Map: What States Have the Most Discouraged Workers?

This map shows the variation in discouraged workers nationally.  Discouraged workers are unemployed Americans who have given up looking for a job for awhile and have not applied for any jobs in the past 4 weeks.

In no states does the percentage of discouraged workers exceed 1%, so the numbers are relatively low. This map calculates discouraged workers as the U4 unemployment measure by the Bureau of Labor Statitistics minus U3.  U4 consists of the official unemployment measure (U3) plus discouraged workers.  So I've pulled discouraged workers out and looked at the spread of data by standard deviations.

North Dakota's oil-fueled jobs boom continues to keep that state's unemployment the lowest in the US.  Nevada's 9.7% unemployment (U4 measure) is actually higher than South Carolina's 9.3% rate, but the Palmetto State has the highest percentage of discouraged workers in the country -at least in December 2013.  Neighboring Georgia, Alabama, and Florida also have higher percentages of discouraged workers compared to the mean for the United States.

Maps: Comparing the Unemployment Measures

This series of maps shows the 4 highest unemployment measures for December 2013:

• U3 -the official unemployment rate
• U4 -U3 plus discouraged workers
• U5 -U4 plus marginally employed workers
• U6 -U5 plus part-time workers unable to find full-time jobs

You can see more discussion of the six measures of unemployment here.

 U4:  The addition of discouraged workers who have not looked for a job in the past 4 weeks because of the lack of jobs pops Nevada's unemployment rate to over 10%.

U5:  Marginally employed workers are those who report they would like a job but are not looking.  If the jobs market was better, they report they would look for work.

U6:  This is the highest measure of unemployment computed by the US Bureau of Labor Statistics.  In December 2013 Nevada led the country in unemployment with a figure of 18.1% on U6.  In other words, almost 1 in 5 workers in Nevada cannot find a full-time job.

Pew: Despite recovery, fewer Americans identify as middle class

Pew Research Center:
Despite recovery, fewer Americans identify as middle class

Map: The OFFICIAL December 2013 Unemployment Figures by State

Last week I posted about the 6 measures of unemployment (U1 - U6) calculated by the US Bureau of Labor Statistics. This map shows the official measure of unemployment (U3).  The national U3 number is 6.7% of the civilian labor force is unemployed.  Nevada has the highest unemployment.  North Dakota has the lowest unemployment in December 2013.

UPDATE: What's the REAL Unemployment Rate?

December 2013 Unemployment Rates, US Bureau of Labor Statistics

Did you know there are actually SIX unemployment rates?  There are.  The US Bureau of Labor Statistics calculates 6 unemployment rates (U1-U6) each month and adjusts them for seasonal employment.  The official unemployment rate is U3 and in December 2013 that rate was 6.7% of the civilian labor force were unemployed.  That's not the whole picture though:

U1 is the percentage of people unemployed for 15 weeks or longer
U2 is the percentage of people who have lost a job or completed a temporary job
U3 is the official unemployment rate and is the percentage of people who are unemployed and have actively looked for work within the past 4 weeks
U4 is the U3 figure combined with discouraged workers who have given up looking for a job until the job market improves
U5 is U4 plus marginally attached workers who are able to work and would like a job but have not looked for a job recently
U6 is U5 plus part-time workers who cannot find a full-time job

So, while the official unemployment rate is down to 6.7% in December 2013, this figure only includes people who have looked for work in the past 4 weeks and who are not employed part-time.

At 6.7%, that means that 1 in 15 Americans cannot find a job.  Using U6, 1 in 8 Americans in the labor force cannot find a full-time job.  1.4% of the labor force have given up looking for a job right now, and 5% of workers are stuck in a part-time job unable to find full-time work.

UPDATE:  My friend Michael points out that these rates are for the civilian labor force and thus do not include American military workers and many/most Federal workers.

