First responders work on a victim of an apparent overdose in Albuquerque, N.M., in August. Despite an encouraging national decrease in overdoses, deaths are still rising in many Western states (Tim Henderson/Stateline).

Despite an encouraging national dip in the past year, overdose deaths are still on the rise in many Western states as the epicenter of the nation’s continuing crisis shifts toward the Pacific Coast, where deadly fentanyl and also methamphetamine are finding more victims.

Overdose deaths remain sharply higher since 2019. Many states are working on “harm reduction” strategies that stress cooperation with people who use drugs; in some cases, states are getting tougher on prosecutions, with murder charges for dealers.

Alaska, Nevada, Washington and Oregon have moved into the top 10 for rate of overdose deaths since 2019, according to a Stateline analysis of federal Centers for Disease Control and Prevention data. Meanwhile the biggest one-year improvements were in Nebraska (down 30%), North Carolina (down 23%), and Vermont, Ohio and Pennsylvania (all down 19%).

The spread of fentanyl, a synthetic opioid that can cause overdose and death even in tiny amounts, explains much of the east-to-west movement in the number of deaths, said Daliah Heller, vice president of overdose prevention program at Vital Strategies, an international advocacy group that works on strengthening public health.

“Fentanyl really came in through the traditional drug markets in the Northeast, but you can see this steady movement westward,” Heller said. “So now we’re seeing overdoses going up on the West Coast while they’re going down dramatically on the East Coast.”

The provisional CDC data estimates drug overdose deaths in the year ending with April 2024, and nationally they decreased by 10%, with more than 11,000 fewer deaths than the year before. But they’re still rising in 10 states and the District of Columbia, including 42% in Alaska, 22% in Oregon, 18% in Nevada and 14% in Washington state. Deaths climbed by almost 1,300 in those states and others with more modest increases: Colorado, Utah and Hawaii.

Experts are still debating why some Eastern states hit early in the overdose crisis are seeing improvements.

“There’s some kind of improvement spreading from east to west and we don’t know exactly what it is yet. Everybody sees their little piece of the elephant,” said Nabarun Dasgupta, a scientist specializing in opioid disorder and overdose at the University of North Carolina’s Injury Prevention Research Center.

In North Carolina and other states with recent improvements, “it feels like we finally got a lid on the pot, but the pot is still boiling over. Things aren’t really cooling down,” Dasgupta said.

It could be a result of better acceptance of harm reduction policies to help those who use drugs, including no-questions-asked testing of street drugs and providing naloxone to counteract overdoses. Or users may simply be getting more wary of fentanyl and its dangers and unpleasant side effects, Dasgupta said.

“Fentanyl is very potent, but potency isn’t the only thing. Otherwise we’d all be drinking the highest proof IPAs (India pale ales),” Dasgupta said.

Alaska now has the nation’s second-highest rate of drug overdose deaths, about 53 per 100,000 population, behind only West Virginia (73 per 100,000). Other Western states that are now in the top 10: Nevada (47 per 100,000), Washington state (46 per 100,000) and Oregon (45 per 100,000).

The CDC data shows Alaska had the largest increase from 2023 — up 42%, to 390 deaths. Republican Gov. Mike Dunleavy in August 2023 proposed legislation making fentanyl dealers subject to murder charges in overdose death cases, writing: “Drugs and drug overdoses have had a devastating effect on our state.” The legislation was signed into law this year.

In May, the state kicked off “One Pill Can Kill,” a national awareness campaign warning about the dangers of fentanyl.

Fentanyl, mostly in the form of counterfeit 30 mg oxycodone pills, has become tremendously profitable for smugglers in Alaska who make use of airline passengers and air shipments of other products to get drugs into the state, said state Department of Public Safety spokesperson Austin McDaniel. Pills that sell for less than $1 near the U.S. southern border with Mexico can fetch $20 in Alaska, McDaniel said.

“We want to make the dealers think twice about targeting Alaska,” said Alaska state Rep. Craig Johnson, an Anchorage Republican, who supported the bill signed into law July 12.

Johnson’s 23-year-old nephew died of a fentanyl overdose two years ago. “This is personal. I don’t want other Alaska families to go through what we went through. I hope we never have to use it, because that will mean nobody else died.”

Other state and federal authorities are also trying a more punitive approach to the fentanyl crisis: Under a state program in Wisconsin meant to ferret out suppliers, three people were arrested in September and charged with first-degree reckless homicide in the fentanyl overdose death of a 27-year-old man. In Michigan, two men pleaded guilty this month to federal charges in a mass fentanyl poisoning that led to at least six deaths.

Such punitive approaches can backfire, experts say, if they drive people toward more dangerous solitary drug use — where no one can see an overdose and try to help — and away from programs such as free testing to unearth fentanyl hidden in other drugs.

“It’s sort of nonsensical, like saying you can beat something out of people. People are still going to use drugs,” said Heller, of Vital Strategies. “This should be a call to action to wake up and really invest in a response to drug use as a health issue.”

In Nevada, health authorities in the Las Vegas area are stressing more cooperation with residents who use drugs, increasing naloxone distribution and encouraging people to submit their drug purchases for testing so they’re not surprised by counterfeit heroin, methamphetamine or other drugs that are increasingly cut with cheaper fentanyl, said Jessica Johnson, health education supervisor for the Southern Nevada Health District.

A state office coordinates goals for county naloxone distribution based on factors such as hospital reports of overdoses. More overdoses trigger more naloxone distribution to community centers, clinics, entertainment venues and even vending machines.

One puzzle in Nevada and in other states is that increasingly, overdoses involve a combination of opioids, such as fentanyl, along with stimulants such as methamphetamine. Almost a third of overdoses in Nevada are caused by both being used together, according to a state report based on 2022 data.

It could be that some people seek the “roller coaster of effects using a stimulant like methamphetamine and a depressant like fentanyl or heroin,” Jessica Johnson said, but mostly she hears that unsuspecting users get cocaine or methamphetamine that’s been cut with cheaper fentanyl.

“We get people saying, ‘Oh I don’t need naloxone because I don’t use fentanyl,’ and our team is able to say, ‘Well, our surveillance data actually suggests there might be fentanyl in your methamphetamine’ or whatever it is.”

Nationally, both drugs are increasingly a factor in fatal overdoses: Synthetic opioids such as fentanyl contributed to 68% of overdose deaths in this year’s CDC data, up from 48% in 2019. Stimulants such as methamphetamine were factors in 35% of deaths, up from 20% in 2019.

Heroin and other partly natural opioids, such as oxycodone, have diminished as factors, together accounting for 13% of deaths in the latest data compared with 40% in 2019.

Some experts theorize that the high potency of fentanyl makes those who use drugs want to tweak or balance the effect with methamphetamine. Fentanyl itself is often cut with xylazine, a non-opioid animal tranquilizer — often known as “tranq” — that can cause unpleasant side effects, including extreme sedation and skin lesions, Dasgupta said.

“During the pandemic, there were a lot of reasons why people were using substances more. Now that things are different, people are tired of the adulteration, the sedation, the skin wounds,” Dasgupta said. “People may take lower doses, and that in itself can help lower overdoses.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and X.

Attorney FritzGerald Tondreau, who helps with immigration issues at Konbit Neg Lakay in Spring Valley, N.Y., shows intimidating videos of gang hostages and enemies being killed or beaten in Haiti. As a new wave of immigrants fleeing chaos arrives, many are moving beyond New York and Florida to find jobs and housing (Tim Henderson/Stateline).

Fortified with work authorizations and a new freedom, Haitian immigrants are moving out of their longtime strongholds in Florida and New York, often finding good jobs while remaining wary of how they will be received in new places in the Midwest and South.

This movement helps explain why Haitian immigrants in Springfield, Ohio, have become embroiled in the presidential election. For several weeks, Republican presidential and vice presidential nominees Donald Trump and J.D. Vance have spread untrue rumors about Haitian immigrants in the city eating their neighbors’ cats and dogs.

Until recently, “we were counting Haitians in the dozens,” said Leonce Jean-Baptiste, who helped launch the Haitian Association of Indiana in 2008. The association’s aim: “just making sure that our children would know there is such a thing as Haitian culture, that their parents come from a very strong, very rich culture and ethnic background,” he said.

Now, the association has its hands full helping new arrivals with housing and learning the ways of the Midwest, Jean-Baptiste said. Immigrants are coming to fill factory jobs in Indiana, a trend that started in the pandemic.

“Here in Indiana, in Ohio, in the Midwest in general, the manufacturing industry was desperate for labor and so it was a perfect kind of marriage,” Jean-Baptiste said. “Haitians were looking for jobs, they might have lost a low-paying job in a hotel in Florida, they can’t access government benefits because they’re not citizens, and here they can do better.”

With more Haitian immigrants free to work legally anywhere because of work permissions granted under the Biden administration, many moved from off-the-books jobs in Florida or New York to factory work in states such as Indiana, North Carolina, Ohio, Texas and Virginia.

Those states had some of the most significant increases in Haitian immigrant population between 2019 and 2023, the most recent estimates available from the American Community Survey, according to a Stateline analysis.

In that time, the Haitian immigrant population in Indiana increased eightfold, to 12,465; almost fourfold in North Carolina, to 7,752; more than doubled in Texas, to 7,010; more than tripled in Ohio, to 5,264; more than doubled in Virginia, to 6,342; and nearly fivefold in South Carolina, to 2,569.

Meanwhile more established strongholds where the most Haitian immigrants live are seeing less growth: New York (up 5%), Florida (up 1%) and Massachusetts (down 1%).

“The situation in New York is that the cost of living and the cost of housing is shutting out the new Haitians. They are moving where there are jobs and there is housing — I know people who have gone to North Carolina, South Carolina,” said Francois Pierre-Louis, a Haitian-born professor of international migration studies at the Queens College campus of the City University of New York.

Those staking out new territory in the Midwest tend to be more established immigrants who already know enough English to get by, Pierre-Louis said.

“To be able to move to the hinterlands, you have to have a level of cultural understanding of the U.S. to be comfortable,” he added.

‘It’s always been a struggle’

In Florida and New York, where about two-thirds of the country’s Haitian immigrants still live, more established immigrants with their own memories of discrimination are helping new immigrants get established.

Mayor Alix Desulme of North Miami, Florida — the city with the highest concentration of Haitian Americans, about 38% in recent years — recalls being taunted as a boy when he arrived in Brooklyn, New York, by people who falsely believed Haitians were spreading AIDS.

“I’m an immigrant and I am a Black man. These things do not go away,” said Desulme. “We’re in a state, Florida, where the governor would like immigrants to go elsewhere. It’s always been a struggle for us as a people, but we came to this country for a better life.”

Dr. Pierre Arty, a Brooklyn psychiatrist born in Haiti, said politically motivated denigration of Haitians has an impact that he’s trying to mitigate in his work with new immigrants for Housing Works, a Brooklyn nonprofit. It happened in the 1980s with AIDS and it’s happening again with false narratives about pet-eating, he said.

“We have social media with quick distribution of false information, negative memes about Haitians and offensive jokes. It can foster inferiority complexes and shame as opposed to pride for being part of this community,” Arty said.

“This fosters dehumanization and resurrects historic Black tropes of us being less than animals,” he said. “Imagine what this can do to the psyche of children when other people make fun of them.”

Growth in Haitian immigrant communities since mid-2023 is hard to gauge, but clearly has continued in some states.

Clark County, Ohio, where Springfield is located, saw an increase in Medicaid enrollment by people with Haitian backgrounds, based on their choice of Haitian Creole language, from about 3,000 in mid-2023 to almost 8,000 in July 2024. The number dropped to about 7,200 in August, according to the county’s Department of Job & Family Services.

The number of immigrants in the community is likely much higher since not all of them have Medicaid, and the Medicaid numbers will likely continue to drop as more get jobs, said the department’s director, Virginia Martycz.

In Indiana, Jean-Baptiste thinks the number of Haitian Americans and other immigrants has increased to 30,000 from the roughly 14,000 counted by the American Community Survey last year, based on contacts to his organization and social service reports based on names.

‘A little more mobility’

In New York, as in Florida, an established community is helping new immigrants get settled before moving on to areas with more jobs and more affordable housing.

“The work authorization is a ticket to a little more mobility,” said Daniel Jean-Gilles of Nyack, New York, where he is part of a wave of earlier Haitian immigrants trying to support newcomers. “I see a lot of new faces here. They come and stay here with family and friends while they wait for work authorization and then they can move around and get that job. I hear about people moving to North Carolina, Arizona for jobs.”

“Housing and jobs are very limited here. They have to go where the jobs are,” said FritzGerald Tondreau, an immigration attorney and child of Haitian immigrants who works in Spring Valley, New York.

Tondreau showed videos of brutal beatings and executions by gangs in Haiti, posted by the gangs to intimidate enemies and families of hostages, and said gangs have set up roadblocks demanding money on major roads. “This affects every facet of life in Haiti and makes it very untenable,” he said.

Work authorization is available to many Haitian immigrants, either as part of the federal temporary protected status for unauthorized immigrants or because of humanitarian parole for those waiting for asylum hearings if they crossed the border legally and don’t have a serious criminal record, said Julia Gelatt, associate director of the immigration policy program at the Migration Policy Institute in Washington, D.C.

Many Haitian immigrants are taking advantage of a new federal program that allows them to travel directly from Haiti if they have a sponsor willing to support them during temporary humanitarian parole.

Temporary protected status, first granted to Haitian immigrants when their nation was deemed too dangerous for return in 2010 because of earthquakes, is now held by an estimated 200,000 Haitian immigrants, second in number only to Venezuelans.

The status was recently extended until 2026 by the Biden administration and could theoretically end, but that’s not likely, Gelatt said. The Trump administration tried to end temporary protected status for Haiti and some other countries, but the policy was blocked by lawsuits until the Biden administration reversed it.

The bottom line, Gelatt said, is that many new Haitian immigrants are protected from deportation and are able to work legally for the time being, but few have a path to permanent legal residence and citizenship.

“This temporary status affects their sense of integration, their willingness to invest in their futures in the United States,” she said. “They can never be sure that they’ll get to stay.”

Over decades in the United States, without a clear path to citizenship for many, Haitian immigrants have learned to make peace with uncertainty.

“The thing is to wait a long time and be good citizens and stay under the radar,” said Pierre-Louis. “And most Haitians are good citizens. They go to church and they work. They want to work. They’re not here begging for anything.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and X.

An apartment maintenance man changes the lock of an apartment after constables posted an eviction order in Phoenix. In Arizona, low wages, a housing shortage, and short-term rental and vacation homes are eating away at the stock of affordable housing for renters (John Moore/Getty Images).

There were 21 states where a majority of tenant households spent 30% or more of their incomes on rent and utilities last year, compared with just seven states in 2019.

Nationwide, about 22 million renters are shouldering that percentage. Anyone paying more than 30% is considered “cost burdened,” according to the U.S. Department of Housing and Urban Development, and may struggle to pay for other necessities, such as food, clothing, transportation and medical care.

Three presidential swing states had among the biggest increases in the share of renters who spent that much on housing: Arizona (to 54% from 46.5%), Nevada (to 57.4% from 51.1%) and Georgia (to 53.7% from 48.4%). The numbers are based on a Stateline analysis of American Community Survey data released today by the U.S. Census Bureau. Florida and Maine also saw large jumps.

In Arizona, low wages, a housing shortage, and short-term rental and vacation homes are eating away at the stock of affordable housing for renters, according to Alison Cook-Davis, associate director for research at Arizona State University’s Morrison Institute for Public Policy.

“You’ve got people across the state kind of pulling their hair out, saying ‘I thought Arizona was supposed to be the affordable state,’” Cook-Davis said.

Rents in Arizona have shot up 40% to 60% in the last two years, she said. And the state’s eviction filings spiked 43% to 97,000 between 2022 and 2023, she said.

In places such as Arizona and Nevada where the housing bubble of the late 2000s left vacant houses, the construction of apartments and other homes has not caught up with population increases, Cook-Davis added.

A University of Nevada, Las Vegas, data brief reported in May that the Las Vegas area had the highest percentage of cost-burdened renters in the state, at 58.3%, more even than the New York City metro area (52.6%) or San Francisco metro area (48.9%).

Today’s newly released census figures showed that in addition to Arizona, Nevada and Georgia, the states with the highest jumps in the share of cost-burdened renters were Florida, which increased to 61.7% from 55.9%, and Maine, at 49.1% from 44%.

That jump left Florida as the state with the highest rate of cost-burdened renters. It was followed by Nevada (57.4%), Hawaii (56.7%), Louisiana (56.2%) and California (56.1%).

“Florida isn’t the deal it used to be,” said Christopher McCarty, director of the University of Florida’s Bureau of Economic and Business Research. “Florida still has disproportionately lower-paying jobs compared to other states, and rents are increasing compared to other states as well.”

The states with the lowest rates of cost-burdened renters as of 2023 were North Dakota (37%), Wyoming (41.2%), South Dakota (41.3%), Kansas (43.5%) and Nebraska (44%).

The share of cost-burdened renters increased since 2019 in every state except Vermont (down to 47.8% from 54%), Wyoming (down to 41.2% from 44%), North Dakota (down to 37% from 38%) and Rhode Island (down to 48.1% from 49%).

There’s hope for the future in Arizona and other states with increased home construction, Cook-Davis said.

“If you keep building, eventually this will sort itself out. But that could take years. It’s a slow process,” she said.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and X.

Maricruz Dominguez, left, and Maria Dominguez visit a memorial marking the spot where 31-year-old police officer Bianca Quintana, their sister and daughter, respectively, was hit and killed by a car Aug. 14 while walking on South Coors Boulevard near her mother’s house in Bernalillo County, N.M. Pedestrians die at the highest rates in Western and Southern rural areas and small cities (Tim Henderson/Stateline).

BERNALILLO COUNTY, N.M. — Bianca Quintana was just taking a walk in the early morning dark near her mother’s house on South Coors Boulevard. There, the city streets of Albuquerque give way to feed stores and irrigation ditches, and the sounds of chickens and crickets mingle with high-speed traffic noise.

Quintana, a 31-year-old mother of two, liked to walk to stay in shape for softball, her passion, and for her job as an Albuquerque police officer.

On Aug. 14, her mother found her lifeless body and the bright, police-issued flashlight she used for work, set to flashing to draw attention. Quintana might have tried to cross the highway, possibly to avoid weeds or a snake in her path, her mother and sister think, when a hit-and-run driver took her life. There are no sidewalks or streetlights nearby and the “boulevard” is really a four-lane highway with 55 mph speed limits and cars often going much faster. Police are still looking for the driver.

In some ways, the tragedy is typical of pedestrian deaths at a time when they have dropped nationally but are still higher than before the pandemic. Pedestrians die at the highest rates not in brightly lit big cities where sidewalks are crowded with office workers, but in Western and Southern rural areas and small cities where poverty forces more people to walk on dark highways with inadequate sidewalks or shoulders.

New Mexico has the highest rate as a state at 6.1 pedestrian deaths per 100,000 residents as of 2023. The state also led the nation before the pandemic; its rate was 4.7 in 2019, according to a Stateline analysis.

And across the country, the 33 counties with the highest rates — each with more than twice the national rate of 2.5 pedestrian deaths per 100,000 — are mostly in the South and West.

Many big cities, including Los Angeles, Phoenix and Houston, have higher numbers of pedestrian deaths, but lower rates per resident. The numbers are based on a Stateline analysis of preliminary death records kept by the federal Centers for Disease Control and Prevention.

More deaths on ‘stroads’

Julian Padilla, a transportation planner for the Mid-Region Council of Governments in New Mexico that includes Bernalillo County, calls roads like Coors Boulevard “stroads” — balancing the incompatible roles of streets with foot traffic and roads meant to push cars through as fast as possible.

Stroads, he said, can be urban as well as rural, as with Albuquerque’s historic Route 66, which runs through the city as Central Avenue and claims an outsize share of pedestrian deaths.

“These thoroughfares are the worst for the drivers and the worst for pedestrians,” Padilla said. “Drivers aren’t expecting to see pedestrians, and pedestrians aren’t expecting the speed of the cars and might perceive it incorrectly, especially in the dark, when most of these accidents happen.”

The fast-driving and rule-skirting motorist habits since the COVID-19 pandemic have drawn plenty of attention nationally. State and local officials are working to prevent pedestrian deaths with solutions such as brighter lighting, crosswalks with automatic flashing signs and “road diets” that cut down the number of traffic lanes.

Nationwide, the number of pedestrian deaths dropped last year after three straight years of increases, but the overall numbers are still 14% higher than 2019’s figures, according to a recent Governors Highway Safety Association report. The report was based on preliminary information from state highway safety offices.

From the Stateline analysis of death records, more than three-fourths of the counties with the highest rates from 2018 to 2023 have persistently high poverty rates above 20%.

Poverty also marks many of the areas within counties where most deaths occur. In Bernalillo County’s South Valley area, where Quintana’s mother lives, the poverty rate is about 21%. And in census tracts in Albuquerque’s International District, a neglected stretch of the old U.S. Route 66 meant for interstate travel, the rate tops out at almost 60%.

‘More likely to be walking’

Advocates for safer streets say poverty is a known risk factor in pedestrian deaths, as people without cars often get around on foot and must contend with speeding cars on dark arterial roads at night.

Rural Washington County, Mississippi, with a poverty rate of 29%, has one of the highest pedestrian death rates at 9.6 per 100,000 residents through last year. The county has seen even more tragedies this year, including an 18-year-old college student who died on a road at 3:45 a.m. in April, and a 36-year-old woman who was killed on a highway at about 5:50 a.m. in July.

“This has been extremely tragic, and we’re all shocked. This weighs heavy on us,” said Carl McGee, president of the Washington County Board of Supervisors. “It seems people are walking late on these roads and they’re not being seen by drivers. We’re meeting to go over ways of making sure it doesn’t happen again.”

Florida has three counties, all considered high poverty, among those with the highest pedestrian fatality rates: Suwannee County, west of Jacksonville; Escambia County, in the panhandle near the Alabama border; and Putnam County, southwest of St. Augustine. A state pedestrian safety improvement plan, begun in 2021 in the city of Pensacola in Escambia County, added mid-block lighted crosswalks and lowered the speed limit from 35 to 30 mph on 2.2 miles of busy West Cervantes Street where pedestrian deaths are common.

Fatality rates are five times higher for low-income neighborhoods compared with high-income neighborhoods, according to a report this year from Smart Growth America, which follows pedestrian fatality trends. And death rates increase as incomes drop.

“People with lower incomes are more likely to be walking, and walking in the most dangerous areas,” the report concludes.

McKinley County, New Mexico, has the highest rate in the state and the third highest in the country at about 18 pedestrian deaths per 100,000 population. McKinley — like the others in the top three, Oglala Lakota County in South Dakota and Apache County in Arizona — has large numbers of people walking and hitchhiking on highways.

In McKinley, a state project will add more lighting and crosswalks to U.S. Route 491, a route often used to reach communities in Arizona, Colorado and northern New Mexico. It will also add fencing and barriers to I-40 to deter pedestrians from crossing the high-speed highway as a shortcut to a local shopping center, said Luke Smith, an engineer with the New Mexico Department of Transportation.

“Improving pedestrian safety is one of the main driving factors in our design,” Smith said. The $16.4 million project, which includes other roadwork, is in the design phase and scheduled to start in 2027.

Even in urban areas of New Mexico, experts say, roadways built solely for cars can become death traps when low-income residents must cross them to get to neighbors and stores. An example is Albuquerque’s International District.

The road is six lanes but has little traffic, and the old motels that once beckoned to tourists along Route 66 have fallen down, leaving only ghostly, faded signs, or are used as shelters for the unhoused residents who often sleep on the neighborhood’s streets. The area has about 5% of the city’s population but more than 20% of its pedestrian fatalities, according to the University of New Mexico’s Geospatial and Population Studies department, a state-funded research group that analyzes pedestrian fatalities.

