Category Archives: Poverty & income gap

Sustaining the Biggest Public Nuisance in Richmond

Mosby Court, public housing project in Richmond

Republished from Cranky’s Blog.

Not satisfied at maintaining the largest public nuisance in Richmond – the one that just led to the shooting death of a State Policeman – the Richmond Redevelopment and Housing Authority (RHHA) now proposes to do nothing realistic about it:

  • Fencing and gates. RRHA says this remedy is “largely . . . impractical.” I guess killing policemen is more “practical.”
  • Parking stickers and IDs. Not a bad idea, but worthless until they have the off-duty cops in place to catch the trespassers.
  • Empowerment programs. So, the problem largely is male visitors and they are going to “empower” the tenant girlfriends who are harboring those males? Please! The remedy is to evict those girlfriends.
  • Summer programs for the kids. Good thing to do but unrelated to the visiting male problem.

This is not rocket science, folks:

  • The feds tell us “(1) that effective property management can have a major impact on the health of a community, and (2) that accessible, legitimate techniques can be used to stop the spread of drug activity on rental property.”
  • Indeed, as to drugs (and certainly as to other crime), nuisance abatement is the sole tactic that has been shown scientifically to reduce crime in residential places. The DOJ monograph says: “With the evidence available we are relatively certain that holding private landlords accountable for drug dealing on their property by threatening abatement reduces drug related crimes.” Whether as to drug activity or other disorder, the landlord is the only entity that can make the physical changes to the property, evict the troublesome tenants, hire the security, control the access, and enforce the lease terms necessary to make the property safe.

Yet, RRHA, aside from the fences they have rejected, is not talking about what we know can help here:

  • Lights;
  • Cameras;
  • Access control;
  • Off-duty cops on patrol;
  • Rigorous trespass enforcement; and
  • Rigorous lease enforcement (i.e., eviction of the girlfriend who harbors the disorder)

As to that last point, the HUD lease [at Para. 25] contains the necessary provisions. These include eviction for, inter alia:

  • Drug related criminal activity engaged in  on or near the premises by any tenant, household member, or guest; and
  • Criminal activity by a tenant, any member of the tenant’s household, a guest or another person under the tenant’s control that threatens the health, safety or right to peaceful enjoyment of the premises by other residents or by persons residing in the immediate vicinity.

Yet, when I spoke with them about this (in the distant past), they said

  • Legal Aid makes it difficult to do anything;
  • The judges are reluctant to enforce the lease;
  • It would be “onerous” to ask RRHA staff to follow up on all offense reports and calls for service; and
  • Given the quality of the people who live in subsidized housing, RRHA can’t be expected to do much better.

To judge from their response to the current murder rate, and the shooting of the policeman by a trespasser who was living at RRHA, their indifferent attitude and the soft bigotry of their low expectations have not improved.

It is clear that RRHA is not serious about controlling its property. City Council is quiescent. The Commonwealth’s Attorney is not prosecuting the RRHA Board for maintaining the nuisance. Your tax dollars at “work.”

The Scourge of Rootless, Predatory Males

Travis A. Ball

Last week 27-year-old Travis A. Ball allegedly shot and killed Virginia State Police Special Agent Michael T. Walter in an apparently unprovoked attack in the Mosby Court public housing project. The murder was the seventh homicide and one of about 20 shootings to take place in the troubled housing project so far this year.

The Richmond Times-Dispatch has done commendable work fleshing out the circumstances of the murder and the background of the alleged killer, but a bigger story remains to be told. The crime gives us a window into the pathology of 21st-century American poverty. Through the story of Travis Ball we can gain insight not only into the social breakdown of inner-city African-Americans in public housing but the spreading social dysfunction among the poor of all races and ethnic groups.

The tip-off appears in Robert Zullo’s article in the T-D today: In his arrest warrant, Ball had listed as his address a home on the 1900 block of Redd Street in Mosby Court. But he had been banned from the property in 2016, and his name was registered on a 4,000-person list of people ineligible to live there. Shortly after that ban, according to a second T-D article, an emergency protective order was issued for the mother of one of Ball’s children. Court records show that Ball had engaged in several acts of domestic violence. The T-D articles indicate that he had two children with one woman, and hint that he may have fathered a child with a different woman.

Think about this: Mosby Court maintains a list of some 4,000 individuals who are banned from living in housing project of only 458 units. That is an astonishing number. The T-D reporting does not give us a profile of these people, but I would be willing to wager that the list is comprised overwhelmingly of men, like Ball, and that the vast majority have been blackballed for violent behavior on the project premises.

