American Forum Op-Ed

By Dr. Lorna Marshall

As specialists in the field of fertility, we cringe every time a higher order multiple pregnancy (three or more gestations) receives special attention. Almost every Mother’s Day contest for “Mother of the Year” selects a woman who has carried and delivered four, five, or six babies at once. Jon & Kate Plus 8, which chronicles a couple raising twins and sextuplets, has become one of the most popular reality TV shows. To fertility specialists, such pregnancies are associated with preterm labor, tiny babies that need weeks or months of special care in the nursery, and likely one or more children with long-term health or behavioral difficulties. So, in a way, the public outcry against the recent birth of octuplets by Nadya Suleman can have a positive effect.

It’s hard to believe that any conscientious professional would ever consider transferring six embryos into a young woman’s uterus. The current guidelines by the American Society for Reproductive Medicine state that women less than 35 should have one or two embryos transferred into their uterus. Indeed, there are times when medical judgment suggests that perhaps three instead of two embryos can be transferred when their quality is poor or when there have been multiple failed cycles. And, yes, a patient has a right to make her own decisions about health care, but her physician has an obligation to ensure that those decisions are well-informed. Dr. Kamrava’s decision to transfer six embryos into the uterus of 32-year-old Nadya Suleman deviated so much from professional guidelines that every agency that has the power to sanction him should.

When medical care falls below the standard of care, there are many avenues available to reprimand the physician. Hospitals can withdraw privileges, medical societies can expel a member, state licensing boards can suspend the physician’s license, and patients can file a liability claim. Whatever official sanctions are imposed, the negative publicity has significantly harmed, if not ruined, Dr. Kamrava’s career. The public backlash should strongly deter other physicians as well.

So why the cry for new laws to “protect” the public from another set of octuplets? Professional guidelines by the American Society for Reproductive Medicine are strong and have been shown to be effective in reducing the number of embryos transferred and risk of multiple pregnancies. Those who label fertility care as the “wild west of medicine” aren’t aware that the clinical delivery of fertility care in the United States is one of the most regulated areas in medicine. Since 2004, fertility clinics and sperm banks must register with the FDA, which sets standards on infectious disease screening of egg, embryo and sperm donation. Many in our field believe that the FDA’s attempt to regulate the field of fertility has neither improved care nor protected patients, only increased the cost to deliver already costly services.

A recent attempt in Georgia to prevent another “octuplet mom” shows how misguided politicians can be when trying to regulate health care. The original Georgia proposal was drafted by the Arizona-based Bioethics Defense Fund, which opposes embryonic stem cell research and abortion, and the proposal was introduced by Georgia Right to Life. Clearly, the agenda included more than the prevention of multiple pregnancies.

Most higher order multiples are not the result of in vitro fertilization, but are due to the use of injectable fertility drugs, also known as gonadotropin therapy. With gonadotropin therapy, it is difficult to control the number of eggs that ovulate, become fertilized, and eventually implant. Jon and Kate of “Jon and Kate Plus 8” conceived their sextuplets this way. A bill like the one initially proposed in Georgia would actually do very little to affect the risk of quadruplets, quintuplets or octuplets. Because most patients have to foot the bill for IVF, many choose gonadotropin therapy first because of its lower cost. Only 14 states make insurers cover some infertility treatments. In the current state of the economy, it would not be popular to suggest legislation to extend this, although this additional service has been shown to cost insurers very little and may even save them money by lowering the risk of higher order multiple pregnancies.

In response to the birth of the octuplets, we should punish the rogue physician who completely ignored established standards of care in the field of reproductive medicine. But until the government mandates insurance coverage for IVF, don’t let lawmakers who know nothing about reproductive medicine -- and often have other reproductive agendas -- pass regulations that protect neither patients, the public, nor future children.
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Marshall is a practicing specialist in reproductive endocrinology and infertility in Seattle, WA. She is president-elect of Pacific Coast Reproductive Society and a former member of the ethics committee of the American Society for Reproductive Medicine.
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Copyright (C) 2009 by the American Forum. 3/09

Places Op-ed was Published:

Springfield Illinois Times, Hernando Today, Artesia News

By Paul Fleisher

Imagine an election in which one candidate could threaten your job if you voted for the other side. That candidate could campaign as much, and whenever, they wish, while the opponent was limited to speaking only during coffee breaks or after work. Suppose that candidate could even decide when the election would take place -- calling the vote only after being certain that it would go in their favor?”

Those conditions don’t sound much like a “free and fair” election -- but they are just the situation employees can be subjected to when they choose whether or not to unionize. It’s those sorts of inequities that the Employee Free Choice Act (EFCA) is intended to remedy.

Under current law, when a majority of workers indicate they want union representation, management gets to decide when the certification election will take place. Meanwhile, the company can campaign against the union in the workplace by holding workplace meetings, distributing literature, and even meeting privately with employees one-on-one. Such campaigning often includes heavy doses of intimidation and threats of job loss. In fact, employers illegally fire union supporters in 25 percent of organizing campaigns. Meanwhile, union organizers may not enter the workplace; employees can only campaign during breaks, or before and after work. And even if 100 percent of workers indicate by signing authorizations that they wish to be represented by a union, the company is not required to recognize and bargain with it. In short, employers are playing with a stacked deck.

