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Let Mayors Authorize Charter Schools

David Harris - December 22, 2014

Next month, as hundreds of new mayors take office, improving local schools will be a top priority for many. Cities across the country suffer from lagging student achievement and high dropout rates, and elected officials know the role that education plays in the overall vitality of their communities.

In most cities, elected school boards, rather than mayors, govern local school districts -- but state legislatures can grant mayors the authority to authorize new charter schools. To make an impact on improving educational outcomes, both incoming and sitting mayors should petition their state legislatures to give them this ability.

Charter schools are public schools that receive taxpayer funds but are exempt from the labor contracts and other strictures weighing down traditional schools. The charter model allows school operators to innovate and tailor their approach to meet the needs of students. And importantly, charters can compensate teachers based on merit, not according to antiquated union rules.

Charters also are positioned for success because they face competitive pressures to improve. Parents are provided information about achievement scores and graduation rates, and they’re free to pull their kids out of an underperforming institution and enroll in a better one.

But critical to charter schools’ success are their authorizers -- the entities that give charters the right to operate and hold the schools accountable for student achievement.

Mayors operate within specific political and policy parameters that position them to authorize high quality charter schools that live up to their potential to transform student lives. Mayors understand the communities that charters serve, and that local context helps them determine whether a team of educators and community leaders applying for a charter can work effectively with parents and teachers.

Importantly -- unlike other charter authorizers -- mayors are directly accountable to their communities. They can be thrown out of office in the next election by dissatisfied parents if they hand out charters to subpar operators. Because of this, mayors have a powerful incentive to rigorously review charter applications and shut down underperforming schools. Under a mayoral authorizer, bad charters won’t be allowed to fail with impunity -- either the school or its authorizer will pay a price.

The mayor-sponsored model is already in action in my home city of Indianapolis -- and it’s making a significant impact in improving educational outcomes.

Back in 2001, the Indiana legislature granted then-Mayor Bart Peterson the authority to issue new public school charters. Peterson, a Democrat, eagerly embraced this new power, and so has his successor, Greg Ballard, a Republican.

In 2001, there were no charters in Indianapolis. Today, there are 37, all of which are governed by nonprofit boards. These schools are succeeding. A report from Stanford University shows that mayor-sponsored charters in Indianapolis generate two to three months of additional learning each year compared to traditional public schools. On this year’s statewide achievement test, students at mayor-sponsored charter schools were 11 percentage points more likely to achieve proficiency in English, and 10 points more likely to achieve proficiency in math, than were students of local public schools, according to an analysis by the Indianapolis Mayor's Office of Education.

The Indianapolis model is recognized as a national model. In 2006, Mayor Peterson’s administration won Harvard’s Innovations in American Government award for the charter school authorizing office it built. During Mayor Ballard’s tenure, the National Association of Charter School Authorizers designated the mayor’s office as a model authorizer.

Part of what has made Indianapolis’s mayor-sponsored charter effort so successful is that schools are held to account. Indeed, the mayor’s office has revoked charters from operators because of consistently poor student scores on achievement exams.

Other mayors have noticed the power of Indianapolis’s approach and have followed suit. In 2013, the Ohio legislature granted Columbus Mayor Michael Coleman chartering authority. More mayors should follow Indianapolis’s and Columbus’s lead. For cities across the country, no other issue could be more important to their economy’s future success, or the well-being of their residents.

David Harris is the founder and CEO of The Mind Trust, a school reform non-profit based in Indianapolis. Previously, Harris served as the City of Indianapolis’s first charter schools director.  

Higher Deductibles Should Be Welcomed

Yevgeniy Feyman & Aobo Guo - December 19, 2014

The Affordable Care Act was supposed to expand access to health care -- and it appears the uninsured rate has indeed fallen. But new concerns have arisen about patients' ability to sustain the high-deductibles and coinsurance now dominating coverage on ACA exchanges.

Commentators have dubbed the phenomenon "underinsurance" -- see Aaron Carroll highlighting the issue, and Brian Eastwood on how Americans are delaying medical care as a result -- arguing that despite the ACA's insurance expansion, high deductibles and out-of-pocket limits are a worrying sign of underlying unaffordability. Certainly, spending 10 percent or more of one's annual income on health-care costs (a common definition of underinsurance) is undesirable. Yet there's far more to this story than simply high deductibles on exchange plans.

The fear is that these deductibles may lead patients to delay or forgo needed health care, leading to more expensive long-run complications. But rather than attack high deductibles per se, critics would do well to understand the core forces driving the present market.

First, insurers are limited to offering products within the ACA's regulatory constraints. Pre-ACA, insurance premiums in the individual market more closely reflected the underlying health risks of prospective patients, as well as the benefits provided. The ACA's limits on age-based rating, elimination of risk-based rating, and mandated generous minimum benefits have forced premiums to rise. Deductibles and out-of-pocket costs are higher now as well: cost-sharing offers insurers a sharp tool for varying the amounts that consumers pay.

Second, the ACA's structure -- with subsidies tied to the price of the second-cheapest Silver plan in a given rating area -- further encourages insurers to tinker with cost-sharing in order to get premiums for their plans as close to the benchmark as possible. This aspect of the law, however, isn't necessarily bad for consumers. Far from it.

Focusing solely on out-of-pocket costs, after all, offers a misleading measure of total health-care costs, which equal out-of-pocket spending plus premiums. Consider a hypothetical choice between two plans, one for $400 a month, the other for $200 a month. The former offers a $1,000 deductible, the latter a $4,000 deductible. Assume annual health-care spending of $780 (the 2012 median for insured individuals under 65, based on a federal survey). Under the less expensive plan, total health-care costs equal $3,180. Selecting the more expensive plan with a lower deductible would cost $5,580. For the lower-deductible plan to be worthwhile, one would have to incur $3,400 dollars in spending in a given year -- sufficient to place in the top 25 percent of all health-care spenders.

For the relatively healthy people who currently constitute at least half the insured population, even high deductibles can therefore be worthwhile. Indeed, even for someone confronted with a string of expensive events over a multi-year period, the odds are that a high-deductible plan will worthwhile in the long run, at least until the person reaches their late fifties. In general, for those without high-cost chronic conditions, taking savings from premiums over time and storing them away for a rainy day is a viable option.

Importantly, higher cost-sharing also incentivizes consumers to seek more cost-effective options. For instance, thanks to cost-sharing for branded drugs and tiered formularies, over 80 percent of drugs sold in the U.S. are generic. Elsewhere, retail health clinics offer cheaper alternatives to doctors' offices and hospitals for certain acute care, while telemedicine makes simple care more accessible (and less expensive), particularly for working parents. Such competition, produced by newly price-sensitive consumers, should be welcomed.

Finally, high deductibles, such as the $4,000 deductible in our hypothetical plan, are also partly due to the high prices Americans pay for their health-care system. Limiting cost-sharing and deductibles won't begin to address such costs -- and may, instead, exacerbate them by boosting demand for health care.

Of course, there are good ways to make cost-sharing more affordable. Reducing tax breaks for employer-sponsored coverage more aggressively, which the ACA avoids until 2018, would create some additional revenue to spend on those faced with high out-of-pocket costs.

Moderating the ACA's regulatory excess is another approach. The law's "essential health benefits," while giving states some flexibility, still have been estimated to increase premiums by 3 to 17 percent. Loosening EHB requirements (for instance, by allowing insurers to vary the benefits covered rather than requiring them to cover ten categories of benefits) would allow premiums (and by extension, deductibles) to vary more.

Allowing insurers to vary prices by age to a greater degree -- say, letting them charge a 64-year-old five times what they charge a 21-year-old, instead of the current limit of three times -- would similarly allow premiums to vary more. In particular, savings would accrue to younger people who might be entering the job market with little savings. A more controversial approach would allow some minimal risk rating, perhaps with front-end subsidies covering higher costs for those with illnesses (on the condition that they maintain continuous coverage).

The point: Current high deductibles on ACA exchanges, as well as rising deductibles in employer-sponsored plans, are driven not only by the U.S. health-care system's existing high costs, but also by new ACA regulations. Trimming the worst ones will relieve pressure on consumers.

Yevgeniy Feyman is a fellow and deputy director of the Center for Medical Progress at the Manhattan Institute. Aobo Guo is a Manhattan Institute intern and undergraduate student at Yale University.

Why the Fed Should Follow Rules

Alexander W. Salter - December 18, 2014

How should monetary policy be conducted? What previously was a question of interest only for a subset of economists has exploded into popular debate since the 2008 financial crisis. This, no doubt, is due to the Federal Reserve's unprecedented activities during the crisis. Some, such as Stanford's John Taylor, have accused the Fed of fueling a speculative boom by keeping interest rates "too low for too long" in the years running up to the crisis. Others, such as monetary-economics blogger Scott Sumner, argue instead the Fed was responsible for not acting swiftly and decisively enough when the trouble in asset markets became apparent. Whatever the reason, many believe that the Fed bears some of the responsibility for putting the "Great" in Great Recession, and that its activities must be scrutinized to discover how its operating framework can be changed to avoid such a calamity in the future.

Monetary policy can be defined as changing the supply of money in order to achieve some predetermined macroeconomic goal. In this case, the organization doing the changing is the Fed, and the macroeconomic goal is nominal stability -- preventing large and unexpected changes in aggregate demand. Typically this can be thought of as trying to offset changes in the demand to hold money with changes in its supply.

Money is the one good in the economy that does not have a market of its own in which it is independently priced. As such, if the demand to hold money changes, the only way markets can fully adjust is if relative prices across the entire economy change. Since prices, and especially wages, are costly to change, the adjustment at first is highly imperfect, which may result in a misallocation of resources. Ideally, the Fed prevents the need for such costly price adjustments by increasing the money supply if demand to hold it rises, and vice versa. This keeps the money market as close to equilibrium as possible.

A significant debate within monetary economics is whether the monetary authority should act according to a predetermined rule, or whether it should be allowed discretion to act as the circumstances require. The financial crisis seems to suggest the latter. After all, how can crises be avoided if the rule the Fed is bound to follow prevents it from taking decisive action when necessary?

