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States to Help Pay ACA Tax on Insurers

Phil Galewitz, KHN - September 2, 2014

When Congress passed the Affordable Care Act, it required health insurers, hospitals, device makers and pharmaceutical companies to share in the cost because they would get a windfall of new, paying customers. 

But with an $8 billion tax on insurers due Sept. 30 -- the first time the new tax is being collected -- the industry is getting help from an unlikely source: taxpayers.

States and the federal government will spend at least $700 million this year to pay the tax for their Medicaid health plans. The three dozen states that use Medicaid managed care plans will give those insurers more money to cover the new expense. Many of those states – such as Florida, Louisiana and Tennessee – did not expand Medicaid as the law allows, and in the process turned down billions in new federal dollars.

Other insurers are getting some help paying the tax as well. Private insurers are passing the tax onto policyholders in the form of higher premiums. Medicare health plans are getting the tax covered by the federal government via higher reimbursement.

State Medicaid agencies say they have little choice but to pay the tax for health plans they hire to insure their poorest residents. That’s because the tax is part of the health plans’ costs of doing business. Federal law requires states to pay the companies adequate rates.

"This situation results in the federal government taxing itself and taxing state governments to fund the higher Medicaid managed care payments required to fund the ACA health insurer fee," said a report by Medicaid Health Plans of America, a trade group.

Meanwhile, many Medicaid managed care companies have seen their share prices – and profits -- soar this year as they gained thousands of new customers through the health law in states the expanded Medicaid. Over half of the 66 million people on Medicaid are enrolled in a managed care plans.

A KHN survey of some large state Medicaid programs found the tax will be costly this year. The estimates are based in part on number of Medicaid health plan enrollees in each state and how much they are paid in premiums. States split the cost of Medicaid with the federal government, with the federal government paying on average about 57 percent.

• Florida anticipates the tax will cost $100 million, with the state picking up $40 million and the federal government, $60 million.

• Texas estimates the tax at $220 million, with the state paying $90 million and federal government, $130 million.

• Tennessee anticipates it will owe $160 million, with the state paying $50 million and the federal government, $110 million.

• California has budgeted $88 million, with the state paying $40 million and the federal government, $48 million.

• Georgia estimates the tax on its plans at $90 million, with the state paying $29 million and the federal government, $61 million.

• Pennsylvania predicts the tax will cost $139 million, with the state paying $64 million and the federal government, $75 million.

• Louisiana estimates the tax will cost $27 million, with the state paying $10 million and the federal government, $17 million.

Texas is believed to be the only state that has not yet agreed to cover the tax for its health plans, according to state Medicaid and health plan officials.  "The premium tax is just another way that the costs of the Affordable Care Act are pushed down to states and families," said Stephanie Goodman, spokeswoman for the Texas Medicaid program.

Medicaid officials in other states complain that paying the tax reduces money they could have spent on covering more services or paying providers.

"I do not feel I am getting anything in return for this," said Tennessee Medicaid Director Darin Gordon.

Officials won’t know exactly how much states owe until the Internal Revenue Service sends bills to insurers at the end of August, and the Medicaid plans submit those to states.

The health insurer tax is estimated to bring in at least $100 billion over the next decade from all insurers, government auditors estimate.

Most non-profit Medicaid health plans are exempt from the tax, which the trade group says gives the nonprofits a competitive edge vying for state contracts. "We consider this tax so badly construed that it should be reconsidered because it makes no public policy sense," said Jeff Myers, CEO of Medicaid Health Plans of America.

The trade group, which represents both nonprofit and for- profit Medicaid plans, also opposes the tax because it takes money from Medicaid programs that could be used to pay plans to improve care, he said.

The Centers for Medicare & Medicaid Services declined to comment on how states and the federal government are covering part of the tax.

Timothy Jost, a consumer advocate and law professor at Washington & Lee University in Virginia, said the lawmakers intended to cover the costs of the law by including as many groups paying in as possible. 

While it may be unusual for the federal government to essentially tax itself, Jost said the situation is no different from the federal government paying a contractor to provide a service, then having that contractor use some of those dollars to pay state sales tax or federal income tax.

"This tax should not have surprised anyone, and it should have been worked into contract prices," he said.

Paul Van de Water, senior fellow with the left-leaning Center for Budget and Policy Priorities, said neither health plans nor states should be complaining about the taxes because both are benefiting from the law.

"States are benefitting from the Affordable Care Act because with more people getting insured, it is driving down their uncompensated care costs," he said. He noted that is true even in states that did not expand Medicaid under the health law.

"People always like to get a benefit and not have to pay for it," he said. "If we did not have this tax, we would have had to raise the money somewhere else.

This piece appears courtesy of Kaiser Health News, where Phil Galewitz is a staff writer. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Robert VerBruggen - August 29, 2014

Embry Howell, Sam Bieler, and Nathaniel Anderson of the Urban Institute have an interesting new paper (PDF) based on hospital data from six states. The number capturing headlines is their estimate that, nationwide, treating gun injuries costs almost $670 million a year, most of which is paid for by taxpayers.

We shouldn't get too caught up in this statistic. As the authors themselves have noted, the toll of gun violence goes far beyond hospital costs -- and I would add that, contrary to the widespread claim that $670 million is a lot of money in this (national) context, it amounts to just $2.13 per person in the U.S. There are many reasons to make the prevention of gun violence a priority, but the potential to save an amount of money equal to 0.01 percent of total government spending is pretty low on the list.

The paper offers a highly valuable account, however, of how gunshot injuries are unevenly distrubuted throughout the population. Here's one chart, for example, with the numbers for males age 15-34, broken down by race:

These numbers (like those discussed by Reihan Salam recently) go a long way toward explaining why we talk about black-on-black crime a lot more than we talk about white-on-white crime, even though most crime for both groups is intraracial. I think they also have ramifications for Ron Unz's argument that Hispanic and white crime rates are essentially the same. (The authors used the Census's American Community Survey to estimate the total population of each group. Given the problem of illegal immigration, any survey in the U.S. might undercount Hispanics, and perhaps there are problems with the hospital data too -- but it would take a pretty dramatic counting problem to produce the disparities seen above.)

I highly recommend reading the whole paper, which is just ten pages long.

Robert VerBruggen is editor of RealClearPolicy. Twitter: @RAVerBruggen

Kids and Guns: Lessons From Arizona

Robert VerBruggen - August 27, 2014

On Monday, a 9-year-old girl accidentally shot and killed a firearms instructor in Arizona. The gun was an Uzi set to full-auto mode -- meaning that the weapon fired continuously when the trigger was held down -- and the girl apparently lacked the strength to control the recoil. The ownership of fully automatic guns is heavily regulated in the U.S., but there are events and ranges where non-owners, including children, can legally shoot them.

I agree with my old National Review colleague Charles C.W. Cooke that an Uzi is quite possibly the worst gun for a 9-year-old girl to shoot. This should not have happened. But here I'd like to stress two crucial distinctions that a lot of the media coverage seems to miss.

To put my cards on the table, I grew up in Wisconsin, my father was a police officer (he's now retired), I have a concealed-carry permit, and I hunt deer. I was probably 8 or 9 when I shot a gun myself for the first time, and my parents bought me a .22 rifle for my 12th birthday.

When I have kids, I plan to give them basically the same experience. Here's why that's different from what happened Monday, and from the other dangerous situations that some parents put their children in.