“That’s the problem with our Western roads in general, is they were never meant for foot traffic,” said Jessica Bloom, a research scientist in the department.

The International District has been slow to draw attention because so many residents are poor and unhoused, said Christopher Ramirez, director of Together for Brothers, a statewide advocacy group supporting boys and young men of color.

“We’ve created a place in Albuquerque where people experiencing homelessness are congregating, but we haven’t seen the resources yet to make sure people can be safely on the streets,” Ramirez said.

The city of Albuquerque plans to implement more pedestrian safety measures that have worked well on other, more gentrified parts of Central Avenue, such as Nob Hill. There, three lanes of traffic have been condensed to one as a so-called road diet, with a bus-only lane and a dedicated bike path filling out the roadway, said Valerie Hermanson, coordinator for Albuquerque’s Vision Zero program. Vision Zero is an international strategy to eliminate traffic fatalities and severe injuries that many American cities have adopted.

With only one lane of cars, pedestrians should be able to cross more safely, especially with new crosswalks that flash warning lights as pedestrians cross.

Among plans for the area: using artificial intelligence to detect pedestrians about to step into the street that would then warn drivers with flashing lights, and more lighting on sidewalks to help walkers navigate and make them more visible.

Streetlights for cars, not pedestrians

West of Albuquerque on Coors Boulevard, where Quintana died, there were 29 pedestrian fatalities from 2018 to 2022, the latest available numbers from the federal Fatality Analysis Reporting System based on police reports.

An $8 million state project is planned to improve pedestrian safety with lower speed limits, new sidewalks, raised medians, crosswalks and lights on Coors Boulevard. But it ends almost 4 miles north of Quintana’s mother’s house, limited to an area with chain stores, gas stations and restaurants that make pedestrian safety more pressing.

A Mid-Region Council of Governments report stressed the importance of better lighting and sidewalks on rural high-speed roads as well as on Central Avenue in Albuquerque.

“Unfortunately, the lighting infrastructure that is available along the street tends to be geared towards vehicular traffic and does not provide adequate lighting for other modes of travel,” the group’s report, approved in August, concluded. Lighting more geared to pedestrian needs “would make a great impact on reducing fatalities.”

Quintana’s sister Maricruz Dominguez and her mother, Maria Dominguez, made a roadside memorial for her, as is traditional in Hispanic cultures. Known as “descansos,” or “resting places,” in New Mexico, they are protected under state law, which prohibits damaging them.

For Quintana, the memorial includes a metal cross with the inscription “Mother, Daughter, Sister, Auntie & Friend,” flowers and balloons, and a yellow softball inscribed with her softball team number, 22, and “We love you B!” There are benches for visitors.

“The kids just don’t know how to process this yet. We’re taking it day by day,” said Maricruz Dominguez. “The only light here is way down the street, and why do cars have to go so fast here? I’ve flown through here at 70. I’m not innocent. But I don’t see why the speed has to be so high.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and X.

(Spencer Platt/Getty Images).

The typical U.S. worker’s pay is about the same as it was in late 2019, after accounting for inflation. But workers in some states have seen sharply higher earnings, especially in scenic areas that are appealing to remote workers and have labor shortages.

In Montana, for example, average pay has increased 28.3% since before the pandemic, easily beating the roughly 19% national inflation rate during that time. That translates into an average raise of $260 a week to $1,178. No other state saw such a large gain, according to a new Stateline analysis of data from the Bureau of Labor Statistics. The numbers are from 2023, the latest available.

Montana has drawn remote workers with the beauty of its parks and mountains, and has lured blue-collar employees with pay that’s competitive with more expensive areas.

Other picturesque places also have drawn remote workers. Average pay increased significantly in these states, though some of them had relatively low wages to begin with. They include New Hampshire (wages up 28%), Florida (27.3%), Washington (27.2%), Maine (26.7%), Vermont (26.5%), Utah (25.7%), Arizona (24.8%) and West Virginia (24.6%).

Pay increased slightly less than the 19.3% inflation rate in North Dakota (16.8%), Wyoming (17.5%), Connecticut and Michigan (18.1%), New Jersey (18.2%), Maryland and Rhode Island (18.6%), Minnesota and New York (18.9%), and Oklahoma and Pennsylvania (19%).

Nationally, inflation-adjusted earnings increased steeply early in the pandemic as low-wage service workers lost their jobs and employers competed for scarce essential workers. Though wages continued to rise, inflation-adjusted pay started to come down sharply in late 2020 and 2021 as inflation took a bigger bite.

The inflation-adjusted wage spike early in the pandemic was somewhat misleading, both because 20 million low-wage service workers left the workforce temporarily and because prices for some things such as gasoline temporarily plummeted, noted Josh Bivens, chief economist at the left-leaning Economic Policy Institute in Washington, D.C.

As the economic recovery has progressed, workers are doing slightly better, Bivens said.

“On the one hand, all else equal, you’d want better wage growth over four and a half years,” Bivens said. “On the other hand, we suffered a horrible economic shock in that period. Relative to other recessions and recoveries, this is superb wage performance, even with the inflation.”

In 2019, the average weekly wage in Montana was $918, 45th among the states. The latest figure, $1,178, ranks 39th. Montana’s natural beauty has drawn new residents from higher-wage states such as New York and California, and many of those working remotely brought their higher salaries with them.

Competition for workers in Montana has been fierce, driving up wages, as has been the case in other newly popular locations. The highest wage growth in Montana has been for those without a college education, a group that saw some of the highest gains nationwide as restaurants and hotels struggled to recover staff after the peak of the pandemic, said Christopher Thornberg, an economist at Beacon Economics, an economic research and consulting firm, who monitors Montana economic trends.

Montana’s economy is heavily geared toward services, and wages may come down again this year from the unusual spike, Thornberg said. But, he added, “there’s little doubt incomes in Montana are higher than they have been in a while, even with it backing off.”

In Florida, where the wage increase was almost as large as in Montana, competition for workers also has driven up wages, and the unemployment rate has been lower than the national average since 2017, said Hector Sandoval, director of the Economic Analysis Program at the University of Florida’s Bureau of Economic and Business Research.

Florida, like Montana, has also been a magnet for well-paid remote workers from New York in fields like finance, said the bureau’s director, Christopher McCarty.

Meanwhile, wages are stagnating in some large coastal cities that are struggling to maintain well-paying jobs, experts said.

“Coastal cities are especially struggling to add new jobs,” said August Benzow, research lead at the Economic Innovation Group, a bipartisan public policy organization. The group has analyzed the improved fortunes of “left-behind” areas — counties with lagging population and income growth from 2000 to 2016 — that had suffered as well-paying jobs concentrated in large cities.

“On the bright side, left-behind counties — particularly those that are more rural — have rebounded swiftly. It remains to be seen whether these areas will continue to see improved growth rates,” Benzow said.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and X.

Students celebrate graduation in May at Cleveland High School in Liberty County, Texas, one of the fastest-changing counties in the country, where the non-white population grew more than 7 percentage points since 2020 to about 52% of the population. Five of the 19 counties that turned majority non-white since 2020 are in Texas (Vanesa Brashier/Bluebonnetnews.com).

Growth in Asian, Black and Hispanic communities is transforming cities and suburban counties, especially in red states such as Florida, Indiana and Texas, according to a new Stateline analysis. The presidential swing states of Georgia, Nevada and Pennsylvania also were among the fastest-changing states.

Nationally, the share of the non-white population grew in 47 states between mid-2020 and mid-2023, according to the analysis of U.S. Census Bureau estimates released in June.

Nevada had the largest change, with the non-white population — mostly Hispanic — growing 2.3 percentage points to 54.3% of the population. Growth in the number of Black residents propelled Georgia to a near non-white majority, up about 1 point to 49.9% of state population, amid continuing Black migration that helped turn the state’s 2020 vote Democratic for president and U.S. Senate.

Hispanic growth was the dominant factor across states, in blue and red counties and in rural and urban areas, according to the Stateline analysis. Growth in the Hispanic population is coming partly from immigration but mostly from higher birth rates, the Census Bureau said in a release.

Only three states — Montana, South Carolina and Tennessee — and the District of Columbia have seen their white population share grow since 2020.

The increase in Hispanic and Black residents — and where it’s happening — could sway outcomes in the 2024 presidential race and local and state races, although these groups’ political allegiances have shifted recently. Black voters have long been considered among Democrats’ most enthusiastic supporters, but their support has declined somewhat. And Republicans are making increasing inroads among Hispanic voters.

Many of the largest changes were driven by Black and Asian migration to cities and suburbs in job-rich red states. The economy is going gangbusters by nearly every national metric, and the availability of jobs outside major cities has become a significant magnet.

That includes Indiana’s Marion County, home of Indianapolis, and Kaufman County, Texas, a Dallas suburb, where Black population growth helped create new non-white majorities as of mid-2023. In Kaufman County, the Black population grew 6 percentage points to 23% and the Hispanic population grew 3 points to 28%. Kaufman County elected its first African American district judge in 2020.

“We do have jobs here, and all those counties are growing dramatically,” said Lloyd Potter, Texas’ state demographer. Asian, Black and Hispanic residents are moving to suburbs from the city of Dallas, he said, and from California and New York state. Meanwhile, local white populations are aging and diminishing, with more deaths and fewer births.

“These are some of the biggest and most significantly growing urban areas in the country, and [the new census data] indicates tremendous diversification in the population. It’s been occurring for some time, but it really seems to have accelerated over the last five years or so,” Potter said.

New groceries, same politics

Kaufman County’s growing Black community remains a minority in a county that voted two-thirds Republican for president in 2020 and governor in 2022. The county commission held hearings on moving a Confederate memorial statue away from the entrance of the county courthouse in 2021, but ultimately decided not to act.

“It’s very red here. It’s super red,” said James Henderson, a longtime resident of the county who favored moving the statue. He said he sees more African Americans like himself moving to Kaufman County cities such as Forney and working remotely for Dallas-based companies. There also are more African immigrants, he said.

Whether increased racial diversity will lead to political change is an open question. Black migration to the Atlanta area in Georgia had an effect on elections in 2018 and possibly 2020, but Republicans remain firmly in charge of state governments there and in Texas.

The younger population is growing more diverse, said demographer William Frey of the left-leaning Brookings Institution think tank. But the older population, which is growing as baby boomers age and is the most likely to vote, is still mostly white, he said.

Asian growth in Collin County, another Dallas suburb, and Hispanic growth in Florida’s Duval County (home of Jacksonville) also helped turn those large counties majority non-white since 2020.

Many of the new Collin County residents are Telugu-speaking tech workers from southern India who have found an economic niche in remote work for Dallas firms, said Farhad Wadia, president of the FunAsia branded radio stations in the area. Their presence is bringing subtle changes to the community, he noted.

New transplants often hold elaborate Hindu housewarming ceremonies that include boiling milk to overflowing to signify prosperity. Stores cater to their tastes with tangy tamarind-based curries and sun-dried peppers.

“If you go into Costco here you will think you are in South India,” Wadia said. “A lot of them come from California, where they could sell their 1,000-square-foot house for a million dollars and get more bang for the buck here.”

Growing rural diversity

Of the 16 counties that turned majority non-white between 2020 and 2023, five were in Texas. Most of the 16 counties voted Republican in 2020.

They included two counties each in California (Napa and Yuba counties, both near Sacramento) and New Mexico (rural Quay and Roosevelt counties), and one each in Alabama (rural Conecuh County), Kansas (rural Stanton County), Mississippi (Lowndes County, along the Alabama border), New Jersey (suburban Somerset County) and South Carolina (Florence County, near Myrtle Beach).

In Georgia, Atlanta suburb Henry County had the largest shift of any county outside Texas, with Black population growth fueling a 7-point increase in the non-white population to 69%. The county was already majority-Black in 2020; retired basketball star Shaquille O’Neal, who bought a home in the county in 2016, helps the local sheriff’s office with community relations and recently hosted a summer youth sports camp.

Hispanic growth also lifted the non-white population share in the presidential swing states of Michigan, Pennsylvania and Wisconsin.

In Texas’ Liberty County, where Hispanic growth helped drive a new non-white majority of 52% — up 7 points since 2020 — schools are bursting with new Hispanic students, said Stephen McCanless, superintendent of the Cleveland Independent School District in Liberty County.

The district, where about 88% of students are Hispanic, grew from about 10,000 to 12,000 students in the past school year and could reach 14,000 next year, he said.

The district has spent more than $17 million on portable classrooms since growth started in 2015, including $2 million in the past year, as bond issues to build more schools have been voted down.

“Tough decisions had to be made. I cut $7 million out of the budget in order to start the [next] school year without dipping into the fund balance too much,” McCanless said.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and X.

In California, where layoffs in tech and the film industry have unsettled the job market, there is less than one opening per unemployed person. In North Dakota, where a brain drain has left a shortage of skilled and educated workers, there are almost three openings per unemployed person (Spencer Platt/Getty Images).

The number of job openings has declined sharply in every state since 2022, better aligning the numbers of unfilled jobs and people seeking work.

Nationally, for the first time since before the pandemic, the number of job openings and unemployed people is roughly in balance: a little more than one opening per person looking for work, according to a Stateline analysis of U.S. Bureau of Labor Statistics data. At the height of the labor shortage in 2022, there were two job openings per job seeker. As of April, the ratio was down to 1.2 openings per person.

But the proportion of workers to jobs ranges widely from state to state. In California, where layoffs in tech and the film industry have unsettled the job market, there is less than one opening per unemployed person. In North Dakota, where a brain drain has left a shortage of skilled and educated workers, there are almost three openings per unemployed person.

The federal government defines a job opening as an available position that an employer wants to fill within a month.

California, one of the few states where unemployment is above 5% and unemployed people outnumber job openings, has replaced Mississippi as the state with the highest unemployment rate. Washington state and Nevada also have less than one job opening per unemployed person.

The epicenter of the decline in job openings has been California’s Bay Area, including the San Francisco and Silicon Valley metro areas. California ended up losing nearly all the tech jobs it gained during a pandemic boom fueled by online work and shopping.

Vishwanath Eswarakrishnan, a 35-year-old software engineer in the Bay Area, was shocked by his layoff from a San Francisco robotaxi firm in December, a day before the birth of his second child. But as soon as he posted the news to social media, he started getting calls from major firms, including Airbnb, Uber and Nvidia. He accepted an offer from Meta within a month and started work again in March.

“There are opportunities out there for folks with eight to 15 years of experience. You do get calls,” Eswarakrishnan said. He added, however, that friends who have less experience or who work in less technical fields, such as product management, are having a harder time.

In North Dakota, by contrast, there are still almost three job openings for every unemployed person, though that’s down from more than four openings in some months of 2022. Before the pandemic, there were 2.7 openings for every job seeker.

North Dakota suffers from a lack of skilled workers to fill open jobs, and many who could fill them move to nearby cities, such as Minneapolis, looking for a more urban lifestyle and more desirable jobs, said Thomas Krumel, a professor at North Dakota State University who studies labor demand.

North Dakota’s oil boom peaked a decade ago but it left a lasting legacy of high wages and cost of living, he added.

“The positions that employers find most difficult to fill do not require a four-year college degree. Skilled trades, healthcare support and technical jobs often face shortages,” Krumel wrote in an email.

Unemployment nationwide was at 4% in May, higher than the 3.5% before the pandemic but still near historic lows. The only states with unemployment rates above 5% were California (5.3%) and Nevada (5.1%), along with the District of Columbia (5.2%). The lowest rates were in North Dakota and South Dakota (2%), and Vermont (2.1%).

A return to a pre-pandemic labor market is a good sign, said Nick Bunker, economic research director at Indeed Hiring Lab.

“It was a strong labor market, robust and seemingly sustainable,” Bunker said.

However, states with the largest declines in job openings could be in for future trouble.

“We’ve hit the spot now where if employers do continue to pull back on openings, the probability of the unemployment rate rising more sharply becomes higher,” Bunker said.

Of the 10 metro areas with the largest decline in job listings since the beginning of the pandemic, four are in California, according to Bunker’s research. San Francisco (-31%) had the largest decline, followed by San Jose in the Silicon Valley (-28%); Seattle (-27%); New York City (-12%); Boston (-8%); Los Angeles (-6%); Oxnard, California (-5%); Provo, Utah, and Washington, D.C. (-4%); and Buffalo, New York (-3%).

In California, there has been a steep decline in the number of jobs in film and tech, especially supporting roles in sales and recruiting that blossomed in the early pandemic years. Some of the boom in startups was fueled by low interest rates that allowed new tech firms to operate for years before reaching profitability. Higher rates have hit hard.

“Most software is built in startups, with the bulk of the work at the beginning of a business. VC [venture capital] is down and there’s been a flood of talent from big companies that have cut the fat,” said Cody Palmer, a software engineer who does contract work for Silicon Valley companies from Denver. He lost a large contract job this year.

“I’ve been doing this for 15 years and I choose jobs that are hard and high-risk, typically startups,” Palmer said. “I’ve seen, like, 13 layoffs in my career. I’ve grown into this mindset of ‘Always be looking, always try and find the next gig, and be wary of just how fast a job can cut you.’”

The cooling of the labor market without an unemployment spike, at least so far, has surprised some economists.

“It had never happened before, but it did happen,” said Olivier Blanchard, an emeritus economics professor at the Massachusetts Institute of Technology. He co-authored an influential paper in 2022 with former U.S. Treasury Secretary Lawrence Summers predicting that by raising interest rates to curb inflation and cool down an “overheated” labor market, the Federal Reserve would cause a “painful” spike in unemployment.

“Larry and I turned out to be wrong,” Blanchard said.

Other economists such as Andrew Figura at the Federal Reserve argued that a “soft landing” without high unemployment was possible as long as layoffs didn’t spike nationally, as they did in California.

California’s creation of new jobs, the largest in the nation before the pandemic, has now reversed into the largest losses in employment, according to an earlier Stateline analysis. Since 2022, when the Fed first raised interest rates, California has lost 93,000 jobs in the information sector, which includes many internet services and also film and sound recording, according to a March report from the Public Policy Institute of California.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and X.

Austin, Texas, has seen significant growth in tech employment in the past five years, fueling the state’s overall job creation. Texas and Florida saw most of the new jobs created since 2019, according to a Stateline analysis. (Brandon Bell/Getty Images)

More than half of the nation’s jobs created in the past five years have come in two states: Texas and Florida.

They’re at the forefront of a job creation revolution in which states with lower wages and a lower cost of living are gaining the highest share of new jobs, according to a new Stateline analysis of U.S. Bureau of Labor Statistics data.

Meanwhile, high-wage states such as California, New York, Washington state and Massachusetts tumbled out of the top 10. California, which had the highest share of new jobs from 2014-2019, crashed to the very bottom in job creation.

The changes closely follow state-by-state labor trends in the years during and since the COVID-19 pandemic. Employers have been less willing to create jobs in higher-wage states. Workers, meanwhile, are avoiding skyrocketing housing costs and taking advantage of new options for remote work.

“In the pandemic’s wake, workers are likely playing a bigger role because many have new flexibility about where to work and live,” said Aaron Sojourner, a labor economist at the W.E. Upjohn Institute for Employment Research in Kalamazoo, Michigan.

“About 1 in 10 U.S. workers now work fully remote jobs, an expansion enabled by organizations’ investments in distributed work capacity during the pandemic,” Sojourner said. “Many families with high-paying remote jobs migrated towards areas with lower living costs because they’re no longer tethered to a high-cost place.”

Between 2014 and 2019, California gained 1.4 million new jobs — more than any other state and 12% of the national total. But for the past five years California has been dead last in job creation, losing about 214,000 jobs. Texas moved into first place during that time, seeing almost 1.3 million new jobs, almost one-third of all new jobs created nationally.

Florida was not far behind, with about 911,000 new jobs, almost 25% of the national total of about 4 million.

Besides California, which plunged from No. 1 to No. 51 in job creation for the states and the District of Columbia, New York fell from No. 5 to No. 50, and Massachusetts from No. 7 to No. 47.

Washington state, Michigan and Tennessee also fell out of the top 10, while Arizona, Utah, Virginia, South Carolina, Oklahoma and Colorado moved into the top 10.

High wages in some states are playing a part in lagging job creation, according to an April analysis by the Economic Innovation Group, a Washington, D.C.-based research organization.

California and New York have average salaries about 18-20% higher than the national average of $65,500, while Texas and Florida are 6-7% lower, according to federal Occupational Employment and Wage Statistics data.

“For the first time since the Great Recession, the richest metro areas are no longer creating the majority of new jobs in the U.S.,” the report noted.

Some of the shift in job fortunes comes from a struggle between California’s Silicon Valley and Texas’ capital city of Austin for primacy in tech jobs. California’s share of tech jobs began to plummet during the pandemic as Texas’ share rose.

In a 2020 Wall Street Journal opinion piece headlined “California, Love It and Leave It,” venture capital entrepreneur Joe Lonsdale described moving his company from San Francisco to “a new land of opportunity: Texas.” He blamed bureaucracy for slowing business progress during the pandemic and restrictive zoning that made it impossible for employees to afford housing near their jobs.

More recently, Jeffrey VonderHaar discussed in February his plans to move much of his business, Specialized Orthopedic Solutions Inc., which involves manufacturing prosthetic limbs and other medical equipment, back to Texas after 14 years in California. In an interview with Business Insider, he complained of business regulations and taxes in California, as well as high housing prices that fed homelessness and people living in parked RVs near his office in suburban Los Angeles.

Last year, Texas Republican Gov. Greg Abbott gleefully proclaimed Austin “THE destination for the world’s leading tech companies” in a tweet, mentioning Tesla’s and Samsung’s expanding operations in the Austin area. Democratic U.S. Rep. Lloyd Doggett, who represents the Austin area, told Stateline that Samsung is building a third semiconductor fabrication plant in the area and already employs thousands of Texans.

But recent cutbacks in tech have led to setbacks in Texas as well as in California. Oracle announced in April a move to Nashville, Tennessee, from Austin, where it had built a massive lakefront campus with the help of tax breaks, citing even more generous incentives from Tennessee. Tennessee approved $65 million in tax incentives in 2021, when Oracle pledged to bring in about 8,500 jobs; Tennessee’s average salary is also about 5% lower than in Texas.

Oklahoma made the biggest jump in the Stateline analysis of job creation rankings, from No. 31 to No. 9. The state has seen a reversal of the “brain drain” it experienced in the late 2010s, a period when it lost educated residents to other states, according to research this year by the Oklahoma City branch of the Federal Reserve Bank of Kansas City.

The state had been losing college graduates and higher-income people to other states before the pandemic, but that has reversed, said Chad Wilkerson, the Oklahoma City branch executive for the bank and author of the report.

Leaders want to grow Oklahoma’s job landscape beyond the cyclical energy industry that attracts blue-collar workers but also creates boom-and-bust cycles, Wilkerson said. Many new Oklahomans have higher education levels and are employed in business services such as research and development and engineering, as well as retail management, reflecting both population growth and a more diverse economy.

“It’s been intentional to some degree by chambers [of commerce] and state policy, the desire to attract more than just oil and gas,” said Wilkerson.

The privately funded Tulsa Remote program, for example, has brought in thousands of remote tech workers from other states with a promise of lower living costs and a shared work space to encourage networking and friendship.

A 2021 study found that $4.5 million spent luring new residents paid off in the form of $62 million in new jobs — both for those workers and other jobs created to support them.

Most states have some form of job creation incentives and evaluate them regularly for effectiveness. Oklahoma has tax incentives for data processing and research and development jobs, and a state commission last year recommended keeping them.

State tax incentives can pay off in the long run, but the effect is modest, said Robert Chirinko, a University of Illinois finance professor whose most recent study of state job creation tax incentives was published in September by the National Tax Journal.

