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Priority Open Recommendations: Department of Homeland Security

Pregnancy in Prison Statistics Project

Chicago Police Departments Use of ShotSpotter Technology


Professional Development Incentives for Oregon's Early Childhood Education Workforce: A Randomized Study

School Districts Have Expanded Their Nonacademic Services for 2021–2022, While Academic Offerings Remain Much the Same

Enhancing Teacher Preparation Through Clinical Experience


Unpacking Data Use in State Temporary Assistance for Needy Families (TANF) Agencies

A Clean Sheet Approach to Space Acquisition in Light of the New Space Force

Using Electronic Devices While Driving: Legislation and Enforcement Implications


The Uninsurance Rate Held Steady during the Pandemic as Public Coverage Increased

Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare's Solvency and Affordability Challenges

The Affordable Care Act After a Decade: Industrial Organization of the Insurance Exchanges

September 3, 2021


In April 2020, the authors identified 29 priority recommendations for the U.S. Department of Homeland Security (DHS). Since then, DHS has implemented 12 of those recommendations. In doing so, DHS implemented a more accurate methodology for the National Flood Insurance Program, strengthened efforts to address fraud risks within the asylum process, improved the U.S. Customs and Border Protection's risk management in the collection of antidumping and countervailing duties, and strengthened the effectiveness of the Transportation Security Administration's Transportation Worker Identification Credential, covert testing, and pipeline security programs. In August 2021, the authors identified 21 additional priority recommendations for DHS, bringing the total number to 38. The 38 recommendations fall into the following areas: emergency preparedness and response, border security, transportation security, infrastructure and management, information technology and cybersecurity, and chemical and nuclear security.

Source: U.S. Government Accountability Office

The Pregnancy in Prison Statistics project collected data for 1 year (2016-2017) from 22 state prison systems, the Federal Bureau of Prisons, 6 jails and 3 juvenile justice systems. These data represent 57% of females in prison and 5% of females in jail. Approximately 4% of females entering state prison were pregnant and about 3% of females entering jails were pregnant. Of the 816 pregnancies in U.S. prisons, 753 resulted in live births, 46 were miscarriages, 11 were abortions, 4 were stillbirths, and 2 were ectopic pregnancies. One hundred seventeen pregnant women admitted to state prisons had an opioid use disorder and 50 pregnant women admitted to jails had an opioid use disorder.

Source: Advocacy and Research on Reproductive Wellness of Incarcerated People, Johns Hopkins School of Medicine

Shotspotter is a gunshot detection system that uses a network of acoustic sensors to identify and locate suspected gunshots. In this report, the Office of the Inspector General for the City of Chicago details ShotSpotter’s functionality and descriptive statistics regarding law enforcement’s activity related to the Chicago Police Department’s response to ShotSpotter alerts. The authors found that between January 1, 2020 and May 31, 2021 a total of 50,176 ShotSpotter alerts were confirmed as probably gunshots by the device. Of the 50,176 alerts reviewed, 9.1% turned up evidence of a gun-related crime. The authors conclude that Chicago Police Department responses to ShotSpotter alerts rarely produce documented evidence of a gun-related crime, investigatory stop, or recovery of a firearm. Additionally, the authors found evidence that the introduction of ShotSpotter has changed the way some Chicago Police Department members perceive and interact with individuals present in areas where ShotSpotter alerts are frequent.

Source: Inspector General for the City of Chicago


Many states seek to increase the education levels of their early childhood education workforce to improve the quality of care for children. Oregon encourages all early childhood education workforce members to sign up for a career lattice, a career pathway system that helps them determine goals related to increasing their education. The state also offers incentives for reaching specific steps in the career lattice and scholarships for college credit and community-based training. This study used two randomized controlled trials in 2018 and 2019 to test whether sending emails and offering different financial incentives to Oregon early childhood education workforce members increased career lattice sign-up and increased education and training levels or workplace retention. The study found that sending emails encouraging career lattice sign-up had no detectable impact on career lattice sign-up or workplace retention. Sending emails offering a monetary incentive at an earlier-than-usual step on the career lattice had a positive impact on training hours recorded but no detectable impact on career lattice movement, college credit hours earned, or workplace retention. Sending emails about automatic enrollment in a scholarship program had no detectable impact on scholarship use, career lattice movement, college credit hours earned, or workplace retention. Lastly, after participants were randomly assigned to study groups, the email campaigns were implemented as planned, reaching all intended participants, although the interventions ended sooner than planned because of a state policy change. The findings suggest that low-touch interventions such as emails have promise for increasing training hours but are not sufficient to induce changes in career lattice sign-up, continuing postsecondary education, or workplace retention for Oregon early childhood education workforce members.

