Archive for the ‘State News’ Category

Mississippi: Continuing To Lead From The Rear

Tuesday, February 7th, 2023

Tonight, President Joe Biden will deliver his State of the Union Address to the nation and a packed Congress. It will be performative, with Democrats applauding and Republicans sitting on their hands. It always makes for a pretty good show. One of the things Biden will ask this Congress for is greater expansion of the Affordable Care Act’s Medicaid provision.

A week ago and a world away, Mississippi’s Republican Governor Tate Reeves stood on the steps of the state capital in Jackson and delivered his State of the State address. Like Biden will tonight, he talked about the Affordable Care Act’s Medicaid expansion provision—and his rigid determination to have nothing to do with it.

Since Congress passed the ACA and President Obama signed it into law on 23 March 2010, 39 states and the District of Columbia have taken advantage of the Medicaid expansion provision. And last November, South Dakota became the seventh state to do so through ballot initiative. The state now has until 1 July to set up a system that would be ready to enroll the estimated 42,500 people who will then become eligible for health insurance coverage under the Affordable Care Act.

Medicaid expansion as of 2023

The one argument Governors and state legislators make in states that have not adopted Medicaid expansion, and the one South Dakota Governor Kristi Noem (R) made before the ballot initiative, is that it is unaffordable and will put untenable strain on states’ budgets.

Nearly 13 years of research has proven this to be untrue. As my dear father would say when presented with a similarly specious claim, “That is an argument full of what makes the grass grow green and tall.”

Of course, there is another argument, the purely political one, and Governor Reeves made it in his State of the State address as reported by the Mississippi Free Press:

During his State of the State address on Monday, Gov. Reeves told Republican lawmakers not to “cave under the pressure of Democrats and their allies in the media who are pushing for the expansion of Obamacare, welfare and socialized medicine.” (The governor often invokes “socialism” when criticizing ideas or opponents, including his 2019 Democratic and Republican  challengers).

In reiterating his opposition to expanding Medicaid, Reeves said, “Instead, seek innovative free-market solutions that disrupt traditional health-care delivery models, increase competition and lead to better health outcomes for Mississippians. Do not settle for something that won’t solve the problem because it could potentially and only temporarily remove the liberal media’s target on your back.”

That statement has the intellectual weight of a soap bubble. The Governor refuses to focus on the real and terrible problems of Mississippi’s health care system.

In May, 2022, the Center for Mississippi Health Policy, an independent, non-partisan, non-profit organization that provides objective information to inform health policy decisions, published its 56-page analysis entitled, Healthcare System Performance – Mississippi Indicators & Healthcare Infrastructure: Opportunities for Improvement. 

The very first sentence in the report’s Executive Summary says, “The performance of Mississippi’s healthcare system is consistently ranked as one of the lowest in the nation.” In four other places it hammers this home:

“Over the past decade,…Mississippi’s healthcare system has continued to rank as the poorest performing state healthcare system of the United States and the District of Columbia.” (page 5)

“Despite diligent efforts, Mississippi continues to maintain the worst performing state healthcare system in the United States.” (page 7)

“Since 2009, Mississippi has ranked last on overall health system performance every year.” (page 8)

“Mississippi has the highest rates of potentially preventable hospitalizations for chronic conditions in the United States.” (page 12)

On every level, in every category, the Center for Mississippi Health Policy’s report is a ringing indictment of health care in the Magnolia State.

Could it look any worse for Mississippi’s health care performance? Well, yes, it could.

Consider deaths from COVID 19.

From the beginning of the pandemic Mississippi experienced the third highest rate of deaths in the nation at 444 per 100,000 people, trailing only Arizona and Oklahoma (but not by much). And in the number of deaths in excess of what would have been expected based on historic mortality patterns, Mississippi led the nation.

The Commonwealth Fund is another organization that analyzes health care performance, both in the US and globally. For the US It publishes annually a Scorecard on State Health System Performance. Last June, it released its 2022 Scorecard.

This is even more damning when one considers that the Commonwealth Fund’s analysis of  US health care performance with respect to its global peers is nothing short of woeful. The Fund’s 2023 report, U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes, paints a picture that should disgust any American who reads it. In nearly every metric measured, our country lags behind its global competitors.

To put it bluntly, in a country that spends far more than any other developed nation, close to 2 to 1 on the average, yet trails its peers in nearly every health care category, in a country where life expectancy at birth is three years less than the OECD average, in a country with the highest maternal and infant mortality, in a country obviously in desperate need of serious health care improvement, Mississippi is dead last.

With all this as background, I now sincerely ask: Why has Mississippi chosen for 12 years in a row to reject availing itself of the proven benefits coming out of the Affordable Care Act?

Accepting Medicaid expansion has nearly eliminated people going uninsured in expansion states, and, because of the federal matching payments of 90% has made it economically neutral, at worst. It has lowered costs and improved health care.

A recent white paper by Manatt Health, prepared in partnership with the Commonwealth Fund and the Robert Wood Johnson Foundation, estimated the fiscal impact of Medicaid expansion in Mississippi. It demonstrated that Medicaid expansion is a better fiscal deal than ever before, especially when you consider that under the American Rescue Plan Act the federal government will increase its portion of payments by 6.2%. In addition to significantly increasing insurance coverage, the paper projects that expansion in Mississippi would cover more than 220,000 adults and, along with significant ongoing savings, would result in zero net cost to the state for more than six years. Yet for 12 years in a row Mississippi has chosen to throw nearly a quarter of a million of its citizens into the land of the uninsured, where hospital emergency rooms become primary care providers.

Which brings us to Uncompensated Care. Right now, at this very moment, 54% of Mississippi’s rural hospitals are on the cusp of closing—38 of them, because they don’t get paid enough for taking care of poor rural people, most of them uninsured. Yet states that have adopted the Affordable Care Act have seen substantial drops in their uncompensated care costs. Between 2013 and 2015, states that were early adopters of the ACA saw Uncompensated Care decline by $8.6 billion, or 23%. But Mississippi doesn’t seem to care. This is a slap in the face and a punch to the gut for the state’s rural communities, which make up 79.3% of the state’s 82 counties.

