Four Crazy Economic Ideas You Might Hear at Tonight’s GOP Primary Debate

Aug 6, 2015Roosevelt Institute

The Republican presidential candidates will have their first televised debate of the 2016 cycle tonight. Here's what they're likely to say about the economy:

1. Cutting taxes on big corporations and top earners is the best way to grow the economy.

The Republican presidential candidates will have their first televised debate of the 2016 cycle tonight. Here's what they're likely to say about the economy:

1. Cutting taxes on big corporations and top earners is the best way to grow the economy.

All the candidates on stage tonight at the GOP primary debate will express some flavor of “trickle-down economics”—the failed idea that low taxes for the most well-off is the best policy for economic growth. Through a series of policies implemented over the past 35 years, we have already tried this tax-cutting strategy—in fact, some would say we are still in the midst of a 35-year trickle-down experiment—and as a result economic growth and business investment have slowed while inequality has risen.

To defend their position, Republican candidates will point out that America’s nominal corporate tax rate is among the highest in the world, but this is misleading. American corporations pay an effective tax rate of just 12 percent. Such a low rate could be justified if corporations were using the proceeds to fund productive investment, but the evidence does not support a connection between lower tax rates and higher investment. Today, U.S. corporations are holding more than $2 trillion sitting in offshore tax shelters, and a growing body of research shows that excess profits are used to enrich shareholders rather than improve a company’s long-term prospects for success.

Taxes on top incomes have fallen precipitously, from nearly 70 percent in 1980 to 39 percent today. While top earners have benefited from lower rates and a growing share of deductions and have captured nearly all of the economic gains of the recovery, median wages and family incomes have stagnated.

Thirty-five years of evidence is clear: the main result of cutting taxes at the top and for big corporations is more inequality, not more economic growth.

2. Supply-side policies will make the economy grow at 4 percent and solve America’s economic problems.

Jeb Bush and Chris Christie pledged to boost the economy to 4 percent growth. Historically, the United States has grown at an average annual rate of 2.9 percent, typically only growing above this trend when the economy is coming out of recession.

As we’ve seen, growth is not synonymous with broadly rising economic wellbeing. U.S. economic growth from 1979 to 2007 certainly benefited the top 1 percent of households, who saw incomes increase by 275 percent; however, compensation for the median households increased just 15 percent over this time—largely because families are working more hours, not because wages are broadly rising. 

The deck is stacked against candidates pledging 4 percent growth: The Congressional Budget Office forecasts that U.S. growth will slow to 2.1 percent by the end of the decade as the native-born labor force ages and shrinks. Not only is a 4 percent growth goal unprecedented in advanced economies like the U.S., but there is no credible way to reach 4 percent without building a more inclusive economy.

3. The United States is nearing a Greek-style debt crisis and needs more spending cuts.

The United States is not Greece. Greece’s main pitfalls were being part of a fundamentally flawed European monetary union, combined with Europe’s fundamentally flawed policy response to the financial crisis: sharp public spending cuts that plunged Greece’s economy into a tailspin, causing it to contract by 25 percent, and ballooned the debt burden, which is on track to exceed 170 percent of GDP by 2022.

Yes, the United States has debt, but at an eminently manageable level. And unlike Greece, which does not control the euro, the United States issues government bonds in a currency over which it has monetary policy control. More importantly, it matters a lot what we spend borrowed money on: war and tax cuts for corporations and the wealthy, or investments in education, infrastructure, and science that would strengthen our long-run potential for growth.

4. The Affordable Care Act and Dodd-Frank financial reform are crippling the economy and must be repealed.

A well-functioning economy needs healthy people to drive innovation and growth and a well-functioning financial system that efficiently channels savings into investment without causing systemic crises. Before the Affordable Care Act (ACA) and the Dodd-Frank Wall Street Reform and Consumer Protection Act, America lacked for both.

The ACA extended health care to 16 million people and lowered health costs for those with public and private insurance. Repealing the ACA would cast millions out from the health care system, raise health care costs across the board, kill the hallmark improvements that ended restrictions on people with pre-existing health conditions, and increase federal budget deficits by $137 billion.

Americans are still suffering the hangover of the financial crisis and housing market collapse that led to $8 trillion in lost household wealth, double-digit unemployment, and a taxpayer-subsidized bailout of the world’s largest financial institutions. Five years after Dodd-Frank, many new rules intended to prevent such a catastrophe from happening again are still yet to be implemented due to rampant opposition, such as the rule for corporations to publish CEO pay ratios.

