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U.S. Intervention in Russia-Saudi Impasse Isn't Tenable (Radio)

Meghan L. O’Sullivan, Professor of International Affairs at Harvard’s Kennedy School, former National Security Council advisor, and a Bloomberg Opinion columnist, discusses the oil market plunge, and the Russia-Saudi relationship. Hosted by Lisa Abramowicz and Paul Sweeney.




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Columbia University Professor Scott Barrett Compares Global Responses to COVID-19 and Climate Change in Special Edition of "Environmental Insights"

Columbia University Professor Scott Barrett assessed the massive global efforts underway to address COVID-19 and the potential impacts of the pandemic on our lives in the future in a special episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program,” a podcast produced by the Harvard Environmental Economics Program. Listen to the interview here.




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Trade secrets shouldn’t shield tech companies’ algorithms from oversight

Technology companies increasingly hide the world’s most powerful algorithms and business models behind the shield of trade secret protection. The legitimacy of these protections needs to be revisited when they obscure companies’ impact on the public interest or the rule of law. In 2016 and 2018, the United States and the European Union each adopted…

       




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Trends in online disinformation campaigns

Ben Nimmo, director of investigations at Graphika, discusses two main trends in online disinformation campaigns: the decline of large scale, state-sponsored operations and the rise of small scale, homegrown copycats.

       




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Study Group on Energy Innovation and the Transition to a Low-Carbon Economy: Advising Fortune 500 Companies

This study group will explore the role of the private sector in evolving energy systems, and how corporations might change in a climate constrained world. 




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U.S. Intervention in Russia-Saudi Impasse Isn't Tenable (Radio)

Meghan L. O’Sullivan, Professor of International Affairs at Harvard’s Kennedy School, former National Security Council advisor, and a Bloomberg Opinion columnist, discusses the oil market plunge, and the Russia-Saudi relationship. Hosted by Lisa Abramowicz and Paul Sweeney.




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Study Group on Energy Innovation and the Transition to a Low-Carbon Economy: Advising Fortune 500 Companies

This study group will explore the role of the private sector in evolving energy systems, and how corporations might change in a climate constrained world. 




mpa

U.S. Intervention in Russia-Saudi Impasse Isn't Tenable (Radio)

Meghan L. O’Sullivan, Professor of International Affairs at Harvard’s Kennedy School, former National Security Council advisor, and a Bloomberg Opinion columnist, discusses the oil market plunge, and the Russia-Saudi relationship. Hosted by Lisa Abramowicz and Paul Sweeney.




mpa

Study Group on Energy Innovation and the Transition to a Low-Carbon Economy: Advising Fortune 500 Companies

This study group will explore the role of the private sector in evolving energy systems, and how corporations might change in a climate constrained world. 




mpa

U.S. Intervention in Russia-Saudi Impasse Isn't Tenable (Radio)

Meghan L. O’Sullivan, Professor of International Affairs at Harvard’s Kennedy School, former National Security Council advisor, and a Bloomberg Opinion columnist, discusses the oil market plunge, and the Russia-Saudi relationship. Hosted by Lisa Abramowicz and Paul Sweeney.




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Is activism against Deepavali firecrackers a one-day campaign against Hinduism?

Air pollution
Why are activists opposing an ‘old tradition’, and why not complain against other festivals? An environmentalist answers.
PTI
The run-up to Deepavali this year saw a fierce debate on religion and tradition versus the environment and pollution. This after the Supreme Court imposed a ban on the sale of firecrackers in New Delhi and NCR in an attempt to curb pollution. With public opinion polarised on the issue, environmentalist Nityanand Jayaraman, working with the Vettiver Collective in Chennai, answers some fundamental questions raised in the debate. There are four questions which I am going to address here. The first is - It is just a few days of celebration.  How much harm can it cause? Second - What about the air pollution during the rest of the year? Third – This is a tradition that we have followed for millennia. This was never a problem when we were growing up. Why is it a problem now? Fourth – What about the pollution caused by other festivals? Here's my response. 1. It is just a few days of celebration.  How much harm can it cause? The intensity of the celebration (bursting firecrackers) depends on the number of people bursting, the duration of the celebration and the quantity and type of firecrackers they burst. This can be ameliorated or worsened by weather conditions, and whether you live in a congested area or an open neighbourhood. The unfettered bursting of firecrackers can send air quality plummeting as it did yesterday (Wednesday), when air quality index (AQI) was 15 times worse than satisfactory levels. As I have written, it is a scientific fact that AQI above 400 will harm even healthy people, and may send children and other vulnerable populations to the emergency ward. Even brief exposures to such high levels can cause extreme distress to such people. Our tradition does not teach us to harm others, and I'm sure people who are bursting firecrackers are not doing that to harm others or send children and the elderly to the hospital. They are doing that because they don't know, and are not told that there are healthier ways to celebrate. At such high levels, there is no escape from the killer dust, which will go deep into your bodies and harm you over a long term. The damage due to short exposures to intense pollution can be significant and prolonged. This is particularly so, when the remaining 365 days are also spent in unhealthy conditions, and you allude to that. This brings me to your second challenge. Read: Chennai chokes on Deepavali, air pollution at hazardous levels 2. Why is enough not being done about air pollution during the rest of the year? Why do people cry and shout only during Diwali? You are right that enough is not being done about air pollution during the rest of the year. I work in a collective that lends support to communities in Ennore, a port near Chennai, where coal-fired thermal power plants and heavy vehicle movement has rendered air quality unhealthy throughout the year. No matter how loudly we shout, we are unable to make ourselves heard. We also talk about pollution of the Ennore Creek with oily wastes from the Manali petrochemical refinery. Every day, the refinery and the industrial estate discharges tonnes of toxic, noxious oily wastes into the Ennore Creek and the Bay of Bengal. Fisherfolk have been shouting about it since 1990s. But they are not being heard. It is not because the fisherfolk are not loud enough. Rather it is because we are deaf or unwilling to listen. It was ironic then that when the oil tanker collision sent oily wastes into the Bay of Bengal, all of Chennai was self-righteously indignant. You are right that after Deepavali the air (pollution) clears. When we think that air has returned to normal, air quality levels will still be high enough to harm us. What that should tell us is not that Deepavali pollution should be condoned, but that the pollution during the rest of the year needs to be curbed by tackling its causes – private vehicles, air pollution intensive electricity generation, poor construction practices and inadequate vegetative cover within the city. Also, it is not only during Diwali that we shout. You will notice a similar spike in concern over air pollution in January around Bhogi, when the burning of old things (including tyres) and unfavourable meteorological conditions intensify air pollution. In September, when the Velankanni Church celebrates the Feast of Our Lady, the beach in Chennai and all roads leading to Besant Nagar are just trashed by earnest devotees. Clearly the problem is not restricted to any one religion, and all religions and all rituals need to be re-evaluated in light of growing evidence that human lifestyles are harming the environment and humans who need air, water, and food to survive. Also read: Air quality plummets in Hyderabad on Diwali day 3. This is a tradition that we have followed for millennia. This was never a problem when we were growing up. Why are we making it a problem now? This is incorrect. Deepavali is a festival of lights, not a festival of noise and smoke. You are right that bursting firecrackers was a part of the Deepavali ritual when we were growing up. But it was not always that way. Lighting lamps which was an important part of Deepavali is hardly done nowadays, and bursting firecrackers has become more common place. The difference between when we were growing up and now is two-fold: a) There were a lot fewer people. In 1970, India's population was 550 million less than half of what it is now. Chennai had a population of 3 million as against a population of 5 million today – two million additional people live in the same land area. b) Overall, there were fewer people, and disposable incomes were small. Today, the middle class has expanded and the disposable income has increased. Hence, more people bursting more crackers. The same thing that we did a few decades ago with little impact has now become deadly. Traditions are not unchanging. Neither are the changes uniformly bad or good. Complaining about Deepavali's pollution is not an attack on Hindu tradition. It is a plea to change that tradition so that Deepavali can actually become a happy one. But Deepavalis of this loud and smoky kind are not happy for many, and particularly traumatic for animals. We would not permit our children to entertain themselves by stoning a kitten or a puppy; rather, we may teach them to enjoy themselves by petting it or feeding it. Similarly, why can't we kindle the spirit of celebration by engaging in compassionate but equally fun engagements? Why can't Deepavali be a festival of lights – a gentle festival, where we invite friends, sing songs, eat good food? 4. What about pollution caused by festivals of other religions? All our places of worship, and our rituals – irrespective of religion – have become anti-life. Christmas is a vulgar occasion of shopping and gifting things we never knew we needed to people who have no need for any more things. Increasingly, Christmas is less and less about Christ and more and more about shopping. So, you're right that we should be questioning and challenging any practices that make one person's celebration into another person's pain. I can appreciate your angst at the use of loudspeakers for religious purposes. This is done by “followers” of all religions, and there is a prohibition on this beyond 10 p.m. We could do better. Happy Smokeless, Noiseless Deepavali!




