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The Trump administration has no significant plan or strategy related to higher education. The only major policy declarations--to eliminate federal regulations on for-profit colleges and revisit federal guidelines on sexual assault on college campuses--both unravel policies developed under the Obama administration. Where the fate of higher education lies is in the innumerable initiatives bent on pleasing Trump's base and in the search for some sort of major legislative victory. As of this writing, this now includes a Republican coalition that wants to cut the funding for most federal agencies to ease the way for massive tax cuts. In the Trump administration's initial federal budget proposal presented last May, Trump planned huge reductions in federal programs, with two glaring exceptions: boosting military spending--including for veterans but also for hardware and more troops--and funding for a continent stretching border wall with Mexico. What about the funding future, and health and well-being, of America's great universities? To make financial room, and to placate some on the right, it is hard to imagine increased or even stable federal spending for research and financial aid. To partially offset tax cuts, spending must come down, at least in a rationale policy world. If this scenario plays out, higher education will be one of many casualties. Then again, confusion regarding the Trump agenda, discord among Republicans, lobbying by the many stakeholders of the current tax system, and even independent analysis of whatever convoluted plan emerges, could derail or significantly alter the tax-cut momentum. Or the thirst for a legislative tax-cut victory might simply temporarily blind Republican deficit hawks. In these scenarios, or a combination, federal funding for academic research and financial aid might only suffer minor cuts, or remain relatively stable--in the short run. For now, muddling through might not be good policymaking, but could be the best one can hope for. For American higher education in the volatile Trump era, disaster averted?

This paper examines the U.S. social insurance system, which we define broadly to include both programs supported by dedicated taxes and other federal programs that provide income support, assistance in meeting basic needs, or services to improve economic opportunity. The paper considers the social insurance system as a whole as well as its component parts, providing an overview of major federal programs in the areas of education and workforce development, health, income support, nutrition, and housing. The paper covers how the social insurance system is organized, how eligibility is determined and who benefits, how the benefits and services are delivered, and how the system affects poverty and inequality. We focus primarily on the system as it operated prior to the onset of the COVID-19 pandemic, but also look at how various programs respond to economic downturns. Coming at a time when policymakers will start shifting their focus from using the social insurance system to provide relief from the pandemic and recession to considering what changes should be made in the system on an ongoing basis, the paper also reprises an array of proposals to strengthen the system in various ways that The Hamilton Project has commissioned in recent years.

While research consistently finds positive earnings returns to educational attainment, there is little evidence on postsecondary education's impact on other employment-related outcomes. Yet nonpecuniary returns to schooling are particularly important in the United States, where fringe benefits are typically tied to employment and there is a great degree of variation in job quality. Using longitudinal data following a nationally representative sample of young persons who enrolled in at least some college education, this paper examines nonpecuniary labor market outcomes associated with different levels of postsecondary educational attainment. Overall, the results indicate that increasing levels of postsecondary educational attainment positively predict a number of beneficial employment outcomes. This is particularly the case for fringe benefits. After controlling for participants' backgrounds and educational experiences, attainment positively predicts access to employer-provided health and dental insurance, retirement, and paid leave. Results concerning job satisfaction and flexibility are weaker and more complex.

