Sunday, February 27, 2011

Round-up of interesting policy articles in late February 2011

Here are some articles related to social welfare you might find interesting.

First, one about social security, a commentary by David R. Francis in the Christian Science Monitor.

This past Thursday, the day after our class, Michelle Saddler (secretary of the Department of Human Services) announced that the Office of Management and Budget had explained that Governor Quinn's cuts to drug treatment wouldn't be so deep.  He is now suggesting cutting something like $100 million, rather than $210 million. 

If you want to listen to a short talk by Quinn about cuts to human services, Rich Miller (of Capitalfax) has posted something on YouTube from Friday.

Read about the case of Kelley Williams-Bolar, who lived in a poorly-funded Akron school district, and tried to get her children into a safer and wealthier public school in the suburbs of Akron, falsified information to do so, and has been convicted of two felonies and gone to jail for this.

Here is a photographic essay about protests in Madison.

Many of you who follow a career path as social workers will be state workers.  Rick Ungar at Forbes Magazine has uncovered some important facts about the pensions paid to Wisconsin State Workers.  Someone might check to see if this is true of Illinois as well.

The NASW blog pointed me to this set of links to articles about poverty available from the Urban Institute:

A good summary of the House-approved budget now before the Senate.

Of course the Senate isn't going to pass the budget passed by the House, but for a more detailed examination of what is in that House budget bill, I had to go to a partisan political source, as I couldn't find a single article by a journalist that presented readers with the sort of details given by Senator Barbara Boxer.


What do our own Illinois Senators have to say about important budget issues?  Our newest Senator Mark Kirk has nothing about the House Bill on his site (as of Sunday the 27th of February), but he does take issue with support for cultural spending to put poetry on signs in zoos where families with children would be exposed to (horrors!) poetry.  He has a big press release about this important "waste" spending (not even a full million dollars) at his web site.Funny, Illinois, his home state, was one of the states that received some of this money (I guess to pay the poet, and the people who made the signs).
(NOTE: My sister was indirectly involved in this project, as she was the director of education for the Wildlife Conservation Society, which did the work on the use of poetry as an educational tool in zoos).

To be fair, Kirk did have a short response to the White House budget (not as long as his press release on poetry in zoos).

Senator Durbin responded to the White House budget, focusing on reducing our deficit and creating jobs, and striking a balance, but he hasn't posted (as of Sunday the 27th of February) anything about the House's version of the budget.

Wednesday, September 22, 2010

New Poverty and Income Figures for 2009

Last week the Census Bureau released poverty estimates for 2009. We also learned in the same report that median household incomes are holding nearly steady ($49,777 real median household income). The earnings for full-time, year-round workers are also about the same ($47,127 for men, and $36,278 for women). Adjusting for inflation, household incomes now are almost the same as they were in 2002-2004 and 1997. Household incomes were highest in 1998-1999 and 2007. Basically, median American households have been getting about $50,000 for their income for the past 14 years, give or take a few hundred (in inflation-adjusted 2010 dollars). But household incomes are influenced by how many people live in a household and how many people work in a typical household. The full-time, year-round worker earnings are the more interesting figure to see how much people earn. Earnings of men peaked around 1973-1974, when they earned almost $50,000 in inflation-adjusted 2010 dollars. Men’s median full-time, year-round wages have had highs and lows since then (with a slump from 1989-1995 when earnings were below $45,000), but have never crossed the $50,000 milestone. Women’s year-round, full-time incomes have been climbing very slowly all along back to 1960, with only a few short and shallow dips, and their current rate is about the same as their highest rate ever, which was measured in 2007.


Poverty statistics go back to 1959. There was a steady and steep drop in poverty (beginning before the War on Poverty of the mid-1960s), with poverty levels hitting their lowest rates (just under 11%) in 1973. Poverty rates have been highest (around 15%) during the early 1980s recession, and then again around 1992. There was steady decline in poverty between 1993 and 1999, so that just before the short recession in 2000 we had almost matched the low rates of poverty last seen in 1973, but since then we’ve had level poverty or growing poverty, and the current rate of 14.3% for 2009 is the highest we’ve had since around 1995-1996. Actually, I had been thinking poverty figures would show a rate around 15% for 2009, so the actual figure of 14.3% seems better than I had hoped for. Childhood poverty is back up above 20%, with 20.7% of American children living in poverty.