The Employee Free Choice Act (EFCA) currently before Congress would increase penalties for violating workers’ First Amendment right to form a union and to negotiate a first contract and would provide mediation and arbitration to assist management and unions through that negotiation process. Finally, it would allow a majority of employees to establish a union by signing authorization cards. This provides an alternative to the current election process, which is subject to intimidation, firings and other disparities favoring a company’s anti-union campaign.

It is this last provision that some business leaders emphasize in their attempt to defeat EFCA, claiming that under “majority sign-up,” workers would be subjected to intimidation from the union, rather than being protected by the “free choice” of an election. The history of employees’ efforts to band together for better working conditions tells a different story. Time and again, union supporters have been threatened, reassigned to less desirable jobs, or simply fired. No one who has been harassed with a barrage of threats of firing or reassignment unless they oppose unionization is making a genuinely “free choice.”

Majority sign-up already has a proven track record. It has been used successfully at several large firms, including AT&T Wireless. In this case, both the company and the Communications Workers of America agreed to remain neutral during the organizing campaign -- allowing more than 17,000 workers to freely express their preference for union representation.

Remember, the EFCA does not require workers to use majority sign-up. Employees are still free to conduct an election supervised by the National Labor Relations Board if they prefer. But faced with a company determined to deter employees from organizing, EFCA could provide workers with another option to help level the playing field.

Over the past century, organized labor has helped bring prosperity and respect for the dignity of work to our nation. Unions campaigned to end to child labor, enabling America’s children to develop the knowledge and skills that have built our country into an economic powerhouse. They gave us the 40-hour work week and fair compensation when the work load requires overtime, negotiated decent benefits (vacation time, sick pay, pensions, health insurance, etc.), and insisted on workplace safety.

These advances have benefited not just union members, but their families and communities, as well as workers who profit from non-union businesses offering comparable wages and benefits to compete for qualified employees.

Union representation is a hard-won American tradition. It deserves protection and encouragement, especially in times of economic crisis. Union contracts bring fair wages and benefits to those who will rebuild our infrastructure, provide essential products and services, and spend their earnings back in their own communities. By giving a fair shake to organized labor, the Employee Free Choice Act can play an important part in America’s economic revitalization--and that will benefit us all.
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Fleisher is an educator, member of the Virginia Education Association Fitz Turner Commission for Human Relations and Civil Rights and life member of the NEA.
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Copyright (C) 2009 by the Virginia Forum. 3/09

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By Amy Hinton

The most promising national policy trend in alternative corrections has been the emergence of specialty courts. These alternative courts -- such as mental health or drug courts -- route eligible offenders into the appropriate social service delivery system while maintaining accountability and protecting public safety.

More than 150 mental health courts in over 25 states are providing offenders with needed mental health services and supports under close court supervision. Significant cost savings could be generated in Alabama if specialty court models for offenders with mental health and addiction disorders were implemented across the state. Results so far from these specialty courts are extremely promising, particularly in reduced recidivism.

In 2008, the Los Angeles County Jail was essentially the nation’s largest mental institution, housing approximately 1,400 seriously mentally ill inmates. Mental health professionals, consumers and advocates would say that this is not a surprising revelation given the fact that so many mentally ill people end up in the criminal justice system.

The deinstitutionalization movement that began in the 1970s was appropriately focused on moving individuals with mental health disorders out of large institutions and into less restrictive community-based programs. But, the movement that began with the best intentions nearly four decades ago has failed the very mental health consumers it was supposed to serve. Due in large part to more politically expedient priorities, money that was previously directed to large, state-operated psychiatric hospitals was never really dedicated to local mental health centers for treating individuals with mental health needs living in the community. The result is that community mental health programs are almost always chronically underfunded, understaffed and unable to respond in a timely manner to the public demand for mental health services.

It is easy to see how prisons and jails across the United States have become the de facto mental health system for vulnerable individuals, particularly those with undiagnosed and/or untreated mental health conditions who self-medicate with alcohol and drugs. Once incarcerated, however, the mentally ill offender faces additional challenges and obstacles to recovery. The high cost of psychotropic medications means that inmates often do not receive the preferred or most appropriate medications for their particular disorder.

Incarcerated adult offenders with mental health disorders are far more likely to commit suicide or to be victimized by other inmates. Inadequate medical care for mental health disorders often makes these conditions much more difficult and expensive to treat over time.

Correctional officers are not mental health professionals and are poorly equipped to serve inmates with serious mental health needs. Correctional facilities are not therapeutic environments. Nationally, the problem of inmates with mental health needs has reached a crisis stage and is magnifying in both size and scope.

In Alabama, Montgomery County is already working to address these issues with its two specialty courts for adult offenders – a drug court and a mental health court. Our attention now must shift toward juvenile offenders with mental health needs.

To that end, a coalition of parent advocates, juvenile justice officials and mental health and substance abuse treatment professionals in Montgomery County have recently completed a 12-month collaborative strategic planning initiative funded by the U.S. Department of Justice and have produced a blueprint for addressing the mental health needs of local juvenile offenders.

The key element of the strategic plan is the development and implementation of a “co-occurring” juvenile mental health court -- the first of its kind in Alabama -- that would concurrently address the mental health and substance abuse treatment needs of eligible juvenile offenders. Efforts like this provide Alabama with the opportunity to be a national leader in this policy area.

As one of Alabama’s greatest federal jurists, Judge Frank M. Johnson noted in his landmark 1972 Wyatt v. Stickney decision, committing mentally ill individuals to psychiatric institutions without providing treatment is little more than “human warehousing.”

