25th Anniversary Issue

THE STATES AND LOCALITIES October 2012 $4.50

“I’m not running against Obama!” State races should focus on state issues. But try telling that to voters.

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go VOL. 26, NO. 1 10.2012

FEATURES 24 ALL POLITICS IS NATIONAL Can you ever really separate federal issues from state elections? By Alan Greenblatt

SPECIAL SERIES 32 STAY AT HOME, MOM States are searching for aff ordable ways to allow seniors in need of long-term care to remain in their homes. By Dylan Scott 38 LAST RIGHTS Aging baby boomers want control of their end-of-life care. By Jonathan Walters 44 HEALTH IT AND THE AGE BOOM Advances in telehealth and better exchanges of health data could fundamentally change the nation’s health-care systems, especially for older patients. By Dylan Scott

48 JUDGMENT CALL Police in Milwaukee have overhauled 911 and the way they respond to serious crimes. By John Buntin 56 GOVERNING IN 2037 This month marks Governing’s 25th anniversary, so we asked leaders for their predictions on how government will A caregiver readies have changed 25 years from now. the room for her client By Ryan Holeywell who returned home after three years in a 62 BLACKOUT nursing facility. A cyberattack could leave large parts of the nation in the dark and under siege. Cover: Iowa Senate By David Hatch candidate Matt PHOTO BY KRISTINA KRUG Reisetter. COVER PHOTO BY CLIFF JETTE

October 2012 | GOVERNING 1

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4 Publisher’s Desk 6 Letters

OBSERVER 9 The Felon Vote Its impact could be even greater than any other set of voter laws. 10 Bidding for Your Job To save money, some cities are making employees bid for work. 12 Monetizing Prevention The experiment with social 20

impact bonds begins. SHUTTERSTOCK.COM

POLITICS + POLICY PROBLEM SOLVER 14 Dispatch 66 Get Out of Jail (But Not for Free) Virginia helps parents keep up with child support A quixotic adventure breaks the payments and stay out of lockup. range barrier for electric cars. 16 Potomac Chronicle 68 Smart Management What felled Alabama’s performance measurement plan? The Libor scandal has cost states and localities millions.

FLICKR/THE CBI 70 Idea Center 17 FedWatch In an eff ort to mobilize young voters, Washington state turns to Facebook. 16 Alaska offi cials want to be free of the Voting Rights Act. 72 Tech Talk 18 Health “Best of the Web” winners showcase must-have features for successful government websites. States race to set up health exchanges in time. 74 Public Money 20 Green Government Consolidating governments is hard to do, but the idea keeps coming up. Can credit-exchange programs clean up lakes and streams? 76 Last Look 22 Economic Engines Upstate New York has a Halloween-ready house. What is public today—police, roads—was once very private.

23 Urban Notebook OF CONGRESS/BAIN NEWS SERVICE LIBRARY Are governments ready to embrace grassroots urbanists?

22

2 GOVERNING | October 2012

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go In this school, employee protection gets straight A’s.

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 Other OK to go PUBLISHER’S DESK

Publisher Erin Waters

Editor Tod Newcombe Executive Editor Jonathan Walters Editor-at-Large Paul W. Taylor Managing Editor Elizabeth Daigneau Senior Editor Zach Patton Our Silver Anniversary Associate Editor Jessica Mulholland Chief Copy Editor Miriam Jones; Copy Editor Elaine Pittman n October 1987, the fi rst issue of Governing rolled off the Staff Writers Ryan Holeywell, Dylan Scott presses. It was an auspicious time for state and local govern- Correspondents John Buntin, Alan Greenblatt ment. America was heading in a new direction after decades Contributing Editors Penelope Lemov, Steve Towns Iof federal growth that stretched as far back as the Franklin D. Columnists Katherine Barrett & Richard Greene, William Fulton, Peter A. Roosevelt era. By the mid-’80s, President Ronald Reagan had Harkness, Donald F. Kettl, Alex Marshall

started to downsize the federal sector, forcing states and localities Editor, Governing.com Kathy A. Gambrell to be more creative in raising revenue and generating new ideas. Deputy Editor, Governing.com Caroline Cournoyer Governing founding publisher Peter Harkness saw an oppor- Data Editor, Governing.com Michael Maciag tunity to “follow the story,” and put the eff orts of state and Social Media Specialist, Governing.com Brian Peteritas local government into a national perspective at a time when Creative Director Kelly Martinelli the rest of America’s media remained preoccupied with Wash- Design Director & Photo Editor David Kidd ington. Peter envisioned a magazine that would cover state Art Director Michelle Hamm and local politics, policymaking and the business of govern- Senior Designer Crystal Hopson ment, and it would identify the problems, highlight the places Illustrator Tom McKeith and spotlight the people who Production Director Stephan Widmaier

make a diff erence. The magazine Chief Marketing Offi cer Margaret Mohr positioned itself as fi ercely inde- Marketing Director Meg Varley-Keller pendent and nonpartisan. The idea succeeded as Governing Founder & Publisher Emeritus Peter A. Harkness came to be recognized nationally Advertising 202-862-8802 as the source for those who work Associate Publisher, Infrastructure Marina Leight for and with states and localities. Associate Publisher, Finance Erica Kraus We’ve grown a lot since 1987, Associate Publisher, IT Fred Kuhn taking our journalistic expertise Account Director Jennifer Gladstone on politics and policies beyond the Account Manager Kori Kemble print publication to events, digi- Offi ce Manager Alina Grant tal platforms and research. The Digital Media Associate Elisabeth Frerichs Erin Waters, Publisher result: new and exciting formats Media Account Coordinators Hillary Leeb and Lauren Mandell for reaching and connecting with Marketing/Classifi ed [email protected] states and localities, while continuing to tell compelling stories CEO Dennis McKenna that enlighten as well as inform. COO Paul Harney Our experience comes to bear as state and local govern- CAO Lisa Bernard ments face some of their biggest challenges since the 1940s. Our Executive Editor Steve Towns coverage, distributed across many platforms, will serve state Executive VP Cathilea Robinett and local leaders who are dedicated to fi xing the problems they Reprint Information face and help them to set a new course for the future. Challeng- Reprints of all articles in this issue and past issues are available ing times push individuals and organizations to do more and (500 minimum). Please direct inquiries for reprints and licensing to to exceed previously held expectations. I look forward to the Wright’s Media: 877-652-5295, [email protected] future and to covering the people, problems and practices of Subscription/Circulation Service state and local government. Eenie Yang [email protected] In celebration of our silver anniversary, staff writer Ryan http://www.governing.com/subscribe Holeywell asked fi ve thought leaders for their predictions on what government will look like in 25 years [see “Governing in 2037,” Governing (ISSN 0894-3842) is published monthly by e.Republic Inc., with offi ces page 56]. We’ve also reached out to our readers on Facebook and at 1100 Connecticut Ave. N.W., Suite 1300, Washington, D.C. 20036 and at 100 Blue Twitter. Visit governing.com/25years to see their answers, and Ravine Road, Folsom, CA 95630. Telephone: 202-862-8802. Fax: 202-862-0032. Email: [email protected]. Periodical postage paid in Washington, D.C., and at chime in with your thoughts on what state and local government additional mailing offi ces. Copyright 2012 e.Republic Inc. All rights reserved. Repro- will be doing in the next 25 years. duction in whole or in part without written permission of the publisher is prohibited. Governing, Governing.com and City & State are registered trademarks of e.Republic I look forward to hearing from you about our coverage. You Inc.; unauthorized use is strictly prohibited. U.S. subscription rates: Government can always reach me at [email protected]. employees—free; all others—$19.95 for one year. Foreign subscriptions: $74.95 in U.S. funds. Postmaster: Send address changes to Governing, 100 Blue Ravine Road, Fol- som, CA, 95630. Subscribers: Enclose mailing label from past issue. Allow six weeks. 4 GOVERNING | October 2012 Member: BPA International. Made in the U.S.A.

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Illegal Medical Marijuana Implicit in the term “governing” is the concept of following the law. Sadly, your recent story on state-approved medical marijuana programs [“Over- the-Counter Culture,” August 2012] largely ignores the irresponsibility of elected offi cials who are clearly attempting to circumvent federal law. Nor is there any mention of the additional crime in states pursuing this misguided pub- lic policy. One need only look at California’s experience to see that dispensaries are magnets for vio- Drivers Need Protection Too In Austin, Texas, where I live, we have seen lent criminals seeking cash and drugs. Or The idea that drivers should be legally an increase in pedestrian deaths and inju- Colorado, where a recent study featured considered at fault when striking pedestri- ries, and as a result the police are cracking in The Denver Post found that three- ans or cyclists when it is not their fault is down ... but not just against drivers! Many quarters of teens enrolled in the state’s completely irrational and would set a dan- of our pedestrian deaths are from indi- substance abuse programs got their pot gerous legal precedent [“Street Litigation” viduals trying to cross freeways on foot. from a medical marijuana cardholder. in Economic Engines, August 2012]. Driv- Others are from pedestrians crossing at a Instead of the current patchwork of ers already assume the inherent liability defi ned crossing but against the light. So, state eff orts to legalize marijuana, there associated with their two-ton vehicles: our police are targeting individuals who is a more sensible, legally sound way to They are subject to manslaughter and other break the law, be the person a driver or a enact the policy sought by advocates of charges when they are at fault. This article pedestrian. If I’m driving the speed limit medical marijuana: Put down the bong [makes it seem] as if law-abiding drivers are on a city street or freeway, and someone on and advocate seriously for a change in going around casually clipping pedestrians foot decides they can make it across, but our federal laws. because they know they can get away with fails, I’m certainly not at fault and strict —Bill Montgomery it. The degree to which pedestrians and liability should not apply as [author Alex] Maricopa County (Ariz.) Attorney cyclists are at risk in American society has a Marshall would like to have it apply. lot more to do with the high degree of auto Regarding cyclists, many obey traf- dependency and associated infrastructure fi c laws, and we have many bike lanes in investments than it does with reckless Austin. Still, on my way to the mall a few Pot Politics drivers. In either case, reckless drivers are weeks ago, I saw no less than fi ve cyclists Should medical marijuana be already subject to the law. Applying the cross a major intersection against the light. federally legalized? Tell us what same legal standard to nonreckless drivers If I had happened to have hit one of them, you think at mailbox@governing. is nothing other than a draconian measure I wouldn’t want the law to say I have no com. So far, readers say: meant to appease anti-car zealots. rights and that it was my fault just because —Scott on Governing.com I’m in the car and he’s on a bike. —Dan Sowards, Austin Such laws are perhaps well intended, but their consequence would simply increase Thanks. (We think.) the danger for bikers, walkers and motor- ists. Accidents are not the result of 29% drivers not caring about us; they are a I have to confess No result of them not seeing us. Coupling our “ I’m boring enough 71% lack of visibility with a sense of entitle- ment sounds dangerous to all involved. If to read things like Yes our intent is truly to save lives, we should Governing magazine.” promote greater use of safety and visibil- —San Antonio Mayor Julian Castro in ity practices for bikers and walkers, not response to a question about where he gets job penalizing fellow commuters. growth ideas, quoted in The Weekly Standard —Joel Dixon, Boise, Idaho

6 GOVERNING | October 2012

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 Other OK to go A Special Report on GENERATIONS Aging in America Coming in GOVERNING September – December

How is the most dramatic generational change in U.S. history affecting our communities, the economy and the work of government itself? . The 65 and over population will increase by 79% over the next 20 years . 1 in 5 people in the U.S. will be over 65 by 2029 . People over 65 will exceed the number of those under 15 by 2035

WATCH GOVERNING in the months ahead for a look at … . How the “silver tsunami” will affect policy and politics in our cities, counties and states . What the impact will be on healthcare costs, state and local budgets, social services and the public sector workforce . How the largest 65+ population in U.S. history will help shape the physical environment of our cities and neighborhoods

governing.com/generations

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go vote, says Susan MacManus, a politi- cal science professor at the University of South Florida, it could be enough to swing the state for Obama. It’s no surprise then, that felon vot- ing rights have become a big issue in the Sunshine State. In one of his fi rst acts in offi ce, Gov. Rick Scott enacted stricter rules for ex-felons trying to regain their right to vote, requiring for- mer inmates to maintain a clean record for fi ve years before petitioning the state. Legislators have sought to undo Scott’s policy, but without success. “I don’t believe felons’ right to vote should become a political football,” says Florida state Sen. Eleanor Sobel, “but it has.” Elsewhere, the trend has been moving toward expanded voting opportunities for felons. Since 1997, at least 23 states have passed legislation or taken other steps to help people with prior convictions regain the right to vote, according to a 2009 study by the Brennan Center for Justice. In 2010, Virginia Gov. Bob McDonnell, a Republican, reduced the waiting The Felon Vote period for nonviolent offenders seeking the reinstitution of voting rights. And in MUCH OF THE TALK about voting eted in recent years, according to a Delaware this summer, state lawmak- rights this election has centered study by The Sentencing Project. As of ers approved legislation that would on new ID laws that critics say are 2010, 5.85 million adults were barred amend their constitution to eliminate a designed to suppress turnout among from voting because of their criminal fi ve-year waiting period before felons immigrants and low-income voters. records—up from 3.34 million in 1996. may regain voting rights. (Legislators But there’s another set of voter laws About 4 million of the felons who can’t must pass it again next term for it to that could have an even greater impact vote today are not incarcerated, says take effect.) This year alone, according on the presidential race: restrictions Christopher Uggen, the University of to the National Conference of State against felons. Minnesota sociology professor who Legislatures, more than 20 states have A record number of felons will wrote the report. considered legislation to relax felon be ineligible to cast a vote this year, It’s an issue that disproportionately disenfranchisement policies. according to The Sentencing Project, affects black voters; in the key swing Still, expanding voting rights for a nonprofi t that advocates for reforms states of Virginia and Florida, more former felons can be diffi cult. In Alaska in the criminal justice system. States than 20 percent of African Americans this year, the state Senate consid- treat felons differently when it comes can’t vote because of a criminal record. ered a bill to expand ex-felons’ voting to voting. In Maine and Vermont, for President Obama—who garnered 96 rights. State Sen. Bettye Davis has example, current inmates can vote. percent of the black vote in 2008— introduced similar legislation almost At the other end of the spectrum, 11 likely needs large turnout among that every term since 2004. It’s always been states have policies restricting ex- demographic in order to win against unsuccessful. “It will keep many from felons from voting even after they’ve Republican candidate Mitt Romney. returning to jail by being able to vote been released from prison. The number In an electoral contest that promises and participate in the community,” of people unable to vote because of to be historically close, every vote Davis says. “It’s just the right thing

SHUTTERSTOCK.COM their criminal convictions has skyrock- matters. If ex-felons in Florida could to do.” —Lauren Henry

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go Bidding for a Job You Already Have

IF YOU WANT TO WORK on a proj- Meanwhile, in Chicago, managed some, the idea is a no-brainer. “The ect for the city of San Diego, you may competition has taken a more literal city and the government—we’re not be required to submit a bid—even if meaning: The city’s recycling operations in the employment business,” says you’re already a city employee. In a have been split between public workers Arizona state Sen. Frank Antenori, twist on the way municipalities have and private companies, and both are who sponsored a bill last year that traditionally done business, more being evaluated for a future contract. would have required the state’s largest public employees across the country Already, city offi cials say, the public- cities to solicit private-sector bids for are being required to participate in a sector workers have reduced costs services. “We’re a service provider. If bid process for project work. The idea, from $4 per cart of waste to $2. Tom we can provide that service cheaper known as “managed competition,” Alexander, a spokesman for Mayor and more effi ciently, we should.” has been around for about 15 years. Rahm Emanuel, says employees have Historically, labor groups have But as cities seek new ways to save found more effi cient ways to route their opposed managed competition, money, the idea is gaining trucks, are using fewer sick days and arguing that profi t-driven companies In Chicago, renewed attention. have renegotiated the labor deal for may not perform work to the same both public In San Diego, the new hires. “We were hoping there would standard as government employees. and private program was approved by be a robust competition, and that’s They also argue that there’s less teams provide a 2006 ballot vote (although exactly what happened,” he says. accountability involved when work recycling it wasn’t fully implemented Charlotte, Phoenix, Indianapolis gets outsourced. services, until 2010). Under the and other cities have pursued In San Diego, leaders with the city’s whilewhile ththee cicityty prprogram,ogram, ccityity leleadersade identifyy managedg competitionp as well. For Municipal Employees Association evaluatesevaluates (MEA) say that if city workers have whichwhich group is to bbidid llikeike a company, they’ll start moremore eeffiffi ccient.ient. acactingting llikeike one. Workers on their way to fi l lll a apo potholet might not stop to pick up a ffallenallen road sign, for example, if ththat’sat’s nnotot iincluded in their bid and wowoulduld afaffect their overall costs and effi cciency. MEA offi cials say ththat as more front-line jobs bbecome subject to managed competition, the public will get a feel for how it really iimpacts city services—and citizens may not end up liking it after all. —Ryan Holeywell

THETHE BRBREAKDOWNEAKDOWN operations they think can be performed for less money. Workers help write the solicitation for bids, while another team—along with private-sector contractors—responds. $166.9m 14.6% City landfi ll employees recently won a bid that will save the city $2.7 million The amount of health insurance The growth in states’ pension annually, in part by cutting 11 full-time rebates that Texans received, which is assets from 2010 to 2011, positions. Interestingly, all four managed more than any other state, under the representing a collective increase competitions completed in San Diego Affordable Care Act. The law requires of $325 billion—still not enough so far have been won by city workers. insurance companies to return a por- to make a dent in most states’ “They won because they found ways to tion of the premiums if they spend pension shortfalls. operate more effi ciently,” says Wally Hill, less than 80 percent on medical care.

