Editorial: Getting Older, Growing Poorer

N.Y. Times, Oct. 6, 2013
By the Editorial Board
The basic outlines of poverty in America are sadly familiar. At last count, 46.5 million people were poor — 15 percent of the population. Women and children, especially in single-mother families, were, as always, hit hardest.
Another group, people 65 and older, now seems vulnerable as well. In analyzing the recent Census Bureau report on poverty, researchers at the National Women’s Law Center foundthat from 2011 to 2012, the rate of extreme poverty rose by a statistically significant amount among those 65 and older, meaning that a growing number of them were living at or below 50 percent of the poverty line. In 2012, this was $11,011 a year for an older person living alone.
An additional 135,000 older women became extremely poor in 2012, raising the extreme-poverty rate in that group to 3.1 percent, And 100,000 older men were extremely poor in 2012, raising the extreme-poverty rate in that group to 2.3 percent In all, nearly 1.2 million people age 65 and up were classified as extremely poor in 2012.
The increase in extreme poverty requires utmost attention. For the most part, Social Security has protected older Americans from poverty. In cases where older people are poor, the afflicted often have been very old women, who have long outlived their spouses and any nest egg.
In the law center’s research, however, the increase in extreme poverty was concentrated in the 65-to-75 age group. Some of them could be among the long-term unemployed, whose jobless benefits have been cut or run out. Or they might be people who would generally qualify for public assistance in addition to Social Security but are having trouble getting those benefits in the face of administrative cutbacks at the state and federal levels.
The numbers alone don’t say why extreme poverty has risen or whether the rise will be lasting or fleeting. But other data echo the law center’s findings. The Census Bureau’s American Community Survey, which tracks a larger sample than in its poverty report, shows an increase in poverty among those 65 and older, from 9.0 percent in 2010 to 9.3 percent in 2011 and 9.5 percent in 2012. That is not a record; poverty rates for that group have reached 9.9 percent
But it would be devastating if recent increases became a growing trend. For now, the best policy response is to do no harm. For example, budget proposals to cut Social Security’s cost-of-living benefit, ill advised in any case, would be especially unwise and untimely.

Latino advocacy group says state provided inaccurate Sandy grant information online

[Posted by Ana Baptista]

Newark Star-Ledger, Oct. 8, 2013

By Erin O’Neill

A Latino advocacy organization filed a complaint against the Christie administration today charging the state with failing to provide accurate information to Spanish-speaking residents about major Hurricane Sandy grant initiatives.

The Latino Action Network said the website where residents may apply for storm recovery funding outlines the appeals process for individuals whose grant applications were denied in English, but not in Spanish. The group also said in the complaint filed with the state Department of Community Affairs that the Spanish-language version of the "reNew Jersey Stronger" website listed incorrect application deadlines and hours of operation for local recovery offices .

“It’s vital information that could make all the difference in the world,” for a resident trying to recover from the Oct. 29 storm, said Christian Estevez, vice president of the Latino Action Network.

The state Department of Community Affairs is responsible for distributing the majority of federal funds allocated to New Jersey by the U.S. Department of Housing and Urban Development for Sandy recovery. Among the grant initiatives is the Rehabilitation, Reconstruction, Elevation and Mitigation, or RREM, program. Eligible homeowners may receive up to $150,000 to help them rebuild or repair their homes through that initiative.

Another grant called the Resettlement program offers homeowners $10,000 to remain in the county where they lived before Sandy for three years.

Frank Argote-Freyre, the president of the Latino Action Network, wrote in a letter to Richard Constable, III, commissioner of the state Department of Community Affairs, that those programs “fail to provide critical and legally mandated documents, forms and other information to Spanish speakers in the language in which they are proficient.”

Lisa Ryan, a spokeswoman for the state Department of Community Affairs, said in an e-mail, "We are working hard to accommodate our Spanish-speaking residents who have been trying to access the many programs available for those impacted by Sandy. We are looking into the issues raised by this group, and if there are areas that need to be addressed, we will take action immediately."

Argote-Freyre called on the state Department of Community Affairs to take a number of steps, including: correcting all issues within seven days, agreeing to extend all deadlines for individuals who say they were impacted by incorrect Spanish-language information and appointing a monitor to ensure information is provided correctly to Spanish-language speaking residents.