Florida has enjoyed a decade of job creation, moving up the rankings from No. 3 to No. 2 in the past five years. But overall, its economic landscape is mixed.

Wages have not kept up with inflation, and housing prices in the Miami area are especially high, making poverty an increasing concern, according to a report last year by Florida International University’s Center for Labor Research and Studies.

“It is a tale of rich and poor,” said Ravi Gajendran, a business professor at Florida International University in Miami. “A lot of the migration [to Florida] is due to well-off individuals moving to Miami, which is part of the reason why real estate prices have risen here to a greater extent.

“For someone moving from New York or California, real estate prices are still cheap here in Miami,” he said. “But for local Miamians, this increases real estate and rental costs, making it less affordable to stay here.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

In the short term, having fewer births means lower state costs for services such as subsidized day care and public schools at a time when aging baby boomers are straining resources. But eventually, the lack of people could affect workforces needed both to pay taxes and to fuel economic growth (Getty Images)

Births continued a historic slide in all but two states last year, making it clear that a brief post-pandemic uptick in the nation’s birth numbers was all about planned pregnancies that had been delayed temporarily by COVID-19.

Only Tennessee and North Dakota had small increases in births from 2022 to 2023, according to a Stateline analysis of provisional federal data on births. In California, births dropped by 5%, or nearly 20,000, for the year. And as is the case in most other states, there will be repercussions now and later for schools and the workforce, said Hans Johnson, a senior fellow at the Public Policy Institute of California who follows birth trends.

“These effects are already being felt in a lot of school districts in California. Which schools are going to close? That’s a contentious issue,” Johnson said.

In the short term, having fewer births means lower state costs for services such as subsidized day care and public schools at a time when aging baby boomers are straining resources. But eventually, the lack of people could affect workforces needed both to pay taxes and to fuel economic growth.

Nationally, births fell by 2% for the year, similar to drops before the pandemic, after rising slightly the previous two years and plummeting 4% in 2020.

“Mostly what these numbers show is [that] the long-term decline in births, aside from the COVID-19 downward spike and rebound, is continuing,” said Phillip Levine, a Wellesley College economics professor.

To keep population the same over the long term, the average woman needs to have 2.1 children over her lifetime — a metric that is considered the “replacement” rate for a population. Even in 2022 every state fell below that rate, according to final data for 2022 released in April. The rate ranged from a high of 2.0 in South Dakota to less than 1.4 in Oregon and Vermont.

Trends for Latina women

The declines in births weren’t as steep in some heavily Hispanic states where abortion was restricted in 2022, including Texas and the election battleground state of Arizona. Births were down only 1% in Arizona and Texas. When health clinics closed, many women might have been unable to get reliable birth control or, if they became pregnant, to get an abortion.

Hispanic births rose in states where abortion is most restricted, even as non-Hispanic births fell in the same states, according to the Stateline analysis. It’s hard, however, to tell how much of a role abortion access played compared with immigration and people moving to growing states such as Texas and Florida.

In states where abortion access is most protected, births fell for both Hispanic and non-Hispanic women.

“The big takeaway to me is the likely increase in poverty for all family members, including children, in families affected by lack of access [to abortion and birth control],” said Elizabeth Gregory, director of the Institute for Research on Women, Gender & Sexuality at the University of Houston.

Many of the nation’s most Hispanic states where abortion and birth control are more freely available saw the biggest decreases in births: about 5% in California, Maryland, Nevada and New Mexico.

“Hispanic women as a group are facing more challenges in accessing reproductive care, including both contraception and abortion,” Gregory said in a university report earlier this year. “Unplanned births often directly impact women’s workforce participation and negatively affect the income levels of their families.”

Hispanic women on average have more children than Black or white women. Their fertility rates rose throughout much of the 1980s and 1990s, then fell in the late 2000s to near the same level as other groups. That’s because both abortion and more reliable birth control became more widely available, Gregory said.

The fact that some of the steepest drops were in heavily Hispanic states outside of Arizona and Texas suggests that Latina women are continuing a path toward smaller and delayed families typical of other groups.

Most of the decline in California has been associated with fewer babies born to Hispanic women, especially immigrants, said Johnson, of the Public Policy Institute of California.

“California has a high share of Latinos compared to other states, and so fertility declines in that group have a huge effect on the overall decline in California,” he said. California was above replacement fertility as recently as 2008, he added, and would still be there if Hispanic fertility had not dropped. California is about 40% Hispanic, about the same as Texas and second only to New Mexico at 50%.

Birth rates also declined steeply in heavily Hispanic Nevada and New Mexico, with each dropping about 4% from 2022 to 2023. But Arizona, Florida and Texas, also in the top 10 states for Hispanic population share but faster-growing, saw relatively small drops of about 1%.

Texas banned almost all abortions after the U.S. Supreme Court overturned Roe v. Wade in 2022. The state also requires parental consent for birth control, a rule that’s included federally funded family planning centers since a lower court ruling that same year.

Arizona also saw the number of abortions drop in 2022. After the high court’s Dobbs v. Jackson decision, an Arizona judge revived enforcement of a near-total ban on the procedure that was enacted in the Civil War era. Many clinics closed and never reopened.

Abortions in the state plummeted from more than 1,000 a month early in 2022 to 220 in July 2022, and never fully recovered, according to state records. The rate of abortions dropped 19% for the year. Births that year increased slightly, by 500, over 2021.

In Texas, Gregory’s research at the University of Houston research saw an effect on Hispanic births when an abortion ban took effect in 2021. Fertility rates rose 8% that year for Hispanic women 25 and older, according to the report.

Both Texas and Arizona also are growing quickly, making the smaller decreases in births harder to interpret, Arizona State Demographer Jim Chang noted. Chang declined comment on the effect of abortion accessibility on state birth rates.

Budget effects

Overall, the continuing fall in birth numbers could have significant effects on state budgets in the future. The slide augurs more enrollment declines for state-funded public schools already facing more dropouts since the pandemic.

“The decline we see in enrollment since COVID-19 is a bigger problem than just the decline in birth rates,” said Sofoklis Goulas, an economic studies fellow at the Brookings Institution. Rural schools and urban high schools have been particularly hard hit, according to a Brookings report Goulas authored this year.

“We don’t have a clear answer. We suspect a lot of people are doing home education or going to charter schools and private schools but we’re not sure,” Goulas told Stateline.

Still, states need to recognize declining births as an emerging factor in state budgets to avoid future budget shortfalls, said Jeff Chapman, a research director who monitors the trend at The Pew Charitable Trusts.

Nationally, births did increase slightly for women older than 40, indicating a continuing trend toward delayed parenthood, said William Frey, a demographer at Brookings.

“The last two post-pandemic years do not necessarily indicate longer-term trends,” Frey said. “Young adults are still getting used to a recovering economy, including childbearing.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

Jelani Bayi, seen with his dog, Dior, bought this four-bedroom house in Detroit’s Rosedale Park neighborhood for $275,000 in 2021. Like many Black-majority areas, his ZIP code has seen big gains recently as the housing shortage intensifies and state and federal efforts to end bias in valuations of Black-owned homes progress (Valaurian Waller/Bridge Detroit).

Black homeowners’ property values are on the rise across the country, with some of the biggest upswings in Midwestern and Southern states. The boon to Black homeowners, after decades of lagging property values, could help them close a racial wealth gap that has kept the American dream out of reach.

Home values increased on average 84% in majority-Black ZIP codes between 2016 and 2023, outpacing growth in white ZIP codes, where values grew 69%, according to a Stateline analysis of federal housing and census data.

A hot market during the COVID-19 pandemic, an intensifying housing shortage, and new state and federal efforts to fight appraisal bias may finally be moving Black homeowners a bit toward property value parity.

Morgan Williams, an attorney for the National Fair Housing Alliance, an advocacy group, cautioned that the push for more fair housing appraisals remains in the early stages. And he noted that even unbiased appraisals can perpetuate undervalued housing by using past sales as a benchmark.

“There was, during the pandemic, an increase in Black wealth. There may be some broad policy actions you could trace that to, but I think a lot of that is going to be more housing-market driven,” Williams said.

Recent research has revealed that homes in majority-Black areas are more likely than those in majority-white areas to be appraised below purchase offers. The disparity remains high but has improved recently, according to federal statistics.

The Stateline analysis found that the home price increases in majority-Black neighborhoods since 2016 are a major shift from the prior 15 years.

Between 2000 and 2016, selling prices in majority-Black communities increased by 40% compared with 48% for majority-white areas, and home values fell in more than a fifth of Black ZIP codes.

Since 2016, however, home values increased in every majority-Black ZIP code tracked by the independent Federal Housing Finance Agency, and on average outpaced increases in white ZIP codes.

Stateline relied on that Federal Housing Finance Agency data on ZIP codes, which uses sales of similar properties — so-called matched pairs — to estimate price changes over time. U.S. Census Bureau estimates were used to find ZIP codes where most homeowners are Black.

In Detroit alone, rising home prices in Black neighborhoods have created almost $3 billion in new wealth for Black homeowners, according to a University of Michigan study released in April. That study focused on 2014 to 2022, the decade after the city’s bankruptcy. The Stateline analysis suggests the turnaround extends far beyond Detroit, across the Midwest and South.

The Stateline analysis identified 92 majority-Black ZIP codes nationally, including nine in Detroit and six in Cleveland, where home values have increased since 2016 after losing value earlier in the 2000s. There were 22 such ZIP codes in Georgia, 21 in Michigan, 17 in Ohio and 13 in Illinois, with others in Alabama, Connecticut, Florida, Indiana, Kentucky, Missouri, North Carolina, Tennessee and Wisconsin.

Another 48 majority-Black ZIP codes across the South and Midwest saw big property value increases of more than 100 percentage points. For instance, ZIP code 32811 in Orlando, Florida, saw 26% home price growth from 2000 to 2016, but that has ballooned to almost 215% in the years since.

Six of the top 10 turnarounds were in suburban Atlanta’s Clayton County, which got a boost when a long-vacant army base was redeveloped into the Gillem Logistics Center, an e-commerce and distribution hub that is projected to add 5,000 jobs and $4 billion into the local economy, said Erica Rocker, the county’s economic development director.

In Clayton County, a new four-bedroom home — with two Tesla chargers, an elevator and keyless doors — recently sold for almost $700,000. It had replaced a smaller home on the property that sold for $40,000 in 2020. The home’s ZIP code in Forest Park, 30297, had the nation’s largest swing in prices, going from a 27% loss to a 214% gain.

Altimese Dees, a real estate broker who has represented Clayton County in real estate and land acquisitions, said home values became artificially low in the Great Recession. Foreclosures sank the county’s average home price as low as $66,500 in 2009, but it has since recovered to about $253,000 this year, she said.

“We had a historic number of foreclosures between 2006 and 2011. Investors were basically getting these houses for pennies on the dollar,” Dees said. “It was a result of people losing their jobs and income during this time, as well as subprime lending targeting our mostly African American and minority community. We’re thankful for the increase in value, but it’s more like getting back to where it should be.”

A similar Stateline analysis in 2018 noted a drop in home values in many majority-Black ZIP codes. Some scholars concluded at the time that, despite the wealth-building potential of home ownership, many first-time Black homebuyers would have been better off renting.

In Detroit, resident Jelani Bayi bought his first home in 2021 in the city’s 48219 ZIP code, part of the Rosedale Park neighborhood. He feels like he’s building wealth for himself and preparing a place to raise a family when he’s ready.

“I definitely think it’s increased in value. I’ve put a lot of time and resources into the house, and values are increasing in Detroit,” Bayi said. “All my adult life I’ve always wanted to be a homeowner, and it was the right time. I just love it. It was very important to me to live in Detroit.”

Bayi said he took advantage of low interest rates in 2021 to buy his $275,000 four-bedroom brick home. Zillow estimates its current value at $316,200.

Sandra Newman, a Johns Hopkins University professor who studies housing and neighborhood change, said pandemic shifts toward suburban living and remote work may have brightened the fortunes of some Black neighborhoods.

“Price trajectories, especially for Black homeowners, depend heavily on location, location, location. The old real estate saw definitely applies,” Newman wrote in an email to Stateline.

Some states, including Mississippi, New Jersey and Texas, have tried to combat appraisal bias after recent cases made the extent of the problem clear.

In a California case, a Black couple sued after getting a dramatically higher appraisal when they “whitewashed” their home by adding family photos of a white family and removing African American art. After that, the appraisal increased by half a million dollars to nearly $1.5 million. The case was settled last year for an undisclosed amount.

In a similar Maryland case, a Black couple got an appraisal two-thirds higher when a white acquaintance posed as the owner of their Baltimore home. That case was settled in March for an undisclosed amount. A Black couple in Ohio also said they got a higher appraisal in 2020 after borrowing family photos from a white neighbor.

Because appraisals rely on personal judgment, many states are looking to diversify their ranks of appraisers. But an outmoded training system that includes thousands of hours of supervised work means many young would-be appraisers simply can’t find supervisors willing to help them get started.

However, in recent years, the racial gap in appraisals has narrowed in almost every state, according to a Federal Housing Finance Agency review published in April. It gauged the effect of a federal task force started in 2021 that “increased awareness of racial bias in home valuations” for states and other governments. The appraisal gap between homes in majority-Black and majority-white neighborhoods declined from 6% to 3.8%, the study found.

The gap closed in every state but Mississippi, which is working to diversify its appraiser workforce. E.C. Neelly IV, director of the Mississippi Appraisal Board, rejected the idea that white appraisers like himself are inherently unfair to Black homeowners.

“I’ve been an appraiser for 34 years, and if you pay an appraisal fee, I don’t care if you’re white, Black, pink or green, I’m doing a good job for you,” Neelly said.

Mississippi used federal funds to pay for alternative training that includes online courses, a move that should allow a more diverse group of would-be appraisers to get licenses. The first class had a high rate of success on licensing tests, and a second class is underway without federal funding, Neelly said.

“This has been just a godsend for the state. Every state is affected by this,” Neelly told Stateline, noting that most of the roughly 25 graduates of the program are non-white and from parts of the state, such as the Delta region, that desperately need more appraisers. The training program, designed and run by appraiser Melissa Bond, has drawn interest from other states interested in getting younger and more diverse appraisers, Neelly said.

“We need more diversity. It’s not just about Black. There are more Black appraisers than Asian, for example,” Bond told Stateline.

Texas recently adopted some online and virtual reality training to reduce an appraiser shortage and to diversify its crop of appraisers, and was the first state to treat appraisal bias cases as civil rights violations, said Melissa Tran, director of the state’s Appraiser Licensing and Certification Board.

And in New Jersey, Democratic Attorney General Matthew Platkin recently announced that state civil rights authorities would investigate appraisal bias there.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

Attendees cheer at the west Michigan city of Grand Haven’s first Pride Fest in June. The surrounding county of Ottawa had more people moving in than any other in the swing state. Like many other fast-growing counties, Ottawa is staunchly Republican but becoming more Democratic (Kristen Norman/The Associated Press).

In recent years, millions of people across the United States have moved from Democratic cities to Republican suburbs, complicating the politics of swing states in a pivotal election year, according to a Stateline analysis.

Republican suburban counties in four swing states — Georgia in the South and Michigan, Pennsylvania and Wisconsin in the Midwest — gained the most new arrivals; heavily Democratic cities lost the most. In Western swing states Arizona and Nevada, meanwhile, the biggest people magnets have been slightly Democratic cities that are expected to be hotly contested.

Those shifts reflect a nationwide trend: In Republican counties, as defined by the 2020 presidential vote, 3.7 million more people have moved in than have left since 2020, while Democratic counties had a net loss of 3.7 million, according to a Stateline analysis of U.S. Census Bureau estimates and county presidential election data kept by the University of Michigan.

The U.S. Census Bureau estimates released in March included people who moved within the country between mid-2020 and mid-2023, a time of pandemic dislocations, lockdowns in big cities, and the rise of remote work that fed a search for affordable housing in less crowded and more scenic settings. Those settings, as it turns out, also tend to be more conservative. The census numbers do not include births or immigration.

Whether the newcomers will vote Democratic this year, or whether they were disenchanted with Democratic policies in their former homes and will vote Republican, remains to be seen. The changes might affect local and congressional races the most, but even a few movers crossing state lines could sway presidential vote totals in swing states.

“We are looking at an election to be determined by a shift of such small numbers of people in each of these states that a few thousand votes in any one state can impact the electoral vote there,” said David Schultz, a political science professor at Hamline University in Minnesota who has edited and helped write several books on presidential swing states.

The counties gaining the most movers in Georgia (Forsyth County), Michigan (Ottawa County), Pennsylvania (Cumberland County) and Wisconsin (Waukesha County) were solidly for then-incumbent President Donald Trump in 2020. But in the three Midwest counties, Joe Biden had the best showing for a Democrat since Lyndon Johnson in 1964.

Politics in a changing county

In some of the growing counties, there has been tension as new residents bring their own expectations.

“People keep moving here because they like it, then they try to make it like the place they left,” said David Avant, who runs a business networking website in Forsyth County, Georgia. His county gained about 17,000 new arrivals between mid-2020 and mid-2023, according to the Stateline analysis.

Politics might not yet be changing in some of the red counties surveyed. In Michigan, Doug Zylstra became the first Democrat elected in almost 50 years to the 11-member Ottawa County Board of Commissioners in 2018 and was reelected in 2022, but the commission took a more conservative turn in 2023 when a new majority took office.

“The people of Ottawa County chose to replace the previous Republican-majority board, which promoted Democratic ideology and practices,” said Sylvia Rhodea, one of the new Republicans on the commission.

In a January 2023 meeting, Rhodea criticized the previous board’s diversity, equity and inclusion program as “based on the premise that county resident characteristics of being 90% white and largely conservative were problematic for businesses” and as one that “seeks to replace the American value of equality with the Marxist value of equity.”

“There is not a racial divide in Ottawa County, there is an ideological divide. The welcoming of people will continue, but the ideology that tries to divide us has to end,” Rhodea said in the meeting.

The Rev. James Ellis III, who is Black and who moved to Ottawa County in April 2023, lives in the area that elected the county’s sole Democrat. He said the “racial divide” remark “feels inaccurate to me, not to mention unhelpful.” And while he said he has no party affiliation, he thinks “people on every side have a hard time listening to each other.”

Ellis grew up in Maryland and has lived in cities including Washington, D.C., and British Columbia, Canada. He attended a local seminary in Ottawa County.

“Ottawa County is not a utopia. It is an area full of wonderful citizens, lakeshore living, lots of churches and winter sports, and yet simultaneously it has power dynamics and inequities like any place that need addressing,” said Ellis, of Maplewood Reformed Church. The county’s population is about 83% white with small but growing Asian, Black and Hispanic populations.

‘They vote for the same thing’

In Wisconsin, affluent and suburban Waukesha County has gained about 5,200 movers, while urban Milwaukee County has lost 37,000. Still, that’s not likely to change the politics of either county soon, said Steve Styza, a Republican who won an open seat on the Waukesha County Board of Supervisors in Tuesday’s election.

“Democrats are definitely trying to make as big of a push as they can to turn the most conservative counties in our state blue or purple and try to gain some kind of foothold because it is strategically important,” Styza said before the election. “If I was on the other team, I’d be trying to do the same thing.”

Waukesha County voted almost 60% for Trump in 2020, though the roughly 38.8% vote for Biden was the highest share for a Democrat since 1964. The county’s 2022 vote for Democratic Gov. Tony Evers was slightly higher at 39.4%. Milwaukee County voted 69% for Biden in 2020 and 71% for Evers in 2022.

Like Avant in Georgia, Styza said that Democratic newcomers sometimes pose a threat to the suburban lifestyle that drew them there in the first place.

“They say, ‘Well, I gotta get out of there because of what’s going on,’ and then they vote for the same thing in a different place and then wonder why things turn out poorly,” Styza said.

In the Western swing states of Arizona and Nevada, the politics are similar, but the largest cities are still growing fast. Arizona’s Maricopa County, home of Phoenix, voted Democratic in 2020 for the first time since 1948, when Harry Truman carried the county.

In Nevada, Clark County, the home of Las Vegas, has voted Democratic for president since 1992, but the Republican vote has been growing since 2008, reaching 44% for Trump in 2020. Some of the new Republican strength could be transplants from California’s conservative inland region east of Los Angeles, said David Damore, a political science professor at the University of Nevada, Las Vegas.

“In contrast, Reno, which has been voting more Democratic in recent cycles, is attracting more liberal Californians from Sacramento and the Bay Area,” Damore said. “Statewide, the vote share that the Democrats lost in Las Vegas, they gained in Reno.”

Some conservative scholars argue that residential moves from blue to red areas show a political preference or at least an attraction to the results of conservative policies.

“Every day, Americans appear to have a clear preference about the sort of state government they want. Far from flocking to states that have imposed mandates and lockdowns, they have freely chosen to move to states that focus on securing the mandates of liberty,” Jeffrey Anderson, president of the conservative nonprofit American Main Street Initiative, wrote in an analysis of state-by-state moving statistics published in City Journal in January.

Other demographers see the movement of people as a search for housing and jobs that doesn’t take politics into account.

“Domestic migration [moving] across state and metro areas is not strongly affected by politics but by labor market and housing conditions,” said William Frey, a demographer at The Brookings Institution. He added that movers from blue to red states “could make their destination states less red — Arizona and Nevada are good examples.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

David Thau, of Washington, D.C., undergoes treatment for colorectal cancer at the Dana-Farber Cancer Institute in Boston. He was diagnosed in 2019 at age 34 with a cancerous tumor after years of consultations with doctors who didn’t suspect cancer. Younger people are increasingly susceptible to colorectal cancer, but they and their providers often misinterpret the symptoms (Courtesy of David Thau).

Responding to new research on the rising incidence of colorectal cancer among younger adults, some states are trying to boost public awareness of the deadly disease with a focus on Black and rural residents.

In 2021, the U.S. Preventive Services Task Force changed the routine screening age for colorectal cancer to 45 from 50, based on growing cases among younger adults. But many people even younger are finding themselves with life-threatening advanced cancer that could have been prevented with earlier detection. It’s unclear why new generations are increasingly susceptible.

Black and rural Americans are more likely to die from colorectal cancer at any age because they’re less likely to get screening in time to save their lives. Using state and federal money, health care groups in Colorado, Delaware, Michigan, Mississippi, North Carolina, Texas, Washington state and West Virginia have had some success in boosting screening rates.

In Michigan, for example, health care groups last year surveyed Detroit-area Black residents 40 and over and found that many mistakenly thought they didn’t need colorectal cancer screenings if they didn’t have any symptoms. The groups increased the screening rate by giving more information to patients and rolling out software to automatically alert providers to schedule screenings.

West Virginia is considering a state version of a national program to raise more awareness among younger adults and their doctors, partly by bringing in trusted messengers in different communities to help spread the word, said Susan Eason, program director of the West Virginia Program to Increase Colorectal Cancer Screening. It’s one of 35 state-level programs supported by federal, state and local money, she said.

“With this on the rise, younger people need to be aware of symptoms, and providers also need to be aware, so when a patient presents with something like blood in the stool, they don’t dismiss it as hemorrhoids,” Eason said.

Rural West Virginia residents face numerous barriers to screenings, including long distances on mountain roads to see doctors and a shortage of gastroenterologists and screening clinics that can mean a six- to nine-month wait for an appointment. In addition, many residents have jobs that don’t allow paid time off for seeking medical help, Eason said. To help fill the gap, her program is increasing access to chemical tests that can be done at home and sent by mail, she said. However, an in-person colonoscopy is preferable because it can detect precancerous growths that doctors can remove.

Two authors of a December report that found that colorectal cancer is increasing with each generation told Stateline that lowering the age for recommended screenings is less important than making sure that people actually get them.

