UCLA Luskin School of Public Affairs

The federal government, along with many states, has adopted policies favoring the provision of public transit by the private sector. During the 1980's, this turn to contracting to halt rising operating deficits prompted several studies into the impact of contracting on operating efficiencies.

Most research found that service contracting saves 10 to 60 percent over publicly operated services. However, no research has yet examined the long-term cost trends of private contracting vis-a-vis public operations. The evaluations done to date often make inappropriate comparisons between small single mode private carriers and large multi-service transit authorities with greater political and social obligations. As a result the findings from these studies are certain to show dramatic savings, yet do not address the underlying dynamics driving transit costs such as political pressures to provide service.

This study examined cost efficiency trends for 142 transit operators providing fixed-route bus transit between 1989 and 1993. This analysis produced no evidence that fully contracted operations cost less per revenue hour than publicly operated services doing no contracting. Vehicle and driver scheduling inefficiencies were found to contribute the most unit costs. Estimated elasticities indicate that a 10 percent reduction in vehicle scheduling inefficiency may produce a 19 percent improvement in cost efficiency. A 10 percent improvement in operator scheduling efficiency shows a 6 percent reduction in operating costs per revenue hour. These findings indicate that transit service contracting may not produce cost savings over the long-term and that strategies of decentralization and changes in the craft structure for labor may be more appropriate ways for relieving the fiscal crisis of public transit.

Over the course ofthis century, public transit systems in the U.S. have lost most ofthe market share ofmetropolitan travel to private vehicles. The two principal markets that remain for public transit systems are downtown commuters and transit dependents- people who are too young, too old. too poor, or physically unable to drive. Despite thefact that transit dependents are the steadiest customers for most public transit systems. transit policy has tended to focus on recapturing lost markets through expanded suburban bus, express bus, andfued rail systems. Such efforts have collectively proven expensive and only marginally effective. At the same time, comparatively less attention and fewer resources tend to be devoted to improving well-patronized transit service in low­ income, central-city areas serving a high proportion of transit dependents. This paper explores this issue through an examination of both the evolving demographics ofpublic transit ridership, and the reasons for shifts in transit policies toward attracting automobile users onto buses and trains. We conclude that the growing dissonance between the quality of service provided to

inner-city residents who depend on local buses and the level of public resources being spent to attract new transit riders is both economically inefficient and socially inequitable. In light of this. we propose that transportation planners concerned with social justice (and economic efficiency) should re-examine current public transitpolicies andplans.

This article demonstrates-based on an interpretive discourse analysis of three types of memes (Rabid Feminists, Women's Bodies, Policy Ideas) and secondary thread discourse on 4chan's "Politically Incorrect" discussion board-two key findings: (1) the existence of a gendered hate based scientific discourse, "science fan fiction," in online spaces and (2) how gender "science fan fiction" is an outcome of the male supremacist cosmology, by producing and justifying resentment against white women as being both inherently untrustworthy (politically, sexually, intellectually) and dangerous. This perspective-which combines hatred and distrust of women with white nationalist anxieties about demographic shifts, racial integrity, and sexuality-then motivates misogynist policy ideas including total domination of women or their removal. 4chan users employ this discourse to "scientifically" substantiate claims of white male supremacy, the fundamental untrustworthiness of white women, and to argue white women's inherent threat to white male supremacist goals.

Mandated minimum nurse-to-patient ratios have been the subject of active debate in the U.S. for over twenty years and are under legislative consideration today in several states and at the federal level. This paper uses the 1999 California nurse staffing mandate as an empirical setting to estimate the causal effects of minimum ratios on hospitals. Minimum ratios led to a 58 min increase in nursing time per patient day and 9 percent increase in the wage bill per patient day in the general medical/surgical acute care unit among treated hospitals. Hospitals responded on several margins: increased use of lower-licensed and younger nurses, reduced capacity by 16 beds (14 percent), and increased bed utilization rates by 0.045 points (8 percent). Using administrative data on discharges for acute myocardial infarction (AMI), I find a significant reduction in length of stay (5 percent) and no effect on the 30-day all-cause readmission rate. The null effect on readmissions suggests that length of stay declined not because hospitals were discharging AMI patients quicker and sicker, rather, AMI patients recovered more quickly due to an improvement in care quality per day.