One thing about the poverty figures is that they tell us the poverty people experienced when we just consider their earnings. In fact, we have a fairly good welfare system in America, and between cash assistance (Earned Income Tax Credit, Temporary Aid To Needy Families, etc.), in-kind assistance (Supplemental Nutrition Assistance Program, Housing Vouchers and Public Housing, Medicaid, School Lunch Programs, etc.) most of America’s persons in poverty end up consuming at levels well above the official poverty line. Still, I estimate somewhere between 2.5% and 4.5% of Americans really experience deep and harmful deprivation, even after all benefits (as is suggested by USDA’s food security surveys, studies of the homeless, and case studies of some of the poorest of the poor). Some conservatives have pointed out that if we just took the total spending on our welfare system and divided it up among the poor, we could give each poor person in America enough money to get them out of poverty, and that would be more efficient. Well, yes it would, and a negative income tax to remove all Americans from poverty is probably a good idea, but it’s politically unfeasible, because studies show that such a program would create disincentives for people to marry, and Americans in general hate the idea of single parents living off of welfare.


On the other hand, a negative income tax to eliminate poverty among Americans over the age of 60 or 65 seems like a great idea to me, and I can’t see any downside to that. I’d even suggest dramatically reducing Social Security benefits while creating a new income floor for all Americans over 64. We would guarantee all elderly Americans an income of at least 105% of the poverty level, and add on top of that some sort of reduced Social Security pension for Americans whose incomes after age 64 are already near or above poverty levels.


Are the poor lazy, dishonest, and are many of them welfare cheats? Certainly not. In the Survey of Income and Program Participation we have monthly data about labor force participation for thousands of Americans, and we can say that between 2004 and 2008 about 31.6% of the population experienced a period of at least two months in which their monthly income dipped below poverty. One can’t argue that over 30% of Americans are lazy, dishonest, or welfare cheats, I think.


There is also significant upward mobility out of the bottom of the income distribution. About 30.9% of the households with incomes in the bottom fifth (quintile) of the income distribution moved up out of the bottom quintile (which, logically means that they were replaced by persons falling down into the bottom quintile). All this just goes to show that about 14% of Americans are moving out of or into the bottom of the distribution in a four-year period. That seems to me like significant mobility. Also, that Survey of Income and Program Participation shows us that only 2.2% of those who live in poverty remained in poverty over the whole 4-year period. And that seems about right, that we have only 2%-4% of the population that is stuck more-or-less permanently in poverty.


When we consider that only 2%-4% of Americans are stuck in poverty, we can consider some other statistics that might help us understand who these people are. First of all, how many Americans have an intellectual disability (mild mental retardation, for example), or nearly have one? That would be about 1%. How many Americans have chronic health problems that make it difficult for them to get and hold a job? Again, that is a figure that must exceed 1% (since over 12% of Americans are labeled as having a disability). How many Americans have personality disorders, and can you imagine wanting to hire or work with colleagues who have personality disorders? Again, we have a figure of 1%-2%. And what about persons with serious, severe, chronic mental health disorders, like severe depression, severe bipolar mood disorders, psychotic disorders, and the like? Again, we’re looking at a figure exceeding 2% here. And then again, there are addictions, where nearly 10% of Americans suffer from an addiction, and surely over 2% have serious addictions that would make it nearly impossible for them to hold a job and earn income. So, when you add up these troubled and disabled populations, it’s really a wonder that we have only 2-4% of Americans in persistent and deep poverty (pre-welfare benefit poverty).


But what about the people who scam the system? I personally think that perhaps 0.25% to 0.5% of Americans are merely lazy, incompetent, dishonest, scheming poor people who would rather game the system than work themselves out of poverty. With 310 million people I’m talking about as many as 1.6 million Americans, which is a high number, but people who think they can balance state or federal budgets by cutting welfare benefits to those who don’t deserve them are either ignorant or else dishonest. If you could magically cut all welfare benefits to undeserving cheats and lazy welfare scammers without adding any administrative costs to the system, you might save, at the very most, $7-$10 billion. Probably the savings would be more along the lines of $2-$3 billion. That’s significant, but it’s not going to make much of a dent in an $400-$800 billion deficit (that would a range for a deficit when we get out of the recession and restore tax levels to pre-Bush tax cuts and stop stimulus spending). But to actually get the $2 billion to $10 billion savings by finding and cutting off the undeserving poor from the welfare benefits they unjustly take, you would need to spend hundreds of millions of dollars to have investigators and social workers intrude into the lives of everyone who receives welfare benefits, and that would cost billions of dollars in itself, possibly even more than the savings you would get.