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Columbia University Professor Scott Barrett Compares Global Responses to COVID-19 and Climate Change in Special Edition of "Environmental Insights"

Columbia University Professor Scott Barrett assessed the massive global efforts underway to address COVID-19 and the potential impacts of the pandemic on our lives in the future in a special episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program,” a podcast produced by the Harvard Environmental Economics Program. Listen to the interview here.




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Webinar: The impact of COVID-19 on prisons

Across America, incarcerated people are being hit hard by COVID-19. The infection rate in Washington, D.C., jails is 14 times higher than the general population of the city. In one Michigan correctional facility, more than 600 incarcerated people have tested positive — almost 50% of the prison's total population. In Arkansas, about 40% of the…

       




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Defense Playbook for Campaigns

The 2018 National Defense Strategy (NDS) is predicated on a single organizing principle: America’s military pre-eminence is rapidly eroding. This is not a new concept. For years, experts have warned that the economic and technological advancements of U.S. adversaries, coupled with the 2008 financial crisis and America’s focus on peripheral conflicts, have caused a decline in America’s military dominance. 

In this context, the advances of near-peer competitors such as China and Russia have created plausible “theories of victory” in potential conflicts across Eastern Europe and East Asia. Competitors’ unaddressed improvements in strategic innovation, economic investment, and dual-use technology increases the risk of conflict and strains the U.S. alliance system. It is urgent that the United States reestablish and maintain credible deterrents against these near-peer competitors. After decades of focusing on post-Cold War ‘shaping’ operations, the American military needs to reinvigorate for full spectrum great power competition.

This report is intended as a blueprint on how to begin that process from graduate students at the Belfer Center for Science and International Affairs at Harvard University. Contained inside are 12 memorandums. Each provides a high-level overview and specific recommendations on a key issue of American defense policy. 




mpa

Study Group on Energy Innovation and the Transition to a Low-Carbon Economy: Advising Fortune 500 Companies

This study group will explore the role of the private sector in evolving energy systems, and how corporations might change in a climate constrained world. 




mpa

U.S. Intervention in Russia-Saudi Impasse Isn't Tenable (Radio)

Meghan L. O’Sullivan, Professor of International Affairs at Harvard’s Kennedy School, former National Security Council advisor, and a Bloomberg Opinion columnist, discusses the oil market plunge, and the Russia-Saudi relationship. Hosted by Lisa Abramowicz and Paul Sweeney.




mpa

Columbia University Professor Scott Barrett Compares Global Responses to COVID-19 and Climate Change in Special Edition of "Environmental Insights"

Columbia University Professor Scott Barrett assessed the massive global efforts underway to address COVID-19 and the potential impacts of the pandemic on our lives in the future in a special episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program,” a podcast produced by the Harvard Environmental Economics Program. Listen to the interview here.




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COVID in the Maghreb: Responses and impacts

       




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Defense Playbook for Campaigns

The 2018 National Defense Strategy (NDS) is predicated on a single organizing principle: America’s military pre-eminence is rapidly eroding. This is not a new concept. For years, experts have warned that the economic and technological advancements of U.S. adversaries, coupled with the 2008 financial crisis and America’s focus on peripheral conflicts, have caused a decline in America’s military dominance. 

In this context, the advances of near-peer competitors such as China and Russia have created plausible “theories of victory” in potential conflicts across Eastern Europe and East Asia. Competitors’ unaddressed improvements in strategic innovation, economic investment, and dual-use technology increases the risk of conflict and strains the U.S. alliance system. It is urgent that the United States reestablish and maintain credible deterrents against these near-peer competitors. After decades of focusing on post-Cold War ‘shaping’ operations, the American military needs to reinvigorate for full spectrum great power competition.

This report is intended as a blueprint on how to begin that process from graduate students at the Belfer Center for Science and International Affairs at Harvard University. Contained inside are 12 memorandums. Each provides a high-level overview and specific recommendations on a key issue of American defense policy. 




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Turning back the Poverty Clock: How will COVID-19 impact the world’s poorest people?

The release of the IMF’s World Economic Outlook provides an initial country-by-country assessment of what might happen to the world economy in 2020 and 2021. Using the methods described in the World Poverty Clock, we ask what will happen to the number of poor people in the world—those living in households with less than $1.90…

       




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Webinar: The impact of COVID-19 on prisons

Across America, incarcerated people are being hit hard by COVID-19. The infection rate in Washington, D.C., jails is 14 times higher than the general population of the city. In one Michigan correctional facility, more than 600 incarcerated people have tested positive — almost 50% of the prison's total population. In Arkansas, about 40% of the…

       




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Trends in online disinformation campaigns

Ben Nimmo, director of investigations at Graphika, discusses two main trends in online disinformation campaigns: the decline of large scale, state-sponsored operations and the rise of small scale, homegrown copycats.

       




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Impacts and implications of the 2020 Taiwan general elections

Taiwan held elections for the president and all the members of the Legislative Yuan on January 11. Although President Tsai Ing-wen had maintained a strong lead in the polls, there were questions about the reliability of some polls. Moreover, the outcome of the legislative elections was very uncertain. China, which has long made clear its…

       




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Hutchins Center Fiscal Impact Measure

The Hutchins Center Fiscal Impact Measure shows how much local, state, and federal tax and spending policy adds to or subtracts from overall economic growth, and provides a near-term forecast of fiscal policies’ effects on economic activity. Editor’s Note: Due to significant uncertainty about the effect of the COVID-19 pandemic on the outlook for GDP…

       




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Health care market consolidations: Impacts on costs, quality and access


Editor's note: On March 16, Paul B. Ginsburg testified before the California Senate Committee on Health on fostering competition in consolidated markets. Download the full testimony here.

Mr. Chairman, Madame Vice Chairman and Members of the Committee, I am honored to be invited to testify before this committee on this very important topic. I am a professor of health policy at the University of Southern California and director of public policy at the USC Schaeffer Center for Health Policy and Economics. I am also a Senior Fellow and the Leonard D. Schaeffer Chair in Health Policy Studies at The Brookings Institution, where I direct the Center for Health Policy. Much of my time is now devoted to leading the new Schaeffer Initiative for Innovation in Health Policy, which is a partnership between USC and the Brookings Institution. I am best known in California for the numerous community site visits over many years that I led in the state while I was president of the Center for Studying Health System Change; most of those studies were funded by the California HealthCare Foundation.

The key points in my testimony today are:

    • Health care markets are becoming more consolidated, causing price increases for purchasers of health services, and this trend will continue for the foreseeable future despite anti-trust enforcement; 
    • Government can still play an effective role in addressing higher prices that come from consolidation by pursuing policies that foster increased competition in health care markets. Many of these policies can be effective even in markets with high degrees of concentration, such as in Northern California.

Consolidation in health care has been increasing for some time and is now quite extensive in many markets. Some of this comes from mergers and acquisitions, but an important part also comes from larger organizations gaining market share from smaller competitors. The degree of consolidation varies by market. In California, most observers believe that metropolitan areas in the northern part of the state have provider markets that are far more consolidated than those in the southern part of the state. Insurer markets tend to be statewide and are less consolidated than those in many other states. The research literature on hospital mergers is now substantial and shows that mergers lead to higher prices, although without any measured impact on quality.[1]

The trend is accelerating for reasons that are apparent. For providers, it is becoming an increasingly challenging environment to be a small hospital or medical practice. There is more pressure on payment rates. New contracting models, such as Accountable Care Organizations (ACOs), tend to require more scale. The system is going through a challenging transition to electronic medical records, which is expensive and requires specialized expertise to avoid pitfalls. Lifestyle choices by younger physicians lead them to pursue employment in large organizations rather than solo ownerships or partnerships in small practices.

The environment is also challenging for small insurers. Multi-state employers prefer to contract with insurers that can serve all of their employees throughout the country. Scale economies are important in building the analytic capabilities that hold so much promise for effectively managing care. Insurer scale is important to make it worthwhile for providers to contract with them under alternative payment models. The implication of these trends is an expectation of increasing consolidation. There is need for both public and private sector initiatives in addition to anti-trust enforcement to foster greater competition on price and quality.