“Rather than lowering the age to initiate screening, I’d like to see us double down on our efforts to optimize screening participation,” said Caitlin Murphy, an associate professor at the University of Texas Health Science Center at Houston.

More than 1 in 3 adults 45 or older has not been screened, according to the American Cancer Society.

The study’s lead author, Samir Gupta, a gastroenterologist and professor at the University of San Diego, agreed.

Gupta said people under 45 should consider a colonoscopy if they have a family history or “red-flag symptoms” such as rectal bleeding, bloody stools, unexplained weight loss and low iron anemia.

Young survivors who spoke to Stateline said they initially ignored symptoms, or that the symptoms were misinterpreted by medical professionals who did not expect cancer in such young patients.

Jameelah Mahmoud, a nonprofit worker in Milwaukee, said she was misdiagnosed four times before a CT scan showed a massive tumor blocking her colon in 2019 at age 33, with stage 3 cancer that had spread to her lymph nodes. She had complained of increasingly sharp abdominal pain for months but was told only to avoid spicy foods and take antacids.

Now cancer-free after surgery and eight rounds of chemotherapy, Mahmoud, who is 37 and engaged to be married, said she tells people not to let doctors take their symptoms lightly.

“I always tell people, if you feel like someone’s not listening to you, go somewhere else. Because you’re precious. You only have one life,” she said.

Rates of colorectal cancer deaths have been slowly decreasing for all ages since 1968, when they were around 28 per 100,000, to around 13 in 2023. However, deaths of patients 45 and younger as a share of colorectal cancer deaths have grown from 2.5% in 1976 to 3.8% in 2023, according to a Stateline analysis of federal mortality data kept by the federal Centers for Disease Control and Prevention.

From 2018 to early 2024, colorectal cancer death rates for all ages and for those under 45 have been highest in West Virginia and Mississippi, consistent with research showing that rural residents have a greater chance of dying from colorectal cancer. Kentucky, Oklahoma, Arkansas, Maine, Tennessee and Vermont also had high rates for all ages and for younger people. The lowest rates were in Connecticut, Massachusetts, Utah, Colorado and New York state.

Rural areas have the highest rates of colorectal cancer deaths, according to the Stateline analysis: Rates are 42% higher for the most rural areas compared with the most urban areas.

In his mid-20s and living in rural North Carolina without health insurance, Jacob “JJ” Singleton didn’t think about cancer at all when he had painful bowel movements leading up to his 2015 diagnosis of stage 4 cancer that had spread to his liver and lungs.

“In my 20s, you know, I just thought I was invincible,” Singleton said. “I told myself it was a pulled muscle because I was doing CrossFit training.”

Eventually his parents prevailed on him to see a doctor when he could feel a pulsating mass in his abdomen that turned out to be a tumor.

Later, testing revealed that Singleton had a genetic disorder called Lynch syndrome that put him at especially high risk for fast-growing colorectal cancer, but he didn’t know or suspect that at the time.

“There’s not a lot of medical history in my family,” Singleton said. “In my family guys don’t go to the doctor much. You get through and don’t complain. If you get sick you just hope it gets better. It’s like it’s God’s will, is the way they think of it.”

But even in big cities where residents have easier access to health care it’s possible for early symptoms to get overlooked.

David Thau, a political fundraiser in Washington, D.C., was diagnosed at 34 in 2019 with a cancerous tumor that had broken through the walls of his colon.

“If there had been some kind of awareness campaign, some kind of posters in my doctor’s office or other places where a 30-year-old could look and see, ‘These are the symptoms of colon cancer,’ I would have gotten this checked out much sooner,” Thau said.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

With the help of universities, some states and local governments are learning to detect trends in COVID-19 and other illnesses from wastewater without relying on swab tests of individuals (Kena Betancur/Getty Images)

Although it’s spotty and inconsistent in many places, wastewater testing is pointing to a new wave of COVID-19 infections, with as many as one-third of Americans expected to contract the disease by late February.

With pandemic fatigue also in full force, and deaths and hospitalizations well down from peaks in 2021 because of high vaccination and immunity rates, many people are inclined to shrug off the new wave, fueled by the JN.1 variant. But COVID-19 continues to take thousands of lives a month. Older, sicker people need to take particular precautions, experts point out, and everybody should think about the debilitating condition known as long COVID that can strike even young, healthy people and last years.

Wastewater testing indicates the current wave of COVID-19 peaked in late December with 1.9 million daily infections, the highest since the omicron wave of 2021. Some experts want to maintain and expand wastewater surveillance to stay on top of future waves at state and local levels, even as the public has wearied of COVID-19 mitigation efforts.

“If you know you are one of the first communities where it’s surging, that could be very helpful,” said Michael Hoerger, a Tulane University School of Medicine assistant professor who made the national estimate about peak infection rates and future infection forecasts.

Like many experts, Hoerger said everybody should be more aware of the high risk and try to avoid getting infected or reinfected with COVID-19, since every new infection increases the chance of long COVID. He said Americans might be experiencing “descent neglect,” the phenomenon that makes people more careless when things are getting better.

“Everyone is vulnerable in some way. The best way to avoid getting long COVID is to avoid getting COVID,” Hoerger said.

Deaths have declined more slowly in states with older populations such as Vermont, Hawaii and Maine, according to a Stateline analysis of preliminary data from the federal Centers for Disease Control and Prevention. Vermont hospital employees started masking again earlier this month amid the new surge.

Alarm bells are going off in other states as well: Indiana’s most populous county asked residents with mild symptoms to avoid crowded emergency rooms to prioritize care for patients seriously ill with COVID-19 and other respiratory illnesses. Michigan reported its highest weekly COVID-19 death toll since late 2022, around 156, in mid-January. Illinois saw a 17% jump in COVID-19 hospitalizations in one week earlier this month.

It can be hard to get a read on local trends, however, when testing is inconsistent and methods of analysis vary.

The CDC publishes a “current conditions” map based on wastewater analysis that shows “high” or “very high” COVID-19 levels in wastewater for every state with sufficient data. The categories are not specific but indicate virus levels that are high compared with the past.

But at the same time, public patience with masking and other precautions is at a low, making it more likely that infection will spread and claim new victims among the vulnerable.

In South Carolina, Clemson University got high marks in 2020 for its wastewater surveillance program, earning a congratulatory visit from the White House coronavirus task force. But today the university has lost interest, said David Freedman, an environmental engineering professor who ran surveillance for three sewer plants, including the university’s.

Today he monitors only one community plant, though he can see that its level of COVID-19 is higher than at any time since 2021 by looking at virus copies detected in tests. Even the university’s plant itself has dropped out of testing, he said.

“The testing is free, but there’s some labor involved in collecting the sample and sending it off, and I haven’t been able to convince the university to keep doing it,” Freedman said. “Interest in this has really fallen off.

“To me it’s almost unethical that we’re not warning people that this highly transmissible virus is still with us and some people should really be taking precautions,” he added. “Some people with higher health risks should really be putting on a mask again.”

A Clemson spokesperson, Joe Galbraith, said the university considers wastewater testing to be a “valuable tool” but decided recently to rely on individual COVID-19 testing instead to monitor the disease within the university. Clemson is, however, partnering with the state and other South Carolina universities to create a statewide wastewater testing program, Galbraith said.

There are statewide wastewater testing programs, based on partnerships with academia, in other states such as New York and Oregon.

Older people and cancer patients make up an increasing proportion of COVID-19 deaths, according to Stateline’s analysis. People 65 or older made up 88% of those deaths last year, compared with 69% in the peak year for deaths, 2021. Cancer patients made up 12% of COVID-19 deaths last year, up from 5% in 2021.

In some states with older populations, COVID-19 deaths remain stubbornly high compared with other states. Vermont had the lowest COVID-19 death rate in the country in 2021 but now ranks fourth in the number of deaths per capita, behind Kentucky, West Virginia and Mississippi.

Last year Vermont had 220 deaths related to COVID-19, according to the analysis. That was almost two-thirds of the 2021 total of 331 such deaths.

No other state had nearly as high a proportion: Hawaii was next with 35% of its peak-level 2021 COVID-19 death toll happening in 2023. That was followed by Maine (32%), Massachusetts (31%) and New Hampshire (29%), all states with relatively old populations.

Texas, which is relatively young, last year had 10% of the COVID-19 deaths that it did in 2021, about 4,700 compared with 48,000.

Vermont has seen increased hospitalizations for COVID-19 this year and has been suggesting that people wear masks if they think they were exposed or have a high risk of serious illness, said Ben Truman, a spokesperson for the state health department. The guidance also applies to the flu and RSV, which are peaking in winter months, he said.

Residents in Vermont reacted calmly and cooperatively in the early days of the pandemic, saving lives early on compared to other states, said John Davy, an epidemiologist for the state health department.

“It wasn’t divisive. It wasn’t an identity issue here,” Davy said.

In some areas the latest wave of infections may even be higher than the 2021 omicron wave, which crested at around 6.5 million infections per day, according to Hoerger’s analysis. In Santa Clara County, home of California’s Silicon Valley, wastewater shows some areas reached their highest infection counts ever earlier this month.

Hospitalizations and deaths in the area remain low, said Sarah Rudman, a deputy health officer at the county health department, but the county is advising vulnerable people to consult with doctors and consider masking. “It’s an individual decision,” she said.

The county’s wastewater monitoring covers 90% of county residents and has benefited from strong support from local universities. The county uses an advanced form of measurement that can estimate the number of cases in the community without individual testing, Rudman said. It helps that the county started gathering data early and can compare levels from the start of the pandemic, she added.

Even those without underlying risk factors can get debilitating long COVID.

Jay Breneman was 39 and athletic, cycling and training for marathons, when he got COVID-19 in the summer of 2022 — too young to qualify for medication such as Paxlovid at the time. He ended up bedridden or in a wheelchair for more than a year.

Now the president of the Erie, Pennsylvania, school board, Breneman said he masks in public despite heckling, including from a man who told him at the county Democratic Party headquarters on election night that COVID-19 was “a hoax.”

“This has been hell. There’s no other word that describes it,” Breneman said. “I wouldn’t wish it on anybody. And every single person I know is sick with something right now. The last thing I want now is to get sick again.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

Attendees mingle at a Hispanic Power Lunch with local business leaders at the Consulate de Mexico in Dallas. The Hispanic middle class has grown faster than the white or Black middle class over the past decade, a Stateline analysis shows (Richard Rodriguez/Getty Images).

The Hispanic middle class has grown faster than the white or Black middle class in the past decade and has reached near-parity with the white middle class in seven states, according to a new Stateline analysis.

Between 2012 and 2022, the percentage of Hispanic households in the country that qualified as middle class grew from about 42% to 48%, while the share of white households in the middle class remained about the same at 51%. The proportion of Black middle-class households grew more slowly, from 41% to 44%.

Hispanic households’ increasing economic success reflects the maturing of a community that now has more U.S.-born residents. But it also reflects a change in fortunes for immigrants filling service jobs that are in high demand, as well as a broader labor shortage that has pushed up wages.

However, the gains are fragile and could evaporate over time, said Thomas Saenz, president of the Mexican American Legal Defense and Educational Fund, which advocates for fair labor practices for Hispanic workers.

“While I welcome the progress, it’s not enough to say we’re close to solving the problems with inequity for communities of color. We’re not,” Saenz said. He noted that middle-class income takes a long time to translate into wealth, which often entails passing the financial benefits of homeownership to future generations.

A Pew Research Center report last year found Black and Hispanic adults are more likely than white adults to fall out of the middle class once they’ve reached it, based on data through 2021. Black and Hispanic Americans still lag in college education, which is associated with greater chances of economic success, Rakesh Kochhar, a senior researcher and author of the report, said in an email.

Furthermore, the percentage of Hispanic households that make more than twice the median income, 10%, is still far lower than the 21% of white households in that category.

For purposes of the analysis, Stateline defined as middle class those households making between two-thirds and twice the state median income adjusted for family size, which ranges from about $70,000 in New Mexico to almost $108,000 in Massachusetts. The analysis is based on responses to the U.S. Census Bureau’s American Community Survey provided by the University of Minnesota at ipums.org.

According to the Stateline definition, a three-person household would have to earn $46,000 to qualify as middle class in New Mexico. The same size family would have to make $53,000 in Florida and $72,000 in Massachusetts and New Jersey. The analysis only included the 15 states where at least 10% of the population is Hispanic.

Among those states, the share of Hispanic families who are middle class is nearly the same as it is for white households in seven states: Arizona, California, Florida, Illinois, Nevada, New Mexico and Texas. In Illinois, Nevada and New Mexico, the Hispanic middle-class share is higher than the white share, and it is within 3 percentage points in the other four states.

In 2012, the only state where the Hispanic middle-class percentage approached the share for white households was New Mexico.

Nevada illustrates the progress that Hispanic families have made. Fifty-seven percent of Hispanic households in Nevada are middle class, compared with 52% of white households. That’s a reversal from 2012, when 53% of white households and 49% of Hispanic households were middle class.

Recently, the roller-coaster fortunes of the Nevada tourism industry have been an economic boon to Hispanic workers. Layoffs came in both the Great Recession and the pandemic, but lately jobs have come back with higher wages than before.

Last month, the Culinary Union ratified a contract for 40,000 Nevada resort workers that will raise pay 32% over five years. For Elsa Roldan, a single mother who cleans guests’ rooms at the Bellagio resort in Las Vegas, that would put her over the middle-class threshold she is already approaching at her $25-an-hour pay. In Nevada, the middle-class household income range is about $54,000 to $161,000.

“I couldn’t be more happy or more proud. I feel like I’m middle class, or maybe working class but I have my benefits, my health care, I own my house in Henderson [a Las Vegas suburb], a very peaceful area where I feel safe, and my son is in college,” said Roldan, who was born in Chicago and lived in Mexico for a time before moving to Las Vegas 17 years ago.

Las Vegas has changed a lot since Antonio Munoz grew up there as the son of laborers who arrived in the 1960s as part of the Bracero Program that brought workers from Mexico to ease labor shortages. Back then, neighborhoods were segregated into different areas for white, Latino and Black families, but now neighborhoods are mixed, he said. Munoz is the first in the family to own his own business, the 911 Taco Bar restaurant and catering service.

Being a small-business owner is not easy, though.

“I feel like we’re doing pretty well, though there are always ups and downs in the restaurant business. We’ve been busy, but with all the inflation we’re not making any more money,” said Munoz. He’s considering buying his own restaurant building, but prices are as much as $1.5 million for a simple drive-thru location, and he’s not sure he can afford such a big loan.

The gap between Hispanic and white middle-class households is largest in Northeast states, where living costs are higher. Hispanic residents in states such as Rhode Island and New Jersey are also less likely to be U.S.-born and to speak English easily, factors that have been shown to boost access to middle-class incomes.

The disparity between the Hispanic and white middle class is still 10 percentage points or more in Connecticut, Massachusetts, New Jersey and Rhode Island.

In Rhode Island, where 13% of households are Hispanic, 39% of Hispanic households are middle class compared with 56% of white households, a gap that’s about the same as it was in 2012.

Many Hispanic residents in Rhode Island are single mothers from Central America with low-paying work in house cleaning and child care, with little chance of buying homes and building wealth in today’s inflated housing market, said Marcela Betancur, director of the nonprofit Latino Policy Institute in Providence.

“Being middle class means more than money. It means being able to pass it on to the next generation,” Betancur said, adding that she sees hope for the future in increasing college enrollment among children of immigrants.

Rosa Flores was born in the Dominican Republic and owns a beauty salon in Providence where she moved after studying at a beauty college in New York City about 20 years ago. A single mother, she endured some hard times in the pandemic, living on her savings when the salon, Disnalda, closed for 72 days.

“People came back, thank God, that was a big relief and we’re doing well now,” Flores said. “I do feel middle class and it’s much easier to get by now that I have my own business. I’m very happy.”

The middle-class gap between white and Hispanic households is 12 percentage points in Massachusetts, 11 points in Connecticut and 10 points in New Jersey.

Overall, the growth of the Hispanic middle class is “rapid but not surprising” as the community matures and includes more U.S.-born citizens who are educated and speak English, said William A.V. Clark, a geography professor at the University of California, Los Angeles, who wrote a 2003 book on immigration and the middle class.

A report published this year by The American Journal of Economics and Sociology also emphasized the importance of fluency in English.

The report looked at spending between 2010 and 2019 and found that English-speaking Hispanic families spent more than those who spoke only Spanish on expenses considered middle-class like home mortgages, car payments and family vacations, said author Hua Zan, a family economics researcher at the University of Hawaii.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

Murrah High School football offensive linemen square up against the blocking sled at practice in August 2022, in Jackson, Miss. Several states have enacted or are considering measures designed to protect residents — with a new focus on younger people (Rogelio V. Solis/The Associated Press).

After two years of record-breaking heat that brought a surge of deaths and health emergencies, several states have enacted or are considering measures designed to protect residents — with a new focus on younger people whose vulnerability is rising with the temperatures.

Nationally, heat-related deaths rose from about 1,000 in 2018 to 1,722 in 2022 and 1,784 so far in 2023, according to a Stateline analysis of federal Centers for Disease Control and Prevention data. Those totals are likely an underestimate because heat waves make death more likely from other causes as well.

The Stateline analysis considered heat-related deaths in CDC epidemiological research, known as Wonder data, where heat is listed as a direct or contributing cause. But deaths caused by heat more indirectly are much higher. A New York City analysis last year, for example, found an average 360 heat-exacerbated deaths in the city annually compared with 10 caused directly by heat.

Climate change is making the problem more urgent: Heat waves have been steadily rising in number and duration since the 1960s. States are responding with strategies that include public warnings, ice baths and cooling centers for those without air conditioning.

As climate change increases the number of extremely hot days, minority groups and people with low incomes will suffer disproportionately, said Samantha Artiga, director of racial equity and health policy at KFF, a national health policy think tank. A recent KFF report on heat-related deaths found the highest death rates were for Native American, Black and Hispanic people.

“We know that while climate change and extreme heat pose risks for everyone, those risks are not felt equally,” said Artiga, who co-wrote the report.

The summer of 2023 was the hottest on record globally, as was the 12-month period ending Oct. 31. A November report published in the medical journal The Lancet said worldwide heat-related deaths could nearly quintuple by 2050.

People 65 or older represent the bulk of deaths — 44% this year — but the youngest also are falling prey to heat. One in 10 heat-related deaths this year were people younger than 35. Among them: a 12-year-old California boy who died after running laps at school in August, a 19-year-old Kansas college football player and a 25-year-old Arizona farmworker who succumbed to the heat in July.

“Addressing increasing numbers of heat-related deaths is a likely reality that will require both new policy and awareness,” said Jesse Berman, an environmental epidemiologist at the University of Minnesota who studies health effects of climate change.

Twelve-year-old Yahushua Robinson died on Aug. 29 while running laps during a gym class at his middle school in Lake Elsinore, California. At the time of his death, state legislators were already considering a bill to give school athletic programs more resources to address heat-related injuries.

Assemblymember Kate Sanchez, a Republican representing part of Orange County, said she sponsored the bill to ensure that all schools, not just wealthy ones, have tools to prevent heat-related illnesses and deaths, such as ice baths and wet-bulb thermometers that measure temperature and humidity. It was signed into law last month.

“This law will help schools, especially in underserved areas, keep our students safe while they’re being healthy and active,” Sanchez said.

The 2016 death of Johnny Tolbert, a 12-year-old Georgia football player who collapsed during football practice, inspired the adoption of a South Fulton city ordinance that requires heat-related training for coaches and the placement of 150-gallon containers at parks that host athletic events. The containers must be filled with ice and water between April and September so that heat-stricken athletes can be immersed in them.

Georgia state legislators are considering a bill, based on the South Fulton ordinance, that would require every city and county park and recreational facility to have at least one container with a capacity of 150 gallons or more and to keep ice on hand between April and September — or whenever the temperature reaches 93 degrees or higher.

“Hopefully we can save the next child’s life and get them to a hospital,” said sponsor state Rep. Lydia Glaize, a Democrat who represents a suburban Atlanta district.

Cold-water immersion tubs also are required in Florida under a 2020 state law.

In the nation’s hottest and most arid states, heat-related deaths have soared.

Arizona had 529 heat-related deaths in 2022 and 710 so far this year — up from about 200 a year in 2018 and 2019. Texas also saw a large increase from about 100 a year in 2018 and 2019, doubling to 203 in 2022 and jumping again to 323 in 2023.

States in the Midwest, including Iowa, Kansas, Missouri and Nebraska, had the highest rate of heat-related emergency room visits this past summer, topping out in late August at a rate of 1,516 heat-related visits per 100,000 total emergency-room visits.

A historic heat wave in the desert West this year, including a record-shattering 54 days of temperatures of 110 degrees or more in Phoenix, has tested decades of experimentation with cooling centers and other public responses to curb heat deaths.

Arizona Gov. Katie Hobbs, a Democrat, ordered new cooling centers on the Capitol Mall and called for more action to combat heat-related deaths in an August executive order. The state health department is due to present an action plan in December.

As a fast-growing state, Arizona has many newcomers and retirees who may not be aware of how debilitating the heat can be, according to Hsin-I Lin Cox, a state epidemiologist. Cities also have large homeless populations that need bus transportation to reach cooling centers.

New York also is taking steps to curb heat-related health problems, especially for workers and athletes.

Legislation introduced this year would create heat thresholds that would trigger protections for delivery workers. It’s still in committee.

Many delivery trucks do not have air-conditioned cabs. Paramedics had to cover a New York UPS driver in ice packs and take him to the hospital in July 2022 after he nearly collapsed at the end of his Long Island route. A UPS driver died in Texas this summer after collapsing in the heat.

“It seems like it’s getting hotter here every year and we don’t want to wait until there’s a tragedy,” said New York Assemblymember Catalina Cruz, a Democrat representing Queens who sponsored the legislation.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

California Highway Patrol officers work at the scene of a fatal vehicle accident in Pasadena, Calif., in June 2022. Traffic fatalities have spiked nationwide and stayed high since 2019 despite fewer miles driven overall. (James Carbone/The Associated Press)

Traffic deaths are lingering near historic highs in most states despite less driving overall, prompting policymakers to consider deploying more police or installing automated monitoring such as speed cameras to curb speeding and reckless driving.

People are driving fewer miles than they were in 2019, but more are dying on roadways. Traffic deaths spiked 18% from 2019 to 2022 — though miles traveled fell 3%, according to a Stateline analysis of federal records from the National Highway Traffic Safety Administration and the U.S. Bureau of Transportation Statistics.

Experts blame bad driving habits that took hold when roadways suddenly cleared out as the COVID-19 pandemic started in 2020. At the same time, law enforcement agencies shifted their priorities away from traffic violations and many struggled to hire officers amid heightened scrutiny and criticism, especially after a police officer killed George Floyd in May 2020 in Minneapolis.

States and cities are trying to reduce the number of deaths caused by risky driving with a mix of more police officers and controversial technologies such as speed and red-light cameras. But many critics see those approaches as potentially troublesome, since traffic tickets are a heavier financial burden on low-income drivers. And others say cameras violate people’s privacy and right to due process.

“Law enforcement has really stepped back from enforcing traffic laws,” said Jonathan Adkins, CEO of the Governors Highway Safety Association. “We have to get police back out there and get support for police back. But this has to be done the right way, and it has to be done fairly. And we do want to look at technology — cameras don’t see race, they don’t see gender.”

The nation’s two most populous states, California and Texas, have taken different paths. In October, California approved a speed camera pilot program, to begin next year. Texas hasn’t reconsidered its 2019 ban on local speed and red-light cameras, but state transportation officials have asked local police to step up ticketing. Police in Fort Worth ramped up enforcement in response to residents’ complaints about reckless drivers, according to press reports, writing 12,000 tickets for speeding and careless driving between November 2022 and April 2023.

