• Tobacco Settlement Funds Should Be Used to Fight Smoking in North Carolina

    Mar 31, 2015Emily Cerciello

    North Carolina continues to risk the health and economic wellbeing of its residents by refusing to use Master Settlement Agreement funds for tobacco prevention and control.

    North Carolina continues to risk the health and economic wellbeing of its residents by refusing to use Master Settlement Agreement funds for tobacco prevention and control.

    Over the last 50 years, more than 20 million Americans have died prematurely as a result of smoking or exposure to second-hand smoke. In the same time period, however, societal attitudes towards smoking have shifted from acceptance of its regularity to disapproval of the behavior as a harmful addiction. Driven largely by a growing body of research illuminating the adverse health effects of smoking and the implementation of widespread interventions that discourage tobacco use, the United States has experienced significant declines in the prevalence of smoking since the 1960s. Despite these successes, one in five adults in North Carolina continues to smoke cigarettes regularly, making North Carolina the 14th highest in smoking prevalence nationwide.

    Every year, North Carolina receives $140 million in state funds from the 1998 Master Settlement Agreement, which requires tobacco companies to compensate tobacco-producing states for tobacco-related illnesses. These funds were intended to be used for youth tobacco prevention and control, but due to flexibility in the wording of the agreement, North Carolina has been able to send most of this money to a general fund. North Carolina even sent $42 million in settlement funds to tobacco farmers for marketing and equipment improvements. In 2014, North Carolina was the leading tobacco-producing state, followed by Kentucky, Georgia, and Virginia.

    In the past, $25 million of this $140 million went to a Health and Wellness Trust Fund that invested in tobacco prevention and cessation programming. In 2012, however, the North Carolina General Assembly (NCGA) abolished the Health and Wellness Trust Fund and spent only $17 million on tobacco prevention. By 2014, this number had dropped to $1.2 million, or just 1.1 percent of the minimum recommended for tobacco prevention programs by the Centers for Disease Control and Prevention (CDC). North Carolina ranks 47th among the states for reaching CDC-recommended funding levels.

    The health and economic impacts of this decision to cut state funds are substantial. In North Carolina, tobacco use costs nearly $2.5 billion in total medical costs and $3.3 billion in lost productivity annually. North Carolinians face an annual tax burden of $564 per household for smoking-related state and federal government expenditures.

    North Carolina can look to examples from other states to improve its strategy for spending settlement dollars. Oklahoma, which reaches more than 50 percent of CDC-recommended tobacco prevention funding levels annually, amended its constitution in 2000 to create the Tobacco Settlement Endowment Trust (TSET), which receives no less than 75 percent of annual settlement payments. Oklahoma ranks among the worst for smoking behaviors, but has seen significant improvements in adult smoking rates with the percentage of smoke-free households reaching over 75 percent in 2010, up from 55 percent in 2001.

    We’ve seen from other states that funding for youth tobacco prevention works. In Florida, where the state is required to spend at least 15 percent of its yearly settlement award on tobacco prevention, the high school smoking rate dropped to just 7.5 percent in 2014 – one of the lowest rates ever reported by any state. North Carolina’s high school smoking rate remained at over 15 percent in 2014.

    While using the money as North Carolina does is not illegal, the state should end this poor practice of using settlement money for unrelated projects. North Carolina has the enormous opportunity and responsibility to use settlement funds to reduce the prevalence of smoking and improve the health and economic wellbeing of millions of residents across the state.

    Emily Cerciello is the Roosevelt Institute | Campus Network Senior Fellow for Health Care, and a senior at the University of North Carolina at Chapel Hill.

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  • Mental Health Care Is an Overlooked Need in North Carolina Medicaid Expansion Debates

    Mar 27, 2015Emily Cerciello

    Medicaid expansion could bring relief to 190,000 uninsured North Carolinians with mental health conditions.

    Advocates for Medicaid expansion in North Carolina have the opportunity to add a new and urgent argument to their already robust arsenal – that Medicaid expansion will create a newly affordable option for thousands of individuals with mental health needs who currently cannot afford treatment.

    Medicaid expansion could bring relief to 190,000 uninsured North Carolinians with mental health conditions.

    Advocates for Medicaid expansion in North Carolina have the opportunity to add a new and urgent argument to their already robust arsenal – that Medicaid expansion will create a newly affordable option for thousands of individuals with mental health needs who currently cannot afford treatment.