Another point to remember is that many of those who have poverty incomes have friends who are not poor, and those friends or family members probably help out. In fact, we know that they generally do help out. So, a family of four that earns $14,000 per year (very poor), may get something like $12,000 in welfare benefits (including the value of having their children on Medicaid), and might get an additional $3,000-$4,000 in gifts from wealthier family members who help out. Thus, their consumption could be at a level of nearly $30,000 after benefits and gifts. If you're in a family of four and earning slightly above $30,000, it may annoy you that neighbors in front of you at the grocery store are affording better food than you can purchase, yet you know they receive welfare benefits. It may be that gifts from generous family members are what get them up to the level of consumption where they can afford things that you don't.


Tuesday, May 18, 2010

Human Services Budget Reductions

Here is a paper that examines state subsidies for day care and the possible situation when these services are cut.


According to the a recent State Journal Register article, Illinois Human Services budget will be cut at least $226 million in the fiscal year of 2011.


According to Governor Quinn’s proposed plan the budget would cut $52 million from services such as subsidized child care for low-income families. Governor Quinn stated the cuts would be from “human capital development”, which is defined as the stock of competences, knowledge and personality attributes embodied in the ability to perform labor so as to produce economic value. In other words, they will no longer be able to provide low-income families with a discounted rate or free day care expenses, so the 100,000 children statewide that receive state-subsidized child care would decrease in number as services are cut. Community Childcare Connections is the name of the Illinois program that currently has 150,000 children enrolled in the program. The program goal is to provide families with access to quality, affordable child care that allows them to continue working and contributes to the healthy, emotional and social development of the child. Families are required to cost-share on a sliding scale based on family size, income and number of children in care. To be eligible for the program the following criteria must be met; low-income, working families, who are receiving Temporary Assistance for Needy Families (TANF), but are participating in education and/or training, or parents that are not receiving TANF but are attending education and /or training, teen parents seeking high school degree, or equivalent; that are attempting to improve their situation.

Their website http://www.dhs.state.il.us, has a eligibility calculator to determine benefits, for example, if a family of 3 is making less than $800.00 a month, they would be eligible for benefits. The parents’ responsibility of payment for a full 5 day week of daycare over 5 hours a day for 2 children would be $25.78 per month.


The parents of the 150,000 children that are currently receiving services from Community Childcare Connections are about to have another financial crisis to worry about, day care expenses. The typical daycare charges $90 to $125, a week, per child who isn’t considered a toddler or who is not yet school age. The price for care given to newborns up to 2 years old can be as much as $150.00 weekly, and care for school age children ranges from $50.00 to $75.00 a week when school is on session. The above prices are for one child, but some daycares offer discount for more than one child. Let’s consider a 2 year old and a 7 year old in full time Summer daycare when the 7-year-old is out of school; the weekly cost due to the daycare is $200.00 a week, for 2 children. Their parents are both working full time 5 days a week at their minimum wage jobs; so they are bringing home each week after taxes about $218.00, for a total of $436.00 a week. According to the estimated calculator from the website, this family is currently paying around $100 a month for daycare expenses. If this family loses their assisted daycare expenses they will be paying out $200 a week, instead of $100 a month just to be able to go to work. These are the people that are going to be affected by Governor Quinn’s human capital development budget cut. These parents that are trying to improve their situation are going to be to have to choose between employment and daycare. Without the daycare assistance from Community Childcare Connections can this family actually afford to work?


Monday, May 17, 2010

Social Work & Religion: A Duty to Inform

As we entered into week two, the class was given the assignment to read pages 178- 207, a section of our textbook that described the field of social work and its inherent affiliation with religion. The authors, Philip Popple and Leslie Leighninger, spent a significant amount of time detailing the religious roots of social welfare. They highlight that this religious affiliation was not limited to one specific cohort. Rather, Popple and Leighninger explain that associations span numerous populations including early Egyptian, Jewish, Christian, and Muslim cultures. In fact, they attribute the profession of social work to three specific movements, each having derived from the church: Charity Organization Society (COS) movement, Settlement House movement, and the development of institutions to deal with an entire range of social problems.