FLICKR/CRAGIN SPRING the city’s assistant chief operating offi cer. IMAGE: SHUTTERSTOCK.COM; SOURCES: THE WALL STREET JOURNAL, CYBER BULLYING RESEARCH CENTER, HOUSTON CHRONICLE, CENSUS

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go Everybody’s Sports Gambling? Driving for Maybe Don’t Bet on It. the Weekend DOES BETTING ON A FOOTBALL game make it less enjoyable for fans? That’s IT’S PROBABLY no the argument being put forth in New Jersey by the four major sports leagues, surprise to hear that Friday along with the NCAA. The group fi led suit against Gov. Chris Christie in August, afternoon traffi c can be a after the governor signed a law to allow sports betting in Atlantic City casinos slog. Statistically, Friday and at racetracks throughout the state. afternoons are the worst The sports leagues’ chief complaint is that gambling could affect the integrity of time of the week to drive professional and college sports. (Their specifi c legal claim is that New Jersey is vio- in nearly three-quarters lating a 1992 federal law that prohibited sports gambling everywhere but Delaware, of metro areas across the Montana, Nevada and Oregon. The law gave New Jersey a one-year window in country, according to data which it could have allowed the practice, but lawmakers in the state didn’t do so at compiled for Governing by the time.) In terms of integrity, wrote National Football League Commissioner Roger the traffi c research firm Goodell in a statement accompanying the suit, sports gambling would promote Inrix. But in the rush to get home for the weekend, cynicism among fans. “If gambling is freely permitted on sports events, normal some cities are worse than incidents of the game such as bad snaps, dropped passes, turnovers, penalties others. In Portland, Ore., for and play-calling inevitably will fuel speculation, distrust and accusations of point- example, the average Friday shaving or game-fi xing.” Fans, he said, would stop having allegiances to teams and afternoon delay is nearly 60 players and would instead focus solely on winning a bet. percent longer than it is for It’s worth noting that that doesn’t seem to have happened so far, despite an the rest of the workweek. estimated $2.76 billion wagered on sports in Nevada in 2010, according to the (Meanwhile in Fresno, American Gaming Association—not to mention countless offi ce pools on Calif., and Augusta, Ga., college hoops. —RH driving home on Fridays is actually a tad faster than some other workdays.) Here’s a list of metro areas with the worst Friday afternoon commutes. —Mike Maciag

METRO AREA FRIDAY AFTERNOON DELAY, IN MINS.* Los Angeles, CA 13.17 San Francisco, CA 10.59 Honolulu, HI 10.47 Austin, TX 10.44 Bridgeport, CT 9.69 Seattle, WA 9.21 ARKORN/SHUTTERSTOCK.COM New York, NY 9.15 Portland, OR 8.58 Washington, DC 7.47 Chicago, IL 7.41 Baton Rouge, LA 6.99 San Jose, CA 6.96 Boston, MA 6.72 1 1in 3 Virginia Beach, VA 6.36 Philadelphia, PA 6.09 Number of states (in The portion of doctors in the Miami, FL 5.94 Baltimore, MD 5.82 this case, Montana) United States who aren’t accepting San Diego, CA 5.64 with no anti-bullying new Medicaid patients—almost New Haven, CT 5.55 laws on the books. twice the rate of doctors who Houston, TX 5.31 aren’t accepting new Medicare or *FIGURE INDICATES HOW MUCH LONGER AN AVERAGE privately insured patients, accord- 30-MINUTE COMMUTE WOULD TAKE THAN IF THERE WERE NO TRAFFIC, FOR ALL ROADWAYS. ing to a new government study. DATA FOR 100 MORE CITIES AT GOVERNING.COM/ COMMUTE

October 2012 | GOVERNING 11

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go Finding Funding for an Ounce of Prevention leader in the world of social impact Palandjian’s organization started getting bonds—a relatively new fi nancial attention when Massachusetts was instrument that promises to earn returns seeking partners for a pair of social for investors while giving state and impact bonds. Her group didn’t win local governments the upfront capital those deals, but it did just enter into they need to pursue money-saving a partnership with New York state to programs. To put it plainly, Palandjian help fi nance a workforce development Tracy Palandjian, says, “It monetizes prevention.” program. Palandjian says she expects founder of the The idea is that if a government a growing number of municipalities nonprofi t Social gets an infusion of capital to pay for to consider SIBs and says federal Finance Inc. prevention programs now (say, to agencies, including the departments support recently released prisoners), of Labor and Justice, are trying to then it will eventually save money in the encourage states to include SIB long run (in this case by avoiding future components in some grant proposals. incarcerations). Investors would front Palandjian is quick to note that IT’S AN OLD TRUISM in government the money for a prevention program, SIBs aren’t a silver bullet. They work that prevention saves money. You and if it works, they’d get paid back best when a particular intervention has can save health costs by preventing along with interest from the savings an established track record. And the obesity. You can save costs on social they achieved. Investors typically earn economics are such that an SIB is only services by preventing homelessness. returns of anywhere from 2 to 13 percent, feasible when the long-term savings Spend a little money now, and you but there’s a risk that they lose it all exceed the cost of the intervention itself. can save a lot in the future. if the programs don’t work. Investors Programs that address homelessness, But two political realities can get in include foundations and philanthropic recidivism, workforce development, the way: Budgets are typically written organizations, wealthy individuals, and senior housing and childhood obesity for a single year, and political lives (eventually) institutional investors. lend themselves to the tool. are short. Both of those factors often The poster-child for social impact “It’s really too early to tell” whether lead governments to make choices bonds (SIBs) is a program launched in SIBs will remain on the periphery of that have lower short-term costs, but 2010 by Social Finance Ltd., an older government fi nance or became a key may be more expensive in the long United Kingdom affi liate of Palandjian’s fi scal tool, Palandjian says. “The track run. Tracy Palandjian wants to help organization that seeks to reduce record of the early transaction will governments make a wiser fi scal choice. the recidivism rate of prisoners in dictate the fate of the market.” —RH As a founder of the Boston-based Peterborough,, EEngland,ngland, bbyy provprovidingiding

WEBB CHAPPELL nonprofi t Social Finance Inc., she’s a them with supportpport upon their release.

“Humanity is getting dangerously close to the point of no return. ” FLICKR/NEON TOMMY —California Gov. Jerry Brown, announcing the launch of an offi cial state website that attacks critics of climate change and seeks to ddispelispel the arguments from the “small but vocal group [that] has aggressivelyssively spread misinformation about the science,” according to the ssite.ite. Source: Stateline

12 GOVERNING | October 2012

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By Paul W. Taylor

Charged Up A quixotic adventure breaks the range barrier for electric vehicles.

SAN DIEGO—Tony Williams had a wed- ding to go to last summer. Airfare was too Tony Williams drove expensive for the trip from Southern Cali- 1,887 miles from fornia to Washington state, so he decided San Diego to British to drive. “I bet I could do it in an electric Columbia in his car,” he told himself. “It would just take electric Nissan Leaf. me longer.” So began a one-man test of the electric vehicle (EV) charging infrastruc- ture along what has been dubbed the West Coast Electric Highway. The 1,400-mile border-to-border route from Mexico to Canada on Interstate 5 is well traveled, except that nobody has driven it in an all-electric vehicle with an estimated range of 70-90 miles. Do the math. It’s a long trip for a short-range vehicle. Still, just because it hadn’t been done didn’t mean that it couldn’t be done. Williams’ adventure may seem a bit whimsical, but fi guring out how we can UNIVERSITY GEORGE BEARD, PORTLAND STATE travel long distances without burning up a 15 new fast-charging stations were lit up made a similar drive across his state. He lot of carbon is serious business. In August, along the north-south corridor across the says long range drives in short-range vehi- the Obama administration issued new two states just 16 days before Williams cles help demonstrate that EVs are “not rules requiring automakers to manufac- headed north. The nascent charging fragile toys; they drive like any other car ture vehicles by 2025 that have an average infrastructure is a curious mix of estab- and they can be charged in the time that fuel effi ciency of 54.5 mpg. Electric power lished players, including a public-private it takes to get a coff ee.” Merkley believes will be a factor in achieving that goal, with partnership involving two state DOTs, a they could play an important role in break- states and localities playing a prominent host of startups and even Williams’ own ing the country’s dependence on oil and role in marshaling the rules, regulations nonprofi t charging service in San Diego. carbon-based fuels. He and Republican and resources that will put in place charg- Williams and his young daughter Sen. Lamar Alexander of Tennessee have ing stations for the next generation of lost time struggling to fi nd charging sta- introduced legislation to provide short- vehicles to travel from point A to point B tions in the Golden State, but managed term incentives for selected communities without getting stranded. to cross Oregon in 12 hours and Wash- to become test beds for modeling the use Williams’ trailblazing drive proved it ington in about 13. Williams was unable of electric vehicles nationwide. could be done. “I’m no Lindy,” says Wil- to line up sponsors for his maiden trip, Williams says he’s seen government liams, an unemployed pilot and electric saying manufacturers, energy companies, offi cials get enthusiastic about the “nifty vehicle enthusiast, referring to aviator government agencies and universities all neat-o reasons for electric cars in the Charles Lindbergh’s transatlantic fl ight. kept their distance at fi rst. He believes immediate future,” but laments that their “But in terms of an adventure, it was they hesitated, thinking, “Here’s another participation so far is a bit like when the pretty high because there were a lot of kook with an idea.” But once it was clear batteries run low, “the plodding speed of unknowns.” He didn’t know, for exam- Williams was determined to make the government in doing something construc- ple, whether charging stations would be drive, it became a big deal. tive will either take a long time or end up available. Then he found out that Oregon Just a couple of weeks after Williams’ being nonexistent.” G and Washington planned to place charg- inaugural run up the Pacifi c Coast, Dem- ing stations on their portion of I-5. In fact, ocratic U.S. Sen. Jeff Merkley of Oregon Email [email protected]

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By Donald F. Kettl

Weighing Libor Losses The global rate-rigging scandal has cost states and localities millions.

few months ago, Baltimore Mayor Stephanie Rawl- Because many state and local governments borrow at fl oat- ings-Blake publicly savaged international bankers for ing rates, investment returns can be highly unpredictable. So to taking money out of the pockets of city residents. The smooth out the highs and lows, fi nancial managers trade the fl oat- A bankers, she told reporters, “are pretty much playing ing bonds for fi xed-rate investments. Most of the rates for fl oating fast and loose with the people they are meant to protect.” She bonds and swaps are pegged to “Libor,” the London Interbank added, “We are not afraid of a fi ght.” Off ered Rate. Insiders know it as BBA Libor (for British Bankers’ How did a mayor of a medium-sized city end up dueling Association Libor), the product of a daily survey among bank- with giant banks like Barclays, Bank of America, Citigroup, ers about the rates banks can get in the London market at 11 HSBC, JPMorgan Chase and UBS? Like many state and local a.m. every business day, across a range of maturities. They toss governments, Baltimore invested its cash in complex fi nancial out the highest and lowest rates, and the average of what’s left instruments, including interest-rate swaps. Rawlings-Blake and determines the interest rates that just about everyone pays for other litigants in a federal lawsuit are charging that the banks set just about everything. In fact, anyone can follow the results on interest rates artifi cially low, which cut governments’ investment Twitter, @BBALIBOR. returns and led to bigger spending cuts. No politician likes to This is rather arcane stuff , but it worked well through gentle- slash programs or raise taxes. Every politician hates to discover men’s agreements for decades until July of this year. In both the they had to do so more than might have been necessary. United States and the United Kingdom, government regulators found that traders working for one of London’s most respected banks, Barclays, had been playing Marcus Agius Libor games by misrepresenting the rates. Soon only lost his job government regulators in Canada and Switzer- as chairman of land joined in the investigation, which spread to Barclays. But the 16 banks, including Bank of America, Citigroup Libor scandal could and JPMorgan Chase in the U.S. Fallout quickly cause investors to ensued when Barclays’ high-fl ying chairman lose as much as Marcus Agius was forced to resign. $176 billion. The regulators probed whether the banks had colluded to keep interest rates artifi cially low, in part to make money on trades and in part to convey the impression that, even in the fi nancial meltdown, they remained solid companies. (The riskier the company, the higher the rates it would have to pay. So lower rates both helped banks play the market better and signal a rosy corporate picture.) That takes us back to Baltimore, and a quickly growing list of state and local governments fi ling legal action. Their claim: By artifi cially driving Libor down, the banks cheated them out of enor- mous investment returns at a time when their budgets were already badly damaged from the Great Recession and when every dollar of invest- ment income was a dollar of services that didn’t have to be cut. The Libor scandal has exploded across the global fi nancial scene. It’s already cost the jobs of top bankers and has dragged many of the world’s

FLICKR/THE CBI leading banks into a very harsh spotlight, just as

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By Ryan Holeywell

they were trying to make the case for the return of fi nancial stability. Mad-as-hell You Got the Wrong Region government offi cials, who concluded they slashed spending more than was necessary, Alaska offi cials want to be free of the Voting Rights Act. are seeking compensation and retribution. Moreover, many state and local investment Alaska wants the federal government to stop intervening in its elections. In August, offi cials holding bonds with variable rates the state sued to end federal oversight, essentially arguing that it shouldn’t be converted them to interest-rate swaps to included in the Voting Rights Act because it’s not a Southern state. stabilize their returns, but now they can’t In 1975, Alaska was grouped with eight other states—almost all in the get out of them because in many cases the South—under the Voting Rights Act because it failed to provide voting materials penalties are too high. So not only are their in languages besides English, despite having a signifi cant population of Alaska investment returns lower than they should Natives who spoke 20 different languages. As a result, like many Southern be—they’re stuck with them. states, Alaska today must get approval from the federal government to make Perhaps most fundamentally, the foun- virtually any changes to the way it con- dations of much they had taken for granted ducts elections. Alaska Assistant have been shaken. It turns out that the key Over the last 30 years, the state’s elec- Attorney General benchmark for most interest rates around tions division says it’s had to get nearly Margaret the world was Libor, and that Libor wasn’t 500 federal “preclearances” for approval Paton-Walsh the actual rates bankers charged but of major and minor changes to voting estimates that could be gamed. As blog- rules. This year, a protracted legal bat- ger Darwin Bond-Graham sharply put tle over its latest round of redistricting it, “Libor was always a club of powerful resulted in a bizarre situation in which the banks inventing the price of money,” and federal government approved the state’s with Agius’ resignation, the workings of maps just days before a deadline to mail that club came under investigation and out absentee ballots. Alaska Assistant the threat of criminal rate-fi xing charges. Attorney General Margaret Paton-Walsh According to one government offi cial, “It’s says if the feds had waited much longer hard to imagine a bigger case than Libor.” to approve redistricting this year, the state might have had to delay its primary That all leads to two fi nal questions. elections and hold them separately from federal elections. She says the lawsuit First, why didn’t the feds step in sooner to was fi led to help prevent a similar situation in 2014. help protect state and local governments? What makes Alaska unique, Paton-Walsh says, is that the state never The Treasury had detected the problem should have been included in the law in the fi rst place. “Congress had almost a few years earlier, and even managed to no evidence of discriminatory voting practices in Alaska,” the lawsuit says. extract a $450 million settlement from State offi cials argue that in the 1970s, it didn’t make sense to provide written Barclays. Some state and local offi cials voting materials because historically Alaska Native languages had only been have complained that federal regulators spoken. Their written texts were developed recently, and there would have were not riding shotgun for them. been few Alaska Natives familiar with their own written languages but not Second, how much of the problem English, she says. came from state and local investment According to Census data, about 10,000 Alaska Natives or Native Americans offi cials putting money into instruments living in the state speak English “less than very well.” It’s unclear, however, exactly whose risks they didn’t really under- how many of those people would benefi t from written voter information in Alaska stand? As Jeff rey Gibbs, director of special Native languages. Anna Berge, an associate professor at the University of Alaska- investigations for Pennsylvania’s auditor Fairbanks, say it’s probably true that there are few people who are familiar with general, put it, swaps, derivatives and written Alaska Native languages but not written English. But she says the discus- other complex fi nancial instruments are sion should be broader since vast cultural differences mean an Alaska Native still typically understood only by the people might not understand the voting process even with knowledge of written English. who sell them. It’s another searing lesson A handful of conservative states have challenged the Voting Rights Act this of the risks of governing in a globalized year, and there’s widespread speculation that a lawsuit by Shelby County, Ala., world, with state and local leaders forced will reach the Supreme Court soon. The county is arguing that the criteria used to navigate through seas they can’t control to determine which jurisdictions fall under the law are outdated. That case could and sometimes can’t even see. G have widespread implications for Alaska Find out what the

and others if it results in a new interpreta- APIMAGES.COM feds are up to at Email [email protected] governing.com/fedwatch tion of parts of the law.