The Latino Action Network has publicly endorsed state Sen. Barbara Buono, a Democrat from Middlesex County, in the gubernatorial race, against her opponent Gov. Chris Christie.

© 2013 New Jersey On-Line LLC.

The Color of Affordable Care

N.Y. Times, Oct. 7, 2013

By Nancy Folbre

Shortly after House Republicans shut down the federal government in an effort to halt implementation of the Affordable Care Act, Sabrina Tavernise and Robert Gebeloff of The New York Times reported that many Republican-controlled states have already strangled an important feature of the legislation by denying extension of Medicaid eligibility to the working poor.

Since the federal government committed to shouldering most of the cost of such extensions, the officials running these states seem to be cutting off their own noses to spite their faces. Then again, perhaps the noses they are cutting off are not their own.

Neither Republican officials nor their most valuable constituencies need help paying for health insurance. When they say they oppose government spending what they really mean is that they oppose spending on programs like Medicaid that – unlike universal programs such as Social Security – target low-income families.

The disparate racial impact is striking: 68 percent of poor and uninsured blacks live in states that are not extending eligibility, compared with 58 percent of poor and uninsured persons in other racial categories.

The concentration of negative effects in Southern states that also represent the stronghold of Congressional opposition to the law itself is not surprising. This episode of political history fits neatly into an established line of research that shows how federal efforts to extend protections to the disadvantaged have repeatedly fallen prey to a toxic blend of racial and regional politics. From civil rights to health insurance, white political leaders from states with large numbers of African-Americans — especially but not exclusively in the South — have cast new federal protections in apocalyptic terms and mounted a powerful opposition.

In her pioneering book “The Color of Welfare,” published in 1994, the sociologist Jill Quadagno persuasively documented the race-based politics that sent the United States down a policy path very different from that of other affluent countries, blocking the federal extension of most universal social programs other than Social Security and Medicare and giving states significant control over means-tested programs targeted at the poor. This control allowed politicians in Southern states to restrict benefits for low-income families, whatever their color.

A host of academic studies have explored the impact of intersections between race and class, noting, for instance, that in states with larger black populations race becomes more salient to the politics of social provision, altering the dynamics of social and political trust. Poor whites are promised protection against labor market competition or higher taxes in return for acquiescence with policies that restrict the social safety net.

As the Stanford economist Gavin Wright shows in his new history of the Civil Rights Movement, “Sharing the Prize,” Southern whites often overestimated the costs – and underestimated the benefits – that integration would bring them.

In “Disciplining the Poor,” an analysis of welfare reforms introduced in the mid-1990s, Joe Soss, Richard C. Fording and Sanford F. Schram demonstrate that states with a large number of African-Americans (especially but not exclusively in the South) imposed particularly stringent rules on access to public cash assistance, as well as keeping benefit levels extremely low.

In “Taxing the Poor,” Katherine Newman and Rourke O’Brien show that state income and sales taxes in the South are far more regressive than those in other regions of the country, penalizing all low-income families.

Overt racism and outright discrimination now elicit strong social disapproval, but racial bias takes a more subtle, coded form. In “Why Americans Hate Welfare,” Martin Gilens documents a tendency for Americans to systematically overestimate the percentage of public welfare spending going to blacks. His content analysis of pictures accompanying stories about poverty in three major newsmagazines between 1967 and 1992 showed that the frequency with which African-Americans were depicted far exceeded their actual representation in the population.

An Associated Press survey of racial attitudes conducted immediately before the presidential election last year clearly suggests that most Americans try not to discriminate, but that racial loyalties shape their perceptions of economic benefits.

When asked if President Obama’s race affected the likelihood they would vote for him, 80 percent of respondents said no. Yet 28 percent of respondents believed that his policies had made black Americans better off, compared with only 15 percent who believed they had made white Americans better off.

I don’t know of any analysis of the president’s economic stimulus program – or any other policy – purporting to show that blacks benefited more than whites. Indeed, the comparison itself is oddly optimistic, because neither black nor white Americans outside the top 1 percent of the population have enjoyed significant increases in family income since 2009.

Respondents predisposed to believe that a black president will try to benefit blacks more than whites are likely to view the Affordable Care Act through a racial lens, which helps explain the results of a recent Pew survey showing that almost 91 percent of blacks currently approve of the law, compared with 29 percent of whites.

