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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Is Expanding Medicaid an Essential Part of Reducing Mass Incarceration? An Interview with Harold Pollack

Mar 11, 2015Mike Konczal

Every policy lever available was pulled in order to create our system of mass incarceration over the past 40 years. Reformers will have to be equally clever and nimble in trying to challenge and dismantle this system. And one important lever that I hadn't thought much about in this context is the Affordable Care Act's (ACA, or Obamacare) expansion of Medicaid. This expansion is being blocked in 22 states, which is preventing 5.1 million Americans from getting health-care.

This came up in an excellent interview between Connor Kilpatrick and the political scientist and incarceration scholar Marie Gottschalk over at Jacobin. Commenting on the limits of the current wave of bipartisan support against incarceration, Gottschalk notes that "If you care about reentry and about keeping people out of prison in the first place, there’s no public policy that you should support more strongly now than Medicaid expansion. Medicaid expansion gives states huge infusions of federal money to expand mental health services, substance abuse treatment, and medical care for many of the people who are most likely to end up in prison. It also allows states and localities to shift a significant portion of their correctional health care costs to the federal tab." Similar concerns were raised by Elizabeth Stoker Bruenig at The New Republic.

I immediately got Gottschalk's new book Caught, the subject of the Jacobin interview, and though I just started the book I highly recommended it as a guide to where the prison state stands in 2015. But I wanted to know more about the relationship between Medicaid and deincarceration.

So I reached out to friend-of-the-blog Harold Pollack. Pollack is the Helen Ross Professor at the School of Social Service Administration at the University of Chicago. He is also Co-Director of The University of Chicago Crime Lab at the University of Chicago. He has published widely at the interface between poverty policy and public health, and he also writes for a wide variety of online and print publications. He is also a thoughtful scholar on health care and crime policy and how they interact in communities.

Mike Konczal: How important is the Medicaid expansion for deincarceration?

Harold Pollack: I’m convinced that Medicaid expansion is essential for this problem. It’s essential for two different purposes. First, individuals in this population need health services, and there needs to be a clear way that individuals can get access to services from qualified providers. The Medicaid expansion does that.

Secondly, the entire ecosystem of care requires proper financing. And for historical reasons, mental health and substance abuse services have been put into their own silos. They are not properly financed, except through a patchwork of safety net funding streams that don’t particularly work well. They have also been poorly-integrated with standard medical care.

Let’s talk about individuals first. In what ways could Medicaid benefit people who are or are likely to get caught up in the criminal justice system?

Think about who is not eligible for Medicaid before health reform. A low-income male who is not a veteran or a custodial parent, or who doesn’t qualify for Ryan-White HIV/AIDS benefits. They may have a serious substance abuse problem, but that wouldn’t qualify them for federal disability benefits. They, with the expansion, can get access to Medicaid simply because they are poor.

The criminal justice population is quite varied, but there are a couple of key areas in which Medicaid expansion would be especially beneficial for them. With the expansion, Medicaid can now cover basic outpatient substance abuse treatment. This is true for both Medicaid and private insurance after health reform. And ACA provides these services in a way that is much more integrated with people’s regular medical care.

One basic challenge with drug and alcohol treatment is that these services are in a separate system that people don’t want to use, and don’t use. With the Medicaid expansion, you can go to a neighborhood clinic and they can help you get Methadone or Suboxone. They can also get you the psychiatric care you need within the same umbrella of your regular care. So it is much more likely that people will use it.

There’s very good evidence that alcohol and illicit drug treatment reduces criminal offending. [Editor note: Both this study and this study, obtained via follow-up email, show treament reduces violent and property crime enough to far pass a cost-benefit test.] Both It partly reduces criminal offending by reducing the need to commit property crimes to get the substances. It also reduces offending by allowing people to be more functional, and thus more likely to stay employed. Especially in the case of alcohol, people getting their substance abuse under control makes it less likely that they’ll be intoxicated, and thus less likely to commit crimes or be victims of crime.

What about those with mental illness?

When it comes to those with serious mental illness, we end up using local jails to try and manage them. It’s important that they can get access to help and mental health treatment outside of the criminal justice itself. It’s ironic that when someone with psychiatric disorders is inside the jail, they do have access to some of these services. But those services are often unavailable or totally disconnected when they leave the jail.

We don’t really know whether, or by how much, these services can be expected to reduce offending among this group. This remains a hypothesis that depends on how well we actually implement programs. Much will depend on how effectively we can implement Medicaid expansion.

How does this element of Medicaid deal with the traditional criticisms of the program?