However, this line of thought gets it backwards. A stable and predictable rule is necessary to anchor market actors' expectations by reducing uncertainty over the future stance of policy. This enables market actors to better coordinate their trading activity, increasing welfare by enlarging the gains from exchange. So long as market actors perceive the rules-based regime to be credible, the expectation of stability afforded by the rule will prevent market actors from engaging in the panicked behavior that can precipitate crises in the first place.

Rules are preferable to discretion for three chief reasons. The first is the famous (at least within economics) time inconsistency problem. This basically says that without something tying the Fed's hands, the public will rationally expect the Fed to engage in more money printing than is optimal, resulting in too much inflation. The Fed can credibly commit to lower inflation, and hence increase public welfare, by binding itself to a rule on which it cannot go back. The second lies in the fact that the Fed often lacks the knowledge to fine-tune a system as complex as the U.S. economy. Given this complexity, providing a stable framework is the best the Fed can do. Lastly, we must also remember the Fed is a bureaucracy that is not accountable to market actors. It is subject to status quo bias, as Harvard's Greg Mankiw argues, like all bureaucracies. Therefore, what is best for the Fed may not be what is best for the economy.

Realizing that a rule is preferable to discretion is only the first step toward reforming monetary policy. We must still decide which rule, from the multitude that economists have proposed over the years, ought to be adopted. Perhaps a strict inflation target, similar to that in the charter of the European Central Bank, is preferable. Perhaps Scott Sumner's proposed regime of using nominal gross domestic product (NGDP) targeting has the best chance of offering stability. More sweeping still, perhaps the Fed should be jettisoned in favor of a return to a gold standard, or some other commodity standard. While this last option may seem fantastic, recent research suggests the Fed has not outperformed the classical gold standard in delivering monetary stability, and may in fact have made things worse.

Reasonable people can disagree over what rule a central bank should adopt, or whether we ought to have a central bank at all. It is clear, however, that the current discretionary regime is not in the public interest. Whichever way forward is chosen, we must remember that any reform, if it is to be effective, must not limit itself to monetary theory narrowly conceived, but must incorporate political economy considerations as well.

Alexander W. Salter is an assistant professor of economics at Berry College and author of a new study published by the Mercatus Center at George Mason University, "An Introduction to Monetary Policy Rules."

As the Bubble Bursts, Opportunities for Reform

Thomas K. Lindsay - December 17, 2014

According to the U.S. Census Bureau, the last two years have seen a substantive decrease (930,000) in the number of college enrollments nationally. Aside from the rebounding economy -- when jobs are scarce, some high-school grads and adult students see college as a more attractive option -- at least two factors account for this decline: the decrease in the number of entering-college-age students in the overall population, and the rising cost of college tuition (and, with it, student-loan debt). As enrollments fall, so does the viability of a large number of colleges and universities, which live or die largely on enrollment numbers from year to year. Amid all this bad news -- or rather, in response to it -- higher-education reformers may find their leverage enhanced.

The challenges posed to the very survival of a growing number of schools was predictable. Over the past quarter-century, average college tuition has increased 440 percent -- faster than general inflation and even health-care costs over the same period. As a consequence, student-loan debt stands at an all-time high of $1.1 trillion. For the first time in history, student debt is greater than total national credit-card debt. Little of this surprises higher-education reformers, who have been arguing for some time that these dramatic increases are unsustainable.

Prospective college students get it. A report by Sallie Mae finds that the college-affordability crisis has begun to change the buying behavior of the college-bound. Based on a survey of 1,600 college-going students and their parents, the study finds that the average amount students and their families are paying for college has fallen for two consecutive years. "American families reported taking more cost-saving measures and more families report making their college decisions based on the cost they can afford to pay."

With fewer applicants -- and these not willing to spend as much on college as in the past -- universities have reason to fear. But making matters worse is the fact that a large number of schools were already in financial trouble before these downturns occurred. A study of college finances titled "The Financially Sustainable University" finds that, on average, university debt is increasing at an average annual rate of 12 percent, which is more than twice the rate of instruction-related expenses. At a time when the state of the economy has driven down both government funding and endowment growth, the result, says the study, is that today approximately one-third of all higher-education institutions have an unsustainable business model.

The report goes on to argue that too many colleges and universities today continue to operate on basis of the "Law of More," that is, on the assumption that more building, more spending, more diversification, and more expansion constitute the formula for continued prosperity. However, this approach has yielded precisely the opposite result, says the study. Too many institutions of higher learning today are overly complex, mired in debt, and unwilling or unable to adopt expeditiously the change demanded for survival. Through overbuilding, overspending, and over-expanding, these colleges and universities have left themselves unmanageably complex and sluggish.

In this crisis, perhaps, lies an opportunity for reformers with financial backing. Those with the means to swoop down and rescue a bankrupt university would have the leverage to erect a new regime in its place, one which avoids the errors that have contributed to our current situation in which too many college students pay too much but learn too little. They could reestablish a required core curriculum in the liberal arts and sciences at the same time that they replaced life tenure with multi-year contracts. The faculty, with reduced publication requirements, could teach more, thus allowing for lower student-faculty ratios. Those courses that continued to be offered as lectures could be offered online. These measures would simultaneously increase student-learning outcomes and reduce the cost of education for students and their families. 

To verify their students' superior progress in critical thinking, analytical reasoning, and writing skills, as well as discipline-specific proficiencies, these schools could require all their students to take the Collegiate Learning Assessment (CLA), as well as GRE subject exams. These measurements of output could be broadcast in an effort to encourage prospective students and their parents to look past the U.S. News rankings when choosing a college. The CLA was the testing instrument used in the nationwide study of collegiate learning Academically Adrift, which found that 36 percent of college students nationwide show little to no increase in fundamental academic skills (critical thinking, complex reasoning, and writing skills) after four years invested in college.

Finally, these reformed universities could offer three-year degrees, something that has been practiced in Great Britain for hundreds of years with no noticeable ill effects. This too would lower costs and likely spur student interest at a time when student-loan debt stands as a major obstacle to college completion.

This brief sketch of a road not yet taken is doubtless littered with daunting roadblocks, chief among which perhaps are the regional accrediting bodies as well as the standards that must be adhered to in order to qualify for federally-subsidized student loans. However, both of these obstacles may come to lose some of their leverage as more and more universities begin to declare bankruptcy, leaving fewer and fewer options for college-ready students.

In sum, an increasingly desperate public would be happy to learn that alternatives to traditional education exist that are not only lower in cost but superior in quality. Were even a mere dozen such schools to be established, they would form a powerful rebuke to the higher-education status quo, spurring still more reform nationwide.

Will those with the means to finance such a reform step to the plate? Only time will tell. But one thing appears certain: The traditional business model governing a large number of American colleges and universities has reached the point of utter exhaustion.

Thomas K. Lindsay directs the Center for Higher Education at the Texas Public Policy Foundation and is editor of SeeThruEdu.com. He was deputy chairman of the National Endowment for the Humanities under George W. Bush. He recently published Investigating American Democracy with Gary D. Glenn (Oxford University Press).

SCOTUS on Police Stops: Two Key Details

Robert VerBruggen - December 16, 2014

A lot of people are angry about a new Supreme Court decision holding that police do not necessarily violate the Fourth Amendment when they stop someone based on a misunderstanding of the law. In the 2009 incident that led to this case (Heien v. North Carolina), two men were stopped for having a brake light out, and consented to a search that turned up cocaine. One of the men later claimed that the stop (and thus the subsequent search) was unconstitutional because North Carolina law does not ban driving with a brake light out -- it mandates only that at least one light be working.

The decision was 8-1. Here are two details that help to clarify why it generated so much agreement.

First, it isn't clear that the cop got the law wrong, at least as it then stood. As the Court wrote (citations removed):

The North Carolina vehicle code that requires "a stop lamp" also provides that the lamp "may be incorporated into a unit with one or more other rear lamps," and that "all originally equipped rear lamps" must be "in good working order."

Second -- and relatedly -- while a state court held that only one brake light is needed, it did so as part of this case; the holding was not available to the officer as he made the stop. As implied above, this decision, from 2011, focused on the references in the law to "a stop lamp" and "the stop lamp," in the singular.

Essentially, the Court held that the officer's decision to make the stop was reasonable, as the Fourth Amendment requires for searches and seizures, given what the law in fact said at the time of the stop. The decision specifically cautions (and Justice Elena Kagan, joined by Justice Ruth Bader Ginsburg, further emphasizes in a concurrence) that cops can't use their sloppy study of a law as an excuse for a stop. The decision also notes that a valid reason for a stop is not the same as a valid reason to uphold, say, a ticket. The majority opinion may be wrong -- Justice Sonia Sotomayor dissented -- but it doesn't say quite what many think it does. 

The decision is brief and worth reading in full to those interested in this area of the law. Orin Kerr of the Volokh Conspiracy has some thoughts on the finer nuances of the case here.

Robert VerBruggen is editor of RealClearPolicy. Twitter: @RAVerBruggen

Small Businesses Drop Coverage as Health Law Offers Alternatives

Jay Hancock, Kaiser Health News - December 16, 2014

For two decades Atlanta restaurant owner Jim Dunn offered a group health plan to his managers and helped pay for it. That ended Dec. 1, after the Affordable Care Act made him an offer he couldn't refuse.

Health-law subsidies for workers to buy their own coverage combined with years of rising costs in the company plan made dropping the plan an obvious -- though not easy -- choice.

"I had a lot of regrets going into it," Dunn, who owns three Italian Oven restaurants in suburban Atlanta, said of his decision. "I don't think I have as many now -- only because I've seen the affordability factor for my managers improve."

Dunn and five managers are now covered under individual plans bought on healthcare.gov. How many other owners make the same decision will help set the future of small-business health insurance. Although the evidence so far is mixed, brokers expect more firms to follow in the next few years.