The problem is that the Richmond Redevelopment and Housing Authority (RHHA) has no effective means of enforcing the list.

“The manpower that’s required, it’s hard to knock on doors on a daily basis,” said RRHA CEO T.K. Somanath. “Neighbors sometimes let us know, and we have our property management [and] maintenance folks inspecting these properties periodically. There are ways to find out if people are not abiding by the lease [which] causes these violations, and we take action.”

The housing authority disbanded its own seven-member police force in 2014 due to budget pressures and the conviction that residents would be better served if the agency deployed its resources consistent with its core mission of providing housing services. It is not clear from the article whether or not the RHHA police were used to enforce the banishment list. Whatever the case, there is no effective enforcement mechanism now.

I am entering the realm of conjecture here, and I advance the following observations not as fact but as operating hypotheses to be confirmed or rejected through follow-up reporting. The RHHA, according to its website, manages and maintains 12 housing developments for low-income families, seven developments for the low-income elderly and the disabled. The low-income housing, I suspect, are dominated by households of single mothers with one or more children. The number of households with married spouses and children approaches zero.

I conjecture the existence of a large floating population of under-employed, unmarried men in low-income communities — be they like Mosby Court or a rural trailer park — who lead a largely parasitical existence. They attach themselves to women as sexual partners, moving into their apartments, eating their food, and contributing only sporadically to the maintenance of the household. These relationships are typically unstable, fraught with domestic violence and child abuse. Men move from woman to woman, impregnating them with no concern for the welfare of the children. Sometimes they establish meaningful relationships with their biological children; often they do not. Nonpayment of child support is endemic. Often, women don’t even know for certain who the fathers are.

I further conjecture that the existence of this population of unattached males explains another widespread and unexplained phenomenon: that of childhood hunger. Low-income families have no trouble obtaining food stamps. Why are children going hungry? Why must school districts maintain breakfast and lunch programs? Why do charities provide children with backpacks of food to take home during weekends? Is it possible that many household food budgets are being stretched by the necessity to feed an adult male whose presence is entirely “off the books”?

The prevalence of unattached, freeloading and often violent males, I submit, is one of the great unacknowledged scourges of poverty in the United States today. Though poor themselves, many of these males are predators and they add immeasurably to the horror of poverty. They prey among the weak in their midst, inflicting routine domestic violence that never makes it into the newspapers (unless a murder occurs). They commandeer the limited resources of the women they live with, often resulting in the abuse and neglect of the women’s children — especially if the children are not their own.

It is not politically correct to portray 21-century American poverty in this way. Progressives are committed to the idea that the pathologies of poverty are the result of endemic injustices such as racism, income inequality, poor schools, and insufficient economic opportunity. Read the academic literature and the politicians’ press releases and you see nothing about the growing population of rootless, predatory males. Unless we acknowledge the realities of poverty, how can we ever hope to combat it?

Let me be 100% clear. Although I am extrapolating from an inner-city housing project, this problem is not unique to African-Americans. Rootless males are prevalent among poor whites, Hispanics and American Indians. (See my post about Jesse Lee Herald, a 27-year-old white man in Shenandoah County who had fathered seven children by six different women.)

This is one of the great untold stories of the United States today. But because of our politically blinkered thinking, we cannot see it.

Elite Universities and Socioeconomic Diversity


Over on Cranky’s Blog, it appears that John Butcher, like me, has little better to do this Memorial Day weekend than to ruminate upon the implications of a recent New York Times op-ed piece written by columnist David Leonhardt. Lamenting the paucity of smart kids from poor schools admitted to the nation’s elite universities, Leonhardt attributes much of the decline to cuts in state support, which forces universities to raise tuition, which in turn makes makes it harder for poor kids to attend. (I previously addressed Leonhardt’s column here.)

Leonhardt believes that the decline of poor kids in elite schools represents a closing off of the nation’s meritocracy. But an alternative way of looking at the picture is that elite schools admit the smartest kids, and that the smartest kids (as defined by SAT scores, which predicts academic success in a higher-education context) tend to be found among poor households in significantly smaller numbers. There is a social problem, but it isn’t elite university admission policies. The question isn’t why elite universities are failing poor kids. It’s why K-12 systems are failing them.

In his op-ed, Leonhardt presents a chart that shows the percentage of Pell Grant students at 20 elite public universities. The University of of Virginia and Virginia Tech are second and third lowest.

Cranky responds to these data points this way: “Those low numbers are not a problem unless one thinks that these schools should dilute their brands by admitting less qualified students.”