And Florida Joins the Same-sex Marriage Fight

Yesterday Equality Florida, that state's leading LGBT advocacy group, filed a lawsuit seeking to overturn Florida's ban on same-sex marriage and legalize same-sex marriage in America's 4th most populous state. This means:

• 21 states with active lawsuits directly seeking to legalize same-sex marriage
• 4 states with active lawsuits related to same-sex marriage
• 17 states + DC where legal same-sex marriages are on-going and uncontested
• 1 state trying to actively ban same-sex marriage by amending its state constitution (Indiana)

It is difficult to categorize some cases as seeking to legalize marriage or only related.  In the four states with active lawsuits related to same-sex marriage, two involve couples being able to file joint state tax returns.  In Kansas a lawsuit is seeking the right of same-sex couples married in other states to file jointly on their state tax returns.  Married couples throughout the US can now file jointly on their Federal taxes.  Next door in Missouri, the governor issued a regulation allowing married same-sex couples to file jointly on their state taxes.  An anti-gay group is now suing to stop joint state tax returns in Missouri.

Wisconsin has a domestic partnership law that gives same-sex couples 44 of the 200+ state benefits of marriage.  An anti-gay group sued claiming this law runs afoul of that state's ban on same-sex marriages.  The case is proceeding there over the partnership law and not marriage.

Similarly, a Montana lawsuit is seeking all the benefits of equal civil marriage for same-sex couples but not actual marriage.

The Typical American, Education

The American Community Survey collects data on educational attainment.  Among Americans aged 25 years and older:

86% have a high school diploma or higher (includes equivalencies such as a GED). 

57.5% of Americans 25 and older have attended college.  

28.5% -or roughly 1 in 3.5- have a Bachelor’s degree or higher.

So like the majority of Americans, Jennifer, our Typical American, graduated high school.  Like the plurality of Americans however, she did not attend college.  If you have a college degree, you are among an elite minority in the United States in terms of educational attainment.

The Typical American, Political Party

Gallup just released a new poll on January 8, 2014, of 18,000 Americans that finds the largest percentage of Americans ever identifying as independents.  While the percentage of Americans identifying as Democrats has held steady since 2010, a number of former Republicans have shifted to identifying as independents.  Thus, Jennifer, our Typical American, would identify as an independent. Party registration and party identification tend to be in monthly flux from Gallup data.  Thus, Jennifer might be registered as a Democrat or Republican but identify her party based on her current satisfaction or dissatisfaction with a political party.

Gallup also finds in another poll that 78% of American adult citizens are registered to vote.  So, Jennifer is registered to vote.

George Mason University’s Elections Project estimates the 2012 voter turnout to have been 58.2% of the voting eligible population.  The majority of Americans –and thus Jennifer- vote during presidential elections but do not vote in non-presidential elections.

UPDATE: Same-Sex Marriage in the USA

"Oklahomo...where marriage comes sweeping down the plain..."  OK, that lyric was just too good to pass up.

Yes indeed, a Federal judge in Oklahoma this week ruled that Oklahoma's state constitutional amendment reserving marriage as a special right for opposite-sex couples violates the US constitution.  Judge Kern overturned the ban, but stayed the ruling from going into effect while Oklahoma appeals the decision.  In other words, Kern's decision means civil marriage for both same-sex and opposite-sex couples is now the law in Oklahoma, but in real terms no actual same-sex marriage licenses can be issued until a higher court rules.

This case has an unusual twist.  It was originally filed a decade ago in 2004 but was revived after the US Supreme Court ruled in United States v. Windsor, the case that overturned the part of the 1996 Defense of Marriage Act barring Federal recognition of same-sex marriages legally performed in some states.

Kern's decision in OK and Judge Shelby's decision in UT both will be heard by the 10th Circuit of the Federal Appeals Court which hears cases from UT, OK, CO, NM, WY, and KS.

The Typical American, Children

Does Jennifer, our Typical American, have children living at home?  The American Community Survey (US Census Bureau) tells us that a minority (around 30%) of households have children living with a parent.  So, no, Jennifer does not have children.  She and her husband fit into the household type making up the plurality in the US:  married without children.

America in 2016?

Today's map pictures the United States in 2016.  Half the states and DC have implemented the Medicaid expansion provision of the Affordable Care Act ("Obamacare").  Massachusetts has had basically the same system ("Romneycare") since 2006.  If the other 24 states and DC follow a similar path as Massachusetts, what could the US look like health-wise in 2016?  Imagine an America where half the country had Medicare, Medicaid, and Social Security...and the other half didn't.  What would the health and economic results look like?