Source: Institute of Education Science

School districts in the United States are responding to the coronavirus disease 2019 (COVID-19) pandemic in significantly different ways. The authors of this report fielded the third American School District Panel survey in June 2021 to discover what changes districts are making to their academic and nonacademic offerings for the upcoming 2021–2022 school year, and whether parental demand has played any role in prompting districts to make these changes. In this report, the authors summarize key survey findings based on the responses of 292 district leaders, after weighting their responses to make them nationally representative. Survey results suggest that while public schools are expanding their non-academic offerings, much of their academic offerings for 2021–2022 remain the same. The authors examine differences between pre-pandemic and 2021–2022 offerings among district subgroups in the areas of summer programming, tutoring, grade retention practices, technology-related services, student health and weekend meals, academic recovery measures, and scheduling. The authors also found that most district leaders did not perceive a strong parental demand for changes to their children's schooling; however, there were some notable exceptions among leaders of urban, suburban, and majority–students of color districts, even though the correlation between perceived demand and district provision is currently weak. Parents' demands may still change public education in the long run, but the authors did not find evidence for this thus far.

Source: RAND Corporation

Effective educator preparation involves both coursework and clinical experience, which provides not only on-the-job training, but also opportunities for mentorship and real-time feedback. This report outlines common types of clinical experience in both traditional and alternative teacher preparation programs. It also points to research that highlights the role that clinical experience plays in retaining teachers and diversifying the workforce. There are several policy considerations provided including an overview of different clinical preparation models, a summary of key research on the benefits of robust clinical experience for recruiting and retaining an effective teacher workforce, and examples of state-level policies that support high-quality teacher preparation, including how to leverage clinical experience to improve workforce diversity.

Source: Education Commission of the States

Government Operations

This report summarizes results from a 2019 needs assessment of the capacity of Temporary Assistance for Needy Families (TANF) programs in 54 U.S. states and territories to analyze data used for the purposes of program improvement, monitoring, and evidence-building. It highlights areas of strength and success in how these agencies use data, as well as areas for growth. It also includes suggested strategies that may improve data use by TANF agencies. Positive characteristics of data use by state TANF agencies include the following: (1) Information is flowing to TANF decision-makers, especially through regular reports of aggregated data; (2) Agencies have access to a consistent set of data elements; (3) Agency staff members have knowledge of fundamental data analysis techniques and tools; (4) TANF staff members rate their agency’s data use highly. Areas for growth in state TANF agency data use include: (1) Limited staff capacity, especially staff time, restricts what agencies can do; (2) Users may not be able to understand or trust the data because of data quality or documentation challenges; (3) Some states have modernized data systems, but other systems are increasingly becoming obsolete; and (4) Agencies report access to employment data for TANF recipients, but access for analytical purposes continues to be a challenge.

Source: MDRC

The United States' newest military service, the U.S. Space Force (USSF), has a unique opportunity to take advantage of the widening range of commercial capabilities and create a new culture and new management processes to respond to the growing challenges presented by potential adversaries in space. To support this effort, U.S. Space Force leadership asked RAND Project AIR FORCE to develop a clean sheet acquisition approach designed around the unique mission and calling of the new service. The clean sheet vision for acquisition embodies a systematic and comprehensive approach rather than providing a menu of items from which to pick and choose. The recommendations in this report derive from a literature review and interviews with more than 45 current and retired senior leaders and space acquisition experts. The authors' clean sheet vision recognizes that potential adversaries are increasingly investing in space capabilities and that the pace of commercial innovation is increasing. The U.S. Space Force relies on space technology as a foundation to develop and sustain its joint warfighting capabilities and thus needs an acquisition approach focused on ensuring that the required capabilities are available when needed. To be effective in this context, acquisition processes must be rapid, agile, and, above all, threat-informed. The authors offer a new clean sheet acquisition vision for the technology-centric U.S. Space Force —acquisition as a warfighting capability rather than a support function.

Source: RAND Corporation

Distracted driving is a complex and ever-increasing risk to public safety on roadways. Drivers’ use of electronic devices significantly diverts human attention resources away from the driving task. The enforcement community faces significant challenges as electronic device use has expanded beyond simply texting or talking. Legislation regulating electronic device use while driving is inconsistent in content and implementation. This report presents the results of an examination of the current state and provincial legislation on electronic device use while driving; evaluates the benefits and impediments associated with enacting, enforcing, and adjudicating electronic device use; and proposes model legislation and educational materials that can be used by relevant stakeholders to enact a law and educate key individuals on the importance of the law. The in-depth review revealed that the jurisdictions used different strategies to enact or revise distracted driving laws, and that the content and wording of electronic device use legislation affect both acceptability and enforcement capabilities.