This approval gap overshadows the effect of factors directly relevant to eligibility for assistance. Among those with annual family incomes of less than $50,000, 50 percent currently approve of the law, compared with 38 percent of those with higher incomes (who are less likely to benefit from it).

It’s important to note that many people who don’t approve (about 17 percent, according to a recent Kaiser Foundation poll) feel the Affordable Care Act doesn’t go far enough in reforming the way we pay for health care. Further, the complexity of the legislation makes it difficult for individuals to predict its economic consequences (the Pew survey reported that only 25 percent of poll respondents said they had a very good understanding of how the law would affect them).

Controversy and confusion make it easier for politicians to prey on pre-existing prejudices that serve their own interests better than those of their least influential constituents, as became apparent in the first stage of the civil rights movement.

This movement has yet to reach its final stage. Access to affordable health insurance should be considered a civil right for everyone.

© 2013 New York Times

We don’t need no education

N.Y. Times, Oct. 4, 2013

By Brent Staples

The Republican shutdown of government is compounding what was already a disastrous year for Head Start, the federal program that prepares disadvantaged 3 and 4 year olds for school. This critically important program is already reeling from the sequester, the senseless across the board budget cuts that began last spring, which caused Head Start centers to scale back on transportation, basic learning materials and, in some cases, to even close their doors.

According to the National Head Start Association, owing to the sequester cuts that began in March, 57,000 fewer children will have access to the program this year — with even deeper cuts to come if the mindless process of budget cutting continues.

The shutdown is doing even more damage. According to the association, for example, the shutdown has prevented Head Start programs serving about 19,000 children across 10 states and Puerto Rico from accessing the federal funds that they had been awarded. Furthermore, programs in five states — Alabama, Mississippi, Connecticut, Georgia and Florida — have already shut down.

As the shutdown and the sequester wear on, in other words, more and more young children will be deprived of crucial services that are intended to help them succeed at school and escape poverty. This backsliding comes at a time when the country should be improving the quality of Head Start offerings and broadening access to especially vulnerable groups like the children of the homeless.

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More In Taking Note
Closing the Government to Save Face
The Republicans’ crusade, ostensibly about dismantling health care reform, is really about showing angry constituents that they’re willing to fight.
With the Jobs Report, No News Isn’t Good News
Due to the shutdown, there’ll be no jobs report on Friday, and decision-making in all spheres will be less informed.
How the Shutdown May Hurt the Environment
Republicans who detest the E.P.A. were not bothered in the least by the fact that the agency furloughed more than 90 percent of its employees.
© 2013 New York Times Company

N.J. Public Schools: Separate, Unequal, and Unfair

NJ Spotlight, Oct. 3, 2013

By Julia Sass Rubin

Policies that disproportionately harm and disenfranchise communities of color are incapable of improving either educational achievement or equity

Is public education the civil rights issue of our time? Yes! And the situation in New Jersey is alarming.

Public schools in our state are among the most racially and economically segregated in the nation. Equally troubling, recent policy initiatives are targeting public schools attended primarily by low-income children of color for harmful interventions while disenfranchising local communities from democratically governing those public schools.

Here are seven of the most significant examples:

Crumbling, Inadequate, and Unsafe School Facilities

Trenton High’s 1,800 students, and thousands of others, attend schools plagued by rats, roaches, asbestos, and black mold because the Christie Administration has all but frozen the work of the Schools Development Authority. The authority is charged by law with building and renovating public schools in the 31 former Abbott districts, while those school districts are precluded from repairing or rebuilding their dilapidated public schools.

State Control of School Districts

All four of the school districts taken over by the State — Camden, Jersey City, Newark, and Paterson — are populated overwhelmingly by students of color. There are many New Jersey school districts facing steep challenges, but only those in communities of color seem to be vulnerable to indefinite State takeover and the resulting loss of democratic control.

Reductions in School Funding

New Jersey public schools have been underfunded by the State by an astonishing $5.2 billion since 2010. This shortfall has been most severe in school districts populated primarily by children of color. For example, the Paterson, Elizabeth, and Newark school districts combined lost over $300 million since 2010. If the New Jersey Supreme Court had not intervened in 2012 to restore some of the funding, the damage would have been even greater. Gov. Chris Christie also tried repeatedly to permanently alter the State’s school funding formula, to reduce funding for the almost 40 percent of New Jersey public school students who are low-income and/or Limited English Proficient.