You won’t find peer reviewed, published studies demonstrating that states have been harmed by ACA expansion. We’ve had more than ten years of research with solid findings in many areas, including expansion’s positive effects on health outcomes, access to services and medications for behavioral health and other needs, providers’ financial stability, and employment. Some recent analyses that include outcomes beyond those typically examined in Medicaid expansion research show that expansion is associated with decreased mortality overall and for certain specific conditions; reductions in rates of food insecurity, poverty, and home evictions; and improvements in measures of self-reported health and healthy behaviors.

There are smart people in Mississippi, a lot of them, and they know the research. They know what expansion would do for their poor neighbors, for their state, for themselves and their families. But there are also modern day troglodytes in Mississippi, and it seems the troglodytes are in charge.

 

 

 

 

Florida’s Governor Ron DeSantis Builds His Educational Petrie Dish

Tuesday, January 24th, 2023

I know it’s masochistic, but I couldn’t help it. I found myself thinking about Florida Governor Ron DeSantis and his all-out assault on education, specifically education about racism, Wokism (if that’s a word), the LGBTQ+ community, and anything else he doesn’t agree with.

I began my long and winding journey down the DeSantis rabbit hole when I learned that yesterday was the day in 1964 when South Dakota became the deciding and 38th state to ratify the 24th amendment to the US Constitution.

The 24th Amendment prohibits making the right to vote conditional on paying a poll tax, or any other kind of tax. It reads:

Section 1. The right of citizens of the United States to vote in any primary or other election for President or Vice President, for electors for President or Vice President, or for Senator or Representative in Congress, shall not be denied or abridged by the United States or any State by reason of failure to pay any poll tax or other tax.

Section 2. The Congress shall have power to enforce this article by appropriate legislation.

The 24th Amendment applied to Presidential and Congressional elections. Two years later, in 1966, the U.S. Supreme Court ruled 6–3 in Harper v. Virginia Board of Elections that poll taxes for any level of elections were unconstitutional. It said these violated the Equal Protection Clause of the Fourteenth Amendment.

Seven states never held a vote to ratify the Amendment. They are Wyoming, Arizona, Arkansas, Oklahoma, Louisiana, South Carolina and Georgia. One state voted to reject the Amendment’s approval altogether. That was Mississippi. Mississippi again. The state seems to rejoice in being the bottom of the country’s bird cage.

Four states, Virginia, North Carolina, Alabama and Texas, waited years to ratify the Amendment, with Texas being the last, in 2009.

If you don’t count Virginia, which enacted a poll tax in 1876, but repealed it six years later in 1882, Florida was the first state to make a poll tax a condition of voting, enacting the legislation in 1885. It became effective in 1889. In 1941, 52 years later, Florida repealed its poll tax.

Florida did not repeal the poll tax because its legislators were conscience-stricken and knew they had to do the right thing. No. The state repealed the tax because too many white legislative candidates (they were all white) were buying votes by paying the tax for poor black and white constituents (disproportionately black, of course) who couldn’t afford it themselves. In essence, the tax was no longer doing what it was intended to do: suppress black votes.

Florida had two other legislatively approved ways to suppress black voting. The first was the Literacy test. According to the Tampa Bay Times:

In 1915, the Legislature enacted a literacy test along with a companion grandfather clause. The clause, common throughout the South, declared that any person who had a relative who voted prior to a certain date did not have to take the test.

According to the proposed Florida law, if you had a relative who was eligible to vote on Jan. 1, 1867, you were exempt from taking the test. Since no black Floridian was voting prior to that date, all of them had to pass the test.

Blacks were frequently asked more technical and legal questions than whites. When one black applicant was asked what “habeas corpus” meant, he responded: “Habeas corpus means this black man ain’t gonna register today.”

The final way the legislature held down, disenfranchised, the black vote in Florida was by means of the Criminal Disenfranchisement Law. This law, first enacted in 1868, reenacted in 1968, and in effect even today, bars anyone with a felony conviction from ever voting. Florida is one of seven states that still retain this disenfranchisement statute, which disproportionately affects blacks.*

Disproportionate imprisonment of blacks is not something peculiar to Florida. Nationwide, according to Bureau of Justice data, 18 and 19-year-old black men are 12.4 times more likely to be imprisoned than their white peers. And it doesn’t get much better as blacks age, as the chart below shows.

With this as background (and here are 24 more charts showing pervasive racism directed at blacks), Governor DeSantis insists there is no such thing as institutional racism, especially in Florida. And he’s gone to great lengths to make sure anyone in Florida who suggests otherwise will require divine intervention to escape punishment.

Ask Andrew Warren. Last August, DeSantis suspended Warren, the twice-elected Hillsborough County State Attorney, saying he violated his oath of office and has been soft on crime (Remarkably, Florida’s Governor has the legislative authority to do this). What had Warren done? Nothing, except for signing a group statement with other prosecutors saying “we decline to use our offices’ resources to criminalize reproductive health decisions.” In other words, Warren was suspended, not for something he did, but for something he said he might do at some time in the future.

Warren sued to get his job back. Yesterday, a federal judge ruled that, although DeSantis violated the Florida Constitution and the First Amendment, he lacked the power to reinstate Warren. In his 53-page ruling, U.S. District Judge Robert Hinkle, while grudgingly dismissing the case, excoriated DeSantis and his staff for attacking Warren for purely political reasons. Nonetheless, DeSantis won, which is usually the way things work in Florida.

And now, as we are smack dab in the second day of “Florida Literacy Week,” comes the Florida Department of Education’s new rules to enforce the Governor’s Parental Rights In Education Act, known by critics as “Don’t Say Gay” or the Stop WOKE Act and Florida law 1467, the Curriculum Transparency Law, which requires school districts to be transparent in the selection of instructional materials and library and reading materials.

Taken together, these two statutes limit what teachers can teach and what their students can read.

The two statutes are supposed to apply to what goes on in the classroom. Consequently, in federal court filings, lawyers representing DeSantis insist  the statutes do not apply to library books. In practice the opposite is true. A recent 23-slide librarian training program, approved by the Florida Department of Education, asserts: “There is some overlap between the selection criteria for instructional and library materials.” One slide says that library books and teacher instructional materials cannot include “unsolicited theories that may lead to student indoctrination.”

Good luck trying to understand what an “unsolicited theory” is, or what “student indoctrination” means. Indoctrination into what?