1. Letting kids shoot vs. letting kids shoot Uzis.

People who didn't grow up around guns often seem to have no idea what the normal practices are when it comes to kids. Many states have no minimum age for hunting, and the ones that do have minimum ages often set them to 10 or 12 -- remember, this is for hunting, and you need to have some experience shooting before you're ready to hunt. There is absolutely nothing unusual about a child of this age shooting a normal gun under proper supervision, and the risks are minimal.

Letting a 9-year-old shoot a fully automatic weapon is a different story. Most civilian-owned guns fire once for each trigger pull -- so even if the gun jumps quite a bit in the child's hands, it won't fire again. But someone without a lot of upper body strength can have trouble controlling a fully automatic weapon.

One gun instructor told the Associated Press that a teacher should help hold the gun in this kind of situation. Others have pointed out that instructors should be behind shooters, not off to the side, as the girl's was. I'd call those guidelines a bare minimum.

2. "Owning" or "possessing" a gun vs. having unsupervised access to it.

As I wrote above, I've "owned" a gun since I was 12. I also "possessed" a gun as a child when hunting or target-shooting with my father. But when I wasn't using guns under supervision, the guns were properly stored.

Though Wisconsin makes it illegal to "possess" a long gun until the age of 18, it makes exceptions for kids who are being supervised while hunting and target shooting (and in fact the state grants hunter's-safety permits to minors). Conversely, many other states, while not regulating possession directly, have laws designed to make sure kids can't get a hold of guns when parents aren't around. In other words, what we're talking about here are policies toward unsupervised access, not "ownership" or "possession" as those terms are used colloquially, and different policies can have essentially the same effect. These policies have little to do with what happened in Arizona.

This is where WonkBlog is a bit misleading: Based on data from, it provides a map of states that have lax or no minimum age requirements for the "possession" of long guns. It neglects other laws regarding kids' access to weapons. By my count -- also based on information from -- nearly half of the 30 states listed as having "no minimum," including California and Texas, the two biggest states in the country, have some kind of child-access law. These range from requiring guns to be locked up, to merely prohibiting the knowing or reckless provision of a gun to a child.

There are certainly lessons in this tragedy -- however rare gun accidents are, they do happen, and they usually happen because someone wasn't following the rules for storing or handling a weapon. There are some states that do little if anything to regulate children's access to firearms, and even when there are regulations, parents aren't always held to account when their children get hurt playing with guns. It may well be a good idea to change that. But let's focus on getting people to follow the rules, rather than expressing a generalized horror that some kids are allowed to shoot guns or overstating the laxity of the laws already on the books.

Robert VerBruggen is editor of RealClearPolicy. Twitter: @RAVerBruggen

[Note: A reference to Uzis as hand-held guns that are not pressed against the shoulder has been removed from this post. From a video of the incident, it appears the gun was outfitted with a stock.]

Will Public Employees Cut Their Own Pensions?

Richard Johnson, Urban Institute - August 26, 2014

A firefighter wants the state to cut his own pension? It's hard to believe, especially as the increasingly acrimonious debate over public pensions divides public servants and their employers. But that's just what the The New York Times reported earlier this month. And it's not as crazy as it sounds.

Bryan Jeffries, head of Professional Fire Fighters of Arizona, argues that pensions must be reduced to prevent layoffs and wage cuts. Like counties, cities, and towns in other states, municipalities across Arizona are being forced to contribute more to the state's pension fund for police officers and firefighters to make up for past shortfalls.

Contributions now average one-third of payroll, more than twice as high as they were 10 years ago. A typical Arizona city that pays a firefighter an annual salary of $60,000 must send another $20,000 to the state to cover pension costs. Some localities, such as Tempe, must contribute as much as half of payroll to the pension fund. As pension costs escalate, something has to give. Taxes must rise, some public-sector jobs must disappear, or public-sector salaries must be trimmed.

's Plan to Cut His Own Pension -- and Those of Other Public Servants
Jeffries's solution is to cut pensions for new hires, retirees, and veteran police officers and firefighters (like himself). Currently, retirees receive pensions that initially pay benefits equal to 2.5 percent of their final average salary multiplied by years of service. Jeffries doesn't want to change this benefit formula. Instead, he advocates boosting required member contributions, raising the number of years that police and firefighters must work before qualifying for benefits, and reducing post-retirement benefit escalators.

Under Jeffries's proposal, all plan participants would have to contribute 11.65 percent of their salaries, up from 10.35 percent today, and new public safety workers would need to complete 25 years of service to qualify for benefits -- up from 20 years for workers already hired. As before, they could begin collecting as early as age 52.

The last piece of his proposal is the most consequential but also the trickiest. The plan now automatically raises benefits 4 percent per year. Such escalators are usually justified to protect beneficiaries from inflation, and many state and local retirement plans -- as well as Social Security -- link annual increases to the change in the consumer price index. All retirees in the Arizona plan, however, receive annual raises regardless of how much prices change. Such automatic increases don't make much sense.

Jeffries's proposal would limit automatic benefit increases to no more than 2 percent per year and forbid them if the pension plan is not adequately financed. Halving automatic escalators would reduce the value of lifetime benefits by about a third, even when the plan is fully funded. However, slicing benefit escalators for retirees involves the additional hurdle of amending the state constitution, because the courts recently ruled that reducing retirement benefits already promised to state workers is unconstitutional.

Better Ways to Reform Arizona
's Police and Firefighter Pensions
It's encouraging that some public employees are acknowledging the financial burdens that rising pension costs impose on local government. But there are better ways to reform Arizona's police and fire plan.

• First, eliminate automatic benefit escalators altogether, but add real cost-of-living adjustments that tie benefit increases to changes in the consumer price index.

• Second, push back the retirement age, so employees can no longer begin collecting retirement benefits at age 52, when nearly everyone is still able to work.

• Third, distribute benefits more evenly across the workforce. Our state and local pension report card recently gave the Arizona plan a D, partly because it failed to provide any benefits to shorter-term employees. Instead of raising the required years of service needed to qualify for benefits, reforms should provide some benefits to retirees with as few as five years of service. And the earnings base used to compute benefits should grow with inflation for those who leave the job before they begin collecting, so that benefits aren't based on decades-old salaries that have lost much of their real value.

Such reforms would provide some retirement security for all public servants protecting Arizona's communities, without upending local government budgets.

Richard Johnson is a senior fellow with the Urban Institute and director of the organization's Program on Retirement Policy. This piece originally appeared on the Urban Institute's MetroTrends blog.

It's High Time for Effective Regulatory Reform

Thomas D. Hopkins & James Broughel - August 26, 2014

Four decades ago this month, in one of his first acts as president following the resignation of Richard Nixon, Gerald Ford signed into law the Council on Wage and Price Stability Act of 1974. The bill authorized the creation of an agency tasked with identifying key causes of inflation, a pernicious problem that was posing a serious threat to the American economy. Over the next seven years, the new agency, nicknamed CWPS, would play a key role not just in the fight against inflation, but in reforming the American regulatory system as well.

CWPS officials intervened in the regulatory process by submitting comments to executive agencies on behalf of the White House. These comments focused on the supporting analysis that agencies produced for their regulations. State-of-the-art tools developed by economists heavily informed the CWPS's perspective. Eventually, in 1981, CWPS was dismantled, but the regulatory oversight role it played did not go away. Instead, review of agency regulatory analysis became a permanent fixture of the regulatory system, and responsibility was moved into the Office of Information and Regulatory Affairs. One of us (Hopkins) was on the agency's staff during the Ford, Carter, and Reagan administrations, and managed its closure as acting director.