Photo by Gage Skidmore

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Bush Didn't Misspeak: The GOP Wants to Dismantle Reproductive Health Programs

Aug 5, 2015Andrea Flynn

Last night Jeb Bush made a slip of the tongue that let us know just where he stands on reproductive health. “I’m not sure we need half a billion dollars for women’s health issues,” he said at an event in Nashville. In a way, he’s right: We actually need much more than half a billion dollars to fully meet the need for publicly funded reproductive health services.

Last night Jeb Bush made a slip of the tongue that let us know just where he stands on reproductive health. “I’m not sure we need half a billion dollars for women’s health issues,” he said at an event in Nashville. In a way, he’s right: We actually need much more than half a billion dollars to fully meet the need for publicly funded reproductive health services. Bush has since backtracked on his comment, which came on the heels of Senate Republicans’ failed attempt to defund Planned Parenthood, but we should not be fooled. His remarks and the recent furor that led to said defunding attempt are a clear illustration of the resentment GOP lawmakers and candidates have for our nation’s reproductive health programs, and reflect their resolve to diminish them.

It’s important to consider Bush’s remarks and the attacks on Planned Parenthood in the political context of the past four years. As Elizabeth Warren indicated in her impassioned speech before the Senate this week, over the past five years Republican state lawmakers have passed nearly 300 new restrictions on reproductive health access. In the first quarter of 2015, lawmakers in 43 states introduced a total of 332 provisions to restrict abortion access, which is increasingly out of reach for women throughout the country. Republicans have voted more than 50 times to repeal the Affordable Care Act (ACA), which has dramatically improved women’s health coverage and access. In the fall of 2013, the party orchestrated a costly government shutdown motivated by their opposition to the ACA’s contraceptive mandate. And in June, House Republicans proposed eliminating funding for Title X, the federal family planning program.

When conservatives talk about “women’s health” funding, they aren’t talking about funding for abortion. Federal law already prohibits public dollars from being spent on abortion or abortion-related care. They’re talking about funding for family planning and other reproductive health services (pregnancy counseling, cancer screenings, STD treatment, etc.), which mainly comes through Medicaid and Title X, two programs that are consistently in conservative crosshairs.

There are no two ways about it: Funding for public reproductive health programs is far below where it should be. Today funding for Title X is 70 percent lower than it was in 1980 (accounting for inflation). If funding for this program had kept up with inflation over the last 35 years, the current funding level would be $941.5 million. In 2015, Congress appropriated $286.5 million for Title X (down from $317 million in 2010).

Congress approved these funding decreases (and Republican senators have proposed even further cuts while their House colleagues have proposed complete elimination of Title X) despite a growing need for services. The Guttmacher Institute reports that between 2000 and 2010, the number of women who needed publicly funded contraceptive services and supplies grew by 17 percent and by 2013 had grown by an additional 5 percent (an additional 918,000 women). Guttmacher attributes this to an increase in the proportion of adult women who are poor or low-income; the current U.S. public family planning program is only able to serve approximately 42 percent of those in need. Turns out “half a billion” isn’t quite enough.

"Title X-funded health centers provide essential preventive care to millions of women and men across the country and are often the only source of health care they receive all year," said Clare Coleman, President and CEO of the National Family Planning & Reproductive Health Association. "The network of publicly funded family planning providers has long been underfunded despite a growing need for these vital services."

Title X-funded clinics—of which some, but not all, are Planned Parenthood providers—are the backbone of the nation’s reproductive health care system, ensuring that low-income individuals, young people, immigrants, and women of color are able to access affordable, quality reproductive health services. Every year, nearly 5 million individuals rely on these providers for birth control, breast and cervical cancer screenings, pregnancy testing, and a range of other preventive services. In 2012, Title X clinics helped women avert 1.1 million unintended pregnancies that would have otherwise resulted in 527,000 unplanned births and 363,000 abortions. In addition to the extraordinary health benefits, Title X is smart economics. It’s estimated that every dollar invested in family planning yields a taxpayer savings of $7.09, and that Title X-funded clinics save more than $5 billion annually in pubic spending.  