If the percentage of uninsured people drop to match Massachusetts' 2010 rate of 5%, then in these 25 states and DC around 1 in 20 people will still be uninsured.  That is quite a bit lower than in many of the other 25 states where 1 in 4 people may be uninsured.

Based on Massachusetts' experience, here are some likely outcomes for the states implementing Medicaid expansion.  With all these newly insured Americans seeking healthcare, demand for medical appointments will be high.  ER visits should also go up.  Wait times for appointments will be longer.  Massachusetts has the highest doctor-to-patient ratio in the US, so this crunch may be even more challenging in other states.

Healthcare delivery also may change with a greater reliance on nurse practitioners, physician assistants, and other means to provide care to more people.  With preventative health screenings now free, the percentage of women 50 and older who have had a recommended mammogram jumps to over 80%.  Hospitals in these states who previously had to provide free care to the uninsured rushing to ERs will now be compensated for the medical care they provide.  With the Federal government picking up the tab for the Medicaid expansion 100% until 2017 and then reducing its coverage percentage to 90% by 2022, states expanding Medicaid will be receiving a massive influx of Federal tax dollars translating probably into more healthcare jobs, a boost in students seeking medical careers, construction jobs as clinics and hospitals expand, and other economic benefits from this huge infusion.

Map courtesy of Kaiser Family Foundation

For the other 25 states, things may potentially be quite different.  The first map showing the US in 2016 likely exaggerates the percentage of uninsured.  The darker brown colors show the actual 2010 percentage of uninsured in each of the 25 states not expanding Medicaid.  Even in these states the Affordable Care Act still mandates all but a handful of groups must be enrolled in some type of health insurance.  Low income Americans are eligible for subsidies to buy private health insurance, but a sizeable chunk of the working poor are being covered in other states by the Medicaid expansion.  As originally planned, these individuals earning between 101-135% of the Federal poverty limit were to be covered by the Medicaid expansion and are not currently eligible for the subsidies.  The decision by some states to not expand Medicaid leaves these low income Americans in the so-called "Medicaid doughnut hole" -and thus are likely to remain uninsured.  This doughnut hole will keep 5 million Americans from getting health insurance in the 25 Medicaid doughnut hole states.  Many of these states already suffer some of the worst health outcomes for their people in the country.  If half the country is getting to see a healthcare provider and getting regular preventative care and a big chunk of Americans in other states are not, we may start seeing a widening health gap between the healthy states and the sick states -especially between the sick South and the healthier rest of the country.

Residents in states that have chosen not to expand Medicaid often face other roadblocks to getting health insurance.  A recent study finds that states which set up their own health exchanges are doing a much better job at enrolling their uninsured citizens than those relying on the Federal healthcare.gov exchange.  Florida's governor even went so far as to ban health department workers from assisting citizens in signing up for health insurance through the Affordable Care Act.  Several FL counties are getting around the ban to help their citizens.

On the economic front, these No-to-Medicaid-Expansion states face the economic short end of the stick.  Hospitals serving the uninsured still must by law provide care to those with life-endangering conditions.  In effect most hospitals almost never turn anyone away.  The Federal government for years has provided a fund to help compensate these hospitals who treat large numbers of the uninsured.  With the ACA planned to cover most all citizens, this fund is cut in half by 2016.  Now with 25 states opting out of expansion, these hospitals will have less Federal dollars to offset their costs.  One of their few options is to raise premiums on their insured customers.  So, expect insurance costs to rise more in the non-expanding states and the possibility of cash-strapped rural and inner city hospitals to close in bankruptcy.  The tax dollars of these mostly Republican Red State voters will be going to help support the Affordable Care Act.  While a chunk of these dollars are flooding into other, mostly Democratic Blue States' Medicaid programs, hospitals, and healthcare providers, they will be draining out of these Red states.    This scenario is pushing hospital associations in a number of states to ask their governors and legislatures to expand Medicaid.  Indiana and Pennsylvania are already working on this.  Republican governors in Arizona, New Mexico, Michigan, etc. already came come on board by expanding Medicaid in their states.  So by 2016 we likely will see several other states expand Medicaid as economic and health realities trump politics.  

