows students to get a grant toward tuition. The grant is to be repaid as a fixed share of post-graduation income for a certain number of years, depending on major and projected earnings. For example, a computer science major with a $26,000 ISA grant would pay 7.3 percent of his or her income for seven years. If this student makes the expected median salary, total payments should be slightly cheaper than a traditional student loan.

The biggest benefit, though, is if the student’s career plans don’t pan out or the economy craters. Under a traditional loan, interest and principal would accrue regardless of borrower hardship. But ISA holders are unburdened by that risk. “This idea of shifting risk from student to school is one of the beautiful ideas behind ISA,” says Mary Claire Cartwright, vice president of information technology at the Purdue Research Foundation, which administers Back a Boiler. “We’re telling students, ‘You’re going to get a great job when you graduate, and if you don’t, we’re here to catch you.’”

So far, Purdue has issued $6.5 million in ISA contracts to more than 750 students, many of whom, Cartwright says, are first-generation students. And according to tech startup Vemo, which administers ISAs, more than 30 universities now have them, as do coding boot camps and trade schools.

While ISAs and other innovations are no silver bullet, states could benefit from experimenting with loan alternatives. First, they could expand their arsenal for making college more affordable, especially if lean budgets disallow expanding grant aid. Second, states could benefit from graduates’ economic success if schools have an incentive to ensure students get jobs to pay back their commitments.

In California, a bill by Republican Assemblyman Randy Voepel to establish an ISA pilot at the University of California system failed to make it past the state Senate last session, but unanimously passed the Assembly. Supporters are optimistic, and its success could pave the way for other state experiments. Federal legislation to recognize and regulate ISAs also enjoyed bipartisan support last Congress and is set for reintroduction this year as well. All this could mean good news for future students.