In honor of CWPS's 40th anniversary, the Mercatus Center at George Mason University released a database of CWPS filings, as well as a study summarizing findings from the many comments CWPS produced. These filings suggest that serious shortcomings persisted throughout the regulatory system in the 1970s. Agencies' analysts routinely estimated costs and benefits of regulations incorrectly, and sometimes didn't estimate costs and benefits at all.

Consider one example: In 1979, the Federal Aviation Administration proposed to increase security for small-airplane operators as a way to deter hijackings. CWPS filed a comment concluding that the FAA had ignored important categories of cost, thereby underestimating the true cost of the regulation. For instance, the FAA had assumed that security staff could be hired for a half-hour at a time. Yet in many cases, a four-hour shift was the shortest period for which such workers could be employed.

Such mistakes are not anomalies, and similar issues can be still found in agencies today. Consider a 2013 Transportation Security Administration proposal to modify the screening process for airline passengers entering airport secure areas. Like the FAA in 1979, the TSA failed to consider important costs -- this time by neglecting to properly account for rising electricity prices and the compensation growth of security personnel.

Poor analysis isn't limited to underestimating costs. Agencies consistently fail to estimate the benefits of their rules, too. Even worse, agencies routinely fail to explain precisely why any new regulation is warranted, casting doubt on whatever benefits they claim to be achieving. A recent Office of Management and Budget report to Congress provided dollar estimates of both benefits and costs for just seven of the thousands of rules finalized last fiscal year. The 2013 TSA analysis also lacked benefit estimates, making it impossible to determine whether the proposal's benefits would outweigh any costs the agency identified.

Forty years ago, the Code of Federal Regulations was just under 68,000 pages in length. Since then, over 100,000 pages have been added, and there are now well over 1 million restrictions with which Americans must comply. As these requirements grow year after year, the problems with our regulatory system mount.

This is why regulatory reform is so critical. Real reform means not only strengthening requirements for agencies to conduct sound economic analysis before regulating, but also requiring analysts to go back through the decades of old rules that have been piling up on the books. Many of these rules' drafters were poorly informed, as evidenced by CWPS's work. Given the nation's disappointing economic performance in recent years, including slow wage growth, now is the time to reform a regulatory system that is constraining economic opportunity.

Thomas D. Hopkins is professor emeritus of economics at the Rochester Institute of Technology, a former acting director of the Council on Wage and Price Stability, and coauthor of a new study released through the Mercatus Center at George Mason University on "The Legacy of the Council on Wage and Price Stability." James Broughel is program manager of the Regulatory Studies Program with the Mercatus Center at George Mason University. 

With Coverage Through Obamacare, Transgender Woman Opts For Surgery

Anna Gorman - August 25, 2014

Devin Payne had gone years without health insurance -- having little need and not much money to pay for it.

Then Payne, who had a wife and four children, realized she could no longer live as a man.

In her early 40s, she changed her name, began wearing long skirts and grew out her sandy blond hair. And she started taking female hormones, which caused her breasts to develop and the muscle mass on her 6-foot one-inch frame to shrink.

The next step was gender reassignment surgery. For that, Payne, who is now 44, said she needed health coverage. "It is not a simple, easy, magical surgery," said Payne, a photographer who lives in Palm Springs. "Trying to do this without insurance is a big risk. Things can go wrong … not having the money to pay for it would be awful."

Payne learned in the fall that she might qualify for subsidies through the state's new insurance marketplace, Covered California, because her income fell under the limit of $46,000 a year. She eagerly signed up in March for a Blue Shield plan for about $230 a month, and began making preparations for the surgery that would change her life.

A 'Pre-existing Condition'
Among the less-talked-about implications of the Affordable Care Act is the relief it is providing to many transgender people, many of whom are low-income and who have struggled to obtain health coverage.

Getting jobs that offer insurance often has been difficult for transgender people  and the cost of purchasing plans on the private market can be prohibitive. Some have been  denied policies altogether after being diagnosed with "gender identity disorder," often considered a pre-existing condition.

Without insurance, many people were unable to afford the hormones, surgeries and counseling needed to complete their transition. Nor would they have been covered in the event of surgical complications, which can include infections.

"We are still dependent on insurance and the medical community for us to be able to live authentically," said Aydin Kennedy, coordinator of the transgender health program at St. John's Well Child and Family Center in Los Angeles.

Now, federal law prohibits health insurance companies from discriminating against transgender people, and it bars insurers from denying coverage based on pre-existing conditions. That makes it possible for more transgender people to purchase private plans. And in states that expanded their Medicaid programs, those with low incomes may get free coverage. 

The federal anti-discrimination regulations have yet to be written, but California insurance regulators have said that companies must treat transgender patients the same as other patients. For example, if plans cover hormones for post-menopausal women, they must also cover them for transgender women. Medicare, the program for the elderly and disabled, lifted its ban on covering sex reassignment surgery earlier this year. 

"The law and policy are on a transgender person's side for the first time," said Anand Kalra, program administrator at the Oakland-based Transgender Law Center. 

Conservative and religious groups oppose using government funds for transgender surgeries, questioning whether they are medically necessary, ethical or effective.

"We would oppose sex change operations all together," said Peter Sprigg, senior fellow at the Family Research Council in Washington, D.C. "But as a public policy issue, we would feel particularly strongly that taxpayers shouldn't be asked to pay for it."

A few obstacles remain for transgender patients. Not many doctors specialize in transgender care. And while the law opens the door to insurance coverage, insurers can set conditions and don't automatically approve payment.  

"Insurance companies are making up their own rules as they go along," said Kalra of the Transgender Law Center. 

Feeling Complete'
Growing up in Kansas, Payne remembers trying on her mother's clothes and dressing as a girl every year for Halloween. She dreamt of having another life after this one, as a girl. But Payne said she mostly suppressed her feelings and tried to live up to the expectations for a male.

"I put it out of my head," she said. 

She married a woman she met at work and they had four children, now ages 7 to 22. But she never felt comfortable in the traditional role of father and provider.

"I was just horrible at it because it wasn't who I was," she said. So Payne became the primary caretaker, playing the "mommy role" as she worked from home doing software development for pharmaceutical companies. 

She felt increasingly anxious, and in late 2012, a therapist helped her to realize that she was meant to live as a woman. Payne said her entire outlook on life changed when she started taking female hormones.

"All my anxiety and all of the bad things that I felt inside were just completely washed away," she said. 

Payne told her wife, who was upset. She told Payne: I married a man, not a woman -- but she also admitted that she wasn't entirely surprised. With mixed feelings, Payne's wife stayed in the marriage, and the family moved from Kansas to California, in part so Payne could be more comfortable living as a transgender woman. They rented a small house in a middle class neighborhood on the outskirts of Palm Springs and sent their children to the public school.

Late last year, Payne's wife, who had battled alcoholism for years, died of liver disease.

Payne said the children worried how people would react to her transition, but she said they soon realized it wasn't as big of a deal as they had feared. When Payne brought birthday cupcakes to her 7-year-old daughter's classroom last year, the children asked if she was a girl or a boy. After Payne told them she was a girl, "they just wanted their cupcakes."

In California, Payne found transgender friends and became an advocate within the community. "You find out that there is a whole world of people out there," said Payne, who wears little makeup or jewelry and calls herself a "T-shirt and skirt kind of a girl."