The rules are confusing for librarians, but they’re even murkier for classroom teachers, many of whom have created little classroom libraries over the years of their teaching. The Department of Education’s new rules require “media specialists” to vet every one of the non-curriculum  books teachers may have in their classrooms, as well as all the books in the school libraries. In Florida, some school librarians earn “media specialist certificates.” These are the “media specialists” tasked with vetting all the books in Florida’s 4,202 K-12 public schools. In Popular Information, Judd Legum reports that Kevin Chapman, the Chief of Staff for the Manatee County School District, told him that County principals told teachers last week they are subject to a third-class felony charge if unvetted books in their classrooms are deemed to violate the prohibitions contained in either of the two statutes.

Needless to say, those little classroom libraries are disappearing faster than the small piece of meat I dropped on the kitchen floor this morning right in front of my 80-pound dog, Lancelot (so named because he’s not Lance-a-little).

Florida law 1467 on Curriculum Transparency is particularly pernicious, because it prohibits teachers from exercising their own educated judgement regarding what is appropriate for their particular students. For Florida’s teachers, this is scary stuff. They are going to have to be very careful with what they say, or even suggest, in their classrooms.

Some teachers, perhaps many, will refuse to give up their intellectual freedom. It will be interesting to see how that plays out. As George Orwell said, “In a time of universal deceit, telling the truth becomes a revolutionary act.”

Nevertheless, it seems Governor Ron DeSantis has achieved in Florida what all autocrats crave. He has brazenly fastened iron bonds on what the next and future generations of Floridians are allowed to know. To my mind, he has also underestimated the youth of his state whose intelligence, curiosity, global involvement, and just plain desire to know and learn cannot and will not be inhibited by anything an autocratic governor, whose overarching goal in life is to rule the world, will ever do.

My money’s on the kids.

_________________

*Angela Behrens, Christopher Uggen, and Jeff Manza, Ballot Manipulation and the “Menace of Negro Domination”: Racial Threat and Felon Disenfranchisement in the United States, 1850-2002, 109 AMERICAN JOURNAL OF SOCIOLOGY 559 (2003).

 

 

Martin Luther King—Sharing The Spotlight With Confederate “Heroes”

Tuesday, January 17th, 2023

Yesterday, the city of Boston celebrated Martin Luther King day as no other city in the nation could. On Boston Common, the oldest public park in America, Mayor Michelle Wu and other leaders unveiled The Embrace, Hank Willis Thomas’s five-years-in-the-making monument to Martin Luther King and Coretta Scott King.* 

The huge bronze hug is 38,000 pounds and sits 22 feet high and 40 feet wide. Boston’s newest monument is inspired by a photo of the Kings hugging after Martin won the Nobel Peace Prize in 1964. The monument sits in an open circle with bench seating in the middle of Boston Common within another memorial, the new 1965 Freedom Plaza, which honors Boston civil rights activists.

The Kings had met as students in Boston and were married there in 1953. Among other things, the monument signifies the linkage between them in the civil rights struggles to which they each committed their lives. Coretta Scott King, in addition to being the wife of MLK, was also an artist, an activist, and a driving force who was by his side  doing the work with him, which she carried on after he was assassinated. She founded the King Memorial Center and never gave up fighting for a federal holiday honoring King’s legacy. Mrs. King’s efforts resulted in the federal holiday we now celebrate, when President Ronald Reagan signed the holiday into law in 1983; it was first observed three years later on January 20, 1986. In 1995, Congress designated Martin Luther King Jr. Day as the first and only federal holiday observed as a National Day of Service. Congress charged the Corporation for National and Community Service with leading this national effort.

All 50 states now recognize Martin Luther King day as a state holiday, South Carolina being the last in 2000. But when that happened, the South Carolina legislature also voted to create Confederate Memorial Day, which would be celebrated on the same day we honor King. And South Carolina is not alone. As Shoshana Gordon, Jacque Schrag and Russell Contreras report in AXIOS, “Ten states — all in the South — observe Martin Luther King Jr. Day plus at least one Confederate holiday.” This from the AXIOS report:

Arkansas, Georgia, Florida, Kentucky, North Carolina, South Carolina, Tennessee and Texas all have at least one day commemorating the Confederacy on other days of the year.

Mississippi and Alabama each celebrate a total of three Confederate holidays every year — Robert E. Lee Day, Confederate Memorial Day and Jefferson Davis’ Birthday — all paid holidays for state employees.

Many lawmakers in the ten states believe it is wrong to celebrate the confederate holidays, but nobody seems to want to propose legislation to repeal any of them. Now why would that be? Here is a map showing the states honoring the confederacy:

Of particular note is Tennessee with its three days honoring the confederacy. Why? Because one of them is Nathan Bedford Forrest Day (first observed in 1921). In honoring the confederate general and first Grand Wizard of the Ku Klux Klan, Tennessee Gov. Bill Lee’s (R) 2019 proclamation saluted a “recognized military figure in American history” and a “native Tennessean.”

In these ten states Martin Luther King is lumped in with slaveholders, secessionists and murderers. The whole thing just oozes a terrible irony, especially when you consider how King’s life ended―and where―Memphis, Tennessee.

Those states aren’t the only places where Dr. King gets little respect. J. Edgar Hoover’s FBI considered King “the most dangerous man in America” and conducted decades-long surveillance of him, surveillance encompassing more than 300,000 pages of documents.

Film director Sam Pollard chronicles Hoover’s efforts in his 2020 documentary, MLK/FBI. According to Pollard’s research and as reported on NPR:

The FBI campaign against King began with wiretaps, but quickly ballooned. When wiretaps revealed that King was having extramarital affairs, the FBI shifted their focus to uncover all evidence of his infidelity by bugging and taping him in his hotel rooms and by paying informants to spy on him. Eventually, the FBI penned and sent King an anonymous letter, along with some of their tapes, suggesting that he should kill himself.

Yes, like all of us walking God’s green earth, Martin Luther King had feet of clay. But he also had a heart as big as Texas and a passionate, life-long commitment to freeing his people from the chains of racism, a struggle that continues to this day, 163 years after the civil war’s first shot.

Were he alive today, King would probably be the first to acknowledge the tremendous strides made in the long journey for true equality in civil rights. He would also be the first to acknowledge how far away the last mile really is.