Medicaid has many shortcomings. It doesn’t pay a market rate for important services. But for all of its faults, Medicaid recipients are grateful to have it. The satisfaction they have is quite high compared to traditional health insurance. Medicaid gives people access to the basic health care that they need to stay healthy and improve their lives. It is also genuinely designed for people who have no money, which is really important for these indigent populations. Medicaid is inferior to private insurance in terms of reimbursement to providers, but it’s better for really poor people than any private insurance I’ve seen, because it’s been road tested for a long time in meeting the needs of indigent people.

And as I mentioned, ACA is especially important, because the ACA includes very specific components in the area of mental health and substance use.

One thing I’ve noticed is that for all the talk about ending mandatory minimums, most of the real energy is about giving judges flexibility to ignore mandatory minimums. But that put a lot of pressure on keeping recidivism down, because judges, especially elected ones, won’t ignore long records.

Deincarceration requires the puzzle pieces to fit together to be sustainable and politically tenable. That requires that we deal with the real-life problems people face when they are released. It requires monitoring and people have access to services, both to improve their quality of life and to reduce the probabilities that they will reoffend.

If we just release people without support services, my fear is that it will not go well. Then it will ultimately generate political backlash. I’m very heartened that we are reducing the mandatory minimums, in particular for older offenders who tend to be less violent. It’s essential that we address the excessive sentencing. But we also have to do what we need to do to make this effective.

Even if judges can reduce sentencing, they are ultimately dependent on the available resources to help and monitor the people that come before them. And if judges don’t see those services, then they aren’t going to use their discretion to release many of these people as early as they might.

And if property crimes are being committed by people under criminal justice supervision, and they have a history of violent offending, then they are much more likely to be sent back with a pretty serious sanctions.

Tell me more about the second issue, how the ACA rationalizes the funding stream for these services.

We’ve had a messy system in the past, and we’ll ultimately rationalize it under Medicaid. Safety net providers for substance abuse and mental illness have always been paid for by a patchwork of public funding through obscure agencies and local governments. It has always been a huge challenge where access has been inadequate, with long waiting lines, and the services provided were often quite forbidding. Given this separate funding, it’s very difficult to integrate this in with people’s overall health care. When you have these silos of places to go, with one for mental health, another silo for substance abuse, and another for safety net health care, that person isn’t going to get the integrated care they really need. The ACA is trying to bring those things together.

Many of these issues will still be in play going forward, but it will be in the context of a coherent system that at-least addresses these issues within the context of broader health care.

Follow or contact the Rortybomb blog:
 
  

 

Every policy lever available was pulled in order to create our system of mass incarceration over the past 40 years. Reformers will have to be equally clever and nimble in trying to challenge and dismantle this system. And one important lever that I hadn't thought much about in this context is the Affordable Care Act's (ACA, or Obamacare) expansion of Medicaid. This expansion is being blocked in 22 states, which is preventing 5.1 million Americans from getting health-care.

This came up in an excellent interview between Connor Kilpatrick and the political scientist and incarceration scholar Marie Gottschalk over at Jacobin. Commenting on the limits of the current wave of bipartisan support against incarceration, Gottschalk notes that "If you care about reentry and about keeping people out of prison in the first place, there’s no public policy that you should support more strongly now than Medicaid expansion. Medicaid expansion gives states huge infusions of federal money to expand mental health services, substance abuse treatment, and medical care for many of the people who are most likely to end up in prison. It also allows states and localities to shift a significant portion of their correctional health care costs to the federal tab." Similar concerns were raised by Elizabeth Stoker Bruenig at The New Republic.

I immediately got Gottschalk's new book Caught, the subject of the Jacobin interview, and though I just started the book I highly recommended it as a guide to where the prison state stands in 2015. But I wanted to know more about the relationship between Medicaid and deincarceration.

So I reached out to friend-of-the-blog Harold Pollack. Pollack is the Helen Ross Professor at the School of Social Service Administration at the University of Chicago. He is also Co-Director of The University of Chicago Crime Lab at the University of Chicago. He has published widely at the interface between poverty policy and public health, and he also writes for a wide variety of online and print publications. He is also a thoughtful scholar on health care and crime policy and how they interact in communities.

Mike Konczal: How important is the Medicaid expansion for deincarceration?

Harold Pollack: I’m convinced that Medicaid expansion is essential for this problem. It’s essential for two different purposes. First, individuals in this population need health services, and there needs to be a clear way that individuals can get access to services from qualified providers. The Medicaid expansion does that.

Secondly, the entire ecosystem of care requires proper financing. And for historical reasons, mental health and substance abuse services have been put into their own silos. They are not properly financed, except through a patchwork of safety net funding streams that don’t particularly work well. They have also been poorly-integrated with standard medical care.