Taxpayer-Funded Vouchers for Private and Religious Education

Christie and some legislators in both parties promote taxpayer-funded vouchers specifically for communities of color. Vouchers were used in Southern states during the 1960s as a method of intentionally perpetuating segregation. To prevent children of color from attending all-white public schools, some districts closed those schools and issued vouchers to the white families that were only good at segregated private schools, known as segregation academies. The more recent history of voucher use in other states confirms that they continue to increase segregation. What vouchers have consistently failed to do is to provide a better education for children. In fact, Wisconsin and Louisiana voucher students actually performed worse than students who stayed in the public schools.

Because efforts to promote universal vouchers have failed to win popular support, proponents began marketing vouchers specifically to low-income communities of color. Despite the marketing, Rutgers Professor Dr. Bruce Baker found that most of New Jersey’s voucher money would actually flow to the parents of children already attending all-white religious schools.

Expansion of Charter Schools

In the wake of significant pushback against the opening of new charter schools in the suburbs, the Christie administration has limited new charters primarily to urban communities of color. These schools are being opened with complete disregard for community wishes.

The administration also has ignored the fact that many of the charter schools are contributing to the segregation of students by income, language proficiency and race.

For example, New Jersey Department of Education 2012 – 2013 data shows that Hoboken’s three charter schools educate 31 percent of the City’s total public school students, but a significantly larger proportion of its white students (51 percent), and a significantly smaller proportion of its impoverished students (6 percent of the free lunch and 13 percent of the reduced lunch). The charter schools also educate none of the city’s Limited English Proficient students.

In this way, the charter schools not only substantially increase the economic and racial segregation in Hoboken, they also contribute to the city’s most impoverished students being concentrated in traditional public schools. That concentration makes it much more challenging for the Hoboken school district to provide a high-quality education for the 69 percent of public school students who attend the district’s schools.

Priority Schools and Regional Achievement Centers

Children of color made up 97 percent of the population of schools that the New Jersey Department of Education classified as “priority” in 2012, and subjected to intervention by state-controlled Regional Achievement Centers (RACs). The RACs are staffed by individuals who report to education commissioner Chris Cerf and are given tremendous power over schools, disenfranchising school boards, parents, and other community members and draining educational resources.

If priority schools do not meet RAC-imposed benchmarks by the summer of 2014, they may be closed, turned into charter schools, or handed over to private management companies, all with no concern for the wishes of their host communities.

Forced School Closings

In New Jersey, forced school closings have taken place exclusively in cities populated by low-income people of color. These closings are likely to increase with the advent of Regional Achievement Centers and the expansion of charter schools, consistent with a national pattern of forced closings of public schools that primarily educate children of color — most recently in New York, Philadelphia, and Chicago. Forced school closings increase instability for children who already face significant life challenges and destabilize communities for whom the public schools are critical anchors.

Policies like these, which disproportionately harm and disenfranchise communities of color, are not only morally deplorable, they also are ineffective at improving either educational achievement or equity. Neither outcome can be attained by increasing segregation or by destroying community participation and democratic control of public education.

We know what is effective: addressing concentrated poverty; involving parents and communities in decision-making; providing adequate funding and healthy and safe facilities; ensuring access to high-quality pre-kindergarten and wraparound social services. The research is clear and consistent. We only need the political will to follow.

========

Julia Sass Rubin, PhD, is an associate professor at the Edward J. Bloustein School of Planning and Public Policy at Rutgers University. She also is one of the founding members of Save Our Schools NJ, a nonpartisan statewide organization.

More Americans Struggle to Afford Food

Gallup, Sept. 12, 2013

Americans’ overall access to basic needs is close to record-low

by Alyssa Brown

WASHINGTON, D.C. — More Americans are struggling to afford food — nearly as many as did during the recent recession. The 20.0% who reported in August that they have, at times, lacked enough money to buy the food that they or their families needed during the past year, is up from 17.7% in June, and is the highest percentage recorded since October 2011. The percentage who struggle to afford food now is close to the peak of 20.4% measured in November 2008, as the global economic crisis unfolded.