Source: Westat

Health and Human Services

Rapid job losses in the early months of the COVID-19 pandemic raised fears that millions of people would lose their employer-based health insurance and become uninsured. However, laid-off workers and their families, regardless of whether they previously had employer-sponsored insurance, had more options for health insurance than in previous recessions because of the safety net established by the Affordable Care Act. Congress further supported access to coverage by not allowing disenrollment from Medicaid through the March 2020 Families First Coronavirus Response Act. In this report, the authors examine national changes in health insurance coverage among non-elderly adults ages 18 to 64 during the pandemic using data from the Urban Institute’s Health Reform Monitoring Survey. Analysis focuses on changes in coverage across three rounds of the survey: March 2019; March/April 2020, just after the pandemic caused a steep decline in employment; and April 2021, more than one year after the secretary of health and human services declared a national public health emergency. The report found: Between March 2019 and April 2021, the share of nonelderly adults reporting had employer-sponsored insurance declined from 65.0% to 62.3%, a decrease of approximately 5.5 million adults. The share reporting public coverage increased from 13.6% to 17.5%, an increase of approximately 7.9 million adults. The national uninsurance rate held steady at approximately 11%. The share of adults reporting public coverage increased between 2019 and 2021 in both states that had and had not expanded Medicaid under the Affordable Care Act. Such coverage increased from 14.9% to 19.2% in expansion states and from 10.7% to 14.3% in non-expansion states. In Medicaid expansion states, the uninsurance rate was near 8% across all three study years. In non-expansion states, the uninsurance rate was higher in 2021 (18.2%) than in 2020 (16.5%) and 2019 (17.2%), though the difference between 2019 and 2021 was not statistically significant. Declines in employer-sponsored insurance and increases in public coverage between 2019 and 2021 were concentrated among adults with low and moderate incomes. Uninsurance rates among the national non-elderly adult population did not change significantly for any income group examined. The share of adults with low incomes reporting public coverage increased in both expansion states (from 54.6% to 62.9%) and non-expansion states (from 30.4% to 37.3%) between 2019 and 2021. More than one in three adults with low incomes in non-expansion states (37.7%) were uninsured in 2021, compared with about one in seven of such adults in expansion states (14.5%).

Source: Urban Institute

The number of people enrolled in Medicare has increased steadily in recent years, and along with it, Medicare spending. In particular, enrollment in Medicare Advantage, the private plan alternative to traditional Medicare, has more than doubled over the last decade. Notably, Medicare spending is higher and growing faster per person for beneficiaries in Medicare Advantage than in traditional Medicare. As enrollment in Medicare Advantage continues to grow, these trends have important implications for total Medicare spending, and costs incurred by beneficiaries. In its 2022 budget, the Biden Administration expressed support for reforming payments to private plans as part of efforts to extend the solvency of the Medicare Hospital Insurance Trust Fund and improve affordability for beneficiaries. This analysis examines Medicare spending per person for beneficiaries in Medicare Advantage, relative to traditional Medicare. The authors build on prior work published by the Medicare Payment Advisory Commission and the Centers for Medicare and Medicaid Services Office of the Actuary to provide estimates of the amount Medicare would have spent for Medicare Advantage enrollees had they been covered under traditional Medicare in 2019 (the most recent year for which data are available). Using publicly available data from the Centers for Medicare and Medicaid Services that includes spending for people who were enrolled in both Part A and Part B of traditional Medicare, by category of service, as well as information on average risk scores and enrollment by county. This allows calculating per-person spending for beneficiaries in traditional Medicare on a basis comparable to federal payments per enrollee in Medicare Advantage. The authors also examine the extent to which the projected growth in Medicare Advantage spending is attributable to the growth in enrollment and the increase in spending per person. Then the authors illustrate potential savings to the Medicare program between 2021 and 2029 under two alternative scenarios where Medicare Advantage spending per person is lower or grows slower than under current projections.

Source: IssueLab

The regulated insurance exchanges set up in the Affordable Care Act (ACA) were designed to deliver affordable, efficient health coverage through private insurers. It is crucial to study the complex industrial organization of these exchanges in order to assess their impacts to date, during the first decade of the ACA, and in order to project their impacts going forward. The authors revisit the inherent market failures in health care markets that necessitate key ACA exchange regulations and investigate whether they have succeeded in their goals of expanding coverage, creating robust marketplaces, providing product variety, and generating innovation in health care delivery. They discuss empirical industrial organization research to date and also highlight shortcomings in the existing research that can be addressed moving forward. They conclude with a discussion of industrial organization research-based policy lessons for the ACA exchanges and, more generally, for managed competition of private insurance in health care.

Source: National Bureau of Economic Research

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