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The St Louis Contrarian

Providing Independent and Intelligent Insight on St. Louis Public Policy Issues

Archive for the month “June, 2017”

St. Louis Housing Authority

Yesterday’s discussion about HOPE VI provides for a natural lead in to today’s discussion about the St. Louis Housing Authority. The authority controls thousands of conventional, section 8, and tax credit projects. Their work has been exceptional. They have been led for many years by Cheryl Lovell who quietly has created a powerhouse organization.

Back before Cheryl took over the housing authority was typically considered trouble and on HUD’s bad list. Negative stories about the authority were common in the media. The reforms started under Tom Costello and continued under Cheryl. They have completed revitalized their older projects, collect more rent, and have contracted out their property management. Written by Paul Dribin

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Hope vi

Hope VI is a now discontinued public housing program that completely rehabilitated distressed public housing projects in this country.   The idea behind the program was to combine physical rehabilitation social services and create mixed income communities. I had the opportunity to work on the Darst Webbe program in the near south side.  That program has been successful in creating a mixed income community and has led to improvements in surrounding neighborhoods. 

Recent research has evaluated HOPE VI.  The program has not really transformed lives and it was noted that displaced public housing residents did not readily move back 

I believe the program has provided urban development benefits but has not significantly improved the lives of residents. The cost is quite high and demolition and new construction may have been cheaper. The jury is still out on mixed income housing. I have serious doubts that given a choice anyone would opt for this type of housing 

Beyond Housing

In writing about great organizations in St Louis Beyond Housing is probably the best. They have been in business for years and fully realize that community development must be comprehensive and is hard work. 

They are focused on Pagedale  and the Normandy School District. Their projects include housing development and rehab,homeownership training, foreclosure prevention,and economic development. They have brought a movie theatre, grocery store, and bank  to the area. They have created the 24:1 imitative which is bringing the smaller communities together to meet common goals.

Their leader is Chris Krehmeyer a talented, passionate, and caring individual. I am proud of their work

The Big Idea

I am repeating an idea I have expressed in previous blogs because I believe it is so important. The idea is that low income people would be significantly better served by a guaranteed income rather than construction of affordable housing. I am writing this for the following reasons:

1. Too much of the money spent on affordable housing is siphoned off to third party people and does not directly benefit the low income resident.

2. Construction is just too hard to get right. Studies have shown that very little affordable housing is build outside areas of concentration of poverty. Research again shows that low income people concentrated in poverty stricken areas have much less chance to improve their lives.

3. Income supplements largely eliminate the stigma attached to affordable housing. People could rent where they liked, use funds for a downpayment on a house, or make the normal market choices that other people do.

4. Desegregation would be easier.

5. The program would benefit more people than a construction program.

6. The program would provide benefits to more landlords and developers. Why? Because if implemented on a full scale the funds generated would provide tremendous demand for an increased number of apartment units. Apartment developers could feel confident there units could be leased.

I have a couple qualifiers to go along with the positive points:

1. These funds should not discourage employment. I would see them as a supplement to low wage jobs and not a substitute for employment. Someone who worked would actually be better off.

2. There still need to be construction programs to target special needs populations-persons with disabilities,elderly, and homeless people.

3. There needs to be a strong mortgage program in place to support the increased housing development. The FHA multifamily programs are potentially excellent, they need to be streamlined and simplified.

I am not confident that my concept will be enacted any time soon. I do think it is one of those rare ideas that can unite progressives and conservatives.

Issues Affecting Housing and Healthcare

Here is an article from the Housing Matters website that discusses the positives and negatives of trying to link housing with healthcare services.

The Future of Integrated Health and Housing Programs

June 14, 2017

by Josh Leopold, Brenda C. Spillman, Eva H. Allen

Americans spend more on health care, but have lower life expectancies and worse health outcomes than any other developed country. This disparity arises partly from a lack of attention to social determinants of health, which include income, education, and housing.

States, localities, and organizations throughout the country have taken advantage of opportunities created by the Affordable Care Act (ACA) and other health system delivery and payment reforms to improve health outcomes by integrating housing and health care.