Payne was ready for the surgery. She started calling the approved providers in Blue Shield's preferred provider network. But they were booked up for months, or years. She felt she couldn't wait -- she wanted to do the surgery while her children were on summer vacation so they could go to her parents' house in Kansas as she recovered. She found an out-of-network doctor in Palo Alto who would do the surgery about a month later.

"The time was right and I wanted to get it done," she said.

Her Blue Shield policy said that gender reassignment surgery -- which uses existing tissue to construct female genitalia -- could be covered if patients met certain guidelines. For example, she had to be diagnosed with gender identity disorder and have an "expressed desire" to live as a member of the opposite sex.

By the scheduled date, Blue Shield had authorized the operation but hadn't determined exactly how much it would pay for an out-of-network provider. Payne got a cashier's check for nearly all her savings, $27,000, to pay the doctor, hoping her insurance plan would reimburse most of it. She worried about all the other expenses too, including the hospital stay, lab work and anesthesiology services.

The day of the surgery at Sequoia Hospital in Redwood City, Payne said she remembers being wheeled in to the operating room and feeling very calm. When she woke up, with oxygen still attached and wearing her hospital gown, a friend told her that the surgery had gone well, without any immediate complications.

Later that day, she had just enough energy to type a few words on her Facebook profile: "Feeling complete."

Grateful for Coverage
On a boiling afternoon in early July, about six weeks after the operation, Payne and her friends sat outside on the patio next to a pool. Misters sprayed above them, and Payne's cat and two dogs wandered beneath their feet. 

Payne said she did suffer a few complications later -- some swelling and an infection -- but she recovered with medication and support from friends.

She is still trying to figure out how much she has to pay out-of-pocket for the surgery and hospital stay -- and how much of that her insurance plan will reimburse. Payne said she believes the lab work, pathology, anesthesiology services and follow-up doctor's visits were all covered. But recently she got a statement saying she was on the hook for $17,000 of the total cost of the surgery.

Payne believes that the government and insurance companies should help cover such operations.  The population of transgender patients who want surgery is small, and she said they are less likely to suffer mental health problems once they have it.

Payne said she will be grateful for whatever coverage she can receive. Her friend Jenny Taylor, who is staying with her during the recovery, has had an even harder time with her insurance.

An outgoing transgender woman who laughs easily and wears colorful outfits and painted nails, Taylor purchased a policy through the insurance exchange in Tennessee. But she soon learned her doctor wasn't in the plan's network and that she had to pay cash for everything, with no hope of reimbursement.

"My insurance, even though I finally got it, was useless," she said.

The policy also wouldn't pay for her hormones. A pharmacist told her the medication was for women -- and her identification still listed her as a male. Taylor recently moved to Palm Springs and said she now plans to apply for insurance through Covered California.

"I was really frustrated," she said. "We're just trying to be ourselves, at the end of the day."

Payne agreed, saying she finally feels like her body matches what she knows to be true -- that she is a woman. "It seems more natural," she said.

Anna Gorman is a staff writer at Kaiser Health News, where this piece originally appearedKaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Jeffrey Stinson, Stateline - August 25, 2014

The day Debra Wolverton was laid off from her retail sales job in June 2013, she stopped by some businesses on her way home in Austin, Texas, to ask for work. She was told to apply online.

She did, countless times for countless job openings. She seldom got a response. Today, Wolverton, 48, is still without full-time employment. She's convinced her resume is often rejected by computer programs that screen out jobless applicants who are older — people employers view as too expensive — or  who have been out of work a long time.

It's awful," she said. "It's all online. You don't even get to speak to anybody."

Some cities, states and President Barack Obama have sought to help long-term unemployed people like Wolverton, who they say shouldn't be passed over for jobs because their resumes show an employment gap. But it hasn't been easy.

As the nation's jobless rate has dropped to 6.2 percent, those who've been out of work for months or years often feel forgotten. And many no longer look for work.

About 3.2 million people have been out of work for 27 weeks or longer, the Labor Department reported earlier this month. Called the long-term unemployed, they comprise about a third of those who are jobless.

Another 2.2 million aren't included in those numbers. They're only marginally looking for work and have all but disappeared from a labor market that's been shrinking since the Great Recession.

New York City and Madison, Wisconsin last year banned employers from discriminating against job applicants who are unemployed. Violators could face fines or possible lawsuits. The District of Columbia enacted a similar law in 2012. The same year, Oregon banned help-wanted advertising that said only those with a job need apply. So did Chicago.

Some states have stepped up efforts to get the unemployed back to work quickly by offering one-on-one or group counseling and training to help people with the actual mechanics of the modern day job search. But state legislation to prevent discrimination against the unemployed has often failed.

Earlier this month, Republican Gov. Chris Christie vetoed a bill that would have made New Jersey the first state to ban discrimination against the jobless, although in 2011 the state outlawed advertising that said only the employed need apply.

The California legislature last week passed a bill that would make it illegal for employers to discriminate against unemployed people in advertising and in hiring. But two years ago, Democratic Gov. Jerry Brown vetoed a less stringent bill that would have banned only discriminatory advertising.

Obama failed to get federal legislation passed in 2011. So in January, he ordered federal agencies not to discriminate against the long-term unemployed. He also signed up 300 major companies, ranging from Apple to McDonald's to Wal-Mart, to pledge to hiring practices that give the jobless a fair shot.

"Folks who've been unemployed the longest often have the toughest time getting back to work," Obama said in unveiling the companies' pledge. "It's a cruel Catch-22: The longer you're unemployed, the more unemployable you may seem."

A White House report out last month on the nation's shrinking labor participation rate said gloomy job prospects likely have driven some older workers into retirement. It also pointed to research that indicates the longer people are unemployed, the lower their odds of finding work. A big factor is that employers discriminate against job applicants with big gaps of employment on their resumes.

In a 2012 study, three researchers from UCLA and one from the State University of New York at Stony Brook found a hiring bias exists against applicants as soon as they're unemployed and only gets worse the longer they are out of work.

Another, conducted last year by Northeastern University researcher Rand Ghayad, found the bias was more severe the longer an applicant was jobless. He found the long-term unemployed had to send out 3.5 times as many resumes as the short-term unemployed just to get an interview.

"It's a stigma," said Ian Calderon, a Democrat who sponsored the Assembly legislation in California. "If you're unemployed, there's an attitude they feel they face (from employers) of ‘If nobody else wants you, why should I want you?'"

Calderon's bill would bar employers and recruiting firms from advertising only for employed people and prohibit employers from rejecting for consideration a qualified candidate just for an employment gap. Violations could carry fines from $1,000 to $10,000.

"It's not like we're trying to tell business who they can hire," Calderon said. "We're just trying to get their feet through the door.  

"I think it's the business of government to see that everyone plays by the rules and everyone has an opportunity," he said.

A Pernicious Practice'
Anti-bias bills to help the unemployed have been introduced in 24 states and D.C. since the start of 2011, according to the National Conference of State Legislatures. But few got very far.

Foes argue that while the discrimination is wrong and employers hurt only themselves if they do it, the laws would be hard to enforce and add to the legal woes of employers who often get hundreds of applications for a few openings in today's tight job market.

"Do I think employers should discriminate against the unemployed? Absolutely not," said Dan Ryan, who runs an executive search and talent development firm in Nashville, Tennessee. "I don't know how you legislate against it."