That is a tremendously important point. Read Cranky’s post to follow his logic and view the data supporting it. In the end, he concludes that a much more interesting question than Leonhardt’s is why poor kids graduate from college at much lower rates. And that brings us to the dismal quality of academic preparation offered by many high schools, as evidence by an article in today’s Washington Post profiling a Washington, D.C., public high school, Ballou High School.

Teacher turnover in schools serving lower-income populations — 25% at Ballou this year — is a perennial scourge. At Ballou, departing teachers cited frustration with large classes of students who were far behind academically, lacked the foundation to be successful, and often disrupted class. School administrators provided little backup to enforce order. As full-time teachers dropped out, temps and substitutes filled in. Instruction became disjointed and incomplete. Even motivated students suffered.

“Students simply roam the halls because they know that there is no one present in their assigned classroom to provide them with an education,” wrote a music teacher. “Many of them have simply lost hope.”

The Post described the situation of 11th-grader Dwight Harris:

 Harris said that since his teacher left, he hasn’t learned much in algebra. Substitutes have told him and his classmates to fill out worksheets, he said, which they answer by Googling the problems.

Many times, Harris said, he stays in the room for 10 minutes, long enough for the sub to mark him present. “I have no idea what my grade is right now,” he said, “but I think I’ll pass the class.”

Admittedly, Ballou is an extreme example of dysfunction, severe even by inner city standards. But problems like social promotion, disruptive students, disorderly classrooms, demoralized teachers, and excessive reliance upon temporary and substitute teachers are endemic. Students may be natively intelligent but it is a stretch to think that someone like Dwight Harris, no matter how bright and motivated, can graduate from such an environment as academically prepared as his peers at functional high schools.

Virginia high schools are graduating a higher percentage of students than ever. Consequently, a higher percentage of young Virginians, especially from poor households, are looking at college as the next step in their career progression. But are they academically prepared for college-level work? I’m persuaded that many are not.

To circle back to Cranky’s point, UVa could compromise its admission standards in order to appeal to the egalitarian sensitivities of David Leonhardt. But would that be a good idea?

At present, lower-income kids at the University of Virginia graduate at almost the same rate as rich kids, as can be seen in the graph at the top of the post. (The gap is wider at Virginia Tech, comparable to that of Virginia four-year institutions as a whole.) In other words, poor kids who gain admission to UVa deserve to be there. They are not displacing other students who could benefit more from a UVa education.

What if UVa began relaxing standards to admit more poor students? Would the poor students wind up better off than if they had attended a different university for which they were academically prepared? Or would they drop out at higher percentages after taking out big loans and saddling themselves with debt? Even from the perspective of the poor kids — to say nothing of kids who would be displaced — it could well be counter-productive to ask UVa or other elite universities to compromise their standards.

The problems of poor kids can be traced back to high school, and from high school back to middle and elementary schools, and from there to poverty-ridden environments at home. That’s the real issue, not a lack of socioeconomic diversity at elite institutions.

How Do We Respond to Declining Economic Diversity in Elite Universities?

Writing in the New York Times earlier this week, columnist David Leonhardt expresses his dismay at the decline in state funding for higher education, the resulting surge in tuition, and the slide in economic diversity at the nation’s top public universities. “The declines in state funding are stunning,” he says. “It’s as if our society were deliberately trying to restrict opportunities and worsen income inequality.”

Source: New York Times. Click for legible image.

Judging by the data he presents, Virginia is no exception to the rule. A chart showing twenty “top public universities” includes the University of Virginia and Virginia Tech. They are second and third from the bottom ranked by the percentage of Pell Grant recipients. (Federal Pell Grants go to students from lower-income families.) Leonardt’s op-ed also displays graphics showing state funding cuts for higher education since 2008. While Virginia isn’t among the worst of the bunch, it’s isn’t one of the better ones either.

“The net result, to put it bluntly, is bad for the country,” says Leonhardt. “Top state universities are displacing impressive low-income students, who have often overcome troubled neighborhoods and high schools. Many of those students then enroll instead in colleges with fewer resources and higher dropout rates. In the process, the higher-education system becomes a bit less meritocratic.”

Bacon’s bottom line. Leonhardt’s op-ed casts the local higher-ed issues that we’ve been examining here in Bacon’s Rebellion in a national light. Misery loves company. I suppose it’s some comfort to know that what we’re experiencing here in Virginia is part of a national trend, not something uniquely perverse to the Old Dominion.

Why would this trend be national in scope? Clearly, the slashing of state aid to higher ed must be viewed in the context of stagnant state budget revenues nationally, caused primarily slow economic growth, and by the crowding out of state General Funds by Medicaid expenditures. State legislatures find it easier to cut higher-ed spending because colleges and universities — unlike, say, public schools, prisons and state police — have the means to make up the difference by raising tution.