Companies like Dunn's -- those with fewer than 50 workers -- provide medical coverage to roughly 20 million people. Unlike larger employers, they have no obligation under the health law to offer a plan. Now they often have good reason not to.

If employees qualify for government subsidies, like the managers who switched from Italian Oven's corporate insurance to individual Obamacare coverage, everybody can win.

Owners don't have to pay premiums, meaning they can give workers raises, invest in equipment or add to profits instead. And employee take-home pay can rise if subsidies -- available even to families with middle-class incomes -- are worth more than what a company was contributing.

Whether to cancel a company plan and let workers buy insurance on healthcare.gov or another online exchange "is something that I would say comes up in every conversation with a small-group" employer, said Adam Berkowitz, a consultant with Caravus, a benefits firm based in St. Louis.

"I just had another [small] business call in today and say, ‘You know, we can't do it. We're packing it in,'" said Roger Howell, head of Howell Benefit Services in Wilkes-Barre, Pa.

Anthem, the largest seller of small-business health insurance, lost almost 300,000 members in such plans -- many more than expected -- in the first nine months of the year. That was 15 percent of the enrollment. Many of those consumers are presumably switching to individual plans sold through exchanges, including those offered by Anthem, officials said.

It's far from clear, however, that most companies will take the same steps as Italian Oven.

Many small employers see health coverage as an essential piece of compensation. They note that premiums in company-sponsored plans are tax-deductible -- for workers as well as employers -- while the tax advantages of individual plans are limited.

"I feel like we have to have a medical plan in order to hire people and keep them employed," said Dan Allen, head of a 15-worker engineering firm in Decatur, Ill. Allen Engineering renewed its Coventry Health Care plan for 2015 even though the premiums rose 21 percent, he said.

No other major insurer has reported cancellation of small-business plans at the same rate as Anthem.

"We didn't see that," said Rick Allegretti, vice president of marketing at Health Care Service Corp., operator of Blue Cross plans in five states including Illinois and Texas. "We actually saw our [small-group] business grow slightly -- mind you it's probably a tenth of a percent."

Businesses shifting workers into the individual exchanges tend to be the very smallest, employing a handful of people, said Skip Woody, a partner at Hill, Chesson & Woody, a North Carolina benefits firm. "Anything above 15, we haven't had any dropping coverage," he said.

Instead, many small companies are taking advantage of rules letting them maintain insurance bought before the health law took effect. President Barack Obama, who promised consumers they could keep coverage they liked, allowed carriers to extend noncompliant plans after facing fierce criticism over their imminent extinction.

Most, but not all, states approved the adjustment. Because older policies may lack features required by the health law and because their rates are often set according to employee health history, not community-wide costs, they can be less expensive than compliant plans, say brokers and consultants.

"I haven't sold one of the new plans yet" to a small employer, said John Jaggi, an Illinois broker and consultant. Faced with price increases of as much as a third or more for new plans, all 40 or so of his small-business clients including Allen Engineering renewed older coverage for 2015, he said.

Heavy renewal of old plans plus workers shifting to individual coverage help explain why the health law's online portal for new small-business plans hasattracted only modest interest, analysts say.

For some companies there is logic to ending coverage altogether.

For Italian Oven's Dunn, "it made sense to recommend that he drop coverage," said Elena Merino, CEO of the Meridian Group, a benefits firm in Alpharetta, Ga. "It hurts me. But that was the responsible thing to tell him."

Italian Oven employs the equivalent of about 30 people -- less than the 50-worker threshold that would get it fined for not sponsoring insurance. The company does not offer coverage to servers and kitchen staff, but full-time managers have always had a plan.

All are eligible for tax credits to buy insurance on healthcare.gov, said Dunn. Next year, the subsidies are available for individuals with income of up to $46,680 and families of four with income of up to $95,400.

With subsidies factored in along with unrelated pay increases, the managers "are going to be saving money out of the deal" while getting coverage comparable to what they had before, Dunn said. "My managers actually got excited about it because they're saving money on their health insurance."

Brokers expect more small businesses to make the same move, especially after the ability to extend older, noncompliant plans expires between now and the end of 2017, depending on state policy. Allen, the engineering firm executive, is concerned premiums could rise even higher next year than they did for the 2015 renewal.

"If it's up in the 25- to 30-percent increase [range] -- I've heard as high as 40 -- we'll just have to drop it," he said. "Turn everybody loose."

This piece originally appeared at Kaiser Health News, where Jay Hancock is a senior correspondent. Kaiser Health News (KHN) is a nonprofit national health policy news service. 

Philip Cohen, The Conversation - December 12, 2014

Observers may be quick to declare social trends "good" or "bad" for families, but such conclusions are rarely justified. What's good for one family -- or group of families -- may be bad for another. And within families, interests do not always align. Divorce is "bad" for a family in the sense of breaking it apart, but it may be beneficial, or even essential, for one or both partners or their children.

This kind of ambiguity makes it difficult to assess what kind of impact the recent recession and its aftermath had on families. But for researchers, at least, it offers a lot of job security -- so many questions, so much going on. In any case, here's where we stand so far.

The effect of the Great Recession on family trends in the United States has been dramatic with regard to birth rates and divorce, and has been strongly suggestive of family violence, but less clear for marriage and cohabitation.

Marriage rates declined, and cohabitation rates increased, but these trends were already underway, and the recession didn't alter them much. When trends don't change direction it's difficult to identify an effect of a shock this broad. However, with both birth rates and divorce, clear patterns emerged.


Birth Rates: A Sharp Drop
The most dramatic impact was on birth rates, which dropped precipitously, especially for young women, as a result of the economic crisis. How do we know? First, the timing of the fertility decline is very suggestive. After increasing steadily from the beginning of 2002 until late 2007, birth rates dropped sharply. (The decline has since slowed for some groups after 2010, but the US still saw record-low birth rates for teenagers and women ages 20-24 as late as 2012.)

Second, the decline in fertility was steeper in states with greater increases in unemployment. Although we don't have the data to determine which couple did or did not have a child in response to economic changes, this pattern supports the idea that financial concerns convinced some people to not have a child.

That interpretation is supported by the third trend: the fertility drop was more pronounced among younger women -- and there was no drop at all among women over 40. That may mean the fertility decline represents births postponed by families that intend to have children later -- an option older women may not have -- which fits previous research on economic shocks.

It seems likely that people who are on the fence about having a baby can be swayed by perceived financial hardship or uncertainty. From research on 27 European countries, we know that people with troubled family financial situations are more likely to say they are unsure whether they will meet their stated childbearing goals -- that is, economic uncertainty doesn't change their familial aims but may increase uncertainty in whether they will be met.

However, some births delayed inevitably become births foregone. Based on the effect of unemployment on birth rates in earlier periods, it appears a substantial number of young women who postponed births will end up never having children. By one estimate, women who were in their early 20s during the Great Recession are projected to have some 400,000 fewer lifetime births and an additional 1.5% of them will never have a birth.


Divorce Rates: A Counter-Intuitive Reaction
In the case of divorce, the pattern is counter-intuitive. Although economic hardship and insecurity adds stress to relationships and increases the risk of divorce, the overall divorce rate usually drops when unemployment rates rise.

Researchers believe that, like births, people postpone divorces during economic crises because of the costs of divorcing -- not just legal fees, but also housing transitions (which were especially difficult in the Great Recession) and employment disruptions.

My own research found that there was a sharp drop in the divorce rate in 2009 that can reasonably be attributed to the recession. But, as we suspect will be the case with births, there appears to have been a divorce-rate rebound in the years that followed.


Domestic Violence: A Spike Along With Joblessness
Family violence has become much less common since the 1990s. The reasons are not entirely clear, but they certainly include the overall drop in violent crime, improved response from social service and non-governmental organizations, and improvements in women's relative economic status. However, when the recession hit there was a spike in intimate-partner violence, coinciding with the sharp rise in men's unemployment rates (I show the trends here).

As with the other trends, it's hard to make a case based on timing alone, but the evidence is fairly strong that the economic shock increased family stress and violence. For example, one study showed that mothers were more likely to report spanking their children in the months when consumer confidence fell. Another study found a jump in abusive head trauma cases during the recession in several regions. And there have been many anecdotal and journalist accounts of increases in family violence, emerging as early as 2009. Are these direct results of the economic stress or mere correlation? It's hard to say for sure.

The ultimate impact of these trends on American families will likely take years to emerge. The recession may have affected the pattern of marriage in ways we don't yet understand -- how couples selected each other, who got married and who didn't -- and may create measurable group of marriages that are marked for future effects as yet unforeseen. Like the young adults who entered the labor market during the period of high unemployment and whose career trajectories will be forever altered unfavorably, how these families bear the scars cannot be predicted. Time will tell.


Philip Cohen is a professor of sociology at the University of Maryland. This article was originally published on The Conversation. Read the original article.

Race and Police Killings Reconsidered

Robert VerBruggen - December 11, 2014

Over the past six months there's been a lively discussion about the demographics of those killed by police -- a discussion haunted by the fact that the government's data on this topic are not particularly good. Vox provided an overview in August; ProPublica made the striking claim in October that black males in their late teens are killed at 21 times the rate of their white male peers; Slate argued that ProPublica's disparity couldn't be explained by racial differences in overall violent-crime rates (drawn from a victimization survey); I reanalyzed the FBI data and found that blacks are actually more heavily represented among homicide offenders than among those killed by police.

Now we have something of a breakthrough: The Wall Street Journal directly contacted more than 100 of the nation's largest police departments, asked for data about police killings from 2007 to 2012, and then compared these numbers with those the departments had reported to the FBI. It was no surprise that the numbers were a mess, with some agencies completely missing from the FBI numbers and others reporting far more (or even fewer) police killings to the paper than they had to the federal agency. The paper's overall tally was 45 percent higher than the FBI's for these departments.

But this exercise did uncover 28 departments that seem to have it more or less together -- where the number reported to the FBI was between 90 and 110 percent of the number provided to the WSJ. Delving deeper into these departments' FBI data, I was able to shed light on two questions: In these jurisdictions overall, are blacks shot by police more often than their involvement in homicide -- as reported by the same departments, in the same FBI report -- would predict? And how do these numbers work out for individual departments?