Conservative lawmakers have spent much more time in recent years finding ways to restrict access basic health care than they have solving the actual problems that plague women and families like pay inequity, low wages, weak worker protections, and a lack of work–family benefits. If recent events are any indication, they’re not going to veer from that course now. Jeb Bush’s recent remarks, the hoopla over Planned Parenthood, and the relentless assault on reproductive health and rights is a clear reminder of where issues central to women and families fall on the priority list of conservative lawmakers: dead last.

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

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Planned Parenthood Vote Highlights the GOP's Broken Moral Compass

Aug 4, 2015Andrea Flynn

Senate Republicans failed yesterday to advance a bill that would have defunded Planned Parenthood, but their crusade against the organization and others like it is far from over.

Senate Republicans failed yesterday to advance a bill that would have defunded Planned Parenthood, but their crusade against the organization and others like it is far from over. Speaking in support of the legislation she sponsored, Iowa Senator Joni Ernst said the Planned Parenthood videos have “shaken the moral compass of our country." But given that members of the “pro-life” party are willing to shut down the government over reproductive health access even as they ignore and exacerbate the actual crises that threaten our families and communities, we must question the alignment of the compass they’re following.

The video saga has now been proven to be complete nonsense. Two state investigations have cleared Planned Parenthood of any wrongdoing. Planned Parenthood is not, as the video’s editors portrayed, harvesting fetal tissue for profit, and their donation of such tissue and their compensation for related costs is, it turns out, perfectly legal. In fact, some of the senators leading this crusade (including Mitch McConnell) signed the very piece of 1993 legislation that legalized tissue donation. There are a number of issues shaking the moral compass of this country, but Planned Parenthood is not one of them.

Child poverty should shake our moral compass. Today, 22 percent of all children live in poverty, including 40 percent of Black children, and almost half live in low-income families. The U.S. child poverty rate is higher than all but one other OECD country. Poor children are more likely to drop out and perform poorly in school, to have developmental delays, and to experience behavioral, physical, and socioemotional problems. Yet conservatives still love to hate on the safety net programs that help keep these kids and their families afloat. In recent years, they have threated to cut funding for SNAP (food stamps) and WIC (the supplemental nutrition program that serves nearly 10 million low-income women and children) and have opposed legislation that would make it more affordable for low-income kids to go to college.

Maternal mortality should shake our moral compass. Today, more U.S. women die in childbirth and from pregnancy-related causes than at almost any point in the last 25 years, and the U.S. is one of only seven countries to see its maternal mortality rate increase over the last decade. Black women are three to four times more likely to die from pregnancy-related causes than white women, and in some communities experience a maternal mortality rate equal to that in some Sub-Saharan African countries. But instead of expanding access to quality, affordable, and comprehensive health care, conservatives are busy closing clinics that predominantly serve women of color, low-income women, and young women. They remain steadfast in their refusal to participate in Medicaid expansion under the Affordable Care Act (ACA), which would extend coverage and care to millions more low-income women. And they are still intent on repealing the ACA in its entirety, despite the fact that it has brought coverage to more than 16 million individuals.

Structural racism should shake our moral compass. The conservatives accusing Planned Parenthood of devaluing human life have been pretty quiet on the systemic violence and discrimination against communities of color. Where’s the outrage over Sandra Bland, Freddie Gray, Trayvon Martin, and the countless others who have died at the hands of law enforcement? Where’s the outrage from the supposed “pro-family” party over the school-to-prison pipeline that has torn apart families and communities across the country? Where’s the outrage over our imbalanced and unjust criminal justice system? Where is the space for these lives under the conservative pro-life umbrella?

Pay inequity should shake our moral compass. The gender pay gap in the United States is alive and well, with women still making 78 percent of the earnings of white men (Black and Latina women make 64 and 56 percent, respectively). This gap results in a significant loss of income for women and their families over the life cycle and contributes to the high rates of poverty among women and single mothers as well as children. If equal pay were realized, it would mean a raise for nearly 60 percent of U.S. women and two-thirds of single mothers. The increase in earnings would expand access to health care, food and housing security, and educational opportunities, and would have countless long-term benefits for children. But GOP senators have voted four times since 2012 to block the Paycheck Fairness Act, which would make it easier for employees to identify and address pay inequities. They are also consistently opposed to raising the minimum wage, a move that would benefit more than one-fifth of all children in the United States.