Let’s talk about individuals first. In what ways could Medicaid benefit people who are or are likely to get caught up in the criminal justice system?

Think about who is not eligible for Medicaid before health reform. A low-income male who is not a veteran or a custodial parent, or who doesn’t qualify for Ryan-White HIV/AIDS benefits. They may have a serious substance abuse problem, but that wouldn’t qualify them for federal disability benefits. They, with the expansion, can get access to Medicaid simply because they are poor.

The criminal justice population is quite varied, but there are a couple of key areas in which Medicaid expansion would be especially beneficial for them. With the expansion, Medicaid can now cover basic outpatient substance abuse treatment. This is true for both Medicaid and private insurance after health reform. And ACA provides these services in a way that is much more integrated with people’s regular medical care.

One basic challenge with drug and alcohol treatment is that these services are in a separate system that people don’t want to use, and don’t use. With the Medicaid expansion, you can go to a neighborhood clinic and they can help you get Methadone or Suboxone. They can also get you the psychiatric care you need within the same umbrella of your regular care. So it is much more likely that people will use it.

There’s very good evidence that alcohol and illicit drug treatment reduces criminal offending. [Editor note: Both this study and this study, obtained via follow-up email, show treament reduces violent and property crime enough to far pass a cost-benefit test.] Both It partly reduces criminal offending by reducing the need to commit property crimes to get the substances. It also reduces offending by allowing people to be more functional, and thus more likely to stay employed. Especially in the case of alcohol, people getting their substance abuse under control makes it less likely that they’ll be intoxicated, and thus less likely to commit crimes or be victims of crime.

What about those with mental illness?

When it comes to those with serious mental illness, we end up using local jails to try and manage them. It’s important that they can get access to help and mental health treatment outside of the criminal justice itself. It’s ironic that when someone with psychiatric disorders is inside the jail, they do have access to some of these services. But those services are often unavailable or totally disconnected when they leave the jail.

We don’t really know whether, or by how much, these services can be expected to reduce offending among this group. This remains a hypothesis that depends on how well we actually implement programs. Much will depend on how effectively we can implement Medicaid expansion.

How does this element of Medicaid deal with the traditional criticisms of the program?

Medicaid has many shortcomings. It doesn’t pay a market rate for important services. But for all of its faults, Medicaid recipients are grateful to have it. The satisfaction they have is quite high compared to traditional health insurance. Medicaid gives people access to the basic health care that they need to stay healthy and improve their lives. It is also genuinely designed for people who have no money, which is really important for these indigent populations. Medicaid is inferior to private insurance in terms of reimbursement to providers, but it’s better for really poor people than any private insurance I’ve seen, because it’s been road tested for a long time in meeting the needs of indigent people.

And as I mentioned, ACA is especially important, because the ACA includes very specific components in the area of mental health and substance use.

One thing I’ve noticed is that for all the talk about ending mandatory minimums, most of the real energy is about giving judges flexibility to ignore mandatory minimums. But that put a lot of pressure on keeping recidivism down, because judges, especially elected ones, won’t ignore long records.

Deincarceration requires the puzzle pieces to fit together to be sustainable and politically tenable. That requires that we deal with the real-life problems people face when they are released. It requires monitoring and people have access to services, both to improve their quality of life and to reduce the probabilities that they will reoffend.

If we just release people without support services, my fear is that it will not go well. Then it will ultimately generate political backlash. I’m very heartened that we are reducing the mandatory minimums, in particular for older offenders who tend to be less violent. It’s essential that we address the excessive sentencing. But we also have to do what we need to do to make this effective.

Even if judges can reduce sentencing, they are ultimately dependent on the available resources to help and monitor the people that come before them. And if judges don’t see those services, then they aren’t going to use their discretion to release many of these people as early as they might.

And if property crimes are being committed by people under criminal justice supervision, and they have a history of violent offending, then they are much more likely to be sent back with a pretty serious sanctions.

Tell me more about the second issue, how the ACA rationalizes the funding stream for these services.

We’ve had a messy system in the past, and we’ll ultimately rationalize it under Medicaid. Safety net providers for substance abuse and mental illness have always been paid for by a patchwork of public funding through obscure agencies and local governments. It has always been a huge challenge where access has been inadequate, with long waiting lines, and the services provided were often quite forbidding. Given this separate funding, it’s very difficult to integrate this in with people’s overall health care. When you have these silos of places to go, with one for mental health, another silo for substance abuse, and another for safety net health care, that person isn’t going to get the integrated care they really need. The ACA is trying to bring those things together.

Many of these issues will still be in play going forward, but it will be in the context of a coherent system that at-least addresses these issues within the context of broader health care.