How can competition be fostered? For the insurance market, public exchanges created under the Affordable Care Act (ACA) and private insurance exchanges that serve employers can foster competition among insurers in a number of ways. Exchanges reduce entry barriers by reducing the fixed costs of getting an insurer’s products in front of potential customers. Building a brand is less important when your products will be presented to consumers on an exchange along with information on the benefit design, the actuarial value and the provider network. Exchanges make it easier for consumers to make informed choices across plans. This, in turn, makes the insurance market more competitive. Among public exchanges, Covered California has stood out for making this segment of the insurance market more competitive and helping consumers make choices that are better informed.

The rest of my statement is devoted to fostering competition among providers. I believe that fostering competition among providers is a higher priority because the consequences of lack of competition are potentially larger. In addition, a significant regulatory tool, minimum medical loss ratios, part of the ACA, is now in place and can limit the degree to which purchasers pay too much for health insurance in markets with insufficient competition.

Fostering competition in provider markets involves two prongs—broadened anti-trust policy and other policies to foster market forces. Anti-trust policy, at least at the federal level, to date has not addressed hospital acquisitions of physician practices. These acquisitions lead to higher prices to physicians because hospitals can negotiate higher prices for their employed physicians than the physicians were getting in small practices. Although not yet extensive, a developing research literature is measuring the price impact.[2] Hospital employment of physicians can also be a barrier to physicians steering patients to high-value providers (another hospital or a freestanding provider). To the degree that it reduces the chance of larger physician groups or independent practice associations forming, hospital employment of physicians reduces potential competitors in contracting under alternative payment models.

Another area not addressed by anti-trust policy is cross-market mergers. The concern is that a “must have” hospital in a multi-market system could lead to higher rates for system hospitals elsewhere. Anti-trust enforcement agencies have tended to look at markets separately, so this issue tends not to enter their analyses.

Many have seen price and quality transparency as a tool to foster competition among providers. Clearly, transparency has become a societal value and people increasingly expect more information about organizations that are important to them in both the public and private sector. But transparency is often oversold as a strategy to foster competition in health care provider markets. For one thing, many benefit designs have few incentives to favor providers with lower prices. Copays are the same for all providers and with coinsurance, the insurer covers most of the price difference. Even high deductibles are limited in their incentives because almost all in-patient stays exceed large deductibles and out-of-pocket maximums also come into play for many who are hospitalized. Another issue is that the complexity of comparing prices is a “heavy lift” for many consumers. Insurers and employers now have excellent web tools designed to make it easier for patients to compare prices, but indications are that the tools do not get a lot of use.

Network strategies have the potential to be more effective. The concept behind them is that the insurer is acting as a purchasing agent for enrollees. To the extent that they have the potential to shift volume from high-priced providers to low-priced providers, money can be saved in three distinct ways. The first is the higher proportion of services coming from lower-priced providers. The second is the additional discounts from providers seeking to become part of the limited or preferred network. Finally, if a large enough proportion of patients are enrolled in plans with these incentives, providers will likely increase the priority given to cost containment. In creating networks, insurers are increasingly using broader and more sophisticated measures of price as well as some measures of quality. Cost per patient per year or cost for all services involved in an episode is likely to have more relevance than unit prices. Using such measures to judge providers for networks has strong analytic parallels to reformed payment approaches, such as ACOs and bundled payments for episodes of care. Network strategies also create more opportunities for integration of care. For example, a limited network or a preferred tier in a broader network could be mostly limited to providers affiliated with a large health care system. Indeed, some health systems are developing their own health plan or partnering with an insurer to offer plans that favor their own providers.

In this testimony, I discuss two distinct network strategies. One is the limited network, which includes fewer providers than has been the norm in private insurance. The other is the tiered network, where the network is broad but a subset of providers are included in a preferred tier. Patients pay less in cost sharing when they use the preferred providers. Limited networks are a more powerful tool to obtain lower prices because patient incentives are stronger. If patients opt for a provider not in the limited network, they are subject to higher cost sharing and might have to pay the provider the difference between the charge and what the plan allows. Results of these stronger incentives are seen in a number of studies by McKinsey and Co. that have shown that on the public exchanges, limited network plans have premiums about 15 percent lower than plans with broader networks.

Public and private exchanges are an ideal environment for limited network plans. The fixed contributions or subsidies to purchase coverage mean that consumers’ incentives to choose a plan with a lower premium are not diluted—they save the full difference in premium. Exchanges do not have the “one size fits all” requirement that constrains many employers in using this strategy. If an employer is offering only one or two plans, it is important that an overwhelming majority of employees find the network acceptable. But a limited network on an exchange could appeal to fewer than half of those purchasing on the exchange and still be very successful. In addition, tools provided by exchanges to support consumers facilitate comparisons of plans by having each plan’s network accessible on a single web site.

In contrast, tiered networks have the potential to appeal to a larger consumer audience. Rather than making annual choices of which providers can be accessed in network, tiered networks allow these decisions on a point-of-service basis. So the consumer always has the option to draw on the full network. Considering the greater popularity of PPOs than HMOs and the fact that tiered formularies for prescription drugs are far more popular than closed formularies, the potential market for tiered networks might be much larger. But this has not happened. In many markets, dominant providers have blocked the offering of tiered networks by refusal to contract with insurers that do not place them in the preferred tier. This phenomenon was seen in Massachusetts, where 2010 legislation prohibiting this practice led to rapid growth in insurance products with tiered networks.

Some Californians are familiar with a related approach of reference pricing due to the pioneering work that CalPERS has done in this area for state and local employees. Reference pricing is really an “extra strength” version of the tiered network approach. An insurer sets a reference price and patients using providers that charge more are responsible for the difference (although providers sometimes do not charge patients in such plans any more than the reference price). So the incentive to avoid providers whose price exceeds the reference price is quite strong. While CalPERS has had success with joint replacements and some other procedures, a key question is what proportion of medical spending might be suitable to this approach. For reference pricing to be suitable, the services must be “shoppable,” meaning that they must be discretionary with the patient and can be planned in advance. One analysis estimates that only one third of health spending is “shoppable.”[3]

While network approaches have a lot of potential for fostering competition in health care markets, including those that are consolidated, they face a number of challenges that must be addressed. First, transparency about networks must be improved. Consumers need accurate information on which providers are in a network when they choose plans and when they choose providers for care. Accommodation is needed for patients under treatment if their provider should drop out of a network or be dropped from one. Network adequacy regulations are needed to protect consumers from networks that lack access to some specialties or do not have providers close enough to their residence. They are also important to preclude strategies that create networks unlikely to be attractive to patients with expensive, chronic diseases. But if network adequacy regulation is too aggressive, it risks seriously undermining a very promising tool for cost saving. So regulators must very carefully balance consumer protection with cost containment.

Some consider the problem of “surprise” balance bills, charges by out-of-network providers that patients do not choose, to be more significant in limited networks. This may be the case, but the problem is substantial in broader networks as well, and its policy response should apply throughout private insurance.

Another approach to foster competition in provider markets involves steps to foster independent medical practices. Medicare has taken steps to ease requirements for medical practices to contract as ACOs. It recently took some steps to limit the circumstances in which hospital-employed physicians get higher Medicare rates than those in office-based practice. Private insurers have provided support to some practices to incorporate electronic medical records into their practices. To the degree that independent practice can be made more attractive relative to hospital employment, competition in provider markets is likely to increase.

Additional restrictions on anti-competitive behavior by providers can also foster competition. These behaviors include “all or nothing” contracting requirements in which a hospital system requires insurers to contract with all hospitals in the system and “most favored nation” clauses in which insurers get providers to agree not to establish lower rates for other insurers.

Although the focus of discussion about policy in this testimony has been about fostering competition, regulatory alternatives that substitute for competition should not be ignored. At this time, two states—Maryland and West Virginia—regulate hospital rates. Some states, mostly in the Northeast, have been looking at this approach. Although I respect what some states have accomplished with this approach in the past, I need to point out that the current environment poses additional challenges for rate setting. The notion that rates would be the same for all payers, a longstanding component in Maryland, is unlikely to be practical today because rate differences between private insurance, Medicare and Medicaid are so large. So differences would likely have to be “grandfathered.” More practical would be to limit regulation to commercial rates, as West Virginia has done since the 1980s.

Another challenge is that with broad enthusiasm about the prospects for reformed payment, those contemplating rate setting need to make sure that the mechanism encourages payment reform rather than blocks it. Maryland has been quite careful about this and its recent initiative to broaden its program seems promising. But with the recent emphasis on multi-provider approaches to payment, such as ACOs and bundled payment, the limitation of regulatory authority to hospital rates could be a problem.