______________________________

*The Embrace has not won instant acclaim from everyone. In fact, there has been quite a bit of snarky criticism, some even calling the artwork “obscene.” It all reminds me of another monument, a memorial dedicated in late 1982—Maya Lin‘s minimalist Vietnam Veterans Memorial in Washington, D.C. When it first opened to the public, politicians, celebrities, regular citizens and, most important, Vietnam Veterans, lined up to criticize it. It became known as “the black gash of shame.” Well, 42 years later, veterans go to the Wall and weep as they see the names of their fallen comrades. It is embraced by all, as will The Embrace be more and more as time goes by.

Cavalier Greed And Cruelty In Minnesota

Wednesday, September 21st, 2022

Yesterday, Federal authorities charged 47 people in Minnesota with conspiracy and other counts in what prosecutors said is, to date, the largest fraud scheme of the COVID-19 pandemic, a scheme that stole at least $250 million from a federal program that provides meals to low-income children.

According to the Justice Department, “The 47 defendants are charged across six separate indictments and three criminal informations with charges of conspiracy, wire fraud, money laundering, and bribery.”

Government prosecutors allege the defendants created companies that claimed to be offering food to tens of thousands of children across Minnesota — nearly all of whom did not exist, — then sought reimbursement for those meals through the U.S. Department of Agriculture’s food nutrition programs. Because the need was so great, some standards were waived and oversight was often minimal. The USDA allowed for-profit restaurants to participate, and allowed food to be distributed outside educational programs. The charging documents say the defendants exploited such changes “to enrich themselves.”

A non-profit called Feeding Our Future was central to the scheme.

The Federal Child Nutrition Program is used to feed low income children in daycare and afterschool organizations. It spends $4 billion a year to feed needy children across the country. Feeding Our Future received hundreds of millions of dollars from the program from 2019 through 2021.

Here’s how it worked.

The government alleges Feeding Our Future, a sponsor in the Federal Child Nutrition Program, established sponsorship contracts with nearly 200 federal child nutrition program sites throughout the state, knowing that the sites intended to submit fraudulent claims. The sites would submit the claims to Feeding Our Future, which would then submit them to the Minnesota Department of Education, which has historically administered the programs, primarily through school programs. With schools closed for the pandemic the rules of the nutrition programs were changed to allow for all of the new entrant providers and the relaxed rules.

Feeding Our Future became a sort of Third Party Administrator for the sham sites and collected 15% of the charges as its fee. It went from receiving and disbursing approximately $3.4 million in federal funds in 2019 to nearly $200 million in 2021.

According to the indictments, “The sites fraudulently claimed to be serving meals to thousands of children a day within just days or weeks of being formed and despite having few, if any, staff and little to no experience serving this volume of meals.”

The massive fraud was allegedly headed up by Aimee Bock, Feeding Our Future’s founder and executive director. The indictments also allege she and some of her employees received additional kickbacks, which were often disguised as “consulting fees” paid to shell companies Bock created.

Andy Luger, the U.S. Attorney for Minnesota, said the fraudsters billed the government for more than 125 million fake meals. He displayed one Form For Reimbursement that claimed a site served exactly 2,500 meals each day Monday through Friday — with no children ever getting sick or otherwise missing a meal.

Luger said, “These children were simply invented.”

Earlier this year, the U.S. Department of Justice made prosecuting pandemic-related fraud a priority. The department has already taken enforcement actions related to more than $8 billion in suspected pandemic fraud, including bringing charges in more than 1,000 criminal cases involving losses in excess of $1.1 billion.

In this case, one of the indictments offered a beyond-brazen example of the fraud. It described a small storefront restaurant in Willmar, in west-central Minnesota, that typically served only a few dozen people a day. Two defendants offered the owner $40,000 a month to use his restaurant, then billed the government for some 1.6 million meals through 11 months of 2021. They listed the names of around 2,000 children — nearly half of the local school district’s total enrollment — and only 33 names matched actual students. And where did the defendants get the names of the children they said the program fed? From a website that randomly provides the names of mythical children. That’s where.

As usual in these kinds of fraud schemes the defendants used the stolen money to buy homes, exotic cars, vacation junkets and expensive clothes and jewelry.

And what did Minnesota’s low income children get? They got hunger.

 

 

 

Paid Sick Leave: Public Policy That Makes Ethical And Economic Sense

Tuesday, August 23rd, 2022

Mississippi: America’s Third World Country

Wednesday, May 11th, 2022

Although I have been there only once, I can’t help thinking about Mississippi.

Mississippi has recently been in the news, of course, because its 2018 Gestational Age Act will be upheld in the same Supreme Court decision overruling Roe v. Wade, which we discovered from Justice Samuel Alito’s leaked first draft opinion for the majority.

This is not Mississippi’s first foray into restricting abortion. In 2007, the state passed its version of an abortion Trigger Law, which “bans all abortions unless necessary to save the life of the pregnant woman or if the pregnancy was caused by rape and charges have been filed with law enforcement,” and which takes effect immediately following the state attorney general certifying the Supreme Court has overturned Roe v. Wade. The Trigger law had 19 male legislative sponsors and zero female sponsors. Regardless, Mississippi has been ready for this for 15 years.

But has it been ready for what comes next?

Matthew Walther, editor of The Lamp, a Roman Catholic literary journal, and a person who will never be accused of favoring abortion, sees predictable and unpleasant consequences after Roe is no longer the law of the land. In his 10 May 2022 guest essay for the New York Times, “Overturning Roe will disrupt a lot more than abortion. I can live with that,” Mr. Walthern acknowledges what very few anti-abortionists want to admit.

Research over the years has suggested that an America without abortion would mean more single mothers and more births to teenage mothers, increased strain on Medicaid and other welfare programs, higher crime rates, a less dynamic and flexible work force, an uptick in carbon emissions, lower student test scores and goodness knows what else.

But Mr. Walther, despite envisioning a gloomy horizon, “can live with that.” I cannot restrain myself from pointing out that Mr. Walther is of the male persuasion and, consequently, faces little likelihood of ever having to “live with” personal pregnancy.

Nonetheless, he makes a good argument, which brings us back to Mississippi.