Income inequality—today greater than at any point since the Great Depression—should shake our moral compass. Thanks to our broken economic rules, the incomes of the top 1 percent increased by as much as 200 percent over the past 30 years while the net worth of the poorest Americans has decreased and stagnant wages and increased debt have pushed more middle-class families into poverty. After the 2008 recession, millions of Americans lost their homes, their jobs and their health care, and they are still struggling to regain their footing. The vast majority of Americans now believe a middle-class lifestyle is well beyond their reach. Yet conservatives continue to support the very policies that got us here in the first place: tax cuts for the wealthy; the erosion of unions and labor protections; and corporate structures that encourage a short-term focus on stock prices instead of long-term investments in growth and innovation.

The inability of individuals to access basic health services should shake our moral compass. Conservatives insist their efforts would not actually impact health access, because Planned Parenthood’s funding would simply be reallocated to other providers. But there are not actually enough providers to fill the void that would be left by Planned Parenthood. As Senator Patty Murray said, “you can’t pour a bucket of water into a cup.” Even with Planned Parenthood and the gains of the ACA, conservative laws have left women across this country reeling. We need more Planned Parenthoods and more of their sister clinics, not fewer.

Conservatives insist they care about the health of women and their families, but their actions indicate otherwise. They have proposed the elimination of Title X, the nation’s only program dedicated to providing family planning care and services. They are threatening—for the third time in four years—to shut down the federal government over reproductive health funding. They continue to support legislation that is closing clinics across the country, cutting access not only to abortion but also to basic preventive health services. The list goes on. This party is more interested in advancing its antiquated, harmful agenda than it is in the health of women—and men, young people, immigrants, trans folks, and low-income families—who rely on Planned Parenthood and other such providers. Their moral compass needs a good shaking up. 

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

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Hillary Clinton's Economic Agenda is Good for Women, But Should Be Even Bolder

Jul 16, 2015Andrea Flynn

Hillary Clinton gave her first major economic policy address earlier this week and outlined her goals for lifting wages for the middle class, expanding social services, and addressing growing economic inequality. She said that an important ingredient to strong economic growth is women’s workforce participation, and promised to knock down many of the barriers that hold women—and our economy—back.

Hillary Clinton gave her first major economic policy address earlier this week and outlined her goals for lifting wages for the middle class, expanding social services, and addressing growing economic inequality. She said that an important ingredient to strong economic growth is women’s workforce participation, and promised to knock down many of the barriers that hold women—and our economy—back. But she failed to mention one issue that is critical to the economic wellbeing of women and their families: access to reproductive health care. 

It was encouraging to hear Clinton acknowledge the important role that women play in the U.S. economy. After all, women’s entrance into the workforce in the 1970s and 1980s is credited with driving a fifth of GDP growth. But over the past 15 years, their participation in the labor market has declined from 60 to 57 percent, not a major decline but certainly a trend in the wrong direction. The U.S. now ranks 19th out of 24 advanced countries on this measure. America’s dismal status can be blamed in large part on the lack of generous and sensible work and family polices we see in other OECD countries. These include paid sick leave, paid family leave, and affordable child care. Another factor is the stubborn wage gap that disadvantages women—and particularly women of color—throughout their working lives and beyond. Clinton indicated that addressing these inequities is a primary focus of her economic agenda. Doing so would significantly improve the lives millions of women and their families. 

But we must do all that and more. Without access to comprehensive, quality, and affordable health care, including the full spectrum of reproductive health care—maternal health care, family planning, and abortion care—women and their families will not be able to take full advantage of the economic opportunities available to them.

I’m not worried that Hillary isn’t going to be a strong supporter of reproductive rights. In her Roosevelt Island campaign launch, she called out Republicans who “shame and blame women, rather than respect our right to make our own reproductive health decisions.” Her campaign sharply criticized House Republicans for passing a 20-week abortion ban earlier this year, saying, "Politicians should not interfere with personal medical decisions, which should be left to a woman, her family and her faith, in consultation with her doctor or health care provider." Historically, she has been an advocate for reproductive rights in both domestic and international policy.

But it would be powerful if she could also articulate reproductive health as a critical component of economic security, as we at the Roosevelt Institute did in our recent blueprint for reversing economic inequality. Voters understand reproductive health as an economic issue. New polling from Virginia shows that 64 percent of voters there believe that a woman’s financial stability is dependent on her ability to control whether and when she has children, and 68 percent believe laws that make it harder to access abortion can have a negative impact on woman’s financial security. Polling conducted in New York and Pennsylvania showed similar results.