The growing overrepresentation of mental illness and addiction disorders among incarcerated populations is a troubling indication that, as a society, we have merely exchanged one type of human warehouse for another. This is both an inappropriate use of limited resources and an affront to human dignity. Expansion of the specialty court model through collaborative mental health policymaking is the best possible solution to a problem that is not going away anytime soon.
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Hinton is a senior consultant with the Auburn University Montgomery Center for Government and Public Affairs specializing in health and human services policy.
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Copyright (C) 2009 by the Alabama Forum. 3/09

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Places Op-ed was Published:

Anniston Star , Montgomery Advertiser , The Huntsville Times

By Lisa Grafstein

President Obama will soon begin making nominations to the Fourth Circuit Court of Appeals as four of the 15 seats on that Court are currently vacant. Of the five states that make up the circuit (North Carolina, South Carolina, Virginia, West Virginia, Maryland) North Carolina has the fewest judges on the Court, even as the state has the largest population in the Circuit.

The sole North Carolinian on the Fourth Circuit – Judge Allyson Duncan -- was appointed by President George W. Bush in 2003. Conventional wisdom is that North Carolinians will be appointed to at least two of the open seats, although it would take all four seats to bring the state into relative parity in terms of population. Nevertheless, all seem to agree that we have been woefully under-represented for years.

Senator Kay Hagan has pledged to move nominations forward in a bipartisan way. Senate rules have permitted a Senator from a nominee’s home state to withhold a “blue slip” and thereby impede the nomination process for a particular nominee. She has argued that the era of partisan use of blue slips should end. Although there has long been political obstruction, Judge Duncan’s nomination in 2003 proceeded (and she was confirmed 93-0) during a Republican presidential administration when a Democratic Senator, John Edwards, was in office.

One significant question about the fate of additional North Carolinians on the Fourth Circuit is which route Senator Richard Burr will take – obstruction or bipartisanship? There is some cause to be hopeful. In May 2005, Senator Burr issued a press release calling for an up or down vote on judicial nominees:

“There is no doubt in my mind that I was sent here to work hard and to accomplish solutions to real problems…There is no doubt in my mind the task includes ensuring that the Senate provides judicial nominees an up-or-down vote. I remain hopeful still today that a resolution can be reached. Many of us have worked toward a fair process where all judicial nominees with majority support, regardless of party, receive an up-or-down vote.”

More recently, Senator Burr told the Charlotte Observer that he would like to see an end to the deadlock and is willing to work toward that end.

However, Republican Senators – including Senator Burr -- have sent a letter to President Obama stating that they will block nominees unless President Obama gets approval from Republican Senators in the nominees’ home states:

“Regretfully, if we are not consulted on, and approve of, a nominee from our states, the Republican Conference will be unable to support moving forward on that nominee.”

Senate Republicans appear to suggest that they will reject nominees based not on any qualities of the nominees, but merely because the President fails to obtain pre-approval from them for his nominees. This is an astonishing attempt to hold the judicial nominations process hostage, and suggests that Senate Republicans’ objections will not be based on the perceived short-comings of any as-yet-unnamed nominees, but will derive from an effort to extort power in the nomination process itself. Given Senator Burr’s prior support of up or down votes, and his expressed desire to end the bickering over North Carolina judicial nominees, it is concerning that he signed on to the GOP demand.

The important process of nominating and confirming judges would be well-served by consultation with home state senators, and careful vetting of candidates’ qualifications by all parties. Wholesale rejection of nominees as a political tug of war will not serve the interests of our justice system. Senator Burr can, and should, help our state move past the politicization of appointments so that North Carolina can regain its rightful role in supplying quality judges to the Fourth Circuit.
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Grafstein is a private practice attorney in Raleigh.
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Copyright (C) 2009 by the North Carolina Editorial Forum. 3/09

By Tamika Felder

British reality star Jade Goody, who rose to stardom overseas by exposing nearly every aspect of her life to a hungry media audience, has recently died, with the media in tow, of cervical cancer. She was only 27 and has left behind two young sons, ages four and five.

Despite the sensationalized nature of Ms. Goody's case, her story is tragic, as are the stories of so many other women worldwide who are struck by cervical cancer in the prime of their lives.

I was 25 when I was diagnosed with advanced cervical cancer and my world was turned upside down. After a radical hysterectomy and weeks of tough chemotherapy and radiation treatment, I was declared cancer-free. I survived and consider myself lucky. But I'll never be able to bear my own children -- something I had always dreamed about -- and I'll have to deal with medical complications from my treatment for the rest of my life.

Cervical cancer is the second most common cancer in women around the world, killing nearly 300,000 women each year. In the United States, the American Cancer Society estimated that 11,070 women would be diagnosed with cervical cancer in 2008, and that 3,870 women would die from it.

The most frustrating aspect of cervical cancer is that it is almost completely preventable. Experts know that it is caused by "high-risk" types of a common infection - the human papillomavirus, or HPV. And we now have available preventive technologies, including the Pap test, the HPV test and the HPV vaccine, to help stop this disease in its tracks.

Despite these advances, why are so many women still dying? There are two key problems.

First, women need access to screening. In the U.S., approximately half of all cervical cancer cases are in women who have never been screened. Minority women and those with lower incomes are less likely to have access to screening programs and consequently, are affected by cervical cancer at higher rates.