Laws will only clog the courts with complaints that will be hard to prove, he said. The problem is so many people are looking for work when jobs are still hard to come by. "No piece of legislation will solve that," he said.

The issue has faded, too, as employers are less blatant in their advertising, said Mitchell Hirsch, who advocates for the unemployed with the National Employment Law Project.

"While it's not as visible as it once was, it's still a pernicious and pervasive practice," he said.

Employers or the recruiting firms that companies hire to screen applicants depend largely on online job applications, he said. They can write computer programs that screen out people with employment gaps.

"It's very difficult to change these kinds of behaviors," Hirsch said. "We would hope that there is less of this happening as the labor market improves."

It's also very hard to prove the discrimination with so many out of work, even the staunchest advocates for the unemployed say.

"How do you tell if someone is discriminating? Even if it's systemic, I'm not sure there's a way to figure that out," said Katherine McFate, president of the Center for Effective Government.

She said efforts instead should go to extending unemployment benefits to help the long-term unemployed survive until the economy creates more jobs.

The legislation may be more of a gesture to the plight of the unemployed than a solution to a problem. The D.C. Office of Human Rights, for instance, has received no complaints of jobless discrimination since the District's law passed in 2012.

Democratic state Sen. Jim Whelan, sponsor of the New Jersey legislation, said he hadn't gotten any complaints from his Atlantic City constituents, but introduced the bill because discriminating against the unemployed "doesn't seem right."

He also has a big unemployment problem in his district that will only worsen as four casinos soon will be shuttered, eliminating even more jobs.

Avoiding Online Applications
Ryan, the recruiter, worked with the Society for Human Resource Management, the world's largest group of HR professionals, to help craft hiring guidelines so the long-term unemployed aren't bypassed. They were incorporated into the practices the companies agreed to follow in January at the White House.

Ryan advises the unemployed to put their efforts into improving their jobs skills and circumventing online applications by networking with people who can help them get an interview.

In Austin, Debra Wolverton decided to try something else after losing her retail sales position. With financial help from her family, she is pursuing a real estate license.

"I just couldn't sit here and do the same thing all over again and again," she said of sending out job applications. "I applied for everything. I couldn't find anything. I decided I had to go into business for myself."

Until she gets her license and can start making money selling houses, she'll continue looking for any kind of work because extended unemployment benefits are gone.

"I've done everything," she said. "I've painted people's rooms. I've done lawn work. I'll do anything."

This piece originally appeared at Stateline, an initiative of the Pew Charitable Trusts, where Jeffrey Stinson is a reporter.

Robert VerBruggen - August 23, 2014

This Atlantic article from Robert P. Jones is making the rounds (see Zack Beauchamp in Vox and Jamelle Bouie in Slate). It says:

Drawing on techniques from social network analysis, PRRI's 2013 American Values Survey asked respondents to identify as many as seven people with whom they had discussed important matters in the six months prior to the survey. The results reveal just how segregated white social circles are.

Overall, the social networks of whites are a remarkable [91*] percent white. ... In fact, fully three-quarters (75 percent) of whites have entirely white social networks without any minority presence. This level of social-network racial homogeneity among whites is significantly higher than among black Americans (65 percent) or Hispanic Americans (46 percent).

In an important way, as Jones writes, these numbers matter -- they show that white Americans are less likely to have interactions with members of other ethnic groups, and therefore might be less likely to understand where people of other races are coming from.

But I'm not sure that these results are surprising, or that they suggest a statistically disproportionate amount of self-segregation for whites. The U.S. population as a whole is 63 percent non-Hispanic white, 13 percent black, 17 percent Hispanic, and 5 percent Asian. This means that the baselines are different for different ethnic groups -- in an America with no sorting whatsoever, whites' social networks would still be 63 percent white, but blacks' social networks, for example, would be only 13 percent black. Similarly, just by chance, white Americans would be far more likely to fall into groups that are entirely same-race. (The odds of a white person's first friend being white as well would be 63 percent, the first two 40 percent, the first three 25 percent, and so on, multiplying by .63 each time. For blacks, the numbers would start at 13 percent and decline rapidly, to 2 percent, 0.2 percent, and so on.)

So, comparing the raw tendency to have same-race friends is highly misleading if we're trying to measure the propensity to self-segregate. And it's not clear what a better method would be. These kinds of comparisons are incredibly tricky -- especially because all the numbers are tied to each other (when one ethnic group avoids others, those other ethnic groups' social circles by definition become more homogenous too), and because the groups' sizes are so different (e.g., it's easily possible for blacks' social networks to be twice as black as the general population, but whites' networks would have to be 126 percent white for that to happen).

Robert VerBruggen is editor of RealClearPolicy. Twitter: @RAVerBruggen

* This change reflects a correction made to the Atlantic article, which originally said 93 percent.

'Less Lethal' Flash-Bangs Used in Ferguson Leave Some Feeling the Burn

Abbie Nehring, ProPublica - August 22, 2014

Peter Callahan was caught between two police lines in the West Florissant section of Ferguson, Mo., on Sunday night, when something fiery hot singed his leg. A nearby protester's shirt briefly caught fire.

Callahan, a Washington D.C.-based journalist, deduced that he had been hit by a flash-bang device. "I was also at Occupy Wall Street," he said. "This is a lot worse."

Among the debris protesters and journalists have picked up in the days since Michael Brown was killed are canisters of the 7290 flash-bang made by Combined Tactical Systems, a "less lethal" diversionary device that has made its way into law enforcement agencies' toolkits to carry out search warrants, and less frequently, to disperse crowds.

Flash-bang devices are one of many military-style weapons being used in Ferguson, along with tear gas and beanbag munitions. While marketed as non-lethal, there have been instances in which flash-bangs have caused serious injury and sometimes death when used by police, prompting debate over their proper use.

Earlier this year, a flash-bang critically injured a two-year-old baby in Georgia when a police special response team threw one into a crib while entering a home on a narcotics warrant.

According to Sgt. Colby Dolly, St. Louis County's 18-member tactical unit used the 7290 CTS flash-bangs for the first time three nights after Michael Brown's death and has continued to use them periodically in the subsequent days.

It's not clear how many people may have been burned or hit by flash-bangs in Ferguson. S.W.A.T. teams typically use them to temporarily paralyze suspects and prevent them from destroying evidence while carrying out search warrants and no-knock raids. They are less commonly used for crowd control and inside prisons.

Flash-bangs are descended from blank grenades developed by military special operations units. In the split second they take to deploy, they emit a wave of heat, light and sound intense enough to cause temporary blindness and deafness within a five-foot radius. Within closer range, they may cause partial hearing loss and bodily injury – particularly for children who are standing lower to the ground and closer to the impact. Some experts say that when used outdoors, flash-bangs can pick up gravel and launch it like shrapnel.

Accidents have been documented since the first days American tactical teams started using flash-bangs. In 1984, less than a year after the Los Angeles Police Department incorporated flash-bangs into their S.W.A.T. team, a woman was killed when a device exploded at her back as a tactical team entered her home to carry out a drug raid.

Flash-bang manufacturing has evolved significantly since then from crude explosives that detonated like grenades without shrapnel, to today's flash-bangs, many of which release a sudden volume of igniting gas through vent holes and leave behind an empty canister, like those found on the streets of Ferguson.