This isn’t just a matter of opinion; the evidence illustrates that reproductive health access has economic benefits for families. Studies have shown links between family planning access and greater educational and professional opportunities for women, as well as increased earnings over women’s lifetimes. Women report that using birth control has allowed them to better take care of themselves and their families, to stay in school, to support themselves financially, and to get or keep a job and pursue a career. And when women don’t have access to reproductive health care, they are economically disadvantaged. Take the results of the recent Turnaway Study, which has shown that women who seek but are denied an abortion are three times as likely as those who access the procedure to end up below the federal poverty line two years later.

In light of these findings, a progressive economic agenda will be incomplete if it does not include access to comprehensive reproductive health care. Lack of access to those services has significant health and economic costs. Women of color, immigrant women, and poor women all experience higher rates of chronic disease, unintended pregnancy, and lower life expectancy than women with higher incomes. U.S. women of color are 3–4 times more likely than white women to die of pregnancy-related causes, and infants born to those women are 2.4 times more likely than those born to white women to die in their first year of life. In some regions of the United States, the maternal mortality rate among Black women is comparable to that in some Sub-Saharan African countries. These disparities impact women’s quality of life. They inhibit these women’s ability to care for themselves and their families, to play an active role in their communities, and to participate in the workforce and achieve economic security. There is no more important time than now to advocate for a broader progressive agenda. Attacks on reproductive health access are at an all-time high and access to basic health services is being rolled back at a rapid rate.

The right and ability to make decisions about our bodies is a fundamental building block of our social and economic wellbeing. We can’t expect people to separate the physical, social, and economic demands and stresses they experience. Are women supposed to worry about their need for an abortion without worrying about the job they might lose if they take a day off to get one? Do they stress over needing to put food on the table for their kids without also worrying about how they will pay for birth control, student loans, and rent? No. For the vast majority of people in this country, life is messy and complicated and overwhelming, and everyday families have no choice but to juggle each of these issues simultaneously.

Progressives know that. Now is the time for them to put forth an economic agenda that will address all aspects of our economic wellbeing—not just those that have historically been politically palatable. 

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

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Once Again, the ACA Survived SCOTUS -- But the Fight Isn't Over Yet

Jun 25, 2015Andrea Flynn

Today the Supreme Court decided in favor of the government and the more than 6 million individuals who now have health coverage thanks to the Affordable Care Act’s subsidies. The 6–3 King v. Burwell decision—which determined that individuals in all states, not just those that established their own health exchanges, could be eligible for federal subsidies—is a win for President Obama, for the law more broadly, and for the health and economic security of millions of women and their families.

Today the Supreme Court decided in favor of the government and the more than 6 million individuals who now have health coverage thanks to the Affordable Care Act’s subsidies. The 6–3 King v. Burwell decision—which determined that individuals in all states, not just those that established their own health exchanges, could be eligible for federal subsidies—is a win for President Obama, for the law more broadly, and for the health and economic security of millions of women and their families. As I described in my recent policy note, the ACA has expanded women’s access to care, improved the quality of their coverage, and in the process increased women’s economic security. Today’s decision ensures that—for the time being—the law will continue to do all of those things and more.

The ACA expanded coverage to 16.5 million people and elevated the floor of coverage for women. Since 2010, 8.7 million women have gained maternity coverage; 48.5 million women with private insurance can access preventive services with no cost-sharing; and as many as 65 million women are no longer charged higher premiums based on pre-existing conditions. In 2013, the number of women who filled their birth control prescriptions without co-pays grew from 1.3 million to 5.1 million, and the share of women who had access to birth control with no out-of-pocket costs grew from 14 percent to 56 percent. This has been a significant improvement over the pre-ACA system in which women had to pay out of pocket for preventive services like pap smears and breast exams, were routinely charged more than men, and many couldn’t afford maternity coverage during pregnancy.