Unless President Trump’s economic policies usher in a new era of growth and prosperity (I’ll let you judge the likelihood of that happening), state budgets will remain chronically stressed. As the population ages, Medicaid expenditures will continue to increase. As Baby Boomer teachers, policemen, and state employees retire en mass, many states will meet a fiscal reckoning in the not-too-distant future as the reality of massively under-funded pension liabilities hits home.

In other words, states’ cruel fiscal choices will not get any easier. State legislatures will continue to nibble away, year by year, at the amount of state support they provide public colleges and universities.

“This country should … be investing more of its resources in education,” writes Leonhardt.

Spending more money is always the answer for some people. Given that such people never advocating spending less on anything, that choice leads ineluctably to higher taxes. Great — educate the middle class. Then run it off with higher taxes.

Here in Virginia and across the nation, we need to challenge conventional thinking about how to provide citizens with the knowledge and skills they need to function in a 21st century society. Perhaps we should re-examine the assumption that a four-year college education is the best path of upward social mobility for lower-income people. So many jobs today require technical training, not a college education. Should lower-income students be encouraged to drop out of the labor market for four years, and rack up debt in the process, in order to enter a four-year institution that the odds say are 50/50 they will never complete?

Instead of spending more on higher education — we spend plenty already — perhaps we should be spending money differently.

Hat tip: Steve Haner.

How to Dismantle the Poverty-Industrial Complex

Marland Buckner

Marland Buckner

Richmond’s new mayor is young, energetic and bursting with ideas. At 36 years old, the James Madison University-educated Levar Stoney represents a new generation of African-American political leadership. He has one foot in the minority community and one in the creative class. His top priority to date has been to restore competence to a city administration plagued by corruption and ineptitude. Now there are signs that he may entertain refreshing ways of thinking about how to deal with poverty.

The traditional Democrat Party urban machine approach has been to spend more money on all manner of government “programs” and “urban renewal” projects that over the years have done little to reverse the scourge of inter-generational poverty and despair. Judging by an op-ed in today’s Richmond Times-Dispatch by Marland Buckner, who served on Stoney’s transition team, City Hall may be open to rethinking that paradigm.

Buckner, co-founder of MB² Solutions, a public policy strategy firm, writes of a “poverty-industrial complex” that encompasses the public housing sector, public schools, and the criminal justice system. It’s not clear exactly how he thinks these institutions have failed the poor, but he advocates four strategies that can help dismantle it.

Evidence-based decision-making. “Evidence-based decision-making,” writes Buckner, “means embracing the tough, costly work associated with evaluating city programs. This is turn requires technology tools and training to ensure that city employees can generate actionable intelligence for decision makers.” Unfortunately, he adds, the city administration is equipped with “technology firmly planted in the 20th century.”

Anti-poverty market research. “Businesses rarely succeed by failing to pay attention to customers,” Buckner says. “The same holds true in anti-poverty policy making. When well-intended programs are built without sufficient attention to what people seeking to lift themselves from poverty actually need, results fall short and disappointment abounds.”

Regional anti-poverty commitments. The Richmond region should pursue anti-poverty programs on a regional basis.

Impact investing. “We cannot tax, spend, or cut our way to helping households achieve self-sufficiency.” Tackling poverty, Buckner says, “demands policy innovation beyond simply asking, “which taxes do we raise or what services must be cut?” He sees impact investing as an alternative — using private dollars to fund social programs that, if successful, create economic value.

The idea of impact investing is appealing, but I would like to see more concrete examples. The only ones that come immediately to mind are not terribly encouraging, such as the privatization of public housing projects by non-profit entities. Still, Buckner is thinking differently, rather than wedding himself to a failed status quo.

Of the four strategies, evidence-based decision-making strikes me as the most important. A couple of weeks ago, I highlighted an example of how the Richmond city jail is using social-scientific analysis to guide its implementation of programs to reduce recidivism. If Stoney accomplishes just two things — restoring competent financial management to city government and instituting evidence-based decision-making — his tenure will be a success. Hopefully, Marland Buckner still has the mayor’s ear.

Running in Neutral: a K-12 and Higher Ed Scandal

If a student hasn’t graduated from college within six years, the odds of completing a degree are extremely low.

In this month’s issue of Atlantic, Nick Ehrmann writes a perceptive article, “Solving the Mystery of Underachievement: Why work hard enough to earn an A when a D will suffice for college admission?” He tells the story of an intelligent African-American lad who was groomed to attend college — and ended up dropping out after the first semester. The article goes to the heart of one of the most pressing issues in American higher education today: the high rate of college drop-outs.

