Search

The centrality of home equity to the balance sheets of American households, and the oppressive legacy of racial exclusion from mortgage markets, compel the design of intentionally anti-racist housing policy capable of building lasting wealth for Black families. In this study, we compare the home-mortgage terms offered to middle-income Whites in the New Deal era, with a contemporary New York City policy offered in formerly redlined districts. The city's Housing Development Fund Corporation policy is for limited-income households but does not limit down payments nor qualify for federal home loans. Using mined listing data and the 2017 Panel Study of Income Dynamics, we find more than 80% of income-eligible urban Black households lack the wealth to purchase the median listing, versus 51% of Whites. Moreover, the policy's market exclusions preclude access to what is now substantial accumulated equity. Unit owners face wide-scale housing-code violations and property seizure, highlighting the limitations of "limited equity" ownership, which counteracts wealth creation. We draw two primary lessons. First, anti-racist policy cannot demand substantial financial assets. Second, financing schemes for building improvement or climate-responsive adaptation, in addition to initial purchase, should be well-tailored to family budgets and designed to deliver equity to the formerly excluded. [ABSTRACT FROM AUTHOR]

This article discusses the relationship between racial wealth inequality and access to care with high-deductible health insurance (HDHP). The study focuses on the impact of this trend on Black consumers, who may face affordability barriers due to income constraints and historical wealth disparities. The findings suggest that Black enrollees in HDHPs are more likely to have lower incomes and fewer assets compared to White enrollees. However, the study does not establish a causal link between racial wealth inequality and affordability disparities. The analysis finds that racial disparities in access to care are greater among high-deductible plan holders, but the inclusion of economic covariates, such as income and wealth, reduces these disparities. The study suggests that income and wealth play a larger role in explaining racial disparities in access to care among high-deductible plan holders. [Extracted from the article]

Several states are considering competitive procurement to help shape Medicaid managed care markets. In New York state, the focus of our study, regulators propose contracts that reward quality improvement and simplify state administration by rewarding plans that operate across several of the state's 62 counties. This case analysis uses novel regulatory data from New York state, obtained via public records request, to examine incentives underlying Medicaid markets and help inform contracting design. The data report plan enrollment by county and plan spending across administrative activities for all 16 Medicaid plans in New York state for 2018. We examine the counties in which plans operate, profitability, and administrative resource allocation. We compare outcomes by tertile of plan profitability, measured as net income per member-month. Plan profitability ranged widely, with the most profitable plan realizing nearly $30 per member-month while the least profitable 5 plans realized net negative earnings. Operational differences across plan profitability emerged most clearly in administrative spending. The most profitable plans reported greater spending on salaries overall and for executive management, and taxes, while the least profitable plans spent more on operational functions including utilization management/ quality improvement, claims processing, and informational systems. We observe modest differences in county rurality and little in geographic breadth. Procurement design that rewards capacity-building in key administrative functions might impact market evolution, given that on average, highly profitable firms spent less on these activities in New York's Medicaid managed care market in 2018., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.