Over the past five years the ACA has begun to ease the financial burdens of health coverage and care for women, who are more likely than men to live in poverty. Today more than two-thirds of low-wage workers are women—half of them women of color—and many work long hours with no health benefits. Wage inequality causes Black and Latina women to lose approximately $19,000 and $23,279 a year, respectively. A loss of subsidies would have been especially harmful to women of color, who represent nearly half of all uninsured women eligible for tax credits in states using the federal exchange. Those subsidies are the only path to insurance for 1.1 million Black women, approximately 2 million Latinas, nearly a quarter-million Asian women, and more than 100,000 Native American women. Many of those women live in one of three states: Florida, Georgia, or Texas.

When women have good coverage and access to care, they are better able to make decisions about the timing and size of their families. They are able to prevent illnesses that cause them to miss work force them to lose a paycheck, and threaten their employment. They have healthier babies and children. Fewer out-of-pocket medical costs free up more money for food, childcare, education, housing, transportation, and savings. Health coverage won’t singlehandedly solve the serious challenges facing low-income women and families. Indeed, our country’s soaring inequality and persistent injustices demand sweeping social and economic reforms. But without the very basic ability to care for their bodies, visit a doctor, plan the timing and size of their families, and make independent reproductive health decisions, women will never be able to take full advantage of other economic opportunities.

Today’s decision is especially important for women considering conservative lawmakers’ relentless attempts to roll back access to reproductive health care. Consider that just yesterday House Republicans voted to completely eliminate Title X (the federal family planning program), to expand religious exemptions allowing employers and insurers to opt out of covering anything they find morally or religiously objectionable, to implement new abortion restrictions with no exception for the life or health of pregnant women, and to renew the Hyde Amendment, which prohibits Medicaid coverage of abortion.

So the ACA is safe for now, and the Supreme Court’s ruling will allow the law to become even more ingrained in our social and political fabric. However, we can be sure the vitriolic political opposition is not over. The GOP presidential hopefuls didn’t waste any time letting their constituents know today’s decision wouldn’t stop their attempts to undermine the law. And conservative lawmakers on the Hill will continue to push budget proposals that would unravel the law’s most important components and reduce funding for social programs critical to the wellbeing of low-income families. We should celebrate the King v. Burwell decision, but we must not stop making the case that for women and families, comprehensive, affordable health coverage—and by extension, care—is as much a matter of health as it is economic security.

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

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King v. Burwell Could Turn Back the Clock for Women's Health

Jun 23, 2015Andrea Flynn

In the coming days the Supreme Court will decide King v. Burwell, a case on which the health coverage of more than 6 million individuals—and in some ways the future of the Affordable Care Act (ACA)—hinges. As we anticipate that ruling, and as conservative lawmakers propose potential solutions to the crisis that will ensue should they “win,” we should pause and remember that the ACA has profoundly improved the quality of women’s health coverage, expanded women’s access to care, and increased women’s economic security.

In the coming days the Supreme Court will decide King v. Burwell, a case on which the health coverage of more than 6 million individuals—and in some ways the future of the Affordable Care Act (ACA)—hinges. As we anticipate that ruling, and as conservative lawmakers propose potential solutions to the crisis that will ensue should they “win,” we should pause and remember that the ACA has profoundly improved the quality of women’s health coverage, expanded women’s access to care, and increased women’s economic security. As I describe in a policy note released today by the Roosevelt Institute, if policymakers are serious about the health and financial wellbeing of women and families, they should expand and strengthen the ACA, not reverse or repeal it.

The ACA expanded coverage to 16.5 million people and elevated the floor of coverage for women. In the pre-ACA system, women were routinely charged more than men, had to pay out of pocket for preventive services like pap smears and breast exams, and many couldn’t afford maternity coverage while they were pregnant. But since President Obama signed the ACA into law, 8.7 million women have gained maternity coverage; 48.5 million women with private insurance can access preventive services with no cost-sharing; and as many as 65 million women are no longer charged higher premiums based on pre-existing conditions. In 2013, the number of women who filled their birth control prescriptions without co-pays grew from 1.3 million to 5.1 million, and the share of women who had access to birth control with no out-of-pocket costs grew from 14 percent to 56 percent .

For millions of women, the ACA has begun to ease the financial burdens of health coverage and care. Before the ACA, women were far more likely than men to have to forgo care because of cost concerns, and for all women—but especially those without coverage—cost was a major barrier to care. Many women had difficulties paying their medical bills (52 percent of uninsured women and 44 percent of low-income women, compared to 28 percent of women overall). This should be no surprise, given that it’s more likely for women—particularly women of color—to live in poverty. Today more than two-thirds of low-wage workers are women—half of them women of color—and many work long hours with no health benefits. Wage inequality causes Black and Latina women to lose approximately $19,000 and $23,279 a year, respectively.