Traffic deaths were up 18% in California and 24% in Texas between 2019 and 2022, the latest full year available from the National Highway Traffic Safety Administration.

In Washington state, traffic fatalities were up 38% last year compared with 2019, reaching a 30-year high. In response, the state is considering expanding its limited speed camera use. State officials plan a visit to Finland next month to see how that country used automated enforcement to reduce traffic deaths.

“When people see a sign, ‘Speed Camera Ahead,’ they slow down,” Gov. Jay Inslee, a Democrat, said in a June interview with the Washington State Standard.

Nationally, most of the change in fatal accidents has been caused by speeding, careless driving and drug or alcohol use, according to federal Fatality Analysis Reporting System data from 2019 to 2021, the latest year available from that source.

Driver deaths increased the most in that time, 21%. Deaths of pedestrians and motorcyclists rose by 18%, and bicyclist deaths by 12%.

Most of the increase from 2019 to 2022 has been in cities, suburbs and small towns, with rural areas less affected, according to separate federal statistics on deaths caused by traffic accidents kept by the federal Centers for Disease Control and Prevention.

Vermont, which has been struggling to fill police jobs, saw the largest percentage increase of any state from 2019 to 2022, a 64% jump from 47 to 77 deaths. Other states with large percentage increases included Connecticut (54%), New Hampshire (47%), the District of Columbia (39%) and Washington state (38%).

Traffic accidents are the most common cause of death for people under 40 in Arkansas, Nebraska and Texas, according to a September Stateline analysis.

The only states to see a decrease in traffic deaths from 2019 to 2022 were Wyoming (down 9%), Rhode Island (down 5%), North Dakota (down 3%) and Idaho (down 2%). Those four states did see increases in the first six months of 2023, however, compared with 2022.

About half of Wyoming’s fatal crashes in 2022 involved speeding or failure to wear seat belts, according to a state report.

Legislative efforts

In California, speed camera legislation has been stymied in the past by disagreements over fines and impacts on residents with low incomes. The compromise bill as enacted in October will allow community service in lieu of fines for low-income drivers who are ticketed in the pilot program, and limit placement of cameras to streets with speeding issues in a handful of cities.

Adkins, the CEO of the governors’ safety group, said other states should be similarly cautious.

“You have to be really careful with these camera programs. We don’t want cameras to be a ‘gotcha,’” Adkins said. “They should only be in areas that have a problem.”

Another state considering more speed cameras is Pennsylvania, where a pilot program put speed cameras on one street in Philadelphia and in work zones statewide. A bill to make the program permanent and expand it within Philadelphia passed the state House and is now pending in a state Senate committee. Pennsylvania’s traffic fatalities increased 12% from 2019 to 2022, according to the Stateline analysis.

In Philadelphia, speed cameras cut fatal accidents in half, saving an estimated 36 lives, and reduced speeding by 95% after they were introduced in 2020 on the 14-mile stretch of Roosevelt Boulevard, a main artery, according to city records obtained by Stateline. Cameras detected 8,305 speeders in February 2023 compared with 224,000 when they were first installed in June 2020.

States that have banned cameras for speeding and/or red-light violations often cite driver complaints about high fines and say it's unfair for drivers to have to face accusations from machines instead of police officers. The National Motorists Association, a driver advocacy group, opposes red-light and speed cameras, saying they infringe upon due process rights.

Some Texas lawmakers called cameras a violation of constitutional principles of presumption of innocence and the right to confront one’s accuser as they passed a bipartisan 2019 measure that banned photographic enforcement. Other states with laws banning traffic cameras include Maine, Mississippi, New Hampshire, New Jersey, South Carolina, West Virginia and Wisconsin, according to the Insurance Institute for Highway Safety, a trade group.

The Missouri Supreme Court struck down St. Louis' red-light cameras in 2015, saying they were unconstitutional because cameras couldn't document who was driving the car. However, in the face of increased fatalities, the city announced in September it is considering a new plan for speed and red-light cameras that record drivers’ faces as well as license plates.

In Iowa, where 19 cities and towns use cameras for speed or red-light enforcement, Republican state Sen. Mike Klimesh said he plans to reintroduce a bill next year limiting fines and requiring revenue-sharing with the state to benefit a retirement fund for volunteer workers like firefighters. Cities should have to prove that the cameras are placed in areas where they improve safety, Klimesh said.

“This would require the cities to provide some data to prove it makes sense to put the camera at that specific location, that it’s not just a gotcha or a revenue generator,” Klimesh said. “We’re trying to make sure they’re looking first and foremost at law enforcement presence, officers in vehicles,” he added. Klimesh sponsored a similar bill this year that did not progress to a floor vote.

Risky behavior

As with Washington officials’ planned visit to Finland, states are increasingly finding inspiration in Europe’s mostly automated traffic control strategies that are cutting fatalities, said Andi Hamre, director of policy and research at the Eno Center for Transportation, a nonprofit traffic policy think tank. That interest could help revive “Vision Zero” initiatives, meant to eradicate traffic deaths entirely, that have recently seen numbers headed the wrong way.

“We’re leaving a lot on the table as far as traffic safety goes, compared to some places in Spain, France and Scandinavia. Vision Zero works. What doesn’t work is ‘Vision Zero Lite,’ which is what we’ve been seeing,” Hamre said. States such as Texas that have banned red-light and speed cameras “have just taken that tool away from localities altogether,” Hamre said.

Along with more speeding and careless driving, there has been a puzzling increase in the number of people killed in crashes who were not wearing seat belts. The number of drivers and passengers killed in crashes who were unbelted rose 24% between 2019 and 2021, according to data from the Fatality Analysis Reporting System. The increases were highest for 25- to 34-year-olds, up 51%.

“It seems like there was something going on with people that was leading to this riskier behavior, and we really don’t know what was causing it,” said Jessica Cicchino, vice president of research for the Insurance Institute for Highway Safety.

“Even when people weren’t driving that much, the people who were driving were doing it in a more risky way,” Cicchino said.

Adkins said the decline in seat belt use is “kind of nuts” but that other factors are more understandable, considering the early pandemic days let some people feel free to drive poorly.

“People started driving crazy because they could,” Adkins said. “They were so used to these roads being full. … And then our driving behavior didn’t go back to normal. We have to learn to share the roads, and absent that we have to have better engineering and more enforcement out there, unfortunately.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

Unemployment has remained below 3% — and in recent years it has stayed low even in winter months, when outdoor work used to stop in brutally cold weather (Getty Images).

Residents of some Midwestern and Mountain states gained the most income per capita during the past four years, a Stateline analysis shows, as competition for workers drove up wages in relatively affordable places to live.

With the COVID-19 pandemic now in the nation’s rearview mirror, Stateline’s analysis offers a more complete understanding of how some states’ residents benefitted economically — and others didn’t — as policy decisions and Americans’ choices shuffled state-by-state outcomes.

The oil and gas industry boosted the per capita incomes for residents of North and South Dakota. Mountain states such as Utah saw high earners moving in from California, Oregon and Texas.

States where inflation-adjusted income declined included Alaska, where oil drilling has been in long-term decline, as well as Georgia and Maryland.

Inflation took the biggest bite out of paychecks in the West and South, with consumer prices rising about 20% in those regions between mid-2019 and mid-2023, according to U.S. Bureau of Economic Analysis figures compiled for Stateline by the Urban-Brookings Tax Policy Center in Washington, D.C. Inflation was a little lower in the Midwest, about 19%, and about 16% in the Northeast.

Stateline’s analysis calculated gains in per capita personal incomes after regional inflation between the second quarter of 2019, before the pandemic, and the second quarter of 2023, the latest available from the Bureau of Economic Analysis. Per capita personal income, which includes all kinds of income from wages to business income and pandemic support payments, often is used as a barometer of economic health for states.

Many of the states in the Mountain West, Midwest and New England that experienced large income increases have scenic or affordable areas that have attracted remote workers looking for a lower cost of living and proximity to recreation.

“Things changed fast. Now there’s competition for workers and upward pressure on wages, and people from Oregon and California are saying ’Hey I could live next to five national parks. This is an incredible place,’” said Shawn Teigen, president of the Utah Foundation, a nonprofit that monitors Mountain State trends.

Newcomers to Utah, for example, brought both more income and oftentimes smaller families than the longtime Mormon population, boosting per capita incomes, he noted. And competition for scarce service and manufacturing workers has forced employers to pay more.

“This used to be a place where we could bring businesses in and say, ‘You can pay minimum wage and people will take the jobs because it’s not expensive to live here,’” he said.

Inflation-adjusted per capita incomes in Utah have grown by about 8% since 2019. Incomes in Colorado, Maine, Montana and Nebraska also grew by roughly that much. Incomes in Arizona, Idaho and Missouri increased by about 7%.

But the greatest gains were in North Dakota and South Dakota, where inflation-adjusted incomes increased by 11% and 9%, respectively.

North Dakota’s per capita personal income rose to $73,414, giving it the 12th highest income in the country, up from 16th in 2019. The gains allowed it to leapfrog states including Illinois, Minnesota and Virginia.

Growth in North Dakota’s energy industry continues to roar ahead, with taxable sales and purchases by the industry up more than 50% in recent quarters compared with the previous year, according to state estimates through mid-2023.

Unemployment has remained below 3% — and in recent years it has stayed low even in winter months, when outdoor work used to stop in brutally cold weather, said Kevin Iverson, a demographer at the North Dakota State Data Center.

The major impediment now is finding more workers to hire, Iverson said.

“It is no longer surprising to see businesses spend their advertising dollars on recruiting workers instead of customers,” Iverson said. The state recently created an Office of Legal Immigration to help recruit workers from abroad and among work-authorized immigrants already in the United States.

Incomes didn’t grow as much in most of the Northeast, partly because low-wage service workers have fared better than the high earners who predominate in the region, said Lucy Dadayan, principal research associate at the Urban-Brookings Tax Policy Center. Some of the highest-income areas in the country, including Connecticut and the District of Columbia, were in the bottom 10 for income growth. New Jersey and New York weren’t far ahead.

Those states still have among the highest incomes, though. Connecticut fell to No. 3 for personal income per capita overall at $86,674, from No. 2 in 2019, behind Massachusetts at $88,197 and the District of Columbia at $100,971.

“Connecticut, New York and New Jersey have a higher share of high-income taxpayers, and the salaries of low-income workers increased far more in the pandemic,” Dadayan wrote in an email. “Moreover, some of the income for high-income workers is often dependent on the stock market performance, which declined in 2022.”

The knocks to personal incomes affected state revenues. In Connecticut, personal income tax revenue took a $1.3 billion hit in fiscal 2023, down nearly a third in one year and erasing gains since fiscal 2019, according to state comptroller records. Comptroller Sean Scanlon blamed the drop on 2022 stock market losses in his annual report to the governor.

However, Connecticut’s general fund revenues showed a surplus overall in fiscal 2023 because of strong gains in use and sales taxes as hospitality and tourism industries recovered. Democratic Gov. Ned Lamont signed a tax cut bill in June.

Both Alaska and North Dakota have economies driven by oil, but North Dakota’s shale boom is still on an upswing while Alaska’s production has been in decline since the 1980s, helping North Dakota rise to the top of income growth statistics while Alaska sunk to the bottom. Alaska’s per capita income dropped 2.4% after inflation over the past four years.

North Dakota landowners are seeing continued profits from oil leases on private land. Alaska’s oil, however, is largely on public land that has seen more cutbacks in drilling rights, said John Connaughton, professor of financial economics at the Belk College of Business at the University of North Carolina at Charlotte.

State-by-state income rises across the Midwest were “all over the map,” from North Dakota’s double-digit percentage increase to just 2% for Wisconsin and 3% for Kansas and Michigan, said Nina Mast, who studied the region’s wage trends in the pandemic in an October study for the Economic Policy Institute, a nonpartisan think tank in Washington, D.C.

The region as a whole suffered lower wage growth compared with other regions in the pandemic through 2022, threatening to increase inequality and hurt middle-class workers, who increasingly lack union representation, Mast said.

Michigan became the first state to repeal an anti-union “right to work” law in March, a step that could help empower workers there, Mast said. “It was a really historic step that could really have important effects for workers in the Midwest.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

A construction worker sands a doorway at a new apartment complex in Miami in February. An unprecedented boom in housing construction may finally be moderating rents in cities such as Miami, where rents spiked 40% since 2020. (Marta Lavandier/The Associated Press)

Read more Stateline coverage of how communities across the country are trying to create more affordable housing.

An unprecedented surge in the nationwide construction of new housing — mostly apartments — may finally be making a dent in fast-rising rents that have been making life harder for tenants.

More than 1.65 million housing units were under construction last year, the highest annual number since federal record-keeping started in 1969. This year, the number was even higher — almost 1.7 million in September.

Meanwhile, the typical annual rent increase nationally fell to zero in June for the first time since the pandemic began, after peaking at 17.8% in 2021, according to Apartment List, a rent information aggregator and research firm. In September, rents fell 1.2%.

Vacancy rates are rising, said Alexander Hermann, a research associate at the Joint Center for Housing Studies at Harvard University.

“You’ve had this huge rush to build apartments in the last couple of years, and projects are bigger and bigger. It’s more common now to be building 50 or more units,” he said. “You can start to see where new supply is coming online, you see starker and stronger rent decreases.”

Federal statistics, which don’t track active construction below the regional level, show that construction hasn’t been higher in the Northeast since 1987 or in the Midwest since 2005, and it’s at all-time highs in both the West and South. A growing share of the country’s housing construction is in the South, up from 40% in 2017 to 46% in 2022.

In some places, rents are falling back a little, but they’re still plenty high compared with just a few years ago. In Texas, Austin has seen rents drop more than 6% for the fiscal year ending in September to $1,734 for a two-bedroom — but that’s still up almost 20% from 2020, according to Apartment List.

Austin’s rent decreases are the most in the Sun Belt, according to Apartment List, while its surrounding metro area is issuing more housing permits than any other large metro — “signaling the important role construction plays in managing long-term affordability.”

Travis County, which includes Austin, increased its housing units by more than a third between 2012 and 2022, creating 169,700 new units in that time as its population swelled by almost 230,000, according to a Stateline analysis of census estimates.

Among the arrivals to Austin in the past decade is K.N., a single father who asked to be identified only by his initials because he doesn’t want his children’s schoolmates to hear about his problems. K.N., a tech programmer who moved from San Francisco a decade ago, said his increasingly high rent may force him to move.

The landlord for his two-bedroom townhouse has asked for annual $100 rent increases in recent years, and just asked for another $200, K.N. said, upping his monthly housing costs with utilities to around $2,500.

“It would reduce my disposable income to basically zero, and that’s not wise with all the extras kids need in school,” K.N. said. “I’d have to pinch pennies to the point that it would cause anxiety. Being housing poor is something I’m trying to avoid.”

Despite a good income, K.N. said, he might have to move farther from his children’s school, which now is within walking distance. He moved to Texas in the first place partly to save money on rent in hopes of buying a house. But he says he sees apartment construction everywhere in Austin.

His observations match reality: Last year, Austin built 24 million square feet of apartment buildings alongside 8.7 million square feet of single-family housing, according to city records.

It’s a similar story nationally, with nearly 1 million apartments under construction as of September. By comparison, there were 914,500 apartments under construction in 2022 and 736,900 in 2021.

The number of single-family homes being built is also high, though the pace has slowed in the past two years. There were about 694,000 homes under construction in September, down from about 736,000 at the end of 2022 and 750,500 at the end of 2021. The last time construction was so high was in 2006, when about 748,000 single-family homes were under construction during the housing bubble before the Great Recession.

The new supply is already having an effect.

Rents dropped in 71 of the nation’s 100 largest cities in the year ending in September. That eclipses the most recent large decrease, in June 2020, when 65 cities had year-over-year declines, according to Apartment List. In early 2022, rents were rising year over year in all 100 cities.

Apartment List said in an October report that construction is one reason vacancies are rising, combined with a decline in remote work as more companies call employees back to the office, which has led to fewer renters in “Zoom towns” in states such as Arizona, Idaho and Nevada.

Other areas with big recent drops in rents are also mostly in the South and West, where construction is at all-time highs. The Austin metro area dropped 6%; Portland, Oregon, dropped 5%; and Atlanta, Las Vegas, Orlando, Phoenix, Salt Lake City and San Francisco all dropped by 4% in the past year as of September.

Some of those areas are, like Austin, just beginning to see modest drops in average rents but remain much pricier than just a few years ago. The Miami metro area, for instance, has had the nation’s biggest jump in rents since 2020, at 40%. Orlando, Florida, rose 32% over the same time, according to Apartment List.

In the past six months, rents dwindled just 1% in each city.

“Recent gains in housing supply have helped to slow rental prices and housing costs, although I would be cautious about calling rent decreases of 1% very significant,” said Randy Deshazo, director of economic development and research at the South Florida Regional Planning Council. Soaring prices are particularly painful in the region, he said, because affordability, in terms of housing costs compared with income, is the worst in the country.

In some parts of the Northeast and Midwest, where the construction boom hasn’t been quite as robust, rents have continued to rise in the past six months as of September. Rents were up by 7% in Providence, Rhode Island, for example. During the same period, the increase was 5% in Boston, New York City and Hartford, Connecticut.

Estimates of the nation’s housing shortage, which many experts blame for high rents, vary. Fannie Mae last year estimated that there were 4.4 million too few units in large metro areas, and Realtor.com this year pegged the shortage at 2.3 million units. About 1.4 million units were finished in 2022, the most since 2007, and another nearly 947,000 were finished in 2023 through August, according to a U.S. Census Bureau construction survey.

Permits issued from mid-2022 to August 2023 point to likely large increases in housing in Utah, Idaho, Florida, Texas, South Dakota, North Carolina, the District of Columbia, South Carolina, Arizona, Tennessee, Georgia and Colorado.

Those states could all see housing stock grow by about 2% above census estimates for mid-2022, the latest available, according to a Stateline analysis.

Nationwide, the number of permits issued in 2023 is down compared with a peak in late 2021 and early 2022, even as the numbers remain high in some states. That’s one reason most analysts expect some kind of slowdown from the recent torrid pace of building, said Hermann, of Harvard’s Joint Center for Housing Studies.

South Dakota’s building permits have fallen back from a 48% surge in 2020 followed by a 24.8% increase in 2022. This year they dropped 37% in the second quarter.

Even so, South Dakota had one of the highest rates of new building permits between mid-2022 and August 2023 — more than 2% of its existing units, or almost 9,000 new housing units, if they all get built.

The initial pandemic boom was “likely induced by more work-from-home options and increased demand for space and land, of which South Dakota has an abundance,” said Aaron Scholl, an assistant economics professor at Northern State University in Aberdeen, South Dakota, who worked on a Dakota Institute report on real estate in September.

The recent decline likely points to stagnation in the state’s housing market and eventually its whole economy, Scholl said.

“Building permits are often a leading indicator for not only housing market demand, but the overall economic landscape,” Scholl said. “As the housing market cools, I’d expect the economy to do so as well.”

(Editors: This story has been updated to include new information released by the U.S. Census Bureau Oct. 18.) 

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

Kimberly Carchipulla, center, and her 5-year-old son, Damien Salinas, right, walk in New York City in September. Carchipulla and her family emigrated from Ecuador in June and have been living in a room at the historic Roosevelt Hotel, converted into a city-run shelter for newly arrived migrant families hoping to find work, a new home and a better life (Andres Kudacki/The Associated Press).

NEW YORK CITY — States and cities are taking advantage of expedited work authorizations for a flood of new migrants, seeking to match them with jobs so they can support their families while they wait for asylum hearings.

Allowing migrants to work might enable many of them to leave shelters in cities that were already strained by local homeless populations but have been further overwhelmed by the newcomers.

New York Democratic Gov. Kathy Hochul said this week that the state Labor Department had identified 18,000 potential jobs for migrants around the state. Hochul had already called on National Guard troops to help with work authorization paperwork.

“Migrants and asylum seekers came here to work — so let’s put them to work,” Hochul said in a statement. “Right now, we have a migrant crisis and a workforce crisis … we can solve them both.”

New York and other states got a big win when the Biden administration announced last month that it would give temporary legal status, which includes permission to work, to Venezuelan migrants who arrived before August. The administration also pledged faster action on work permits for other migrants seeking asylum. About 44,000 of the 107,000 migrants who entered New York City between spring 2022 and August 2023 are from Venezuela.

Also this week, New Jersey said it would spend $2.5 million to connect migrant workers with employers through a new website. Illinois Democratic Gov. JB Pritzker said that he was “thrilled” by the Biden administration’s promises of new work authorization for Venezuelans, who make up the largest share of Chicago’s new arrivals. But Pritzker urged the federal government to speed up authorizations and waive fees “for those who cannot afford them and just want to be able to work and build a better life.”

The question of how to handle an influx of migrants is a quandary in states and cities around the country. A labor shortage has employers scrambling to find workers, while city shelters are overflowing with newcomers who can’t work legally to support themselves.

“People are seeking freedom and protection, but we also have a big ‘Help Wanted’ sign out there. There’s a push and a pull [bringing immigrants here],” said Abel Nuñez, director of the nonprofit CARECEN, which works with new migrants in Washington, D.C.

Among those seeking work is Edgardo Marín, a 34-year-old forklift operator who fled Venezuela with his wife and small children and now lives in a Manhattan shelter in New York City. Marín, who was getting asylum advice at a Methodist church in the city on a recent day, said he had to leave his home country because he had been identified as a dissident by a “colectivo,” a far-left paramilitary group aligned with the government.

“We had to flee Venezuela because I am against the government,” Marín said, speaking in Spanish. “I always hated it. It produces nothing but poverty and steals everything for itself. I was part of a group marching against the colectivo, trying to put pressure on them. They came after me and tried to kill me and my family — my mother and my brother-in-law were imprisoned because of all this.”

The colectivos are part of a pattern of violence in Venezuela that blurs the line between politics and crime, said Héctor Arguinzones, a Venezuelan native who fled in 2015 and now works with new migrants in New York City.

“There’s a very fine line between political oppression and gang crime in Venezuela, and that’s a big reason why Venezuelans are fleeing,” Arguinzones said. “Sometimes the gangs get control of the government and use it to threaten people. Sometimes the government uses the gangs to control the population.”

Gang violence is a valid asylum claim, but federal law is complicated. About 29% of asylum cases from Venezuela were granted in fiscal 2023, according to the latest federal statistics.

State help

California, Colorado and Minnesota have been most active in helping immigrants without regard to legal status, said Eric Figueroa, a senior manager at the Center on Budget and Policy Priorities in Washington, D.C. States have shown they can give access to health insurance, driver’s licenses and resident college tuition discounts, he said.

A Minnesota law allowing driver’s licenses went into effect Oct. 1. Illinois has many of the same benefits for migrants, regardless of immigration status, but had to cut back on health care benefits in a recent budget crunch.

“What people really need is federal legislation to normalize their status, but if that’s not going to happen, the states can do something to step in and ease their way a little bit,” Figueroa said. “You can help millions of people live better with something like driver’s licenses, a mundane thing for you and me, but it’s a huge deal for unauthorized people.”

In New York, a 31-year-old woman who asked to be identified only as Judy said she and her family are eager to work when they get permission. She can cook and clean houses to get started, she said.

Judy said she fled Colombia because her business as a street food vendor was ruined by escalating gang demands for protection payments gang members called a “vacuna,” or vaccination.

“They wanted money and food for all of them, and they threatened to beat us when we couldn’t pay,” Judy said. She, her husband, a baby daughter and 6-year-old son made a perilous journey with friends on foot to the United States, using the last of their money in Piedras Negras, Mexico, on bus fare to the U.S. border. Drug dealers on the bus stole the last of their possessions, she said.

“We got here with nothing,” said Judy, who lives in a New York City shelter.