But the prospects of ACA repeal and the president’s proposed budget for fiscal year 2018 threaten to reverse recent progress in collaborations between housing and health care providers. Deep cuts to the US Department of Housing and Urban Development (HUD) and Medicaid could make it harder for states to provide basic care to low-income people and leave fewer resources to improve outcomes through integrated health care and housing.

How can housing support health?

Lack of housing makes it hard for vulnerable people (such as the elderly and those with disabilities or experiencing homelessness) to manage chronic health conditions, leads to reliance on emergency rooms for health care and emergency shelter, and contributes to poor health outcomes and reduced life expectancy.

Supportive housing combines a rental subsidy with case management and has been shown to reduce health care spending and improve health outcomes for people experiencing chronic homelessness. In subsidized housing, health care and social services available on-site can help people stay healthy enough to remain at home and avoid hospitalizations and nursing home admissions.

How can housing and health care providers collaborate?

Several ACA provisions aimed to improve care coordination and shift the health care system to value-based payments, where providers have more flexibility in the services they provide, but also are more accountable for improving patient outcomes. Value-based payments are intended to motivate health care providers to take a “whole-person” approach that includes addressing social determinants of health.

The Urban Institute conducted a review of nearly 40 state and local health and housing initiatives. By encouraging cross-sector collaboration, using community resources strategically, and taking advantage of health reform opportunities, many states and communities integrated health care with housing and other services to improve vulnerable populations’ health and well-being.

Three initiatives were particularly promising:

New York State’s Medicaid Redesign Team used state savings generated by Medicaid system reforms to pay for housing for high-needs populations, including construction of new affordable housing units, rental assistance, and supportive services to residents. The state recently committed an additional $1 billion to develop 6,000 new units of supportive housing in the next five years as part of a larger commitment to build 20,000 supportive units over the next 15 years.
Houston’s Integrated Care for the Chronically Homeless initiative paired housing vouchers from HUD with health care and case management services funded by the Medicaid Delivery System Reform Incentive Payment program to serve people experiencing homelessness who have chronic physical and mental health conditions and are high users of costly medical services. Early program results show reductions in participants’ preventable emergency department use, improved mental health functioning, and reduced depression rates.
Housing with Services in Portland, Oregon, brought together several organizations, from nonprofit service providers to Portland’s housing authority to the largest Medicaid health insurer, to coordinate health care and social services for low-income seniors and people with disabilities living in federally subsidized housing. Evaluation results indicate that program participants were more likely than those not connected to the program to use preventive and mental health services, had better access to long-term services and supports, and experienced less food insecurity.
What are barriers to these collaborations?

Although many health and housing partnerships have developed or been strengthened since the ACA’s passage, several obstacles limit the reach of such partnerships, a problem that budget cuts will only exacerbate. In interviews, local leaders and national experts frequently cited the widespread shortage of affordable housing as an obstacle to creating and sustaining housing and health care collaborations. Federal Medicaid funds can sometimes be used for housing-related services, but cannot pay for room and board. Some state Medicaid agencies, hospital networks, and health insurance plans have invested in rental assistance and affordable housing development, but they remain the exceptions.

Competing priorities, restrictions on the use of health care funding for nonclinical services, and lack of housing-related expertise make it unlikely that the health care sector will become a significant funder of new affordable housing. One policy expert said advocates have been overly focused on “trying to find ways that Medicare and Medicaid should fund housing that we eliminated at the HUD level.”

Proposed budget cuts would hamper efforts to integrate housing and health care

The proposed budget aims to cut HUD by $7.4 billion and eliminate the Housing Production Trust Fund and Community Development Block Grants. In addition, the proposal to cut the corporate tax rate from 35 percent to 15 percent has already made affordable housing development more difficult. The proposed cut has reduced investment in Low-Income Housing Tax Credits, the primary funding source for affordable housing, because investors are less motivated to buy the credits to offset their income taxes.

In this environment, housing providers may focus on stemming losses rather than supporting new collaborations. The vulnerability of housing and health partnerships to changes in federal funding was demonstrated recently, when HUD advised the Houston Housing Authority to stop issuing new vouchers for the remainder of the year because of an anticipated budget shortfall.

The budget also calls for reductions in federal Medicaid spending, that, coupled with reductions proposed in the House-passed health plan, would cut Medicaid spending 47 percent over 10 years.