Many things may change by 2016, but there is a real possibility of a growing economic and health divide to emerge between the states insuring millions of their uninsured and those that do not.

The Typical American, Names

Reuben Fischer-Baum 

Reuben Fischer-Baum 

The Typical American, Sex & Age

The Four Corners: Gay, Married and Confused in 2014!

Imagine going to the beautiful Four Corners where the states of Arizona, Colorado, New Mexico, and Utah meet.  This quirk of state boundary lines creates the only place where 4 states meet at one point.  This spot also underscores the growing complexity of being gay and married in 2014 America:

Let's say you are gay and married:

So let's start with our foot in New Mexico.  Good news!  New Mexico recognizes your marriage.  You and your spouse can file state taxes jointly, have your names changed on state forms easily, adopt together, be recognized as the legal parent of your step-children, not have to testify in court against your spouse, apply for immigration for your non-citizen spouse, be granted a divorce, have inheritance rights, and so on and so on. You and the mister/missus and kids get the whole treasure box of 1000+ Federal benefits plus the dozens/hundreds of state ones.

But wait!  If you're a member of the Navajo Nation, there is a complication.  New Mexico recognizes your marriage, but the Navajo Nation does not for purposes of tribal benefits.  The Navajo Nation spans parts of New Mexico and Arizona.

Next let's shift our foot over into Arizona.  Alas, no marriage for you!  Arizona's constitution specifically bans same-sex marriages and their recognition.

But wait!  After the 2013 US Supreme Court ruling regarding DOMA (the Defense of Marriage Act), the Federal government does recognize your marriage if you got married someplace outside of Arizona.  You can at least file your Federal taxes jointly.  Arizona though will still require you file your state taxes separately and has created a new form to be used by married couples...who aren't married in Arizona but are married in the USA.  Headache?  Perhaps the pending lawsuit to overturn Arizona's ban on marriage will clear things up.

Next let our foot scoot over to neighboring Utah.  Things are even more complicated here.  Two-thirds of deeply conservative Utah's voters approved an amendment to the state's constitution stomping out the specter of same-sex marriage.  Alas, a Federal judge ruled in December 2013 that this state ban violated the US Constitution based on the DOMA ruling.  Hundreds of couples scurried to marry.  The state sought a stop to the marriages while it appealed the ruling.  The original judge said no.  The Federal Circuit Court of Appeals said no too.  Finally, the US Supreme Court in January stopped the Utah wedding bells until the case gets settled.

So, what if you married in Utah in December?  Are you still married?  Will the state recognize you as married while the appeals process goes on?  Who knows?!

It gets even more complicated.  After the DOMA ruling, the Federal Department of Defense began granting married same-sex couples the same benefits it provides other married couples.  So, if you're a soldier and got hitched recently in New Mexico, no problem!  But, the Department of Defense is stumped too whether these recent Utah marriages are legal or not.  So it isn't sure it will grant your family military benefits if you got married in December in Utah.

Add to this situation that Utah's state government hasn't decided either how to handle state taxes for same-sex couples married in Utah...or married in another state too.  Better seek an accountant this year!

Whew!  Let's end our journey over in Colorado, the land of Rocky Mountain Highs...cough cough.  Yes, recreational marijuana is now legal in Colorado but not same-sex marriages.  On the other hand, the state does offer civil unions along with its tasty brownies and ski slopes.  If you get a civil union, you get most of the state same benefits to civil marriage except the name.  Even opposite-sex couples can get a civil union in Colorado.  Plus, the state will recognize your civil union if performed in another state.

But wait!  You're married; not in a civil union. Now things get tricky.  Colorado's legislation makes it clear that a civil union is not a marriage.  So you'll need to get a civil union to go with your marriage.  Are you a bigamist if you have a civil union and marriage with the same person?  Consider for a moment that North Dakota's Attorney General recently ruled that a ND man married to another man who lives in another state can marry a woman in North Dakota without getting divorced first from his first marriage to his husband.

But back to Colorado.  A legislator just filed a bill that will allow married same-sex couples to file their state taxes jointly.  If, however, you only have a civil union then you will still have to file separate state tax forms.