Follow or contact the Rortybomb blog:
 
  

 

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Make the Stop Overdose Stat Act a Priority for 2015

Feb 26, 2015Emily Cerciello

It’s time for Congress to take an evidence-based and public health focused approach to the epidemic of opioid overdoses.

It’s time for Congress to take an evidence-based and public health focused approach to the epidemic of opioid overdoses.

Opioid overdose is an epidemic in the United States. Drug overdose death rates have more than tripled since 1990, with the vast majority of these deaths attributable to an increase in the prescription and sale of opioid medications. The death rate from heroin overdose doubled between 2010 and 2012, and young people are now more likely to die from drug overdose than from motor vehicle crashes.

These statistics may be surprising, but their causes are familiar – commonly abused prescription opioid medications include names such as Vicodin, OxyContin, Percocet, or codeine, as well as the illicit drug heroin, which creates similar pain-relieving effects. Prescription drugs are often considered a “gateway” to heroin use as heroin addiction often begins as a cheaper alternative to prescription painkillers.

In March 2014, Rep. Donna Edwards (D-MD) introduced the Stop Overdose Stat (SOS) Act to create a federal plan for preventing fatal drug overdoses and prioritizing community- and state-based efforts for the development of best practices. The SOS Act would provide federal support for overdose prevention programs, which can include training bystanders, law enforcement, and first responders in recognizing signs of overdose, seeking medical assistance, or administering naloxone. Naloxone is a life-saving medication that reverses the effects of heroin or opioid prescription overdose. As of December 2014, twenty-six states and the District of Columbia have removed legal barriers to provider prescription and layperson administration of naloxone. Additionally, 20 states and the District of Columbia have established Good Samaritan protection, which grants immunity from arrest for calling 911 to seek medical assistance in the event of overdose.

The SOS Act, cosponsored by 39 legislators, approaches opioid prevention and treatment through a public health and health equity lens. While no socioeconomic or demographic group is immune to the abuse of prescription drugs or heroin (the most dramatic increases have occurred among white, middle-aged women in rural areas), urban areas with large African American populations are still where the majority of overdoses are happening. The SOS Act would create a grant program administered by the Centers for Disease Control and Prevention that gives priority to community organizations working to prevent overdose in high-risk populations.

The SOS Act would also create a mechanism for detailed reporting of overdose data for the development of best practices for preventing overdose deaths. It would require the Secretary of Health and Human Services to develop a national plan to be submitted to Congress within 180 days of enactment that incudes a public health campaign, recommendations for expanding overdose prevention programming, and recommendations for legislative action.

The bill was closed out of the 113th Congress, but should be reconsidered in the current session as the issue builds momentum in both Democratic- and Republican-led states. The re-introduction of the SOS Act is an opportunity for Congress to take immediate action in responding to a significant public health issue with a bipartisan solution. States are implementing evidence-based laws to address the worsening overdose epidemic. It is time for the federal government to follow suit.

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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Daily Digest - February 25: The Big Banks Had a Bad Year

Feb 25, 2015Rachel Goldfarb

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

Annual Bank Profit Falls for First Time in Five Years (WSJ)

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

Annual Bank Profit Falls for First Time in Five Years (WSJ)

Victoria McGrane says the trend is primarily because seven of the 10 largest banks posted lower earnings, while other parts of the banking sector, like community banks, are thriving.

The White House Has No Back-Up Plan if SCOTUS Rules Against Obamacare (Vox)

Sarah Kliff reports on the announcement that the Department of Health and Human Services has been unable to find an administrative fix in case they lose in King v. Burwell.

State Orders Minimum Wage Increase for Tipped Workers (Capital New York)

The New York State Labor Department has ordered an increase in the minimum wage for tipped workers from $5.00 to $7.50 per hour, writes Jimmy Vielkind.

Labor Takes Final Stand as Wisconsin Prepares Way for Anti-Union Law (AJAM)

Ned Resnikoff says Wisconson labor leaders see the governor's new support for right-to-work legislation as proof that he's already focused on appealing to donors for a 2016 presidential run.

Obama Proposal Recognizes How Retirement Saving Has Changed (NYT)

Neil Irwin argues that by requiring those who manage retirement savings to put their clients' best interests first, Obama is bringing back some of the protections of old-school pensions.

One Sign Americans Won't See Big Raises Anytime Soon (Bloomberg Business)

An increasing share of hires are workers who are just entering or re-entering the workforce, writes Jeanna Smialek, which is good for labor force participation but keeps salaries down.

New on Next New Deal

Guns on Campus: Not an Agenda for Women's Safety

Roosevelt Institute Fellow Andrea Flynn breaks down the data that proves allowing guns on campus will only increase the safety risks women face, not reduce sexual assault.