The Great Recession officially ended in June 2009. However, the labor market has made agonizingly slow progress toward a full recovery, and the slack that remains continues to be devastating for workers of all ages. The weak labor market has been, and continues to be, very tough on young workers. Though the labor market is headed in the right direction, it is improving very slowly, and the job prospects for young high school and college graduates remain dim. A key finding of this paper is that there is little evidence that young adults have been able to "shelter in school" from the labor market effects of the Great Recession. This briefing paper examines the labor market that confronts young graduates who are not enrolled in further schooling--specifically, high school graduates age 17-20 and college graduates age 21-24--in an attempt to focus as closely as possible on the labor market outcomes of those who are starting their careers. Key findings include: (1) Unemployment of young graduates is extremely high today because young workers "always" experience disproportionate increases in unemployment during periods of labor market weakness--and the Great Recession and its aftermath is the longest, most severe period of economic weakness in more than seven decades; (2) In today's labor market, there are nearly 1 million "missing" young workers; (3) Unemployment and underemployment rates among young graduates are improving but remain substantially higher than before the recession began; (4) Overall unemployment rates of young graduates mask substantial disparities in unemployment by race and ethnicity; (5) The large increases since 2007 in the unemployment and underemployment rates of young college graduates, and in the share of employed young college graduates working in jobs that do not require a college degree, underscore that the current unemployment crisis among young workers did not arise because today's young adults lack the right education or skills; (6) The long-run wage trends for young graduates are bleak, with wages substantially lower today than in 2000; (7) The erosion of job quality for young graduates is also evident in their declining likelihood of receiving employer-provided health insurance or pensions; (8) Graduating in a bad economy has long-lasting economic consequences; (9) The cost of higher education has grown far more rapidly than median family income, leaving students with little choice but to take out loans; and (10) Because the scarcity of job opportunities for the Class of 2014 is a symptom of weak demand for workers more broadly, what will bring down young workers' unemployment rates most quickly and effectively are policies that will generate strong job growth overall. Tables and figures are appended.

This paper discusses the background and character of changes introduced by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), examining post enactment responses by Congress, the states, and the courts. It explores the impact of the law on benefit use among immigrants, highlighting changes in usage among different immigrant groups and factors related to these changes, such as naturalization and rising incomes. For immigrants, the law set out a comprehensive scheme for determining immigrant eligibility for a wide range of social benefits provided by governments at all levels. Data from the 1995 through 2000 Current Population Survey indicated that PRWORA reduced immigrants' overall use of all major public benefits, and decreases in use were greater for non-citizens than citizens. Low-income immigrant families with children had lower use rates for Temporary Assistance for Needy Families and food stamps than did their low-income citizen counterparts. Low-income, working age non-citizens had substantially larger declines in Medicaid use than their citizen counterparts. Declines in immigrants' use of benefits were evident nationwide. The declining benefit use was not accounted for by increased naturalizations or rising incomes within immigrant families. (Contains 23 references.) (SM)

Dental disease is one of the most prevalent illnesses facing children in the United States today. Eighty percent of untreated dental disease in permanent teeth is found in roughly 25 percent of 5- to 17-year old children, most of whom come from low-income and other vulnerable populations. The State Children's Health Insurance Program (SCHIP) offers states an opportunity to expand health insurance and, by extension, financial access to dental care. This paper analyzes whether and how the coverage and delivery of dental services is changing under SCHIP, examining key differences between new separate SCHIP initiatives and traditional and expanded Medicaid programs. Data from telephone interviews and site visits with 18 states indicated that states did not focus particular attention on dental issues during SCHIP program development, though dental health coverage constituted a fundamentally important component of child health programs. All but one state elected to cover dental benefits. The extent of dental coverage under SCHIP was quite broad, although not as comprehensive as Medicaid dental coverage. Copayments on dental services were nominal in most separate SCHIP programs. Under separate SCHIP programs, some states raised dental payment levels above Medicaid's in an effort to raise dental provider participation, while other states paid about the same for dental services. In two states, early SCHIP dental program successes hastened reform efforts under Medicaid dental programs. Results suggest that improvements in access may be occurring under separate SCHIP programs that are paying dental providers at market rates when compared with Medicaid. (Contains 15 references.) (SM)