So what are my bottom lines for legislative priorities? I have two. States should address restrictions on anti-competitive practices such as anti-tiering restrictions, all-or-none contracting restrictions, and most favored nation clauses. My second is to regulate network adequacy wisely. It is a potent tool for fostering competition, even in consolidated markets. Network strategies do have problems that need to be addressed, but it must be done while preserving much of the potency of the approach.

A concluding thought involves acknowledging that provider payment reform approaches are likely to contribute to consolidation. Small hospitals and medical practices are not well positioned to participate, although virtual approaches can often be used in place of mergers, for example as California’s independent practice associations have enabled many small practices to participate. But I see payment reform as having major potential over time to reduce costs and increase quality. So my advice is to proceed with payment reform but also take steps to foster competition. Rate setting is best seen as a “stick in the closet” to use if market approaches should fail to control costs.


[1] Gaynor, M., and R. Town, The Impact of Hospital Consolidation – Update, Robert Wood Johnson Foundation Synthesis Report (June 2012).

[2] Baker, L. C., M.K Bundorf and D.P. Kessler, “Vertical Integration: Hospital Ownership Of Physician Practices Is Associated With Higher Prices And Spending,” Health Affairs, Vol. 35, No 5 (May 2014).

[3] Chapin White and Megan Egouchi, Reference Pricing: A Small Piece of the Health Care Pricing and Quality Puzzle. National Institute for Health Care Reform, Research Brief No. 18, October 2014.

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Authors

      




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Africa in the news: COVID-19 impacts African economies and daily lives; clashes in the Sahel

African governments begin borrowing from IMF, World Bank to soften hit from COVID-19 This week, several countries and multilateral organizations announced additional measures to combat the economic fallout from COVID-19 in Africa. Among the actions taken by countries, Uganda’s central bank cut its benchmark interest rate by 1 percentage point to 8 percent and directed…

       




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How Saudi Arabia’s proselytization campaign changed the Muslim world

       




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On April 30, 2020, Vanda Felbab-Brown participated in an event with the Middle East Institute on the “Pandemic in Pakistan and Afghanistan: The Potential Social, Political and Economic Impact.”

On April 30, 2020, Vanda Felbab-Brown participated in an event with the Middle East Institute on the "Pandemic in Pakistan and Afghanistan: The Potential Social, Political and Economic Impact."

       




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AdiEU: The impact of Brexit on UK cities

How will the U.K.'s cities be affected by Brexit? A new report from Metro Dynamics explores the significant impact Brexit will have on U.K. cities and shows why it is critical they have a seat at the table during exit negotiations with Brussels and in the creation of a new national budget.

      
 
 




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Perceived Impacts of International Service on Volunteers

International volunteer service is defined as an organized period of engagement and contribution to society by individuals who volunteer across an international border. There is growing interest in the potential of international service to foster international understanding between peoples and nations and to promote global citizenship and intercultural cooperation. Studies suggest that international service develops skills, mindsets, behaviors and networks that prepare volunteers for living and working in a knowledge-based global economy. Many believe that even short-term experiences abroad can begin to prepare participants for longer-term engagement and future international service.

International service may be growing in prevalence worldwide. In the United States, more than one million Americans reported volunteering abroad in 2008. Despite the scale of international service, its impacts are not well understood. Although there is a growing body of descriptive evidence about the various models and intended outcomes of international service, the overwhelming majority of research is based on case and cross-sectional studies, which do not permit conclusions about the impacts of international service. Scholars and practitioners in the field have called for rigorous research that documents impacts.

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Authors

  • Amanda Moore McBride
  • Benjamin J. Lough
  • Margaret Sherrard Sherraden
     
 
 




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Compassion Across Borders

High unemployment, the Gulf oil spill, and mounting fiscal worries clouded our July 4th celebrations. Yet, one patriotic highlight in President Obama's first year was bipartisan support of the Serve America Act, which expanded opportunities for Americans of all ages to meet urgent domestic challenges through community and national service. In the process, Americans who otherwise would have been unemployed are engaging in productive work, at low cost to taxpayers, to meet problems like the high school dropout epidemic. Similar efforts can expand volunteer service abroad.

As President Obama made clear in his first major policy speech to the international community in Cairo, Egypt, the world must unleash its collective imagination through social innovators, entrepreneurs and citizen diplomats to contribute to global development, respond to natural disasters, and initiate interfaith action to tackle preventable diseases like malaria. The moment is now.

Fifty years after John F. Kennedy's call for a Peace Corps, we might reconsider our obligations to meet needs around the world. President Kennedy said that the Peace Corps would be serious when 100,000 Americans were serving abroad each year. Although the Peace Corps is America's flagship international service program, today less than 8,000 volunteers are spread across 77 countries. Since 1961, America has sent and returned nearly 200,000 volunteers, a number significantly less than the millions Kennedy envisioned by his Peace Corps' 50th year. Had the Peace Corps grown at the rate Kennedy envisioned, the course of our country's foreign policy, diplomatic strategy and global awareness over the past 50 years would be very different.

Last week, ServiceWorld, an international service coalition of more than 300 non-profits, colleges, corporations and faith-based institutions, released a bold plan to meet President Kennedy's goal of mobilizing 100,000 Americans every year - and one million over a decade - to serve abroad. The proposed Sargent Shriver International Service Act calls for doubling Peace Corps to 15,000 by 2015, lowering costs per volunteer, and forging partnerships with the hundreds of non-profits that have emerged since its creation. Doubling of the Peace Corps is a goal that both Presidents George W. Bush and Barack Obama have embraced.

Volunteers for Prosperity will tap 75,000 skilled Americans for flexible term assignments to work on international challenges Congress and many Presidents have made priorities, such as HIV/AIDS, malaria, and clean water. Global Service Fellows will enable Members of Congress to nominate top talent from their districts and states, as they do for the military academies today, to serve for up to one year abroad. Together with the Peace Corps, these efforts will meet John Kennedy's goal of mobilizing 100,000 Americans to serve abroad each year.

The Service World plan focuses on multi-lateral partnerships and exchanges so Americans serve side-by-side with people from other countries, including in the United States. Under the plan, both skilled and non-skilled volunteers of all classes and ages will serve abroad for both long- and short-term assignments and veterans have specific opportunities to utilize their many skills in a civilian capacity. We believe an inclusive and mobile model of volunteering will contribute to the development of a new generation of global leaders, provide skills for U.S. citizens to compete in a global economy, increase international awareness, strengthen development, and improve the image of America abroad.

Volunteer service by people of all nations should become a common strategy in meeting pressing challenges in education, health, the environment, agriculture and more. By having national policies that engage more Americans in international service at every stage of life, we will be sharing our most valuable assets - the skills, talents and perspectives of our people - to make a significant difference in communities and nations throughout the world.

Authors

Publication: The Huffington Post
     
 
 




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Impacts of Malaria Interventions and their Potential Additional Humanitarian Benefits in Sub-Saharan Africa


INTRODUCTION

Over the past decade, the focused attention of African nations, the United States, U.N. agencies and other multilateral partners has brought significant progress toward achievement of the Millennium Development Goals (MDGs) in health and malaria control and elimination. The potential contribution of these strategies to long-term peace-building objectives and overall regional prosperity is of paramount significance in sub-regions such as the Horn of Africa and Western Africa that are facing the challenges of malaria and other health crises compounded by identity-based conflicts.

National campaigns to address health Millennium Development Goals through cross-ethnic campaigns tackling basic hygiene and malaria have proven effective in reducing child infant mortality while also contributing to comprehensive efforts to overcome health disparities and achieve higher levels of societal well-being.

There is also growing if nascent research to suggest that health and other humanitarian interventions can result in additional benefits to both recipients and donors alike.

The social, economic and political fault lines of conflicts, according to a new study, are most pronounced in Africa within nations (as opposed to international conflicts). Addressing issues of disparate resource allocations in areas such as health could be a primary factor in mitigating such intra-national conflicts. However, to date there has been insufficient research on and policy attention to the potential for wedding proven life-saving health solutions such as malaria intervention to conflict mitigation or other non-health benefits.

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Image Source: © Handout . / Reuters
      
 
 




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There are policy solutions that can end the war on childhood, and the discussion should start this campaign season

President Lyndon B. Johnson introduced his “war on poverty” during his State of the Union speech on Jan. 8, 1964, citing the “national disgrace” that deserved a “national response.” Today, many of the poor children of the Johnson era are poor adults with children and grandchildren of their own. Inequity has widened so that people…

       




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Trends in online disinformation campaigns

Ben Nimmo, director of investigations at Graphika, discusses two main trends in online disinformation campaigns: the decline of large scale, state-sponsored operations and the rise of small scale, homegrown copycats.