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Guns on Campus: Not an Agenda for Women's Safety

Feb 25, 2015Andrea Flynn

Allowing guns on campus won't reduce sexual assault on campus - instead, it will increase the risk of homicide.

Allowing guns on campus won't reduce sexual assault on campus - instead, it will increase the risk of homicide.

Two years ago, Republican leaders released a post-mortem analysis of the 2012 election in an effort to better understand how they lost the single woman’s vote by 36 percent. The 100-page report recommended that GOP lawmakers do a better job listening to female voters, remind them of the party’s “historical role in advancing the women’s rights movement,” and fight against the “so-called War on Women.” Look no further than recent GOP-led efforts to expand gun rights on college campuses under the guise of preventing campus sexual assault as evidence that conservative lawmakers have failed to take their own advice.

Today, lawmakers in at least 14 states are pushing forward measures that would loosen gun regulations on college campuses. In the last few days a number of them have seized upon the growing public outcry over campus sexual assault to argue that carrying a gun would prevent women from being raped. (So far they’ve been silent on how we might prevent young men – who, of course, would also be allowed to carry a gun – from attempting to rape women in the first place.)

Republican Assemblywoman Michele Fiore of Nevada recently told The New York Times: “If these young, hot little girls on campus have a firearm, I wonder how many men will want to assault them. The sexual assaults that are occurring would go down once these sexual predators get a bullet in their head.” (Really? Hot little girls?) And as the Times highlighted, Florida Representative Dennis Baxley jumped on the “stop campus rape” bandwagon recently when he successfully lobbied for a bill that would allow students to carry loaded, concealed weapons. “If you’ve got a person that’s raped because you wouldn’t let them carry a firearm to defend themselves, I think you’re responsible,” he said.

Let’s be clear. People aren’t raped because they aren’t carrying firearms. They are raped because someone rapes them. What a sinister new twist on victim blaming. As if anything positive could come from adding loaded weapons to the already toxic mix of drugs, alcohol, masculine group think, and the rape culture endemic in college sports and Greek life on campuses around the country.

These lawmakers have appropriated the battle cry of students who are demanding more accountability from academic institutions to prevent and respond to campus sexual assault. It’s a vain attempt to advance their own conservative agenda of liberalizing gun laws. This is an NRA agenda, not a women’s rights agenda. According to Everytown for Gun Safety, each of the lawmakers who have supported such legislation has received an “A” rating from the National Rifle Association (NRA). They have enjoyed endorsements from the NRA during election years and some – including Fiore and Baxley – received campaign contributions from the organization.

These lawmakers are pointing to the demands of a handful of women who have survived sexual assault and are advocating for liberalized campus gun laws. The experiences of these students are real and deserve to be heard and considered as we debate how to make campuses safer. We must also recognize that these students are outliers. Surveys have shown that nearly 80 percent of college students say they would not feel safe if guns were allowed on campus, and according to the Times, 86 percent of women said they were opposed to having weapons on campus. And for good reason.

Research shows that guns do not make women safer. In fact, just the opposite is true. Over the past 25 years, guns have accounted for more intimate partner homicides than all other weapons combined. In states that that require a background check for every handgun sale, 38 percent fewer women are shot to death by intimate partners. The presence of a gun in a domestic violence situation increases the risk of homicide for women by 500 percent. And women in the United States are 11 times more likely than women from other high-income countries to be murdered with a gun. Guns on college campuses would only make these statistics worse.

If the GOP wants to show they care about women – or at the very least care about their votes – this is just one of the realities they need to acknowledge. And they need to listen to the experiences of all women who have experienced sexual assault – like those who have created the powerful Know Your IX campaign – not just those who will help advance their NRA-sponsored agenda. 

Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn.

 

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Daily Digest - February 23: The Republican Health Plan is Less Coverage, More Costs

Feb 23, 2015Rachel Goldfarb

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

GOP Health Plan Would Leave Many Low-Income Families Behind (The Hill)

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

GOP Health Plan Would Leave Many Low-Income Families Behind (The Hill)

Roosevelt Institute Fellow Andrea Flynn explains how the Republican substitute for the Affordable Care Act would leave people with higher costs, worse coverage, and fewer protections.

Walmart Sends Wage Signal to U.S. Business (Financial Times)

David Crow and Sam Fleming speak to Roosevelt Institute Senior Fellow Damon Silvers about Walmart's wage hike, which he says will create pressure on other low-wage businesses.

U.S. West Coast Port Employees Agree to Deal (Bloomberg Business)

James Nash and Alison Vekshin report on the deal brokered by Labor Secretary Tom Perez, which will end the slowdowns at West Coast ports but won't immediately fix the cargo backlog.