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By David Levine

A Race Against the Clock Thirty-two states are scrambling to set up health insurance exchanges in time.

ick … tick … tick … the deadline is nigh. With the to take over. “I was particularly gratifi ed to hear [Acting Direc- Supreme Court’s decision to uphold most of the Aff ord- tor of the HHS Center for Consumer Information and Insurance able Care Act, states that delayed or outright refused Oversight] Mike Hash say that the federal exchange is moving T to set up health insurance exchanges (HIX), one of the full speed ahead and working on compatibility issues with states,” cornerstones of the act, are now compelled to do so. And they Jost says. “They realize states are still holding back, but want to must do so by Jan. 1, 2014. That’s a very short runway on which encourage them to be prepared to join their exchange if needed.” to land a very large plane. Some states are holding back in part because they hope a Mitt Only 16 states and Washington, D.C., have passed legislation Romney presidency and a Republican Congress would scuttle or issued an executive order establishing a health insurance the ACA. Short of that, these states most likely will announce on exchange as of July 2012, according to The Commonwealth Fund. Nov. 16 that they plan to partner with the feds. After that, “The That leaves 34 states scrambling. And the next important dead- smartest thing is to set up a state HIX and take control,” says Jost. line isn’t in 2014. It’s Nov. 16 of this year, when those states have Collins agrees. “We may see more states using the to declare to the U.S. Department of Health and Human Services federal exchange at the outset, and then creating (HHS), in writing, what they plan to do. their own later on,” she says. There is a signifi - What can they do? The Alliance for Health Reform tried to cant amount of federal money still available help answer that question in July, when it held a seminar bluntly to the states to help create their titled, “Health Insurance Exchanges: Can States and the Federal own exchange. “The grants are Government Meet the Deadline?” The speakers included repre- available through the end of 2014,

Some states are holding back in part because “ they hope a Romney win could scuttle the ACA.

sentatives from HHS, the National Governors Association and and [can be used] beyond the National Association of Insurance Commissioners. They 2014,” she says. agreed that the short answer to the titular question is, yes, they The ACA allows consid- will meet the deadline—because the law says they have to. The erable design creativity for longer answer is more complicated, of course. state exchanges, which Event speakers Sara Collins, a vice president of The Com- Collins says furthers the monwealth Fund, and Timothy S. Jost, a professor at the argument that even the Washington and Lee University School of Law, both say that most obstinate states the remaining states have a couple options left. They can try to would be wise to bring get their own exchange up in time. They can continue to balk, an exchange under their in which case their citizens will have to purchase insurance control. But whether a through the federal exchange. Or they can strike a short-term state chooses to do so or partnership with the feds and, in eff ect, buy themselves some not, it won’t be left hung more time. out to dry. “The important The third option may be the best, says Jost. “Everyone [at the thing from the consumer’s seminar] agreed that state insurance commissioners know their perspective,” Collins says, markets better than the federal government, and that those com- “is that each state will have an missioners should be in charge of those markets, which now insurance exchange in 2014.” include an exchange. The problem is that states who have been That’s the law, after all. G doing nothing will not get there in time.” But, he adds, one HHS

SHUTTERSTOCK.COM representative at the event made it clear that the feds are ready Email [email protected]

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 Other OK to go Politics+Policy | GREEN GOVERNMENT

By Elizabeth Daigneau

Trading Water Can credit-exchange programs clean up lakes and streams?

uddenly, lots of people are talking about “water qual- Oregonian. “With this, the two biggest forces in the biosphere can ity trading.” It’s not a new concept—cities, counties and now do business together, rather than just fi ght.” states have utilized water quality trading programs on So what exactly is water quality trading? It’s similar to carbon S and off for the past 40 years as a means of restoring trading programs, and it involves the voluntary exchange of pol- the health of rivers, streams, lakes and oceans. But the concept lution reduction credits from sources with low costs of pollution is getting new attention. President Obama has been touting the control to those with high costs of pollution control. In Medford, idea, including during a speech on conservation in March. And in the city paid farmers to plant trees in strategic spots along the August, three states launched the nation’s fi rst multistate water river. Offi cials monitored the ecological impact of the restoration quality trading program. to ensure it was working. Why now? For one thing, this year’s drought—the worst in In the Midwest, the Ohio River Basin Water Quality Trading more than half a century, according to the National Oceanic Program is striking a similar deal with farmers and industrial and Atmospheric Administration—has shone a spotlight on the facilities. Starting in 2015, at least three power plants and 30 farms health of America’s waterways, many of which are in seriously in Indiana, Kentucky and Ohio will implement best practices and poor condition. Of the 3.6 million miles of streams and rivers in then trade credits in an eff ort to eliminate annual run-off of up to this country, more than a third are designated as impaired under 45,000 pounds of nitrogen and 15,000 pounds of phosphorus into the Clean Water Act. the river. “Trading provides point sources with a cost-eff ective On top of that, advocates say that water quality trading has option for meeting nutrient reduction targets and has the added dual benefi ts of economic savings and environmental improve- benefi ts of improving water quality … and providing fi nancial sup- ments. That makes the program attractive to governments looking port for farmers and local counties,” Jessica Fox, senior scientist for healthy-living solutions in an era of tight budgets. In Obama’s for EPRI’s Water and Ecosystems Program, told an audience at March speech, he told the story of Medford, Ore., which had the agreement’s signing ceremony. been returning its treated wastewater to the Rogue River. But In fact, the commission overseeing the restoration of the the wastewater was too warm and was threatening the river’s Chesapeake Bay is considering a similar multistate compact. RTI native species. Medford faced two options: build a $15 million International, an economic consulting fi rm from North Carolina, cooling tower or spend $8 million to plant trees along the river has found that savings could range from 20 to 80 percent, depend- and cool it naturally. Medford chose the latter. Today, the city is ing on how trading is structured. That could be welcome news for in compliance with the Clean Water Act, and it has saved millions state offi cials in Delaware, Maryland, Pennsylvania and Virginia,

of dollars. “The water quality trading model creates for the fi rst who are grappling with how to pay for a clean-up plan imposed SHUTTERSTOCK.COM time a lingua franca between the economy and the environment,” by the Environmental Protection Agency. G wrote Joe Whitworth, president of the Freshwater Trust, which oversees the Medford project, in an August op-ed in the Portland Email [email protected]

20 GOVERNING | October 2012

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2013 Escape coming spring 2012.

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go Politics+Policy | ECONOMIC ENGINES

By Alex Marshall

Economic Surprises What is universally public today—police, water, roads, libraries—was once very private.

have been observing, studying and writ- by government, which means their con- police, schools and more. Changing these ing about cities for about 25 years— struction is a political decision. Along the services from private to public did not proof I’m getting old, but also that way to this conclusion, various lessons come easy. II’ve had enough time to pick up a few have emerged. Take public education. Even if one insights on the subject. The primary one is that nothing is favors vouchers or is a critic of teacher To me, the journey has been about easy. Things we utterly take for granted unions, there is virtually unanimous understanding how places and people today—things that the left, right and cen- support in this country for the idea that work, to try to see the fundamental nature ter agree on—were only achieved through children should be educated at public of things. This resulted in my fi rst book, long hard political battles, always lasting expense. But it was not always that way. How Cities Work, and it has led to my decades, sometimes for more than a cen- The fi rst common schooling laws were newest book, The Surprising Design of tury. I’m talking about really basic stuff , proposed during and after the American Market Economies. like public water and sewers, policing, Revolution in the late 18th century. But it Although the title would indicate the public education, public roads and public wasn’t until the early 20th century that book is about economics—and it is—it’s libraries, to mention just a few. every state in the union had laws requir- also about cities, government and politics, You see the common word here: ing all children to go to school, and that because by my reckoning those things are “public.” Before the 19th century, there such schools be paid for by public dollars. central to economics. My thesis is that were many private sellers of water, but In between were decades of argu- markets in an economic sense are built few public providers. The same goes for ments, state by state, over who should pay for what. They were remarkably similar in tone and content to today’s arguments about health care, which, one might observe, have been going on for at least a half century. As with schools, will we make the leap from privately paid health care to publicly avail- able to all? I don’t know. Ask me in a half century. Or take policing. New York City was one of the fi rst to have a uniformed police force, with men wearing badges that identifi ed them as police. Their mission was to catch criminals and to keep the peace. Modeled on London’s police force, which was set up in the 1820s, it was controversial. The idea of uni- formed men under a military-style command walking among citizens was seen, perhaps rightly so, as a threat to the New York was one of the fi rst cities in America to provide police new democracy. protection as a public service. Before this time, there had only been private security guards, and a small pub- lic force of night watchmen. New York set up a police force several times, only

to disband them. It wasn’t until 1857 that OF CONGRESS/BAIN NEWS SERVICE LIBRARY

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By Tod Newcombe

the city established the present force, and at fi rst they wore no uniforms and City Building from the Bottom Up carried no weapons, only badges. After Are governments ready to embrace grassroots urbanists and the turmoil of the Civil War, other cities their ideas? followed New York’s lead. Similar political battles were fought Last July, I was visiting my mother, who lives in Oakland, Calif., when I began spot- over public water systems. Philadelphia ting small wooden blocks attached to the base of telephone poles. Each block had a led the way, followed soon by New York, miniature painting of a gnome on it. They were everywhere in her neighborhood. I which went deeply into debt to pay asked my mother about them and she said they had just started showing up one day. for the Croton Aqueduct system that Nobody seemed to know who had put them there or why. opened in 1842. A half century of leg- Graffi ti? Not really. Guerrilla art? Perhaps. Small public images of gnomes at the islative battles preceded it, dating back base of utility poles may seem whimsical, but they are a subset of a much larger move- to the fi rst proposal for a public water ment known as “DIY urbanism.” In recent years, as system in the 1790s. the economy has taken a big bite out of arts budgets Libraries merit a book unto them- and city planning eff orts, do-it-yourselfers have selves, no pun intended. Rich folks were increasingly stepped into the picture, setting up tem- proud of their private libraries. (Congress porary parks, installing public furniture, painting bike set up the Library of Congress by buy- lanes and displaying art in empty buildings or, as in ing Thomas Jeff erson’s private library.) Oakland, in unusual locations. In fact, private lending libraries, where Helping these projects take hold and gain popular- one paid a fee or a subscription, were the ity is the Internet, social media and a groundswell of norm. Public libraries were few and far public interest in urbanism. What seemed like a fad between. Industrialist Andrew Carnegie grown out of fi scal distress has become a distinct, pos- moved the ball along with his widespread sibly game-changing trend. “Our current recession is donations. Today, we accept that public inspiring its own strategies and tactics: It’s increas- libraries are a good thing: a place where ingly a catch-all for a host of urban interventions,” books, paid for by the public, are avail- writes Mimi Zeiger, editor and publisher of Loud able to all, for free. Sounds like socialism, Paper, a blog on architecture and culture. doesn’t it? It’s an example of how once Unlike government’s top-down approach to something is accepted, the labels don’t planning, DIY urbanism (also called “tactical urban- matter anymore. ism”) is usually bottom-up with an emphasis on I’ve talked mostly about the physical creative uses for public spaces. It also tends to be aspects of our life. There are also plenty inexpensive. Converting parking spaces into miniature parks doesn’t cost much. The of stories to tell about the way we have set same goes for urban farms in abandoned lots, Dumpster pools or mini golf courses up less visible networks, such as corpo- built from scratch. There’s even a trend toward building little libraries in cities.

rations, which have a fascinating history. When the Occupy Movement moved into New York City’s Zuccotti Park in 2011, COLBURN DAVID Did you know that most cities are state- one of the temporary structures the protesters set up was a library. Since then, little chartered corporations, just like Apple or libraries have popped up in phone booths, mailboxes, public parks and train stations, IBM? As states have increased the power according to Shannon Mattern, a faculty member in the School of Media Studies at of private corporations, they have dimin- the New School in New York City. ished the power of public corporations The enthusiasm for DIY urbanism has led to its inevitable mainstreaming. The like cities, which used to have a greater idea of parklets [see “On-Street Parking” in Governing, June 2012] has gained traction degree of autonomy and independence. and has been embraced by a number of city governments. There’s the grand example Whether it’s a city, a school, a library or of New York City’s Department of Transportation turning a portion of Times Square today’s “free” market, all are designed by into a pedestrian park. And San Francisco, home to some of the most vibrant forms of us, through government. G DIY urbanism, has launched a website that guides residents through all the bureau- cratic processes necessary to create bike corrals, guerrilla gardens, art installations, Email [email protected] sidewalk fi xtures, permits for car-free events and, of course, parklets. Will DIY urbanism spread beyond pop-up parks, pools and libraries, to the heart The Surprising Design of Market Econo- of how cities make decisions on where and how to build bridges, roads and schools? mies, recently published by The University Stay tuned. G of Texas Press, is available at private book- stores and public libraries. Email [email protected]

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go ALL POLITICS IS NATIONAL Can you ever really separate federal issues from state elections?

Every time he runs for offi ce, Iowa Senate candidate Matt Reisetter turns up at the Cedar Falls home of Betty Wisby.

BY ALAN GREENBLATT PHOTOGRAPHS BY CLIFF JETTE

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go RANDY FORMANEK is what you might call a persuad- able voter. He’s decided to stick with President Obama this year despite not being “100 percent about this Obamacare.” He also believes the president has not done enough to secure the bor- der. Still, Obama deserves a second term, in his opinion, if only because Republicans have been unwilling to work with him. “Obama’s my man,” he says. But Formanek also says he’s going to vote for a Republican in his state Senate district in Iowa. You see, Jane Jech, the Repub- lican seeking the seat, has come to his home in the small town of Chelsea and asked him personally for his support, just after visiting with his dad right around the corner. “She seems like a nice lady,” Formanek says, standing on his porch in Bud Light pajama pants. “I don’t know who she’s run- ning against. Why should I vote for someone I don’t know when I know this nice lady?” It’s people like Formanek that keep people like Jech going door to door nearly every night of the week. Jech lost a state House race

The way people normally vote these days is by party. The electorate is highly polarized, particularly in a presi- dential year. This dynamic may be especially important in a state like Iowa, which is considered a swing state in the presidential contest and as a result has already seen tens of millions of dollars worth of TV ads attacking Obama and Republican candidate Mitt Romney. Jech knows that most voters will be paying far less attention to her state In rural counties, Senate contest. “The presidential will defi nitely have an it’s easiest to fi nd eff ect,” she says. But, she adds, “When you go out and voters gathered at meet people individually, that’s what makes a diff erence.” events such as hog That’s become a defi ning tension in state legislative roasts, Jech says. contests. Most legislators will tell you that they run inde- pendent campaigns, getting to know their constituents as neighbors by knocking on half the doors in their district. by just 300 votes two years ago. She believes she can win over Long before running for the legislature, they have established enough new supporters this time to take a Senate seat—in part themselves as leaders in their communities, as local elected offi - because redistricting means that a lot of voters, like Formanek, cials or activists. They believe they have established their own don’t know the incumbent Democrat, Steve Sodders. Turning up identities and are able to make their own appeals to voters. “Iowa at people’s doors—and small-town parades and ice cream socials politics is a contact sport,” says Shelley Parbs, a Democratic can- and hog roasts—gives voters a sense that you’ll listen to them once didate running for Senate in a three-county district between Des in offi ce, Jech says. “There is no doubt that it makes a diff erence. Moines and Iowa City. “People want to see their candidates.” If they go into the booth and they don’t know you, they’ll vote the Still, legislative candidates are also swimming either with way they normally do.” or against strong tides. When legislative candidates make their

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rounds, many fi nd themselves asked less often about their stances on issues aff ecting the state than about their partisan identifi ca- tion. Often, the issues at the top of voters’ minds are federal matters they can do little to nothing about. “It is diffi cult for a local candi- date to explain that what goes on in Washington is not what goes on in Iowa,” says Democratic state Sen. Jeff Danielson. For all their protestations about politics being local and know- ing their own districts, every couple of years legislators of one party or the other seem to get tossed out en masse. “We need to win the top of the ticket to win the bottom of the ticket,” says Matt McCoy, another Iowa Democratic senator. “We’re totally tied together. That’s why we’re embracing the president.”

he stakes in Iowa are high. Republicans took con- trol of the state House two years ago and also regained the governorship. But they fell a couple of seats short in the Senate—half the seats in the chamber come up for election every two years—so TGOP leaders are pinning their hopes on candidates like Jech, who are going door to door. Similarly, Matt Gronstal, the leader of the Iowa Senate Dem- ocrats and himself a top target for Republicans this November, believes that despite the money that’s coming into the most con- tested races, it’s still all about standing on people’s front porches

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and talking directly to them. He dismisses the idea that his race Romney—including his political home state of Mas- and those of his colleagues are at the mercy of the national con- sachusetts. On the other hand, there are also lots of test, noting that Democrats lost chambers in Iowa in each of the places where Democrats are trying to put as much years Bill Clinton was elected president and gained Senate seats in distance as they can between themselves and Obama. 2004 when George W. Bush was re-elected. “It’s not really about Arkansas has the last legislature in the country that whether we’re going to ride anybody’s coattails,” he says. “I’ve Republicans have never won, but the GOP likes its lived here all my life; I’ve raised my family here. My constituents chances this year. Obama, who lost the state by 19 see me going through the grocery store with coupons in my hand points in 2008, may do even worse this time around. just like they do.” “I believe President Obama has hurt the Democrats At the same time, Gronstal concedes that the presidential race in Arkansas signifi cantly,” says Tim Griffi n, a GOP will have a big eff ect, if only in terms of mechanics. It’s the state congressman from the state. “What President Obama party, in coordination with the national campaign, that runs the did was strip away the idea that there was somehow eff ort to get people to vote by absentee ballot, which can account a diff erence between national Democrats that tended for as much as 40 percent of the total turnout in a state Senate to be portrayed as liberal and Arkansas Democrats race. Much of the political engagement in Iowa is an outgrowth who were somehow diff erent.” from the presidential caucuses, which, as Gronstal notes, brings Lots of Democratic state candidates are fi nding new crops of volunteers to the parties every four years. One rea- themselves under attack this year as Obama enablers. son that Democrats believe that Shelley Parbs has a chance to Ed Martin, the Republican candidate for attorney unseat incumbent Republican Sen. Tim Kapucian is that, due to general in Missouri, derides incumbent Democrat redistricting, he now represents Grinnell College. “The Grinnell Chris Koster as “Obama’s lawyer.” In fact, launching College Democrats are fi red up, and I believe they’ll work hard Obama-fueled attacks has been a tactic used this year for Obama,” Parbs says, “and that will help local Democrats too.” even against Republicans—most notably in Kansas, Having supported Obama in the fi rst-in-the-nation where during the primary season conservatives routed Democratic caucuses four years ago, Iowa voters may have moderate Republicans who controlled the Senate by especially strong feelings about him. (Republicans believe linking them to Obama and his health-care plan. “This those will be feelings of buyer’s remorse.) But Iowa is not is a huge, nationalized-type movement,” says Leticia Van de Putte, a Democratic state senator in Texas. “I am sad to see particularly conser- vative legislators defeated by a strong ‘throw the bums out’ attitude that is really directed toward Washington, D.C.” But it happens all the time. When vot- ers think about politics, they think about the politicians they see on television, says William Schneider, a public policy profes- sor at George Mason University. As a result, “very, very few people know who their state legislator is,” he says. “When most people think about the way things are going, when “Most voters are they think about the government, they think not poring over about who the president is.” data about who That makes the presidency “the key- can control the stone to American politics,” Schneider says—an Iowa Senate,” eff ect that extends even to higher-profi le races like says Democrat the governorship. Most states moved their guberna- Jeff Danielson. torial elections away from the presidential campaign year in order to isolate them from the national tide. “There is simply no question that the primary moti- at all unique in having its politics shaped by the presidential vation was to reduce presidential coattails on the election for race this year. In other swing states where chambers are in governor and to increase the voters’ attention on state rather play, such as Colorado and Nevada, the presidential contest than national issues,” says Larry Sabato, who directs the Uni- is going to have a strong gravitational pull that will aff ect versity of Virginia Center for Politics. the outcomes of many local races. In some cases, legislative In many ways, that move has backfi red. In midterm elections, candidates are having to run either toward or far away from without the ability to vote for or against the president, many vot- their party’s presidential nominees. There are places where ers take their feelings out on his party in state contests. There’s Republicans are doing their best to distance themselves from no doubt that a candidate for governor can establish his or her