Witnesses to this week's unrest in Ferguson told ProPublica it feels like the ground is shaking when the devices deploy nearby. "It was a real loud explosion and people began to run, but they didn't know where to run to," said Tef Poe, who has been on the streets the past 12 days.

Dolly said that his agency hasn't been able to track injuries because individuals scatter when a flash-bang is deployed near them. "If you say you're injured, you're implicating yourself in causing trouble," he said.

The St. Louis County tactical unit uses flash-bangs occasionally when carrying out search warrants, but Dolly could not recall his unit ever using them to disperse crowds until this week.

In St. Louis County, tactical officers get a four-hour training course on flash-bangs taught by a member of their team. The in-house instructors are sent to Combined Tactical Systems for a three-day course to become certified trainers. CTS didn't respond to inquiries about what its training courses cover.

Proper training is critical to ensuring that flash-bangs are used safely, said R.K. Miller, who teaches tactical officers with the California Peace Officers Standards and Training. "They're dangerous if they're not used correctly."

The National Tactical Officers Association also offers training and sample guidelines on the use of diversionary devices including flash-bangs. Many tactical teams also attend training programs run by device manufacturers.

Peter Kraska, a professor in justice studies at Eastern Kentucky University who has written extensively on police militarization, contends that S.W.A.T. units typically offer much less training than the 250 hours per year the NTOA recommends. ,"Over 50 percent of teams in smaller jurisdictions receiving a mere 50 hours per year per officer," Kraska has reported.

In 2008, flash-bang manufacturers agreed to best practices and launched a voluntary program preventing sales of flash-bangs to law enforcement agencies that lacked certified trainers. Don Whitson, who teaches a course for the officers' association on 'less lethal' tactics including flash-bangs, says he has seen fewer injuries from flash-bangs since the agreement, but data quantifying these injuries does not exist.

Some law enforcement experts say that, even with the training issues, flash-bangs are preferable to other devices the police have used for similar purposes.

"I would rather see flash-bangs used than gas grenades which contaminate everyone, guilty and innocent," said Charlie Mesloh, a professor at Northern Michigan University who studies less lethal weapons. "There is very low risk of injury unless it literally went off when it was in contact with a person."

Still, Dolly acknowledged that there's no way to eliminate all risk, especially in the volatile and fast-changing situations police have faced on Ferguson's streets.

"Anytime you deploy a less-lethal device there's risk involved," he said. "You always consider the background and what's in the environment."

This piece originally appeared at ProPublica, where Abbie Nehring is a research intern.

Robert VerBruggen - August 21, 2014

At a Heritage Foundation event today, Kellyanne Conway of the Polling Company, Inc./WomenTrends (TPC/WT) outlined the new immigration polling data her organization has published. The results lean toward the populist/immigration-skeptic point of view, so it's informative to compare the questions with those of two polls I wrote about in June, whose results were friendlier to high levels of immigration.

The simple reality, it seems, is that most Americans don't have fully fleshed out immigration-reform plans floating around in their heads. (Shocking, I know.) As a result, depending on how you ask the question, you can get them to support or oppose pretty much any proposal.

Even on the most basic issues the differences are stark. For example, in June a survey from the Public Religion Research Institute (PRRI) and the Brookings Institution's Governance Studies program asked people to choose between citizenship, legal residence, and deportation for illegal immigrants; 62 percent were in favor of citizenship, and another 17 percent supported a different kind of legal status. A similar question in the other June survey, by, had a different blend of responses but also found a strong majority in favor of citizenship or legal status. And even when PRRI/Brookings polled another option in a different survey -- so-called "self-deportation," defined as "making conditions so difficult for illegal immigrants that they voluntarily return to their home countries" -- they found only 34 percent support.

The new survey, by contrast, asked respondents whether illegal immigrants should be given legal status or "encouraged" to go home. 70 percent picked the latter. So, a strong majority of Americans support legal status if the alternative is deportation, only a minority support making life "difficult" for illegal immigrants ... and yet a strong majority support "encourag[ing]" illegal immigrants to leave instead of granting them any kind of legal status.

What about the economic effects of immigration? As I noted in June, even the PRRI/Brookings data by themselves show how hard it is to poll the question:

70 percent of respondents said immigrants take jobs Americans don't want, while only 22 percent said they take jobs from American citizens. However, a very similar question that singled out illegal immigrants prompted very different answers: 45 percent say illegal immigrants "help the economy by providing low-cost labor," while 46 percent say they "hurt the economy by driving down wages for many Americans."

Once again, the TPC/WT data show a much more populist side to Americans' views. One question offered two ways of dealing with a lack of workers -- businesses could pay more, or the government could let in more immigrants -- and three-quarters of respondents said businesses should pay more. Three quarters also agreed that the government has a responsibility to use immigration law to protect low-income natives "from competition with illegal immigrants for jobs." Four-fifths of respondents agreed that "Americans who need work ought to have an opportunity to do the jobs that are currently done by illegal immigrants."

So, in the view of the American public, immigrants take jobs Americans don't even want ... but Americans need protection from illegal-immigrant competition, and businesses should raise wages instead of relying on immigrants if they can't find enough workers.

At the Heritage event, Conway suggested that immigration isn't an issue that should be decided on the basis of polling and political expediency. Instead, lawmakers should just do what's right. I'm actually optimistic on this -- not because any politician would make that choice voluntarily, but because it might be the only option. Given the state of the polling data, it's far from clear which a side self-interested legislator should pander to.

Robert VerBruggen is editor of RealClearPolicy. Twitter: @RAVerBruggen

What Ferguson Means for Urban Planning

Randal O'Toole, Antiplanner - August 21, 2014

The sad events in Ferguson, Missouri are being used by urban planning advocates to popularize their latest cause: suburban poverty. Ferguson is "emblematic of growing suburban poverty," says the Brookings Institution. "Hit by poverty," says CBS News, "Ferguson reflects the new suburbs." According to a Brookings infographic, between 2000 and 2011 the numbers of central city poor grew by 29 percent while the numbers of suburban poor grew by 64 percent.

There was a time that the suburbs were demonized because only middle-class and wealthy people lived there, leaving poor people in the inner cities. Now that lower-income people are living in the suburbs, the suburbs are being demonized for having "concentrated poverty," with a distinct implication that wealthy whites have moved back to the cities leaving the undesirable suburbs to the poor and minorities.

The reality is that all demographic classes -- all ages, races, and income levels -- are growing faster in the suburbs than the cities. The suburbs offer less congestion, lower-cost housing, and often better schools and other benefits over the cities. Instead of turning the movement of low-income people to the suburbs into some kind of crisis, this movement should be celebrated as a success.

Take Ferguson as an example. According to the 2012 American Community Survey, the median income of black households in Ferguson is only 60 percent that of non-Latino white households (tables B19013B and B19013H) . But it is 36 percent higher than black median incomes in St. Louis, and 4 percent higher than black median incomes in the St. Louis urbanized area. And while it sounds bad that black incomes are only 60 percent of white, in both the city of St. Louis and the St. Louis urban area they are less than 50 percent of white incomes.

Ferguson blacks also enjoy higher homeownership rates than blacks in the rest of the urban area. The rate in Ferguson is 46 percent, well below the white rate of 85 percent (tables B25003B and B25003H). But only 34 percent of city of St. Louis black households, and only 41 percent of St. Louis urban area black households, own their own homes.