These proposals could slow or reverse the momentum for housing and health care integration. Given the promise of housing and health collaboration for the nation’s most vulnerable populations, further reducing the stock of affordable housing and supportive services could thwart progress in improving their health care outcomes and quality of life.

An earlier version of this post was published on Urban Wire, the blog for the Urban Institute.

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TAGS: Health, housing, Budget
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Health Care and Housing

More attention is being paid to the relationship between housing and healthcare. There are a couple obvious connections. Someone living in unsafe housing is more likely to suffer from serious Heslth problems. We know asthma increases for children living in substandard housing.

Second, families spending a disproportionate amount of money on housing do not have funds left over for healthcare. 

Third health care reform penalizes hospitals for readmisdion if patients. Hospital Social Workers tell me that they often have trouble finding decent affordable housing for patients. This contributes to readmissions

Work is underway to better mesh housing and healthcare. We need to begin the process in St Louis

Better Together

Better Together is a non profit group formed to help bring the region together and eliminate redundant units of government and has indicated the unnecessary spending levels caused by the large number of governmental units. I have a little concern with the group because the board consists of the same old moneyed interests that have guided St. Louis down the tubes. Nevertheless, I welcome every effort to improve our feudal and futile governmental system. They have recently released a report that again documents the terrible costs of a large number of small governments. Here is their vision statement:

VISION

Striving together to create a just and prosperous Saint Louis region.
MISSION

We support the St. Louis region by acting as a catalyst for the removal of governmental, economic, and racial barriers to the region’s growth and prosperity for all of our citizens by promoting unity, trust, efficiency, and accountability.
COMMITMENTS
We are committed to fact driven research to address the challenges of fragmentation in the region and to inform policy.
We are committed to open and direct dialogue with all constituencies and stakeholders for the greater good of our community.
We are committed to supporting organizations that share our mission and vision.

Here is the announcement about the report. I urge you to read this and look into what you can do to bring the region together. The St. Louis region will not prosper until these issues are addressed:

Better Together Releases Report Showing Government Spending in St. Louis Continues to Grow, Announces Task Force to Study Models and Propose Solutions
Jun 12, 2017 |
Better Together Releases Report Showing Government Spending in St. Louis Continues to Grow, Announces Task Force to Study Models and Propose Solutions
Government spending continues to grow in St. Louis—fueled by 100 tax increases during the last five years—new task force to study models and propose solutions
Introduction
Today, Better Together released an update to one of its essential studies that they performed in 2014 and revealed the next steps for the organization.
The original study—Regional Spending Comparison Overview—reported that overall spending for municipal services in St. Louis was $2.3 billion and that when compared to Indianapolis and Louisville, two cities that have consolidated their governments, St. Louis was spending between $750 million and $1 billion more per year. Researchers at Better Together were curious as to what had happened with spending over the last three years and undertook to update this report.
Spending for municipal services grew by $119 million
The overall spending for municipal services has grown to $2.5 billion annually. This is due to an increase of $119 million in just the past three years. “Our research shows that our region is spending $119 million more per year than we were just three years ago. This increased spending was paid for largely through 100 tax increases. At the same time, 2016 census estimates show that population declined in both the city and county by 8,625 persons overall. So, we are paying more to deliver the same services to fewer people,” said Dave Leipholtz, Director of Studies for Better Together. “By way of comparison, our peer cities of Indianapolis and Louisville continue to grow and thrive.”
A call to action
“The next phase of our Better Together project is to identify and report on governmental reforms that can improve the cost and effectiveness of St. Louis’ municipal services,” said Nancy Rice, Executive Director of Better Together. To that end, Better Together is forming a task force which will lead this next phase and ultimately issue reports and recommendations to the community. Leading the task force will be:
Suzanne Sitherwood, President and CEO of Spire (formerly Laclede Group), who came to St. Louis from Atlanta and has become deeply involved with her new home community. She is the incoming Chair of Civic Progress and Chair of the community-wide United Way campaign, and previously chaired the Saint Louis Regional Chamber.
Will Ross, Associate Dean for Diversity, Professor of Medicine at Washington University School of Medicine. Dr. Ross has a long and distinguished record of involvement in the St. Louis community and served as Chairman of the Missouri Foundation for Health.
Arindam Kar, Partner at the international law firm of Bryan Cave LLP. Kar specializes in anti-trust litigation. He, his wife and five children call south St. Louis county home. Mr. Kar is active in the community, devoting time to the International Institute, the United Way, the Regional Business Council Young Professionals Network, and the Gateway Region YMCA.
How should St. Louis government be organized?
The Task Force and Better Together staff will endeavor to issue reports and recommendations on ideal governmental structures for St. Louis. To accomplish that, they will work with other community organizations and the general public. “We want to give St. Louis residents the opportunity to choose an ideal governmental structure—one that will provide high quality services in a cost-effective manner,” said task-force member Suzanne Sitherwood. Another member, Dr. Will Ross agreed, “we aspire to create a region steeped in racial, social, and economic equity where everyone can achieve their full potential. We hope to recommend a structure that allows the St. Louis region to provide opportunities for all our citizens while celebrating the uniqueness that has made St. Louis a wonderful place to call home.”
Mayor Krewson and County Executive Stenger endorse effort
Mayor Lyda Krewson and County Executive Steve Stenger attended Better Together’s press conference and showed support for this effort.
“Over the last two years I’ve seen the limitations that our current structure places on us. It frequently prevents us from changing and adapting to the times we live in. Businesses struggle with our fragmentation,” said County Executive Stenger. “In order for us to reach our true potential, we must make some changes. I’ve heard many solutions talked about, and without a formal presentation of options and without a deep dive and a thorough analysis we will not know which path forward is the correct one. But I know it’s time for us to look hard at the alternatives, to perform the necessary analysis, and choose a path forward with respect to these issues.”
Mayor Krewson agreed. “I recognize that the city is going to have to change in order to thrive. I said that many times during my campaign and these first several weeks in office have affirmed that opinion. I’m grateful to Better Together and the task force for taking this on and I look forward to their findings.”
Stenger and Krewson pledged to work with the Task Force as needed. “The time for this effort is now,” said Stenger.
To view the updated report in full, visit: http://www.bettertogetherstl.com/regional-comparison.