This study examined the enrollment process for the State Childrens Health Insurance Program (SCHIP) and the outcomes of that process. Data were collected during spring and summer of 2000 through telephone interviews with state program officials from eight states selected based on a variety of demographic and programmatic variables; the states were Alabama, California, Colorado, Florida, Michigan, Missouri, New York, and North Carolina. States had a difficult time producing outcome data and varied considerably in data collection and reporting practices. The major findings include the following: (1) states have implemented many similar strategies for simplifying the SCHIP enrollment process, but simplifications to Medicaid policies and procedures are less extensive; (2) inconsistencies between SCHIP and Medicaid eligibility rules and requirements made enrollment more difficult and confusing for families; (3) in most states, less than half of applicants were approved for SCHIP eligibility, with a large proportion referred to Medicaid; (4) large proportions of SCHIP applications were denied for procedural reasons; (5) SCHIP programs ask families about existing health insurance coverage as part of the application process, and deny coverage to families covered by other insurance; and (6) state SCHIP and Medicaid data systems are highly variable in their capacity to report eligibility outcome data. Implications of these findings for future policy include the need to ensure that appropriate referrals for Medicaid translate into approvals for Medicaid, to consider available alternatives for reducing the number of children denied coverage for procedural reasons or incomplete submissions, to monitor the relationships between public and private health coverage, and to improve states administrative data systems. (A discussion of the limitations of state data systems is appended. Contains 13 references.) (KB)

This study examined states efforts to retain children in their State Childrens Health Insurance Program (SCHIP). Data were obtained during spring and summer of 2000 through telephone interviews with state program officials from eight states selected based on a variety of demographic and programmatic variables; the states were Alabama, California, Colorado, Florida, Michigan, Missouri, New York, and North Carolina. The major findings include the following: (1) states procedures for conducting SCHIP eligibility redetermination were quite similar to one another, but had not been simplified to the same level as initial enrollment processes; (2) less than half of enrolled children retained SCHIP eligibility at redetermination; (3) high rates of parents who do not respond to renewal notices nor submit renewal applications for their children may be cause for concern; (4) denial of eligibility for failure to pay premiums did not provide information on premium affordability because the denial code reflected several possible outcomes; and (5) state SCHIP and Medicaid data systems were highly variable in their capacity to report eligibility and redetermination outcome data. Implications of findings for future policy include the need to simplify eligibility redetermination procedures, to monitor the dynamics of families with children enrolled in SCHIP, to make renewal notices more user-friendly, and to improve states administrative data systems. It was concluded that if states are to make informed improvements in their eligibility renewal policies, they need either to invest in improving administrative data systems, or to periodically conduct research to understand better what happens to children once they lose their SCHIP eligibility. (Contains 11 endnotes and 9 references.) (KB)

Under the State Childrens Health Insurance Program (SCHIP), states have the option to subsidize employer premiums for low-income workers with children. Given the potential for subsidized employer-sponsored insurance (ESI) programs to reduce the number of uninsured children, this study examined SCHIPs regulations and state experiences with premium assistance programs. In addition to a literature review, three states, Massachusetts, Mississippi, and Wisconsin, were selected for in-depth examination. Data were collected through telephone interviews with officials from each state and from the Centers for Medicare and Medicaid Services regarding the impact of SCHIP regulations, state implementation experiences, and lessons learned. Findings revealed that although state officials viewed premium assistance as a worthwhile means of expanding health coverage, the experiences of Massachusetts and Wisconsin suggest that subsidizing ESI programs is administratively complex due to federal requirements addressing concerns about crowd out--the potential that SCHIP might displace private insurance coverage. These states found that outreach efforts had to be augmented with specific efforts targeting employers. Enrollment procedures were complex, time-consuming, and challenging, especially the requirements to compare employee benefit packages to the state-selected SCHIP benchmark. Massachusetts and Wisconsin officials cautioned other states from being overly optimistic about initial enrollment, with Wisconsins enrollment currently at 47 families. Mississippi had yet to implement its program, but state officials were optimistic that it is a worthwhile strategy within the broader context of expanding health coverage. It was concluded that it is reasonable for states to question the efficiency of this strategy for reducing the number of uninsured among low-income children, given the limited target population and the small likelihood that federal regulations for premium assistance under SCHIP will be relaxed. (Contains 25 endnotes and 24 references.) (KB)