Because of the focus on large police departments, this analysis can't be nationally representative. But it can give us a better picture of what's going on in some of the nation's urban areas.

I looked at victims and offenders who were (A) identified as black or (B) identified as white but not also as Hispanic. (See the final paragraph for some methodological decisions I made that excluded some cases.) Bottom line: Between 2007 and 2012, these departments told the FBI they killed 1.7 blacks for every white they killed (374 vs. 220). They also reported 4.9 blacks as homicide offenders for every white reported (5,773 vs. 1,171). In other words, the racial disparity in homicide offenders is nearly three times that in police killings. This is an even bigger gap than I found when I used all the data in my earlier post (0.82:1 vs. 1.5:1, itself nearly double).

Want more numbers? Here they are, department by department. Bear in mind that each jurisdiction here has its own demographic mix, so the most fruitful comparison will be between the two black-to-white ratios for each department (one for those killed by police, one for those identified as offenders):

To be sure, this leaves a lot of room for debate. Even if there are no statistically problematic patterns, there may be bias in individual cases. And maybe homicide reports aren't the right baseline to use, especially since that approach suggests an anti-white bias on the part of police officers, which seems unlikely given how white police departments tend to be. Perhaps there's bias in the reporting process, or perhaps homicide offenders are not representative of the people who get into lethal confrontations with police officers. But at the very least, the introduction of homicide data reveals a whole new way of looking at the numbers.

You can download the FBI's Supplementary Homicide Reports here, a spreadsheet I made of numbers from the Wall Street Journal report here, and the R code I used to generate the statistics in this post here. Please e-mail or tweet me if you have questions, suggestions, or comments.

Finally, here's a technical note to explain some decisions I made and some differences between my analysis and the WSJ's. The WSJ excluded some years for some departments from its data, so I did too. If a victim or offender's race was marked as white but the ethnicity (Hispanic/non-Hispanic) wasn't listed, I counted the person as white. The Riverside and Los Angeles county sheriff's departments also report for "contract cities" they're responsible for; the WSJ went through the trouble of sorting out the quirks of these arrangements and including all the jurisdictions, but for the sake of simplicity I kept my numbers to the core departments. Also for the sake of simplicity, I kept my analysis to the victims and offenders listed first in each incident report, as I did in my previous post, whereas the WSJ hunted down the secondary victims lurking here and there in the data. A big thanks to Rob Barry, the lead author of the WSJ piece, for helping me sort out many of the details above.

Robert VerBruggen is editor of RealClearPolicy. Twitter: @RAVerBruggen

With 1.5 Million Sign-Ups So Far, Obamacare Enrollment Is Brisk

Phil Galewitz, Kaiser Health News - December 11, 2014

With less than a week until the deadline to buy individual health insurance that begins Jan. 1, experts say sign-ups are on course to hit or exceed the Obama administration's projection of about 9 million enrollees in 2015.

Several weeks into the second year of the Affordable Care Act's insurance exchanges, about 1.5 million people have enrolled in coverage, according to data from state and federal exchanges.

As of Dec. 5, almost 1.4 million had enrolled through the federal insurance exchange, which serves 37 states, the Centers for Medicare & Medicaid Services reported Wednesday. Another 183,000 chose plans through state exchanges, including nearly 49,000 in California, according to a Kaiser Health News analysis of state exchange data. Enrollment figures were not available for exchanges in New York, Idaho and Rhode Island.

"Exchange enrollment is far ahead of 2014's pace due to improved technology performance," said Caroline Pearson, vice president of Avalere Health, a consulting firm.

She said sign-ups are on track to "far exceed" the Obama administration's 9 million projection, made just before open enrollment began in November. If enrollment continues at this pace, she said, the federal and state exchanges should enroll between 4 and 5 million new participants, she said. That’s in addition to 6.7 million who got coverage for 2014, many of whom are expected to re-enroll for 2015.

Enrollment in 2014 plans reached nearly 7 million despite the disastrous rollout of the federal and several state exchanges, which made it difficult if not impossible to sign up in the early months.

Sign-ups for 2015 began Nov. 15 and continue through Feb. 15. However, those who want coverage in January must enroll by Monday.

Some Republicans have argued that enrollment would suffer in the law's second year because people would be unhappy with their coverage and prices would skyrocket. So far, that does not appear to be happening.

Several state insurance exchanges reporting data appear to be ahead of where they were several weeks into open enrollment last year, including Massachusetts, Maryland and Vermont.

It is not known how many of the enrollees in some state exchanges are new to the market. But on the federal exchange about 48 percent of the people selecting plans are new, while 52 percent had coverage in the marketplace this year, according to CMS.

California officials said it was too early to tell how many of the 1.1 million current enrollees have returned for 2015. In most states, consumers will be automatically re-enrolled in the same plan or one like it if they have not selected a plan by Dec. 15. They can switch before Feb. 15.

"The pace of enrollment is very strong," Peter Lee, executive director of Covered California, told reporters Wednesday. The state is already on its way to meeting its goal of 750,000 new enrollees this year, Lee said.

He said he expected the momentum to continue, with more than 40 enrollment events planned through Dec. 15.

On the federal exchange, tens of thousands of people have started accounts but not yet selected a plan.

Charles Gaba, a blogger based in Bloomfield Hills, Mich. who accurately forecast 2014 enrollment, predicts that about 12 million Americans will enroll in exchange coverage in 2015.

The Congressional Budget Office had predicted about 13 million sign-ups for 2015, but in November, administration officials estimated about 9 million, in part because fewer employers than expected were dropping coverage and sending their workers to the exchanges. That includes those who re-enroll in coverage as well as new sign-ups.

Similar to last year, the biggest surge in enrollment is expected immediately before the Dec. 15 deadline to have coverage by Jan. 1 and then, right before Feb. 15, which is the final deadline to have coverage in 2015, Gaba said.

Dan Schuyler, senior director of exchange technology at consulting firm Leavitt Partners, said state exchanges are performing much better than they did last year, though there have been minor glitches.

Two state exchanges -- Nevada and Oregon, switched to the federal healthcare.gov portal after abandoning their own failed software. Maryland, meanwhile, took software from the Connecticut exchange.

"It seems like state exchanges have turned the corner this year," Schuyler said.

Jon Kingsdale, who oversaw the Massachusetts health insurance exchange from 2006 to 2010 and is a managing director of the Wakely Consulting Group, said customer call centers are also working better with better-trained staff.

One big challenge facing the exchanges, he said, is how well they "hand off" enrollments to health plans which was a problem in some states last year.

The exchanges also have to make sure automatic re-enrollment works later this month, Schuyler said. Many consumers who are automatically re-enrolled may be shocked to learn their plans have raised rates or changed their benefits, he said.

State and federal officials also have to keep reaching out to consumers. California's insurance exchange has partnered with hospitals and medical groups to get the word out about the availability of coverage. The agency also stepped up advertisements, including a bilingual campaign featuring people who enrolled last year.

There has also been strong interest in Medi-Cal -- California's version of Medicaid, the state-federal program for low-income people. About 160,000 have applied and three-quarters were enrolled immediately, while the others are still going through the process, said Toby Douglas, director of the state's Department of Health Care Services. "It is clear that Californians' desire for health coverage remains really strong," he said.

This piece originally appeared at Kaiser Health News, where Phil Galewitz is a senior correspondent. Anna Gorman and Lisa Gillespie contributed to this story. Kaiser Health News (KHN) is a nonprofit national health policy news service.  

Tax Reform: Consumption and Carbon

Mark Mackie & John Campbell - December 10, 2014

Incoming congressional leaders have placed reform of "the insanely complex [income] tax code" at the top of their to-do list, but the only thing more complex than this code may be its reform. Here's a proposal that reaches far beyond anything under consideration on the Hill -- and could be easier to enact.

The grand bargain: Junking virtually the entire personal and corporate tax regime, Congress embraces a consumption tax coupled with a carbon/methane tax -- via constitutional amendment. The new federal tax system would consist of a VAT or retail consumption tax set at about 10 to 20 percent of the value of all goods and services sold in the U.S., with a carbon/methane tax add-on of perhaps 2 to 10 percent. If the plan fell short of replacing current revenues, income above a given amount would be taxed at a flat rate of 3 to 15 percent to make up the difference.

In exchange for applying the carbon and consumption brakes favored by the Left, the Right would get a constitutional amendment that would keep Congress from inflating the rates set by the original bill. States would have to ratify (a) a repeal of the 16th Amendment (income tax) and (b) a cap on consumption-tax rates at the percentages specified by Congress. Emergency assessments could breach the rate caps by supermajority congressional votes and would automatically lapse, say in six months, unless supermajorities subsequently voted to continue them.

A spillover flat tax, if needed, would apply only over a congressionally specified level of income, e.g. $70,000, with no other deductions. For those squeamish about enshrining a tax regime in the Constitution, note that federal tax law and rules now exceed 50,000 pages; our bet is that the country has had its belly full of such tripe and would gladly chuck it for perhaps ten paragraphs in the Constitution.

Goody Bag For the Left: You'd get a tax system that penalized consumption with an overlay of carbon taxes in a mixture you helped craft (because constitutional amendments require congressional supermajorities). Widespread replacement of carbon fuel by renewables would be assured. Not only would the new regime drive carbon and methane emissions radically down in the U.S., but a move toward what economists call Pigovian taxes (i.e., penalizing harmful activities) could help us lead the way to worldwide pollution reductions. President Obama's newly minted commitment in China could easily be met without singling out coal. At home, you would have a seat at the table to set the progressivity of exemptions for low-income citizens from the consumption taxes (certainly essential groceries, some housing, and fuel) and rebates for low-income individuals that could approximate or exceed the Earned Income Tax Credit.