    The North Carolina Medicaid Expansion Coalition – a collection of progressive groups including Planned Parenthood South Atlantic, the League of Women Voters of North Carolina, and the NAACP, among others – is fervently pushing back against a North Carolina legislature that has repeatedly declined expanding Medicaid to 500,000 would-be-eligible North Carolinians. Debates have focused on the high out-of-pocket prices required of uninsured patients for physical conditions like heart disease, asthma, musculoskeletal problems, or cancer, as well as the millions in federal money being turned away every year that North Carolina decides not to expand. In this high-profile role, coalitions also have the opportunity shed light on the devastating effects of untreated mental illness and the relief that Medicaid expansion could bring to 190,000 uninsured North Carolinians with mental health conditions.

    In 2009, 75 percent of individuals with mental health needs in North Carolina were left untreated. Early intervention for mental illness can improve a patient’s physical and emotional wellbeing and can prevent destructive consequences for themselves, their families, and their communities in the future. Medicaid expansion will allow individuals to be secure in their access to primary mental health care and reduce their utilization of the emergency room when they experience an acute episode or when their chronic conditions become too debilitating.

    Mental illness disproportionately affects individuals with lower family incomes, the same families who are most impacted by Medicaid expansion. States that have expanded Medicaid have seen pent up demand for mental health care, indicating a high need for mental health care among newly eligible Medicaid beneficiaries.

    North Carolina has the capacity to accommodate newly eligible individuals who seek treatment for mental illnesses given that only 11 of North Carolina’s 100 counties are considered to have a shortage of mental health providers. While systems will need to expand to meet the demand from new patients, North Carolina can be an example for turning the challenge of Medicaid expansion into an asset for increased access to health care among its most vulnerable residents.

    Advocates for Medicaid expansion in North Carolina have already made great strides in swaying reluctant legislators to consider the issue in 2015. In the most recent election debates, Republican Senator Thom Tillis agreed that the state of North Carolina is trending in a direction that warrants discussions about Medicaid expansion. In January, Governor Pat McCrory met with President Obama and several other Republican state leaders to discuss the adaptability of Health and Human Services waivers to state-developed Medicaid expansion plans. And just last week, thousands of North Carolina residents marched at the ninth annual Historic Thousands on Jones Street (HKonJ) Moral March in Raleigh, hoping to influence legislators to consider Medicaid expansion.

    Legislators need to take significant steps to reform mental health care both in North Carolina and across the nation. The North Carolina Medicaid Expansion Coalition, mental health providers and advocacy groups, and others supporters can work together with the legislature to make affordable mental health care a reality for low-income individuals and families. North Carolina cannot wait until the system is perfect to implement changes that can improve the mental health of its residents and the economic wellbeing of the state.

    Emily Cerciello is the Roosevelt Institute | Campus Network Senior Fellow for Health Care, and a senior at the University of North Carolina at Chapel Hill.

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  • While Congress Plays Politics, New York State Must Invest in Young People

    Mar 26, 2015Kevin Stump

    Last week, the House of Representatives and the U.S. Senate released budget proposals that include a slew of policy changes that would negatively impact young people’s ability to fully participate in the economy.  

    Last week, the House of Representatives and the U.S. Senate released budget proposals that include a slew of policy changes that would negatively impact young people’s ability to fully participate in the economy.  

    The proposals would, among many other bad ideas, freeze funding on Pell Grants for 10 years and eliminate mandatory funding for the program, leaving it vulnerable to the unstable political culture of Washington, D.C. Both budget proposals would charge students interest on all their loans while they’re still in school, costing the average borrower thousands of dollars more. Each budget also eliminates the Pay As You Earn student loan repayment program, which caps monthly payments based on borrower incomes to make payments more affordable for moderate- and low- income debt holders.

    It’s concerning that Congress cares so little about an entire generation of young Americans — the very generation that will have to repair what today’s leaders have broken.

    While Congress continues to play politics, states need to make investments so this generation isn’t subject to spiraling economic inequality and missed opportunities. As New York approaches its April 1 budget deadline, the governor and the state legislature need to prioritize policies that will help young people to fully realize their potential and participate in the economy.