Prior to the enactment of the State Children's Health Insurance Program (SCHIP), policymakers examined the need to safeguard the private insurance market from "crowd out," the substitution of public health insurance coverage for private health insurance coverage. This qualitative study examined how 18 states are addressing crowd out, the degree to which state officials perceive crowd out to be occurring, and the implications of crowd-out prevention strategies on enrollment. Data were collected through site visits and telephone interviews with a broad range of key informants in the 18 states (Alabama, California, Colorado, Connecticut, Florida, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Texas, Washington, and Wisconsin). Findings indicate that 17 states adopted policies to address crowd out. Seven types of crowd-out strategies were identified: (1) waiting periods; (2) monitoring/application questions regarding children's health insurance status; (3) verifying insurance status against databases of private coverage; (4) cost sharing; (5) subsidizing employer-based coverage; and (6) imposing obligations on employers or insurers. SCHIP and Medicaid officials, as well as other key informants, consistently reported little to no concern over crowd out. However, the pressures to increase enrollment have begun to outweigh concerns about crowd out at the state and local levels. It was concluded that although it is difficult to predict the direction that SCHIP will take, clearly the issues surrounding crowd out will continue to influence the discussion, particularly as the program reaches higher income families. (Two appendices delineate the types of policies to deter crowd out in 50 states and the District of Columbia, and list key SCHIP and Medicaid contacts in the study states. Contains 16 references.) (KB)

Noting that children with special health care needs (CSHCN) make up one of every six children eligible for the State Children's Health Insurance Program (SCHIP), this study examined how SCHIP responded to the needs of children with chronic illnesses and disabilities. This qualitative study was based on the implementation experiences in 18 states. Key findings were organized into six areas. Findings indicated that none of the study states made overt efforts to target CSHCN for enrollment. Benefit packages under separate programs were more limited than those covered by Medicaid. In almost every state, SCHIP programs relied on managed care, with CSHCN being served through the same care systems serving all children. Three states reported policies that exempted CSHCN from cost sharing or somehow protected them from undue expense. Waiting periods disproportionately affected families of CSHCN. States reported difficulty in identifying and enrolling large numbers of CSHCN into SCHIP programs. Based on findings, two changes to current policy are recommended: (1) permit SCHIP coverage to "wrap around" existing private health insurance for selected priority populations; and (2) encourage or require states to broaden their waiting period exceptions policies to allow CSHCN to drop private coverage if that coverage is significantly limited or expensive. (An appendix lists the key SCHIP and Medicaid contacts in the study states. Contains 30 references.) (KB)

This paper addresses issues related to health care reform and the impact of managed care on health care services to children and youth with disabilities or special health care needs. Federal laws governing support for children with disabilities and their families are listed and briefly reviewed, noting a trend toward the dismantling of guarantees for children with disabilities. Major health care needs of disabled and chronically ill children are noted, including the finding that about 10 million children have no health insurance, that massive cuts in Medicaid could cause another 5 million to lose health coverage, and that one-third of children with chronic illness or disability have no source of care. Concerns of families are also listed, such as lack of sufficient family income, inability to locate necessary services, and difficulty in communicating with the health care provider. The current status of Medicaid-managed care for disabled children is summarized and model state programs are noted. Sixteen recommendations for advocates of children with disabilities are offered, such as to become informed about issues of public and private financing of health care, to insist on guaranteed access to medically necessary speciality care, to lobby legislative bodies at all levels, and to form coalitions with others concerned about children and health. (Contains 24 references.) (DB)

One of the objectives of the U.S. Department of Education's National Goals for Education is that "Children will receive the nutrition and health care needed to arrive at school with healthy minds and bodies, and the number of low birthweight babies will be significantly reduced through enhanced prenatal health systems." This paper provides background information on the current state of child health, nutrition, and health care in the United States, and on medical conditions and public health problems relevant to academic achievement and the functioning of schools. The paper begins with observations about the relationship between child health and learning. Several ways in which ill health can interfere with the learning process are outlined. The paper touches on the influence of economic disparities in child health status, health limitations, the infant mortality rate, frequency of medical care, place of care, health insurance coverage, nutritional status, and birth weight. The paper concludes by noting that there is a link between child health and educational outcomes, but even substantial progress in improving children's health status cannot be relied on to dramatically alter group differences in academic achievement. Contains 26 references. (CW)

This document provides an analysis of key themes, as they relate to the U.S. Latino population, included in the President's 2016 State of the Union Address. Addressing these issues is critical to extend opportunity to more people to help ensure national prosperity and security for generations to come.