In other words, Ferguson is a step up the ladder from St. Louis. Instead of decrying the fact that low-income households are rapidly growing in the suburbs, we should celebrate the fact that large numbers of low-income people have been able to increase their incomes and move to the suburbs where they enjoy higher homeownership rates than they could have in the more expensive cities.

The Department of Housing and Urban Development and urban planners in regions such as the Twin Cities are using the specter of "concentrated poverty" to justify their plans to build denser housing in the suburbs. As I've noted before, this is based on a fallacious belief that multifamily housing is more affordable than single-family; in fact, this is only true because multifamily units tend to be smaller. So, in consigning low-income people to multifamily housing, planners are effectively condemning them to small dwelling units with little privacy.

The truth is that "concentrated poverty" is simply a derogatory term for a natural sorting that takes place when people decide where to live. Low-income people don't want to live in neighborhoods where the only grocery stores are Whole Foods any more than high-income people want to live in neighborhoods where the only groceries are Walmarts. For a variety of similar reasons, people prefer to live with other people who share the same tastes, and that often means people of similar incomes. This is not an indicator of racism or "incomism," but simply a reflection of shared personal preferences.

What has happened and is happening in Ferguson is a sad reflection of the racism that remains latent in our society. But it is not an indicator that we need urban planners telling people how and where to live.

Randal O'Toole is a Cato Institute senior fellow working on urban growth, public land, and transportation issues. This piece originally appeared at The Antiplanner.

The FCC Needs to Rethink Its Auction Rules

Zack Christenson - August 20, 2014

When Congress passed the Middle Class Tax Relief and Job Creation Act in 2012, the bill included a provision that would allow broadcasters to auction off the spectrum they owned. This was meant to help alleviate congestion on wireless Internet networks, a problem that's growing rapidly as consumers increase their use of smartphones and other data-focused devices.

There has, however, been a major hiccup in rolling out these spectrum auctions that could have a detrimental effect on the consumer. In writing the auction rules, the FCC decided to restrict the bidding of the "dominant" carriers in each area -- usually Verizon and/or AT&T. These two companies combined serve 220 million subscribers, accounting for 65 percent of the wireless market.

The rule is meant to make more spectrum available for smaller carriers -- but it does so at the expense of the carriers that need wireless-broadband capacity the most. Consumers are hurt if the broadband isn't allocated according to the actual demand for it: One recent study estimated that these rules could lead to billions of dollars of consumer-welfare losses.

And, as if these bidding rules weren’t damaging enough, last week Spint and T-mobile filed with the FCC, claiming that the agency's favoritism toward them has not gone far enough.

The goals of these auctions should be twofold -- first, to make spectrum more flexible so that it's used in the most efficient way possible; and second, to ensure that the profit potential of putting spectrum up for bid reflects the maximum value of that spectrum. By restricting the biggest players in the wireless-broadband industry, the FCC is setting back both of those goals.

The FCC detailed its plans in a blog post, saying that after "trigger point" (largely a dollar-amount threshold) is hit in these auctions, some spectrum will be reserved for smaller carriers. If the FCC truly wants to benefit consumers, the agency should reconsider -- or at least impose target prices that are high enough not to trigger these restrictions except in the rarest of occasions. And the last thing the FCC should do is make these rules even more restrictive, as T-Mobile and Sprint have requested.

Many broadcasters have also been wary about the intentions of the FCC. Though the auctions are voluntary, the FCC has been vague about the rules, about the approval processes, and about how spectrum will be handled after the auctions. National Journal reports that just 70 television stations are considering entering the auction.

With the restrictions the FCC has put into place, consumers could continue to face poor service quality and spectrum rationing, combined with the potential for higher costs and data caps. The FCC should work to make the auctions more competitive by reconsidering its restrictions.

Zack Christenson writes on digital-tech issues for the American Consumer Institute Center for Citizen Research, a nonprofit educational and research organization.

What to Look for in Autopsies of Michael Brown

A.C. Thompson, ProPublica - August 19, 2014

In the next few weeks, separate teams of doctors will issue autopsy reports about Michael Brown, the unarmed African American shot to death by a police officer in Ferguson, Missouri. If history is any guide, they will differ, perhaps significantly, on how to interpret the gunshot wounds on his body. Michael Baden, the veteran medical examiner chosen to autopsy the body by Brown's family, has released the preliminary results of his autopsy and both the St. Louis County Medical Examiner and U.S. Justice Department have announced plans to conduct or commission separate post mortems.

As a journalist, I've read roughly 1,000 autopsy reports and spent much of my career reporting on fatal encounters between police officers and civilians. Here's some of what Baden found and what experts will be looking for as they examine Brown's corpse:

1. Evidence that Brown was fleeing from the officer who shot him, Darren Wilson. Shots to the back are a red flag, indicating the victim may have been running from the officer rather than attacking. The basic law on use of force turns on whether a police officer acted from a "reasonable belief" that he or she was facing a lethal threat. Baden - who was hired by Brown's family - believes Brown was shot at least six times with all the bullets striking him from the front.

2. Signs of a physical altercation. Forensic pathologists study the exterior of the body for bruises, scrapes and lacerations which can be signs that a scuffle preceded the fatal shots. Witnesses have said Brown and Wilson wrestled in the moments before the killing. On Baden's diagram of Brown's body, the doctor does not appear to have noted any significant injuries other than the gun shot wounds. Baden did not find gunpowder residue on Brown's hands, one piece of evidence that would likely be present if the two men were struggling for control of a gun discharged at close range.

3. Bullet trajectory. Shots fired at a downward angle may indicate the officer fired while the victim was on his knees or laying on the ground. A person in those positions generally poses less of a physical threat. Baden said a shot to Brown's head appeared to have come from above; he believes this was the fatal shot.

4. Number of shots. Baden voiced concern over the fact that Brown was hit by at least six shots. The doctor, who served earlier in his career as chief medical examiner for New York City and as an expert for the New York State Police, was quoted by the New York Times as saying, "In my capacity as the forensic examiner for the New York State Police, I would say, 'You're not supposed to shoot so many times.'" The number of shots may or may not be significant. Training on lethal force varies from department to department. Many forces train officers to continue firing until the suspect has been completely subdued. Some experts say that incidents in which a civilian has been hit with a single shot are more suspicious than those with multiple shots: The lone bullet could have been fired accidentally or in a moment of rage.

5. Gunshot residue. The presence of gunshot residue (GSR) on the skin or clothes of the victim may mean that the person was shot at very close range. Baden found no GSR on Brown's body, but said he did not scrutinize his clothing. Additionally, bullets fired from a few inches away leave distinct wound patterns on the flesh. Baden's report suggests the shots were fired from further away.

6. The presence of alcohol or drugs. Baden has not reviewed the toxicology tests, but results of those tests should be available soon (though it could take the authorities months to release them). Forensic pathologists typically fill vials with bodily fluids - urine, blood, or vitreous humor, the fluid within the eyeballs - and send them off to outside laboratories to be screened for alcohol, prescription drugs, and street drugs. If drugs or alcohol are discovered Brown's system, that information might provide some additional context to the fatal events.

In some police-civilian clashes, the evidence discovered during an autopsy turns out to be crucial. In the case of Michael Brown, it's not clear how useful this trio of autopsies will be. As the nation tries to understand what happened on August 9, the autopsy results may well not prove conclusive on the key questions.

A.C. Thompson covers criminal justice issues for ProPublica, where this piece originally appeared. He has been a reporter for 12 years, mostly in the San Francisco Bay area.

Arm Citizens and Let Them Police Themselves?