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Better Together Releases Report Showing Government Spending in St. Louis Continues to G

St. Louis Development Guidelines

The City of St. Louis has issued draft development guidelines for the use of incentives. This material is very important and perhaps controversial. Here is the link:

https://www.stlouis-mo.gov/government/departments/sldc/documents/upload/Development_Incentives_Input_Session_FINAL_06-08-17.pdf

Statistics on Lack of Housing Affordability

Everyone knows there is a serious lack of affordable housing in this country. This gap contributes to homelessness, poor school performance, childhood trauma, and mental and physical health problems. The National Low Income Housing Coalition (NLIHC) presents a report every year which documents the housing affordability problems. They compare the minimum wage income to rents and then deduce the level of housing non affordability. They compare the monthly minimum wage income to the median rent in the area and calculate that anyone paying more than 30% of their income for rent is paying too much for housing.

Like I said, I am a big affordable housing advocate and understand the lack of affordable housing. I disagree with the methodology used in this study. Many minimum wage workers are students or retirees and do not expect to live on this income. Others double up with roommates to meet housing costs. Third most minimum wage workers do not stay at that salary level for long. I believe the average tenure at minimum wage is six months. For better or worse, minimum wage was never intended to be a living wage.

A more valid comparison would be between median salary and median rent. This statistic would still tell and alarming story, but the data would be more truthful. I have the highest respect for the National Low Income Housing Coalition. They do great work.

Development Incentives in St. Louis

The City of St. Louis has for years handed out huge development subsidies in the form of TIFs, tax abatement, and other measures. They also offer soft second loans on developments which usually do not need to be paid back. Are these incentives effective? It is difficult to know. The Board of Aldermen Hud Committee is proposing a more rational approach to this issue and is gathering testimony from the public. Everyone involved in development needs to pay close attention.

My take on incentives is that it is difficult to use a formula to provide incentives. Ideally the development getting help would not be built without the incentives and the project would provide a real boost to the city. The Chase Park Plaza Hotel comes to mind. There would be less need for incentives if the city had a more rational, and fair permitting and development process. Most developers tell me the city is the most difficult place to do business.

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