A few points worth considering:

  • Poverty: According to the Department of Agriculture, 20.29% of Mississippi’s adults and 27.6% of its children live below the poverty line. This is the highest poverty rate in America where the national average is 11.4%.
  • Income: The median family income in Mississippi is $45,081. This is the lowest in the nation. According to the National Census Bureau, the national average in 2019 was $65,712.
  • Education: Only Texas, at 84%, ranks lower than Mississippi, at 85%, for the percentage of high school graduates. The national average is 89.6%. Only West Virginia, at 21%, ranks lower than Mississippi’s 22% for the percentage of college graduates. The national average is 31.28%.
  • Life Expectancy: At 74.4 years, Mississippi has the lowest life expectancy rate in the nation. Of note, the life expectancy rate for Mississippi’s men is 71.2 years.
  • Fetal Mortality: Mississippi’s fetal mortality rate, the number of deaths at 24 or more weeks of gestation per 1,000 live births, is 6.6. This is the highest in the nation. The national average is 3.68. If that isn’t enough, fetal deaths have lately doubled among unvaccinated pregnant women who suffer COVID-19 infections, State Health Officer Dr. Thomas Dobbs said during a Mississippi State Department of Health press conference in September, 2021.
  • Infant Mortality: The Infant Mortality Rate is the number of infant deaths per 1,000 live births. At 8.27, Mississippi’s is the highest in the nation, far exceeding Louisiana’s rate of 7.53, which is the second highest.
  • Maternal Mortality: According to the Centers for Disease Control and Prevention (CDC), Mississippi’s maternal mortality rate is 20.8, again, the highest in the country, where the national average is 17.4, which is the highest among all members of the Organization for Economic Co-operation and Development (OECD). A maternal death is defined by the World Health Organization as, “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.”
  • Maternity Leave: Mississippi has no guaranteed Maternity or Sick Leave in its state laws.
  • Smoking: According to the CDC, 20.4% of Mississippians smoke. This is the fourth highest in the nation.
  • Autopsies: Something you probably have never have considered until now: Autopsy backlogs. According to the National Association of Medical Examiners (NAME), 90% of all autopsies should be completed within 60 days of death. The NAME has never accredited Mississippi, which has the highest backlog in the nation. The Mississippi State Medical Examiner’s Office was waiting for about 1,300 reports from as far back as 2011, records sent to the Associated Press in early April show. Around 800 of those involve homicides – meaning criminal cases are incomplete.
  • Abortion: According to the Mississippi Department of Public Health, the state has about 3,500 abortions annually. This represents 4.3 abortions per 1,000 women of reproductive age.
  • Finally: Mississippi ranks highest in the nation for Percent of Births to Unmarried Mothers, Cesarean Delivery Rate, Preterm Birth Rate, and Low Birthweight Rate.

Reading the above, one might be forgiven for thinking  there is a significant population in Mississippi who are actual victims of the state’s inability, or outright refusal, to carry out its first responsibility: to provide for the security and safety of its citizens.

Thinking about this, I have to ask: Given how well it’s doing now, how in the world is Mississippi going to cope with 3,500 new births per year? On CNN this past Sunday, Jake Tapper interviewed the state’s Republican Governor, Tate Reeves. That interview offered a glimpse of what is likely coming, a catastrophe becoming worse than it already is, which is considerable.

Tapper: Mississippi, as you know, has the highest rate of infant mortality in the United States. You have the highest rate of child poverty in the United States. Your state has no guaranteed maternity leave that’s paid. The legislature in Mississippi just rejected extending post-partum Medicaid coverage. Your foster care system is also the subject of a long-running federal lawsuit over its failure to protect children from abuse. You say you want to do more to support mothers and children, but you’ve been in state government since 2004. Based on the track record of the state of Mississippi, why should anyone believe you?

Reeves: I believe in my heart that I was elected, not to try to hide our problems, but to try to fix our problems. We are focusing every day on fixing the challenges that are before us.

Good luck, Governor. You and all those “unborn” children who are about to be “saved” are going to need a lot of it. And so are the Mississippi women who are about to become the state’s newest victims.

 

 

 

 

How Much Does Truth Matter In America Today?

Friday, March 18th, 2022

In 399 BCE, the Greek philosopher Socrates was accused of corrupting the youth of Athens and impiety, in that he “failed to acknowledge the gods that the city acknowledges.” He was tried, found guilty on both charges by a jury of male Athenians chosen by lot, and condemned to death.

Socrates real crime was in challenging his students to think critically. He asked political and philosophical questions and did not accept trite answers. Athenian leaders and other intellectuals resented his elenctic method of questioning, because it threatened their own credibility.

The trial of Socrates is an early example of a state restricting the knowledge its citizens can access and debate, and ever since then autocrats have done exactly that to get and maintain power.

In the 20th century, Adolph Hitler rose to power by building his own falsity factory and feeding the German people only a single version of “the truth.” And today, Vladimir Putin, a modern-day a devil disguised in a bespoke suit of skin, has imposed a crude and draconian crackdown on anyone who doesn’t toe the company line. I find it interesting that yesterday Kremlin spokesman Dmitry Peskov, defending Putin from nearly worldwide condemnation, called him a, “very wise, prescient, and cultured international figure.” That’s rich.

Here in America, we daily face similar attempts, some subtle, some not, to package lies and sell them as gospel truth. They pummel us from all sides. The tragedy is that so many of us open wide and swallow.

A case in point can be found in many states that are now restricting what teachers can teach and what books their students can read. Right now, in eleven states, teachers and librarians can be prosecuted for violating restrictions recently enshrined in law by their legislators and governors.

Reading these laws (I did), one gets the impression they were mostly written by the same person. Their focus is race and sex. They all contain the the following language taken from Texas that prohibits teachers from introducing a concept by which:

(vii)  an individual should feel discomfort, guilt, anguish, or any other form of psychological distress on account of the individual’s race or sex;

Right on page one, in South Dakota’s summary of its new law it says it aims to “protect students and employees at institutions of higher education from divisive concepts.” Whatever they are.

Similar versions of these restrictive laws have been passed in Arizona, Florida, Idaho, Iowa, North Dakota, Oklahoma,. South Carolina, Tennessee, Texas, Utah and Mississippi.

FutureEd has done a good job of cataloguing both the enacted legislation and the bills currently under consideration devoted to racism and sex. You might want to visit. There are 96 of them, nearly all of them in red states.