A Friendly Office Debate Over Wages (NYT)

David Leonhardt and Neil Irwin agree that whether wage growth will accelerate is the biggest economic question of the year, but disagree on the likelihood of a positive answer.

The Rise of the Non-Compete Agreement, from Tech Workers to Sandwich Makers (WaPo)

Lydia DePillis looks at new research on non-compete agreements, which are surprisingly widespread in industries where they don't really seem necessary.

New on Next New Deal

The One Where Larry Summers Demolished the Robots and Skills Arguments

Roosevelt Institute Fellow Mike Konczal praises Summers and others for a recent panel in which they argued that unemployment and lack of wage growth can't be blamed on technology.

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Daily Digest - February 17: The Shame of Denying Corporate Responsibility

Feb 17, 2015Rachel Goldfarb

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Obama Shames Companies Who Don't Want to Provide Health Insurance (Melissa Harris-Perry)

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Obama Shames Companies Who Don't Want to Provide Health Insurance (Melissa Harris-Perry)

As guest host on Melissa Harris-Perry, Roosevelt Institute Fellow Dorian Warren examines the president's comments about a Staples policy that prevents workers from obtaining insurance.

The State Where Even Republicans Have a Problem With Busting Unions (The Nation)

John Nichols says that Illinois Governor Bruce Rauner is having trouble maintaining support for his plans to weaken public sector unions, with his Republican Comptroller refusing to cooperate.

The Rich Own Our Democracy, New Evidence Suggests (AJAM)

New studies show that Congress votes closest to the desires of its donors, writes Sean McElwee, and donors' ideological extremism has probably produced our dramatic polarization.

States Consider Increasing Taxes for the Poor and Cutting Them for the Affluent (NYT)

Shaila Dewan explains that shifting from income taxes to consumption-based taxes in the states increases the burden on the poor, and has led to huge budget shortfalls in Kansas and North Carolina.

The Tall Task of Unifying Part-Time Professors (The Atlantic)

Kate Jenkin looks at the challenges of organizing a group of workers who are part-time and shift from campus to campus each semester in light of the upcoming National Adjunct Walkout Day.

The War on the War on Poverty (TNR)

Michael A. Cooper Jr. looks at Republicans' efforts to shut down the Center on Poverty, Work, and Opportunity at UNC Law. These same politicians try to argue that poverty isn't a problem.

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The Obama Budget: Weak on Reproductive Health

Feb 9, 2015Andrea Flynn

Family planning is both vital for econoimc stability and a solid investment with strong returns, so why wasn't it better funded in the President's budget?

Family planning is both vital for econoimc stability and a solid investment with strong returns, so why wasn't it better funded in the President's budget?

Last week President Obama unveiled a 10-year budget that reflects the ambitious and progressive agenda he laid out in his State of the Union address. With investments in infrastructure, education, and economic supports for the middle class, the President’s funding plan aims to lift up low-income families and address the growing and historic U.S. class divide. But Obama has fallen short on one area that is critical to women and families: reproductive health.

There were hopes that the president would request a significant increase for Title X – the nation’s only program dedicated to providing quality, affordable reproductive health services – and also the repeal of the Hyde Amendment, a 1976 law that prohibits women from using federal health benefits such as Medicaid to pay for abortion, except in cases of rape, incest, or life endangerment. But Obama did neither.

Given conservative control of Congress, President Obama’s budget has little chance of being passed as is. But as John Cassidy pointed out in the New Yorker this week, the budget is as much a political document as it is an economic one. “The White House is using it to frame the political debate for this year and for the run-up to the 2016 Presidential election – an effort that began with the State of the Union address,” Cassidy wrote. Obama had an opportunity to show that reproductive health is a critical component of any agenda meant to lift up low-income families, and one the federal government must invest in if their other efforts are to bear fruit. But he missed that opportunity.

The president’s $300 million request was a modest increase from last year’s budget of $286.5 million – Title X’s first increase since 2010 – but still leaves the program woefully underfunded. Title X has still not recovered from the drastic cuts it endured between 2010 and 2013, when lawmakers cut the budget from $317 to $278 million, and as a result prevented 667,000 patients from receiving care. Family planning experts estimate that in order to completely fulfill the nation’s unmet need for reproductive health care, Title X would require somewhere in the ballpark of $800 million, a far cry from today’s budget.

Title X is like the little engine that could of public programs. It prevents more than one million unintended pregnancies annually, and thereby avoids nearly 600,000 unplanned births and more than 400,000 abortions. Without Title X, the U.S. unintended pregnancy and abortion rate would be 35 percent higher among adult women and 42 percent higher among teens. Not to mention that in 2010 every dollar invested in Title X saved $5.68. How’s that for a return on investment?

