Thursday, March 6, 2014

Policy Analysis or Political Talking Points: "The War on Poverty: 50 Years Later"

It has been 50 years since President Lyndon B. Johnson signed the Economic Opportunity Act (EOA), declaring a “war on poverty." The EOA was passed in August 1964 and included programs meant to help lift low-income individuals out of poverty. These included the Job Corps; Neighborhood Youth Corps; Head Start; Adult Basic Education; Family Planning; Community Health Centers; Congregate Meal Preparation; Economic Development; Foster Grandparents; Legal Services; Neighborhood Centers; Summer Youth Programs; Senior Centers; and others.

Over the decades more and more assistance programs have been implemented at the federal level. There are currently 92 federal programs aimed at assisting low-income Americans including food-aid, educational programs, housing programs, and job training and placement programs. Despite the approximate $799 billion being spent annually on these programs the national poverty rate has only fallen 2.3 % since 1965, while the number of Americans living in “deep poverty” has reached its highest level in our nation’s history. [1] This disparity in numbers has left many frustrated with what they believe is a failure of these federal programs and policies.

Cover Image of House Budget Committee Report: "The War on Poverty: 50 Years Later"
This week the House Budget Committee Majority Staff released a report entitled “The War on Poverty: 50 Years Later.” The report was released just one day before President Obama laid out his own budget proposal for Fiscal Year 2015. It outlines most of these federal assistance programs and discusses the purpose, history, funding, and evidence of success or failure for each program.

The report is spearheaded by Rep. Paul Ryan (R-WI) and was drafted by the Majority Staff rather than the full committee, and should therefore be evaluated in the context of its partisan spirit. Ryan’s report has already been criticized by many Democrats. The Democratic National Committee (DNC) spokesman, Michael Czin, gave a statement to CNN Politics that read:

This report is just a rehash of a failed economic agenda that Americans keep rejecting…"Republicans just don't get it. Their plan is to block a minimum wage increase, cut access to higher education, slash early childhood programs, voucherize Medicare and shred the social safety net — a safety net that lifted 45 million Americans out of poverty in 2012 alone” (CNN Politics, 3/03/2014).

Further, Congresswoman Barbara Lee (D-CA) released a statement on Tuesday slamming Ryan’s report, saying:

“This report is nothing more than an ideologically bankrupt battle plan to attack the poor. Not only does this report disregard current and respected data in the field, this is a callous look at the state of our country. Republicans are continuing their attack on the social safety net with tired proposals that fly in the face of the evidence. Republicans continue to try and gut the safety net at the expense of families, children, and the elderly.

What our country needs is investments in job creation and training, proven anti-poverty programs and early childhood education, and to open access to high-quality college education, as laid out in the budget that President Obama released today. In stark contrast to Rep. Ryan’s report, the President’s budget lays out a vision for the future that supports families, encourages growth, and creates opportunity for all.”

Given the partisan nature of the report, it is encouraging to find that two of the most progressive HIV/AIDS programs faired relatively well: “Ryan White HIV/AIDS Program” (i.e. state ADAPs) and the “Housing Opportunities for Persons Living with AIDS” (HOPWA).

The report estimates Ryan White Care Act funding to be at $2.367 billion for the 2012 fiscal year. It identifies the services included in the funding appropriations to be the following: “medical care, drug treatments, dental care, home health care, and outpatient mental-health and substance-abuse treatment.” According to the report, Ryan White funds serve more than half a million people, 29% of which are uninsured and an additional 56% that are underinsured.

The report goes on to cite empirical studies which lend validity to the efforts of Ryan White-funded programs. The first acknowledges that Ryan White programs have been successful in filling in gaps in Medicaid’s HIV/AIDS services and points to a study which has shown high satisfaction rates among RW recipients.[2] It goes on to clarify stating that, “…Ryan White–funded facilities offered more clinic, non-clinic, and adherence support services than non-RW–funded facilities.”[3]

Additionally, the report recognizes the strides that Ryan White funding has made in addressing comorbidity with regard to persons living with HIV/AIDS and the Hepatitis B or C virus stating that, “The Ryan White program is funding two programs to test a new model of integrating hepatitis C treatment into their clinical practices.”[4]

Finally, the report contends that Ryan White programs have helped to reduce mortality and morbidity rates [5]:

In 2010, 546,156 individuals received RW services. Of these: o Seventy-nine percent had documentation and received RW case management/outpatient care; o Of those who received RW funded medical care and had dates available, 76 percent were retained in medical treatment; and o Similar performance outcomes were demonstrated across the continuum of RW services.”