Imagine yourself a history teacher in any of these states. How do you cover The Mud Sill speech of South Carolina Senator James Henry Hammond, delivered in the U.S. Senate on 4 March 1858, without causing some “discomfort”? That’s the speech in which Hammond said:

In all social systems there must be a class to do the menial duties, to perform the drudgery of life. That is, a class requiring but a low order of intellect and but little skill. Its requisites are vigor, docility, fidelity. Such a class you must have, or you would not have that other class which leads progress, civilization, and refinement. It constitutes the very mud-sill of society and of political government; and you might as well attempt to build a house in the air, as to build either the one or the other, except on this mud-sill. Fortunately for the South, she found a race adapted to that purpose to her hand. A race inferior to her own, but eminently qualified in temper, in vigor, in docility, in capacity to stand the climate, to answer all her purposes. We use them for our purpose, and call them slaves.

Or, how do you discuss the Cornerstone speech of Alexander Stevens, Vice President of the Confederacy, former U.S. Representative from Georgia, and future Governor of Georgia in 1882? In the Cornerstone speech, he said:

Our new government is founded upon exactly the opposite idea; its foundations are laid, its corner-stone rests, upon the great truth that the negro is not equal to the white man; that slavery subordination to the superior race is his natural and normal condition.

It seems to me a violation of all that’s sacred to sugar-coat this stuff. In discussing it with intellectual honesty, a teacher is probably going to offend somebody somewhere, be it a student, a parent or a politician. The truth requires honest discussion of all of America’s history, both the good and the awful. An open discussion in the safety of a classroom where students are free to think critically, and are led by a teacher drawing out the best their brains have to give in the manner of Socrates is good for the students and for the future of America.

Painful though it may be, truth matters.

 

 

 

Zelenskyy’s Heroism, Women’s Long March To Equality, And Then There’s Ron DeSantis

Tuesday, March 8th, 2022

“Be not afraid of greatness. Some are born great, some achieve greatness, and others have greatness thrust upon them.” — William Shakespeare, Twelfth Night

Ukraine update

Last night, Ukriane’s president, Volodymyr Zelenskyy, posted a nine-minute video from the Presidential Office Building on Bankova Street in central Kyiv.

Zelenskyy opened from a window looking out over Kyiv at night (a nice way to show everyone he was really there), and then selfied his way down corridors to his office where he sat at his desk to address the world, as well as the people of Ukraine. His fierce determination not only to defend Ukraine, but, more than that, prevail against a barbaric enemy was on full display. Speaking for all Ukrainians, he said, “I’m here, it’s mine, and I won’t give it away. My city, my community, my Ukraine.”

He closed his address by letting the nation know he had earlier in the day bestowed medals for bravery on 96 “heroes.” He then singled out five and described what they had done to earn the medals. Brilliant stuff.

Zelenskyy continues to unite his country and keep its spine stiff. His leadership, his rhetoric, his example are sharp enough to slice bread. He must be setting Putin’s hair on fire.

International Women’s Day

Today is International Women’s Day, and The Economst has released it’s annual glass-ceiling index, which measures the role and influence of women in the workforce across the countries of the Organization for Economic Cooperation and  Development (OECD).

According to The Economist:

A country’s performance on the index is measured along ten metrics, including the gender pay gap, parental leave, the cost of childcare, educational attainment and representation in senior management and political jobs.

We give more weight to the indicators which affect all women (such as labour-force participation) and less to those which affect only some (such as maternity pay). Paternity pay is also included. Studies show that where fathers take parental leave, mothers tend to return to the labour market (emphasis added), female employment is higher and the earnings gap between men and women is lower.

That “return to the labour market” point is important, given the tremendous difficulty American women are having right now in returning to the labor market due to the ridiculous cost of child care.

It is unfortunate that, in this year’s glass-ceiling index, the United States continues to rank lower in how it treats its women than the OECD average, 20th out of 29 countries.

You may notice the top four countries in the rankings, Sweden, Iceland, Finland and Norway, are Nordic countries so often ridiculed by conservatives as prime examples of “totalitarian socialism.” Actually, these countries have combined successful capitalism with, yes, welfare state benefits that allow their citizens to have a high standard of living, universal health care, and life expectancies higher than most other countries, certainly higher than the U.S.

But all is not Panglossian with the Nordic Model. These countries have large challenges, most notably what to do about an aging population and an influx of immigrants. Time will tell whether they’ll be able to marshal the political will to deal successfully with these significant headwinds.

That said, on International Women’s Day it seems fitting to suggest that, due to the collective culture the Nordics have fostered, their women are much better positioned for success than their peers in America. It pains me to write that.

DeSantis continues to be…well, DeSantis

Yesterday, at the conclusion of a 90-minute virtual video forum (make that show) in West Palm Beach, Florida’s Governor Ron DeSantis and his Surgeon General Joseph Ladapo announced a new state policy that will recommend against giving a coronavirus vaccine to healthy children, regardless of their age.

Sitting in front of what could have been mistaken for an IMAX screen where hundreds of forum participants were pictured, Ladapo enthusiastically proclaimed, “Florida is going to be the first state to officially recommend against the covid-19 vaccination for healthy children.”

Let’s hope it’s the last one, too. National data from the Centers for Disease Control and Prevention show more than 40 Florida children, from birth to age 17, have died from COVID-19. Nationally, the number is nearly1,600.

In an interview reported in today’s Washington Post, Peter Hotez, a professor of pediatrics and molecular virology and microbiology at Baylor College of Medicine and a leading expert on the virus, said, “To be at such distinct variance from the hundreds of physicians and scientists at the CDC and the FDA is reckless at best and dangerous at worst.”

Look, we get it that Governor DeSantis features himself as the next president of the United States and that he’ll say or do just about anything to get there. This is the man who just last week bullied a group of high school students for wearing masks at an event at the University of South Florida. “You do not have to wear those masks. I mean, please take them off. This is ridiculous,” he told the teens just before slamming his folder on a lectern.

These folks are playing with kids’ lives, all for their own opportunistic and hypocritical ends. I can only hope there’s a special place in hell reserved for such people.

I’ll leave you today with this question: How do you think DeSantis would do in Zelenskyy’s chair on Bankova Street? Or, would he have skedaddled to safety before the fun began?

Just a thought.

 

 

North Carolina And Ohio: Worlds Apart

Friday, January 14th, 2022

Law requires all the states to redraw their state and congressional districts in the year following the decennial census of the country. Once they do that their legislatures approve the new maps, and the maps become enacted law. Then the lawsuits begin.