       




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Trends in online disinformation campaigns

Ben Nimmo, director of investigations at Graphika, discusses two main trends in online disinformation campaigns: the decline of large scale, state-sponsored operations and the rise of small scale, homegrown copycats.

       




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The market makers: Local innovation and federal evolution for impact investing


Announcements of new federal regulations on the use of program-related investments (PRIs) and the launch of a groundbreaking fund in Chicago are the latest signals that impact investing, once a marginal philanthropic and policy tool, is moving into the mainstream. They are also illustrative of two important and complementary paths to institutional change: fast-moving, collaborative local leadership creating innovative new instruments to meet funding demands; federal regulators updating policy to pave the way for change at scale.

Impact investing, referring to “investment strategies that generate financial returns while intentionally improving social and environmental conditions,” provides an important tier of higher-risk capital to fund socially beneficial projects with revenue-generating potential: affordable housing, early childhood and workforce development programs, and social enterprises. It is estimated that there are over $60 billion of impact investments globally and interest is growing—an annual JP Morgan study of impact investors from 2015 reports that the number of impact investing deals increased 13 percent between 2013 and 2014 following a 20 percent increase in the previous year.

Traditionally, foundations have split their impact investments into two pots, one for mission-related investments, designed to generate market-rate returns and maintain and grow the value of the endowment, and the other for program-related investments. PRIs can include loans, guarantees, or equity investments that advance a charitable purpose without expectation of market returns. PRIs are an attractive use of a foundation’s endowment as they allow foundations to recycle their limited grant funds and they count towards a foundation’s charitable distribution requirement of 5 percent of assets. However they have been underutilized to date due to perceived hurdles around their use–in fact among the thousands of foundations in the United States, currently only a few hundred make PRIs.

But this is changing, spurred on by both entrepreneurial local action and federal leadership. On April 21, the White House announced that the U.S. Department of the Treasury and Internal Revenue Service had finalized regulations that are expected to make it easier for private foundations to put their assets to work in innovative ways. While there is still room for improvement, by clarifying rules and signaling mainstream acceptance of impact investing practices these changes should lower the barriers to entry for some institutional investors.

This federal leadership is welcome, but is not by itself enough to meet the growing demand for capital investment in the civic sector. Local innovation, spurred by new philanthropic collaborations, can be transformative. On April 25 in Chicago, the Chicago Community Trust, the Calvert Foundation, and the John D. and Catherine T. MacArthur Foundation launched Benefit Chicago, a $100 million impact investment fund that aims to catalyze a new market by making it easier for individuals and institutions to put their dollars to work locally and help meet the estimated $100-400 million capital needs of the civic sector over the next five years.

A Next Street report found that the potential supply of patient capital from foundations and investors in the Chicago region was more than enough to meet the demand – if there were ways to more easily connect the two. Benefit Chicago addresses this market gap by making it possible for individuals to invest directly through a brokerage or a donor-advised fund and for the many foundations without dedicated impact investing programs to put their endowments to work at scale. All of the transactional details of deal flow, underwriting, and evaluation of results are handled by the intermediary, which should lead to greater efficiency and a significant increase in the size of the impact investing market in Chicago.

In the last few years, a new form of impact investing has made measurement of social return to investments even more concrete. Social impact bonds (SIBs), also known as pay for success (PFS) financing, are a way for private investors (including foundations) to provide capital to support social services with the promise of a return on their investment from a government agency if some agreed-upon social outcomes are achieved. These PFS transactions range from funding to support high-quality early childhood education programs in Chicago to reduction in chronic individual homelessness in the state of Massachusetts. Both the IRS and the Chicago announcements are bound to contribute to the growth of the impact bond market which to date represents a small segment of the impact investing market.

These examples illustrate a rare and wonderful convergence of leadership at the federal and local levels around an idea that makes sense. Beyond simply broadening the number of ways that foundations can deploy funds, growing the pool of impact investments can have a powerful market-making effect. Impact investments unlock other tiers of capital, reducing risk for private investors and making possible new types of deals with longer time horizons and lower expected market return.

In the near future, these federal and local moves together might radically change the philanthropic landscape. If every major city had a fund like Benefit Chicago, and all local investors had a simple on-ramp to impact investing, the pool of capital to help local organizations meet local needs could grow exponentially. This in turn could considerably improve funding for programs—like access to quality social services and affordable housing—that show impact over the long term.

Impact investing can be a bright spot in an otherwise somber fiscal environment if localities keep innovating and higher levels of government evolve to support, incentivize, and smooth its growth. These announcements from Washington and Chicago are examples of the multilevel leadership and creative institutional change we need to ensure that we tap every source of philanthropic capital, to feel some abundance in an era where scarcity is the dominant narrative.

Editor's Note: Alaina Harkness is a fellow at Brookings while on leave from the John D. and Catherine T. MacArthur Foundation, which is a donor to the Brookings Institution. The findings, interpretations and conclusions posted in this piece are solely those of the authors and not determined by any donation.

Image Source: © Jeff Haynes / Reuters
     
 
 




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Contemplating COVID-19’s impact on Africa’s economic outlook with Landry Signé and Iginio Gagliardone

       




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On April 30, 2020, Vanda Felbab-Brown participated in an event with the Middle East Institute on the “Pandemic in Pakistan and Afghanistan: The Potential Social, Political and Economic Impact.”

On April 30, 2020, Vanda Felbab-Brown participated in an event with the Middle East Institute on the "Pandemic in Pakistan and Afghanistan: The Potential Social, Political and Economic Impact."

       




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Trade secrets shouldn’t shield tech companies’ algorithms from oversight

Technology companies increasingly hide the world’s most powerful algorithms and business models behind the shield of trade secret protection. The legitimacy of these protections needs to be revisited when they obscure companies’ impact on the public interest or the rule of law. In 2016 and 2018, the United States and the European Union each adopted…

       




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Trends in online disinformation campaigns

Ben Nimmo, director of investigations at Graphika, discusses two main trends in online disinformation campaigns: the decline of large scale, state-sponsored operations and the rise of small scale, homegrown copycats.

       




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Assessing the impact of foreign assistance: The role of evaluation


Event Information

March 30, 2016
3:00 PM - 4:30 PM EDT

Saul/Zilkha Rooms
Brookings Institution
1775 Massachusetts Avenue NW
Washington, DC 20036

A conversation with USAID Administrator Gayle Smith



On March 30, Global Economy and Development at Brookings and the Modernizing Foreign Assistance Network (MFAN) hosted Gayle Smith, administrator of U.S. Agency for International Development (USAID) for an address on the fifth anniversary of the USAID policy on evaluation.

A principal recommendation of the Presidential Policy Determination on Global Development, signed by President Obama in 2010, was greater accountability for U.S. foreign assistance funds, including evaluation of development programs. In 2011, USAID adopted a formal policy on evaluation and since has average some 200 evaluations a year.

Among the issues that will be addressed during the event are the success and challenges in implementing the evaluation policy, the use of alternative evaluation methods, and building a system and process for turning evaluations into learning. Administrator Smith was introduced by Brookings Senior Fellow George Ingram. Following her address, he moderated a panel discussion of Ruth Levine, Wade Warren, and Jodi Nelson.

 Join the conversation on Twitter using #AIDeval

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A Review of New Urban Demographics and Impacts on Housing

In this presentation Robert Puentes provides a deeper understanding of trends that are impacting metropolitan America and how those trends may impact the demand for multi-family housing in the coming decades. The presentation stresses several key points including dramatic changes in household formation, the plight of older, inner-ring "first" suburbs, and the increasing diversity reflected in both cities and suburban areas.