Literally millions of young Americans, disproportionately minorities, borrow money, attend a few semesters, and then drop out, never acquiring the college credential that will allow them to pay off their debt. A primary goal of Virginia higher education policy today is to reduce the number of these college drop-outs, who are all-too-prevalent in the state, as elsewhere in the country. The “retention” rate is a key metric used to measure the performance of Virginia’s public colleges and universities. (See the chart above.)

In my commentaries on the subject, I have assumed that dropping out of college could be explained by one of two factors: (1) poverty, or (2) lack of academic preparedness. True enough, poor kids can qualify for tens of thousands of dollars in Pell grants, federal loans and institutional financial aid. But that assistance rarely covers all costs, and students from lower-income families typically have to work part-time jobs, or even drop out for a semester or two to find the extra money. Once a student drops out, he or she is at higher risk of never re-enrolling. The other problem is that lower-income kids tend to come from lower-income neighborhoods, which tend to have poorer schools. The inadequate academic preparation makes it difficult to keep up with college-level work. Discouraged and demoralized, students question what they’re doing in college at all.

Ehrmann’s article suggests a third reason why kids drop out of college — the phenomenon of “running in neutral.” The article, I believe, is so important that I will summarize its contents in detail, highlighting what I deem to be key insights. But don’t settle for the Bacon’s Digest version — read the full essay yourself.

Enrollment in higher education is reaching record-high levels, just a hair below 70% of all high school graduates. But being “eligible” for higher education does not mean that students are academically prepared, writes Ehrmann. He knows from first-hand experience teaching kids in Washington, D.C. He mentored one young man, Travis Hill, who showed flashes of brilliance, and kept tabs on him through the years.

In the fifth grade, Travis was admitted into a scholarship program through the “I Have a Dream” Foundation, which guaranteed that any participating student who graduated from high school would receive a college scholarship. The idea was that removing financial obstacles to college enrollment would encourage students to achieve. “Travis, like many of his classmates,” writes Ehrmann, believed there was ‘no doubt’ he would graduate from high school and enroll in college. He did graduate, and he did enroll in Lincoln University, a historically black university in Pennsylvania. But he dropped out after a semester. Why?

In Ehrmann’s view, there are two schools of thought. One is the “culture of poverty” theory in which “low-effort syndrome” or cultural adaptations like a prejudice against “acting white” prevent young people from living up to their potential. The other is the “structural barriers” theory that emphasizes how poverty, institutional racism, segregation and lack of adequate health care stack the deck against poor, minority students.

Writes Ehrmann:

The problem is that neither story is completely right. Over the course of a decade … I witnessed a significant number of students develop a sophisticated logic of underachievement that challenged the popular accounts for how inequality in higher education is created and sustained. For many students, their pursuit of long-term educational success was grounded and strategic. Educated in environments that measured academic success primarily by enrolling in college — not necessarily graduating with a degree — they developed strategies to achieve that goal with minimal effort in school.

Travis made no effort to make As and Bs. To the contrary, he skated by with the minimum passing grades. “Doesn’t matter,” he said. “I work hard when I want to work hard, and that’s what a lot of people can’t do. Some people might not look at it as a skill, but to me it’s a skill.”

That message was inadvertently reinforced from other directions. During his freshman and sophomore years on overnight campus trips sponsored by his high school’s college-placement office, Travis learned that “a couple hundred” colleges and universities across the United States would offer him admission. “Everyone was telling me I could get into college with my grades,” he confided. “I don’t remember exactly how or when I heard it, but that message was seeping into my brain. If I got straight Cs, admissions would be a breeze.”

Every marking period, Travis let his grades slip, When midterm grades were sent home, his grades were typically Cs, Ds and Fs. His mother and stepfather got on his case, and he promised to get his act together. In the final weeks of the term, he approached his teachers one by one and exhibited greater effort in class. His strategem: “Just go to the teacher and act like you care.” Continue reading

Government’s War on the Poor: College Loans

Chart credit: Mercatus Center

Students graduating in recent years are defaulting on student loans at a significantly higher rate than earlier age cohorts, finds Mark J. Warshawsky, a senior research fellow with the Mercatus Center at George Mason University, in a posting on the Mercatus website.

“Some students, particularly from nontraditional backgrounds, seem to have been harmed by the increase in federal funding of student loans,” he says. “They have not seen increases in their incomes as workers, have often not completed their education, are more likely to default on their loans, and miss out on job-related income and training.

Click for more legible image.