Second, women need to know what technologies are available and appropriate for them. At around age 21, women should get screened with the Pap test, the traditional way to screen for cervical cancer. When women reach 30, they should get an HPV test along with their Pap. The
HPV test detects the virus that causes cervical cancer. Studies show that using both tests together to screen women aged 30 and older offers the best protection against cervical cancer. This approach is included in leading medical organizations' screening guidelines.

HPV vaccination now offers significant potential to reduce cervical cancer rates. One HPV vaccine is already FDA-approved for girls and young women aged 9 to 26, and another vaccine is under FDA review. Both vaccines have been shown to be 100 percent effective - in women not previously infected - at preventing infection from the two HPV types that cause 70 percent of all cervical cancers. Importantly, women who have been vaccinated still need to be screened regularly.

Having advanced technologies, however, is not enough. Every woman and girl must be informed about and have access to these preventive methods. In January of this year, my organization, Tamika & Friends, Inc., along with several other leading advocacy groups, launched the U.S. Pearl of Wisdom Campaign to Prevent Cervical Cancer, a united, global effort to help ensure that women and girls everywhere know about and have access to lifesaving cervical cancer prevention tools. The campaign also promotes the Pearl of Wisdom as the global symbol for cervical cancer prevention.

I encourage women everywhere to educate themselves about how to prevent cervical cancer. And then spread the word to your mother, daughters, sisters, friends, and others. Please help make the elimination of cervical cancer part of Jade Goody’s lasting legacy.
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Felder is the founder of Tamika & Friends, Inc., a national nonprofit organization that raises awareness about cervical cancer, and a partner in the Pearl of Wisdom campaign to prevent cervical cancer (http://www.pearlofwisdom.us/).

Places Op-ed was Published:
The Seattle/Portland Skanner, WTTG, Kalamazoo Gazette, La Prensa San Diego, Newton Kansan, Delaware County Daily Times, Monitor Herald, Bandon Western World

This year is the 55th birthday of the birth control pill. It is also 44 years since the U.S. Supreme Court decriminalized birth control in Griswold v. Connecticut. Yet, debates over family planning and contraception are alive and widespread. Coloradans witnessed this first hand last fall when the "personhood" amendment that could have re-criminalized birth control in the state was defeated. Similar measures have already been introduced in seven other states so far this year.

However, current health policy discussions about the role of publicly funded preventive reproductive health care services demonstrate a great step forward in accepting that health care includes family planning. In fact, debates over the availability of affordable birth control, sex education and the financial wherewithal to acquire said resources, are moot without considering the critical role government can play to empower individuals to make responsible reproductive health decisions. This includes the support of publicly funded family planning programs like Title X and the Medicaid family planning waiver.

According to a recent report by the Guttmacher Institute, 2 million unintended pregnancies and 810,000 abortions nationwide are prevented annually by publicly funded family planning services. In Colorado, publicly funded family planning centers are estimated to have saved more than $69 million in 2004 alone and, in 2006, prevented 28,500 unintended pregnancies and 11,900 abortions. These numbers demonstrate the value of publicly funded, equitable resources that enable families of all socio-economic backgrounds to acquire the means for a secure livelihood.

Further, the current economic downturn puts a significant strain on state resources. For Colorado, where state taxpayer dollars cover prenatal, delivery, and infant-care expenses for an estimated 28,000 births every year, the Guttmacher report states an easy path to minimize health care expenditures covered by the state is to invest in preventive reproductive health care.

Last year, Gov. Bill Ritter signed into law a bill that removed a statutorily imposed income-eligibility cap for preventive family planning services provided through the state's Medicaid program. The law authorizes the Colorado Department of Health Care Policy and Financing (HCPF) to determine an appropriate income-eligibility limit indexed to the federal poverty level that demonstrates budget neutrality. HCPF must submit a waiver to the federal Centers for Medicare and Medicaid Services for this change to go into effect. If approved, the waiver will enable Coloradans who don't have health insurance and who otherwise would not qualify for full Medicaid benefits to be eligible for preventive reproductive health care services.

Colorado joined the ranks of more than 25 other states that are working to expand their publicly funded family planning programs to ensure affordable access to critical services that not only yield significant cost savings, but also have a tremendous impact on reducing unintended pregnancy, the need for abortion, and the spread of dangerous diseases.

Research verifies that $4 are saved for $1 invested in preventive reproductive health care services, from birth control counseling, distribution of contraceptive drugs and devices, and screenings for sexually transmitted infections. And Colorado pays just 10 cents of every $1 spent on these preventive family planning services, unlike other health care services covered by Medicaid.

As of 2008, 26 states had obtained federal approval to extend eligibility for Medicaid family planning services to individuals who would otherwise not be eligible; 20 states extend benefits under an income-eligibility formula similar to that pursued by Colorado. These states have demonstrated that expanded family planning services have dramatically reduced overall state and federal spending because of a decrease in Medicaid expenditures for prenatal, delivery, and infant care coverage.

More than 270,000 Colorado women and girls aged 13 to 44 needed publicly funded birth control services and supplies in 2006. This number will only rise as private insurance rates increase and Coloradans who have been laid off lose their health care benefits. Colorado already has taken steps to maximize the opportunities for savings, but given the current climate, we can and must do better.