Eventually, the field of social work became more secular. Following the general secularization of society, public view began to stray from the “God’s Will” mentality of unfortunate events. Instead, individuals began to seek scientific, rational explanations for more of life’s events. As the growth of government services increased, funding with religious affiliation decreased. The 1960’s and 1970’s brought along with it waves of new students entering the social work profession, fueled by political and ideological incentives rather than religious motives.


Today, it can be argued that the tides are once again turning. The argument that social work has begun to see the reversal of secularization does not go without merit. In the past few years there has been a large amount of growth in conservative churches. Principles such as lack of birth control have fostered large population increases. Since President Reagan, trends in governmental control have shifted to incorporate more religious association. Communities continue to see the establishment and growth of professional organizations such as the North American Association of Christians in Social Work. Education programs continue to develop, offering a religious focus while those in doctoral pursuits are choosing dissertations with a religious aim. Still, social work and religion continue to be sensitive companions.


It has been a common argument that religion presents difficulties for both the individual social worker and agency. Those with strong religious views tend be less concerned with the material needs of the client. Agencies face concern with policies that outline client self- determination and non-judgementalism. Furthermore, most agencies agree that social work is not a place for “whitnessing”. The subject is often the topic of much debate and has not gone without capturing the attention of the media.


Author George Will begins his piece Code of Coercion by recapping the 1943 Supreme Court case, West Virginia State Board of Education v. Barnette, where it was determined that government funded schools could not force children in attendance to recite the Pledge of Allegiance. He goes on to argue that this decision continues to be disparaged by teachers at public universities, particularly in the field of social work. Fortunately, George Will’s accusations fall apart with minimal investigation. Highlighted as a shining example of his allegations, Will tells the story of a former UIS student, Sandra Fuiten, who halted her pursuit of a BSW after a professor “told her that it is impossible to be both a social worker and an opponent of abortion” (Will, 2007). Between her comments for the Indianapolis Star and her self- written article, Anti- Catholic Social Work, one can see through her use of language and inconsistencies that her credibility is questionable at best. At one point, Fuiten states, “Surely Jane Addams has turned over in her grave myriad times, but I am sure she has at least for me.” I think, the only one that would be turning over in their grave would be Ms. Sandra Fuiten’s legal consultant.


All things considered, I challenge Mr. Will to pay homage to several other famous Supreme Court cases such as Brown v. Board of Education (1954), Roe v. Wade (1973), and United States v. Nixon (1974). For in the company of educators, doctors, and government officials, social workers share the responsibility of informing the individual(s) in which they serve regardless of race, gender, status, political affiliation, or religious identification. It is not a question of forgoing personal beliefs but rather maintaining client autonomy and self-determination.

Editorial about Food Security Policies

Here is a student paper about hunger and food security policies.


The food and hunger policy in America is very beneficial for our fellow Americans. The policy has its ups and downs but throughout the years it has become a huge success for those who suffer from hunger. While there is still a high number of people who don’t receive a sufficient amount of food throughout the year, the numbers of people who receive government assistance are increasing with the help of the government and our local communities. Do you ever wonder how the awareness of hungriness is discovered? The Economic Research Services plays a large role in research on a federal level of food security. From the statistics gathered in 2008 by the Economic Research Services, it was found that in the United States eighty-five percent of people in the United States were secure with food in their households, while 14.6 percent did not have a secure amount of food in their houses sometime throughout the year. There are many different food programs designed by the government that provides assistant for those who have an insecure amount of food in their homes. The most popular program is SNAP, Supplemental Nutrition Assistance Program, which is a very good program and provides people with a reasonable amount of grocery voucher money monthly. This program has helped over 24 million low-income Americans each month, according to the United States Department of Agriculture from 2008 figures. There was also a total of $37.5 billion used to supply the SNAP program amongst those low-income American families.

This program is sufficient because it focuses on helping those who are in need for food the most based on their income status and household size. While this program provides food for families it also educates them on proper dieting that helps them maintain their health for the better. So because of this requirement, education around the United States is increasing and helping people to make wiser food choices when they shop at grocery stores.