Not only is the program underfunded, but in states across the country conservative lawmakers have implemented restrictions that have prevented Title X funds from actually going to family providers, effectively chipping away at what was once a robust health safety net and exacerbating a pre-existing shortage of reproductive health providers. It is largely low-income women, women of color, immigrant women, and young women who are left without anywhere to turn for preventative care.

And what happens when those women find themselves needing to terminate a pregnancy? Between the restrictions set forth under the Hyde Amendment and the rapidly shrinking network of abortion providers, they have few options. In 1976 – just three years after the Supreme Court’s Roe v. Wade decision legalized abortion – Congress passed the Hyde Amendment and made abortion the only medical procedure ever banned from Medicaid. Ironically, Medicaid covers all the costs related to family planning and pregnancy.

By this point, you might be thinking this is all irrelevant, thanks to the Affordable Care Act (ACA). If only. While the ACA has extended care to scores of women who were previously uninsured, conservative opposition has diluted its potential impact and many people will remain without health coverage. Indeed, nearly four million women will be left without coverage this year thanks to conservative opposition to expanding Medicaid. In addition, federal restrictions ban many immigrants from Medicaid, the contraceptive mandate has been compromised and contraception is now your boss’s business, and this term the Supreme Court may very well take federal subsidies away from millions who need them in order to afford health insurance.

We need an increased investment in reproductive health now more than ever. If we are serious about improving the circumstances of low- and middle-income U.S. families, we must extend critical care and services to all of those who need and want them, and also shape the political debate in a way that will give all women and families all of the tools – not just a select few – that they need to thrive.

When the president, who espoused his support for reproductive rights in his State of the Union address, doesn’t push for a significant expansion of reproductive health care while he is putting his political capital behind broader education, income, and work-family supports, it signals that reproductive health, perhaps, is not as critical as these other issues. It suggests that with other supports women can lead economically secure lives, even if they cannot control their fertility and determine the timing and size of their families. That is simply not the case.

An agenda without bold investments in reproductive health is not a comprehensive agenda for women and families. And if women cannot access quality and affordable health care, they will not be able to make the most of the other important initiatives the president has proposed.

Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn.

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Daily Digest - February 9: Replacing Obamacare Without Real Care

Feb 9, 2015Rachel Goldfarb

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

Under GOP Plan, Pay More for Junk Insurance, Leave More Uninsured (The Hill)

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

Under GOP Plan, Pay More for Junk Insurance, Leave More Uninsured (The Hill)

Roosevelt Institute Senior Fellow Richard Kirsch breaks down the Republican plan for replacing the Affordable Care Act, which he says will allow barebones high-cost plans instead of real coverage.

A Needless Default (TAP)

David Dayen takes a deep dive into the failures of the Home Affordable Modification Program, which was supposed to help homeowners but actually created opportunities for banks to foreclose.

Much Stronger Job Growth is Needed If We’re Going to See a Healthy Economy Any Time Soon (Working Economics)

Elise Gould shows just how slowly the labor market is catching up to pre-recession levels at current rates. At 257,000 jobs per month, we'll be waiting until May 2017.

Rand Paul Has the Most Dangerous Economic Views of Any 2016 Candidate (TNR)

Danny Vinik says that Paul's Audit the Fed bill would give politicians the ability to interfere with monetary policy, a very scary idea since Paul so fundamentally misunderstands monetary policy.

Don’t Listen to Anyone Who Says the Unemployment Rate is a “Big Lie” (WaPo)

Matt O'Brien points out that while the unemployment rate, which only accounts for those actively looking for work, isn't perfect, we don't have better measures of unemployment.

Consumer Protection Agency Seeks Limits on Payday Lenders (NYT)

Jessica Silver-Greenberg says that since payday lenders continue to morph their practices to evade state regulation, federal regulation has the potential to create broader change.

New on Next New Deal

The Obama Budget: Weak on Reproductive Health

Roosevelt Institute Fellow Andrea Flynn argues that when the president chooses not to push for better funding for reproductive health programs, he's saying the issue isn't critical.

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Get Young People Involved to Reduce Chronic Disease

Feb 6, 2015Raymond Dong

A youth advisory committee for the Department of Health and Human Services has the potential to reduce the costs of chronic disease for generations to come.

A youth advisory committee for the Department of Health and Human Services has the potential to reduce the costs of chronic disease for generations to come.