On the good side, this Colorado situation is so new that I bet there is not a single wedding etiquette book that says you cannot register twice:  once for your civil union ceremony and again for your marriage out-of-state.  Twice the fun.  Twice the loot.  Right?

Sigh!  Is your head spinning?  Well, better be careful.  If you fall and are knocked unconscious, in which state you land may determine if your spouse/'friend' gets to stay with you in the hospital and make medical decisions for you.

January 2014 Status of Same-sex Marriage in the US

The status of same-sex marriages and their legal recognition is rapidly changing in the United States.  Let's do a quick recap:

Federal:  In 2013 the US Supreme Court overturned the 1996 Defense of Marriage Act (DOMA) which barred federal benefits to same-sex couples legally married in the United States or abroad.  As a result, same-sex marriage is basically legal in all 50 states ...in terms of Federal benefits.  So, if you get married in a state allowing same-sex marriages, various Federal agencies will recognize your marriage regardless of whether you live in a state with legal same-sex marriage or live in a state without same-sex marriages.  Thus, a couple in Kentucky can marry in Illinois and file their Federal taxes jointly, sign up their spouse for military benefits, be treated as a married couple for the purposes of immigration, etc.  In other words, these couples will be treated in theory no differently than any other legally married couple.

At least this is the case in theory.  Several states which ban same-sex marriages are requiring these married couples to file separately on their state taxes -even though the state forms require referencing their joint Federal tax return.  What a headache!

17 States With Legal Marriage:  In 17 states, DC, and in six tribal nations, a same-sex couple can walk into the property local office, apply for, and get a marriage license.  (See the dark blue states on the map above.

Utah:  In December 2013 a Federal judge threw out Utah's constitutional ban on same-sex marriage and opened the doors for hundreds of Utah couples to marry.  Utah requested a stay on the decision until the state government could appeal the decision.  The original judge and the 10th Circuit of Appeal both turned down a stay.  Utah then appealed to the US Supreme Court which in January 2014 granted a stay until the appeal could be heard.  So now the lower court's decision is being appealed, and the status of the hundreds of newly married couples is unknown.  In the only similar situation when CA legalized and then banned same-sex marriages, the courts recognized those couples who had married when marriage was legal there. (It is legal again since 2013 in California by the way).

Ohio:  Another Federal judge in Ohio ruled in 2013 that Ohio must recognize same-sex couples who have legally married in another state on death certificates.  So, this ruling is narrow and only involves death certificates.  In this case and in Utah, both judges relied on the recent US Supreme Court's ruling on DOMA.

Oregon:  Oregon has offered same-sex couples civil unions since 2007.  It also has a constitutional ban on same-sex marriage.  Now there are efforts to remove this constitutional amendment in Oregon and legalize marriage.  In the meantime the state has announced it will recognize same-sex marriages performed in other states and abroad.  A lawsuit is also challenging the state ban on marriage.

North Dakota:  In a truly bizarre legal twist, North Dakota's attorney general ruled in 2013 that a North Dakota man who had married another man in another state could marry a woman in North Dakota ...without getting a divorce!  The potential bigamist could not get a divorce from his husband in ND because neither he nor his husband lived in states recognizing same-sex marriage.  Since ND doesn't recognize his marriage, the ND Attorney General ruled he could legally marry a woman in ND.

Lawsuits in 20 States:  As of January 8, 2014, there are legal cases pending in 20 states (including UT and Oregon) seeking to have these states recognize same-sex marriages.

Other 12 States:  In 12 states same-sex marriages are banned, and I could find no current pending lawsuits challenging these bans.  In Ohio the death certificate case opens the door for a wider challenge.  Wyoming's legislature considered a civil unions bill but shot it down.  In Florida the leading LGBT organization is reportedly seeking plaintiffs to challenge that state's ban.  Missouri's governor has said the state will recognize legally married same-sex couples for tax purposes but some members of the legislature are vowing to fight this regulatory policy change.

Navajo Nation:  The Navajo Nation's reservation lands include areas of New Mexico where same-sex marriage became legal in 2013, but a 2005 law bans same-sex marriage recognition by the tribal government.  There is now a push to legalize same-sex marriages in the Navajo Nation.  If successful, the Navajos would join 8 other tribes where same-sex marriages are now legal and recognized.