A loss of subsidies would be especially harmful to women of color. In states that are using the federal exchange, women of color represent nearly half of uninsured women eligible for tax credits. Those subsidies are the only path to insurance for 1.1 million Black women, approximately 2 million Latinas, nearly a quarter-million Asian women, and more than 100,000 Native American women. Many of those women live in one of three states: Florida, Georgia, or Texas.

Comprehensive, affordable coverage—and by extension, care—is as much a matter of health as it is economic security. When women have good coverage and access to care, they are able to prevent illnesses that take them out of work, threaten their employment, and force them to lose a paycheck. They are better able to make decisions about the timing and size of their families. They have healthier babies and children, fewer out-of-pocket medical costs, and more money for food, childcare, education, housing, transportation, and savings. Health coverage won’t singlehandedly solve the myriad challenges facing low-income women and families; indeed, the United States’ soaring inequality demands sweeping social and economic reforms. But without the very basic ability to care for their bodies, visit a doctor, plan the timing and size of their families, and make independent reproductive health decisions, women will never be able to take full advantage of other economic opportunities.

The political vitriol of the past five years has blurred our collective memory of just how badly we needed health reform before we got it. Opponents of the ACA argue that we cannot afford for the law to prevail. But the truth is we can’t afford for it not to. In most other countries families are not driven into poverty because they seek needed care, and they don’t avoid seeking care out of fear that doing so will drive them into bankruptcy. The United States is unfortunately exceptional in this regard. For too long the right to health has been unfulfilled in the United States, and the ACA has begun to change that for millions. Neither the Supreme Court nor conservative lawmakers should turn back the clock now.

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

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Connecting Pediatricians to Local Anti-Poverty Resources Can Improve Child Health

Jun 10, 2015Missy BrownEmily Cerciello

Childhood poverty is growing in North Carolina. As of 2012, more than half a million children in the state are living in poverty, and of these, more than half are in extreme poverty.

Childhood poverty is growing in North Carolina. As of 2012, more than half a million children in the state are living in poverty, and of these, more than half are in extreme poverty. The health implications for these children are profound; research shows children born into poor families have higher hospital readmission rates, sick days, rates of chronic illness, and death rates compared to children in non-poor families.

As most pediatricians have patients who fall below the poverty line, they are seeing the negative health consequences of poverty. Pediatricians are looking for ways to address these issues, which are affecting an increasing number of their patients. Unfortunately, conditions of poverty—inadequate housing, lack of access to healthy foods, lack of transportation for appointments—are not easily remedied.

Pediatricians cannot tackle these issues themselves, nor do they have to. Across the state, organizations and agencies across the states are working to address these issues on at the grassroots level. After speaking to North Carolina pediatricians, however, we found that most were unaware of these local resources and the services they provide.

Our team of students at UNC set out to fix this by assembling a community health toolkit—a concise, informative database of local resources, the services they provide, and their contact information. With this toolkit, pediatricians can begin to address these larger issues. For example, if patients come in with asthma symptoms exacerbated by their family’s housing situation, instead of merely addressing the symptoms, the doctor can make referrals to an organization that works to get families better housing. This way, pediatricians can provide more than Band-Aid solutions to the problems they’re seeing. In addition, the toolkit benefits community organizations by helping them reach their target populations.

The idea of connecting pediatricians to these resources is coming at a critical time. The Affordable Care Act aims to shift the health care system to a system of value-based reimbursement instead of volume-based reimbursement. Under a value-based system, pediatricians are paid based on the health of their patients, not the number of medical services they provide. Therefore, pediatricians now have even more reason to look at the health of their patients more holistically and address the larger health factors at play.

What we have done by creating this community health toolkit is only the first step in what we see as a necessary change in how we approach health care. Research shows that the causes of poor health are multifaceted, so our solutions should be, too. We hope to see this toolkit model expanded so pediatricians across the nation can bring in local groups to help address the systemic poverty affecting millions of children.

Missy Brown and Emily Cerciello are recent graduates of the University of North Carolina at Chapel Hill. Emily is the Campus Network's Senior Fellow for Health Care.

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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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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.

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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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