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The State of the States in Developmental Disabilities: It's Not Good, Especially in Red States

Pardon my excursion into graphs and scatterplots today. There is a broader purpose.

Last Tuesday I hit the “send” button on a big grant concerned with intellectual and developmental disability (I/DD) policy issues. Last Wednesday, the bible of the field, State of the States in Developmental Disabilities, appeared in my mailbox. Such is life.

State of the States is a periodic compendium of state policies, service patterns, and spending across the country. (It’s a telling commentary on the separation between disability policy and health policy wonkdom that few among the latter group even know that State of the States exists.) It has been a few years since David Braddock and his University of Colorado colleagues put out the last version of this book.

The 2011 edition extends previously-available data from 2006 to 2009. As such, it provides a sobering window into the human impact of the current recession. I/DD services serve a highly-valued, highly-vulnerable population. Yet these services are also quite costly, particularly to states and localities having difficulty carrying the load. States’ different approaches to preserving or to cutting these services in hard fiscal times thus provides a real signal of states’ larger values and vision of government.

By a variety of metrics, state budgetary retrenchment in I/DD is the deepest anyone has seen since the late 1970s when records were first kept. Between 2008 and 2009, 23 states reduced their inflation-adjusted spending on ID/DD services.

If one excludes federal dollars from the calculation, 47 states reduced I/DD service spending between 2008 and 2009. (I am grateful to David Braddock for permission to reproduce the above graphic.)

Such retrenchment comes at a delicate time, when many states are finally closing large institutions and seeking to implement better intellectual disability care models at a more human scale. As Braddock puts things, “It’s unfortunate that the U.S. economy and state budgets encountered such difficulties just at the time of liftoff from institutions to community-based care. This is a huge setback to millions of intellectually disabled people and their families.”

Across the nation, the average spending reduction was twelve percent, with Alabama, South Carolina, Idaho, and Rhode Island reducing state expenditures by more than one-quarter. Increased federal support partly cushioned the impact, but not completely.

As at least the first three of these states suggest, ideology and visions of government also play a role. (I’m not sure what’s happening in Rhode Island, historically one of the nation’s top spenders.) Although almost every state faces serious fiscal challenges, states can respond to these challenges in many different ways, ranging from tax increases to wage and spending freezes to cutting corrections and K-12 education, and more.

States’ responses obviously reflect specific circumstances. With due allowance for this fact, the State of the States data are striking in the extent that states’ funding cuts are correlated with broader partisan politics and ideology.

I graphed two scatterplots with Braddock’s data to show the broader point.

In the first scatterplot, the vertical axis represents states “fiscal effort” on intellectual and developmental disability services. Following convention, fiscal effort is simply defined as dollars spent per $1,000 of personal income. It’s not a perfect measure, but it’s a useful general indicator with some implicit adjustment for the varied economic landscape across the nation.

The horizontal axis is an even simpler measure designed to distinguish blue from red states. It is the proportion of the state’s voters who cast their vote for Barack Obama rather than for John McCain in the 2008 presidential election.

I also performed a simple regression analysis to quantify these relationships. The predicted values from this analysis are shown in the straight dotted line.

A more respectable analysis would include other factors, such as the governor’s party affiliation. The results are simple enough. Many traditional red states such as Oklahoma, Utah, Alabama, and Texas are clustered in the southwest quadrant. In contrast, traditional blue states such as New York, Connecticut, and Maine are clustered, well, in the northeast quadrant of the above graph. In fact, a one standard-deviation rise in Barack Obama’s voting share was associated with an accompanying 0.54 standard deviation rise in states’ fiscal effort in supporting intellectual disability services.

I then examined states’ responses to the great recession. The scatterplot below shows the percentage change in states’ spending on I/DD services from 2008 to 2009, again graphed against Barack Obama’s share of the two-party presidential vote. I again performed a simple regression analysis and plotted up the resulting predicted values.

The same general pattern held. In the regression analysis, a one standard-deviation rise in Barack Obama’s voting share was associated with an accompanying 0.47 standard deviation rise in states’ fiscal effort in supporting intellectual disability services.

It’s especially concerning that some of the states with the lowest fiscal effort going into the great recession—South Carolina, Oklahoma, Texas, and others—were among those making the deepest cuts between 2008 and 2009.

These graphs are incredibly concerning, especially when one considers that by all accounts the numbers for 2010 and 2011 are expected to be worse. The end of the stimulus withdraws key federal assistance dollars keeping many states afloat. The end of the stimulus also signals the end of its enhanced federal matching rate for Medicaid services. The enhanced match provided very strong financial inducement for states to maintain costly Medicaid services.

These are hard times for Americans who need human services. Hard times also place our political values into stark relief. States are making hard choices about the size and role of government.

When it comes to providing services to the intellectually and developmentally disabled, the differences between blue and red states are pretty stark.