Warshawsky does not offer an explanation of why loan default rates are climbing. But the answer is obvious: Uncle Sam has been shoveling out more and more loans without any consideration of credit risk. As the percentage of high school graduates enrolled in two- and four-year institutions of higher education has increased over the years (see chart immediately above), we have seen an increase in the number of students who (a) are not academically prepared for college-level work, (b) lack the family resources to complete college, even with loans, or (c) both.

These college drop-outs and defaulters are disproportionately poor and minorities. The federal government cannot issue loans on the basis of credit quality, for that would mean discriminating against the poor and minorities, a political impossibility. So, instead, Uncle Sam dishes out loans indiscriminately, and the poor and minorities are the ones who wind up defaulting disproportionately on student loans and suffering the adverse consequences of ruined credit scores and debt they cannot discharge.

Thus the price of misguided compassion…

Do you want stronger proof? The percentage of high school graduates attending college has ticked down slightly since 2009, while the total of state and federal grants and loans has dipped since 2010. If I my logic above is correct, and absent an economic downturn and widespread job loss, at some point we should see a reversal of the trend shown in Warshawsky’s chart and a decline in the rate of defaulting students.

How Important Is Insurance to Health Outcomes?

The variability in health insurance by city and county accounts for 30% of the difference in health outcomes. What about the other 70%?

The variability in health insurance by Virginia city and county accounts for 30% of the difference in health outcomes rank. What explains the other 70%?

A dominant strain of political rhetoric tells us that having health care insurance is absolutely vital to maintaining peoples’ health and longevity. Without health insurance, people will die! The logic makes sense if one assumes that the United States (and Virginia) have a binary health care system in which people either (a) have health insurance (including Medicaid and Medicare), giving them full access to the health care system, or (b) lack insurance and receive no medical treatment. But in the real world, there’s a big fuzzy zone. Some insurance, frankly, stinks — limited choices, high deductibles and the like. And some uninsured people enjoy at least limited access to medical care at clinics, emergency rooms and hospital care.

On a lark — I honestly had no idea what results I’d get — I created a scatter graph comparing two data sets for 132 Virginia counties and cities. One comes from the StatChat blog: Health Care Coverage Across Localities in Virginia in 2015, based on data from the U.S. Census Bureau American Community Survey. The other comes from the Robert Woods Johnson Foundation 2017 County Health Rankings, which ranks city and county health outcomes on a basket of health quality and longevity metrics.

The chart above shows the results. As one would expect, there is a significant correlation — localities with lower percentages of uninsured working-age populations tend to have better health outcomes, and vice versa, higher percentages of uninsured populations translate into worse health outcomes.

But the R² coefficient is only .3044. That’s statistics-speak for saying that the variation in the percentage of the insured population accounts for only 30% of the variation in health-outcome rankings. (Note: that’s health-outcome rankings, not actual health outcomes. I readily concede that this is a quick-and-dirty analysis.) Thirty percent is significant, but it leaves a lot unexplained. Seventy percent of the variance is due to other factors.

The debate about health care in the United States over the past half century has focused mainly on expanding access to health insurance as a way of expanding access to medical treatment. But insurance accounts for maybe 30% of the problem. What about the other 70%? The Robert Woods Johnson (RWJ) attributes the following weights to different health factors:

  • 30% — health behaviors (tobacco use, diet & exercise, alcohol & drug use, sexual activity);
  • 20% — clinical care (access to care, quality of care);
  • 40% — social & economic factors (education, employment, income, family & social support, community safety);
  • 10% – physical environment (air & water quality, housing & transit).

Here in Virginia, Democrats are obsessed with Medicaid expansion, as if the percentage of population with insurance is the be-all-and-end-all of health policy. Unfortunately, Republicans have offered few reasons to oppose Medicaid expansion other than to emphasize the stress it would impose upon state finances.

Instead perpetuating this sterile debate out of partisan loyalty or antipathy to former President Obama’s signature legislative achievement, we should ask if we can make bigger gains in health outcomes at less expense than by expanding Medicaid. The RJW report gives heavier weight to personal behavior as reflected in smoking, substance abuse, sexual activity, nutrition and exercise. Perhaps the politicians should, too.

Probing the “Insurance Coverage” Numbers

Insurance coverage broken down by state.

Insurance coverage broken down by state. Chart source: StatChat

With Governor Terry McAuliffe making another bid to expand Medicaid via a budget amendment, the publication by the StatChat blog ten days ago of data on the extent of insurance coverage in Virginia couldn’t be more timely.

The blog post is content to present the data with little commentary or explanation of what’s happening, however, so I’ll try to fill in the gaps.