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go Many candidates hand It’s no trick in Iowa to fi nd people who out pens and fans that support Obama, or even have a hard time say- show off their names, ing the words “President Romney,” especially but Kapucian believes along the Interstate 80 corridor connecting bubble gum makes a Des Moines and Iowa City. Conversely, there good impression. are plenty of people who can’t wait to get rid of the incumbent. Cedar Falls resident Lynn Leitz hasn’t voted since the days of Ronald Reagan, but says he’s casting a vote this fall to turn out Obama, who “has done nothing but cripple this country.” It’s hard to fi nd people anywhere near as worked up about state Senate contests, despite the fact that the entire tax and educa- tion agenda of Iowa Republicans hangs in the balance. “I honestly don’t know who’s running to tell you the truth,” says Roger Sturtz, sitting with his wife Jean in front of their house in Urbana, just moments after Parbs and Kapu- cian passed by in the Urbanarama parade. Matt Reisetter knows the presidential race is going to have an eff ect on his fortunes. “You always get drowned out down ticket,” he says. That’s precisely why he’s pounding the pave- ment, trying to meet as many voters as he can in his state Senate race in Blackhawk County. Rei- setter, who is running against Jeff Danielson, believes that soliciting votes door to door can make a diff erence of several percentage points either way, which would be more than enough to decide a race in a district like his. Reisetter, a Republican, lost a state House race back in 2006, which was a strongly Democratic year, by 106 votes. Danielson, by contrast, won re-elec- tion in 2008 by just 22 votes “with the Obama landslide at his back,” as Reisetter puts it. Although the presidential election will have an impact, Reisetter understands that he’s operating on a diff erent channel. While voters may be doing their best to tune out the noise on TV from all the advertising, he’s off ering a personal touch, coming to their own identity and run against the general partisan trend in voting homes and asking for just a minute of their attention. Not many in any given year. “[But] it is easier to link president and gover- people go door to door selling products anymore, but Reisetter is nor—and Congress and state legislatures,” Sabato says, “because spending the bulk of daylight hours doing just that. The old adage almost all Democrats are liberal and almost all Republicans are that people in sales are really selling themselves is never more true conservative, at least on critical social, tax and spending issues.” than for candidates for offi ce. “When people see me coming to their door, they think, ‘What’s this crap?’” Reisetter says. “That’s owa was only one of three states to switch its vote from why I want to leave them in a better mood than when I came.” 2000 to 2004, before Obama won it handily in 2008. This To do that, Reisetter roams an older neighborhood in Cedar Falls year, it’s once again a tossup. “Iowa today is all about the with an iPad in hand, doing his best not just to learn the names of the presidential race, so legislators do have trouble punch- people he’s about to meet but trying to remember something about ing through some of that,” says David Yepsen, who runs each family. Reisetter is 36 and can rattle off connections with many Ia public policy institute in Illinois, but was a longtime political local people, such as having gone to high school with their chil- reporter with The Des Moines Register. “That said, Iowa’s small dren or his brother having been in their class. Still, most people he enough that a legislator can get known by a lot of people.” encounters on a Saturday afternoon are more concerned with fi nd-

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ing out whether he’s a Republican or a Democrat than his stance on The earnest nature of his appeal seems to work for Wisby. any particular issue. Danielson, the Democratic incumbent, believes She also doesn’t mind the time he spends listening to her talk that Reisetter will be vulnerable not because of his partisan affi liation about her long-ago career as a photographer. Still, she tells him, or any association with Romney, but because of his years working for “I don’t vote Republican.” Bob Vander Plaats, a prominent but controversial social conservative That rankles Reisetter, if only because Wisby has already in Iowa. “You’re Matt and I’m voting for your opponent,” one man described herself to him as an independent. Walking away from tells Reisetter by way of greeting him when he comes to his door. her house, he decides he’s going to send her a postcard chiding

Reisetter hopes the personal impression he makes on Wisby will be enough to turn her vote.

For his part, Reisetter bucks the common practice of turning up her for not keeping an open mind. With someone like that, he only at homes of people likely to support a Republican or consid- reasons, he has nothing to lose. ered by party databases to be persuadable. Reisetter wants to talk to But he gets to make his case in person about an hour later, everybody. His goal is to win people over one by one and by so doing when he runs into Wisby out taking her daily walk with a neigh- run ahead of his ticket. “The unwritten theme of our campaign is ‘no bor. “How can you call yourself an independent, but you won’t stone unturned,’” Reisetter says. “You have to have the resources to vote for a Republican?” Reisetter asks her. run ads in a competitive race, but door-knocking is where it’s at.” “I absolutely adore Obama,” Wisby tells him. He’s not about to give up on Betty Wisby. Wisby, who is 55 “I’m not running against Obama,” Reisetter reminds her. He’s years his senior, says she remembers him showing up at her door already spent some time reassuring other voters that if they want four years ago as a House candidate and says she was impressed to vote for both Obama and him, he has no problem with that. by him. He off ers her his standard pitch: Always leave the camp- In Wisby’s case, that just might work. “You’re a nice guy, I site in better shape than you found it. It’s a motto he learned in might fl ip my vote,” she says. the Boy Scouts, and the political lesson he draws from it is that for Reisetter walks away laughing. “I might’ve gotten her the next generation’s sake, Iowa needs to spend tax dollars more vote,” he says. But just to be safe, he’s going to follow up with wisely and maybe spend less of them. “If you can make a personal a postcard anyway. G connection, that’s where most people are,” he says later. “You have these policy wonks coming to the door, that turns people off .” Email [email protected]

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States are searching for affordable ways to allow seniors in need of long-

term care to After three years in a nursing home, remain in Delores Powers moved in with her their homes. son and daughter-in- , Mom law. Her caregiver, By Dylan Scott Angie, helps her around the house PhPhoto ogo raaphs byby Krirists inina Krugu fi ve days a week.

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or three years, Delores Powers languished icaid pays for almost all long-term care services for low-income in a nursing home. Already struggling with patients. Medicare, the federal insurance program for individ- diabetes and early dementia, the 86-year- uals 65 and older, covers more acute care, such as emergency old Decherd, Tenn., resident landed in the room visits and most prescriptions. Low-income seniors, such hospital in 2008 after mismanaging the as Delores, are known as “dual eligibles.” They qualify for both dozen or soF medications she takes every day. Doctors told Delo- programs and are constantly bouncing back and forth between res’ son David and his wife Dale that unless somebody could stay them—Medicare for an operation, Medicaid for long-term recov- with her all day, she needed to live in a nursing home. Both David ery. Sometimes, Medicaid pays part of a patient’s out-of-pocket and Dale work full time, so staying home was not an option. Delo- costs for Medicare premiums. res was moved to a nursing home, the default option for someone It’s a maze. in her situation. As a result, reconciling the two programs can be a night- “She seemed to be going downhill, picking up speed,” says Dale mare. Many primary care doctors who work under Medicare of how her mother-in-law handled the move. She recalls the con- are not aware of their patients’ options for long-term home- or versations she and her husband had about what they could do. They talked about Dale quitting her job to stay home with Delores. “But we really couldn’t aff ord that.” Then, a few years ago, Tennessee law- makers approved a new program called CHOICES. Implemented in 2010, the pro- gram was conceived as a way to help seniors on Medicaid receive home- and commu- nity-based care instead of living in a nursing home. After an assessment of Delores’ con- dition and fi nances, state offi cials approved her for the program. This June, Delores came home. A care- giver named Angie, whose salary is paid by the state, comes from 7 to 5 every weekday. Angie gives her a bath, doles out her medi- cations, checks her blood sugar, prepares lunch and takes Delores on walks outside. “You could say she does everything,” Dale says. A physical therapist works with Delores at the house twice a week, and a registered nurse stops by once a week to check her vitals. Under CHOICES, Today, Delores’ life is getting back to normal. It’s the little community-based care under Med- Angie’s help allows things: a shopping trip to Walmart, her fi rst hair salon appoint- icaid. Everyone involved in health Delores to remain ment in years, sitting on the porch in her small town of 2,200, policy has heard horror stories as independent as waving as people walk by. In the afternoons, Angie hangs up a of patients being stuck in a nurs- she can. One recent curtain in Delores’ bedroom so she can watch movies late into ing home while the two programs afternoon, Angie took the night, just as she likes. bickered over which would pay for Delores to get her hair The concept of managed care—the model that allows people diff erent services. done for the fi rst time like Delores to remain at home—has been around in health pol- It’s a piecemeal system and one since she came home. icy circles for years. But it’s now gaining particular attention for that’s unacceptable, says Matt Salo, seniors. The idea is that one company or organization oversees executive director of the National Association of Medicaid all of a patient’s health-care needs. The company manages long- Directors. Speaking at a Washington, D.C., conference this July, term aides and caseworker visits. If a patient ever needs more Salo called it “a national shame that we’re subjecting the poor- acute health care, such as a trip to her physician or specialist, est and sickest among us to this fragmented care.” the organization contracts with doctors, “managing” her care in Dual eligibles can also be a major expense for states. They a more holistic way than if she were left to navigate the system make up 15 percent of the 62 million Medicaid enrollees nation- on her own. wide, but they account for nearly 40 percent of the program’s Coordinating every aspect of one patient’s health care is costs. And roughly 70 percent of those costs are tied up in long- complicated enough. But when that care is paid for by the term care. Better management of long-term care for dual eligibles government, coordination can become next to impossible. Med- means a lower burden on state resources.

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go STAY AT HOME, MOM generatıons That’s why a program such as CHOICES is so attractive to policymakers. A decade- long study published in Health Aff airs in 2009 found that states with established home- and community-based care programs had cut their overall Medicaid long-term care spending by nearly 8 percent. States that instead relied on institutions like nursing homes saw their long-term costs increase by almost 9 percent. According to a 2011 report from the Bowles-Simpson presidential commission on fi scal reform, placing dual eligibles in Medicaid managed-care programs like CHOICES could save up to $12 bil- lion by 2020. “As the population ages and more and more people need long- term care, if nursing homes are our default option, we’re not going to be able to aff ord that,” says Patti Killingsworth, chief of long-term services and supports at Tennessee’s Medicaid offi ce, which oversees CHOICES. But improved coordination is not just about keeping costs down. It could also mean higher quality of care and a better patient experience. The federal Centers for Medicare & Medicaid Services (CMS) estimated in 2005 that 45 percent of hospitaliza- tions for dual eligibles could have been avoided through better coordination between the two programs. Better coordination means greater independence for patients.

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More than 80 percent of Americans over 50 say they want CHOICES Act passed the state General Assembly in May 2008 to remain in their home as they age, according to AARP. That without a single “no” vote. A federal Medicaid waiver, which was includes Delores. “We didn’t want her to leave before her time, required to modify the state’s program, was granted in July 2009. and we felt like it was getting to that point. We had to do some- “Everybody understood the goals we were trying to achieve,” says thing. This is the best thing that ever happened,” Dale says. Tennessee’s Killingsworth, “and believed, based on everything we “When they can come home, it changes everything. She’s happy, had studied and reviewed and analyzed, that this was the thing she’s going places, she’s doing things.” that was going to get us there.” Of course Tennessee is not alone in searching for new ennessee may seem an unlikely place to look for approaches for its long-term care population. Oregon’s coor- a national model of health-care reform. Before dinated care organizations served as a model for Tennessee CHOICES passed in 2009, Tennessee had a policymakers when they were designing CHOICES. Vermont Tpoor record on long-term care. According to had already implemented a tiered system similar to CHOICES, an AARP analysis, it had the nation’s lowest percentage of low- in which patients who didn’t require nursing-home care could income seniors who received home- or community-based care. opt to stay at home. Arizona and Texas have had managed long- In 1999, less than 1 percent of Tennessee seniors on Medicaid term care systems in place for more than 10 years. At the federal received that kind of care. In 2009, as planning for CHOICES was level, the Aff ordable Care Act created the Medicare-Medicaid under way, the share was still below 10 percent. “We really had Coordination Offi ce within CMS. Twenty-six states—including nowhere to go but up,” says state Sen. Lowe Finney, who formed Tennessee—have told the new offi ce they will develop dual- a study committee after taking offi ce in 2006 to explore options eligibles demonstration projects over the next few years to for improving care for those individuals. improve coordination. Tennessee’s Medicaid program, TennCare, has one of the most But Tennessee did something those other states hadn’t. It inte- expansive managed-care systems in the country. Health-care grated CHOICES into its overall managed-care program, rather providers are paid on a per-patient basis, rather than per proce- than creating a separate entity for long-term care recipients. The dure, as was the case in more traditional fee-for-service models. idea was that it would be more effi cient if that population could TennCare has been in place since 1994, but seniors hadn’t been draw on the resources of the larger program. Since its implemen- integrated into the managed-care system. Instead, the default tation, Killingsworth says her offi ce has fi elded calls from more option for Medicaid-eligible seniors in need of long-term care than 20 states about CHOICES. Other states’ offi cials involved was living in a nursing home. with developing long-term care strategies have visited to see the In his 2008 State of the State address, then-Gov. Phil Brede- program at work fi rsthand, as have offi cials from CMS. sen made the CHOICES program the centerpiece of his plan for Since Tennessee’s program took eff ect, the number of long- the state. “We need to make it easier to stay at home with more term care recipients who stayed in their homes or their commu- home- and community-based services. We need more residen- nity doubled from 17 percent in 2010 to 34 percent in 2012. The tial alternatives to nursing homes,” Bredesen said in his speech. “If you want to stay in your home, if it makes sense to do so, this is the year we’re going to start making it easier.” With that, planning for CHOICES accelerated. Finney’s study commit- tee had found that 90 cents of every state dollar spent on long-term care went to nursing-home residency, the most expensive kind of care. So policymakers set dual goals: fi nding a more cost-eff ective solution and giving seniors a choice about what kind of care they would receive. Unsurprisingly, nursing homes were concerned that they would lose sub- stantial amounts of revenue if more patients received at-home care. Law- makers included provisions in the bill allowing nursing homes to pro- vide additional services, such as adult day care, to make up for the reduc- tions in permanent residents. The

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go STAY AT HOME, MOM generatıons state is seeing a fi nancial benefi t as well: Its Medicaid program’s handle those needs. And there’s uncertainty costs are projected to increase by half the national average in 2013. about proper oversight and how to measure Other states are now developing managed-care systems mod- and maintain quality when health-care services are increas- eled on Tennessee’s. When Kansas offi cials decided in 2010 to ingly being delivered in individual patients’ homes. Some implement a managed-care program, including for long-term ser- patient advocates have already warned against rushing into vices, they spoke to Killingsworth and her offi ce. “They’ve been Medicare-Medicaid coordination. “Part of our concern is that there, done that, and they’ve been successful,” says Susan Mosier, there is a lot of vagueness, a lot of unknowns,” Patricia Nemore, director of the Kansas Medicaid offi ce, which is set to implement senior policy attorney at the Center for Medicare Advocacy, KanCare in January. told Governing’s Health newsletter in July. “You can’t talk about Similarly, New Jersey offi cials determined that they should duals uniformly. You can’t even talk about a state uniformly: adopt a managed long-term care system. (Like Tennessee prior The infrastructure is diff erent in city versus rural, one part of to CHOICES, New Jersey has ranked near the bottom in terms of a state versus another part.” home- and community-care services.) Before fi ling a waiver application with CMS last September, New Jersey offi - cials sent potential health-care pro- viders on site visits to meet with their counterparts in Tennessee. Valerie Harr, director of the New Jer- sey Medicaid offi ce, says she regularly exchanges emails with Killingsworth about how Tennessee’s experience could be translated to her state. “They’re a model. You have to look to states that have been in the same situation,” Harr says. “They’ve already asked all the questions that we’re trying to answer.”

anaged long-term care is the first step toward a coor- Mdinated approach on dual eligibles. Of the 26 states set to initiate dual-eligibles demonstra- tion projects, 15 say they plan to move forward next year; the other 11 say they will to start theirs in 2014. Tennes- see was one of 15 states to receive a $1 Since 2010, CHOICES million federal grant to plan its demonstration. The state plans But federal offi cials say the best has doubled the to integrate Medicare benefi ts into its managed-care system. option available is to let states exper- number of seniors like Patients would have a single insurance card and a single care iment with diff erent approaches. Delores who receive management offi ce to oversee their needs. Savings are expected “There’s not one model that would home-based long- for both Medicare and Medicaid within three years if the dem- work in every case,” says Alper Ozi- term care. A regular onstration is successful. nal, a CMS spokesman. “We need to exercise routine, That’s just one of the myriad ways that states are proposing to be fl exible enough to recognize that overseen by Angie, improve coordination for dual eligibles. Generally, the plans fall states have diff erent strengths and ensures Delores is as into one of two categories: blended rate, which sets a single rate delivery systems to build around.” healthy as possible. for health-care providers to off er both Medicare and Medicaid Now is the time to act, say advocates services; and state coordination, in which the state takes respon- of dual-eligible reform. With a rapidly aging population, they say, sibility for integrating care and could qualify for fi nancial bonuses states must be as proactive as possible. “You have two options,” says if certain savings targets are met. Killingsworth. “You can either plan now or you can wait till it gets There’s widespread agreement that dual eligibles and managed here. The only way we’re going to be ready is if the planning occurs long-term care off er an important opportunity for policymakers. now and these kind of decisions are made now rather than later.” G But there are challenges, to be sure. Dual eligibles are, almost by defi nition, a high-needs population. There are many questions Email [email protected] about whether state-run managed-care systems are prepared to More stories on aging at governing.com/generations