Culture and Health

In my years of working in public health, I've come to see how culture plays an important part in the health behaviors we choose.  So today's post tells one of stories I've collected over the years about health choices:

I used to share an office suite with a retired dentist.  Jim is a great guy and would tell me stories from his decades of experience in oral health care in Kentucky.  One day he told me about a time a mother brought in her 16 year old daughter to his office.  The mother had false teeth, and Jim figured that this may have driven her to be concerned about her own daughter's oral health.  Jim checked the daughter's teeth and was happy to tell the mother than the daughter's teeth were in good condition.  He asked if there was any special problems beyond a routine cleaning and checkup that may have brought the pair to the dentist.  The mother quickly spoke up and said:  "Oh yes.  She's 16, so it's time."  

Jim:  "Oh?  Time?"

Mother:  "Yes.  For you to pull her teeth so she can get her false teeth."

Jim (shocked):  "What?"

Mother:  "I had my teeth out when I was 16 and got my false teeth.  So it's time."

Jim explained that the daughter had perfectly healthy teeth and did not need to have them extracted.  The mother strongly disagreed and demanded Jim pull her daughter's teeth and replace them with false teeth.  Jim refused, and the mother left in a huff.  He heard she eventually found a dentist who did pull her daughter's teeth and replace them with false teeth.  

I found this story rather bizarre.  I have no idea how long ago this scene took place or how this rural family became convinced that good oral health meant getting false teeth at the age of 16.  It certainly isn't the norm today among rural or urban Kentucky families.

Gestational Diabetes

The percentage of American adults who have ever been diagnosed with gestational diabetes is relatively low, but there are some significant differences between states.  Some states with relatively high gestational diabetes numbers (CA for instance) are below average in the percentage of adults with Type 2 diabetes.

Diabetes in America

As Americans have grown fatter, the percentage of adults with diabetes has also risen.  Diabetes involves the inability of the body to process sugars derived from the foods we eat.  Type 1 (AKA childhood diabetes) is inborn where a child's body lacks the ability to produce enough insulin.  Type 2 (AKA adult onset diabetes) usually involves obesity where a steady diet of sugar, carbohydrates and other such foods have burnt out the body's ability to produce enough insulin and/or created a condition where the body's cells have developed resistance to insulin.

Another kind of diabetes develops among some pregnant women -gestational diabetes.  Diabetes is an inflammatory disease and some recent studies point the possibility that Alzheimer's disease is actually Type 3 diabetes.

In more than a fifth of states -12 to be exact- the percentage of diabetic adults has now risen to more than 10%.

Fat in America

Happy New Year!  The start of a new year is often also the start of a new diet or health plan for many Americans.  The holidays have come and gone and left many with a few extra pounds.  So I thought today would be a good day to look at what else -obesity data!

Measuring obesity is somewhat complicated.  Because it is a relatively easy measure to gather, most survey data -including the CDC's Behavioral Risk Factor Surveillance Survey (BRFSS) data- use people's height and weight to calculate their Body Mass Index (BMI).  It is far from a perfect measure.  If you really are "big boned" as the country saying goes or are muscular, you may have a higher BMI but not be overweight. Or, you might come from an ethnicity of smaller framed people and rate as underweight when you are actually a healthy weight.  Still, for most people, the BMI is a relatively accurate measure of obesity.

The CDC breaks overweight people into the categories of Overweight (see above) and Obese (see below). Overweight people have a BMI of 25 to 29.9.  Obese people have a BMI of 30 or higher.  Being overweight puts you at risk for a shorter life, heart disease, diabetes, knee problems, and even psychological issues related to stigma against the overweight.

You'll notice that some states have relatively high percentages of people who are overweight but not that high of percentages of people who are obese.  Arizona stands out with this pattern.  Mississippi -which leads the country in the highest percentage of overweight and obese adults- has a relatively low percentage of people who are overweight in part because so many adults have transitioned into the obese category.

Even while obesity has risen across the country, a general pattern has emerged where the western states and northern tier states are relatively thinner than the South.