Percentage of Americans Who Struggled to Afford Food

Americans’ ability to consistently afford food has not yet recovered to the prerecession levels seen in January through April 2008, when less than 17% in the U.S. reported that they had problems affording food in the past year.
This is only the third time in 68 successive months of Gallup and Healthways’ tracking, which began in January 2008, that at least 20% of Americans said they struggled to afford food in the past year.
Americans’ Access to Basic Needs Hovers Near Record-Low
Americans remain as likely to have access to basic necessities in general now as they were in October 2011, when it was at its lowest point. The Basic Access Index, which includes 13 questions about topics including Americans’ ability to afford food, housing, and healthcare, was 81.4 in August, on par with the all-time low of 81.2 recorded in October 2011.
The Basic Access Index peaked at 84.1 in September and October 2008 at the start of the economic crisis. It steadily declined until March 2009 and has never recovered to prerecession levels, defined as at least 83.0.

U.S. Basic Access Index, by Month

The percentage of Americans who say they have a personal doctor or health insurance has declined the most in August compared with September 2008, when the overall index was at its high point. Americans’ perceptions that their city or area is getting better as a place to live have improved the most since that time, followed by their access to fresh fruits and vegetables.
(For complete results for all items included in the Basic Access Index for August 2013 compared with September 2008, see page 2.)
Implications
One in five Americans reported in August that they did not have enough money to buy the food that they or their family needed in the past year, more than said so earlier this year and near highs seen since 2008. Similarly, Americans’ overall access to basic necessities has not recovered to the levels seen before the economic crisis. These findings suggest that the economic recovery may be disproportionately benefitting upper-income Americans rather than those who are struggling to fulfill their basic needs.
Stagnant wages are one possible reason why Americans’ ability to afford food and other basic needs has not improved since the recession. According to an August 2013 Wall Street Journal analysis of Labor Department data, “the average hourly pay for a nongovernment, non-supervisory worker, adjusted for price increases, declined to $8.77 [in July 2013] from $8.85 at the end of the recession in June 2009.” Depressed wages are likely negatively affecting the economic recovery by reducing consumer spending, but another serious and costly implication may be that fewer Americans are able to consistently afford food and meet other basic needs.
Increasing wages alone, however, is not enough to significantly increase the percentage of Americans who have the ability to afford food. Federal government programs also play a role in addressing this issue. As food stamp (SNAP) enrollment increases, Republicans in Congress are proposing substantial cuts and reforms to the program, while Democrats are resisting such reductions. Regardless, food stamp benefits are set to be reduced in November after a provision of the 2009 fiscal stimulus program expires. Therefore, it is possible that even more Americans may struggle to afford food in the immediate future.
About the Gallup-Healthways Well-Being Index
The Gallup-Healthways Well-Being Index tracks wellbeing in the U.S. and provides best-in-class solutions for a healthier world. To learn more, please visit well-beingindex.com.

Survey Methods
Results are based on telephone interviews conducted as part of the Gallup-Healthways Well-Being Index survey Aug. 1-31, 2013, with a random sample of 15,729 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia.Monthly samples through 2012 were comprised of 28,000-30,000 respondents per month, while 2013 monthly samples were about half that size.For results based on the total sample of national adults, one can say with 95% confidence that the margin of sampling error for any given month in 2008-2012 is ±0.6 percentage points. The margin of error for any given month in 2013 is ±0.8 percentage points
Interviews are conducted with respondents on landline telephones and cellular phones, with interviews conducted in Spanish for respondents who are primarily Spanish-speaking. Each sample of national adults includes a minimum quota of 50% cellphone respondents and 50% landline respondents, with additional minimum quotas by region. Landline and cellphone numbers are selected using random-digit-dial methods. Landline respondents are chosen at random within each household on the basis of which member had the most recent birthday.
Samples are weighted to correct for unequal selection probability, nonresponse, and double coverage of landline and cell users in the two sampling frames. They are also weighted to match the national demographics of gender, age, race, Hispanic ethnicity, education, region, population density, and phone status (cellphone only/landline only/both, and cellphone mostly). Demographic weighting targets are based on the March 2012 Current Population Survey figures for the aged 18 and older U.S. population. Phone status targets are based on the July-December 2011 National Health Interview Survey. Population density targets are based on the 2010 census. All reported margins of sampling error include the computed design effects for weighting.
In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.
For more details on Gallup’s polling methodology, visit www.gallup.com.

Basic Access Index Items: September 2008 vs. August 2013

Copyright © 2013 Gallup, Inc. All rights reserved.

Millions of Poor Are Left Uncovered by Health Law

N.Y. Times, Oct. 2, 2023

By Sabrina Tavernise and Robert Gebeloff

A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.

Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help. The federal government will pay for the expansion through 2016 and no less than 90 percent of costs in later years.

Those excluded will be stranded without insurance, stuck between people with slightly higher incomes who will qualify for federal subsidies on the new health exchanges that went live this week, and those who are poor enough to qualify for Medicaid in its current form, which has income ceilings as low as $11 a day in some states.

People shopping for insurance on the health exchanges are already discovering this bitter twist.

Gladys Arbila of Houston with her son, Christian Vera. Texas chose not to expand the Medicaid program, so Ms. Arbila does not qualify for it or for new federal insurance subsidies.
MICHAEL STRAVATO FOR THE NEW YORK TIMES
“How can somebody in poverty not be eligible for subsidies?” an unemployed health care worker in Virginia asked through tears. The woman, who identified herself only as Robin L. because she does not want potential employers to know she is down on her luck, thought she had run into a computer problem when she went online Tuesday and learned she would not qualify.

At 55, she has high blood pressure, and she had been waiting for the law to take effect so she could get coverage. Before she lost her job and her house and had to move in with her brother in Virginia, she lived in Maryland, a state that is expanding Medicaid. “Would I go back there?” she asked. “It might involve me living in my car. I don’t know. I might consider it.”

The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers. About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides.

“The irony is that these states that are rejecting Medicaid expansion — many of them Southern — are the very places where the concentration of poverty and lack of health insurance are the most acute,” said Dr. H. Jack Geiger, a founder of the community health center model. “It is their populations that have the highest burden of illness and costs to the entire health care system.”

The disproportionate impact on poor blacks introduces the prickly issue of race into the already politically charged atmosphere around the health care law. Race was rarely, if ever, mentioned in the state-level debates about the Medicaid expansion. But the issue courses just below the surface, civil rights leaders say, pointing to the pattern of exclusion.

Every state in the Deep South, with the exception of Arkansas, has rejected the expansion. Opponents of the expansion say they are against it on exclusively economic grounds, and that the demographics of the South — with its large share of poor blacks — make it easy to say race is an issue when it is not.

In Mississippi, Republican leaders note that a large share of people in the state are on Medicaid already, and that, with an expansion, about a third of the state would have been insured through the program. Even supporters of the health law say that eventually covering 10 percent of that cost would have been onerous for a predominantly rural state with a modest tax base.

“Any additional cost in Medicaid is going to be too much,” said State Senator Chris McDaniel, a Republican, who opposes expansion.

The law was written to require all Americans to have health coverage. For lower and middle-income earners, there are subsidies on the new health exchanges to help them afford insurance. An expanded Medicaid program was intended to cover the poorest. In all, about 30 million uninsured Americans were to have become eligible for financial help.

But the Supreme Court’s ruling on the health care law last year, while upholding it, allowed states to choose whether to expand Medicaid. Those that opted not to leave about eight million uninsured people who live in poverty ($19,530 for a family of three) without any assistance at all.

Poor people excluded from the Medicaid expansion will not be subject to fines for lacking coverage. In all, about 14 million eligible Americans are uninsured and living in poverty, the Times analysis found.

The federal government provided the tally of how many states were not expanding Medicaid for the first time on Tuesday. It included states like New Hampshire, Ohio, Pennsylvania and Tennessee that might still decide to expand Medicaid before coverage takes effect in January. If those states go forward, the number would change, but the trends that emerged in the analysis would be similar.

Mississippi has the largest percentage of poor and uninsured people in the country — 13 percent. Willie Charles Carter, an unemployed 53-year-old whose most recent job was as a maintenance worker at a public school, has had problems with his leg since surgery last year.

His income is below Mississippi’s ceiling for Medicaid — which is about $3,000 a year — but he has no dependent children, so he does not qualify. And his income is too low to make him eligible for subsidies on the federal health exchange.

“You got to be almost dead before you can get Medicaid in Mississippi,” he said.

He does not know what he will do when the clinic where he goes for medical care, the Good Samaritan Health Center in Greenville, closes next month because of lack of funding.

“I’m scared all the time,” he said. “I just walk around here with faith in God to take care of me.”

The states that did not expand Medicaid have less generous safety nets: For adults with children, the median income limit for Medicaid is just under half of the federal poverty level — or about $5,600 a year for an individual — while in states that are expanding, it is above the poverty line, or about $12,200, according to the Kaiser Family Foundation. There is little or no coverage of childless adults in the states not expanding, Kaiser said.