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By Jonathan Walters

ssisted suicide. Euthanasia. Death panels. Rationed health care. There’s nothing like a well-chosen phrase to infl ame talk about end-of-life care—how the health-care system cares for those who are in the last stages of a terminal illness and how much control patients and their families have over that process. It can Abe an emotional and divisive issue, and for lawmakers, a dangerous business. That’s certainly something President Obama quickly learned when a provision in the Aff ordable Care Act (ACA) that encouraged doctors to engage patients in discussions about end-of-life care quickly deteriorated into a nationwide war of words over whether such one-on-one discussions between patient and physician would result in “death pan- els” determining who should receive care. But with America rapidly aging, the subject of end-of-life care isn’t going to go away. It has the attention of any legislator or government offi cial trying to make sense of health-care budgets in general and Medicare expenditures in particular. That’s because in their last year of life, older adults consume more than a quarter of Medicare’s expenditures, costing more than six times as much as other benefi ciaries. It also has the attention of hospital offi cials. Under the ACA, hospitals will be penalized by Medicare for high readmission rates. That means there will be more focus on avoiding the ping-ponging of terminally ill patients that often takes place between nursing homes and hospitals as people near the end of their lives. Meanwhile, an increasing percentage of Americans say they want more con- trol over how they will be treated should they become terminally ill. Faced with

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go the mechanistic environment of hospital intensive care units, the Hospice and Palliative Care Association of New York State, many older patients say they prefer to die at home, surrounded it has led to a statewide coalition of all the health-care organiza- not by machines but by their family. Others want every option tions that represent institutions like hospitals and nursing homes explored, every high-tech trick tried to prolong their lives, and gotten them to pull in the same direction on end-of-life care even if they are unconscious. counseling. “The way to get real change,” McMahon says, “is to Today, the discussion over end-of-life care is alive and well— get the groups representing the facilities that are required to do but not on a national level. “It’s pretty quiet right now, and has this to buy in.” been since 2009 and the whole death panel debate,” says John But working through health-care professionals and health- Carney, president and CEO of the Center for Practical Bioethics, care facilities to promote end-of-life care counseling is not getting formed in 1984 to parse out complicated ethical issues around a huge amount of traction in other states. More promising is a medicine and medical research, including issues like end-of-life rapidly growing end-of-life care phenomenon known as “physi- care. Rather, the debate and press toward a political solution are cian orders for life-sustaining treatment,” or POLST. currently taking place at the state level. There, policymakers and advocacy groups are managing to defuse the raw emotional he basic idea behind POLST is to give anyone responses that national, partisan-fueled battles elicited when the who is judged to have less than a year to live ACA was being debated. the chance to set out very detailed directions The reason for that is straightforward. Rather than pursu- about what sort of care they want or don’t ing the “death with dignity” approach to end-of-life decisions— want. “It’s basically a DNR on steroids,” says which immediately infl ames the right-to-life lobby—a low-key Carney ofT the Center for Practical Bioethics. But unlike a “do movement has evolved in the states. This movement is focused not resuscitate” order, or an advance directive, POLST forms on giving patients facing tough decisions about end-of-life care are formal physician’s orders worked out in advance with a more say in what medicine and medical procedures they want patient or a patient’s advocate. “We have found POLST to be a or don’t want. very successful way to convey immediately actionable medical If advocates for more rational and patient-centered end-of-life care based on patients’ wishes,” says Dr. Alvin Moss, director of care can avoid the specter of death panels and health-care ration- the Bioethics Program at the West Virginia University School ing, there’s the real possibility of progress. Dr. Susan Tolle, who of Medicine. practices general medicine in Oregon and serves as director of the The other advantage of POLST, at least when done thoroughly, Center for Ethics in Health Care at the Oregon Health & Sciences is that it is instantly accessible to everyone from EMTs in an University (OHSU), says, “When people are using language like ambulance to doctors in an emergency room. That’s the case in ‘death panels,’ there’s more emotion and fear than if you say you Oregon, where the state maintains a rapidly expanding registry of want to honor the wishes of this individual.” more than 100,000 POLSTs available online 24 hours a day, seven days a week. There are currently fi ve states with POLST regis- ne tack that end-of-life care activists are tries, although as electronic medical records systems evolve and taking is to push state legislation requir- grow, POLSTs are likely to become part of any patient’s instantly ing health-care professionals to counsel accessible online record. terminally ill patients and their families Given the registry and general knowledge of POLSTs in Ore- on medical choices and palliative care, gon (the state implemented its POLST program way back in 1995), which is Oan area of health care that focuses on relieving and there’s been a signifi cant shift in the behavior of both patients preventing the suff ering of patients. Such initiatives have not and health-care professionals. “There is a huge amount of pub- triggered a negative response with right-to-life interests. But lic empowerment in this,” says Tolle of OHSU, which hosts the that doesn’t mean it has been easy to pass such laws. Oregon POLST registry. “We’ve seen a major transformation from According to the national chapter of Compassion & Choices, ‘We didn’t ask, we just intubated,’ to [medical personnel] asking if which is dedicated to advocating for more open discussion around someone has a POLST form.” alternatives to intensive and intrusive end-of-life interventions, As for the politics of POLST, the death panel insinuation only California and New York have counseling laws on the books. has not materialized. That may be because health profes- In New York, it was the Medical Society of the State of New York sionals involved in the movement learned their lesson during that came out strongly against the Palliative Care Information Act. the ACA fi ght. Now, when a state legislature is considering a Doctors there argued that it inserts the state into what should be POLST bill, there is a concerted eff ort to get all interests to private physician-patient relationships. That argument didn’t get the table at the very start, including right-to-life and disability far in Albany; the law passed in 2010. rights groups. Last year, New York took that approach one step further. The In West Virginia, the key to successfully establishing its Legislature passed the Palliative Care Access Act, which requires POLST program was to send a clear message that POLST wasn’t institutions like hospitals, nursing homes and other long-term about helping or even coercing patients to forgo care. It’s about care facilities to off er end-of-life and palliative care counseling. patient choice, says Moss, who also serves on a national POLST This step is more signifi cant than the Palliative Care Informa- task force. The right-to-life lobby agreed to stay neutral on the bill, tion Act. According to Kathy A. McMahon, president and CEO of he says, because they understood that POLSTs were optional. “If

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National POLST Paradigm Programs

Endorsed Programs Developing Programs No Statewide Programs

Let’s Talk * AS OF SEPTEMBER 2012 About the End Talking about death isn’t easy for anyone. % But when the conversation goes public, it can 23 become so politically charged that it simply It is more important to extend the life deteriorates into a war of words. Since about of seriously ill 25 percent of all Medicare spending is on 71% patients through end-of-life care, the conversation is a vital every medical one. A February 2011 National Journal and It is more important intervention possible. Regence Foundation poll asked which of the to enhance the statements to the right most closely refl ected quality of life for respondents’ beliefs. While talk of death seriously ill patients, panels has put the end-of-life care discussion even if it means a on hold at the national level, states have shorter life. 6% quietly picked up the torch. “Physician orders Don’t know for life-sustaining treatment,” or POLST or refused to programs, are now in 14 states. These answer. initiatives give people the chance to defi ne clearly what kind of treatment they want or don’t want at the end of their lives. POLL, CONDUCTED FEBRUARY 2011 (CHART) JOURNAL POLL, CONDUCTED FEBRUARY NATIONAL FORCE (MAP); REGENCE FOUNDATION/ TASK POLST PARADIGM SOURCES: NATIONAL

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go Dying at Home State by State, a person does want to fi ll one out, they can say they want CPR, they want a feeding tube. They can have all that.” 2005-2009 The notion of patient control and choice and its two-way nature seems to be fundamental to why POLST has not been as Percentage of Total Deaths Reported in Home controversial as other laws related to end-of-life care. District of Columbia 15.2 Working in its favor, says West Virginia state Sen. Ron Stollings, Georgia 15.5 is the simple reality that it’s directly in line with patients’ wishes. South Dakota 17.3 “It’s what my patients want,” says Stollings, a general practice North Dakota 17.7 physician who sees a large percentage of elderly clients. “They Rhode Island 18.3 want high-touch, low-tech. They want meals on wheels and in- Nebraska 18.7 home services. They want to get out to the grocery store if they Iowa 18.8 can. They don’t want CAT scans and MRIs.” Connecticut 19 More than 14 states now have some form of a POLST system Maryland 20.2 New York 20.5 in place, with another 25 states considering programs. Typically, Ohio 22 POLST laws and regulations also include language granting New Hampshire 22.2 caregivers immunity if they follow a POLST form. In register- Kansas 22.6 ing, POLST participants almost uniformly agree that the form Pennsylvania 22.7 be accessible to all health-care providers, which gets around the Massachusetts 22.9 privacy concerns of Health Insurance Portability and Account- Wisconsin 23.3 ability Act regulations. Illinois 23.7 But POLST’s low profi le cuts both ways. While it is off the Indiana 23.9 radar of the political social wars, the lack of awareness of or Hawaii 24.2 information about POLST is considerable, which means in New Jersey 24.4 some states it is nowhere near to living up to its potential. “The Florida 24.6 process is a slow one,” says David Leven with Compassion & Minnesota 24.7 Choices of New York (the state passed a POLST law in 2009). Maine 24.8 “That’s unfortunate because studies show that when there Wyoming 25.2 is a POLST document it’s much more likely that a patient’s North Carolina 25.2 wishes will be honored and they will have less aggressive inter- Tennessee 25.7 ventions, which makes for a higher quality of life. Right now Texas 25.8 there’s a major defi cit in knowledge.” Arkansas 25.9 The steep learning curve aside, the ultimate promise of Kentucky 26 POLST is signifi cant. So far, the programs haven’t elicited the Michigan 26.3 strong opposition that arrives with assisted suicide bills. That Mississippi 26.3 diff erence is on full display right now in Massachusetts. There, a West Virginia 26.8 bitter, high-profi le battle is raging over a ballot initiative to allow Arizona 26.8 terminally ill patients to give themselves a lethal dose of drugs. Montana 26.8 (Three other states have such laws in place: Montana, Oregon Louisiana 27.1 Oklahoma 27.2 and Washington.) Virginia 27.2 Meanwhile, Massachusetts is also pursuing a POLST initia- Missouri 27.2 tive. As long as it hews to hospice and palliative care discussions South Carolina 27.4 and doesn’t wander into the territory of assisted suicide, it isn’t Nevada 27.5 a problem with right-to-life interests in the state, says Anne Fox, Colorado 27.6 president of Massachusetts Citizens for Life. Vermont 27.8 The end-of-life care movement is clearly gathering steam. Washington 29.5 Public offi cials and the medical community alike are discussing Delaware 30.4 the topic in growing numbers. With good reason: An aging baby California 30.4 boom cohort and their families are much more tuned in to the Alabama 31.5 subject than previous generations. Idaho 34 Ultimately, the drive toward a more rational, reasoned and New Mexico 34.1 patient-centered approach to dying is pretty straightforward. Oregon 35.1 “We are,” says West Virginia’s Moss, “spending lots of money on Alaska 35.5 people who die within a year, in settings they don’t like, getting Utah 41.7 SOURCE: CDC AND THE NATIONAL CENTER FOR HEALTH STATISTICS: “UNDERLYING CAUSE OF DEATH” DATA OBTAINED FROM CDC WONDER ONLINE DATABASE OBTAINED DATA CAUSE OF DEATH” “UNDERLYING STATISTICS: CENTER FOR HEALTH SOURCE: CDC AND THE NATIONAL treatments they don’t want.” G

THE PLACE OF DEATH IS OBTAINED FROM DEATH CERTIFICATES AND REFERS TO WHERE A DEATH IS PRONOUNCED. INDIVIDUALS WHO PASS AWAY IN THEIR HOMES, BUT ARE TRANSPORTED TO HOS- PITALS, WILL NOT BE RECORDED AS DYING AT HOME. FIGURES ARE FOR NON-INJURY RELATED DEATHS. Email [email protected]

42 GOVERNING | October 2012

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go In 2030 1 in every 3 Americans will be 50 or older

Is Your Community Ready? AARP can help you meet the challenge and seize the opportunities. Through research, policy analysis, and on-the-ground experience, we offer practical guidance for making your community more livable for people of all ages— from improving public transportation and accessibility, to developing housing and land-use policies. Learn more about communities at aarp.org/home-family/livable-communities And to see our policy reports visit aarp.org/research/ppi/liv-com

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Telehealth will revolutionize health care for aging patients—if states can get out of the way.

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By Dylan Scott

his exists: a pair of house shoes, equipped patient relationship or a prior in-person exam—severely limiting with pressure sensors and a special pedom- for an industry that frequently crosses state lines. Just two years eter, that can sense when the wearer is ago, in a ruling that was decried by telehealth advocates, the Texas about to stumble and send out an instant Medical Board expressly prohibited physicians from treating new message to that person’s doctor. Developed patients virtually without an initial face-to-face exam (or a refer- by AT&T inT 2009, the slippers monitor the gait of the person wear- ral from another doctor who had met with the patient in person). ing them and can alert a physician if there’s anything unusual. The national Federation of State Medical Boards convened in That early notifi cation might prevent a dangerous fall and a costly March 2011 to examine the relationship between regulation and trip to the emergency room. telemedicine. Members voiced concerns over maintaining qual- Seem crazy? How about a doctor’s visit that takes place ity of care and providing adequate tech training for physicians. entirely through video conferencing? Or an in-home blood-pres- But there was an acknowledgment that telemedicine off ers an sure monitor that instantly relays a patient’s stats to her doctor’s important opportunity. “We have scarce resources, and there is offi ce? Or glucose meters that constantly upload information to a recognition that life has changed when it comes to how best to password-protected website, allowing a diabetic patient’s daugh- ensure access to medical care for those in need,” Dena Puskin, ter to track her mom’s health online? a senior adviser at the federal Human Resources and Services It still sounds a little like science fi ction for senior health care: Administration, told the group. Jetsons Age technology for a generation that grew up on “The Jet- Some states are embracing telehealth. The New Mexico Medi- sons.” But it’s part of the very real, very rapidly growing telehealth cal Board, for example, will issue a telemedicine license to any industry, which is expected to triple in size to $27.3 billion by 2016, health-care provider outside the state who is licensed in any other according to projections by BCC Research, a market research fi rm. state or territory in the United States. At least nine other state It could be a cost-saver too. Some industry analysts have said boards have modifi ed their licensing requirements to allow some remote monitoring could lead to savings of 20 to 40 percent by kind of telehealth practices across state lines. But with the other reducing unnecessary hospitalizations and catching chronic 40 states maintaining in-state licensing requirements, telehealth problems early. Others have cited pending doctor shortages— advocates say more action is needed. a national gap expected to reach 130,000 by 2025, as the baby “The best thing we could do is get rid of the term ‘tele- boomer retirement wave crests—as reason to embrace remote medicine,’” said Jay Sanders, president and CEO of the Global health-care technology. Telemedicine Group, at the 2011 conference. “When we started But state policies must fi rst catch up. using CAT scans we didn’t call it ‘CAT-scan medicine,’ and when

Regulations set by state medical boards can make it diffi cult for ultrasounds came in we didn’t call it ‘ultrasound medicine.’ It’s SHUTTERSTOCK.COM doctors to practice telemedicine, Gary Capistrant, senior director of medicine, period.” G public policy at the American Telemedicine Association, told Kaiser Health News in May. State boards often require an existing doctor- Email [email protected]

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Zoom: 30% Angle: 0 Pelvis Uncompressed

Information, Please! 46 GOVERNING | October 2012

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Better exchanges of health data could fundamentally change the nation’s health-care systems, especially for older patients.