Goody Bag For the Right: You don't have to accept a single conclusion of the U.N.'s Intergovernmental Panel on Climate Change for this deal to make sense to you; in terms of efficiency and enhancing investment, limited consumption taxes beat unconstrained income taxes on almost every front and have a weighty conservative pedigree (e.g., President Reagan pushed use taxes). Carbon taxes that are revenue-neutral get good reviews too: See G. Mankiw and A. Laffer. A bonus: The IRS Ring Wraiths will be thrown from their steeds, crippling their ability to harass the free speech of ordinary Americans. Double bonus: Wildcatters may howl, but these taxes will defund and defang Mideast satraps and Russian belligerents faster than any conceivable near-term American policy.

By sending this amendment to the states for ratification, every Senate and House member in these debates would be going big, setting before statehouses the chance to deliberate climate change and the abolition of the IRS at the same time.

We wonder how that will go.

Mark Mackie is former chief counsel for the U.S. Senate Committee on Rules and Administration and practices law in the Dallas/Fort Worth area. John Campbell is also a former congressional staffer and was a deputy undersecretary of agriculture for George H.W. Bush; he is now an investment banker for agricultural concerns in Omaha, Neb.

Jay Hancock, Kaiser Health News - December 9, 2014

Two years ago General Dynamics, one of the biggest federal contractors, reported a quarterly loss of $2 billion. An "eye-watering" result, one analyst called it.

Diminishing wars and plunging defense spending had slashed the weapons maker's revenue and left some subsidiaries worth far less than it had paid for them. But the company was already pushing in a new direction.

Soon after Congress passed the landmark Affordable Care Act, the maker of submarines and tanks decided to expand its business related to health care. Its 2011 purchase of health-data firm Vangent instantly made it the largest contractor to Medicare and Medicaid, huge government health plans for seniors and the poor.

"They saw that their legacy defense market was going to be taking a hit," said Sebastian Lagana, an analyst with Technology Business Research, a market research firm. "And they knew [the ACA] was going to inject funds into the health care market."

They were right. In a way that is deeply changing Washington contracting, growth opportunities from the federal government have increasingly come not from war but from healing, an examination by Kaiser Health News and The Washington Post shows.

Politics are frozen. Budgets are tight. But business purchases by the Department of Health and Human Services have doubled to $21 billion annually in the last decade and are expected to continue rising.

HHS is now the No. 3 contracting agency, thanks to health-law spending combined with outlays for computer upgrades and Medicare's drug program that grew during the administration of George W. Bush. HHS outranks NASA and the Department of Homeland Security in business deals and spends more than the departments of Justice, Transportation, Treasury and Agriculture combined, federal data show.

If health care is "the new oil," as some investors hope, HHS is one of the richest fields -- along with massive opportunities in health-related computer spending by the departments of Defense, Veterans Affairs and Treasury.

"The DOD market is very weak," said Steve Kelman, a Harvard management professor and contracting specialist. "The two growth markets are cybersecurity and health care. So everybody's trying to get into those."

The new money is buying medical-record software, insurance websites, claims processing, data analysis, computer system overhauls, consumer education and consulting expertise to control costs and identify fraud.

True, it's a fraction of the $200 billion-plus the Pentagon spent on planes, bombs and other purchases in fiscal 2014. But thanks largely to automatic cuts set in 2011, defense contracting has dipped by more than a third since 2008 despite continuing conflict in Afghanistan and the Middle East.


Few expect that to happen to health contracting -- even with limited budgets and Republicans opposed to the health law controlling both sides of Congress. Analysts expect the Ebola crisis to add billions more to an HHS budget that was already expected to grow.

"It's going to be really hard to find more money," said Stephen Fuller, an economist at George Mason University who follows federal spending closely. "But I would think HHS is in a position to sustain their funding levels and gain some as well where other agencies are going to find it more difficult just to keep what they have."

HHS' contracting budget is separate from the billions the agency pays in reimbursement to caregivers of Medicare patients; its grants to states for Medicaid; and its awards through the National Institutes of Health to clinical research institutions such as the Johns Hopkins University.

Traditionally HHS vendors processed Medicare claims, made vaccines and managed information technology. HHS spending had already spiked in 2009, before the health law was passed, thanks to extraordinary purchases of H1N1 flu vaccines. But the ambitious ACA, intended to expand health coverage, overhaul payments and reengineer care -- and with ample budgets to attempt all three -- changed the game.

"Just because of the Affordable Care Act our health care business has probably doubled in the last five years," said Nelson Ford, CEO of LMI Government Consulting, which helps HHS analyze and regulate the new, private insurance plans sold under the law.

The law effectively created major companies from scratch as well as growing new divisions at established businesses.

"It just occurred to me: If this bill does become law it will be a level playing field [for contractors] and we'll have a head start," said Sanjay Singh, who founded Reston-based hCentive based on the Affordable Care Act's promise. "And we can build a company."

Today hCentive employs more than 650 people. The company built the federal government's online marketplace for small-business health plans and is working on insurance portals for Massachusetts, New York, Colorado and Kentucky.

Business at HighPoint Global, with offices in Virginia, Maryland and Indiana, ballooned from a few million to more than $100 million annually after it landed the job of training and quality control for dozens of call centers handling questions about the insurance marketplaces, federal data show. HighPoint CEO Ben Lanius declined a request for an interview.

For contractors, profiting from the health law goes far beyond the $840 million-plus HHS has already spent on the troubled healthcare.gov portal. (This year the agency fired CGI Federal, the site's primary contractor, and replaced it with Accenture. HHS contracted with CGI for work worth $339 million the last two years; with Accenture, $192 million in contracts, records show.)

Defense giant Serco has done more than $400 million worth of business with HHS in the past two years, records show, much of it for collecting paper insurance applications that surged when the online marketplaces failed.

HHS' innovation lab, with a $10 billion budget over a decade, is hiring research firms such as Mathematica to test alternatives to traditional, "fee for service" medicine that encourages unnecessary procedures. The ACA also furnished an extra $350 million to hire cyber sleuths to fight Medicare fraud.

A related law, the HITECH Act of 2009, steered another $30 billion via Medicare reimbursements to spur hospitals and doctors to buy medical-record software from private industry.

For traditional defense contractors, health care isn't the new oil. It's the new F-35 fighter or Zumwalt-class destroyer.

"This is a pretty exciting time to be in the federal health IT space," said Horace Blackman, Lockheed Martin's vice president of health and life sciences. "The biggest opportunities I would point to are efforts associated with the Affordable Care Act."

While Lockheed has run HHS computers for a long time, its business with the agency has increased by more than half since 2006 to $300 million annually, according to federal records.

The company won part of a $15 billion data management contract from the Centers for Medicare and Medicaid Services in 2012, along with Accenture, CGI Federal and others. It's bidding with many others on another giant health job -- an $11 billion Pentagon contract to modernize the military's computer medical records.

Defense vendors are recycling products from battlefield to bedside. Lockheed says it converted missile-defense software into a hospital tool for the early identification of sepsis, a life-threatening response by the body to infection.

"We're seeing a lot of these companies quietly repositioning and reusing their legacy capabilities," said John Caucis, a senior analyst with Technology Business Research.

Along with cybersecurity smarts, Washington employers especially prize health analytics skills, recruiters say.

"We have 200 epidemiologists. We have clinical statisticians. We have physicians. We have nurses," said Amy Caro, head of the health division at Northrop Grumman, better known for its B-2 stealth bomber.

Among other HHS work, Northrop manages data sharing for the National Institutes of Health; helped launch the health law's accountable care organizations to control costs and improve care; and turned telecommunications software into a Medicare fraud detector.

The quickest way to acquire a particular expertise needed by HHS, some contractors have found, is often to mimic General Dynamics and buy somebody already doing the work.


In October Xerox said it acquired Consilience Software, maker of patient case-management and disease-surveillance programs for government agencies. The same month defense and intelligence giant Booz Allen Hamilton said it bought the health division of Genova Technologies, a tech company that has done $90 million in HHS business since the health law was passed, according to federal records.

The deal is part of a larger push by Booz, majority owned by the Carlyle Group, a private equity firm, to sell technology services and consulting to HHS.

Its yearly business with the agency has quadrupled in the last decade to $170 million even as its overall revenue from the federal government has shrunk, according to contracting data. (However, the extent of Booz's government work is unclear because its jobs for spy agencies don't show up in official records, contracting specialists say.)

This summer Booz won part of a huge (potentially $7 billion) job to help HHS' innovation lab design, run and evaluate tests to improve care results and control costs. Other awardees include RTI International, a nonprofit; Deloitte, a consulting firm; the Lewin Group, a consultancy owned by insurer UnitedHealth Group; and Truven Health Analytics, a research shop owned by private equity investors Veritas Capital.

Booz officials did not respond to repeated requests for interviews.

Health-care acquisitions by defense contractors don't always work smoothly. In 2011 General Dynamics paid Veritas nearly $1 billion for Vangent, a seller of health information technology and business services.

General Dynamics did not make executives available for interviews. But the deal did not go as well as the company hoped, as Vangent's corporate culture clashed with that of the buyer, said Technology Business Research's Lagana. Part of General Dynamics' $2 billion quarterly loss at the end of 2012 was -- ironically -- related not to defense but to Vangent and its health-care work, he said.

But thanks to Vangent, the company got the task of staffing call centers to explain healthcare.gov to consumers. That job became bigger than anybody imagined when the site crashed during insurance enrollment a year ago. General Dynamics ended up hiring 8,000, mostly temporary workers to run hotlines for Obamacare as well as Medicare.

This year healthcare.gov is working better, by many accounts. Enrollment began Nov. 15. Again General Dynamics has been hiring to answer the phones. The company's $815 million in spending commitments from HHS made it the agency's top contractor for fiscal 2014, not counting vaccine makers.

And because its call-center jobs are "cost-plus" contracts, every hire comes with a built-in profit.

This piece originally appeared at Kaiser Health News, where Jay Hancock is a senior correspondent, and also ran in the Washington Post. Kaiser Health News (KHN) is a nonprofit national health policy news service. 