In the United States, chronic diseases including heart disease, stroke, cancer, diabetes and obesity are among the most common, costly, and preventable of health problems. Half of all adults have one or more chronic health conditions, and seven out of the top ten causes of death in 2010 were chronic. As chronic disease is projected to increase to 171 million patients by 2030, the $2 trillion in healthcare spending in this arena is also projected to skyrocket. The CDC says that eliminating three risk factors (poor diet, inactivity, and smoking) would prevent 80 percent of heart disease and stroke, 80 percent of type II diabetes, and 40 percent of cancer. Recent research by University of Chicago Nobel laureate economist James Heckman shows that high-quality childhood development programs with health care and nutritional components can prevent or delay the onset of chronic disease.

The U.S. government has instituted policy and programs targeting lifestyle changes in youth, such as Let’s Move and the Health Hunger-Free Kids Act. The Let’s Move campaign strives to solve childhood obesity through healthier foods and more physical activity; the Health Hunger-Free Kids act let the Department of Agriculture set portions and nutrition standards for school lunches.

These two programs have not had tremendous success. Many schools have complained about the food portions being too small and the food tasting bad, to the extent that many students are refusing to eat these meals and go hungry. Wealthier schools are even backing out of the national program to self-fund food students prefer. When students do not eat the revised federal school lunches, schools also lose money, which may lead to budget cuts in other programs. Meanwhile, a 2012 CDC survey showed that merely one in four U.S. kids aged 12-15 met the criteria for physical activity recommended by Let’s Move.

Although youth are in a powerful position to understand the rationale behind lifestyle decisions of their peers, there is currently very little youth representation in the Department of Health and Human Services. Youth have the potential to help create innovative projects and policy to address these childhood lifestyle issues, but lack the voice to do so.

It would be extremely beneficial for the HHS to create a youth advisory board to the U.S. Department of Health and Human services to increase youth engagement in preventing chronic diseases. In order to guarantee a diverse board, HHS would operate a national competition and a rigorous interview process to select a ten-member advisory board. A staff member from HHS would be designated the task of constructing this board and advising it. This proposal stems from the impact the U.S. National Commission for UNESCO’s youth advisory board has had in areas in which older adults have been unable to serve. The youth board utilized technology and social media to connect over 1,500 youth from 120+ countries in conversation on culture, science, and education.

The proposed HHS youth advisory board would be largely unfunded, as they would implement inexpensive projects. They would engage youth with policy and programs centered on improving lifestyles harmful to long-term health. The first project could be a social media campaign (Twitter chats, Google Hangouts, Facebook groups) to spread awareness and to promote conversation on the importance of exercise, nutrition, and banning tobacco in order to prevent chronic disease. After hearing conversations from youth across the country, the board could then work with the HHS to implement specific programming at their local schools. This could include giving schools recommendations on adding healthier food options or incorporating more nutrition education into classes.

The board could also spend time simplifying WHO, CDC, and World Bank reports on health and chronic disease to make them directly pertinent to youth. The committee could also host a nation-wide competition (in conjunction with private and public partners) to encourage youth to submit innovative ways to improve health practices. Similar competitions have been hosted by the U.S. Federation of UNESCO Clubs to engage hundreds of youth around the world on pressing social issues.

There are certainly a few potential obstacles that could hinder the creation of an HHS youth advisory board. One possible concern is that youth do not have the experience or capability to contribute to HHS projects on a national scale. This can be addressed by looking at the impact that many other youth advisory committees have had. When Dell wanted to enhance technological environments in the classroom, they called upon a youth advisory board to launch a national competition to help achieve the goal. The U.S. National Commission for UNESCO wanted more youth engagement in culture, science, and education; they called upon 10 young people to spearhead a global project connecting teens to UNESCO’s ideals.

A second concern would likely be that the youth advisory board requires a member of the HHS to advise them. This will require a significant time and commitment for that staff member during the initial formation of the group, but afterwards the advisory role would be much lighter. The current advisor to the UNESCO board sits in on one conference call every 2-3 months and is copied on emails to keep up with the board’s projects. Of course, the advisor would have to approve new appointments to the board every year as older members transition out of the board. Asking for time from a staff member is justified because the advisory board has the potential to increase information dissemination and penetration into an increasingly important youth audience.

A last concern would be how to fund the committee. Most of the projects and initiatives can come at a low cost since spreading awareness and information dissemination can largely be done over social media. In the case that money is needed to execute a program in a school, the federal government should allocate funds to such ideas to promote youth innovation and awareness in these healthcare issues.

It is important for the department of HHS to listen to such a proposal asking for an increased youth presence. Youth represent 14 percent of the total U.S. population and have a very large stake in total healthcare costs and outcomes nationwide. If youth become motivated to live healthy lifestyles, the cost savings over their lifetimes will be incredible.

Raymond Dong is a senior at the University of Chicago studying Economics and Biology

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