The good news is that in Virginia, more than 90% of the population has some form of insurance (including Medicare and Medicaid). The bad news is that 9.1% of the population still has no insurance coverage. And, despite a lower unemployment rate and a higher median household income than the national average, the percentage of the insured population hovers just at the national average.

By eyeballing the chart above, we can see that Virginia’s uninsured population bounced around the 12% mark for several years, then jumped ahead one or two percentage points after the implementation of the Obamacare health exchanges. One also can surmise that some states leaped ahead of Virginia in the rankings by extending Medicaid to the working poor while the General Assembly rejected the option.

These data would seem to back the McAuliffe narrative on the desirability of expanding the Medicaid program, 90% of the cost of which would be paid for by the federal government. If Virginia added just 5% of the population to the Medicaid rolls, the state would have a higher rate of insurance coverage than all but five states.

But dig a little deeper, and the picture gets more complicated. The chart above breaks down those with and without health insurance by age. Roughly two-thirds of the uninsured population is below 45 years old. This younger demographic segment tends to be considerably healthier than the older age cohorts, and its medical needs correspondingly less. Indeed, thousands likely opted out of the Obamacare exchanges because they did not need or want the coverage at the price it was available. Although we can’t tell from this data how many opted out, it is worth noting that some portion of Virginia’s 10% uninsured population is voluntarily uninsured.


Finally, it’s worth studying the map above, which shows the variation in the uninsured population around the state. (I would refer you to the interactive map at StatChat for details.) The uninsured rate in the working-age 18-to-64-year-old age cohort varies from 32.3% in the city of Manassas Park to 4.6% in the nearby city of Falls Church. Clearly there is a link between income, unemployment and insurance coverage. One could argue that the best antidote to uninsurance is a strong economy and high employment; if we want more people covered by insurance, perhaps we should be investing state funds in making people more employable.

But other factors are at play, although I’m not sure what they are. Why, for example, do the Interstate 81 corridor localities of Roanoke, Botetourt and Montgomery counties — not exactly known for a booming economy — have such low percentages of working-age uninsured? Are there unique institutional forces at work? It’s worth looking into.

Bacon’s bottom line: The debate over health care has gotten hung up on the number of uninsured. But that number is almost meaningless without considering the quality of the insurance programs.

For example, thousands of Virginians are “insured” through Medicaid. But what quality of care people do people receive when low reimbursement rates discourage 22% of Virginia physicians from participating, according to a 2016 Physicians Foundation survey? What percentage of Medicaid patients, unable to find a personal physician, routinely get their health care in hospital emergency rooms? And how does the quality of care compare to that provided uninsured people who go to emergency rooms and have their expenses written off as “charity” care or “uncompensated care”?

Another example: Thousands of Virginians have coverage through Obamacare health care exchanges. But what kind of access do they enjoy? Are they restricted to certain hospitals and physicians? How high are their deductibles and co-pays? To what degree, as a practical matter, has the quality of their health care improved? Likewise, how many Virginians forced into Obamacare lost their old insurance policies, how many lost access to their physicians, and how many perceive that they have worse insurance coverage than they had before? Nobody is generating that data.

One more point: How extensive is the safety net for the uninsured in Virginia compared to that in other states? Virginia has a fairly robust system of clinics that provide primary care to the uninsured and under-insured. How many people are getting at least some of their medical needs met through these clinics? How many are  slipping between the cracks? And what happens to clinic patients when they require treatment unavailable at the clinics?

Counting the percentage of the “insured” population provides a rough measure of access to the health care system. But there’s a lot it doesn’t tell us. Before undertaking a massive expansion of Medicaid at considerable fiscal risk to the commonwealth, we need a keener understanding of how Virginia’s health care system functions. We should not blindly accept the proposition that an expanded Medicaid program will improve real-world access to the uninsured. While the StatChat data is valuable for starting a discussion, it does not purport to tell us all we need to know.

Slum Maintenance at Essex Village

Crime scene at Essex Village.

Crime scene at Essex Village. (Photo credit: WTVR)

Who needs tenement slums when we’ve got public housing projects? The supposed “market failure” of the private sector to provide the poor and working class with decent shelter provided the justification for the federal government to get into housing business in the 1930s. We all know the result. Uncle Sam turned out to be the worst slumlord of all. In desperation, the government tried outsourcing to the private sector. How’s that working out?