Big Changes in Fine Print of Some 2015 ACA Plans

Charles Ornstein, Lena Groeger & Ryann Grochowski Jones, ProPublica - December 9, 2014

At first glance, the 2015 health plans offered by the Ohio nonprofit insurer CareSource look a lot like the ones it sold this year, in the Affordable Care Act's first enrollment season.

The monthly premiums are nearly identical, and the deductibles are the same.

But tucked within the plans' jargon are changes that could markedly affect how much consumers pay for health care. Generic drugs will soon be free, but the cost of expensive specialty medications will increase. Co-payments for visits to primary-care doctors will go down, but those for emergency room trips will be higher.

Millions of people nationwide bought health insurance this year through the federal government's health insurance exchange, often through the website Healthcare.gov. Now, as they pick plans for next year, they face a complex battery of choices and changes.

They have until Dec. 15 to select a new plan or they'll be re-enrolled automatically in the one they currently have. Or, if that plan no longer exists, they'll be enrolled in another product offered by the same insurer, when available. But even if they get the same plan — of the nearly 2,800 health plans offered in 2014, about 1,700 of them will exist in the same form next year — their benefits may not stay the same.

"You're getting re-enrolled in the same carrier, but there's basically no guarantees that your product looks anywhere near the same as it did last year," said Caroline Pearson, vice president of Avalere Health, a consulting firm.

Much attention has focused on changes to plans' monthly premiums, but changes to other kinds of benefits — affecting the cost of things like doctors' visits and prescriptions — can be trickier to understand and make a huge difference in annual health care costs.

A ProPublica analysis of the 2014 and 2015 plans in 34 states being offered on the exchange shows the adjustments taking place. ProPublica has created a tool that allows users to see, quickly and easily, some significant ways the plans have changed from one year to the next.

Customers of more than 900 plans will see their out-of-pocket maximum for medical bills increase, usually to $6,600 for individuals, the most allowed by law for next year. Only about 250 plans are lowering their out-of-pocket maximums. About 180 plans are being discontinued for at least some customers, and the rest are keeping the same limits.

Members of more than 600 plans will see their medical deductibles increase, while those in about 380 will see their deductibles drop. Consumers of one Illinois plan will see their deductible increase by $4,800. Those re-enrolled in plans offered by Florida Blue face deductibles as much as $3,650 higher than those this year, while other customers of the same company will see deductibles decrease by up to $3,000. Florida Blue did not respond to a request for comment.

More than a quarter of the 2,800 health plans altered the costs of specialty medications for conditions like multiple sclerosis and AIDS, mostly increasing the patients' share.

Some policy changes appear subtle, just a matter of adding or subtracting a few words, but are actually quite significant. This year, many insurers charged members a set fee of a few hundred dollars for emergency room visits. For next year, some of those plans changed the wording of their benefit, adding "co-pay after deductible." That means the insurers won't pay for any portion of an emergency room visit until consumers meet their deductible, spending thousands of dollars.

"Everyone has focused on premiums in the press because premiums are at least easy to understand," Pearson said. People have a harder time detecting the effect of changes to what's called a plan's benefit design. "It's just incredibly hard to do, but I think it's really important."

What ProPublica's analysis suggests is that even those who would be willing to pay higher premiums to keep their current plan may be surprised to learn that substantial details have changed. They should go back to Heatlhcare.gov or to ProPublica's news app to make sure their plan is still the best choice.

Shopping around is essential — and there's little time to delay.

The open enrollment period continues until Feb. 15, and customers who are automatically renewed in their plans can still make changes until that time, but only changes made by Dec. 15 will take effect on Jan. 1.

The Health and Human Services secretary, Sylvia Burwell, has been encouraging consumers to take an active role in the renewal process. But in the first two weeks of open enrollment, fewer than 400,000 consumers actively re-enrolled. "The first deadline is just a couple of weeks away," she said in a news release on Wednesday. "We're encouraging everyone who is already covered through the marketplace to come back and shop because there could be savings."

Everyone's health care needs are different. Some people might do best with a plan that has a higher premium and lower out-of-pocket costs for particular services; others might save money by choosing a plan with a lower premium and higher co-payments.

Those earning less than four times the federal poverty rate ($62,920 for a couple) qualify for subsidies to pay their premiums, and those earning even less may qualify for additional help to lower their out-of-pocket costs once enrolled.

Changes to insurance benefits are hardly exclusive to the Affordable Care Act marketplaces. They happen regularly in health plans offered by employers.

Under the law, insurers are somewhat limited in how they can change their plans. Products are grouped by tiers: Bronze plans cover about 60 percent of their members' overall health services; silver plans 70 percent; gold plans 80 percent. To stay at those levels from year to year, plans can't just increase all of their charges. If they charge more for some things, that often means charging less for others.

That's what happened at CareSource, the Ohio nonprofit. Officials there said they changed their benefits based on comments from members and conversations with others who are uninsured. "Many didn't understand the value of health insurance," said Scott Streator, vice president of Enterprise Strategy at CareSource. "Therefore, we changed our plan design to make it more simple, more understandable and more preventive, focused on everyday types of health care needs."

That translated into free generic drugs and lower co-pays for physician office visits, Streator said. "If you make these changes, there's trade-offs," he said. "The costs go up somewhere else." In contrast with this year, when members pay $250 for emergency room visits, they will need to meet the plan's deductible next year before their E.R. visits are covered with a co-payment that varies from $250 to $500. And members will now pay 40 percent of the cost of specialty medications, up from 25 percent this year.

CareSource enrolled more than 30,000 people during the 2014 open enrollment cycle and expects to double that amount this time around, Streator said.

Another insurer whose products are changing is Coventry Health Care. One Coventry silver plan in the Kansas City, Kan., region is decreasing the costs of primary care visits to $5 from $10, but is increasing its medical deductible to $2,750 from $2,000, increasing its out-of-pocket maximum to $6,600 from $6,350, and increasing the cost of generic drugs to $15 from $10, among other changes. Premiums are also going up.

A spokesman said the company tries to balance its benefits and costs.

Vantage Health Plan, based in Louisiana, is increasing the medical deductible in its silver plan to $2,900 from $1,800 and is raising its maximum out-of-pocket costs, too. But the company said most of its members won't feel the changes much. That's because about 85 percent of the 8,400 members who enrolled in the last cycle received government subsidies.

Although those without subsidies "are going to get hit, all that was designed so that all those who are getting the subsidy, their blow would be softened because that's where the majority of our business falls," said Billy Justice, Vantage's director of marketing and sales.

Vantage hopes to double its enrollment for next year.

The data analyzed by ProPublica does not include information for states that run their own insurance exchanges, including California and New York. In California, plans are required to offer a standard benefit design, which allows consumers to compare plans more easily. Insurers compete on their brand's reputation, premiums and on the size of their doctor and hospital networks.

"There can be a big difference in the experience of the consumer in terms of what they pay out of pocket if you don't have standardized benefits," said Anthony Wright, executive director of the consumer advocacy group Health Access in California.

The government's plan to automatically re-enroll consumers for 2015 has come under criticism, with some warning that consumers who don't make a choice themselves could end up in a plan with higher costs. As a result, the government is considering a different system for 2017 in which consumers who don't pick their own plan could be shifted to the lowest-cost plan in the market.

This piece originally appeared at ProPublica and was co-published with The New York Times' The UpshotHas your insurance company changed your benefits this year? ProPublica would like to hear about it. Email Charles.ornstein@propublica.org.

Juvenile Life Without Parole, Our Serial Offense

Clio Chang - December 9, 2014

One million listeners of the hit nonfiction podcast Serial have been obsessing over one question -- who killed Hae Min Lee? For the few of you left who aren't in the loop, Serial centers around the 1999 murder of Lee, a Baltimore high-school student, and the subsequent conviction of Adnan Syed, her 17-year-old ex-boyfriend.

Adnan, a minor, was tried as an adult and sentenced to life plus 30 years in prison.

Juvenile life without parole (JLWOP) sentencing is a topic that the podcast, thus far, has barely touched upon. Technically, Adnan has a chance of parole, but the odds of his actually getting it are slim to none. Although Sarah Koenig, the producer of Serial, refers to Adnan as a "teenager in America doing American teenage things," the court refers to him as a "man" who committed a premeditated murder.

It's an essential distinction that Koenig neglects, and in doing so, she ignores an important aspect of Adnan's experience in the justice system.


Living as a Child, Tried as an Adult
Despite the immense popularity of the podcast, Adnan's story is far from exceptional. In fact, he is one of approximately 2,500 individuals convicted as juveniles who are today serving life without parole in America, the only industrialized country that gives such a sentence to those under 18 years of age.

Children as young as 13 in the United States have been tried as adults and sentenced to life in prison. To put this in perspective, that's the age in which students in school are typically learning about the Earth's layers and how to classify triangles.

In 2012, the Supreme Court ruled in Miller v. Alabama that juveniles convicted of murder could not automatically receive life sentences without parole and that judges must be allowed to take a juvenile's age into account when deciding on the appropriate punishment. However, the question of retroactivity -- of whether the decision applies to prisoners who were sentenced before the ruling -- has thus far been left to the states.

Only four states have passed legislation allowing for resentencing among the current JLWOP population, and only six state courts have ruled that Miller applies retroactively, while three have ruled the other way, leaving thousands of prisoners to serve out sentences that have been determined cruel and unusual punishment by the nation's highest court.

While Maryland has since convened a Task Force on Juvenile Court Jurisdiction, it hasn't changed its laws, and it still lists life imprisonment as a possible sentence for someone as young as 14 years of age who commits first-degree murder. And the state's courts have not even addressed the retroactivity of Miller, so Adnan currently has little hope of re-sentencing.


Punishing Bad Luck
Perhaps the only exceptional element in Adnan's story is that he grew up in a healthy and supportive middle-class family.

Whereas Adnan's trial filled the courtroom with family and friends, most JLWOP prisoners are not so lucky. A third of them grew up in public housing, half were physically abused, and four out of five witnessed violence in their homes.