Sam Bieler & John Roman, Urban Institute - August 18, 2014

A city with limited resources and stubbornly high crime rates, Detroit is ripe for justice system innovation. Police Chief James Craig has seized on this opportunity, implementing a broad range of changes to the department.

These reforms appear to be making an impact. In the past year, Detroit has experienced significant declines in robberies, break-ins, and carjackings. Craig has split the credit for Detroit’s recent crime decline between the work of his officers and a policy suggestion he made in late 2013: encouraging citizens to carry concealed firearms.

Detroiters appear to be heeding the call. In 2013, Michigan State Police issued 6,974 concealed carry permits in Detroit, more than double the number issued in 2009. However, attributing the crime drop to armed citizens and advocating for more of the same may be opening a Pandora’s box.

Craig’s equation is simple: more armed citizens means less crime. But research shows it’s not quite that straightforward. The effect of privately owned firearms on crime is easily one of social science’s most hotly debated topics. Every imaginable conclusion has been reached at least once: policymakers can take their pick of studies showing that more citizens carrying firearms reduces crimeincreases crime, or has no clear effect.

Without good research, it’s impossible to determine what’s actually brought the city’s crime rate down: policing, more civilians with guns, or some factor we’ve yet to discover. As has been said many times, when you conflate correlation and causation, you can come to all sorts of silly policy conclusions.

Given the muddled guns-crime relationship, policymakers may want to look at what research does tell us about increasing gun access to determine whether encouraging citizens to arm themselves is sound public policy. Beyond crime rates, there are verified consequences to expanded gun ownership that should be considered.

Domestic violence and gun ownership have a troubling relationship. As our colleague Janine Zweig has noted, female intimate partner homicide remains stubbornly high, making it a particular policy concern for law enforcement. Gun ownership has consistently been linked with increased risk of intimate partner homicide, particularly for women. Indeed, firearms are particularly common in the homes of battered women, where abusive partners may use them to both threat and assault. The consistent link between firearm access and serious intimate partner violence should give any public official a reason to pause before encouraging a community to increase the number of weapons in circulation.

Gun ownership also entails a significant suicide risk. While the relationship between crime and gun ownership is still the topic of debate, the finding that guns increase the risk of suicide has been consistently and repeatedly demonstrated. Citizens should be free to balance personal defense and increased suicide risk for themselves, but policymakers should think twice before encouraging behavior with such a severe, clearly identified risk.

Giving citizens the choice to own a firearm is one thing, but given the risks and the lack of clear evidence that guns deter crime, it is worth reconsidering whether encouraging gun ownership should be a police-endorsed tactic. Instead, policymakers’ tactics of first resort should be evidence-based solutions with proven track records of reducing crime, like gang and gun violence interruption projects and programs that divert juveniles from the justice system.

Detroit has made important strides in fighting crime, and Craig’s reforms have likely played a key role in making the city safer. Detroit police have embraced this momentum, developing a strategic plan that puts more officers on the street and uses rigorous analysis to support officers with sound data and policing tactics.

Advocating for more guns in the hands of civilians might be a step back. When it comes to making Detroit safer, Craig might be better off continuing to place his bets on arming Detroit’s police officers with evidence-based crime reduction strategies, rather than its civilians with firearms.

Sam Bieler is a research associate, and John Roman is a senior fellow, with the Urban Institue's Justice Policy Center. This piece originally appeared on the Urban Institute's MetroTrends blog.

Making Good on Bad Promises

Lewis M. Andrews - August 18, 2014

Hardly a day goes by without some headline about a town or city struggling to bridge the gap between the retirement promises it made to its employees and the reality of its budget. But what has received comparatively little attention is the shape of the solution that is emerging for these shortfalls.

Consider first the pension problem itself. According to a 2013 Pew Foundation study of 61 key American cities -- the most populous in each state plus all other cities with over half a million people -- the gap between promises to municipal workers and what has actually been saved is more than $217 billion. Pew has estimated the total underfunding for all of America's towns, counties, school districts, and other non-federal government entities at $1.38 trillion, a figure that is expected to rise sharply when new bookkeeping guidelines from the Government Accounting Standards Board are fully implemented.

Less well-known is the fact that many cities once dismissed as fiscal basket cases have actually found a way out of their pension problems, showing us what the future might look like. In 2011, Atlanta mayor Kasim Reed and his city council negotiated a plan that saves $25 million annually. A year later, Lexington, Ky., municipal officials and union representatives came to an agreement that was passed by the city in January of 2013 and later ratified by the state legislature. In Jacksonville, Fla., a task force recently announced a settlement, and the city's public-safety workers appear on track to ratify it.

The agreements vary in many ways. But there's a common denominator: a guarantee of previously promised pension payouts in return for substantial concessions from new hires. The Atlanta reform, for example, extends the retirement age for new employees and combines a smaller defined benefit with something similar to a private company's 401(k). Lexington's future hires will be on the job five years longer, must put in 25 years before benefits vest, and will face declining cost-of-living adjustments (COLAs). Jacksonville's new employees are slated to get a reduced pension package as well.

Even in Detroit -- a financial disaster area if ever there was one -- existing pensions were just cut 4.5 percent, while new hires who retire after 30 years will receive pensions worth 40 percent less in inflation-adjusted dollars than those who retired in 2011. In other words, new hires gave up about ten times as much.

What such agreements reveal is that public labor is indeed willing to help resolve the pension crisis, but only as long as past promises are enshrined with what David Draine, a senior researcher at the Pew Foundation, euphemistically calls "a credible and achievable plan to pay down any existing pension debt." As a practical matter, this means disproportionately burdening new hires with benefit plans that have larger co-pays, longer requirements for vesting, and/or an emphasis on contributions over payouts.

After years of statistics showing that public employees are better compensated than comparable private-sectors workers, fiscal hawks might initially celebrate this tradeoff. After all, the revised terms for new hires are probably closer to what current and retired public employees should have been offered all along. But it is hard to view this solution in the context of larger political trends without coming to some very disturbing conclusions.

First, consider that current public employees have clearly emerged as the biggest political winner of the 2008 financial crisis. The 2009 federal stimulus package, advertised by President Obama and the Democratic Congress as an infrastructure program but in reality a subsidy for state and city employment, allowed local governments to leave previously contracted pay and benefit increases intact. In effect, Washington increased compensation for public workers with seniority at a time when private-sector employment was stagnant or declining. The current thrust of pension reform will now make these gains permanent.

Second, bear in mind the insidious coalition of union leaders and blue-state Democrats, in which the former subsidized the campaigns of the latter in exchange for excessive benefit increases. Public employees in a few of the most troubled states may eventually lose a fraction of their retirement benefits, but most existing promises will be kept -- meaning that the union tactic of financially compromising elected representatives has, in the end, proved depressingly successful.

From the taxpayers' perspective, it might be acceptable to make good on the inflated pensions of present and previous government workers if this means an improved methodology for providing public services in the future. Unfortunately, the partnership between labor and the Democratic party is far from destroyed, and thus it is far from clear that these cuts will be maintained in the future.

In their defense, most municipal officials who have signed on to the emerging pension-reform template do boast of adopting more stringent budgeting policies. We can only hope these policies prove stringent enough, for the current expedient of making good on bad promises gives union leaders and their elected allies every hope of one day doing it again.

Lewis M. Andrews is the senior policy analyst at Connecticut's Yankee Institute for Public Policy.

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