The Chilean authorities plan to raise budgetary allocations over the medium term for a variety of social programmes, including education, health care and housing. This incremental spending will need to be carried out in a cost-efficient manner to make sure that it yields commensurate improvements in social outcomes. Chile's health indicators show that it fares relatively well in relation to comparator countries in the OECD area and in Latin America. But this is less so in the case of education, where secondary and tertiary educational attainment remain low, despite a significant increase over the years, and performance is poor on the basis of standardised test scores, such as PISA. Even though comparison with countries in the OECD area is difficult, a sizeable housing deficit has yet to be closed in Chile. To meet these various challenges, efforts will need to be stepped up to: i) narrow the disparities in performance that currently exist among schools with students from varying backgrounds through use of the "differentiated" voucher scheme and additional measures to improve the quality of teaching and management; ii) improve risk sharing among private and public health insurers, while increasing the coverage of health insurance to a broader variety of pathologies under AUGE; and iii) continue to tackle the shortage of housing, while enhancing the quality of subsidised housing units and their surrounding neighbourhoods for the poorest segments of society. This paper relates to the "2007 Economic Survey of Chile" (www.oecd.org/eco/surveys/chile). (Contains 9 footnotes, 10 figures, and 6 tables.)

Workers in flexible staffing arrangementsincluding temporary agency, direct-hire temporary, on-call, and contract workersare much less likely than regular, direct-hire employees to be covered by laws mandating or regulating workplace benefits. They are also much less likely to receive pension, health insurance, and other benefits on the job. Several factors affect whether and how workers in flexible arrangements are covered by benefits regulations. The first is whether the worker is an employee or an independent contractor. Laws governing benefits pertain only to employees. If the worker is an employee, who is the statutory employer for the purposes of benefits regulation? This issue arises in the context of temporary agency workers, contract company workers, and leased employees who are paid by one employer but perform work for another. Finally, benefit laws typically include hours or earnings thresholds and thus exclude many temporary and part-time workers from coverage. Although reducing benefits costs is not the only reason employers use flexible staffing arrangements, it is an important factor motivating many employers to use them and the level of and growth in these arrangements would be lower in the absence of this incentive. (Appendixes include 29 references, 5 tables, and 1 figure.) (YLB)

Use of flexible staffing arrangements--including temporary help agency, short-term, on-call, regular part-time, and contract workers--is widespread and two-thirds of employers believe this trend will increase in the near future. A study examined which employers use flexible staffing arrangements, why they use these arrangements, and their implications for workers and public policy. Data were collected from a nationally representative survey of private sector businesses, using a telephone survey of 550 employers. The traditional reasons concerning the need to accommodate fluctuations in workload or absences in staff are the most commonly cited reasons for using all types of flexible staffing arrangements. Many employers also use agency temporaries and part-time to screen candidates for regular positions. Finally, savings on benefits costs is an important factor determining employers' use of flexible staffing arrangements. Workers in flexible staffing arrangements typically are not covered by regulations governing benefits, and they usually do not receive key benefits, such as pension benefits and health insurance, when these benefits are offered to regular full-time workers. (Survey data and methodology information are appended.) (Contains 31 references.) (KC)

Legislative and professional medical committee developments in graduate medical education needs and directions are reviewed in this background paper. The Graduate Medical Education National Advisory Committee (GMENAC) represents a critical nonregulatory step in the establishment of goals for the training and differentiation of physician manpower. It is responsive to the intents and judgments expressed by many public and private bodies in recent years and provides an opportunity for the identification and development of issues of concern to the public and the profession. GMENAC will be able to highlight issues in the development of national health insurance that relate to graduate education, and to present strategies to HEW for consideration in the planning of new health manpower legislation that will be in its early conceptual stages in 1978 and 1979. (Author/LBH)