There is growing attention to how unfounded beliefs about biological differences between racial groups affect biomedical research and health care, in part, through race adjustment in clinical tools. We develop a case study of the Eighth Joint National Committee (JNC 8)'s 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults, which recommends a distinct initial hypertension treatment for Black versus nonblack patients. We analyze the historical context, study design, and racialized findings of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) that informed development of the guideline. We argue that ALLHAT's racialized outcomes emanated from a poor and artificial study design and analysis weakened by implicit assumptions about race as biological. We show that the acceptance and utilization of ALLHAT for race correction arises from its historical context within the "inclusion-and-difference paradigm" and its indication of the inefficacy of angiotensin-converting-enzyme inhibitors for Black patients, which follows from the enduring, yet, refuted slavery hypertension hypothesis. We demonstrate that the JNC 8 guideline displays the self-fulfilling process of racial reasoning: presuppositions about racial differences inform the design and interpretation of research, which then conceptually reinforce ideas about racial differences leading to differential medical treatment. We advocate for the abolition of race adjustment and the integration of structural competency, biocritical inquiry, and race-conscious medicine into biomedical research and clinical medicine to disrupt the use of race as a proxy for ancestry, environment, and social treatment and to address the genuine determinants of racialized disparities in hypertension.

INTRODUCTION: Despite having worse healthcare access and other social disadvantages, immigrants have, on average, better health outcomes than U.S.-born individuals. For Latino immigrants, this is known as the Latino health paradox. It is unknown whether this phenomenon applies to undocumented immigrants. METHODS: This study used restricted California Health Interview Survey data from 2015 to 2020. Data were analyzed to test the relationships between citizenship/documentation status and physical and mental health among Latinos and U.S.-born Whites. Analyses were stratified by sex (male/female) and length of U.S. residence (<15 years/>= 15 years). RESULTS: Undocumented Latino immigrants had lower predicted probabilities of reporting any health condition, asthma, and serious psychological distress and had a higher probability of overweight/obesity than U.S.-born Whites. Despite having a higher probability of overweight/obesity, undocumented Latino immigrants did not have probabilities of reporting diabetes, high blood pressure, or heart disease different from those of U.S.-born Whites after adjusting for having a usual source of care. Undocumented Latina women had a lower predicted probability of reporting any health condition and a higher predicted probability of overweight/obesity than U.S.-born White women. Undocumented Latino men had a lower predicted probability of reporting serious psychological distress than U.S.-born White men. There were no differences in outcomes when comparing shorter- with longer-duration undocumented Latino immigrants. CONCLUSIONS: This study observed that the Latino health paradox may express patterns for undocumented Latino immigrants that are different from those for other Latino immigrant groups, emphasizing the importance of accounting for documentation status when conducting research on this population.

Immigrants without legal or long-term residency are even more likely to be purposefully excluded from public healthcare or healthcare assistance. Due to the Healthy Illinois campaign and network of health equity-focused organizations, Illinois has made much progress in expanding Medicaid-like healthcare services to all low-income residents in Illinois, regardless of immigration status. Currently, Illinois has three immigrant-focused healthcare programs that are almost functionally identical to federal Medicaid: All Kids (ages 0-18), Health Benefits of Immigrant Seniors (ages 65+), and Health Care for Immigrant Adults (ages 42-64). As a result, immigrants who are federally ineligible for Medicaid between the ages of 0 to 18 and 42+ have access to state healthcare coverage. However, there is a gap in coverage for those ages 19 to 41. Using enrollment data from the Illinois Department of Health and Family Services (HFS) and analyzing interviews with HBIS/A enrollees and healthcare providers, we identified important program data such as enrollment rates, insurance claims, program costs, health conditions affecting enrollees, and gaps in program or health resources. From that analysis, a few main findings emerged. First, there are enrollees in both HBIA and HBIS throughout the state. These programs benefit not only the densely populated Cook County but the affected population that resides throughout Illinois in every community. Second, there are more 42-54-year-olds enrolled in HBIA than any other age group enrolled in HBIA or HBIS. Several factors may contribute to this enrollment rate and we encourage the program administrators to consider potential program barriers for older populations. Third, enrollees credited community-based organizations in assisting them through the application process. These organizations are a critical part of the care network.Based on data analysis informed by this research, we have provided Healthy Illinois with supporting data and recommendations for expanding Medicaid-like healthcare benefits to immigrant adults in the 19-41 age group.

We examine pre-COVID declines in transit ridership, using Southern California as a case study. We first illustrate Southern California's unique position in the transit landscape: it is a large transit market that demographically resembles a small one. We then draw on administrative data, travel diaries, rider surveys, accessibility indices, and Census microdata for Southern California, and demonstrate a strong association between rising private vehicle access, particularly among the populations most likely to ride transit, and falling transit use. Because we cannot control quantitatively for the endogeneity between vehicle acquisition and transit use, our results are not causal. Nevertheless, the results strongly suggest that increasing private vehicle access helped depress transit ridership. Given Southern California's similarity to most US transit markets, we conclude that vehicle access may have played a role in transit losses across the US since 2000.