The New York Times analysis excluded immigrants in the country illegally and those foreign-born residents who would not be eligible for benefits under Medicaid expansion. It included people who are uninsured even though they qualify for Medicaid in its current form.

Blacks are disproportionately affected, largely because more of them are poor and living in Southern states. In all, 6 out of 10 blacks live in the states not expanding Medicaid. In Mississippi, 56 percent of all poor and uninsured adults are black, though they account for just 38 percent of the population.

Dr. Aaron Shirley, a physician who has worked for better health care for blacks in Mississippi, said that the history of segregation and violence against blacks still informs the way people see one another, particularly in the South, making some whites reluctant to support programs that they believe benefit blacks.

That is compounded by the country’s rapidly changing demographics, Dr. Geiger said, in which minorities will eventually become a majority, a pattern that has produced a profound cultural unease, particularly when it has collided with economic insecurity.

Dr. Shirley said: “If you look at the history of Mississippi, politicians have used race to oppose minimum wage, Head Start, all these social programs. It’s a tactic that appeals to people who would rather suffer themselves than see a black person benefit.”

Opponents of the expansion bristled at the suggestion that race had anything to do with their position. State Senator Giles Ward of Mississippi, a Republican, called the idea that race was a factor “preposterous,” and said that with the demographics of the South — large shares of poor people and, in particular, poor blacks — “you can argue pretty much any way you want.”

The decision not to expand Medicaid will also hit the working poor. Claretha Briscoe earns just under $11,000 a year making fried chicken and other fast food at a convenience store in Hollandale, Miss., too much to qualify for Medicaid but not enough to get subsidies on the new health exchange. She had a heart attack in 2002 that a local hospital treated as part of its charity care program.

“I skip months on my blood pressure pills,” said Ms. Briscoe, 48, who visited the Good Samaritan Health Center last week because she was having chest pains. “I buy them when I can afford them.”

About half of poor and uninsured Hispanics live in states that are expanding Medicaid. But Texas, which has a large Hispanic population, rejected the expansion. Gladys Arbila, a housekeeper in Houston who earns $17,000 a year and supports two children, is under the poverty line and therefore not eligible for new subsidies. But she makes too much to qualify for Medicaid under the state’s rules. She recently spent 36 hours waiting in the emergency room for a searing pain in her back.

“We came to this country, and we are legal and we work really hard,” said Ms. Arbila, 45, who immigrated to the United States 12 years ago, and whose son is a soldier in Afghanistan. “Why we don’t have the same opportunities as the others?”

© 2013 New York Times

A Historic Fair Housing Decision Reaffirmed

N.Y. Times, Sept. 30, 2013

By the Editorial Board

The New Jersey Supreme Court has wisely rejected an attempt by Gov. Chris Christie to undermine its 30-year-old-ruling in the Mount Laurel fair housing case, one of the more important civil rights decisions of the modern era. In last week’s strongly worded decision, the court made clear that it would be keeping a close eye on both the Christie administration and wealthy communities that might be inclined to flout the law, which limits the use of exclusionary zoning as a means of preventing the construction of affordable housing.

The original case dates to the 1960s, when low-income minority citizens found themselves priced out of the suburb of Mount Laurel, not far from Philadelphia. The families went to court after local authorities barred the construction of a small affordable housing development. The court ruled that municipalities could not exclude affordable housing and, further, had an affirmative obligation to write zoning laws that provided for a “fair share” of such housing based on growth, job opportunities and income.

The landmark ruling has encouraged the construction of tens of thousands of homes for low- and moderate-income working families, giving less-well-off families access to jobs and allowing their children to grow up in safer communities with better schools. Mr. Christie, however, has been attacking the Mount Laurel decision from almost the day he was sworn in. He also sought to dismantle the independent agency that oversees affordable housing, but he was prevented from doing so by the court.

The central issue in last week’s ruling was Mr. Christie’s effort to interpret the “fair share” mandate in a way that would essentially allow communities to decide for themselves how much affordable housing should be built. This, in turn, would give hostile communities license to block affordable housing.

Confronted with this threat, the court asserted that it had a clear duty to enforce the rights of low-income citizens under the State Constitution. In so doing, it served notice that it would brook no more foot-dragging on the part of the state.

© 2013 The New York Times