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Publication: National Multi Housing Council Research Forum
     
 
 




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The impact of the coronavirus on mortgage refinancings

Mortgages, whether purchase or refinance, require a long to-do list. If any of the steps in the chain cannot occur, the ability to get a mortgage is jeopardized. The unprecedented shutdowns caused by COVID-19 threaten to break multiple links in the mortgage chain. This article examines what is at risk for one segment of the…

       




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Webinar: The impact of COVID-19 on prisons

Across America, incarcerated people are being hit hard by COVID-19. The infection rate in Washington, D.C., jails is 14 times higher than the general population of the city. In one Michigan correctional facility, more than 600 incarcerated people have tested positive — almost 50% of the prison's total population. In Arkansas, about 40% of the…

      




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Trade secrets shouldn’t shield tech companies’ algorithms from oversight

Technology companies increasingly hide the world’s most powerful algorithms and business models behind the shield of trade secret protection. The legitimacy of these protections needs to be revisited when they obscure companies’ impact on the public interest or the rule of law. In 2016 and 2018, the United States and the European Union each adopted…

       




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Rewarding Work: The Impact of the Earned Income Tax Credit in Chicago

The federal Earned Income Tax Credit (EITC) will boost earnings for over 18 million low-income working families in the U.S. by more than $30 billion this year. This survey finds that the EITC provided a $737 million boost to the Chicago regional economy in 1998, and lifted purchasing power in the city of Chicago by an average of $2 million per square mile. Large numbers of Low-income working families lived not only in inner-city Chicago neighborhoods, but also in smaller cities throughout the region like Aurora, Joliet, Elgin and Waukegan. The survey concludes by describing steps that state and local leaders could take to build on existing efforts to link working families to the EITC, such as increasing resources for free tax preparation services, helping EITC recipients to open bank accounts, and expanding and making refundable the Illinois state EITC.

 

EITC National Report
Read the national analysis of the Earned Income Tax Credit in 100 metropolitan areas. It finds that the EITC provided a $17 billion stimulus to these metro areas in 1998, and that the majority of EITC dollars flowed to the suburbs.
National Report 10/01
EITC Regional Reports
Read the local analysis of the Earned Income Tax Credit in 29 metropolitan areas. Using IRS data to analyze the spatial distribution of working poor families, the surveys find that the EITC is a significant federal antipoverty investment in cities and their regions.
29 Metro Area Reports  6/01

 

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Charts of the Week: Coronavirus’s impacts on learning, employment, and deaths of Black Americans

In this week's edition of Charts of the Week, a look at some of the impacts that the coronavirus pandemic is having on various policy areas, including education, jobs, and racial inequality. Learn more from Brookings scholars about the global response to coronavirus (COVID-19). Learning inequality during COVID-19 Worldwide nearly 190 countries have closed schools,…

       




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COVID-19’s impact on the Brookings Institution’s Spring intern class of 2020

Just after New Year’s, I moved to Washington, D.C. after graduating early from Boston University to begin an events internship in the Brookings main Office of Communications. The Brookings Internship program provides students and recent graduates with a pre-professional experience in the Institution’s research programs and business offices. For two months, I had assisted with…

       




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Charts of the Week: COVID-19’s impact on different groups in America

In Charts of the Week this week, more insights into how COVID-19 is having an impact on different groups in America. Learn more from Brookings scholars about the global response to coronavirus (COVID-19). COVID-19 spreading to suburban, whiter, and more Republican-leaning areas Bill Frey discusses how “new counties showing a high prevalence of COVID-19 cases…

       




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The Impact of Density and Diversity on Reapportionment and Redistricting in the Mountain West


Executive Summary

During the first decade of the 21st century the six states of the Mountain West — Arizona, Colorado, Idaho, Nevada, New Mexico, and Utah — experienced unprecedented political and demographic changes. Population growth in all six states exceeded the national average and the region is home to the four states that underwent the largest population gains between 2000 and 2010. As a consequence, the region is now home to some of the most demographically diverse and geographically concentrated states in the country— factors that helped to transform the Mountain West from a Republican stronghold into America’s new swing region. This paper examines the impact that increased diversity and density are exerting on reapportionment and redistricting in each Mountain West state and assesses the implications that redistricting outcomes will exert both nationally and within each state in the coming decade.  Nationally, the region’s clout will increase due to the addition of three seats in the House of Representatives (one each in Arizona, Nevada, and Utah) and electoral contexts in Arizona, Colorado, Nevada, and New Mexico that will result in competitive presidential and senate elections throughout the decade. At the state level, the combination of term limits, demographic change, and the reapportionment of state legislative seats from rural to urban areas will alter the composition of these states’ legislatures and should facilitate the realignment of policy outcomes that traditionally benefitted rural interests at the expense of urban needs.

Introduction

As reapportionment and redistricting plans across the 50 states are finalized and candidate recruitment begins in earnest, the contours of the 2012 election are coming into focus. One region of the country where reapportionment (redistributing seats to account for population shifts) and redistricting (drawing boundaries for state legislative and congressional districts) are likely to have significant consequences in 2012 and beyond is in the six states of the Mountain West: Arizona, Colorado, Idaho, Nevada, New Mexico, and Utah. Driven by explosive growth during the past decade, the Mountain West is now home to some of the most demographically diverse and geographically concentrated states in the country. As a consequence, the region has increasingly become more hospitable to Democrats, particularly Colorado, Nevada, and New Mexico and to a lesser extent Arizona. In this paper, I examine how these changes are affecting reapportionment and redistricting across the region. Specifically, after summarizing some of the key regional demographic and political changes, I offer a brief overview of the institutional contexts in which the maps are being drawn. This is followed by an assessment of outcomes in each state. I conclude with a discussion of the national and state level implications that reapportionment and redistricting are likely to engender across the Mountain West.

A Region in Transition

Between 2000 and 2010 population growth in all six Mountain West states outpaced the national average of 9.7 percent and the region contains the four states that experienced the largest percent population increase in the country (Nevada = 35.1 percent; Arizona = 24.6 percent; Utah = 23.8 percent, and Idaho = 21.1 percent).[i] As a consequence, Nevada and Utah each gained their fourth seats in the House of Representative and Arizona was awarded its ninth. Beginning with the 2012 election, the Mountain West will have 29 U.S. House seats (Idaho has two House seats, New Mexico has three, and Colorado has seven) and 41 Electoral College votes.

Across the Mountain West, population growth was concentrated in the region’s largest metropolitan statistical area (MSA).[ii] Most notably, the Las Vegas metro area is now home to nearly three out of four Nevadans — the mostly highly concentrated space in the region. In Arizona, roughly two-thirds of the population now resides in the Phoenix MSA, which grew by nearly 30 percent. The Albuquerque MSA experienced the largest overall increase as a share of total population (nearly 25 percent) and now contains 44 percent of New Mexico’s population. And while Idaho remains the state in the region with the least dense population, growth in the Boise MSA significantly outpaced that state’s overall population gain and nearly 40 percent of all Idahoans reside in and around Boise. On the other end of the spectrum are the Salt Lake City and Denver MSAs, which as shares of the Colorado and Utah populations decreased slightly from 2000. Still, better than half (50.57 percent) of all Coloradoans live in Denver and its suburbs and around 41 percent of Utah’s population is concentrated in the Salt Lake City MSA.

In addition to further urbanizing the region, the prior decade’s growth continued to transform the region’s demographics as all six Mountain West states are now more ethnically diverse as compared to a decade ago.[iii] The largest changes occurred in Nevada where the minority population increased by over 11 percent and now better than 45 percent of Nevadans are classified as non-white. While the bulk of this growth was among Hispanics, whose share of the population increased by 7 percent and are now 26.5 percent of all Nevadans, the Silver State also recorded large increases among Asian and Pacific Islanders. Arizona experienced similar increases as that state’s minority population mushroomed from 36.2 percent to 42.2 percent with Hispanics now constituting 30 percent of the population. In Colorado, the minority population increased by 3.5 percent to 30 percent. Nearly all of this change was caused by an increase in Hispanics, who now constitute 20.7 percent of the state’s population. New Mexico continues to be the Mountain West’s most diverse state as nearly three out of five New Mexicans are minorities and the state contains the region’s largest Hispanic population (46 percent). And while Idaho and Utah remain overwhelmingly white, both states’ non-white populations grew at levels similar to Colorado. Idaho is now 16 percent non-white (including a Hispanic population of 11.2 percent) and nearly one in five Utahans is a minority. Between 2000 and 2010, Hispanics increased by 4 percent to constitute 13 percent of Utah’s population.

Politically, these changes helped to create competitive electoral contexts across the region. Indeed, with the obvious exceptions of Idaho and Utah, the Mountain West is now more hospitable to the Democratic Party than it was in 2000. In particular, Democrats were able to make significant gains in Colorado, Nevada, and New Mexico and effectively flipped those states from Republican leaning in 2000 to Democratic leaning in 2010. In Arizona, the Democratic performance was highly variable and moved in near perfect tandem with the broader national political environment. At the same time, the downturn in Democratic support in 2010 indicates that the party has not yet consolidated its gains. Riding a favorable 2010 macro-environment, Mountain West Republicans gained one governorship (New Mexico), seats in ten of the region’s 12 state legislative chambers, and seven House seats (out of a total of 26 in the region).[iv] Thus, heading into the 2011 redistricting cycle, Republicans control the executive and legislative branches in Arizona, Idaho, and Utah and there are no Mpuntain West states where the Democrats have unified control as the partisan composition of the Colorado legislature is divided and Nevada and New Mexico have Republican governors and Democratic legislatures.