I’ve highlighted the disastrous Kippax Place in Hopewell in previous posts. Now, courtesy of the Richmond Times-Dispatch, we learn that Essex Village in Henrico County has similar problems. Here’s how Debbie Truong leads off the story:

Inside one apartment building in Henrico County’s largest federally subsidized housing complex, the bathroom ceiling leaked, the stove thermostat was faulty and the windows wouldn’t stay open.

Across Essex Village, stairs were in disrepair, and there were mice and leaking water heaters. In November, raw sewage bubbled to the surface of manhole covers and, in December, drains backed up in four ground-level apartments.

Since April 14, 140 cases of building code violations were either reported or discovered by the county as part of an enhanced effort to turn around what officials say has languished into the county’s most poorly maintained housing complex.

Henrico County officials have vowed to get the housing complex back up to an acceptable standard. It will continue to pursue inspections aggressively and it will pilot a “family stabilization” project that will bring health, financial literacy, social services and other resources to the 1,600-resident complex, reports Truong.

Gregory Perlman

GHC Housing Partners, which owns the 496-unit complex, said it has addressed the building code violations, which were “fairly minor” in any case. Also, CEO Gregory Perlman noted that Henrico had failed to support a proposal last year seeking federal tax credits that would have helped pay for renovations.

Who is this Perlman person? In 2012 he claimed to have invented a “new approach to affordable housing.” This comes from a GHC press release:

“We focus on our residents and provide them with the opportunity to better their lives through self-improvement programs as well as support from the non-profit Perlman Foundation.”

… GHC Housing Partners specializes in acquiring and managing primarily Section 8 housing and providing social services and amenities that go far beyond HUD requirements. Vegetable gardens, dog parks, job counseling, college scholarships and summer camps are only part of this transformation of affordable housing. GHC Housing Partners is focused on initiatives and programs that improve lives and provide bootstrap opportunities for residents to achieve a higher standard of living.

Wrapping public services around public housing is the hot concept in the non-profit world. But how has the idea fared in the real world? The building code violations speak for themselves. The T-D also quotes a Rev. Joe Ellison who previously ran a day care at Essex and served as a pastor in the community. He left in 2005 “crestfallen over the living conditions.”

He said he approached management at Essex two  years ago, hoping to establish a program that involved mentoring and job creation. After a lukewarm response, he instead turned his sights to Fairfield Court in Richmond.

GHC warrants a closer look, far closer than I can provide in this quick blog post. The company is part of a housing-industrial complex that has grown up around public housing and, some have told me, exists as much to provide a comfortable living for a vast ecosystem of for-profits, non-profits, consultants and government administrators as for the poor themselves.

On its website, the Sherman Oaks, Calif.-based GHV claims to be the ” industry’s leading affordable housing owner and developer.” Since 1993, the company has acquired 20,000 housing units across 24 states in $1.25 billion worth of projects.

I infer that the company is for-profit, as the website makes no mention of a non-profit status. The parent company, GHC Housing Partners, is affiliated with GHC Investment Holdings, which acquires, owns and manages affordable housing; GHC Development, which develops properties using tax-exempt bonds and low-income housing tax credits; PK Management, a property management arm whose mission includes providing “quality service to its residents;” and a charitable arm, the All Ways Up Foundation.

In 2014, according to its IRS 990 form, the All Ways Up Foundation provided $128,777 in grants to organizations and $123,935 to individuals — sums that work out to an average of $12 per housing unit across the GHC system — and hosted an educational summit.

PK Management, which manages 18,000 units, purports to employ 41 social service coordinators to oversee resident welfare, focusing on delivering expanded services to its residents. It also offers “educational and professional opportunities designed to break the cycle of generational poverty.” (It’s not clear from the website if PK Management serves Essex Village, nor who pays for these services.)

The federal government turned to outsourcing after it became clear that it was doing a terrible job of running public housing projects itself. Perhaps it is time to ask if the non-profits and for-profits are doing any better. Anecdotal evidence is piling up that they are not, although Essex and Kippax may not be representative of performance at other housing projects. My suspicion is that private players master the latest buzz words and throw out a lot of flash-and-dazzle to impress the bureaucrats and win big contracts but that there’s not much follow through.

Perhaps the Times-Dispatch could do a little digging. What is the precise nature of GHC’s relationship with Essex Village? Does it own the property outright? Does it have a contract with the federal government? Does it provide wrap-around social services? Does the All Ways Up Foundation provide any grants? How much revenue does the project generate, and what is the cost structure? Most pertinently, how much money does GHC devote to maintenance and upkeep? Surely, this information would be available through the Freedom of Information Act.

Related questions: Who in the federal government, if anyone, is responsible for looking over GHC’s shoulder to make sure it is maintaining basic standards — and why has Henrico been forced to step in?