By Dylan Scott

n the ongoing eff ort to rein in health-care Once it has as much federal data as it can get its hands on, North costs, many policymakers and health wonks Carolina will run the information through algorithms to identify view data and information as a crucial next dual eligibles with the highest risks. Those individuals can then frontier. The increasing expenses of health be targeted for disease management and medication management care, the thinking goes, are often a symptom to make sure they are controlling their conditions as best they can. of poor coordinationI and communication, a problem that could That should lead to lower costs. State offi cials project they’ll see be remedied if health-care providers and governments were savings within the fi rst 12 to 18 months if all goes according to plan. better equipped to share data. More than 250 health information exchanges like the one at “More and more innovation is happening with more and more work in North Carolina are operating across the country. Some are data being made available,” U.S. Chief Technology Offi cer Todd government-run; others are run by insurance companies or health- Park said at the 2012 Health Datapalooza in Washington, D.C., in care providers. They allow patient data to be shared electronically June. “Health data is no longer a government initiative. It is an across providers and government agencies, giving doctors and hos- American initiative.” pitals a more complete picture of the people they’re treating. For Seniors—and specifi cally dual eligibles [see “Stay at Home, a high-needs population like dual eligibles, who typically have a Mom,” page 32]—could benefi t the most. With the dual-eligi- history of health issues, that information can be invaluable. ble demonstration projects created by the Aff ordable Care Act, Many analysts have extremely high hopes for these informa- intended to improve coordination between state-run Medicaid tion exchanges. A recent survey of senior health IT specialists and federally run Medicare for the nine million people under found that 40 percent believe that health information exchanges, both, states are gaining access to Medicare data for the fi rst time. more than anything else, “can have the most impact on patient Some state offi cials are almost giddy at the prospect. “We care by improving clinical and quality outcomes.” had a huge void because we didn’t have access to that data,” says Obstacles remain. Maintaining these exchanges requires fund- Denise Levis, director of clinical programs and quality improve- ing, and it can be diffi cult to facilitate trust among the health-care ment at Community Care of North Carolina, the organization providers involved. Overcoming those challenges is important, overseeing that state’s demonstration. “Now that we do, it should advocates say, because of the potential for data exchanges to revo- have a huge impact.” lutionize the health-care industry. “Electronic health information North Carolina is one of 26 states developing dual-eligibles exchange addresses a critical need in the U.S. health-care system demonstrations under the health-care reform law. It has already to have information follow patients to support patient care,” begun integrating Medicare data into its existing health informa- wrote offi cials with the federal Offi ce of the National Coordinator tion exchange, an online warehouse that collects information for Health Information Technology in Health Aff airs this March. from several state agencies and now the Centers for Medicare “Today little information is shared electronically, leaving doctors

& Medicaid Services (CMS). In March, the exchange received without the information they need to provide the best care. ... The SHUTTERSTOCK.COM Medicare data on hospital and primary care claims for the fi rst demand for health information exchange is poised to grow.” G time. The state is currently negotiating with CMS to access its prescription data as well. Email [email protected]

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go gment Call Police in Milwaukee have overhauled 911 and the way they respond to serious crimes.

ight years ago, Vicki Kopping moved back to Milwaukee, into the com- fortable two-story home owned by her mother in a tidy, middle-class neighborhood in the northwest cor- ner of the city. When the economy tipped into recession in late 2007, however, Kopping’s neighborhood began to change. Banks foreclosed Eon her neighbors’ homes. Drug dealers started selling out of the apartment building across the street. Soon they were running a discreet but open drug market, complete with lookouts, runners and curbside sales. Kopping tried to ignore it. She could still sit on her stoop in the morning and enjoy a cup of coff ee; the drug dealing didn’t start until 11. Then one morning she discovered that someone had broken into her car. So Kopping did what thousands of Americans do every day when confronted by crime: She called 911. In West Bend, Wis., where Kopping had lived previously, “police came immediately whenever you called them,” she says. Not in Milwaukee. Instead of a visit from a squad car, Kopping got a phone call from an offi cer assigned to a recently created unit, Diff erential Police Response (DPR). DPR is the brainchild of Milwaukee’s reform-minded police Instead of racing from chief, Ed Flynn. Flynn arrived in Milwaukee four years ago, after call to call, patrol offi cers serving as police chief in Springfi eld, Mass.; Arlington, Va.; and in Milwaukee are now expected to solve problems. By John Buntin Photographs by David Kidd

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“It’s our job to create neighborhoods capable of sustaining civic life,” says Police Chief Ed Flynn.

several other cities. He also served as Massachusetts’ secretary Today, nearly three years later, approximately 13 percent of of public safety under Gov. Mitt Romney. In Milwaukee, Flynn dispatched calls for service in Milwaukee are handled over the found a department “trapped in amber,” the majority of whose phone by one of the police department’s seven DPR units. Flynn’s offi cers were focused on clearance rates and response times attempt to curb 911 and rethink the role of patrol offi cers have rather than on preventing crime. made him into a fi gure of national signifi cance. But within Mil- Flynn had a diff erent vision for the department and indeed for waukee, Flynn’s reforms have created powerful critics, most police in general. “It’s our job to create neighborhoods capable notably the Milwaukee Journal Sentinel, which has run stories of sustaining civic life,” he says. By being visible in high-crime that question the department’s crime statistics and its response neighborhoods, by working with other government entities to times. The pushback from a respected paper and other critics solve problems and by encouraging residents “to reoccupy their raises the question: Are the risks of challenging policing’s status public spaces,” Flynn believed that the police could help neigh- quo worth the rewards? borhoods regain the ability to police themselves. But in order to do that, he needed more offi cers. Changing the way his depart- n 1968, AT&T created a single number for emergency ment dealt with 911 calls was one way to get them. services nationwide, 911. “The whole focus,” says Chuck “When your computer breaks, they don’t send a guy to your Wexler, executive director of the nonprofi t Police Exec- house to fi x your computer,” says Flynn. “You dial a number and utive Research Forum, “was on making police more some very nice person in India tells you what to do with your responsive, more accountable.” The advent of 911 gave computer.” Instead of dispatching “the armed authority of the ordinary citizens a power once enjoyed only by police state to your living room,” he reasoned, there was no reason that Icommanders: the ability to aff ect police deployment. Depart- for certain types of calls—nuisance or noise complaints or stolen ments, in turn, had a new measurement they could track: property reports—a police offi cer couldn’t handle it by picking up response time. By the 1970s, response time, numbers of arrests the phone and making a call. and clearance rates (cases solved) had become the holy trinity

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of American policing. But there was a problem with this new, Policing Services). But after 18 months of recession and three more democratic approach to police deployment. It didn’t work. years of anemic economic growth, American police departments The 911 systems reinforced some of the least eff ective prac- are no longer expanding. On the contrary, many are now facing tices in policing, notably police departments’ reliance on radio cuts. As Melekian sees it, that has presented departments with a patrol cars. Since the 1930s, American police departments had choice: revert to the traditional model of policing or truly commit been moving offi cers from foot beats into radio-equipped squad to a new approach. “The overwhelming majority of departments,” cars. The theory behind this shift was that by circulating quickly says Melekian, “are not going to have the resources to do both.” and unpredictably, police would create an illusion of omnipres- There was never any doubt as to what Ed Flynn’s choice would ence. Criminals would be afraid to commit crimes because they be. Flynn’s selection as chief in 2008—only the second time in never knew when a squad car might appear. The reality was that the 153-year history of the Milwaukee Police Department that the so-called routine preventive patrol had no eff ect on crime, fear or chief had come from outside the department—was a clear sign disorder, as demonstrated by a famous experiment conducted in that Milwaukee Mayor Tom Barrett and the Fire and Police Com- Kansas City, Mo., in the early 1970s. mission (whose members the mayor appoints) wanted changes. Departments largely ignored this fi nding. Instead, as the vol- Flynn lost no time in delivering it. He focused fi rst on the depart- ume of 911 calls began to rise, they put more offi cers in radio cars. ment’s data systems, instituting Compstat, the computerized For a generation of police offi cers, the experience of policing crime tracking and deployment system developed by the New became racing from one call to the next. Offi cers were measured York Police Department in the early 1990s. However, Flynn soon not by how many crimes they prevented—the conventional wis- turned his attention to the more controversial topic of transform- dom was that police couldn’t prevent crime—but by how quickly ing the culture of the Milwaukee Police Department. they responded, notwithstanding research that suggested that Flynn wanted uniformed offi cers deployed to hot spots. quick police responses only rarely increased the probability of an But the city was facing steep reductions in state assistance. While Mayor Barrett was prepared to defend the department’s budget, there would be no resources for more offi cers. To get them, Flynn would have to think creatively. That thought process got a jump- start when, soon after arriving in Milwaukee, Flynn was headed to an event at the police academy. A squad car sped past him, sirens fl ashing. Flynn asked his chief of staff what was going on. It turns out someone had called 911 about a red car that was speeding through the neighborhood. No one had got- ten a license plate number, and the speeding red car was presumably many miles away. Flynn was incredulous. Police were chasing after a red car, some- where in the city, that had been speeding at some point in the past. But the department handled all kinds Milwaukee resident Vicki Kopping says local police are not as responsive to of issues in a similar fashion. Instead 911 calls as they should be. When she used to live in West Bend, Wis., she of treating everything as urgent, says, the “police came immediately whenever you called them.” Flynn thought, “For the love of God, why can’t sworn offi cers who’ve had years of experience and hundreds of arrest being made. During the late 1970s and early 1980s, depart- hours of training tell you on the phone how to deal with your ments began to experiment with new approaches that fell under problem?” Then Flynn realized something: They could. Soon the rubric of community policing; however, cities continued to thereafter, the DPR program was launched. encourage citizens to treat 911 as the gateway to police services. Milwaukee’s 911 system receives more than 900,000 calls a “That was OK as long as departments could continue to grow,” year for an average of one call every 35 seconds. Under DPR, tele- says Bernard Melekian, the former Pasadena, Calif., police chief communicators handle the calls and assign each incident a code, who now heads the federal COPS offi ce (Community Oriented depending on how serious a threat it is.

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On a recent Monday afternoon at the District Three emer- the car. We can handle it the way the offi cer on the patrol handles gency command center, a dozen or so 911 telecommunicators and it. It’s just that the citizen is talking to an offi cer here.” police department dispatchers were sharing a barn-like room on Surveys conducted every month by the police department the third fl oor. They were preparing for the spike in calls that show that more than 80 percent of residents who deal with a normally starts when school lets out and crests around 7 p.m. DPR unit are satisfi ed by the experience. According to Michael This particular afternoon, there were a smattering of high-prior- Tobin, executive director of the Fire and Police Commission, ity code one and code two calls—a ShotSpotter (gunfi re locator) only seven citizens have fi led complaints. Kopping is one of the alert, a suspect with a gun and a possible arson investigation. seven. The week after her fi rst 911 call, someone broke into her There were a much larger number of code three and four calls— car again. This time she found clothes and a screwdriver in her an assault on an animal, one by an animal and a missing elderly car. She called the police. Then she waited—for four hours, she person. And then there were the code fi ve calls. says. Finally, in frustration, she drove over to District Seven and Code fi ve calls now go to the DPR units at the seven district presented her complaint in person to the desk sergeant. police stations. Today in District Three, that means they’re “I walk in and he says, ‘Well what do you want us to do?’” appearing on the computer screen of Offi cer Josh Nemeth, relates Kopping. “I said, ‘You’re a goddamn cop! Do something.’ whose computer and desk sit one fl oor down from the main room. Pardon my French, but that’s what I told him.” Now she doesn’t Nemeth was on the phone, talking with a woman who had called bother to call about the little things. 911 about an older man who was dating her much younger daugh- Kopping’s experience underscores Michael Crivello’s reserva- ter. She wanted him to keep his distance; Nemeth was walking her tions about the DPR program. Crivello, president of the Milwaukee through the process of getting a restraining order. Police Association, the local union, asks, “Should we be responding “They seem to like the quicker response over the phone,” he to everybody’s little call where it really is not a criminal matter says. Sometimes the solution is as simple as his calling a noisy or quality-of-life issue? Probably not.” However, Crivello worries neighbor and asking him to turn down the stereo or send his that not sending patrol cars to whole categories of quality-of-life guests home. On occasion, he has issued a citation by mail. complaints essentially trains citizens not to call the police at all. “The benefi t of it is, it is not tying up our squads,” says Lt. Iris “The less [frequently] we dispatch cars, the more disinterested we Ziolkowski, who oversees District Three’s DPR unit. If a resi- get people in calling the police,” he says. “When you look at the dent calls in the afternoon to report that someone broke into his statistics, crime has dropped, but has it really dropped, or is it the car and stole his radio the night before, police wouldn’t respond calls to police that are dropping?” immediately. “Sending a squad car to respond many hours later These concerns have been amplifi ed by Milwaukee’s daily just makes citizens angry,” Ziolkowski says. “This way, DPR can newspaper. During Flynn’s early years as chief, the Journal Sen- get all the information, and I can get somebody to go [fi nger]print tinel generally provided positive coverage of the chief’s reforms. Recently, however, the newspaper has turned critical. Last fall, the paper ran a major story alleging that the police department’s response times had grown longer—10 percent longer during Flynn’s fi rst three years as chief compared to his predecessor’s fi nal three years—thus threatening public safety. By focusing on incidents where the department had failed to respond promptly to serious inci- dents while discussing the department’s new DPR policy on responses, Flynn felt the paper had painted a misleading por- trayal of the new program. “They tried to discredit me by high- lighting mishandled Priority One calls,” Flynn says, with obvious irritation. The mistakes were real, he says, but they were isolated mistakes that had nothing to do with DPR. As for the broader charge, Flynn acknowledges that overall response time has slowed, but it’s because the department is now handling non-emer- gency calls diff erently. “We’re creating Dispatchers only send out patrol cars to handle emergencies. About time to be proactive,” Flynn says. “They 13 percent of all dispatched calls are now dealt with over the phone. caught me doing what I promised to do.”

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Police respond to an alleged stabbing incident in central Milwaukee. Under the new 911 response system implemented by Chief Flynn, offi cers are expected to stay at a crime scene and investigate from start to fi nish.

lynn’s changes to 911 are part of his eff ort to clear calls for service, patrol offi cers are supposed to take the time to the way for patrol offi cers to focus on problem investigate incidents from start to fi nish, including such serious solving. One of his other reforms, which builds on off enses as aggravated assault and armed robbery. the changed 911 system, is far more controversial. The process has not been an easy one. “We have had grow- When Flynn arrived in Milwaukee, he found a ing pains on that,” says Tobin. Assistant district attorneys have department dominated by its detectives, particu- had to deal with cases that were not as well prepared as when Flarly its homicide detectives. Working closely with the district investigations were conducted by detectives. Sometimes cases attorney’s offi ce, they routinely “cleared” more than 80 percent of were dismissed as a result, and uniformed offi cers have been total homicide cases. If case clearance was the goal, notes District disciplined for botching investigations. Attorney John Chisholm, “it was an extremely eff ective system.” Police Association President Crivello, himself a detective, While clearance rates are important, Flynn felt the depart- makes it clear just how much anguish Flynn’s changes have cre- ment was focused on the wrong goal. It was important to solve ated. “It has caused a division in our department,” says Crivello. crimes, but it was also important to prevent them. The role of the “Detectives are not allowed to do their jobs, and police offi cers uniform patrol needed to be redefi ned and expanded. With the are mandated to.” support of the mayor and the Fire and Police Commission, Flynn A response to a 911 call one summer evening in District Three took key plainclothes commanders from the Criminal Investiga- off ers a glimpse into both the challenges and the opportunities tion Bureau, put them back in uniform and moved them from the of this new approach. A man called in that he had been stabbed Police Administration Building downtown out to the districts. in the hand during a dispute with a roommate. Because the inci- The elite plainclothes units were disbanded and consolidated. dent involved an assault with a deadly weapon and the alleged Now, instead of patrol offi cers running from “hitch to hitch,” says perpetrator was still at the scene, it was a code one call. By the Tobin of the Fire and Police Commission, referring to individual time Sgt. Adam Riley arrived at the scene of the incident, police

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Police Association President Michael Crivello worries that keeping offi cers from responding to some complaints will train citizens to not call 911 at all.

offi cers and fi refi ghters were already Riley asked if she’d called anyone there and talking to the victim, who was about it. The woman said she’d called the nursing his hand while angrily denounc- anonymous tip line a couple of times. ing his roommate. It would be satisfying to report that The wound didn’t look very serious. Riley was able to promise the woman beat Switch from paper to But since the roommate was at home one or bike patrols, or that he referred her to an electronic expense reporting block away, offi cers went to investigate. innovative community-prosecution unit with integrated card data There, they heard a completely diff erent embedded in District Three. In fact, though, from MasterCard. story. The complainant started the fi ght, he just listened. Then, he asked her for her Watch the MasterCard® the roommate claimed. As for the stab- name, date of birth and phone number. Smart Data video demo at bing, yes, he had a penknife but he hadn’t “When people are out drinking and mastercard.com/commercial. used it. loitering, call it in,” he told her. “If the Three years ago, Sgt. Riley would department gets enough calls, there might probably have been on his way at that eventually be things we can do.” Then, point. Instead, he stayed to try to sort almost as an afterthought, Riley said he things out. The police entered the house would like to pass the woman’s informa-

to look around and found drug para- tion on to the community liaison offi cer. *Switching from paper-based to electronic expense reporting reduces the average cost to process an expense report by nearly 60%. phernalia. When Riley stepped outside, “For her to actually come up and say (Source: RPMG Travel Study, 2009.) a young woman walked over from the listen, ‘This is a drug place,’ you know, house next door. She was there visiting that doesn’t happen often,” he says. her mother, she told Riley, but had grown “They’re scared. They’re like hostages in up in the neighborhood. Working-class their own homes.” people, friends of her grandmother, had His follow-up—and her follow-up—is once lived in the house. They had moved what will ultimately determine if Flynn’s to Atlanta and now, she said in a low voice, vision of the police as problem-solvers “This is a dope house. It’s ridiculous. I am is realized. G

sure you know how many people have ©2012 MasterCard. been killed over here.” Email [email protected]

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2037IN

This month marks Governing’s 25th anniversary covering state and local government across the country. We asked leaders in various fi elds for their predictions on how government will have changed 25 years from now—which problems we will have solved, and what challenges will remain on the horizon. Here are their edited and condensed responses.