    As outlined in my critique of Governor Cuomo’s student loan program, New York State must: (1) inject resources into public higher education, (2) roll back tuition hikes, (3) reform the Tuition Assistance Program, and (4) require that economic develop initiatives include some type of student loan relief for employees.

    But even those measures won’t be enough by themselves. In order for the state to forge ahead and truly invest in youth, it will also need to do the following:  

    1. Increase the minimum wage. With Millennials making up 71 percent of minimum wage workers, raising the wage would give young people a chance to pay down debt, invest in the economy, and start building their economic future. 
    2. Charge the governor’s 10 Regional Economic Development Councils with developing a serious comprehensive plan to integrate paid apprenticeship and internship programs into the criteria for doing business with the state. To help combat the double-digit unemployment rate for 16–24-year-olds across the country, New York State should take advantage of its economic development projects, like START UP NY and NY SUNY 2020, to (1) provide young people with income and (2) impart the skills necessary to compete in today’s economy.
    3. Pass the NY DREAM Act to give thousands of New York’s undocumented youth access to state financial aid so they too can fully participate in the economy.
    4. Expand Governor Cuomo’s proposal to double the Urban Youth Jobs Program. This will help reward businesses that hire and train inner-city youth. In addition, this will help give New Yorkers ages 16–24 the opportunity to learn professional skills while also getting paid.

    Conservatives and progressives are both trying to shift the political pendulum in their direction as they gear up for the 2016 election, which will consequently shape the fabric of our political system for the next decade. But Republicans in Congress, as evidenced by their budget proposals, continue to forget about young people. It is now up to President Obama to reject these failed principles and for states to get serious about enacting the real policy changes we need to give young people a fighting chance.

    As Roosevelt Institute | Campus Network National Director Joelle Gamble articulates so well, “the young people who are inheriting the effects of the decisions made at all levels of government today… want to see investments made in a more prosperous future.”

    Kevin Stump is the Roosevelt Institute | Campus Network's Leadership Director.

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  • What Would You Do Today to Ensure a Good Economy 25 Years From Now?

    Mar 24, 2015Laurie Ignacio

    In January, the Roosevelt Institute gathered 30 experts and practitioners in technology, education, finance, and economics to discuss the next American economy. We asked them what they would do today to ensure a good economy 25 years from now.

    Over the next few weeks, Roosevelt will be highlighting some key suggestions. Check out the experts in attendance and then explore their revolutionary ideas:

    In January, the Roosevelt Institute gathered 30 experts and practitioners in technology, education, finance, and economics to discuss the next American economy. We asked them what they would do today to ensure a good economy 25 years from now.

    Over the next few weeks, Roosevelt will be highlighting some key suggestions. Check out the experts in attendance and then explore their revolutionary ideas:

    First up we have Michelle Miller, co-founder of Coworker.org, a digital platform that provides workers with campaigning tools and other digital organizing support.

    Michelle recommends reimagining how we classify employees. As more and more people freelance and rely on alternatives to full-time employment, like selling crafts on Etsy or driving for Uber, Michelle says that we should rethink the current employment classification system in order to expand protections, like health care deductibility, that are currently available only to more traditional employees.

    To read more about American workers’ changing roles and new challenges, check out the links below.

    "The future of work: There's an app for that," The Economist

    "Lawsuits facing Uber, Lyft could alter sharing economy," CNBC

    "What Happens To Uber Drivers And Other Sharing Economy Workers Injured On The Job?," Forbes

    Michelle Miller is the co-founder of Coworker.org, a digital platform that matches campaigning tools with organizing, media and legal support to help people change their working conditions. Since its founding in 2013, Coworker.org has catalyzed the growth of global, independent employee networks at major companies like Starbucks, Wells Fargo, Olive Garden and US Airways. Miller’s early work developing Coworker.org was supported by a 2012 Practitioner Fellowship at Georgetown University’s Kalmanovitz Initiative for Labor and the Working Poor. She is a 2014 Echoing Green Global Fellow.

    Before co-founding Coworker.org, Miller spent a decade at the Service Employees International Union where she pioneered creative projects that advanced union campaigns. She is also a nationally recognized media artist and cultural organizer. Most recently, she directed the participatory media creation process for Hollow, a 2014 Peabody award-winning interactive documentary about her home state of West Virginia.

    Learn more about Michelle Miller’s work by visiting coworker.org and her profile at EchoingGreen.org.

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