Yesterday, I wrote about a State Court Panel of the North Carolina Superior Court’s decision, rendered on Tuesday of this week, to uphold that state’s recently enacted election redistricting maps, maps the Court strongly affirmed were examples of extreme partisan gerrymandering in every respect in every district. Why? Because the Court said history had shown that’s the way the legislature and the state’s electorate wanted it regardless of which Party was in power.

It’s about 480 miles from Raleigh, capitol of North Carolina, to Columbus, capitol of Ohio. But from yesterday’s ruling on the same subject by the Ohio Supreme Court, you’d think they were on separate planets.

The three signers of the North Carolina decision are Republicans, and in the Ohio Supreme Court there is also a Republican majority. But on a 4-3 vote, with Chief Justice Maureen O’Connor, a Republican, siding with the three Democratic Justices, the Court invalidated the GOP’s recently-drawn legislative maps.

The Ohio Constitution requires mapmakers to attempt to match the statewide voting preferences of voters over the past decade. That amounts to 54% for Republican candidates and 46% for Democratic candidates. According to the decision, “The commission is required to attempt to draw a plan in which the statewide proportion of Republican-leaning districts to Democratic-leaning districts closely corresponds to those percentages.” The Court ruled that did not happen. What did happen was extreme partisan gerrymandering.

Until November 2015, Article XI of Ohio’s constitution specifically allowed, and the Court upheld, partisan gerrymandering. However, in that year Ohio voters overwhelmingly approved an amendment to the constitution repealing Article XI and replacing it with a new version, which established a new process for creating General Assembly districts. The amendment provided for the creation of a seven-member Ohio Redistricting Commission, composed of elected officials, such as the Governor and other legislative leaders. The Ohio Redistricting Commission that drew up the new maps under dispute consisted of five Republicans and two Democrats.

The Ohio commission is responsible for redistricting the boundaries of the 99 districts of the House of Representatives and the 33 Senate districts in the year immediately following the release of the federal decennial census. This is the same procedure followed in North Carolina and in every other state. However, Section 6 of Ohio’s new Article XI mandates: “No general assembly district plan shall be drawn primarily to favor or disfavor a political party.” Further, “The statewide proportion of districts whose voters, based on statewide state and federal partisan general election results during the last ten years, favor each political party shall correspond closely to the statewide preferences of the voters of Ohio.”

And that’s not all. The Court’s majority, interpreting the state’s constitution, wrote, “To adopt a plan under Section 1(C) (of Article XI), at least two members of each of the two largest political parties represented in the General Assembly must be in the majority voting for the plan.” Wow! The Ohio Supreme Court’s interpretation of the state’s constitution is requiring Republicans and Democrats to work together to establish state voting districts. With respect to gerrymandering, the Court has handcuffed the partisan Commission.

The Ohio Supreme Court’s decision is 146 pages (Thank you very much; North Carolina’s was 260.). The beginning of it gives a highly readable history of the drawing up of the maps. Anyone interested in an application of the quote about laws and  sausages misattributed* to Germany’s Iron Chancellor Otto von Bismarck should read pages 6 through 21. Enough said.

Because 2 February 2022 is the deadline in Ohio for candidates for legislative offices to submit petitions and declarations of candidacy, the Court ordered the Commission to meet, draw up, and submit new redistricting maps to the Court within ten days of its decision.

In yesterday’s column I wrote about North Carolina’s two decade charade in which the Party out of power repeatedly calls for an Independent Commission to formulate map redistricting, rather than elected officials. That is, until they come to power, when it suddenly doesn’t seem like such a good idea. In Chief Justice O’Connor’s concurring opinion she begins by saying she agrees with everything in the Court’s decision and order. But then she goes into depth about how Ohio’s voters might want to amend the Constitution again in order to create such an Independent Commission in an attempt to stop all the partisanship, or at least slow it down. She analyzes Arizona’s decision to do just that. In my next column, I’ll examine the Arizona change and report on its results thus far.

But for the moment, ask yourself this: Are we one country, or are we fifty countries? Are the shenanigans that go on every ten years in every state capitol what we really want for America? Or, do we want one, unified system that insures all elections, at least at the federal level, are governed by the same rules?

I’d love to know how America’s voters, not America’s legislators, would answer those questions.

*The true author is now  believed to have been American poet John Godfrey Saxe, who said it in 1869, 25 years before Bismarck. Saxe’s exact quote is, “Laws, like sausages, cease to inspire respect in proportion as we know how they are made.”

 

 

 

Reflections On WCRI’s Recent Virtual Annual Conference: In A Word, It Was Excellent

Tuesday, March 30th, 2021

COVID-19 impact analysis

Last year, the Workers’ Compensation Research Institute held its Annual conference in Boston at the Westin Hotel on 5 and 6 March. The ballroom was full. COVID-19 was talked about in the conference and on the breaks, but it was too new to be on the Agenda. Everyone was doing elbow bumps instead of hand shaking. Four days after the conference wrapped, Governor Charley Baker declared a Massachusetts State of Emergency. The WCRI conference was likely the last one held in the City before everything shut down.

At that time, per the Johns Hopkins University COVID-19 Dashboard, the nation had seen ~139,000 cases and 2,425 deaths. In Massachusetts, where the conference was held, there had been 4,955 cases and 48 deaths.

The following month, the National Council on Compensation Insurance (NCCI) issued a Research Brief titled, COVID-19 and Workers’ Compensation: Modeling Potential Impacts. 

NCCI’s analysis projected a best case scenario, in which loss costs would increase $2 billion, and a worst case scenario, in which they would increase $81.5 billion, or 250% more than then current total loss costs. Willis Towers Watson also released a scenario-based analysis that suggested pretty much the same thing.

Also in April, the California Workers’ Compensation Insurance Rating Bureau (WCIRB) projected loss costs if conclusive (rebuttable) presumptions were provided to front line workers, something Governor Gavin Newsom actually did through Executive Order one month later, so the “if” became a “done.” The WCIRB report concluded costs would range “from $2.2 billion to $33.6 billion with an approximate mid-range estimate of $11.2 billion, or 61% of the annual estimated cost of the total workers’ compensation system prior to the impact of the pandemic.