Although State participation in SNAP Education is voluntary, I feel as if it would be beneficial if it was a requirement and not an option. This education is given to improve the life of the Americans and it would help people to live longer and have less health problems as they age. This program is also beneficial to the low-income Americans because it decreases the number of children living in poverty. According to the Economic Research Service, the number dropped 4.3 percent because of SNAP. With the SNAP program more people are likely to feel secure about the amount of food they have in their homes versus not having SNAP and people feeling insecure. When people have the needed amount of food in their homes for their families they are more likely to succeed in taking care of other areas in their households. Some of those things would be employment, education, parenting, and basically life skills.

Social Worker Safety

A student wrote this paper for one of the descriptive paper assignments.


The dangers of Social Work are on the rise. Studies have shown an increase in verbal and physical abuse in the past 15 years. Some states are taking steps to help protect Social Workers. Many of these states are fighting budget crunches, like many other policies. In 2007, a bill was introduced by Dennis Moore of Kansas. He re-introduced it again in 2009. The Bill, Teri Zenner Social Worker Safety Act, is still in committee today. The Bill lays out a plan on issuing grants to states that find themselves in need of funds to properly train and protect their workers. The Bill could help states ease the burden their budget cuts have had. Currently, the Bill offers $5 million dollars a year in grant money to states, but this amount needs to be increased. Social Workers have a direct correlation to the future well being of children and need to be funded accordingly.

A 2002 survey conducted by the National Association of Social Workers found that violence and threats were common. The survey which was taken from 800 social workers found that 19 percent of them had been victims of violence and 63 percent of them had been threatened. What is so shocking is the number of respondents who had been threatened. In many cases, not only in the public sector, but also in the private sector social workers find themselves making home visits alone and not knowing what they will find when that door opens. In 2006, a similar study was head by the same organization. This time it involved 5,000 participants. The results were just as telling, with 44 percent responding that they face safety issues while on the job. Social workers making in home visits are there to ensure the safety of the children involved and are constantly looking for signs that they may be in a dangerous setting. These surveys show that not only do they need to be looking out for the child’s safety but their own as well. A 2000 Bureau of Labor Statistics found that social service workers were 7 times more likely to be victims of violent assaults while at work, than other workers in the private sector. It is clear that this is a dangerous yet necessary field.

In 2008, the U.S. saw a major downturn in the economy which lead to fewer tax revenues but not lower spending. This combination meant many states found themselves in budget crisis, from California to Florida to Michigan. All states in the union found themselves with choices to make and cuts to the budget to produce. Many states looked at the Social Workers as areas they could cut employees by adding to the case loads of other case workers. The state of Illinois is looking at a budget shortfall of 13 billion dollars this coming year. Legislatures are looking at the state’s Human Services Budget for cuts. These cuts would test a budget already stretched too thin. On Feb 24th, the Center for Tax and Budget Accountability released a study showing the state of Illinois underfunded the Human Services Budget by 4.4 billion dollars from 2002 to 2010. States need assistance to ensure that they can keep these vital programs operating and operating at the safest possible levels.

In 2007, Dennis Moore, a lawmaker from Kansas introduced the HR-2165 Teri Zenner Social Worker Safety Act. This bill would allow states to receive federal funding to help ensure the safety of Social Workers. The bill is in honor of Teri Zenner, a social worker in Kansas, who had been stabbed and killed in a routine in home visit in 2004. This tragic event may have something good come from it if legislation like this can be passed. The first Teri Zenner Social Worker Safety Act referred in the future of this paper as HR-2165 was dedicated to provide funding for proper training of social workers. HR-2165 had eight areas where funds were to be directed. First, funds would be used to provide safety equipment such as cell phones and GPS devices for workers, training in self defense and crisis management, facility safety improvements, provision of pepper spray for self defense, cultural competency training, training to help work with the mentally ill, educational resources to train staff on safety awareness measures and finally other activities determined by the Secretary to be safety training. Of these eight points the three most important may be the self defense and crisis management training, installation of safety equipment, and provision of pepper spray. Sadly this bill died in Committee only to reappear in 2009 under HR-1490 Teri Zenner Social Worker Safety Act. The bill was yet again introduced by Dennis Moor and sponsored by 50 others but it too is currently stuck in Committee. It would seem that safety of social workers takes a back seat in politics and many Americans don’t fully understand what social workers do, with many not having any experience with them. HR-1490 is an exact copy of HR-2160, but it would seem the states need of the bill is even greater at this point with the budget cuts that many states are facing.