By working in collaboration with medical experts, community-based organizations, and reproductive health care advocates, Colorado policymakers can develop common-sense strategies that ensure preventive family planning services are considered core health insurance benefits and essential components in comprehensive health care reform. As a result, Coloradans can realize both tremendous cost savings related to reproductive health care, and healthier families and communities.
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Ailts is executive director of Denver-based NARAL Pro-Choice Colorado.
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Copyright (C) 2009 by the American Forum. 3/09

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By Robyn Frost and Sue Heilman

The Patrick administration is seeking new and innovative ways to deal with the growing number of families experiencing homelessness in Massachusetts. Under a Housing First strategy, the governor is seeking to hold the state’s housing agency responsible for finding permanent, affordable housing for homeless families. We applaud the governor’s efforts to find permanent solutions to homelessness.

At the same time, however, Patrick is proposing changes that will limit homeless families’ access to emergency shelter and services. These restrictions should not be implemented as the recession deepens and more families than ever are in need of emergency shelter. Children, who constitute most of the people living as part of a homeless family, will suffer, resulting in long-term harm, at a high cost to society.

Unless supplemental funding to help families with children experiencing homelessness is quickly provided, many of these new limitations will take effect as soon as April 1.

Fortunately, the proposed restrictions are unnecessary to close the shelter program’s projected deficit. Under the new federal stimulus package for which the governor personally advocated, Massachusetts is eligible to receive more than $17 million this fiscal year and another $23 million next year in emergency TANF funds that are specifically intended to help the state meet the costs of serving more low-income families in need. The state and local communities will also receive over $44 million in stimulus funds to help prevent homelessness and to re-house families experiencing homelessness.

The challenges involved in ending homelessness are significant. The number of families in the state’s emergency shelter system has increased 40 percent in the past year alone, rising to an all time high of 2,695 families per night. Beyond the doors of shelter, tens of thousands more families and individuals are facing homelessness and are staying in “doubled up” situations with family or friends, or in unsafe conditions. These trends are reflected all around the country due to the national economic downturn.

Things were already bad before the current economic crisis hit. There has been growing income inequality in Massachusetts. Many low-income families did not benefit from the state’s economic recovery following the recession of 2001. Real hourly wages for the lowest-income workers saw an actual decline, and poverty in Massachusetts increased from 8.7 percent in 2001 to almost 10 percent in 2007.

Now, the worst economic crisis since the Great Depression is taking its toll. Unemployment is up, and foreclosures are rising. The result: more people than ever are reaching out for state-funded shelter and services at a time when the state revenue needed to pay for these services is declining.

Through the Massachusetts Interagency Council on Housing and Homelessness, the state is looking at ways to find permanent solutions to prevent and end homelessness. Helping families experiencing homelessness to secure affordable housing will allow families and their children to move out of shelters and save the state money over the long run.

This worthy goal cannot be reached, however, without an increase in permanent housing subsidies. Until those resources are developed, and effective homelessness prevention strategies are implemented statewide, shelters and other temporary supports will be necessary to help families affected by the recession. Protecting this safety net for families with children experiencing homelessness is a moral imperative in these difficult economic times. And thankfully, Congress is providing the state with the means to do so.
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Frost is executive director of The Massachusetts Coalition for the Homeless. Heilman is executive director of Horizons for Homeless Children.
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Copyright (C) 2009 by the Massachusetts Forum. 3/09

By Dianna King

There were sighs of relief from our elected officials when it became apparent that Ohio would receive Federal Stimulus Dollars. Much of this relief is because $5 billion of these dollars would be used to fill considerable holes in our state budget due to the current economy and poor decisions made in the past.

However, despite these additional dollars, the budget proposed by the governor does not do nearly enough to protect low-income Ohioans. It leaves in place the tax cuts approved in 2005 that primarily benefit the affluent and corporate Ohio, cuts that have contributed heavily to the lack of sufficient revenue in our general fund to adequately subsidize our current health and human services needs.

As welcome and needed as the stimulus dollars are, they do not provide sufficient revenue to restore the many cuts in health and human services programs experienced over the years. Even with the stimulus dollars, there are insufficient funds in this budget to prevent further cuts to critical programs such as senior community services, which provide meals, companionship and support services for our elderly, and the kinship care program which assists grandparents and others who are caring for young relatives in their own homes.

We remain unable to provide even minimal funding for adult protective services, which responds to elderly abuse reports, and continue to force those parents with earnings below 90 percent of the federal poverty limit to miss out on needed health care services. Our food pantries continue to have to beg for the means to feed the hungry.

There are other programs that cry out for additional dollars that would enable them to better respond to the daily needs of the less fortunate. This includes our free clinics, our federally qualified health centers, Ohio Works First and the senior assisted living PASSPORT Program.

The stimulus money gives the false illusion that Ohio’s tax system is not in need of fixing. It is entirely appropriate for the federal government to aid the states with the stimulus program; aid which will keep people working and services in place. However, according to the Strickland administration, the state will lose more than $2 billion a year in revenue when the 2005 tax overhaul is fully implemented in the next fiscal year. This is money the state cannot afford to lose on a long-term basis.

It is not that we do not know what to do, but that we choose not to do it. We could choose to reverse these tax cuts and restore them to their levels of 4 years ago, which would enable us to bring back much needed revenue. Then, along with the stimulus dollars, we could restore a real safety net across Ohio, allowing the money to benefit our needy.

The 21 percent reduction in the income tax and business tax changes coupled with the elimination of the corporate income tax were originally made with the belief that the dollars saved would be used to stimulate our economy and raise everyone’s standard of living. As we look around us today, we must admit that this plan has failed.

