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The economy fell off a cliff in 2008 as we experienced the most devastating downturn since the Great Depression. Unemployment hit double digits resulting in significant economic hardship and increasing demands on government safety nets and services to help those in need. At the same time, state revenues plummeted as workers lost their jobs and business activity contracted. As states struggled to balance their budgets in this weak economic climate, public officials in multiple states argued that the fiscal gaps were due to government workers and their unions.The fallout from the political jostling around public workers has been that hundreds of bills related to public employees and unions were introduced in state legislatures—most of which sought to restrict public sector unions. At least twelve states have significantly restricted collective bargaining through new legislation in 2011 including: Wisconsin, Ohio, Indiana, Arizona, Idaho, Michigan, New Hampshire, Oklahoma, South Carolina, Tennessee, Utah and Wyoming. A common rationale for these proposals is that growing costs associated with public sector workers, especially union-represented workers, are at the root of state budget deficits. Governor Scott Walker of Wisconsin said "we can no longer live in a society where the public employees are the haves and taxpayers who foot the bills are the have-nots." A conservative columnist in the Daily Journal noted "like Governor Christie, he [Governor Walker] decided to actually fix the problems that brought Wisconsin to this point. His budget limits government collective bargaining…" But, were public sector workers and their unions to blame for state budget problems?In this brief, we review the relevant research and analyze the relationship between public sector workers, their unions and state budget deficits. Our analysis finds that the size of the public sector workforce perthousand residents is not growing and previous studies have found that public sector compensation, as a share of public budgets, has not grown. Researchers have consistently found that public sector workers are not compensated more highly than their private sector counterparts after taking into account level of education, experience and other important factors. Finally, our regression analysis shows large state deficits were due, in large part, to the decline in house prices and not due to public sector workers and their unions. The bursting of the housing bubble was the precursor to the Great Recession and it is clear that the large drop in house prices (which capture much of the deteriorating economic climate) was central.

Enrollment navigators and government-employed Medicaid workers were an important element in the Affordable Care Act's (ACA) initial enrollment success. The Centers for Medicare and Medicaid Services eliminated 41% of funding for 2017 navigator programs and 90% of funding for outreach, arguing less investment was needed. Given that many remain uninsured, it is critical to identify effective enrollment practices. This study characterizes barriers and enrollment strategies from the perspective of California's Medicaid government and community-based enrollment workers (n=101 in eight focus groups). Participants identified a need for communication with policymakers, the state exchange, and each other regarding changing enrollment processes. Solutions include increased contact between enrollment workers to share strategies and policy updates regarding application processing, uniform policy interpretation, and details of ACA-related immigration law. Given efforts to weaken the ACA, it is critical to engage frontline workers in problem solving to streamline enrollment strategies, particularly for vulnerable populations.

Enrollment navigators and government-employed Medicaid workers were an important element in the Affordable Care Act's (ACA) initial enrollment success. The Centers for Medicare and Medicaid Services eliminated 41% of funding for 2017 navigator programs and 90% of funding for outreach, arguing less investment was needed. Given that many remain uninsured, it is critical to identify effective enrollment practices. This study characterizes barriers and enrollment strategies from the perspective of California's Medicaid government and community-based enrollment workers (n=101 in eight focus groups). Participants identified a need for communication with policymakers, the state exchange, and each other regarding changing enrollment processes. Solutions include increased contact between enrollment workers to share strategies and policy updates regarding application processing, uniform policy interpretation, and details of ACA-related immigration law. Given efforts to weaken the ACA, it is critical to engage frontline workers in problem solving to streamline enrollment strategies, particularly for vulnerable populations.

In early 2013, the California Legislature will consider bills implementing a key provision of the Affordable Care Act (ACA) which required states to expand Medicaid eligibility to low-income adults under age 65, including those without children living at home. This Expansion was effectively made optional for states by a 2012 Supreme Court decision and has not yet been formally enacted in California. In this report, the authors find that the Medi-Cal Expansion offers California the opportunity to significantly increase health insurance coverage at minimal cost to the state budget. Using the California Simulation of Insurance Markets (CalSIM) model, the authors predict that more than 1.4 million low-income adults will be newly eligible for Medi-Cal under the Expansion beginning in 2014. Other mandatory provisions of the ACA will lead to increased enrollment among Californians who are already eligible for Medi-Cal but not enrolled. This increase in coverage will have far-reaching benefits for Californians' health outcomes and the California economy. The report also estimates that the federal government will pay for at least 85 percent of new Medi-Cal spending in 2014 through 2019. In the initial years of implementation, most new state Medi-Cal spending will result from required Medicaid changes and will occur whether or not the Expansion is implemented. We find that the new state spending on Californians newly eligible for Medi-Cal will be largely offset by increased state tax revenues and potential savings in other areas of the budget. This is a joint report from the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research and funded by The California Endowment.