One of the issues with HR-2160 and HR-1490 is the apparent lack of funding in the bill. The bill only offers a $5 million dollar provision to be spread among all states every year for five years. Most states like Illinois, where the Human Services Budget has been under funded by $4.4 billion dollars over 8 years, would see this grant money as a drop in the pool lacking funds. The bill needs to make more money available for grants especially in this economic climate. The key would be to ensure that the money given to the different states organizations is really used to increase the safety of the social worker in the field. Training sessions should be set up in major cities throughout each state to make sure that social workers have access to the latest techniques in dealing with a crisis. It is possible, if the bill was to make it out of committee and onto the floor for a vote it would garner national attention. Then it could be expanded as Americans learn what social workers find themselves up against on a daily basis.

Social worker safety has seen an increase in attention in the past 15 years but not in action. Surveys have shown that many social workers feel that they are in dangerous situations when out in the field. In a study conducted in 2002, 19 percent had been victims of violence while 63 percent had been threatened. Studies like this show there is a very present danger in social services field and it is important to ensure that the workers are going into the field with the best possible training and equipment. In 2007, Dennis Moore introduced a bill that would provide states with grant money to provide such training and funding. Although that bill would die, it did make reappearance in 2009 and is currently in committee, where it will hopefully find its way to the floor for a vote. Over the years, there have been several high profile stories of social workers meeting their deaths in the field but many more acts of violence or threats never go reported.

Health Care Costs and Health Care Reform.

Here is a short descriptive paper one of the students wrote about health care costs and the health care reform of 2010.


Frightening statistics surrounding the healthcare field appear to be released every day. In 2008, it was projected that 16.2% of our nation’s economy is spent on healthcare. New reports have that number increasing again for 2009. Early estimates report that Americans spent $2.5 trillion on healthcare, giving the overall percentage a gain to about 17.3% of our nation’s budgetary allowance. This symbolizes the biggest one-year expansion of healthcare’s share in our nation’s economy on record. Justifications for such dramatic increase are accredited to the recession. As millions of Americans have lost their jobs and consequently their health insurance, Medicaid has seen a record increase involving those individuals that qualify. Roughly 45 million people remain uninsured, translating into sky rocketing costs for current insurance holders.


The United States government may or may not have finally come up with a solution. Following decades of failed attempts by Democrats, the United States House of Representatives made history when they passed health care reform in a 219 to 212 vote on March 21st, 2010. Two days later, President Obama signed the bill it into law. So far, Democrats vow that the new law will yield great changes for the American public. Beginning with the reduction of premium costs and providing the largest middle class tax cut for health care in history, 32 million Americans are expected to be able to afford healthcare who otherwise would go uninsured. It sets the stage for a new competitive health insurance market, allowing millions of citizens to choose from the same pool that members of Congress do. By overseeing insurance companies, the government boasts that there will come an end to the discrimination of people with pre-existing conditions. Perhaps at a greater sell, the nonpartisan Congressional Budget Office projects that the healthcare reform will reduce the federal deficit by $138 billion over the next ten years. Yet, the reality of healthcare reform has not been met without criticism.


Just as one argues that the reform will greatly reduce our nation’s budget, those that oppose argue that the $938 billion price tag for this bill (over the next ten years) outweighs its advantages. Lack of funding to support the massive bill would, in turn, lead to rationed care, longer waits, and delays. Furthermore, the bill neglects a secondary source of negligent spending, the pharmaceutical industry. In 2009, spending increased a whopping 5.2% to $246.3 billion dollars. Researchers hold the growth of brand name drugs, the demand for H1N1 vaccines, and the increased per-person use of drugs as responsible. Some concerned insurance holders fear that the quality of medical care will nose dive as the demand for care steadily increases.


Regardless of what the supporters and those that oppose the bill say, the outcomes of the healthcare reform have yet to be tallied. What faces the American public now is a lengthy waiting game.


The following websites were used as references:


http://prescriptions.blogs.nytimes.com/2010/02/04/us-health-care-spending-rose-at-record-rate-in-2009/

http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insurance_and_managed_care/health_care_reform/index.html