Marín said his family also made the arduous journey on foot through the jungles of Panama, seeing bodies of migrants by the path and finding a Venezuelan flag left at a resting spot.

“It was horrible. Four days in the jungle,” Marín recounted. He said he would like to make money and get out of a city shelter but hasn’t been able to find work. “They ask me for papers and a Social Security card, and I don’t have them,” he said.

A surge of immigrant arrivals

About 2.2 million migrants crossed the United States’ southern border from October 2022 through this past August, up about 3% from the same period the previous year and up more than fivefold from 2020. Recent asylum-seekers are concentrated in New York City, Miami, Los Angeles, Houston and Chicago, according to an analysis by TRAC at Syracuse University based on immigration court filings from March 2021 to May 2023.

At least a dozen Republican states have sent National Guard troops to the Texas-Mexico border to attempt to deter illegal border crossings. They include Arkansas, Florida, Iowa, Mississippi, Nebraska, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Virginia and West Virginia. Ohio sent state highway patrol officers to the border in Texas.

Last year, Republican Govs. Greg Abbott of Texas and Ron DeSantis of Florida — a presidential candidate — made headlines by busing newly arrived migrants to Democratic-controlled cities and states such as Washington, D.C., California and New York. This year, Arizona Democratic Gov. Katie Hobbs also put migrants on buses, saying she wanted to help get them closer to their final destinations.

The resulting tide of families has overwhelmed many cities. Nuñez, the CARECEN director, said earlier waves of migrants only used Washington as a transfer point to reach family and friends elsewhere.

“We then also began to deal with the fact that 10% to 20% also wanted to make D.C. their home, to integrate into our city,” said Nuñez, speaking at a September conference on immigration policy.

“When you’re the actual final destination, it creates a whole host of other issues,” he said. He recalled how migrants arriving at a D.C.-area bus station found themselves walking through a tent encampment in search of help.

“Our inability to house people, period, was a challenge. Most of them have been on this arduous journey. It breaks your heart to hear some of their stories. They think once they made it over the border, they’re on easy street. And we have to tell them, ‘No, the journey continues.’”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

A child watches on the South Lawn during the arrival ceremony for India’s Prime Minister Narendra Modi at the White House in Washington, D.C., in June. About 130,000 new immigrants from India arrived in the United States between 2021 and 2022 (Andrew Harnik/The Associated Press).

NEW YORK — A late-pandemic surge of new arrivals from India, Venezuela and China, reflecting people with legal visas and those fleeing across the United States’ southern border seeking asylum, helped bring more than 900,000 new immigrants to the U.S. between 2021 and 2022, according to a Stateline analysis of new census data to be released Thursday.

Florida received the most migrants, according to available data, followed by Georgia, Texas, Maryland and North Carolina.

New immigrants have helped fill jobs and stem population shrinkage in larger cities, as suburbs and smaller cities attract more movers within the country since the pandemic. In some cases, they’ve also strained schools and shelters from Texas to New York.

The U.S. Census Bureau’s American Community Survey data shows 46.2 million immigrants living in the U.S. in July 2022, compared with 45.3 million in July 2021, an increase of 912,000.

That includes an increase of about 130,000 from India, a 5% increase in one year; about 122,000 from Venezuela, a 22% increase; and about 86,000, a 4% increase, from China. The survey data includes U.S. citizens, permanent residents, and immigrants and migrants living in the country either legally or illegally.

Florida saw the largest one-year increase with 208,000 new immigrants, a 5% jump. That included an increase of 65,000 from Venezuela, a 30,000 increase from Haiti, and about 18,000 more from Peru. Detailed country of birth data was released only for 28 states with enough immigrant population to measure with the American Community Survey household survey.

There also were large one-year increases in immigrants in Georgia (up 85,000), Texas (up 77,000), Maryland (up 51,000) and North Carolina (up 47,000).

Immigrant population dropped in California and Hawaii (down 24,000 in each) and Colorado (down 13,000), while there were smaller drops in Alaska, Delaware, Kentucky, Louisiana, Nebraska, Rhode Island, Wisconsin and Wyoming.

Countries of origin

Arrivals from India and China are more likely to use legal visas, while those from Venezuela and other countries in Central and South America, are more likely to cross the border on foot and claim asylum, living a “quasi-legal” existence while they file claims that can take years to come up in clogged courts, said Julia Gelatt, associate director for the U.S. Immigration Policy Program at the Migration Policy Institute, a nonpartisan think tank in Washington, D.C.

Immigration court backlogs are at an all-time high, with Florida, Texas, California and New York having the most cases pending.

Immigrants from India and some from China likely were mostly high-skill workers and their families with education and investor visas commonly used in both countries. In 2022, some controversial investor visas were overhauled to support more job creation in U.S. rural and high-unemployment areas. Some real estate developers have been accused of defrauding Chinese investors seeking the visas.

There also have been recent accounts of migrants from India and China crossing the southern border and seeking asylum, for reasons ranging from sexual orientation to sectarian violence.

Immigrants from India, including long-time residents and recent arrivals, are concentrated in California (about 580,000), Texas (340,000), and New Jersey (270,000). The largest county population is in Silicon Valley’s Santa Clara and Alameda counties (about 250,000 combined) in California, where many are recruited for high-skill visas.

Many migrants from Venezuela, typically fleeing political and economic turmoil, come by foot through the jungles of Colombia and Panama to reach the U.S. border and apply for asylum. As of 2022, almost half of the Venezuelan-born U.S. residents are in Florida, about 330,000 of the national 668,000 total, mostly in South Florida’s Miami-Dade, Broward and Palm Beach counties. Another 100,000 Venezuelans live in Texas, mostly in Harris County, where Houston is located.

The numbers don’t reflect the past year; border crossings remained high during several months from mid-2022 to mid-2023.

Strained resources

Some asylum-seekers have been traveling to New York, the District of Columbia and Chicago on voluntary buses supplied either as a service or as a protest by Republican governors, though many riders move on to other, less costly destinations or get off along the way.

Today Venezuelan asylum-seekers can receive humanitarian parole and eventually work authorization if they pass screening at border checkpoints. But many find the process too long and confusing, and end up living on charity while waiting for asylum cases, said Héctor Arguinzones, co-founder of a New York nonprofit helping Venezuelans and other new immigrants.

“It’s worse this way, because now people think they’re just coming here to make money, when all they really want is just to get some food and supplies for their families and put a roof over their head,” Arguinzones said.

New York Democratic Gov. Kathy Hochul has proposed state-level work authorization for migrants, which she recently called “the only way to help asylum seekers become self-sustaining, so they can move into permanent housing.”

New York City Mayor Eric Adams, a Democrat, has said the migrant influx will cost the city $12 billion over the next three years, as the city provides shelter, other services and education for thousands of new children.

Likewise, schools face a funding crisis in Liberty County, Texas, between Houston and Beaumont. There, the immigrant population more than doubled to about 15,000 between 2017 and 2022, including an increase of more than 2,000 between 2021 and 2022, almost all from Latin America. About 20% are U.S. citizens. The American Community Survey did not report individual countries of birth for that county.

The Cleveland Independent School District in Liberty County has a $125 million bond resolution on the November ballot to build more schools, but voters have rejected similar resolutions in the past, said Superintendent Stephen McCanless. It’s impossible to hire enough licensed teachers to handle the crush, he said, so the district has an arrangement to put employees with two-year degrees into classrooms with teachers supervising them.

“We went out on a limb creating this program but we had no choice, and it’s proven to be so successful it surprised even us,” McCanless said. Enrollment doubled to about 11,000 between the 2017-18 and 2021-22 school years, according to the National Center for Education Statistics.

Students are still pouring into the district, McCanless said. More than 1,300 new students showed up during the first four weeks of school this year. Without funds for new buildings, the district is buying portable classrooms that may end up filling sports practice fields temporarily, he said.

India became the No. 1 country of immigration in Michigan (displacing Mexico) and Virginia (displacing El Salvador). The only other change was in Pennsylvania, where the Dominican Republic became the top country, overtaking India.

There also were large increases in immigrants born in Honduras, up 76,000, or 10%, and Afghanistan, up about 71,000, or 57%. Some Afghans who helped the United States during the war in their country have been offeredhumanitarian parole with legal residency and work permission through the Operation Allies Welcome and the Enduring Welcome programs starting in late 2021.

Immigration from Nicaragua was up 15%, or 39,000. But immigration from Mexico, the nation’s largest immigrant group at nearly 11 million, was down by about 19,000 since 2021 and has dropped by almost 600,000 since 2017.

India and China are the second- and third-largest nationalities, respectively, both at about 2.8 million since 2021.

Over the longer run, Indian immigration is up 9% since 2017, or 229,000, but the Chinese immigrant population is still down slightly from 2017, by about 11,000, less than 1%.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

Bags of heroin, some laced with fentanyl, are displayed before a press conference (Drew Angerer/Getty Images).

A new Stateline analysis shows that U.S. residents under 40 were relatively unscathed by COVID-19 in the pandemic but fell victim to another killer: accidental drug overdose deaths.

Death rates in the age group were up by nearly a third in 2021 over 2018, and last year were still 21% higher.

COVID-19 was a small part of the increase, causing about 23,000 deaths total between 2018 and 2022 in the age group, which includes the millennial generation (born starting in the early 1980s), Generation Z (born starting in the late ’90s) and children. Vehicle accidents and suicide (about 96,000 each) and gun homicide (about 65,000) all took a cumulative toll from 2018 to 2022, according to a Stateline analysis of federal Centers for Disease Control and Prevention data.

Overdose deaths, however, took almost 177,000 lives in that time.

Accidental overdose became the No. 1 cause of death in 13 states for people under 40, overtaking suicide in nine states and vehicle accidents in five others; it’s now the top cause in 37 states. The only other change was in Mississippi, where homicide became the main cause of death, overtaking car accidents. In 40 states and the District of Columbia, overdose was the biggest increase in deaths for young people.

States are responding to the skyrocketing death rates with “harm reduction” strategies that can include warning of the new danger of recreational drugs laced with deadly fentanyl, training and equipping people to counteract overdoses when they see them, and even considering controversial supervised drug use sites to keep addicts safer.

A “fourth great wave” of accidental overdose deaths driven by drugs spiked with powerful fentanyl is now washing over young America, said Daliah Heller, vice president of drug use initiatives at Vital Strategies, an international advocacy group that works on strengthening public health.

Prescription opioids led to one surge in drug dependency from 2000 to 2016, then when supply waned in response to crackdowns, users turned to heroin, synthetic opioids and finally fentanyl, which is 50 times more potent than heroin and easier to get in the pandemic, Heller said.

‘Very common’ experience

Jonathan Diehl of Silver Spring, Maryland, died in 2019 at age 28 after using heroin he likely did not know was spiked with fentanyl, said his mother, Cristina Rabadán-Diehl. Jonathan Diehl earned a degree in construction management and was starting a promising new job in home heating and air conditioning four days before he died, his mother said.

“I think Jonathan’s trajectory was very common,” said Rabadán-Diehl, who now works as an adviser on substance use disorders. “He started with opioid pills, and when the government started putting restrictions on prescriptions, he as well as millions and millions of Americans transitioned into the illegal market. And then fentanyl made its appearance.”

Now, a fresh wave of overdose deaths — different from the first three — is fed by fentanyl making its way into all kind of recreational drugs, and by pandemic isolation that led to more solitary drug use, Heller said.

“Somebody might think they’re getting a Xanax [for anxiety], or methamphetamine or cocaine,” Heller said. “They have no experience with opioids, it’s not what they’re expecting and now they have a much higher risk of overdose and death.”

Authorities generally classify overdose deaths as an accident or suicide based on individual investigations of the circumstances surrounding each death.

States struggling the most with deaths of young people, driven mostly by accidental overdoses, include New Mexico, which eclipsed West Virginia and Mississippi since 2018 to have the highest death rate in the nation for people under 40 — about 188 deaths per 100,000, up 43% since 2018.

Other states with high death rates for the age group include West Virginia (170 deaths per 100,000), Louisiana and Mississippi (164), and Alaska (163).

In New Mexico, where accidental overdoses became the main cause of death for people under 40 in 2022, overtaking suicide and rising 90% to 394 deaths since 2018, the overdose problem has generally been concentrated in poverty-plagued rural areas such as Rio Arriba County on the Colorado border.

Democratic state Rep. Tara Lujan, who has relatives in that county, sponsored harm reduction legislation signed into law last year. It is similar to laws in many other states that include wide distribution of naloxone to reverse overdoses, legalized testing equipment for deadly additives like fentanyl, and good Samaritan laws that allow friends to report overdoses without legal consequences for their own drug use.

Lujan hopes to reintroduce a bill that would create so-called overdose prevention centers or harm reduction centers where drugs can be used in a supervised and safe environment. The legislation died in committee this year after Republicans called the idea “state-sponsored drug dens.”

“It’s all issues that were in place before the pandemic, but the pandemic made everything completely off the rails,” Lujan said. “My committee meetings have been packed with family members saying, ‘We know they won’t quit on their own, but we don’t want them to die.’”

Only New York City has two such facilities in operation, run by advocates; the sites claim some success in reversing overdoses. But federal law enforcement authorities are threatening to shut them down without a specific state mandate, since otherwise they fall under a federal law banning operations that allow illegal drug use on-site.

In California, Democratic Gov. Gavin Newsom last year vetoed legislation that would have allowed jurisdictions to open safe injection sites, saying they “could induce a world of unintended consequences” in cities such as Los Angeles, San Francisco and Oakland.

“Worsening drug consumption challenges in these areas is not a risk we can take,” Newsom wrote in a veto message.

Rhode Island is the only state so far to pass legislation allowing supervised drug-use sites as a pilot project, in 2021, but has yet to open any centers. New legislation introduced this year would push the expiration of the pilot project from 2024 to 2026.

Bills on the same topic of supervised drug-use sites were under consideration this year in Colorado, Illinois and New York but did not pass.

In a sign of the impact on young people, a Massachusetts bill would have required all state university dorm assistants to have naloxone training to reverse overdoses, but it stalled.

New Hampshire is one of several states experimenting with vans that go to known drug-use locations and offer overdose prevention supplies and advice.

Death rate disparities

The lowest death rates for young people in 2022 were in Hawaii (78), Massachusetts and Rhode Island (79), and Utah and New Jersey (80). Massachusetts and New Jersey were the only states to see decreases in overall deaths for people under 40 since 2018, and also had drops in overdose deaths, although overdose remained the No. 1 cause of death for young people in both states.

Nationally, accidental overdoses dominated the increase in deaths in residents under 40 across racial and urban-rural divides, but many disparities exist. The increase in young overdose death rates was 154% for Black Americans, 122% for Hispanic residents and 37% for white people, yet even for white residents they represented the largest increase.

The largest urban areas saw increases in overdose death rates of 70%, and rural areas 64% — the largest increases in both areas for any cause of death.

Across races and age groups overdose death rates are higher for men and slowed in 2017, but picked up again after 2018 and skyrocketed in the pandemic until 2021, according to a federal National Center for Health Statistics data brief published last year.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

A researcher works in a lab developing testing for COVID-19 at Hackensack Meridian Health Center for Discovery and Innovation in New Jersey in 2020. New Jersey was the first state hit by high COVID-19 death rates in 2020 but now is the only state to have fewer deaths than before the pandemic. (Kena Betancur/Getty Images)

Several months after President Joe Biden ended the national emergency for COVID-19, preliminary health data indicates the historic degree to which the pandemic increased death rates nationwide — not just because of the virus itself, but also through the pandemic’s reverberating effects on society.

Deaths from vehicle crashes, homicides, suicides and overdoses spiked in many states during the national health emergency that began in January 2020. Deaths of despair, which include people who died by suicide or from an accidental overdose, reached their highest numbers during the first year of the pandemic. And even as fewer cars were on the roads during shutdowns, vehicle fatalities jumped.

Yet after historic increases during the pandemic, deaths in most of the country are nearing a return to pre-pandemic levels, according to a Stateline analysis of preliminary federal statistics.

Still, in the first half of this year, the death count in some states and the District of Columbia was much higher than it was during the first half of 2019. The District’s death count was 35% higher than before the pandemic, and in six states the count was at least 15% higher: Arizona, Delaware, Nevada, Tennessee, Texas and Utah.

Nationally, death counts for the first six months of 2023 are about 7.7% higher than they were for the same period in 2019, before the pandemic, the analysis found. That’s just a bit above the 6.7% increase to be expected anyway; counts routinely inch up annually with the United States’ aging population.

Before the pandemic, the historical trend since 1900 was for the number of deaths to rise a little every year as the population got larger and older, and for age-adjusted death rates to go down and life expectancy to rise every year due to advances in health and medicine.

COVID-19 played havoc with that pattern, bringing historic spikes in both death counts and death rates. Between 2019 and 2020, the number of U.S. deaths from all causes jumped 19%, a 100-year record. The current U.S. death toll from the virus is more than 1.1 million people, according to the World Health Organization.

The year-over-year spike in death rates between 2019 and 2020 surpassed that of the 1918 flu epidemic. In 2020, the death rate rose 17% to 835.4 per 100,000 people, compared with a 12% jump between 1917 and 1918. The death rate peaked at 879.7 in 2022.

Life expectancy in the United States dropped 2.7 years by 2021, the biggest dip in almost 100 years.

States where COVID-19 hit first, such as New Jersey and New York, are the closest to complete recovery.

Public health experts debate why deaths might be stubbornly high in some areas of the country — as in Arizona, where death rates rose the most between 2019 and 2022, and where increases in deaths continue to be high in preliminary 2023 data.

There’s some evidence that COVID-19 deaths have gone unrecognized, and that the chaos from the pandemic caused still more deaths by shutting sick people out of hospitals packed with COVID-19 patients.

“There’s a lot of things going on that might cause [continued high death rates]. It’s not just one thing,” said Robert Anderson, chief of the mortality statistics branch at the federal National Center for Health Statistics in Maryland.

Nationally, only about 62% of the increase in death rates between 2019 and 2022 is directly attributed to COVID-19, according to the Stateline analysis. But that might be an undercount because COVID-19 was not always detected as a cause, according to Boston University School of Public Health research published in January.

In the pandemic, unexplained or “excess deaths” tended to peak earlier than COVID-19 deaths did, suggesting that many deaths really were undetected COVID-19 deaths.

COVID-19 cases were more likely to be misclassified in Arizona, the Rocky Mountain states, the South and rural areas, than in New England and in mid-Atlantic states such as New Jersey and New York, the article said.

As deaths peaked in New Jersey in 2020, a report from the New Jersey Hospital Association said two trends suggested people were dying from lack of hospital care as well as COVID-19: an increase in deaths at home from conditions usually treated in hospitals, and a decrease in hospital admission for life-threatening emergencies like heart attacks and strokes.

New Jersey, despite being the first state hit hard by COVID-19 in 2020, is now the only state with fewer deaths in early 2023 compared with the first six months of 2019. Eight other states saw increases of about 2% or less, including New York, another of the states slammed early in the pandemic.

The other seven states with death rates falling back to normal are Connecticut, Illinois, Maryland, Mississippi, South Dakota, West Virginia and Wyoming.

COVID-19 is listed as a contributing cause of only 1,143 deaths in New Jersey so far this year, down from more than 14,000 in the same time frame in 2020. Similarly in New York, COVID-19 deaths were down to 2,685 from more than 32,000 early on.

New Jersey, like many other states, has worked hard to get the virus under control, reaching its goal to vaccinate 4.7 million people who live or work in the state by mid-2021, and zeroing in on hot spots as they popped up with concentrated publicity campaigns to boost testing and vaccination, said Nancy Kearney, a spokesperson for the state Department of Health, in a statement.

As an early epicenter of the virus, New Jersey became a laboratory for techniques that became standard practices in the rest of the country, said Cathy Bennett, president of the New Jersey Hospital Association.

“New Jersey health care providers were writing their own playbook for responding to this novel virus,” Bennett said. “Our hospital teams were among the first to use new medication and tactics like proning [turning patients face down] to ease the burden on COVID-19 patients’ lungs.”

But even Arizona is slowly returning to normal death patterns, despite spikes in February, April and May, according to an analysis by Allan Williams, an Arizona epidemiologist who collaborates on state reports. COVID-19 deaths in the state are down to fewer than a thousand so far this year, compared with about 7,000 at the peak during the same time period in 2021.

“Deaths are returning to normal,” Williams said.

The state faces unique challenges in that COVID-19 deaths spiked late compared with the East Coast, with peaks coming in late 2020 and early 2021 at much higher rates than nationally, according to Williams’ analysis.

Williams said Arizona also saw increases in deaths from a multitude of other factors, including traffic accidents, overdoses, firearms, heart disease and strokes.

The state-by-state difference in COVID-19 deaths has been studied and discussed by experts for years. COVID-19 had the biggest cumulative impact on Arizona from 2020 to mid-2022, according to a study published this March in The Lancet, which concluded some states did better than others in extending health care access equitably and in convincing residents to get vaccinated.

Hawaii, which took an early hit economically when tourism from Asia stopped even before the pandemic hit the United States, has been one of the least-affected states in terms of deaths.

A White House Council of Economic Advisers analysis last year calculated that if deaths in the whole country followed Hawaii’s pattern, another 780,000 people would have survived the pandemic. Hawaii and New England states got high marks for health care during the pandemic, though Hawaii is facing new challenges from COVID-19 as well as wildfire deaths on Maui.

The Council of Economic Advisers study also suggested that lower rates of health insurance were associated with more deaths. Health insurance rates have been rising and reached an all-time high last year, the latest figures available. Among those states with death counts that are at least 15% higher this year than they were during the first six months of 2019, Arizona, Texas and Nevada were also in the top 10 for uninsurance rates as of 2021, and Tennessee was 11th.

Changes in population could explain some of the differences among states. Many of the states with large death count increases also grew rapidly in 2022, and many of those with small increases are losing population.

But in some states, such as Arizona, the increase in deaths outpaced population gains. Between 2019 and 2021, the height of pandemic death rates nationally, Arizona’s age-adjusted death rate rose 38%, the biggest increase among states. Arizona also had the highest change in death totals between 2019 and 2022 at 21%.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

An embryologist uses a microscope to examine an embryo, visible on a monitor, at a clinic in New York. Efforts to extend fertility-related health care to Medicaid patients have failed over cost concerns (Richard Drew/The Associated Press).

As more states require private insurers to cover fertility-related health care, many efforts to extend similar protections to Medicaid patients this year have foundered over cost concerns.

Only two states provide significant fertility coverage through Medicaid: New York, which offers fertility medications, and Illinois, where Medicaid will cover the storage of sperm or eggs for those facing a medical treatment that will likely render them sterile, such as for cancer. Both states modified their Medicaid plans to include the new services in 2019.

Twenty-one states already require private insurers to cover fertility treatments, and more are considering it as fertility rates drop and more women postpone childbirth into their 30s and 40s. But some legislators have noted that such laws leave out women with low incomes who receive health care coverage through Medicaid, a joint federal-state program that covered nearly 20 million women in their reproductive years in 2019.

A Connecticut bill to add in vitro fertilization, known as IVF, to the state’s private insurance mandate and to include it and other fertility treatments in the state’s Medicaid program failed to pass this year.

In 2020, Utah requested a waiver from the federal government to provide IVF and genetic testing for Medicaid recipients with cystic fibrosis, spinal muscular atrophy, sickle cell anemia and several other conditions. In 2021, the state added a request to expand Medicaid coverage to include fertility preservation for people diagnosed with cancer. Negotiations between the state and federal officials are ongoing.

District of Columbia legislators also proposed adding in vitro fertilization coverage to Medicaid and other low-income insurance as part of broader legislation requiring that private insurers cover IVF. But because of cost concerns, they dropped the Medicaid portion of the measure from the final law enacted this year and set to take effect in October.