The Institutional Context

Because of variation in the institutional arrangements governing how each state approaches reapportionment and redistricting, the impact that the demographic and political changes outlined above are exerting on map drawing differs across the region. To be sure, there are a number of commonalities across the states such as requirements of equally populated U.S. House districts, minimum population variation for state legislative districts, and boundary lines that are compact, contiguous, and maintain communities of interests. 

Beyond these constraints, mapmakers across the region are afforded different degrees of latitude in how they go about doing their work. For instance, in Nevada and New Mexico, the residency of incumbents can be considered, while Idaho forbids it. Idaho allows for twice as much inter-district population variation for state legislative districts as Colorado and New Mexico, and Idaho only allows state legislative districts to cross county lines if the counties are linked by a highway. Arizona and Idaho mandate that two lower chamber districts be nested within the boundaries of a state senate seat, while Colorado, Nevada, New Mexico, and Utah do not. Nevada also allows for multi-member member state legislative districts. Lastly, Arizona’s redistricting plans must be pre-cleared by the U.S. Department of Justice. While Arizona is the only state in the region subject to preclearance, protection of minority voting rights also has been a point of contention in prior redistricting cycles in New Mexico.

The Mountain West states also vary in terms of who oversees the redistricting process. State legislators control the process in Nevada, New Mexico, and Utah, while Arizona and Idaho use commissions. In Colorado, the General Assembly draws the map for the state’s seven U.S. House seats, while a commission oversees the drawing of state legislative maps. For the three states that use commissions for either all or part of their processes, commission size and composition differs significantly and only the Arizona Independent Redistricting Commission (AIRC) is charged with drawing maps that are competitive.[v] 

However, the most significant constraint on reapportionment and redistricting in the Mountain West is the small size of the region’s state legislatures.[vi] The mix of small chambers, increased urbanization, and large geographic spaces means very large and increasingly, fewer and fewer stand- alone rural districts. This dynamic also helps to explain the region’s history of malapportionment that often allocated seats by county regardless of population.[vii] 

State Summaries

Based upon the overview presented above, expectations about the general contours of reapportionment and redistricting in the Mountain West are fairly straightforward: the clout of urban and minority interests will increase and to the degree that those factors benefit the Democrats, the Democrats should gain some partisan advantage. Realizing these outcomes, however, has proven to be less than amicable. With the exception of Utah, all other states in the region have had various aspects of their processes litigated, and map drawing for Colorado’s U.S. House seats and all of Nevada and New Mexico’s redistricting is being completed in state courts. Below, I summarize the status of reapportionment and redistricting in each state.

Arizona

Beginning its work amid criticism of its composition, calls for its abolishment, and an investigation by the Arizona attorney general, the voter-initiated Arizona Independent Redistricting Commission (AIRC) has struggled to balance the conflicting demands of drawing competitive districts with the protection of minority voting rights. The commission’s work has been further hindered by Republican Governor Jan Brewer’s unsuccessful attempt to impeach the commission’s nonpartisan chair. In addition, Arizona has filed a lawsuit in federal court challenging the state’s preclearance requirement.

Republican attempts to undermine the AIRC stem from the fact that given unified Republican control of the Arizona governorship and legislature, Republicans would otherwise be in a position to implement a partisan gerrymander. At the same time, the GOP’s present dominance is partially an artifact of the 2001 redistricting. To gain preclearance in 2001, the AIRC’s maps created a large number of majority-minority state legislative districts and minority-friendly U.S House seats by packing Democratic voters into these districts. In so doing, Democratic support in the surrounding districts was weakened; allowing Republicans to more efficiently translate their votes into seats.[viii] Thus, despite a slight partisan voter registration advantage (4.35 percent as of July 2011), Republicans presently hold more than two-thirds of the state legislative seats and five of eight U.S. House seats.

Given Arizona’s growth patterns between 2000 and 2010 coupled with the AIRC’s charge of creating competitive district, drawing a map as favorable to the GOP in 2011 is virtually impossible unless the size of the Arizona legislature is increased. Still, in order to protect minority voting rights, Arizona’s final maps are likely to tilt in favor of the GOP — just not to the degree that they have in the past. In particular, the elimination and consolidation of rural state legislative districts and a more urban orientation for Arizona’s nine U.S. House districts should provide the Democrats with electoral opportunities that will only increase as Arizona’s population continues to diversity and urbanize.

Colorado

As noted above, Colorado uses a commission (the Colorado Redistricting Commission) for redistricting state legislative seats and the Colorado General Assembly draws the maps for the state’s seven U.S. House seats. Neither process has gone smoothly. For the state’s seven U.S. House seats, the Democratic-dominated state senate and the Republican-controlled lower chamber failed to find common ground after exchanging two rounds of maps. Because Democratic governor John Hickenlooper refused to call a special session, redistricting of Colorado U.S. House seats was completed in state court. After a good deal of legal wrangling, the Colorado Supreme Court upheld a map favored by Colorado Democrats that creates two safe Republican districts, one safe Democratic district, and four districts where neither party’s registration advantage exceeds 4 percent. As a consequence, Colorado will feature a number of competitive U.S. House elections throughout the coming decade.

Map drawing for state legislative seats by the CRC has also been hindered by partisanship. Hoping to break a partisan stalemate, in late summer the nonpartisan chair of the CRC offered maps that combined parts of prior Democratic and Republican proposals to create thirty-three competitive seats (out of a total of 100) and twenty-four seats with Hispanic populations of 30 percent or more. After being approved by the CRC with some Republican dissents, the plan was rejected by the Colorado Supreme Court, which must sign-off on the CRC’s plans before they can be implemented. By attempting to draw more competitive maps — a criterion that the CRC is not obligated to consider – the CRC’s maps undermined its charge of producing districts that keep communities of interest intact. The CRC’s second set maps, which were widely viewed as favoring the Democrats, were upheld by the Colorado Supreme Court.

Idaho

While partisan considerations have loomed large in the reapportionment and redistricting processes in Arizona and Colorado, in Republican-dominated Idaho the main points of contention have been spatial. Indeed, because of the difficulty of satisfying a constitutional requirement limiting county splits and a state law constraining how geographic areas can be combined, the Idaho’s Citizen Commission for Reapportionment (ICCR) failed to reach an agreement before its constitutionally imposed deadline. After sorting through a number of legal and constitutional questions, a second set of commissioners were impaneled and completed their work in less than three weeks. Given Idaho’s partisan composition, the final maps are a regional anomaly as they benefit the GOP while being somewhat more urban oriented. This was accomplished by moving rural Republican voters into urban Democratic state legislative districts and adjusting the lines of Idaho’s 1st House district to shed roughly 50,000 citizens. At the same time, because of Idaho’s strict constraints on how cities and counties can be divided, the map for the state legislature paired a number of incumbents in the same district and one district contains the residences of five incumbents, setting up a number of competitive primary elections.

While growth patterns and demographic and partisan change in Nevada between 2000 and 2010 insured a redistricting process that would favor Democrats, Nevada Republicans sought to delay this inevitability as long as possible. The state’s Republican governor, Brian Sandoval, vetoed two sets of maps passed by the Democratic controlled legislature and Sandoval refused to call a special session to complete redistricting. Instead, he and his party hoped for a better outcome in state court. Despite drawing a supervising judge who was the son of a former Republican Governor, Nevada Republicans fared no better in state court. Ultimately, the process was turned over to three special masters who rejected Nevada Republicans’ claim that section 2 of the Voting Rights Act required a majority Hispanic U.S. House district.[ix] As a consequence, two of Nevada’s U.S. House seats favor Democrats, one is safely Republican, and the fourth is a swing district. In the Nevada legislature the representation of urban interests will increase as parts of or all of forty-seven of the sixty-three seats in the Nevada legislature are now located in the Democratic stronghold of Clark County. 

New Mexico

The 2011 process in New Mexico has essentially been a rerun of the gridlock that engulfed the state’s 2001 redistricting debate. Once again, the Democrats sought to use their control over both chambers of the New Mexico legislature to preserve their majorities and draw the boundaries for the state’s three U.S. House seats in manner favorable to the party. However, because of bickering among Democrats the legislature failed to approve its map for the state’s three U.S. House seats prior to the end of the special session and the plans for the state legislature that were passed on party line votes were vetoed by Republican governor Susana Martinez. Thus, once again, New Mexico’s divided state government coupled with the state’s history of litigating redistricting plans (in 2001 map drawing and court battles cost the state roughly $3.5 million) means that redistricting will be completed in state court. While the Republicans may be able to gain some concessions through the courts, New Mexico is the most Democratic state in the Mountain West and, as noted above, the state’s growth during the prior decade was concentrated in heavily Democratic Albuquerque and its suburbs. Thus, as in 2001, the likely outcome in New Mexico is a redistricting plan that will be favorable to the Democrats and weaken the influence of rural interests.