The rationale against reversing these tax cuts is that it is not politically expedient to increase taxes at this time. The reality is that the poor cannot continue to wait. Feeding the hungry, providing for the sick, and protecting our elderly, cannot wait for a better political climate. The time for change is now.

It is time to make hard decisions that can, and will, dramatically impact the lives of those in need in our community for the better. Until then, the numbers of those in need will continue to grow. We must admit that the actions of past administrations have failed, and that we need to take bold steps to restore the necessary level of funding for those programs which struggle today or have already fallen by the wayside.
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King is the chair of Advocates for Budget Legislation Equality.
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Copyright (C) 2009 by the Ohio Forum. 3/09

By Lauren Waits

The American Recovery & Reinvestment Act of 2009 was signed amid a flurry of speculation over its scope and impact. Questions persist about how Americans in general will benefit through federal stimulus spending for infrastructure and transportation projects, job creation and state budget stabilization. Little has been said, however, about the one population who could benefit the most from the package and provide a return to long-term growth: children.

We know that the early years are critical to a child’s healthy development. Neuroscientists can now show us that the quality of children's earliest experiences shape their brain architecture in permanent ways-for better and for worse. So when children, especially high risk children, receive care that is nurturing, supportive and based on their unique needs early on, we can put them on a course for success over their lifetimes. Key provisions of the stimulus bill contain investments designed to assure that infants, toddlers and preschoolers get what they need to thrive.

It's now up to us to make sure these available funds are deployed correctly for maximum impact and return on that investment. Our youngest children depend on three groups -- parents, businesses and the state – to claim their share of the stimulus funds and ensure their ability to contribute to a renewed nation as they grow.

Some money will flow directly to families through tax credits. Parents of very young children are often in the early stages of their own careers and earn significantly less than parents of older children. The families of approximately 540,000 children in Georgia will become newly eligible for sliding scale tax credits of up to $1,000 per child. These funds can help to put a more nutritious meal on the table, support the family in choosing a higher quality child care provider, or allow a parent to take a few hours off work for a child's visit to the doctor or dentist.

Also, communities and small businesses such as child care providers can apply for expanded Head Start and Early Head Start resources. The Act emphasizes Early Head Start, which assist both parents and children from birth up to age four by providing home visitation, health and developmental screenings and quality child care in a variety of settings. Expansions should be directed to the areas of most intense need in Georgia, and Bright from the Start (Georgia’s Department of Early Care and Learning) is well-positioned to identify vulnerable populations of young children. With Head Start providers already in place from Alapaha to Willacoochee, Georgia has a sound framework for expansion.

The state itself is the third entity that needs to channel stimulus funds to programs supporting young children. Governor Sonny Perdue and School Superintendent Kathy Cox can direct some of Georgia's $1.28 billion in fiscal stabilization funds to school modernization, renovation or repair. Many school systems have waiting lists for Georgia PreK because they lack the physical space. Schools seeking to serve more four-year-olds in PreK should receive favorable consideration as projects are approved. The flexibility in additional education funding provided through the Act should also allow Governor Perdue to restore his proposed $30 million cut to the school nurse program. Georgia will also receive stimulus funds for special education through IDEA grants, with a portion set aside specifically for infants and toddlers.

As an added measure, the stimulus will provide Georgia with $82.8 million to subsidize child care for low income working families. Georgia's child care subsidy program has never been able to serve all the families who are eligible. These new dollars can help eliminate waiting lists for services and expand the eligibility level so more parents can be assured of safe, healthy environments for their children while they go to work.

We all know this massive spending increase will need to be paid back at some point by future generations; essentially today's young people. Done right, the investments we make today on our youngest people can serve as a sizeable down payment on that debt and we'll be putting them in a much better position to capitalize upon it down the road.
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Waits is policy director for Voices for Georgia’s Children.
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Copyright (C) 2009 by the Georgia Forum. 3/09

By now we are used to the grim economic news that fills our newspapers and airwaves on a daily basis. What people are interested in is a plan to move forward toward economic recovery. On this question, however, two very different conversations are unfolding.

In Washington, the conversation is about how to get our national economy moving again, how to create jobs, save homes, provide health care, and help people get back on their feet. At the center of these questions is the role of government. In tough times, what can government do for people that people cannot otherwise do on their own?

In St. Paul, Governor Pawlenty has shaped the debate squarely on cuts, cuts, and more cuts. He has focused on tax cuts for corporations as well as deep cuts to essential public services that Minnesotans need now more than ever due to job losses and home foreclosures. Cutting the jobs of public employees who provide the vital services we all depend on and who are themselves essential to our economic and social well-being.

At his inauguration, President Obama said that the question we should ask “is not whether our government is too big or too small, but whether it works.” So why is the debate here in Minnesota about how best to shrink government, as though small government were the solution to an economic crisis of this depth?

The Minnesota State Constitution mandates that the state budget be balanced by June 30. While this provision is bad public policy (nearly all economists agree that measured deficit spending is prudent in tough economic times), our budget will be balanced by either difficult legislative compromise or gubernatorial fiat (also known as unallotment). But a debate only about how to balance the books, with the needs of one neighbor pitted against the other, misses the point entirely. In this economic climate, Minnesotans expect more from state leaders than “balancing the budget” and “ending on time.”

