This report examines the basic expenses Ohio families face, to better understand why so many Ohioans cannot afford to purchase insurance or pay their growing portion of costs for premiums, co-pays, costsharing, deductibles and prescriptions.

For undocumented immigrants, the explicit denial of coverage under the Affordable Care Act (ACA) has kept many without access to preventive services and basic health care. Although ACA enrollment in California has far outpaced any other state, over one million undocumented immigrants still lack access to quality, affordable health coverage. The inability to access health coverage has severely marginalized the undocumented community. For example, undocumented immigrants play a pivotal role in providing food for all Californians, since over half of farm workers are undocumented; however, they themselves are banned from partaking in the health care system despite serving as the backbone of our supermarkets and grocery stores. Moreover, undocumented immigrants have been found to contribute more in taxes than the federal government spends to provide services for them. Yet, despite their undeniably positive impact, barriers to coverage have limited the chances for undocumented immigrants to maintain their health. For members of the undocumented community who manage to stay healthy, including those we interviewed for this project, many attribute their well-being to luck and good fortune.

Polling conducted in advance of the 2018 legislative session in key battleground states showed broad support among likely voters for policies that provide working families with economic security. In particular, the polling found high levels of support for expanded healthcare coverage and paid family and medical leave policies, investment in K-12 education and teacher salaries, expanded funding to make child care more affordable, and expanded overtime pay to cover more workers. This provides a strong contrast to the agenda pursued by the Trump administration and the Republican-controlled Congress.

Anchor institutions (often referred to as "eds and meds") are place-based enterprises, firmly rooted in their locales. In addition to universities and hospitals, anchors may include cultural institutions (such as museums), health care facilities (such as nursing homes), and municipal governments. Typically, anchors tend to be nonprofit corporations. Because they are rooted in place (unlike for-profit corporations that may relocate for a variety of reasons, such as lower labor costs, more subsidies, or fewer environmental regulations), anchors have, at least in principle, an economic self-interest in helping ensure that the communities in which they are based are safe, vibrant, and healthy.

This policy brieft evaluates the economic benefits for each county in California due to the state's expansion of Medicaid to low-income adults are were not currently eligible for Medi-Cal coverage. They find it will not only impove health outcomes but will provide an economic boost to the state in a large variety of industries.

Chester, Pennsylvania, a small, formerly industrial city located on the Delaware River, not far from Philadelphia, exemplifies the problems and possibilities faced by older manufacturing cities across the United States, especially in the Northeast and Midwest. Chester's problems of poverty, stagnation, and unemployment stem from the late 20th-century decline of an industrial economy in the United States - which in Chester was primarily centered on automobile manufacturing and shipbuilding - and the flight of the more affluent residents to the suburbs. The remaining residents face high poverty, high unemployment, a crumbling infrastructure, lack of services and businesses, and underperforming schools. There is hope, however. Although the Federal Reserve Bank classifies Chester as a "struggling city," Chester also embodies the possibilities in the concept of resilience defined as "the individual and collective capacity to respond to adversity and change." The project of turning Chester around is a work in progress, but Chester is also a community that has taken intentional action "to enhance the personal and collective capacity of its citizens and institutions to respond to and influence the course of social and economic change." In fact, Chester, and one of its key partners in community revitalization, Widener University, can serve as a case study of what building resilience can look like in the face of daunting challenges.

For generations, cities have been places where people of every background have sought opportunity. But as urban economies have evolved in recent decades, our cities have experienced sharp growth in economic disparities, and many communities have suffered. Addressing these disparities requires leveraging cities' economic assets in order to better create, prepare people for and connect them to economic opportunity.

Anchor institutions are place-based entities such as universities and hospitals that are tied to their surroundings by mission, invested capital, or relationships to customers, employees, and vendors. These local human and economic relationships link institution well-being to that of the community in which it is anchored. Increasingly, anchor institutions across the nation are realizing this interdependence and are expanding their public or nonprofit mission to incorporate what we call an "anchor mission." In other words, they are consciously applying their long-term, place-based economic power, in combination with their human and intellectual resources, to better the long-term welfare of the communities in which they reside.

Health care is a top concern for many American families - and for good reason. Health care spending in the United States accounts for 17.9 percent of the nation's GDP, and medical bills are the number one reason for American bankruptcies. Prescription drug prices are a huge factor in those costs - in recent years, pharmaceutical companies and pharmacy benefi managers (PBMs) have rapidly increased prices. Additionally, new drugs have reached the market with price tags that easily exceed most Americans' annual income. Americans spent approximately $323 billion on prescription medicines in 2016, with some estimates of spending reaching over $400 billion by 2021. Fortunately, there are many policy options for states to address prescription drug prices.

The power of local governments to pass laws that protect the health, safety and welfare of their citizens is waning and under increasing attack. Over the past four years, a historic number of local interference (preemption) bills have been filed and passed in state capitals across the country. Over time, these bills, crafted to strip local governments of their power to act on everything from fracking bans to anti-discrimination measures, have become wider in scope and more hostile to home rule. More industries and special interest groups now consider preemption a legislative imperative, including the oil and gas industry and groups opposing LGBTQ rights.