“At this point, if states cover fertility treatments from Medicaid recipients, states must cover 100% of the cost,” said D.C. Councilmember Christina Henderson. “This makes it nearly impossible for any state to provide that expanded coverage.” The new law directs District health officials to negotiate for cost-sharing in the future, she said.

Similarly, a Washington state bill that would have included in vitro fertilization coverage for some state employees on Medicaid survived two committee votes but failed to reach a final vote. State Rep. Monica Stonier, a Democrat who sponsored the bill, said she heard some supporters wanted to wait for a state cost study that didn’t come out until this week.

“They’re waiting for another piece of information,” Stonier said. “I don’t think that was necessarily a good reason to stall. We could have made adjustments as we needed to. The sooner we can do this, the sooner employees can start making financial plans for this.”

The report estimated the cost of adding in vitro fertilization and fertility preservation for everyone in Washington’s Medicaid program to be $22.6 million for 2024.

“Unfortunately, expansion of fertility coverage into Medicaid has been, politically speaking, a non-starter in most states,” said Dr. Christopher Herndon, medical director of the Division of Reproductive Endocrinology & Infertility at the University of Washington.

The federal Centers for Medicare & Medicaid Services, known as CMS, which signs off on state Medicaid changes, does not require states to cover infertility under Medicaid but allows them to do so, said spokesperson Julie Brookhart in an emailed statement. “States may elect to cover such services and determine the types of covered treatments,” Brookhart wrote.

Some states do cover some diagnosis costs for infertility under Medicaid, according to a KFF report: Georgia, Hawaii, Massachusetts, Minnesota, New Hampshire, New Mexico and New York.

Medicaid coverage is critical to make infertility treatment available equitably, especially to Black families, according to a study published last year in the American Journal of Obstetrics & Gynecology. State mandates for private insurance alone don’t help with racial disparities when it comes to in vitro fertilization, and may make them worse, according to the study.

Data from Massachusetts, one of the states in the study, showed that “Insurance mandates [for private insurers] increased the total utilization of fertility care, but predominantly among those who were already most likely to access it, specifically, White, educated, wealthy women.”

A co-author of the study, Katherine Kraschel, an assistant professor of law and health sciences at Northeastern University, said she helped draft Connecticut’s bill, which two committees approved but which did not reach a floor vote, even after a legislator proposed dropping the Medicaid provision until the state could evaluate it. 

Henderson, the District of Columbia council member, said in a hearing she hopes to expand access to fertility treatment in the District for both Medicaid and DC Health Care Alliance, a health insurance program for low-income residents who don’t qualify for Medicaid.

The District will negotiate with federal officials, Henderson said. Meanwhile, the D.C. law will only require private insurers to cover in vitro fertilization and fertility preservation, while Medicaid will only cover fertility diagnosis and medication, similar to New York state’s Medicaid program.

“This change matches the most extensive Medicaid coverage in the country,” Henderson said. “The [health] committee did hope to expand Medicaid and DC Alliance coverage to include the full spectrum of care including IVF and fertility preservation services. However, as no state has ever done this, there were concerns that CMS [Medicaid] would not consider such services medically reasonable and necessary.”

Also, Henderson said in the hearing, many fertility specialists are not enrolled as Medicaid providers. The District needs to reach out to them to ask them to do so, she said, “to ensure that not just coverage but real access to fertility services are available to all District residents.”

Kraschel, the Northeastern University assistant professor, said states may be reluctant to be the first to try something but noted that New York and Illinois have shown that Medicaid coverage for fertility is possible, at least in a limited way.

“I would hope this moment emboldens state legislatures to do everything they can to secure reproductive freedom for all their constituents, that states would be proud to be the first to provide comprehensive fertility coverage through Medicaid,” she said. “That’s just not happening so far.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

Andy and Miraya Gran pose with their daughter, Isla, after the couple — who took out a second mortgage and asked their family for help to raise $102,000 for out-of-pocket fertility treatments costs — testified in favor of a fertility insurance mandate in Minnesota this year. States are increasingly considering such measures, as fertility rates drop and women postpone childbirth. (Courtesy of Miraya Gran)

As fertility rates drop and more women postpone childbirth into their 30s and 40s, more states are considering mandating that private insurers cover fertility treatments to help people start a family without the crushing out-of-pocket expenses.

Such laws would help people such as Miraya and Andy Gran of Bloomington, Minnesota, who ended up spending $102,000 to have their now 2-year-old daughter, Isla, through in vitro fertilization after trying other expensive options. Miraya Gran has since become an advocate for state laws requiring insurance coverage for fertility treatments.

“I had a lot of resentment and a lot of anger on top of the financial sacrifice. I just thought it was wrong. I don’t want other parents to go through this,” Gran said.

Twenty-one states require such coverage, but a proposed mandate failed to pass the Minnesota legislature this year. With the exception of New York, Medicaid programs do not cover fertility treatments.

Minnesota was one of at least 16 states, including Missouri, where legislators introduced bills this year to create or expand fertility insurance mandates. The District of Columbia recently approved legislation and California, New Jersey and Pennsylvania are still considering bills. Last year, Illinois enacted a new law that requires insurers to cover the treatments and mandates that employers offer paid leave for people recovering from unsuccessful procedures.

Some states are expanding mandates to cover more residents, including single people or same-sex couples. They’re also expanding mandates to include coverage of fertility preservation procedures for cancer patients or others who would like to preserve sperm or eggs before undergoing treatments that could make them infertile.

Mayor Muriel Bowser, a Democrat, signed the District of Columbia insurance coverage mandate in July, but Congress still must approve it, said the bill’s sponsor, Councilmember Christina Henderson.

Henderson has said she heard from people who took on extra part-time jobs just because those employers’ health insurance covered fertility treatments. The bill would take effect in 2025.

Decades of history

Fertility coverage mandates have a long history, beginning with the first one passed in West Virginia in 1977 that required HMOs to cover unspecified “infertility services.”

Maryland’s mandate in 1985 was the first to specifically cover in vitro fertilization, widely considered the most effective fertility treatment. It has a roughly 50% success rate in producing babies in women under 35 years of age. But the cost of in vitro fertilization, in which fertilized eggs are transplanted to the womb, can be prohibitive without insurance.

“The cost of IVF remains the greatest barrier to infertility care in the US,” concluded a Duke University study published last year in the journal Reproductive Biology and Endocrinology, which notes that the cost for each successful birth can be $60,000. “State infertility insurance mandates are a crucial mechanism for expanding access to fertility care in the US in the absence of federal legislation.”

West Virginia’s mandate came before the first IVF birth, and recent bills to add the procedure to the state mandate — including proposed legislation this year — have failed to pass. Fourteen states include IVF in their mandates, according to RESOLVE: The National Infertility Association, which tracks state and federal legislation.

Limited mandates like those in Texas and California only require insurers to offer fertility coverage when employers request it. A California bill that would expand the mandate to require that all large insurance plans provide coverage passed the state Senate and has progressed in the state Assembly.

The proposed expansion of the California mandate would cover unlimited embryo transfers, though other states have set limits. Maryland limits its coverage requirement to three IVF attempts per live birth and sets a $100,000 lifetime cap. Connecticut has a lifetime limit of four embryo implantations.

Religious objections

Jessica Tincopa of Orange, California, and her husband, Rob Tran, have endured six miscarriages since 2015. They had saved $20,000 for an IVF procedure before the pandemic hit, but were forced to spend their savings to stay afloat when their wedding photography business dried up. They’ve tried to find jobs with IVF insurance but have not succeeded.

“Our insurance company was billed $100,000 for the miscarriages — they would have been better off covering one trial round of IVF for us at $30,000,” Tincopa said.

Last year, 61% of large employers had health plans that covered fertility treatment, and 47% covered IVF, according to an annual survey by Mercer, a consulting firm.

Even California’s new law wouldn’t cover the small group policy Tincopa has now, since it only applies to large group policies, but at least it would create more opportunities to find a job with insurance she can use, she said.

But in California and other states, insurers have raised objections to basic or expanded fertility insurance mandates.

One insurer in Oregon, for example, objected to a fertility insurance mandate bill that would cover IVF, saying that the procedure runs afoul of a Catholic doctrine that declares the method immoral.

The insurer, Providence Health Plan, asked in written testimony to the legislature for an exemption from covering IVF. Oregon’s bill did not pass, though there was an amendment stripping the IVF requirement.

An insurer in North Dakota said the procedure could create legal issues and uncertainty when people stop paying for embryo storage because of job changes or other reasons.

The Sanford Health Plan, which provides coverage throughout the upper Midwest, also argued there would be higher costs, citing a state study that showed a plan with a $50,000 maximum benefit could increase premiums by anywhere from $1.98 to $24.85 monthly for each person insured. By a quirk of North Dakota law, the mandate must apply first to retiree insurance before the legislature can pass a general fertility insurance mandate.

The bills in Oregon and North Dakota failed to pass this year, as did others in Connecticut, Illinois, New Hampshire, New York, Vermont, Virginia, Washington, West Virginia and Wisconsin.

In North Dakota, Republican state Rep. Mike Brandenburg said it was his third attempt to get the bill through the legislature.

“I’ll keep trying,” Brandenburg said. “We’re making headway. I can see more younger people coming in (to the legislature), and it’s gaining votes all the time. If we can assist people who want to have families, why not?”

Like the Grans in Minnesota, parents in North Dakota testified about the financial burden and emotional stress of fertility treatments.

Elizabeth Carter of West Fargo, in a January letter to the legislature, said she and her husband both have advanced degrees and full-time jobs but have started moonlighting to try to pay for treatments.

“I wish I had greater access to affordable medical care for infertility through my insurance benefits so that my husband and I could also have the chance to have even a single child, who could be born into a stable household to two parents who fought and worked very hard to bring them into the world,” Carter wrote.

In Wisconsin, Democratic Gov. Tony Evers added a fertility coverage mandate to the state budget this year, but the provision didn’t make it through the Republican-dominated legislature. Democratic state Sen. Kelda Roys told Stateline she plans a stand-alone bill later this year.

“Infertility is a common disease and should be covered by insurance like any other health need,” Roys said.

A New Hampshire bill to study the cost of extending a fertility insurance requirement to single people and same-sex couples stalled in committee, but state Sen. Rebecca Perkins Kwoka said she’s still hoping to convince the state Department of Insurance may do the study without legislation.

Postponing childbirth

Some bill sponsors have pointed out that residents may postpone childbirth because of the high cost of housing and child care, as well as the reality of younger women increasingly working to establish careers before parenthood. But it’s unlikely such laws will have an effect on fertility rates that have been below the replacement rate of two children per woman since 2010.

One study from the University of California, Irvine found a connection between low fertility and states’ willingness to pass mandates, though author Katherine Bogaard said in a video presentation last year that “states are following each other’s leads” as the issue gains more attention. Bogaard told Stateline she’s preparing to publish a more detailed study.

Alison Gemmill, a demographer and fertility expert at Johns Hopkins University, said lower fertility rates are linked to postponed childbirth. That’s likely what’s driving new state legislation, along with increased concerns with equality for groups like single parents and same-sex couples, she said.

“It’s about states being receptive to messaging and advocacy from infertility treatment advocates, including many from the LBGTQ+ community,” Gemmill said. Even with more insurance, however, birth rates overall are likely to keep falling, she said.

“The increasing use of fertility treatment won’t have a large impact on U.S. birth rates just yet,” she said. “Births involving assisted reproductive technologies make up a small share, 2% of all births. It would take quite an uptick to move the needle on overall births.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

Naomi Knowles participates in a training program for construction workers in Deerfield, Wis. Women’s employment is at an all-time high, but fields such as construction and tech management remain male dominated (Courtesy of Mustang Christie/Operation Fresh Start).

After fears of a “she-cession” during the pandemic, women have returned to the workforce at unprecedented rates.

Much of the gain reflects a boom in jobs traditionally held by women, including nursing and teaching.  Many good-paying jobs in fields such as construction and tech management are still dominated by men, a continuing challenge for states trying to even the playing field for women workers.

In June, the national share of employed women ages 25-54, considered prime working age, hit 75.3%, the highest recorded since the U.S. Census Bureau’s Current Population Survey started reporting the numbers in 1948. The share of women 25-54 working or looking for work also hit a new high of 77.8% in June, the third straight month it beat the previous record of 77.3% from 2000.

“It’s good news that women are finding jobs in this economy at a greater rate than they were previously,” said Elise Gould, a senior economist at the left-leaning think tank Economic Policy Institute. She noted that brisk hiring in health care and government has helped more women find jobs.

But there is still a gap between rates of men and women in the workforce overall in every state except Vermont. As of March 2022, the latest figures available, the largest gap is 18 percentage points in Arizona, where 89.6% of prime-age men have jobs compared with 71.4% of women. The smallest is in Maine, where 77.8% of men in that age range have jobs compared with 77.3% of women.

Mothers of small children lost work at three times the rate of fathers early in the pandemic as they struggled to supervise remote learning sessions. Even when schools and day cares reopened in person, they often closed down unexpectedly during outbreaks, drawing out employment woes for many working women with children. Combined with early pandemic job losses in tourism and hospitality, fields where many women hold jobs, women’s employment dipped as low as 63.4% in April 2020, the lowest since 1984.

For some women, getting back to the workforce after the pandemic slump in women’s employment is a relief, and in some cases hybrid work has created the flexibility they need to return to jobs.

“It really means a lot because apart from the feeling that you’re contributing to your family, which is so important in today’s world, there’s just more fulfillment as a person,” said Deepika Gosain of Fremont, California. She started work in April as a learning and development specialist at a surgical company, finding that hybrid work helped her return to the workforce after taking several years off to care for two small children.

Health care and education represented the biggest gains for women in the past year, between June 2022 and June 2023, comprising about 778,000 of the 2 million jobs added for women, according to a Stateline analysis. Government and hospitality jobs added another 727,000 jobs for women.

Jobs in construction and tech management remain stubbornly male dominated, however. Men are 96.5% of carpenters and nearly 74% of computer system managers, for example.

Karen Arrigo-Hill is looking for work in financial tech again after taking a break to raise small children. Like Gosain, she’s used the networking group Women Back to Work for tips on California jobs for women who have taken breaks from work. She also participates in an incubator program for underrepresented genders in tech, called In the Lab Product Management.

“The biggest thing I notice is all the support there is for the women who took a career break for caregiving and want to return to work in technology,” Arrigo-Hill said. “This process of returning is a long process, and it really helps.”

States such as California, Massachusetts and New York are working to get more women into male-dominated fields.

A Democratic-sponsored bill in the New York State Assembly calls for $500,000 in funding to get more women into high-wage jobs, including construction and some tech fields, where they make up less than 25% of workers.

Elsewhere in the region, the state-funded Massachusetts Commission on the Status of Women in June recommended passage of a legislative resolution saying that COVID-19 had an outsized effect on women, including on their jobs, and that “prejudices against gender and race have served to make it difficult for women to fill roles demanded by society and their professions.” In its annual report, the commission urged passage of bills that would provide more day care and improve pay transparency, which can lead to women earning higher salaries.

California has budgeted $30 million over the last two years to helping more women get jobs in construction, including grants for apprenticeships and child care.

“When we spoke with women in construction, they told us childcare costs were one of the biggest barriers to working in the trade,” said Katie Hagen, director of the state Department of Industrial Relations, in a statement.

In Wisconsin, using state, local and private funding, the Operation Fresh Start Build Academy is helping 21-year-old Naomi Knowles train for a career in construction. On a recent day she hung drywall in a home under construction in Deerfield.

“Being the only girl on a crew of all men, it feels like a lot of pressure,” Knowles said. “They expect you to be less than them. But I’ve proven them wrong. I love the people and I love the results — seeing this house go from studs to walls in here and siding. It’s amazing.”

Construction is an important field for women to get into because the pay can be good, there’s a labor shortage, and a college degree isn’t necessary, according to a forthcoming report by the Institute for Women’s Policy Research in Washington, D.C. Since the pandemic started, there are 126,000 more women working in construction for a total of 1.1 million, though women still make up only 14% of workers in the industry.

“The percentage is so low for women that it can easily send the message that this is clearly a sector just for men,” said Ariane Hegewisch, the group’s program director for employment and earnings. The U.S. Commerce Department is also pushing to double the number of women in construction as federally funded infrastructure projects ramp up.

Vermont is the only state where prime-age women work at a greater rate than men: 83% compared with 81% for men. Vermont may be unique because of its mix of jobs, said Mathew Barewicz, the state’s labor market information director. “Vermont has a diverse industry composition without an overreliance on typically male-dominated industries [like] mining, transportation, finance.”

Progress in bringing more women to the workplace is likely to continue, said Beth Almeida, a senior fellow at the progressive Center for American Progress think tank specializing in women’s economic security.

“This generation of women ages 25-54 have more college degrees than any other generation of women, and having college degrees is a very strong predictor of labor force attachment,” Almeida said.

“They’ve made a substantial financial investment in their future. But their employment is very impacted by caregiving, because women have a greater responsibility when it comes to family.”

A waiter serves drinks outside a restaurant in July 2020 in New York City. Low-wage workers in many states saw a big boost in their pay during the COVID-19 pandemic, between 2019 and 2022 (Jeenah Moon/Getty Images).

Employers grappling with a nationwide labor shortage gave low-wage workers the largest pay increases in most states between 2019 and last year.

But even so, many of those workers — more than 40% of all U.S. households, by one estimate — are struggling to cover the inflated costs of basic expenses.

In the past several years, businesses such as bars and restaurants have engaged in bidding wars for scarce workers. In 28 states, people working in food preparation and service jobs had the biggest pay bumps: Waiters and waitresses made at least 50% more in New Jersey, Wisconsin and Utah, according to a Stateline analysis of new federal wage data. There were similar spikes for bartenders in Utah, Arizona and Kentucky.

Many states have raised minimum wages in recent years, with more increases coming this year. But low-wage workers got significant raises even in states that use the federal minimum wage of $7.25 an hour.

Median pay for food workers such as cooks and waiters increased 33% in Kansas and 31% in Idaho, faster than any other job category in those states. In Kentucky and Mississippi, transportation workers got an increase of 22%, outpacing all other categories of workers. The minimum wage is $7.25 in all of those states.

Farmworkers in California got bigger raises, by percentage, than computer professionals. The hourly pay for computer and math jobs rose 20% to $61.87, enough to beat the 14.1% inflation rate for that time frame.

But pay for California farmworkers jumped 30% to a median of $16.12.

The federal data from the U.S. Bureau of Labor Statistics, called the Occupational Employment and Wage Statistics, measures hourly wages by state and job for May of the previous year. The 2022 data was released in April.

Nationwide, gains in pay for low-wage jobs have reached historic proportions, according to an Economic Policy Institute report in March. Compensation for the lowest-paid jobs rose 9% between 2019 and 2022, adjusted for inflation. That’s much higher than the 4.9% for high-wage jobs and 2.4% for middle-wage jobs. And it was the biggest bounce for low-wage workers since at least 1979, according to the report.

“The labor market is stronger now, particularly for workers who are historically disadvantaged because of their relative scarcity,” said Elise Gould, a senior economist at the Economic Policy Institute and lead author of the March report.

“Employers are scrambling to get them hired back,” she said. “They can look across the street and see better wages and bonuses.”

However, research from the Economic Policy Institute and other groups shows a continuation of the decadeslong trend of low-wage workers falling behind as rising costs outpace their incomes.

Despite the recent gains, low-wage workers have faced stagnant wages for decades. Their costs for basics such as housing and health care have risen even faster than inflation, according to a report from United for ALICE, a project led by the United Way of Northern New Jersey. 

The effects are significant: The typical retail sales worker, the most common job in the country, lost $26,000 in buying power between 2007 and 2022, according to the report.

“You see people getting paid a decent wage and then you realize it’s really expensive to live there. It’s a big factor even with the higher pay recently for people in low-wage jobs,” said Stephanie Hoopes, director of the ALICE team that compiled the statistics as a more realistic yardstick of families’ economic well-being.

Nationally, 41% of households were either in poverty or unable to afford basic needs in 2021, according to the United for ALICE report. The share of households in that situation ranges from 32% in Alaska to 52% in Mississippi.

Cost of living

Cost of living plays a big part in hourly pay. Statewide median pay ranged from $17.36 in Mississippi, which also has the lowest cost of living, to $28.10 in Massachusetts, which is one of the most expensive states. Cost of living is measured as of 2021 by the federal Bureau of Economic Analysis, which shows the highest cost of living is in Hawaii, where median pay was $23.35 last year.

Some Midwestern states saw big pay increases for their most common jobs. For example, manual laborers in Indiana and Illinois had median pay increases of 24% and 25%, though those workers still make less than $18 per hour. In Pennsylvania, where there are more manual laborers than any other category except home health aides, median pay increased 22% but the median is still less than $18 per hour.

Pay like that is a step up from fast food and retail jobs for a high school graduate, but not enough to pay for housing for a family in Indiana, said Rachel Blakeman, director of Purdue University’s Community Research Institute. And, she said, such jobs are always subject to layoffs and replacement by new technology.

“In Indiana, we’re kind of stuck at $17 an hour. There’s an idea that we need workers to fill the factories and we’re going to do that with the kids,” Blakeman said, adding that there should be more support for Midwestern high school students who want to go to college or learn professional trades.

“Most of our students have to pay for college. It’s not a free endeavor. But we forget there’s also a cost to not going to college,” Blakeman said.

In Alabama, personal care workers had the biggest hourly pay increase, up 19% to a median $12.38 an hour. The personal care category includes hairdressers, whose pay was up 39% to a median $13.98, and recreation workers, up 25% to $12.63.

One state where higher-wage workers fared better than low-wage ones was Massachusetts, where a biotech boom gave the biggest wage bump to science professionals, whose pay rose 24% to $47.14 an hour.

Stateline is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

Nationwide, the median age was below 30 until 1980, but it rose to 38.9 as of 2022, according to census estimates (U.S. Census Bureau).

The median age rose in almost every state last year, census estimates show, continuing a long-term trend that is pushing states to prepare for aging populations.

Seventeen states had median ages over 40 in 2022, according to new U.S. Census Bureau estimates of the age at which half of residents are older and half are younger. That’s up from 12 states in 2020 and just seven in 2010.

Nationwide, the median age was below 30 until 1980, but it rose to 38.9 as of 2022, according to the bureau estimates.

That leaves more states planning for future health and housing challenges for older residents. Some states have issued or are considering executive orders, agency plans and legislation to assist state residents who need more help with health crises, housing and long-term care as they live longer.

Millennials started turning 40 last year, and the youngest baby boomers are quickly approaching 60.

“As the nation’s median age creeps closer to 40, you can really see how the aging of baby boomers, and now their children — sometimes called echo boomers — is impacting the median age,” said Kristie Wilder, a Census Bureau demographer, in a statement.

Lower birth rates also play a role and will likely continue to drive median age slowly but steadily higher, Wilder added. Some states have passed legislation requiring that health insurers cover fertility treatments in response to lower fertility rates, according to a University of California, Irvine study published last year. New York state’s 2020 law, for example, requires coverage of in vitro fertilization in some cases.

No states saw a drop from 2021 to 2022, and states with unchanged medians were Alabama, Maine, Tennessee and West Virginia, along with the District of Columbia. The largest increase in median age in recent years was in Delaware, where it rose three years since 2010 to age 41.8.

The portion of Delaware residents over 60 will jump from a quarter to more than a third of the state population by 2040, according to a 2020 state report, creating new challenges for state services. A Delaware Journal of Public Health report published in 2021 said a growing number of Delaware’s older residents suffer from dementia, requiring more expensive help from the state and family caregivers.

Vermont held six public listening sessions around the state last year to help prepare recommendations this year for Age Strong Vermont, its road map for an “age-friendly state.”