Evan Miller, the respondent in the Supreme Court case, suffered so much abuse throughout his life that he attempted suicide four times -- the first time was when he was 6 years old -- before he received his JLWOP sentencing at the age of 14. He did not choose his childhood; it was simply his misfortune to be born into it.

This is not be belittle Miller's crime -- he and his older accomplice were convicted of brutally murdering their victim. But capping short, nasty childhoods with a lifetime in prison seems like a cruel justice, especially when stories like Miller's, not Adnan's, are the norm when it comes to juvenile criminals.


Race Matters
The latest Serial episode questions whether racial stereotyping of Adnan's Muslim heritage contributed to his conviction (but, strangely, not his harsh sentence).

While Koenig does not squarely pin the blame on anti-Muslim sentiment, the truth is that racial disparities plague the justice system all the time, with juvenile minorities receiving an outsized portion of heavy sentences.

Black youths represent 17 percent of the overall youth population, but make up 30 percent of those arrested, and are 62 percent of those tried as adults. And while there are four times as many black minors arrested for killing a white victim than white minors arrested for killing a black victim, 12 times more black minors receive a life sentence without parole for killing whites than vice versa.

While sentencing any child to life imprisonment is cruel (it's actually considered inhumane by U.N. standards), allowing unjust racial disparities to persist when sentencing child offenders is only doubling down on this cruelty.

As Ta-Nehisi Coates states in The Atlantic, when looking at racial disparities in the way our society enforces the law and dispenses justice, it's important to remember that these cases begin not with individual deaths, but with existing government policies at every level, including juvenile sentencing.

So when we fight to eliminate disparities in our justice system, it is important to remember that we need to extend that battle to reach America's incarcerated children.


So What Now?
In January 2013, California set the bar for compassion by passing the Fair Sentencing for Youth Act, which allowed JLWOP prisoners to ask for a new sentencing hearing, thus giving them the chance of parole.

Research has shown that children have a large capacity for reform, or as the American Psychological Association terms it, "greater changeability." Locking juveniles up for life and trying them as adults ignores this fact. Additionally, JLWOP is incredibly expensive for taxpayers -- the annual cost of incarceration per inmate is approximately $31,000, which amounts to almost $2 million over an average lifetime.

Other states should not only eliminate JLWOP from their court systems, but also follow California's example and apply retroactivity to current JLWOP prisoners.

As for you Serial fans, you should be obsessed not only over who killed Hae Min Lee, but also over why there are still children being condemned to life in prison.


Clio Chang
is a policy associate at the Century Foundation.

Putting the People Back in Policy and Practice

Molly M. Scott - December 8, 2014

Poverty is a seemingly intractable problem. Policymakers, practitioners, and researchers have been looking for solutions for decades now without a whole lot of success. It seems like we need some more help from the real experts -- the people who live in poverty.

Common sense, definitely. Common practice, not quite yet.

Much of our social service structure functions on submerged assumptions about the poor that have little or no mooring in actual client experience.

The CEO of a large food bank offered a great example of this at a recent conference. For years, his food bank had established rules for how many times a month clients could come for food. But, challenged by a new Feeding America initiative to put clients at the center of efforts to end hunger, he woke up one morning and realized, "Wow -- we never even asked any of the clients how long food lasted or how frequently they needed to come! How can we ever hope for our programs to alleviate hunger if we don't understand something that basic?"

The gold standard for understanding client perspectives generally relies on formal methodologies like surveys, administrative data analyses, focus groups, and key informant interviews, which can be tremendously effective ways to make sure diverse voices are heard.

The trouble is that, absent a large grant or contract, most nonprofits and local governments simply don't have the money to contract out this formal data collection to professionals with the kind of frequency or duration needed to really make a difference.

In light of these limitations, many organizations revert to informal methods and rely on staff to gather information about client experiences through everyday interactions. Unfortunately, this approach usually doesn't work very well for a number of reasons.

Clients who depend on staff to get their most basic needs met often don't feel safe or comfortable giving them direct feedback. Staff, wary of how they might be perceived by management, have little incentive to report negative or mixed reviews. Taking on the responsibility of data gathering on top of other core responsibilities can also be a substantial burden. And many of the staff who directly serve clients just don't have the sufficient training or expertise to be effective in this role.

In addition, both the formal and informal methods described here are mostly one-sided efforts. To genuinely learn from and collaborate with the people served by our poverty programs, we all need to think more about how to sustain a meaningful, ongoing, multidirectional dialogue.

For all these reasons, we need new, rigorous, low-cost, and respectful ways of creating feedback loops that will make our programs and systems more effective and ultimately improve the lives of people in poverty.

To this end, the Fund for Shared Insight, a new collaborative of multiple foundations, recently issued its first grants to practitioners, researchers, and foundations -- among them the Urban Institute and its partner Feeding America -- to pilot, test, and scale innovative ways to learn from low-income people, adapt our approaches to problems, and share back with clients how their insights make a difference.

These grants won't magically transform all our systems and programs. But they may be an important step toward creating a transformative culture that puts people at the center of policy and practice.

It's worth a try.

Molly M. Scott is a senior research associate in the Urban Institute's Metropolitan Housing and Communities Policy Center.

Social Programs That Work

Ron Haskins, Brookings Institution - December 4, 2014

As I argue in my new book, Show Me the Evidence (co-authored with Greg Margolis), the last six years have seen the most impressive expansion of evidence-based policy in the history of federal social programs. The Obama administration has launched a series of evidence-based initiatives that have the potential to revolutionize the way the federal government funds social programs and what program sponsors at the state and local level must do to win and retain federal dollars. Specifically, grantees must show they are spending their federal dollars on programs that have evidence from rigorous evaluations of producing positive impacts on children's development or achievement as measured by outcomes such as teen pregnancy, educational achievement or graduation rates, performance at community colleges, employment and earnings as young adults, or reducing rates of incarceration. Second, they must evaluate their programs using scientific designs to ensure that they are continuing to have impacts and to reform the programs if they are not.

This strategy requires a pipeline of social programs that have been tested and shown to be effective by rigorous evaluations. However, experience shows that most social programs, including some of the most celebrated such as DARE and Head Start, produce modest or no impacts that last when subjected to rigorous evaluations. An important virtue of focusing on evidence is not simply that the public will have reliable information about whether programs work, but that the evidence places pressure on programs to change and improve when they are not working.

In addition to improving existing programs, government and foundation research dollars are being used to develop and obtain evidence on new programs, some of which have been found to produce significant benefits for children or adolescents by rigorous evaluations. The most important claim of the Obama evidence-based initiatives is that if government spends its intervention dollars on programs shown by rigorous evaluations to work while simultaneously using rigorous evaluations to improve existing programs and develop new programs that work, in the long run federal spending on social programs can produce more benefits for more children and move the needle on the nation's most important social programs.

But do we really have examples of social programs that produce these hefty impacts on social problems? The answer is a resounding yes. What follows are overviews of five of my favorite programs, all of which have produced big and lasting impacts on social problems (most of the overviews were adapted from the website of the Coalition for Evidence-Based Policy; the summary of the Small Schools of Choice program was taken from the website of MDRC, a prominent program evaluation firm):


Career Academies
Career Academies are high school education programs that have three distinguishing characteristics:

• They are organized as small learning communities (150 to 200 students) to create a more supportive, personalized learning environment;

• They combine academic with career and technical curricula around a career theme; and

• They establish partnerships with local employers to provide career awareness and work-based learning opportunities for students.

Each Academy typically focuses on a specific field (e.g., health care). Students enter a Career Academy in 9th or 10th grade, and are taught by a single team of teachers through grade 12. The most powerful evidence of the impact of Career Academies is provided by a large, multi-site, randomized controlled trial. The trial evaluated nine Career Academies in high schools located in or near large urban school districts across the United States. These Academies had each implemented and sustained the core features of the Academy model for at least two years. They represented a variety of the career themes that Academies typically offer (e.g., technical, service-oriented, or business-related). The effects summarized here were obtained 8 years after the students’ scheduled high school graduation:

• 11% increase in average annual earnings -- i.e., $2,460 per year -- over the previous eight years ($24,560 in annual earnings for the Career Academy group versus $22,100 for the control group).

• The earnings effect was sustained over the full eight years, and showed no sign of diminishing.

• The earnings effect was concentrated among men, who experienced a 17% increase in annual earnings over the follow-up period. There was no statistically significant effect on women's earnings.

• 23% increase in the likelihood of living with a child and partner.

• 35% decrease in the likelihood of being a non-custodial parent (5% for the Career Academy group versus 8% for the control group).

• The approximate 3-year cost of $2,300 per student was at least partly (and perhaps fully) offset by the increased tax revenue resulting from the gain in earnings of Career Academy students and perhaps by reduced use of social programs as well.


Nurse-Family Partnership
The Nurse-Family Partnership (NFP) program provides nurse home visits to pregnant women with no previous live births, most of whom are low-income, unmarried, and teenagers. The nurses visit the mothers approximately once per month during pregnancy and the first two years of their children's lives. The nurses teach positive health related behaviors, competent care of children, and maternal personal development (family planning, educational achievement, and participation in the workforce). The program costs approximately $13,600 per woman over the three years of visits.

The evidence supporting NFP is contained in three randomized controlled trials (RCTs) of the program (see herehere, and here). The three trials -- each carried out in a different population and setting -- all found the program to produce sizable, sustained effects on important mother and child outcomes. The replications of the NFP intervention program in multiple sites (in New York, Tennessee, and Denver) provide confidence that the program would be effective if faithfully replicated with other, similar populations and settings. However, the specific types of effects often differed across the three studies. The specific effects that were replicated, with no countervailing findings, in two or more of the trials -- and thus are the most likely to be reproducible in a program replication -- are:

• reduction in measures of child abuse and neglect (including injuries and accidents);

• reduction in the number of subsequent births during the mothers' late teens and early twenties;

• reduction in prenatal smoking among mothers who smoked at the start of the study; and

• improvement in cognitive and/or academic outcomes for children born to mothers with low psychological resources (i.e., low intelligence, mental health problems, lack of self-confidence).