People are concerned about how the economy impacts their own bottom line – not just the state ledger. State leaders should be debating how our budget will restore economic security, fairness and opportunity for all Minnesota families. That means jobs, access to health care and the ability for families to remain in their homes. That's really what Minnesotans are asking for. And that's what we expect the Governor and legislature to figure out through whatever mix of revenue increases and program restructuring are necessary.

Our state history shows us how state leaders are instrumental for economic recovery. In the early 1930s, our economic outlook was much more dire than today. Governor Floyd B. Olson’s response was to create the state’s progressive income tax structure, institute a minimum wage, propose a statewide unemployment insurance system, and direct significant state funds to public works programs. He used the resources of the state to address the immediate crisis of its residents and put in place a sustainable path for economic recovery.

Governor Olson did not achieve such transformational change on his own. He was the state’s first Farmer-Labor governor, and as such was accountable to a base of people who created the political space for bold change to happen.

Making government disappear isn’t going to help our state. We are economically and morally obligated to get people back on their feet and to provide a sustainable path for economic recovery for future generations. To that end, a different conversation is needed up at the Capitol. I hope the governor and state leaders are ready to talk.
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McGrath is the executive director of TakeAction Minnesota.
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Copyright © 2009 by the Minnesota Editorial Forum. 3/09

Places Op-ed was Published:

Bemidji Pioneer, Crookston Daily Times, St. Cloud Times

By Gloria Tristani

While the number of radio stations is growing, ownership is concentrated in fewer and fewer hands due to widespread media consolidation. This means today's radio often offers national playlists, syndicated programming and other piped-in content that threatens localism and the diversity of voices on the public airwaves.

When I was a member of the Federal Communications Commission (FCC), we established low power radio service in 2000 as a partial antidote to the negative effects of consolidation.

Low power radio (LPFM) makes new licenses available for nonprofit community organizations, churches, schools and local governments.

Low power radio informs people about what is going on in their neighborhood or town; features local musicians and unique programming that reflects the local culture; and breaks from the same homogenized content that have pushed radio listeners away.

When LPFM was created, it was intended to reach across the whole country from rural areas, to towns and cities; only excluding the most congested urban markets like New York and Los Angeles. These ambitions were halted when Congress placed unfair restrictions on the service due to existing broadcasters' exaggerated charges of interference. Congress directed the FCC to commission a study to investigate these claims.

In 2003, MITRE, a not-for-profit engineering and consulting firm, concluded its report and found, as the FCC had from the beginning, that this service would not cause harmful interference to existing radio stations. There are currently 800 existing LPFMs, but there is space for hundreds, potentially thousands more if Congress acts to remove the unnecessary restrictions placed on this service.

There are wonderful examples of LPFM in rural areas, playing an important part in bringing communities together. Clay, West Virginia is an Appalachian coal town just north of Charleston and is home to one of the only local radio stations in Clay County. WYAP-LP is run by a handful of dedicated volunteers and the programming ranges from bluegrass music, to coverage of local sports games -- and on Friday they only play West Virginia artists, giving a boost to many old-time musicians throughout the area.

WQRZ-LP in Bay St. Louis, Mississippi brought national attention to the life-saving potential of LPFM when station manager Bryce Phillips waded through Katrina's flood water with a battery-pack strapped to his back in order to keep the station on air-broadcasting important emergency information-in the face of the deadly storm.

In the fields of Southwest Florida, the Coalition of Immokalee Workers immigrant farmworkers who pick tomatoes for the largest fast-food companies and suppliers in the country, have carved out their slice of the airwaves with Radio Conciencia. WCIW-LP, carries programming in Spanish, Haitian Creole, and a number of indigenous Mayan languages spoken by the workers who are currently battling against sub-poverty wages and in extreme cases, modern-day slavery in Florida's tomato fields.

With the repeal of Congressional restrictions on LPFM, there could be more stations like WYAP, WQRZ, or WCIW not only in rural but also in suburban and urban America.

Low power radio promotes localism and diversity, not by limiting the rights of existing voices, but by adding new voices to the mix. Congress must enhance the statutory obligation to "encourage the larger and more effective use of radio in the public interest" by allowing this service to expand.

Bipartisan members of Congress have recently introduced a proposal to do so. President Obama’s past support of similar legislation; and his pledge to encourage diversity in the ownership of broadcast media and to promote the development of new media outlets for expression of diverse viewpoints
demonstrate his commitment to expanding low power radio.

Moreover, the issue of expanding low power radio is ultimately a popular demand from community and civil rights groups, churches, schools, immigrants and average citizens. When I served as FCC Commissioner, we received scores of calls and letters from people across the country who wanted to use the public airwaves to reach out to their communities or who wanted to hear more diversity and local content that reflects their community. These people's voices have been ignored for far too long. It's time we hear these voices. We can do so by expanding low power radio.
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Tristani is a former FCC Commissioner.
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Copyright (C) 2009 by the American Forum. 3/09

By Yifat Susskind

If you haven’t thought about the Iraq War as a story of U.S. allies systematically torturing and executing women, you’re not alone. Likewise, if you were under the impression that Iraqi women were somehow better off under their new, U.S.-sponsored government.

In the spring of 2003, Fatin was a student of architecture at Baghdad University. Her days were filled with classes and hanging out in her favorite of Baghdad’s many cafes, where she and her friends studied, shared music, and spun big plans for successful careers, happy marriages, and eventually, kids.

Today, Fatin says that those feel like someone else’s dreams.