Ryan White-funded programs were not the only HIV/AIDS programs assessed by the report. The Housing Opportunities for Persons with AIDS program (HOPWA) was also evaluated by the House Budget Committee Majority Staff. HOPWA was created to provide housing assistance and supportive services for low-income individuals living with HIV/AIDS and their families. Specifically, funds are used for “acquisition and rehabilitation of housing units, rental assistance, and homelessness prevention,” according to the report. Additional supportive services are said to include, “case management, substance-abuse treatment, and job training programs.”

The Office of Management and Budget Program Assessment Rating Tool (OMB PART) evaluated this program in 2008. The report states that it found the program to be “effective” saying that its specific mission is, “…high levels of results in assisting a vulnerable population to achieve beneficial outcome.” [6] It went on to claim that recent studies have shown that providing housing to persons living with HIV/AIDS reduces the use of medical care, showed improvement in overall stability, and led to improved health outcomes.” [7]

The estimated budget for this program was $334 million in the 2012 fiscal year.

Photo of Rep. Paul Ryan during House Budget Committee hearing, looking at the camera
The budget negotiations are a conspicuous test of faith for the former conservative darling
Chip Somodevilla/Getty Images
Republicans like Rep. Paul Ryan have taken a lot of heat for their criticism of entitlement programs. This recent report will likely serve to continue to fuel the fire of debates with regard to the war on poverty. However, it is reassuring for those working in the field of HIV/AIDS-related public health and advocacy that Ryan White-funded programs, such as ADAP, and other assistance programs, like HOPWA, continue to demonstrate their cost-effectiveness in the public sector.  

[1] A household living in “deep poverty” makes less than 50 percent of the poverty line (according to the House Budget Committee Report: The War On Poverty: 50 Years Later
[2] “The Study of Medicaid and Ryan White Program Coordination: Where Does the Responsibility Lie?” The Center for Public Policy Research and Ethics, the AIDS Institute for The Florida Department of Health, Bureau of HIV/AIDS, Accessed 28 Feb. 2014.
[3] E. Valverde, C. Del Rio, L. Metsch, P. Anderson-Mahoney, C. S. Krawczyk, L. Gooden, and L. I. Gardner, “Characteristics of Ryan White and Non-Ryan White Funded HIV Medical Care Facilities across Four Metropolitan Areas: Results from the Antiretroviral Treatment and Access Studies Site Survey,” AIDS CARE, Vol. 16, No. 7, Oct. 2004.
[4] Rupali K. Doshi and Laura W. Cheever, “Ryan White Program Addressing Coinfection with Viral Hepatitis,” U.S. Department of Health and Human Services, Health Resources and Services Administration,, 2 May 2013.
[5] “Continuum of HIV Care Among Ryan White HIV?AIDS Program Clients. U.S., 2010,” U.S. Department of Health and Human Services, Health Resources Administration, HIV/AIDS Program, Accessed 20 Feb. 2014.
[6] “Program Assessment: Housing Opportunities for Persons with AIDS”, Accessed 11 Feb. 2014
[7] Richard Wolitski, Daniel Kidder, Sherri Pals, Scott Royal, Angela Aidala, Ron Stall, David Holtgrave, David Harre, Cari Courtenay-Quirk, “Randomized Trial of the Effects of Housing Assistance on the Health and Risk Behaviors of Homeless and Unstably Housed People Living with HIV,” AIDS and Behavior, Vol. 14, No. 3, Jun. 2010.

1 comment:

Robert Reynolds said...

RW programs funded in part and monitored at the federal level are implemented locally.. The war on poverty has been funded and regulated at the federal level. Do-gooders and powerful lobbies determine policy and regulations. The results clearly demonstrate that one size fits all does not effectively meet local needs. The federal role is to ensure equity in application avoiding local prejudices and greed.