Of special note because of its long-term follow-up is the original RCT, conducted in Elmira, NY, beginning in the late 1970s. Women were randomly assigned either to a group given the opportunity to participate in the Nurse-Family Partnership, or a control group that was provided developmental screening and referral to treatment for their child at ages 1 and 2 and, in some cases, free transportation to prenatal and well-child care. Approximately 90% of the women were white, 60% were low income, and 60% were unmarried. Their average age was 19. Here is an overview of the results for the Elmira trial at the final follow-up study after 15 years:

• 48% fewer officially-verified incidents of child abuse and neglect as of age 15 (an average of 0.26 incidents per nurse-visited child versus 0.50 per control-group child).

• 43% less likely to have been arrested, and 58% less likely to have been convicted, as of age 19 (21% of nurse-visited children had been arrested versus 37% of control-group children, and 12% versus 28% had been convicted, according to self-reports).

• 57% fewer lifetime arrests and 66% fewer lifetime convictions (an average of 0.37 versus 0.86 arrests, and 0.20 versus 0.58 convictions, according to self reports).

• 20% less time spent on welfare (an average of 53 months per nurse-visited woman versus 66 months per woman in the control group).

• 19% fewer subsequent births (an average of 1.3 births versus 1.6).

• 61% fewer self-reported arrests (an average of 0.13 versus 0.33).

• 72% fewer self-reported convictions (an average of 0.05 versus 0.18).

The cost of three years of home visits by a trained nurse using the Nurse-Family Partnership model is $13,600. There are numerous outcomes found in one or more of the trials that save government spending. These include a 20–50 percent reduction in child abuse and neglect, a 10-20 percent reduction in subsequent births in the late teens and early 20s, and reduced welfare payments.


Carrera Adolescent Pregnancy Prevention Program
Sponsored by the Children's Aid Society, the Carrera Adolescent Pregnancy Prevention program is a comprehensive youth development program for economically disadvantaged teens who enter the program at ages 13-15 and usually participate for three years. The program is provided after school at local community centers, and runs for about three hours each weekday after school.1 The program includes five main activities:

• Daily academic assistance (e.g., tutoring, homework help, assistance with college applications);

• Job Club 1-2 times per week, including such activities as learning to complete a job application and interview for a job;

• Family life and sex education 1-2 times per week, led by a reproductive health counselor;

• Arts activities 1-2 times per week (e.g. music, dance, writing, or drama workshops); and

• Individual sports activities 1-2 times per week (e.g. tennis, swimming, martial arts).

The program also provides free mental health and medical care through alliances with local health care providers. A key component is reproductive health care, including physical exams, testing for sexually transmitted infections, a range of contraceptive options, and counseling. Carrera program staff schedule the teens' health appointments and accompany them on their visits. The program costs approximately $4,750 per teen per year to implement (2009 dollars).


The evidence to support the program comes from a large, multi-site RCT (linked above). This trial evaluated the program as implemented in 12 well-managed community youth agencies in 6 states during the period 1997-2004; 1,163 teens aged 13-15, who were not parenting or pregnant, participated in the evaluation; 45% of the teens were African American or Caribbean black, and 29% were Hispanic. 58% were from single or no-parent households, and 54% lived in households that had no employed adult and/or received entitlement benefits (e.g., public assistance, Medicaid).

On average, Carrera group teens attended program activities for 12 hours per month during the three years after random assignment. At the end of the third year, 70% of the Carrera group teens were still involved in the program. Here is overview of the program impacts at the end of the program:

• For Carrera group females:

• 40% less likely to have ever been pregnant (15% of Carrera group females had been pregnant vs. 25% of control group females).

• 50% less likely to have ever given birth (5% vs. 10%).

• More than twice as likely to be using Depo-Provera -- a highly effective hormonal contraceptive -- at last intercourse (22% vs. 9%).

• For Carrera group males, there were not significant effects.

• For the full sample (males + females):

• 7% reduction in likelihood of having had teen sex (statistically significant at the 0.10 level but not the 0.05 level).

• 16% more likely to have had some work experience (89% of the Carrera group vs. 77% of the control group).

• Positive effects on some educational outcomes (PSAT scores and college visits) but not others (e.g. grades).

• Effects at 7 years after random assignment, at average age 21:

• 30% more likely to have graduated high school or obtained a G.E.D. (86% of the Carrera group had graduated or obtained G.E.D. vs. 66% of the control group).

• 37% more likely to be enrolled in college (63% vs. 46%).

The Carrera program produced many outcomes that reduce government spending. These include substantial reductions in teen pregnancy rates, a 30 percent increase in high school graduation or GED achievement, and a 37 percent increase in college enrollment. Just the increased enrollment in college is likely to offset all the program costs in the long run.


Success for All
Success for All is a comprehensive school-wide reform program, primarily for high-poverty elementary schools, with a strong emphasis on early detection and prevention of reading problems before they become serious. Key program elements include daily 90-minute reading classes, each of which is formed by grouping together students of various ages who read at the same performance level; a K-1 reading curriculum that focuses on language development (e.g., reading stories to students and having them re-tell), teaching students the distinct sounds that make up words (i.e. phonemic awareness), blending sounds to form words, and developing reading fluency; daily one-on-one tutoring (in addition to regular classes) for students needing extra help with reading; and cooperative learning activities (in which students work together in teams or pairs) starting in the grade 2 reading classes.

The evidence of Success for All's effectiveness is based a research design in which 41 schools across 11 states were randomly assigned to an experimental or control group. Grades K-2 but not grades 3-5 were included in the evaluation Prior to random assignment, at least 80% of the schools' teachers had voted in favor of adopting Success for All and the schools had agreed to allow data collection over the course of the study. The schools contained a total of 2,694 entering kindergarten students administered a pretest at the start of the study. The student population in these 41 schools was 56% African-American and 10% Hispanic, and 72% of students were low-income (i.e., eligible for federally subsidized lunches). Approximately three years after random assignment, the study assessed reading outcomes for all 2nd-grade students in the sample schools. Sixty-nine percent of these students had been exposed to Success for All, or the control condition, for all three years of the study (i.e., in grades K-2); the other 31% had enrolled in the Success for All or control schools during the study, and so had received partial exposure.

Here is an overview of the effects of Success for All on school-wide second-grade reading outcomes, three years after random assignment (versus the control schools):

• On average, 2nd-graders at Success for All schools:

• Passage comprehension: From an effect size of -0.10 in year 1, to 0.12 in year 2, to 0.21 in year 3.

• Word identification skills: From 0.09 to 0.19 to 0.24.

• Word attack skills: From 0.32 to 0.29 to 0.36.

• Scored higher in passage reading comprehension than approximately 58% of their counterparts at control group schools (this equates to a standardized effect size of 0.21).

• Scored higher in word identification skills than approximately 60% of their counterparts at control group schools (this equates to a standardized effect size of 0.24); and

• Scored higher in word attack skills than approximately 64% of their counterparts at control group schools (this equates to a standardized effect size of 0.36).

• To express these effects as grade level equivalents: On average, 2nd-graders at Success for All schools score approximately 25-30% of a grade level higher in reading ability than their counterparts at the control schools.

• The program's effects generally grew in size from the first to the third year of the study.

• This was a large, multi-site study evaluating Success for All as it is typically implemented in high-poverty elementary schools, thus providing evidence about the program's effectiveness in real-world public school settings.

• The study had a reasonably long-term follow-up, and low-to-moderate attrition: Three years after random assignment, reading test scores were obtained for students in 85% of the sample schools -- i.e., 35 of the original 41. (Of the six schools lost at follow-up, five closed due to insufficient enrollment and one dropped the Success for All model due to local political problems and refused to participate in data collection.) The number of schools lost in the Success for All versus control group was the same (3 each).

Success for All costs about $510 per student for the 3-year program. The major impacts shown to date are on school achievement, primarily reading skills. This increase in skills is likely related to high school graduation and college enrollment rates, both of which have been shown to produce reductions in government spending in the long run. Whether Success for All has impacts on long-term measures such as these remains to be seen.


Small Schools of Choice
In 2002 New York City closed 31 large, failing high schools and replaced them with small schools of choice (SSC) that featured specialized curriculums, close associations with outside groups such as businesses and non-profit organizations, and teachers and principals who developed their school philosophy together and advertised it to students and parents. Students entering high school (at grade 9) were allowed to apply to several schools. As a result of student (and parent) self-selection, 105 of the SSCs were oversubscribed. This overflow of students caused the New York school system to randomly assign students to the SSCs and other types of schools. This procedure was repeated for four consecutive years, creating the opportunity to study four cohorts with a total of about 21,000 students who were assigned randomly to either an SSC or a different type of school. Nearly 95% of the students were black or Latino and nearly 85% of the students were from low-income families as measured by eligibility for free or reduced-price school lunches.

As shown in several reports by the research firm MDRC (see here and here), the SSC schools have produced substantial impacts on two measures that have been difficult to impact in previous education evaluations:

• Students in SSC's had significantly higher graduation rates than control students (71.6% vs. 62.2%).

• Students in SSC's had significantly higher rates of enrollment in colleges (49.0% vs. 40.6%).

These impacts are achieved despite the finding that “the cost per high school graduate is substantially lower for the small-school enrollees than for their control group counterparts.” This favorable cost result is achieved because although the per-pupil cost of control schools is about the same as SSCs, students at control schools are more likely to require a fifth year of schooling to graduate and they are less likely to graduate at all. Beyond this finding, which shows cost savings for government at the time the program takes place, the increased high school graduation rate and the higher college entry rate will likely produce benefits to the individuals involved, especially in their lifetime earnings, and to government in the form of increased taxes and reduced payments for welfare programs in the future.


A former White House and congressional advisor on welfare issues, Ron Haskins co-directs the Brookings Center on Children and Families and Budgeting for National Priorities Project.
This piece originally appeared on the Brookings Institution's Up Front blog.

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