Key issues pertinent to federal support of nursing education and training are considered. Policy options for nurse training include: support for programs to increase aggregate supply, support for programs to improve geographic distribution of nurses, support for programs to increase the availability of nurses with advanced training, and support for programs to expand minority enrollment. In addition to analyzing trends in the supply and demand for registered nurses, the impact of major health system changes, such as health insurance, on supply and demand is examined. The current status of programs authorized by the Nurse Training Act of 1975 and other federal programs that support nursing education and training are described. A summary assessment of the models developed to estimate the future demand for and/or supply of RNs is included. (SW)

A multitude of public policy issues currently surround the tax treatment of employee benefits, particularly since the tax-favored status of employer contributions to pensions and health insurance has been blamed for a shrinking tax base that has exacerbated the federal budget deficit, an inefficient and bloated health-care sector, overinsurance by many recipients of employer-provided health insurance, rising health care costs, and a tax system made more regressive because those who receive tax-favored employee benefits tend to be in higher-income households than those who do not. A relatively low cap on health insurance contributions--perhaps at an employer contribution of $1,125 annually--would improve efficiency and has at least five points in its favor: (1) it partially addresses the problems of rising health care, overuse of the system, and an inefficiently large health-care sector; (2) it addresses the concern that the tax base will continue to be eroded as health care costs rise and as employer contributions increase; (3) it would not limit or reduce access to basic health care by currently or potentially insurable workers; (4) it would imply an improvement in the equity of the tax system; and (5) it would not foreclose the option of mandating health insurance benefits. (The document contains 85 references, 11 tables, 1 figure, and appendices that discuss data problems in research on employee benefits and review recent studies of the tax treatment of employee benefits.) (CML)

This study of the potential labor market consequences of government mandating of employee benefits suggests that mandating benefits will increase benefit coverage and generosity for insurance coverage will not be helped; even when mandating benefits does improve benefit provision, there will be other offsetting effects, including wage and other benefit cuts, reduced work hours, reduced employment, and possible output reductions; and employer bias against workers who are particularly expensive to insure may also result. A variable cost format where benefits accrue according to hours worked somewhat mitigates the drawback of raising labor costs for low-wage workers and is more responsive to worker and firm differences in the demand for benefits. Any tax incentives should be paired with a cap on the overall fraction of payroll that can be used for tax-shielded employee benefit contributions in order to make the tax and benefit systems more equitable as a whole. If benefits are to be mandated, each element of a target mandated benefit package should be ranked in a priority list and justified on both efficiency and equity grounds. A separate approach should be designed to meet the needs of those not covered by employer-provided benefit programs. (73 references) (CML)

It is the position of the National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse) serves a vital role in the delivery of health care to our nation's students within the healthcare system reshaped by the Patient Protection and Affordable Care Act of 2010, commonly known as the Affordable Care Act (ACA). This law presents an opportunity to transform the healthcare system through three primary goals: expanding access, improving quality and reducing cost (U. S. Government Printing Office, 2010). School nurses stand at the forefront of this system change and continue to provide evidence-based, quality interventions and preventive care that, according to recent studies, actually save healthcare dollars (Wang et al., 2014). NASN supports the concept that school nursing services receive the same financial parity as other healthcare providers to improve overall health outcomes, including insurance reimbursement for services provided to students. [This document replaces the Position Statement "Health Care Reform" (Adopted June 2006, Revised June 2010).]

Public health insurance programs comprise a large share of federal and state government expenditure, and these programs are due to be expanded as part of the 2010 Affordable Care Act. Despite a large literature on the effects of these programs on health care utilization and health outcomes, little prior work has examined the long-term effects of these programs and resultant health improvements on important outcomes, such as educational attainment. We contribute to filling this gap in the literature by examining the effects of the public insurance expansions among children in the 1980s and 1990s on their future educational attainment. Our findings indicate that expanding health insurance coverage for low-income children has large effects on high school completion, college attendance and college completion. These estimates are robust to only using federal Medicaid expansions, and they are mostly due to expansions that occur when the children are older (i.e., not newborns). We present suggestive evidence that better health is one of the mechanisms driving our results by showing that Medicaid eligibility when young translated into better teen health. Overall, our results indicate that the long-run benefits of public health insurance are substantial.