INTERVIEWS BY RYAN HOLEYWELL

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Mayor Smith says that localities will have to rethink the way they tax residents, since the current methods are too inconsistent. FLICKR/GAGE SKIDMORE Scott Smith is the mayor of Mesa, Ariz., and vice that lane.” Very reluctantly, the citizenry will say, “I get it now.” president of the U.S. Conference of Mayors. And they’ll accept public-private partnerships as another tool in the box. A tax overhaul. There’s no doubt that the three primary sources of revenue for local governments—sales tax, property Same services, diff erent sources. The basic types of things tax and income tax—are under strain. The wide swings in prop- people expect from their communities will stay the same. There erty valuations have created a complete mess. It’s going to force are things that can only be provided by a community. I don’t us to look at a diff erent way. I think we realize that there is very think that will change, but I think who delivers those services little correlation between property value and services that are may change. You’ll see a basic change in not just the relation- provided. If you have a house, whether it’s a $250,000 house ship between cities and states in Washington, but also cities and or a $750,000 house, the number of fi re units that show up if it each other. You’ll see city boundaries shrinking or even disap- catches on fi re is the same, and that doesn’t change whether the pearing as we look at new and innovative ways of doing things. valuation goes up or down. I think you’ll see an evolving model as we look for effi ciencies, Governments want to ensure a stable source of revenue. I because less money is coming from Washington and we’ll have think what you will see is an attempt to tie more services with to do more on our own. the cost. Twenty-fi ve years from now, it wouldn’t surprise me if some of our taxation of property was based on some sort of fee- basis related to services associated with property. Joshua Schank You’ll see a broadening of the tax base and a lowering of the is president and CEO of the rate, and perhaps more of an imposition of a consumption tax Eno Center for Transportation. He advised then-Sen. Hillary than a sales tax. Everyone recognizes the taxing system is out of Clinton on transportation policy, and worked in the inspector sync with the economy we live in. general’s offi ce at the U.S. Department of Transportation and then the Metropolitan Transportation Authority in New York. More and more P3s. Public-private partnerships have been perfected in other countries because they simply didn’t have the Funds from the feds. It seems unlikely we’ll be dealing with government money and had to rely on private money. What we’ll [uncertainty in federal transportation funding] in 25 years. I know see is not that America has to rely on private money; what you’ll that’s surprising, but in the long run, I’m optimistic about our see increasingly is if we want these assets, we’ll have to expand ability to address these things. At some point, the chicken comes our sources of revenue. As freeways don’t get built and conges- home to roost. People start to notice a substantial downgrade, to

DAVID KIDD DAVID tion gets worse, we’ll say, “Hey, we don’t have the funds to add the point that they do make it into an issue. It takes time for it to

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happen. Will the anti-tax [fervor] of the U.S. government con- and say we need to invest. They’ll start beating up on places that tinue? No, I don’t think that’s possible. I don’t think that you can don’t. You’ll see places that get left behind saying, “Wait a minute, have a government that works that way. I guess we do need to spend money.” And they will. It’s a naturally Since the interstate system was created, the federal govern- correcting system. ment has in some ways gotten a little over-involved in dealing I’m certainly hoping federal funding becomes more reliable. with local transportation issues. It makes sense for them to But I think the pot is likely to dwindle. scale back. The end of gridlock? It’s shocking to me that we don’t already Forget VMT. In 25 years, I’d be surprised if we had a federal have perfect information about every traffi c route at every moment. vehicle-miles-traveled (VMT) system. At the federal level, you’ll It’s only a matter of time until that happens. We have almost per- see a greater dedication of general funds to transportation. Once fect information about traffi c in real time. We have computers that we realize that the gas tax isn’t sustainable—and nobody is will- can say, because of the traffi c, you should take this route. But very ing to agree to VMT fees—we’ll dedicate X percentage of revenue few people have that in their cars. When that’s ubiquitous, the sys- or the income tax or whatever to transportation, and we’ll use tem will function much more effi ciently. that to fund transportation like any other domestic discretion- ary program. At some point you say, “Why are we bailing out the Highway Trust Fund every couple of years?” Let’s admit what Ron Sims we’re doing. It’s a general fund program, and it’s worth federal is a member of the Washington State investment. The benefi ts accrue to everybody. University Board of Regents. He’s previously served as So I don’t think it will be addressed through VMT at the fed- executive of King County, Wash., eral level. Much more likely is a combination of things: States and as deputy secretary for the and regions [will] rely on VMT fees to pay for transportation, U.S. Department of Housing and basically like an extension of E-ZPass. Urban Development (HUD).

Regions step up. It’s a question of to what extent the states and Disappearing towns. I think localities will be able to raise their own revenues to compensate in major metropolitan areas, for the downturn of the federal contribution. I think it’s going to you’re going to see fewer cit- move in both directions: Some places will step up, like Los Angeles, ies. We’re moving into the age of [consolidated] metropolitan government. Cities are failing. The cost of pensions will catch up. The cost of competing will catch up. And the demands for services will catch up. You’ll see jurisdictions disappearing. Federal transportation When I’d go into jurisdictions dollars will come to [as deputy HUD secretary], I be more reliable but didn’t see how all these jurisdic-

less signifi cant, says tions could stand. People expect APIMAGES.COM transportation consultant a high quality of outcomes from States could cut high Joshua Schank. the government, but you can’t school by a year to save pack [multiple cities] with enough money and give students people to generate revenues to a head start on higher sustain them. We’re beginning to education, says Sims. see the fallout. Investors will basi- cally see that these are long-term risks and say, “How does a city that small bail itself out of trouble?” Wall Street will be the reason everything changes. They’ve gone through a period of being burned by investments that were not secure. After a while there’s a risk. I think every year will continue to be a bad news year for smaller cities, and you’ll basi- cally see the emergence of metro areas.

Priced out of the burbs. States will see the loss of federal income for large infrastructure needs. State governments will

FLICKR/THISISBOSSI have to have far more toll roads than they do now. That will

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go GOVERNING IN 2037 Donald Boyd result in a loss of residents in smaller cities that are farther away is a senior fellow at the Rockefeller from employment centers: “I’ve got my house payment, my car Institute of Government and the executive director of the State payment and now a toll payment to get to work? That gets fac- Budget Crisis Task Force, created by former Federal Reserve tored into their cost of living, and they’ll begin to migrate to Chairman Paul Volcker and former New York Lt. Gov. Richard larger cities. Ravitch. The task force, which is examining long-term fi scal chal- lenges facing states, released its fi rst report earlier this year. A K-11 education. I think the fourth year of most people’s high school is a waste of time. They’ve got their college acceptances. I Not so rosy. I think there are serious, entrenched problems think graduating with four years of high school will go away. You and risks that most states face. Medicaid is not going away as a have to unburden K-12, [so we’ll say] by the end of junior year, problem. [Nor are] pensions. Some of the states face very deep you’re out. We’ve given you all you need to compete in technical problems, and the system itself is broken. As you look at the chal- schools or community colleges or four-year schools by then. lenges, it’s hard to come away being sanguine.

Toward more perfect unions. The union movement in gov- More Medicaid, more problems. In 25 years, we’re still likely ernments will have to fundamentally be redesigned. I believe in to be facing the problem of Medicaid. It’s a combination of two unions. [But] unions have a choice. You can have the old guard things, one of which is hard to change, and one that’s impossible that says this is the status quo, or you can have the new guard. to change. First, there are growing health-care costs. The other We’re going to have to manage diff erently. The idea of people big thing is the aging problem. It’s so much more expensive to [staying] in government because they can hang on 30 or 40 care for the post-65 and especially post-85 population. Those years and not produce? That’s gone. You’re going to basically costs are going to rise pretty substantially. That’s not going to see unions having to allow [the public sector] to get rid of inef- change. People are willing to care for the elderly and disabled, fi ciency and ineffi cient people. and it seems unlikely our country is going to abandon that.

Exciting times. If you think the government today is the gov- Gambling on pensions. Pensions are something where the ques- ernment of 25 years in the future, you’re out of your mind. It’s too tion is, “Do you feel lucky?” The actuarial systems assume they’ll earn costly to sustain. All these problems excite me. There are going to 7.5 to 8 percent. We could get lucky and get out of this. If you had 20 be gigantic problems that will look overwhelming to us. I wish I years of 8 percent growth, [the underfunding problem] can go away. was just starting my career. It could also get dramatically worse. They’re so heavily invested in

Boyd says a panel is necessary to explain to Congress how federal defi cit reduction will affect other levels of government. APIMAGES.COM

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equities that if they get unlucky—I won’t say it’s the making of a catas- States as tech vendors. In some cases, another state or trophe, but it’s something that requires truly dramatic change. another county may be providing the services for you as a state or local government. In some cases, it may mean the federal Defi cit distress. Federal defi cit reduction, we don’t know when, government is providing a standard service that you as a state but we know it’s going to happen. And it’s hard to conceive of a sce- purchased. On the other side, it could mean you as a state or local nario of federal defi cit reduction that doesn’t hurt states. The feds government may actually be a provider of service for other state don’t understand the impact of debt reduction. That’s why one of or local governments. the recommendations of our report is to consider an entity like the Look at the electronic health insurance exchange website cur- [now-defunct] Advisory Commission on Intergovernmental Rela- rently under way. It’s basically laid out so that each state can create tions as a way of examining and making clear the potential impact its own website or utilize the federal government’s site. I could of federal defi cit reduction. This is probably the most important envision that going a step further, where, for instance, you might of the issues we’re addressing. Nobody ever went broke betting on do it state-by-state. Michigan might buy services from California the ability of political leaders to put off problems until the future. because they thought California’s site was better. Or the Western states would come together to form a consortium, with a single development by Washington, Oregon and California run by one of Teri Takai them and used by the others. A provider could be a private com- is the chief information offi cer at the U.S. pany. It could be the federal government. It could be another state. Department of Defense. She previously served as CIO of Michigan It could be a nonprofi t. and of California. E-Gov. (Finally.) One of the things state and local governments Buying smarter. State and local governments are going to recog- struggle with today is that they have to maintain their current nize they can no longer be fi efdoms and run their own technology. [methods of delivering services]—offi ces and phone calls and so Most state and local governments run a mixture of homegrown on. Twenty-fi ve years from now, as the demographics change, we technology and stuff they buy. Going forward, they’re going to will actually be able to do a reduction in the offi ces we have. I have to learn how to purchase and manage services as opposed won’t say you’ll have no offi ces. [But] if you can drive the digital to purchasing and managing technology. literacy of our children in line with the capabilities of our tech- That’s a big leap. It means that they’ll need adequate technical nology, then I can envision a time when we would not need those expertise to be a good purchaser and a good manager—without offi ces. The whole e-government revolution that was anticipated actually having grown that technical expertise from having devel- several years ago will actually come to fruition. oped, purchased and installed that technology. Techies in the House. Legislatures approve the money, and if the legislature doesn’t have an appreciation of how technology can be used to make services easier, faster, better and more cost- eff ective, then they will not appreciate how to allocate the funds and how to do eff ective over- sight of the technology projects to ensure citizens’ money is spent well. But legislators are not drawn from corporate America. They’re lawyers, public policy people or educators. They’re drawn from vocations where they don’t necessarily understand the implica- tions of technology on a large organization, which is what state and local governments are. Over the course of the next 25 years, I think you’re going to—I hope—see many more technology-savvy individuals in our governors’ offi ces and in the legislatures and in the departments. We’re going to see the CIO be more of a business innovator. I hope the CIO becomes less the promoter of Takai argues that the technology and more the role of promoting inno- “e-government revolution” vation and ensuring the multitude of technology will materialize in the next platforms to make it eff ective. G 25 years. Email [email protected]

CGI INITIATIVE FOR COLLABORATIVE GOVERNMENT FOR COLLABORATIVE CGI INITIATIVE More predictions at governing.com/25years

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go New York City’s 2003 blackout could happen again, say experts.

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go BY DAVID HATCH

ver two steamy days in August 2003, New York City’s crippled power grid paralyzed the Big Apple and invoked chilling reminders of the Sept. 11 ter- rorist attacks two years earlier. Elevators froze in skyscrapers, hotel guests with inactive key cards were locked from rooms, and commuters were forced to abandon the subway and resort to walking, hitchhiking and cajoling rides in grid- locked streets. Flights were canceled and even A CYBERATTACK bus service was interrupted. The neon lights of Times Square went dim as the Brooklyn Bridge COULD LEAVE transformed into a slow-moving expressway for weary pedestrians. The outage was part of a much larger black- LARGE PARTS out that impacted an estimated 50 million people in Canada and eight states across the Eastern OF THE NATION seaboard and Midwest. The cause was later determined to be overloaded transmission lines IN THE DARK AND compounded by human error—and not a rogue band of hacktivists or shadowy cyberterrorists. UNDER SIEGE. But the incident underscored a key vulnerability that makes the nation’s power grid a marquee target for cyberintruders bent on exploiting existing weaknesses: its reliance on IT systems and net- works. The 2003 blackout could happen again, experts say. Only this time, a cyberattack would be responsible for crippling the nation’s infrastruc- ture and leaving states, cities and whole regions in the dark with no Internet, phone service or elec- tricity. Even worse, fi nancial institutions, water

supplies and public transit could be attacked since APIMAGES.COM all are penetrable via the Internet.

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The specter of an electronic assault on New York’s power supply is so worrisome that the White House STATE SECURITY OFFICERS conducted a private simulation in March for U.S. sena- tors that mimicked the 2003 blackout in an eff ort to CAN’T JUST WORRY ABOUT highlight vulnerabilities and muster support for the pas- sage of comprehensive cybersecurity legislation (the bill DATA THEFT. THEY MUST stalled in the Senate in August). Homeland Security Secre- tary Janet Napolitano, FBI Director Robert Mueller and PLAN FOR THE UNTHINKABLE. White House counterterrorism adviser John Brennan were among the participants. While the focus on physical threats is an emerging cyberterror Robinson and other state advocates say they welcome assistance issue, state and local computer networks have long been high-value and guidance from Washington that doesn’t come with strings, targets. “State governments have the most comprehensive infor- like unfunded mandates and preemption of state laws. mation about citizens, from birth all the way to death,” says Srini States are now racing to fi ll the perceived regulatory void. Subramanian, principal with Deloitte & Touche and leader of the Forty-six states have enacted data protection laws designed fi rm’s state cybersecurity initiative. Over the last 15 years, states to safeguard personal information. According to NASCIO, 41 have migrated much of that information online, a move that off ers states have adopted or expect to adopt strategic plans designed convenience but adds risk, notes Subramanian, co-author of a 2010 to better coordinate Internet security eff orts. Among them is study with the National Association of State Chief Information Offi - Michigan, which adopted its plan last October—during National cers (NASCIO) on cyberpreparedness. Cybersecurity Awareness Month—with strong backing from As Internet-based perils grow in sophistication and frequency, Gov. Rick Snyder, who formerly served as president, chair- critics complain that Congress and the Obama administration are man and interim CEO of Gateway computers. Snyder treats not providing suffi cient leadership and resources to states and cyberprotection as a top priority and “economic development localities. “Federal regulations and guidance around this are dis- opportunity,” says Dan Lohrmann, the state’s fi rst chief security harmonized,” says Doug Robinson, executive director of NASCIO, offi cer. Under the initiative, Michigan is poised to launch the noting that each federal agency issues unique requirements detail- fi rst state-level “cyber-range” to train its employees in next- ing the handling of its data, making compliance tedious for states. generation defensive technologies. He adds: “No one in the federal government is saying, ‘We ought For state executives tasked with thwarting electronic intru- to get together and coordinate all this so we’re not infl icting so sions, the obstacles are daunting. “States are constantly running

APIMAGES.COM much pain on the states that are executing our federal programs.’” to catch up to the nature of the threats,” Robinson says. Each day,

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The 2003 state networks face electronic assaults “States are sovereign organizations, and most of them don’t like a NYC blackout that can number in the tens of thousands, lot of oversight by the federal government,” he says. forced people even millions. Breach attempts take the Weatherford says that federal agencies do, in fact, comply with out of buildings form of malware, viruses, denial-of-ser- uniform cybersecurity standards, but acknowledges that each and subways, vice attacks and network probes searching agency issues its own security and privacy requirements. That’s and onto for weak links such as easy-to-guess pass- necessary, he says, because agency needs vary widely depending crowded streets. words. Perpetrators run the gamut from on the sensitivity of their information. “We try to be as consis- corrupt employees, crime syndicates and tent as we possibly can in how we work with each of the states,” activists to rogue nations and terrorists. They use technology to Weatherford says. Regarding funding, he notes that DHS pro- cloak identities and whereabouts, and if based overseas, are poten- vides grant money to the Multi-State Information Sharing and tially beyond the reach of U.S. law enforcement. Analysis Center, a nonprofi t, private-sector group that conducts Increased reliance on third-party contractors and vendors cybertraining and outreach. Additional federal money that states expose states to new dangers if partners are not fully compliant can devote to cybersecurity is available through FEMA’s home- with security protocols. The ubiquity of ever-changing personal land security grants program. “If I had more money that I could technology, from smartphones to tablets to laptops, makes it dif- provide, I would love to be able to do that,” he says. “We in the fi cult to plug all security holes. Regular training, monitoring and government are in a resource-constrained environment.” vigilance are required to keep pace with hackers. State security As states assert their authority, they enter muddy regulatory offi cers can’t just worry about data theft. They must plan for the waters complicated not just by federal mandates, but also inter- unthinkable: so-called blended attacks that combine conven- national laws and treaties. “Virtually everything is murky in this tional warfare or terrorism with coordinated cyberintrusions, area and there are very few clear answers,” says Michael Glennon, and are potentially lethal. And there’s the challenge of raising professor of international law at Tufts University’s Fletcher School and maintaining awareness about largely invisible threats that and author of a detailed legal analysis of state cyberlaw. States crisscross borders and datelines. run an ongoing risk of federal preemption. “It’s always within While some states have bolstered security to match the most the authority of the Congress to enact preempting legislation,” stringent federal safeguards, others lag due to funding shortfalls and and “hard to conceive of any area involving cyberoperations that scarce resources. A 2010 NASCIO study found that states only devote would be seen by the courts to constitute a realm of exclusive state 1 to 3 percent of IT budgets to cyberprotection. Data gathered for a authority,” he says. For now, states have broad jurisdiction because 2012 update indicates that those fi gures slipped to 1 to 2 percent of there’s little the federal government has done that could be viewed IT budgets, which mostly stayed fl at. “That means it’s probably half as preemptive. Still, Glennon says, “That could always change.” or less than what it should be because the states have been under California’s sweeping data protection law, which took eff ect fi scal crisis,” says Robinson. As a result, Deloitte’s Subramanian in 2004, requires companies to bar unauthorized access to the says, attacks on state governments and agencies are mounting. Two personal information of its residents. “California really took the breaches in April that each involved the theft of hundreds of thou- lead when it comes to data protection and concerns about corpo- sands of personal records highlight the trend. Hackers who remain at rations negligently misplacing or failing to protect sensitive data large infi ltrated a Utah server via a state contractor to steal Medicaid that they have on fi le,” Glennon says. “Other states have looked to records, Social Security numbers and other sensitive information, California as the model for data protection.” while in South Carolina, a state employee was arrested for accessing The hodgepodge of state laws and the Internet’s global structure personal information from Medicaid benefi ciaries. have given rise to legal quirks. A similar Massachusetts law that For cash-strapped states, mustering the necessary funds for took eff ect in 2010 applies to residents wherever they travel, and to cybersecurity is a challenge when streets and bridges need repair. stores in other countries that retain the credit card data of Massa- Cybersecurity programs also become sidelined when states don’t chusetts residents—even when purchases are made online. If a Paris shelter them from political squabbles. In June, a dispute between hotel keeps computer fi les on dozens of vacationers from diff erent Florida’s governor and Legislature resulted in the elimination of states, it might be forced to comply with numerous U.S. data pro- the state CIO position. “There are diff erent levels of maturity” to tection plans, Glennon says. “Unless all these plans get harmonized state readiness, says Mark Weatherford, deputy undersecretary for through preemptive federal legislation, some entities are going to cybersecurity at the Department of Homeland Security (DHS) and confront a disincentive for dealing with Americans,” he warns. former chief security offi cer for California and Colorado. “Does it With the collapse of federal cybersecurity legislation, law- concern me? Of course it concerns me.” To address the imbalance, makers are sparring over the direction of a fresh legislative push he and his team regularly urge governors to elevate cybersecurity and whether President Obama should issue an executive order as a top priority. to create a new program to protect critical infrastructure. In the But Weatherford acknowledges that there’s room for improve- meantime, state security offi cers are left to wonder each day if ment at the federal level as well. “We can always do more. There’s they’ve done enough to safeguard their networks against the sort not enough money, resources or time to do everything we want of catastrophic breach—like the 2003 blackout—that’s guaran- to do,” he says. Citing the extensive outreach that his department teed to stir Washington into action. G conducts with governors, security offi cials and other stakeholders, though, he insists his department is doing all it can to help states. Email [email protected]

