Manhattan Institute for Policy Research

Why do states subcontract Medicaid to private insurers when government funds it, sets coverage and prices, and often doesn’t competitively bid contracts?

A new MI report by Chris Pope finds Medicaid Managed Care covers 77% of enrollees but shows little evidence of cost savings or better care. Instead, opaque contracting has enabled funding loopholes, including a $19B windfall in California over four years.

It also finds higher denial rates than Medicare Advantage and weak payment transparency—raising serious questions about how the system is working in practice.

Pope recommends closing funding loopholes, standardizing contracts nationally, requiring detailed spending disclosures, and allowing states to outsource claims administration directly to the federal government for greater accountability.

Read the full report: https://bit.ly/49q7R3s

Federal agencies often govern through informal guidance documents—not just formal regulations—creating what some scholars call “regulatory dark matter.”

A new MI brief by Alex J. Adams examines how HHS's Administration for Children and Families eliminated roughly 75% of its outdated or redundant guidance documents and implemented reforms to prevent future buildup.

Read the entire issue brief: https://bit.ly/3PRsM93

More than half of L.A.’s street homeless population are not from Los Angeles.

In a new City Journal piece, Christopher F. Rufo and Kenneth Schrupp report that a majority of individuals experiencing homelessness in Los Angeles originated outside the city or county.

In a street survey of more than 200 individuals across Hollywood, Venice, and Skid Row:

• 64% said they were from outside the City of Los Angeles
• 53% said they were from outside Los Angeles County
• Nearly 40% said they were from other U.S. states
• 6% said they were from outside the United States

These findings align with prior LAHSA and RAND datasets, which also found a significant share of unsheltered individuals were last housed outside the region.

The implications of the survey are clear: simply building housing will not solve Los Angeles’s homelessness problem, and the wrong kind of housing program may even make it worse. Providing permanent housing with no conditions, the argument goes, simply encourages more nonresidents to come to Los Angeles.

The real solution, it concludes, is to reverse the polarity of the “magnet” by enforcing drug and camping laws, mandating treatment, and insisting on clean and orderly streets.

Read the entire piece: https://bit.ly/4uiAdVL

What good is a school building without students in it?

A new MI issue brief by Danyela Souza Egorov examines the growing impact of declining public-school enrollment in New York City and across the country.

K–12 public school enrollment is projected to fall 6% by 2030, driven by declining birth rates and more families choosing alternatives like charter schools and homeschooling.

NYC enrollment alone is expected to drop from roughly 845,500 students today to about 750,000 by 2030.

The report finds that many NYC schools are operating with fewer than 150 students while spending far above the citywide average per pupil. Egorov argues that merging or closing persistently under-enrolled schools and ending the city’s costly “hold-harmless” funding policy could save hundreds of millions annually.

As enrollment declines continue, districts will face difficult decisions about how to allocate resources sustainably while continuing to serve students effectively.

Read the full issue brief: https://bit.ly/434ySWs