“Vermont had this older demographic for a long time but it’s taken a while for the state broadly to really reckon with that,” said Angela Smith-Dieng, Vermont’s Adult Services Division director. Part of the challenge is that older Vermont residents tend to live in big rural houses and need help with in-home health care, renovations for mobility and transportation on demand, she said.

A New York executive order in November also calls for a statewide plan on aging.

Vermont and New York joined other states already planning comprehensive strategies for aging populations: California, Colorado, Massachusetts and Texas, according to a January report by the National Conference of State Legislatures.

California’s Master Plan for Aging, released in 2021, aims to create an “age-friendly California” by 2030, including housing and health care strategies. A bill currently progressing in the state legislature would create a statewide system of respite providers by 2025 to help give primary caregivers of older adults enrolled in Medi-Cal, the state's Medicaid program for low-income residents, a break.

Elsewhere, an Oregon bill to study long-term care needs for older residents has passed both chambers of the legislature.

Only North Dakota is younger now than it was in 2010, down 1.2 years from age 37 to 35.8. The state’s burgeoning oil industry has drawn younger workers to jobs that pay well and don’t require four-year college degrees.

Energy counties in other states have seen similar influxes of young people. Loving County, Texas, for example, saw its median age decrease from 52.7 in 2010 to 35.3 in 2022, a difference of more than 17 years.

Skeet Lee Jones, county judge there, said the tiny county has work camps for more than 1,000 oil workers and hundreds more young workers living in recreational vehicle camps, with good-paying jobs that create their own challenges for county government.

“We’ve had to start paying our own county workers what we call ‘oil-field wages’ just to get things done, about four or five times minimum wage,” Jones said.

The oldest state in the country remains Maine at 44.8. It also was the oldest in 2010, at 42.7.

Other states with median ages at 40 or above in 2022: New Hampshire (43.3), Vermont (43.2), West Virginia (42.8), Florida (42.7), Delaware (41.8), Pennsylvania and Connecticut (40.9), Hawaii (40.7), Rhode Island (40.6), Wisconsin (40.4), New Jersey, Oregon and South Carolina (all 40.3), Montana and Michigan (40.2), and Massachusetts (40.1).

The youngest states and the only ones with median ages below 37 were Utah (31.9), the District of Columbia (34.8), Texas (35.5), and Alaska and North Dakota (35.8)

On the county level, the median age in 2022 was as low as 20.9 in Madison County, Idaho, home of Brigham Young University-Idaho, where many young students are also starting families.

The median age was as high as 68.1 in Sumter County, Florida, part of the sprawling The Villages retirement community. In 2010 Sumter County’s median age was 62.7, the only county with a median age of 60 or higher in the nation at the time.

In 2022 there were six others: Catron County, New Mexico (62.1); Jeff Davis County, Texas (61.7); Harding County, New Mexico (60.5); Jefferson County, Washington (60.4); Charlotte County, Florida (60.2); and Highland County, Virginia (60.0).

Stateline is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

Workers install a power plant transmission tower in Houston in 2022. Labor productivity fell in most states last year, even in key large states such as California and Texas (Brandon Bell/Getty Images).

U.S. worker productivity has dropped significantly, including in key large states, leaving some economists alarmed by the decrease in a measure that could mean trillions of dollars to the economy.

Labor productivity — the value of the goods and services produced on average by an hour’s work — ranged from $58.80 in Mississippi to $120.67 in New York last year, according to a Stateline analysis of federal Bureau of Labor Statistics (BLS) data released in May.

Thirty-seven states and the District of Columbia saw worker productivity drop from 2021 to 2022 after adjustment for inflation. So far this year, productivity nationwide dropped through the first quarter.

Lower productivity raises the cost of goods, slowing the economy and threatening wages. That hurts residents’ quality of life and the profits that feed tax coffers.

Even states that have led productivity in recent years had decreases between 2021 and 2022 — California, New York, Texas and Washington. From 2007 to 2019, those states contributed more than half the country’s productivity growth.

Some economists see the unprecedented drop in national productivity numbers as an alarm bell, though others see it as an expected reset from pandemic highs, when tech industries in California and Washington soared along with the financial industry in New York. Only nine states had productivity drops when comparing 2019 with 2022.

Gregory Daco, a chief economist for Ernst & Young, called the recent decrease a “recessionary signal” in a May 4 tweet, noting that the five consecutive year-to-year quarterly declines through early 2023 had never happened since the BLS began calculating the statistic in 1948.

“The economy remains in a productivity slump at the moment,” Daco wrote in an executive briefing for clients provided to Stateline by Ernst & Young. Likely reasons, Daco wrote, are labor market churn causing businesses to lose skilled employees as well as unequal access to technology that could speed up work.

Several factors could be at play, economists say. A labor shortage has brought more new and untrained people to work, and the post-pandemic resurgence of service and hospitality jobs has added more low-wage jobs back to the mix.

Experts debate whether the rise of remote work has lowered productivity. And some commentators have argued that the drop is because workers are exhausted from years of pandemic stress.

Energy-producing and tourism-dependent states took the biggest hits in productivity: Alaska was down 7.1% to $99.80, Louisiana down 6.1% to $72.90, Nevada down 5.9% to $71.06, Hawaii down 5.3% to $75.39, and North Dakota down 5.1% to $90.28.

Parents walk with their 7-year-old and 10-week-old sons in June of 2020 in Stamford, Conn. Births increased last year in Texas and Florida, where population is booming but most states saw fewer babies in 2022 (John Moore/Getty Images).

Fast-growing Texas and Florida had the biggest increases in the number of births last year, while a dozen other states — half of them in the South — continued to rebound from pandemic lows.

In the United States as a whole, however, the number of births has plateaued after a modest increase following the worst of the pandemic, according to preliminary data from the federal Centers for Disease Control and Prevention.

Births increased in only 15 states from 2021 to 2022, compared with growth in 43 states between 2020 and 2021. More detailed statistics, which could shift slightly, are due for release June 1.

Overall, the new data shows the continuation of a long-term trend toward fewer births in the United States, said Phillip Levine, an economics professor at Wellesley College who studies birth trends. Births were down more than 650,000 or 15% over the past 15 years.

“We’re back where we started before COVID hit,” Levine said. “Births are still declining, albeit perhaps at a slower pace. There certainly is no reason to stop sounding the sirens on the long-term decline in births in the United States.”

Without an increase in immigration, that trend could mean an older population, a smaller workforce and diminished economic productivity. That’s true even in Texas, where second-generation immigrants and women under 30 in general are increasingly postponing parenthood.

Illinois, Pennsylvania and Michigan, states where the overall population is declining, experienced the largest decreases in births.

In Texas and Florida, the number of births was up 4% in 2022 compared with 2021. In terms of overall population, they are the fastest-growing states as of mid-2022, according to the latest U.S. Census Bureau estimates.

In Texas, births increased by almost 16,000, compared with an increase of 5,400 between 2020 and 2021. In Florida the increase was about 8,200 compared with 6,600 the previous year. Other states with increases between 2021 and 2022 were Georgia (about 1,900), North Carolina (1,200), New Jersey (795), Arizona (526), Virginia (361), Tennessee (359), Delaware (353), South Carolina (302), Maryland (272) and Kentucky (262). Kansas, Idaho and Alaska had increases of fewer than 100 each.

Nationally, there were 700 more births in 2022 than there were in 2021. Between 2020 and 2021, the number of births increased by 51,000.

Florida’s increase in births is partly a reflection of more people moving to the state, but also higher birth rates after a dip during the depths of the pandemic, said Stefan Rayer, population program director at the University of Florida’s Bureau of Economic and Business Research. Even in Florida, however, the long-term trend is bending downward, with birth rates for Black, white and Hispanic women well below the peaks in the mid-2000s.

Arizona’s increase of about 500 births, about half the number of the previous year’s increase, may already be turning into a small decrease in early 2023, State Demographer Jim Chang said.

Illinois had the biggest drop in births, about 4,400, almost four times the previous year’s drop of 1,100. Pennsylvania and Michigan (both about -2,800) and New York (-2,300) saw births decline in 2022 after increases between 2020 and 2021.

It was a different story between 2020 and 2021, when New England states saw the largest increases. New Hampshire, Connecticut and Vermont had the largest percentage increases, according to final 2021 birth data released earlier this year.

Only North Dakota has bucked the overall trend of fewer annual births since 2007. Despite a drop in 2022, the state still had about 800 more births in 2022 than it did in 2007. As North Dakota’s fracking industry in the Bakken Formation has grown in that time, it has attracted more young people of childbearing age, said Kevin Iverson, a demographer in the state Department of Commerce.

In Texas, some lawmakers are worried about too many babies being born without the health and social services infrastructure to support them. Prenatal care is already difficult to find, especially for poor women in rural areas of Texas, and the state recently enacted a strict abortion ban.

Texas state Rep. Claudia Ordaz Perez, a Democrat representing part of El Paso, has called Texas “one of the most dangerous states in the nation to have a baby,” citing high maternal mortality and low rates of health insurance.

Like other Western states, Texas has seen a recent decline in birth rates because of a downturn in immigration from Mexico and fewer births to young women in general, according to a 2021 report by the Federal Reserve Bank of Dallas.

Some attribute declining birth rates to more women recognizing that they can find success and fulfillment working outside the home — whether or not they decide to become mothers.

“There might be unique explanations for each little squiggle in fertility trends, but the world is going to have to adjust to reality of permanent below-replacement fertility,” said Charles Hirschman, a professor emeritus at the University of Washington who studies fertility trends He cited recent work by Frances Goldscheider, a sociologist at the University of Pennsylvania.

“We have successfully had the first gender revolution with women almost reaching parity in traditional male roles, but there has been little progress in bringing men into participating equality in household and child-rearing roles,” Hirschman said.

Stateline is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

Venezuelan migrants wait for food at a hotel provided by a local charity in El Paso, Texas. An increase in border crossings has created a backlash in some states as a pandemic-era policy known as Title 42 expires (Joe Raedle/Getty Images).

The end of a pandemic-era policy that allowed U.S. border authorities to quickly turn back some migrants has prompted a mixed reaction from state and local governments, including new restrictions on immigrant workers, beefed up border enforcement and entreaties for more federal help.

But unlike the 2010s, when conservative states such as Alabama, Arizona and Georgia enacted a series of strict anti-immigrant policies, the reaction from most red-state officials has been long on rhetoric and short on concrete action. Their reluctance reflects the influence of agricultural interests and other employers who rely on migrant workers and are wary of shutting off the spigot amid a nationwide labor shortage.

Another factor that is giving some states pause is that the courts ultimately struck down the earlier anti-immigrant laws.

“[The 2010s were] a high-water mark and it had since subsided because courts found that states can play only a very limited role,” said Muzaffar Chishti, a senior fellow at the nonpartisan Migration Policy Institute. But increased illegal border crossings have fueled enough outrage in some states to draw some state and local governments back into the immigration fight.

Surprisingly, border crossings have decreased by half since Title 42 procedures expired last week. Nevertheless, fears of a surge prompted some states to act.

In Texas, for example, Republican Gov. Greg Abbott last week announced the creation of a new tactical border force to supplement the National Guard soldiers and state troopers he first deployed to the border in 2021 to intercept immigrants crossing illegally, drugs and arms. Equipped with Blackhawk helicopters and C-130 Hercules aircraft, the new force is charged with repelling large groups of migrants, according to Abbott’s office.

Also last week, the Texas House passed a bill that would make illegal border-crossing a state crime and create new law enforcement agencies and courts focused on immigration.

Meanwhile in Florida, Republican Gov. Ron DeSantis last week signed legislation limiting social services for undocumented immigrants and stiffening requirements for businesses to verify employees’ eligibility to work. The Florida measure also provides $12 million for the DeSantis administration to transport migrants to other states, and mandates that hospitals that accept Medicaid inquire about patients’ immigration status.

“If Florida and Texas are any guide, then it’s clear that state leaders are favoring the interests of those who pay the price of this historic mass illegal migration over the interests of the employers and NGOs who profit from it, and this is a new development,” said Jessica Vaughan, director of policy studies for the conservative Center for Immigration Studies.

But Chishti said agricultural interests successfully watered down some parts of the Florida package. The legislation DeSantis signed allows the transportation of migrants within the state, for example, and it preserves in-state tuition breaks for undocumented students.

In Texas, some supporters of beefed-up border security also worry about the labor shortage. Democratic state Rep. Eddie Morales represents nine of the state’s 14 border counties and is a co-sponsor of the bill the House approved last week. But in a letter to Abbott last year, Morales asked the governor to expand ports of entry to facilitate trade with Mexico and create a program that would allow migrant workers to work legally for Texas employers that need them.

In Congress, House Republicans from agriculture-heavy districts cited similar concerns earlier this month in delaying the eventual passage of a broad GOP border security bill, which would eventually require employers to electronically verify the work status of their new hires.

Republican U.S. Rep. David Valadao of California, who is a dairy farmer, said he voted for the bill only after receiving assurances from GOP leaders that they would address the farm labor shortage. “Many industries in the Central Valley, including agriculture, rely heavily on immigrant labor,” Valadao said in a statement. “While these workers play an essential role in feeding America, many of them live in fear.”

Many Republican governors criticized the Biden administration for allowing Title 42 to expire. Iowa Gov. Kim Reynolds called it “our most effective tool to slow this invasion of our country,” while Montana Gov. Greg Gianforte called the end of Title 42 a “disastrous milestone … throwing gasoline on the fire that is the crisis at our southern border.”

North Dakota Gov. Doug Burgum said “the security risk grows even worse with the expiration” of the policy. At the same time, however, Burgum called for expanding business hours at the state’s 310-mile border with Canada, shortened during the pandemic, to “better facilitate legal cross-border traffic that supports our economy and friendship with our Canadian neighbors.”

For their part, Democratic governors mostly have expressed support for migrants but also dismay at the flood of people crossing the border looking for asylum. Since mid-2021, U.S. officials have reported roughly 200,000 border encounters with migrants each month, compared with about 50,000 in 2020.

New York Gov. Kathy Hochul declared an emergency days before the expiration of Title 42 and called out National Guard troops for “logistical and operational support” as New York City transfers some migrants to suburban shelters. Hochul offered $1 billion in state funding for shelters, health care, legal help and voluntary relocation.

But some local leaders are resisting such efforts. Republican officials in Rockland County, New York, a suburb of New York City, sent sheriff’s deputies to stop any buses headed for a local hotel to be used as a migrant shelter.

The Biden administration’s plan for controlling the border after Title 42 “does not adequately address this crisis,” Arizona Democratic Gov. Katie Hobbs wrote last month to federal officials, asking for more help for border communities trying to house and feed asylum-seekers. California Democratic Gov. Gavin Newsom also has asked for more federal help with migrants. “We cannot continue to do this work alone,” Newsom said.

The Biden administration has followed the expiration of Title 42 with new border restrictions aimed at stopping asylum-seekers from rushing over uncontrolled border areas. Now asylum-seekers will have to use a phone app from outside the country to make appointments at ports of entry. Anybody crossing the border between ports of entry will be denied asylum, a move that’s already drawn fire from the American Civil Liberties Union and other immigration advocates who are suing to stop it.

Republicans favored Title 42 because it offered an “expeditious” way to turn back migrants from Mexico and Central American countries, Chishti of the Migration Policy Institute said. But Mexico had to agree to the expulsions and would not accept the return of many people from outside Central America, causing a rush to the border by people who knew they could not be returned under the policy, such as Cubans, Haitians and Chinese migrants, Chishti said.

“It outgrew a lot of its usefulness. There are exceptions and now you have to interview people to find out if they’re exceptions, and that takes time. Now it’s not so expeditious,” Chishti said.

The states with the largest drops were California, Illinois and New Mexico, where the child population declined by 6% between 2017 and 2022, according to a Stateline analysis of U.S. Census Bureau data (Getty Images).

Thirty-five states, including Missouri, have fewer children than they did five years ago, a situation caused by declining birth rates nationwide, but also by young families migrating across state borders in search of cheaper housing.

Even in the 15 states that gained children, all but North Dakota experienced greater growth in the adult population, meaning children now make up a lower percentage of residents.

In states where the number of children has declined, school officials are facing the possibility of teacher layoffs or even school closures when pandemic aid expires next year. A decline in school enrollment could provide short-term cost savings and might be a benefit to children if there are more resources to go around, but it bodes poorly for future state workforces.

In states where the drop in the number of children is part of a broader population decline, there will be additional fiscal, economic and political ramifications, such as diminished representation in Congress.

The states with the largest drops were California, Illinois and New Mexico, where the child population declined by 6% between 2017 and 2022, according to a Stateline analysis of U.S. Census Bureau data. Idaho and North Dakota saw the largest increases, at 4%.

The declines mostly are a reflection of historically low fertility rates, which have been below the replacement rate of two children per woman since 2010. Births increased in only a handful of states in 2021.

But in the 35 states that experienced declines, high housing prices also are a factor. In California, jobs pay well but the state’s housing shortage has sent prices beyond the means of young families, said Hans Johnson, a senior fellow at the Public Policy Institute of California, a nonpartisan think tank.

“People want to buy a house and have children, but they realize they can’t do it here so they look in the vicinity, states close by, and work remotely so they can keep their California paychecks,” Johnson said.

Slow population growth cost California a seat in Congress after the 2020 census. The number of adults in California grew in the past five years, according to the Stateline analysis, but the decline in the number of children led to a lower overall population.

California also has experienced a phenomenon shared by other Western states: The children of Hispanic immigrants have lower birth rates than their parents. California’s total fertility rate dropped from 2.15 per woman in 2008 to a historic low of 1.52 in 2020, the lowest since records have been kept, Johnson wrote in a January report.

California, Illinois and New Mexico all have seen lower school enrollment in recent years, even as they’ve tried to rekindle interest in public education after pandemic upheavals.

In New Mexico, enrollment has dropped particularly sharply in the northwestern part of the state, where there are many Indigenous students, according to a January state report. Between 2012 and 2022, enrollment declined by 22% in the majority-Native Central Consolidated Schools in San Juan County, compared with a statewide decline of 7%, according to the report. Indigenous and other children in the mostly rural area struggle to stay in school because of long bus commutes and lack of internet access at home.

The recent closure of a coal mine and the power generating station it fueled forced many families with children to move away from San Juan County to find jobs, according to Central Consolidated school board President Christina Aspaas.

“A lot of Navajo workers who were employed had to relocate to Phoenix or elsewhere out of state to earn the same wages,” Aspaas said. “It affected the local tribes, Hopi and Navajo, Diné. Seeing the impacts makes my heart break. These are all my children, and they deserve the best in education and in life.”

In Idaho and North Dakota, annual school enrollment has increased over the past five years, except for temporary drops early in the pandemic. But Idaho is bracing for a decline starting in 2025, when children from a historic 2007 baby boom in the state start turning 18.

The gap between White and Black homeownership rates is wider now than it was in 1960, when housing discrimination was rampant and legal (Getty Images).

This story was originally published by Stateline.

Some cities and states are trying to boost Black homeownership, which dropped to a 60-year low even before the economic turmoil wrought by the COVID-19 pandemic.

Black homeownership fell in 2019 to 40.6%, down from the 2004 peak of 49.7%. The rate has rebounded somewhat since then, but advocates remain dismayed at how, decades after the 1968 Fair Housing Act, Black families still struggle to become homeowners at the same rate as White peers.

“To see the Black homeownership rate lower than the generation before is shocking, considering what earlier generations faced,” said Janneke Ratcliffe, vice president of the Housing Finance Policy Center at the Urban Institute in Washington, D.C.

The persistence of redlining, the Great Recession, gentrification and the increasing number of homes being scooped up by investors all have contributed to a growing Black-White disparity in homeownership, which is larger now than it was in the early 1960s, before the 1968 Fair Housing Act and other civil rights legislation.

The Urban Institute is working with cities in a dozen states and the District of Columbia on strategies to bring Black homeownership back up. Among them are financial assistance to Black homebuyers to help them cover down payments and closing costs, and support for current homeowners facing foreclosure.

The gap between White and Black homeownership rates is wider now than it was in 1960, when housing discrimination was rampant and legal, U.S. Census Bureau data shows. In 2022, 74.6% of White households owned their homes, compared with 45.3% of Black households — a gap of more than 29 points. In 1960, the White homeownership rate was 65%, and the Black rate was 38%, a 27-point gap.

Recent redlining complaints against banks accused of denying loans to buyers in predominantly Black and Hispanic neighborhoods illustrate the existing barriers.

Last month, for example, New Jersey-based Lakeland Bank created a $12 million homeownership fund as part of a settlement with the U.S. Department of Justice, which had accused it of redlining. The bank did not admit to wrongdoing, but it agreed to increase mortgage lending in communities of color in the wake of a seven-year federal investigation of its lending practices.

In the past year, the Justice Department has negotiated similar settlements with lenders in Houston, Memphis and Philadelphia.

Earlier this month, Washington, D.C., Mayor Muriel Bowser, a Democrat, unveiled a plan that aims to add 20,000 Black households to the ranks of the city’s homeowners by 2030. Among other strategies, the city will use $10 million to create a public-private fund that would make homes more affordable to Black families; help residents transfer homes to their children and heirs; and accelerate zoning and permitting for affordable units.

“We know if we can close that gap we can increase Black wealth in our city,” Bowser said during an Oct. 3 press conference. “We know that that is the way to pass down generational wealth.”

Brittany Freeman of Washington, D.C., speaking at Bowser’s press conference, said she grew up in transitional homeless housing in the district and had been on government assistance before getting a college degree and using a city-sponsored down payment and closing-cost assistance to buy a home.

“Homeownership is possible, and I am definitely my ancestors’ wildest dream,” Freeman said.

Down-payment assistance is the most important help Black homebuyers need, Ratcliffe said. With longer histories of homeownership, White families are more likely to give their children financial help to buy homes, she said.

Some of the Washington, D.C., strategies are targeted at all families, regardless of race. Others, such as bridge loans to prevent foreclosure and money for renovation, are specifically targeted at Black homeowners. The task force that made the recommendations asked for legal review to ensure such preferences are legal. The mayor’s office did not respond to Stateline inquiries on the status of that review.

Republican U.S. senators objected to similar national policies, announced in June by the Federal Housing Finance Agency, to aid Black and Latino homebuyers.

“Discrimination on the basis of skin color is simply wrong. That remains true even when intended to benefit minorities,” a dozen GOP senators wrote in a July letter.

The District of Columbia’s Black homeownership rate improved by 1 point to 35% last year, which is 3 points below what it was in 2010.

Black homeownership has not declined in every state in the past decade, and it has declined faster in some states than in others. Between 2010 and 2021, the percentage of Black residents who owned their homes rose by 3 points in New York and Delaware and 2 points in South Carolina and Illinois, according to the Census Bureau’s American Community Survey.

During the same period, Black homeownership dropped by 3 points in Mississippi, Ohio, Tennessee and Texas, as well as in the District of Columbia.

Last year, the city with the lowest Black-White homeownership gap was Jersey City, New Jersey, a rental-heavy city where the White homeownership rate was 32%, compared with 25% for Black households. Detroit (59% to 50%) and Philadelphia (58% to 48%) also had relatively small gaps.

Recent price increases have made housing more unaffordable for Black buyers, compared with their income, in California, Oregon and Utah, said Nadia Evangelou, senior economist at the National Association of Realtors, a trade group that studied race and home affordability in a report this year.

The most affordable states for Black families were Kansas, Maryland and West Virginia.

In Tennessee, the Housing Development Agency is collaborating with mortgage bankers on the Convergence Memphis program, which aims to increase Black homeownership in the Memphis area with more affordable housing and financial education. Organizers worked with the Urban Institute on the plan, according to Katie Fallon, a senior policy manager at the institute. The group also contributed to Bowser’s plan.

Convergence Columbus in Ohio, which also has worked with Urban, has similar goals and includes the Ohio Housing Finance Agency. An expansion to Philadelphia is planned for next year.