Utah

Utah is the only state in the region where conditions exist (e.g., unified partisan control in a non-commission state) for the implementation of a partisan gerrymander. However, to accomplish this end required the slicing and dicing of communities and municipalities particularly those in and around the state’s urban center. Most notably, in drawing the state’s four U.S. House seats, Republicans divided the Utah’s population center (Salt Lake City County) into four districts by combining parts of the urban core with rural counties - a plan that, not coincidentally, cracks the only part of the state where Democrats are able to compete. Similarly, maps for state legislative districts increase the number of seats that favor the GOP and, in many instances, protect incumbents from potential primary challengers by dividing communities into multiple districts. Democrats in Utah are so depleted that they were unable to get the Republicans to even agree to include recognition and protection of minority communities of interest to in Utah’s redistricting guidelines. Thus, despite constituting nearly 20 percent of the state’s population, minorities received no consideration in Utah’s 2011 redistricting.

Implications and Conclusions

Reapportionment and redistricting are often regarded as the most political activities in the United States; an expectation that is certainly being realized across the Mountain West. In the swing states where legislators draw the maps (for example, Colorado, Nevada, and New Mexico) but where state government is divided, partisan considerations loomed large, causing all of these states to conclude all or parts of their redistricting processes in the courts. The conflicts between Arizona’s preclearance requirement and the AIRC’s commitment to drawing competitive districts have partisan consequences as well. In one-party Idaho and Utah, the politics of space were at issue.  Geographic constraints on district boundaries imposed through statute and the Idaho constitution ensured that more rural seats were preserved and that the growing influence of urban interests will be checked. In Utah, Republicans moved in the opposite direction by carving up the very communities from which they are elected in order to implement a partisan gerrymander. 

Another school of thought, however, argues that the most typical redistricting outcome is not partisan gain or loss, but an uncertainty that shakes up the state political environment and facilitates political renewal. In the case of the Mountain West, there is evidence to support that claim as well. The biggest source of uncertainty will continue to be growth. While the economic downturn has slowed migration to the region, the Mountain West states remain poised to keep expanding in a manner that will further concentrate and diversify their populations. A second source of uncertainty is the region’s large number of nonpartisans. While redistricting is often framed as a zero-sum game played between Democrats and Republicans, the electoral hopes for either party hinges on its ability to attract the support of the region’s expanding nonpartisan demographic.[x] 

At the state level, with the exception of Idaho, the most significant consequence will be a reduction in rural influence. The combination of term limits in Arizona, Nevada, and Colorado, small legislative chambers, and fast growing urban populations will continue to decrease the number of entrenched rural legislators and the number of stand-alone rural districts. Consequently, urban interests should be positioned to align state policy with demographic reality. The void created by the demise of rural legislators will be filled by minorities, particularly Hispanics. To date, the increased political activism of Hispanic communities across the region has primarily benefited Democrats; helped in no small part by the hard-line rhetoric and policies championed by some Mountain West Republicans.[xi] More generally, depending on growth patterns, by 2020 Nevada and perhaps Arizona may join New Mexico as states with majority-minority populations. Thus, with or without Section 2 of the Voting Rights Act, minority legislators, primarily Hispanics, will increase their ranks significantly. The only question is whether all of these politicians will be taking office with a “D” next to their names or whether some will be elected as Republicans.  

Nationally, the impact of reapportionment and redistricting is mixed. Certainly, the addition of three U.S. House seats after the 2010 census will give more voice to regional issues in Washington D.C. At the same time, because the Mountain West’s House delegation will continue to be split along partisan lines and many of the region’s competitive House seats will rotate between the parties throughout the decade, it may be difficult for any but the safest Mountain West representatives to accrue the requisite seniority to become players in the House. Also, because of pending retirements in Arizona and New Mexico, a successful 2010 primary challenge in Utah, and a resignation in Nevada, the region’s influence in the U.S. Senate is likely to decline in the near term. Indeed, after the 2012 election the only senators from the region who will have served more than one term will be Nevada’s Harry Reid, Arizona’s John McCain, Idaho’s Mike Crapo, and Utah’s Orrin Hatch (presuming a successful 2012 reelection).

Thus, the arena where the region is likely to garner the most attention is in the coming decade’s three presidential elections. Colorado, Nevada, and New Mexico were all battleground states in 2004 and 2008, with Republican George W. Bush narrowly winning all three in 2004 and Democrat Barack Obama flipping them blue in 2008 by wider margins. Obviously, Idaho and Utah will remain out of reach for the Democrats in statewide contests for some time.  However, Arizona is likely to become the region’s fourth swing state in the near future. Thus, continued investment in Arizona and throughout the region will allow the Democrats to further expand the number of Mountain West states in play while forcing the GOP to spend resources to defend turf that it once could safely call its own.

Endnotes
[i] U.S. Census Bureau, “State and County Quick Facts,” August 2011 (http://quickfacts.census.gov/qfd/index.html ).

[ii] U.S. Census, “American Fact Finder,” August 2011 (http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml ).

[iii] U.S. Census Bureau, “State and County Quick Facts,” August 2011 (http://quickfacts.census.gov/qfd/index.html ).

[iv] Despite close elections in Colorado and Nevada, none of the region’s U.S. Senate seats changed parties in 2010.

[v] The Arizona Independent Redistricting Commission (AIRC) consists of five appointed members: four partisans chosen by the party leaders of each legislative chamber and a nonpartisan who is chosen by the other four members and serves as chair. The Colorado Redistricting Commission (CRC), which oversees redistricting for state legislative districts, consists of 11 members: four of whom are picked by the party leaders of the General Assembly; three who are selected by the governor; and four who are chosen by the Chief Justice of the Colorado Supreme Court. The Idaho Citizen Commission for Reapportionment (ICCR) consists of six members, four of whom are chosen by party leaders of the Idaho Legislature and one member chosen by each of the state chairs for the Democratic and Republican parties.  

[vi] Excluding Nebraska (because of its unicameral structure), the average size of the lower and upper houses of the other 49 state legislatures are 110 and 39.22 respectively. Only the 42-member New Mexico Senate exceeds the national average chamber size. The largest lower house in the region, Utah’s 75-seat House of Representatives, is 35 seats below the national average. 

[vii] Legislative size, however, is not immutable. To increase the size of the legislatures in Colorado, Idaho, and New Mexico would require amending those states’ constitutions. The lower chamber of the Utah legislature could be expanded as it is presently below its constitutional cap. Arizona and Nevada set the sizes of their legislatures by statute.

[viii] In this regard, redistricting outcomes in Arizona are similar to those in another Section 2 region, the South. In both instances, the provisions of the Voting Rights Act have the perverse effect of increasing symbolic representation for minority groups while decreasing the number of legislators who may be receptive to minority interests. See, Kevin A. Hill, “Congressional Redistricting: Does the Creation of Majority Black Districts Aid Republicans?” Journal of Politics (May 1995): 384–401, and David Lublin, The Paradox of Representation: Racial Gerrymandering and Minority Interests in Congress (Princeton University Press, 1999).

[ix] Governor Sandoval and Republicans in the legislature claimed that Section 2 of the Voting Rights Act requires the use of race as the basis for drawing a Hispanic U.S. House seat — a position clearly at odds with the holding in Shaw v. Reno (509 U.S. 630, 1993), which allows race to be taken into consideration but does not allow it to be the predominant factor. Democrats and many Hispanic activists countered that packing Hispanics into a single House district would marginalize their influence in Nevada’s other three U.S. House districts and because white voters in Nevada do not vote as a block as evidenced by the fact that Hispanic candidates won eight state legislative seats, the attorney generalship, and the governorship in 2010 without such accommodations, race-based redistricting in Nevada is unnecessary

[x] At the time of the 2010 election, nonpartisan registrants constituted over 30 percent of Arizona voters, 26 percent of the Colorado electorate, and around 15 percent of voters in Nevada and New Mexico (Idaho and Utah do not report partisan registration figures)

[xi] For example, Arizona’s 2010 Support Our Law Enforcement and Safe Neighborhoods Act (SB 1070) and Utah’s 2011 Utah Illegal Immigration Enforcement Act (HB497). 

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