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go Problem Solver Real-world solutions and ideas for government managers. FLICKR/MARK STROZIER Get Out of Jail (But Not for Free) Virginia helps parents keep up with child support payments and stay out of lockup. By Caroline Cournoyer

ore than $35 billion is owed parents to jail, more than half of states more than $2 billion to nearly half a million in child support payments now have programs to help noncustodial children, judges refer people facing jail in the U.S. In fact, one out of parents overcome the barriers that are time to the Intensive Case Monitoring Mevery four parents who are keeping them from making good on their Program. ICMP matches them up with a owed child support gets nothing; and child support payments. case manager who works with community parents who owe it reportedly pay less Even in an ideal economy, most parents partners to solve the problems keeping than 60 percent of their debts on average, still rack up child support debt because them from paying child support, such as according to the National Center for State they don’t have a job and can’t aff ord the the inability to secure steady work. Courts. When parents don’t get the money payments—a problem that only worsens Since ICMP began four years ago, it they need from noncustodial parents, they when the country is in a recession. In Vir- has expanded to 25 courts and resulted often look instead to government welfare ginia, where noncustodial parents owe in the collection of more than $4 million programs to help make ends meet. The traditional solution for getting noncustodial parents to pay up is to send THE TAKEAWAY: them to court and then jail if the judge • The traditional solution for getting noncustodial parents to pay child support fi nds them in contempt. This method has is to send them to court and then jail if the judge fi nds them in contempt. proven ineff ective, perhaps because sit- ting in jail makes it hard to write checks— • More than half of states have programs to help parents overcome the and even harder to earn money so those barriers keeping them from paying support. checks actually clear. It’s not always that parents don’t want to pay their child sup- • Virginia’s program not only solves the underlying issues that keep port; it’s often that they can’t. So instead parents from paying, but keeps them out of jail too. of sending already fi nancially struggling

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go in child support, according to Glenn plan for how the participant will resolve another third who have been removed Stratton, the state’s ICMP manager. the root of his problems. If parents fail to from or dropped out of the program. Even “The judges recognize that incarcera- comply with the program at any point, they when parents don’t fi nish ICMP, though, tion doesn’t work for everyone,” he says, can be booted out of ICMP and into jail. they pay almost three times more child “because some people have legitimate Parents “graduate” from the program once support after participating in it compared reasons for not being able to pay.” they have a steady job and demonstrate the to before; while parents who graduate pay Not just any parent found in contempt ability to pay child support over time. more than triple the amount of child sup- of court for failing to pay child support can Virginia is just one of at least 28 states port than before ICMP. enter the program. Participants must be that have some kind of program for helping Eighty-six percent of program par- referred. There’s no checklist of criteria a parents with child support debt get jobs, ticipants are men. In addition to helping person must meet, Stratton says, but “the but few allow parents to avoid jail once fathers pay their dues, the program also ideal person is someone who might pay they’ve been found in contempt of court. hopes to encourage noncustodial parents child support if they can overcome some Programs in at least two states—Kentucky to become more involved in their chil- of the barriers keeping them from paying.” and North Carolina—put parents under dren’s lives and to improve communication Once a person receives a referral, he house arrest while electronically moni- between parents. It already does that, but immediately meets with the district’s case toring their movement. Virginia modeled Virginia wants to up its game and is looking manager. The pair identify what’s keep- its program after a similar one in Texas, for ways to expand its fatherhood resources ing the parent from paying child support, which began in 2005 and has since col- and co-parenting activities. “This is one of sign a contract with appropriate program lected close to $16 million in child support. the few initiatives that’s actually successful requirements (such as getting substance More than 1,300 parents have been at reaching out to fathers,” Stratton says. G abuse treatment or applying for a certain referred to ICMP—roughly one-third of number of jobs) and create a customized whom have successfully completed it, and Email [email protected]

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By Katherine Barrett and Richard Greene

SMART Is Stumped What felled Alabama’s performance measurement plan?

while back, we uncorked to develop and meet goals from the which three he should close. “It gives you some journalistic champagne budgeting side of the equation. Most the justifi cation,” he says. bottles and toasted a step nonbudgetary elements of SMART, how- Beyond perceptions of the utility of A forward for the state of Ala- ever, are being retained. SMART, it’s rather clear that there were bama. In 2004, it embarked on its fi rst While regular readers of this col- at least a few elements that may have led real statewide foray into performance umn know that we’re big fans of to the current state of aff airs. Looking measurement. The program was dubbed performance measurement eff orts, we forward, these can be lessons for other SMART. The acronym stood for Specifi c have to admit that there were some states that want to use performance results, Measurable key goals, Account- rational reasons for this change. The information for budgeting: able to stakeholders, Responsive to incoming governor decided that the • States need deep-seated legislative customers and, fi nally, Transparent to agencies’ goals weren’t in sync with buy-in. It’s not enough to send a everyone. As we wrote in the February the state’s scarce resources. Agency whole stack of measures to legislators 2005 issue of Governing, “This is the fi rst budgets were being cut anyway. “Agen- if they’re disinclined to accept their signifi cant eff ort ever launched in Ala- cies would ask for money to meet their utility. “There was no real signifi cant bama to encourage strategic planning or goals,” Traylor says, “but we are so buy-in from the legislative branch to performance budgeting.” strapped for cash in Alabama that it use it as part of their discussion in the Less than a decade later, we see that didn’t work out.” budget,” says Jon Barganier, senior SMART, like a number of other similar That makes some sense, right? But consultant for the Auburn University- programs in the states, has fallen on hard in our minds one of the most signifi - Montgomery Center for Government times. As of October 2011, agencies were cant uses of performance data isn’t in and Public Aff airs. “That was prob- no longer required to submit SMART deciding how to spend new dollars, but ably the missing link in this thing.” budget request forms. For agencies, there in determining the most eff ective and • The measures need to be deeply didn’t seem to be much to connect the effi cient way to cut back dollars when instilled enterprisewide with strong initiative to budgeting results. Agencies times are tough. The Alabama Depart- leadership “Even ... years down the “did all the paperwork and reporting, ment of Forensic Sciences, for instance, road certain departments and agencies but no one actually saw their amount of had experienced a 40 percent reduction never fully bought into the process,” money change,” says Gail Traylor, direc- in its budget over the last few years and Barganier says. “The successes had tor of the state’s audit division. was forced to close three labs in the state. more to do with the agencies buying The removal of the budget request Michael Sparks, the department’s direc- into it and seeing it as a tool for them

SHUTTERSTOCK.COM forms eff ectively unties the state’s eff orts tor, used SMART to help him identify to manage internally.”

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By Brian Peteritas

• The technology that permits this infor- mation to be used easily is critical. The Facebook Voter Some in Alabama have long com- Getting voters to take the time to register is often diffi cult, especially when it plained that the basic step of feeding comes to younger voters. Looking for ways to reverse that trend, Washington information into the computer system state has partnered with Facebook to develop a voter registration app for the could be a challenge. At the other end of social media giant’s website. Designed by Microsoft, the application works by the equation, even proponents confess pulling a screen from the state’s registration site onto a user’s Facebook page, that it wasn’t easy to see how the yearly and then uses that person’s profi le information to populate large portions of the goals related to the big picture strategy registration form. Since Washington law requires identifi cation, users will have for the state. to input their driver’s license or state ID card number to complete the process. But before we jam the cork into the Once they have done so, they are given the option to “like” the registration page bottle we opened nearly a decade ago, and share it with friends. The MyVote app is the fi rst of its kind. we think it’s worthwhile exploring the debate over whether SMART, without its performance budgeting component, still has value. There are, one state leader argues, “concepts that can be derived from the planning—and that can be just as important as the budgeting function, especially in state government where we have a revolving door of leadership. It is important to have articulated roles. In my personal opinion, the management tool is priceless.” It’s not easy to fi nd people who are inclined to disagree with this notion entirely. But some observers, in Alabama as in other states, believe that without the budget staff ’s powerful carrots and sticks, the management tool won’t be used. “People don’t like to plan,” says Anne Evans, who served as the executive assistant to the director of the Depart- ment of Mental Health in the early years of SMART. “The most eff ective way to get this done was to tie planning to the budget. Without tying to the budget, it is of no value.” Based on our experience over the years, we believe that the truth lies Paying to Produce Plumbers someplace in between. To be sure, tying Looking to boost the number of qualifi ed applicants for skilled labor jobs like measures to the budget gives them force plumbers, mechanics and construction workers, the state of Kansas is offering they wouldn’t otherwise have had. By to pay school districts $1,000 for each student who graduates with an industry- the same token, the benefi ts of the mea- recognized credential in high-need jobs. The state will also pick up the entire tab

surement process to agencies—in setting for high school juniors and seniors who take qualifi ed technical courses at their SHUTTERSTOCK.COM goals and making changes to achieve local technical or community college. While it’s relatively common for states to them—are very real. Alabama should pay for high school students’ technical education, research manager Catherine provide an excellent petri dish to see Imperatore at the Association for Career and Technical Education says this is one just how much good this can accomplish, of the fi rst times she’s seen a state offer fi nancial incentives to schools for getting even without throwing the budget offi ce students involved in technical education. State offi cials say the new program will into the dish. G increase collaboration between school Find more ideas for creative programs at districts and two-year colleges in meeting Email [email protected] governing.com/ideas the needs of current Kansas employers.

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By Steve Towns

Web Bragging Rights ‘Best of the Web’ winners showcase must-have features for successful government sites.

ast month, Government Technology (our sister publication) released its 16th annual “Best of the Web” L survey of state and local govern- ment websites. A panel of analysts and current and former CIOs judged nearly 100 entrants on innovation, functionality and their impact on government effi ciency. For the record, the top sites came from Sites like the state of Alabama; Orange County, Mississippi’s Fla.; and the Louisville, Ky., Metro Gov- let users ernment. But beyond the annual beauty map nearby contest, the survey off ers a snapshot of state offi ces. the state of the art for public websites. So what can you learn from some of the best public-sector websites in the nation? Based on what’s off ered by the winners and other highly ranked sites, here are some must-have features: • Mobile friendliness: More and location data from smartphones and emergency events. The Louisville more website visitors are arriving tablets to automatically give mobile website combines location informa- via smartphones, tablets and other users information tailored to their tion with notifi cation services to give mobile devices—and states will need location. Within a few clicks, the site users targeted reminders for activities to accommodate them. In California, showed state parks near my location. I or information they’re interested in. for instance, more than 10 percent of could fi nd fi shing spots by county and Residents plug in their address, and all visitors to state government web- even access a fi sh-stocking schedule to access information such as garbage sites in August were mobile users. increase my odds of success. pickup days and crime data. Integrated The percentage rises to nearly half of • Live help: As states work to entice with the mapping features are sign-up all users for some individual agency more citizens into receiving services options for alerts on roughly 400 city sites. To meet the demand, California online—and as online services take topics. The city boasts 90,000 digital and others are using a technique called on more complex tasks—more web- subscribers to its notifi cation service. responsive design, which automatically site users will need a hand. States like Although most of these ideas have scales and reformats website content to Nebraska and Mississippi let users been around for a few years, the top gov- fi t smaller screen sizes. The state also open a chat window and get help from ernment websites are combining and pre- launched an app store on its site, pro- a live representative. And the mobile senting them in ways that rival some of viding citizens a one-stop shop for all version of the Alabama state portal the best commercial sites. You still have to mobile apps created by state agencies. helpfully off ers users the option of cover the basics—the top-rated sites also • Location awareness: The best web- texting state staff for assistance. off ered hundreds of online transactions, sites know your location and show you • Notifi cation services: A growing paid careful attention to site navigation nearby offi ces or attractions. Missis- number of state and local sites let resi- and usability, and included rich links to sippi’s homepage asks users to choose dents subscribe to email or text-based social media—but adding some of these their location from a menu of metro reminders and alerts. Orange County, other features might earn you bragging areas within the state, and then allows Fla., off ers a free service that texts sub- rights, and more important, the gratitude them to map the location of nearby scribers’ mobile devices with alerts for of your citizens. G DMV offi ces, hospitals, state parks life-threatening weather, severe traf- and post offi ces. California’s site uses fi c disruptions, evacuations and other Email [email protected]

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Business solutions through information technology®

cgi.com/stateandlocal _experience the commitmentTM

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By Mark Funkhouser

Cities, Counties and the Urge to Merge Consolidating governments is hard to do, but the idea keeps coming up.

onsolidating city and county according to Dennis Hays, who has been says, the consolidation has allowed Nash- governments is an idea with administrator of that unifi ed government ville to deal with issues such as economic intuitive appeal. In a country since it was created 17 years ago (and who development and securing sports teams C with nearly 90,000 units of before that was the city’s administrator without involving a lot of small political local government, wouldn’t it make sense for three years). Before the consolida- jurisdictions. And consolidation has pro- to combine some of them to reduce dupli- tion, he says, “we were slipping into the vided a larger tax base, something that’s cation of services and gain economies of deep abyss, and if we hadn’t done consol- critically important in eff orts to improve scale? The boundaries of our cities and idation when we did, who knows where services while holding down costs. As counties were established long ago—cen- we’d be?” Since then, he says, the quality another bit of evidence of the success of turies ago, in some cases—for reasons that of services has improved, thanks to econo- consolidation, Dean notes that once or often have been forgotten. And many of mies achieved by combining duplicative twice a year someone from another city the problems our governments face today departments. Taxes have been cut by 15 asks Nashville how to do it. pay no attention to political boundaries percent, and the combined workforce has The answer, of course, is that consoli- established when a day’s horseback ride been reduced by 20 percent. But in Hays’ dations are politically very diffi cult to pull might have determined the location of a view, having a single policy-making body off . Somebody has to give up power, and county seat. willing to take on the tough decisions has consolidations usually require a vote of the electorate in each of the combining juris- dictions. So it shouldn’t be surprising that there have been many more defeats than Consolidations are politically very diffi cult victories. Between 1921 and 1996, there to pull off. Somebody has to give up power, were 132 formal consolidation attempts “ with only 22 successes, according to a his- tory of consolidations by Pat Hardy of the and consolidations usually require a vote of the University of Tennessee’s Municipal Tech- nical Advisory Service. In the 1990s alone, electorate. So it shouldn’t be surprising that there were 13 unsuccessful consolidation referenda votes. there have been more defeats than victories.” Little wonder that many pundits keep declaring the idea dead. Yet it keeps com- But while those who lead consoli- made the biggest diff erence, resulting in ing up. Since 1805, when New Orleans dated city-county governments believe real improvements to the local quality of combined with Orleans Parish, there that the benefi ts are substantial, the evi- life. “We are an older blue-collar commu- have been 33 city-county consolidations, dence is mixed, at least as far as spending nity, and now we are seeing young people according to Hardy’s research, with about is concerned. Kurt Thurmaier, director wanting to move into Wyandotte for the two per decade since World War II and of the Division of Public Administra- fi rst time in decades.” four in the 1990s. The most recent con- tion at Northern Illinois University, says Nashville, Tenn., is in the process solidation was that of Louisville, Ky., and that while the selling point is effi ciency, of celebrating 50 years of consolida- Jeff erson County in 2003. that doesn’t happen very often. Some- tion with Davidson County. Mayor Karl Consolidation is not a panacea, but times, for example, only the major cities Dean, the combined government’s sixth in the end structure does matter. Where within the county are included, and when mayor since consolidation, believes that would New York City be today if it were employee salaries and benefi ts within the the overwhelming majority of his con- still fi ve separately governed boroughs? combining jurisdictions are brought in stituents would see the merger as a key Marrying political sovereigns is hard, line with each other, the rounding tends component of the success the city has but no consolidated government has to be up, not down. had, including not experiencing the pop- ever divorced. G Things have worked out better for ulation exodus that a lot of cities have. In Kansas City, Kan., and Wyandotte County, addition to effi cient service delivery, Dean Email [email protected]

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Editorial Prepress Cyan Magenta Yellow Black ® Page 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Other OK to go WHAT WE GUARANTEE IS AMERICA’S ABILITY TO MAKE PROGRESS.

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DAVID KIDD

The Halloween-ready home of New York state Sen. Webster Wagner, who served in the Legislature from 1871 until his death in 1882, was built in 1876 in the village of Palatine Bridge. Wagner was a railroad magnate who made his fortune building luxury “palace cars.” In a twist of fate, Wagner was killed in one of his own designs, when his train caught fi re after a crash in the Bronx. The house was added to the National Register of Historic Places in 1973 but has fallen into disrepair in recent decades. —Zach Patton governing.com/lastlook

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