A year later, at this week’s virtual annual conference, WCRI Economist Olesya Fomenko, Ph.D., reported results from her analysis of workers’ compensation claims in WCRI study states for Q1 and Q2, 2020. This period, ending 30 June, encompassed the pandemic’s first of what has been up to now three surges.*

Her data and presentation slides are preliminary, but more than likely will stand up to future scrutiny. Her findings confirmed what most students of COVID-19 were intuitively thinking. To wit, it does not appear that, at least through the study period of two quarters, COVID-19 would deal a death blow to the workers’ compensation industry. Claims in her analysis of 27 study states are plentiful, but relatively inexpensive. There is wide variation in the geographic distribution of claims, probably because COVID-19 surged at different times in different states. New York is not among the WCRI study states, but during the period of Fomenko’s analysis, it was the state with more COVID problems than any other. A lot more.

During the study period, Massachusetts, Connecticut and New Jersey had the most reported claims. Massachusetts claims were 42% of all reported claims in the study states and 59% of all lost time claims. Dr. Fomenko suggested that the presence of presumption laws, pay without prejudice (in the case of Massachusetts) and other compensability issues (in New Jersey) might is some way contribute to the high numbers in those states.

Looking at Massachusetts for a moment might be instructive.

At the top of this column we showed Massachusetts with relatively few cases as of early March, two-thirds of the way through Q1. Let’s look at Massachusetts now, at the end of Q1 a year later. The state has been hit hard, but has also rebounded. Here’s a look at the state by county:

As you can see, no county has had less than 3,000 infections, and three have had more than 10,000. But what came of those infections? How did the patients make out medically? Here is a look at cumulative cases from 9 March 2021 through yesterday, 29 March 2021.

There have been 17,130 total deaths since the beginning of the pandemic, but 97% of infected patients have recovered. Deaths are at 3%, which is less than the 5% predicted by the CDC one year ago. And this is the case for most of the country, and is one of the reasons Dr. Fomenko’s data shows claims to be relatively inexpensive.

NCCI Analysis

The WCRI studies define the concept of “early days.” So do those from the National Council on Compensation Insurance (NCCI). The point is, however, that analyses from both organizations appear to be congruent and complementary.

The lasting costs of COVID-19 to the workers’ compensation industry, aside from deaths, are going to come from permanent total and permanent partial disability awards. To that end, in October, 2020, NCCI published a Research Brief updating the Brief cited earlier in this column and titled, COVID-19 And Workers’ Compensation: Permanent Disability. These costs will be significant. NCCI’s analysis determined the average age of hospitalized COVID-19 patients at 49.5 years old. Average life expectancy allows for about 30 more years of benefits. The organization writes:

Given that severe cases are expected to have a higher likelihood of permanent disability, particularly PTD injuries, NCCI
assumed that all PTD claims would occur in this symptom grouping (infections and lung claims). Adjusting our PTD rate to between 0.0% and 1.5% to be applicable to only severe cases, we observe a PTD rate between 0% and 10% (= 1.5% / 15%) using the default Critical Care Rate from the NCCI Hypothetical Scenarios Tool.

Permanent Partial Disability cases are another matter. Here the frequency will be higher as well as the costs:

One interpretation of this assumption could be that moderate cases behave more like infection claims which tend to have a
near-zero PTD rate. If we compare the lung and infection PPD rates, we observe that lung claims have about twice the
likelihood of a PPD injury compared to infection claims. To the extent that moderate cases of COVID-19 behave like
infection claims and severe cases behave like lung claims, then a similar difference in the PPD rate may be expected. Under
this view, the Severe PPD rate would range between 40% and 50% with an implied Moderate PPD rate ranging between
20% and 25%.

With assumptions it clearly states contain wide variability, NCCI suggests the following COVI-19 benefits by injury type:

We’ll continue to follow the NCCI analyses as well as WCRI’s ongoing research.

Interview by John Ruser, PhD, with John Howard, MD, MPH, JD, LLM, MBA

John Howard is the longest serving Director of the National Institute for Occupational Safety and Health, three terms and counting. He is a legend in the field, and WCRI attendees got a good look at why during this wonderful interview by John Ruser. Howard, who has more letters after his name than there are years in elementary and high school combined, put on quite a show.

Some people are one inch wide and ten miles deep; others ten miles wide and one inch deep. Howard seems to know no inch or mile boundaries.  His subject was The Future of Work, and he made a number of highly interesting and prescient points, even going so far as to describe Aristotle’s concerns about automation in the ancient world of 350 BCE.

Asked about fears of jobs disappearing because of Artificial Intelligence and automation, Dr. Howard pointed to a study showing that in 2018 there were 60% more jobs than existed in 1940. Jobs have always gone away, but they’ve been replaced, and then some, by new jobs.

He’s concerned about a safety ergonomic vacuum employers are going to have to manage somehow. He believes employers are facing a “real challenge” adjusting to the new Work From Home paradigm.

My question is: How do employers deal with, let alone manage, workers’ compensation claims bound to occur while working in the home. You’re at your desk or dining room table working, get up for lunch, fall down the stairs and break an arm. Is that compensable? Is your employer going to make you prove it actually happened while you were actually working, and not just taking Junior out to the back forty for a little tag football?

And what responsibility does an employer have with respect to OSHA’s General Duty Clause, the one about providing a safe and healthful workplace?

If anyone can figure this stuff out, my money’s on John Howard.

Conclusion

Under trying circumstances, WCRI did an admirable job of hosting its 2021 Annual Conference. I’m told attendees gave it high marks, as well they should have. At the end of the second day, Dr. Ruser announced next year’s conference as being back in Boston’s Copley Westin Hotel on 15 and 16 March 2022. And I have a suggestion: After this ridiculously stressful year, it would be helpful and probably appreciated to devote a session to the impact of COVID-19 on employee mental health. A lot has happened in the last year to the field of Behavioral Health. It seems to have fitted in quite well to the new paradigm called Telehealth. It would be interesting to learn about that.

 

* Yesterday, CDC Director Dr. Rochelle Walensky said, “We do not have the luxury of inaction. For the health of our country, we must work together now to prevent a fourth surge. I so badly want to be done. I know you all so badly want to be done. We are just almost there, but not quite yet.” Walensky said she is now feeling a sense of “impending doom.”

**The Future of Work: The Economist is presenting a discussion on 8 April, at 4 pm, EST. To reserve a place, go here.