Soon after the U.S. invasion, Fatin began seeing groups of bearded young Iraqi men patrolling the streets of Baghdad. They were looking for women like her, who wore modern clothes or were heading to professional jobs. The men screamed terrible insults at the women and sometimes beat them.

By the fall, ordinary aspects of Fatin’s life had become punishable by death. The “misery gangs,” as Fatin calls them, were routinely killing women for wearing pants, appearing in public without a headscarf, or shaking hands and socializing with men.

As the occupying power, the U.S. was legally obligated to stop these attacks. But the Pentagon, preoccupied with battling the Iraqi insurgency, simply ignored the militias’ reign of terror.

In fact, some of the most treacherous armed groups belonged to the very political parties that the US had brought to power. By 2005, the Pentagon was giving weapons, money and military training to these Shiite militias, in the hope that they would help combat the Sunni-led insurgency.

Fatin’s closest encounter with the militias occurred when armed men burst into her university classroom one morning, threatening to kill any female student without a head scarf. After that, young women dropped out in droves. The next semester, Fatin’s parents refused to allow her to re-enroll.

While the Pentagon was arming militias bent on brutally ousting Iraqi women from public life, the U.S. State Department was busy brokering the new Iraqi Constitution. Hailed as “progressive” and “democratic” in Washington, the new Constitution designates religious law, which discriminates against women, as the basis of all legislation. It also restricts women’s rights by upending one of the most progressive family status laws in the Middle East -- a law that Iraqi women fought for and won in 1959, before Saddam Hussein took power.

For Fatin, the bitter irony is that her new Constitution, courtesy of the USA, destroyed women’s rights that were once guaranteed in Iraq, even under the brutal regime of Saddam Hussein.

Fatin has now been out of school and unemployed for more than three years. Her mother, a pharmacist, and her aunt, trained as a veterinarian, have also been unemployed for years now and are too afraid to try to find work.

Here in the U.S., we’ve rarely heard the story of the Iraq War told from the perspective of women. So what are Iraqi women saying on the sixth anniversary of the US invasion? The same thing they’ve been saying since 2003: end the occupation. Polls consistently show that a majority of Iraqis want US troops out.

We’ve been told that if the U.S. withdraws, violence would again soar in Iraq. That’s a compelling argument for those of us who care about the suffering that the U.S. has already visited on Iraqi women and their families. But Iraqis themselves, who have the best grasp of their security situation, say that U.S. troops are causing, not confronting, violence. In multiple polls, most Iraqis say they would feel much safer without U.S. troops.

Who can blame them? Since the invasion, over a million Iraqis have died violently and four million have been driven from their homes. The resources that women need to care for their families -- electricity, water, food, fuel, and medical care -- have become dangerously scarce, sometimes totally unavailable.

This week marks six years since the U.S. invaded Iraq. In that time, women have not only faced with mounting violence -- they have also organized a movement to confront US occupation and violence against women.

Looking for a way to speak out against the repression she witnessed, Fatin joined the Organization of Women’s Freedom in Iraq (OWFI). In partnership with MADRE, an international women’s human rights organization based in New York, OWFI has worked to promote women’s human rights, creating a network of women’s shelters to protect women fleeing violence.

The women of Iraq are creating the foundation on which a peaceful and just future will be built. It’s time we started listening to them.
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Susskind is the communications director of MADRE: Rights, Resources and Results for Women Worldwide.
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Copyright © 2009 by the American Forum. 3/09

By Atiba Madyun

When President Barack Obama was sworn in as the 44th President of the United States of America he inherited a global economic crisis and two wars. Yet, one of the most important policy issues that the president will have to address is -- the return of our military veterans.

During his campaign, President Obama spoke of his opposition to the war in Iraq, and the importance of reallocating resources to Afghanistan. Managing those resources will be difficult, but developing a plan to support hundreds of thousands of American servicemen and women will be just as difficult.

Since 2001, America has sent more than 1.5 million troops into Afghanistan and Iraq. The daily process of carrying out military operations, staying alive, staying connected to loved ones, is stressful both to the troops and to their families. Over the past six years, thousands of military veterans have returned from Iraq and Afghanistan. Sadly, 4,000 have returned in coffins, and tens of thousands returned with injuries and scars (mental and physical) that will affect them for the rest of their lives. Their return in the midst of high unemployment, foreclosures, and instability in financial markets will factor greatly into their re-entry to civilian life.

The affects of war can be mentally debilitating, and what we don’t hear or discuss enough is the accounts of men and women who return home seemingly normal, but in fact unknowingly have severe mental effects resulting from their tours of duty. These individuals carry with them the memories of constant explosions, lost comrades and comrades left behind to fight -- memories that can trigger severe mood swings, bouts of depression, and even memory loss.

The Depression and Bipolar Support Alliance (DBSA), which regularly partners with the Veterans Administration, reports that more than 35 percent of Afghanistan and Iraq veterans treated at the Veterans Administration have been diagnosed with some type of mental disorder. This number does not take into account those individuals who have not sought care.

Undetected, post traumatic stress syndrome will greatly affect the lives of these returning veterans, and their families. For these reasons, the mental health of our veterans must be one of the highest priorities for the Obama administration. It’s important that not only our returning troops receive treatment but also their families who for months at a time have been without their loved ones and upon their return must adapt to having them back in their lives on a daily basis.

When we look at the challenges of returning servicemen who served in Vietnam, we find that more than 30 years later many are still struggling to assimilate. Their return coincided with an increase in homelessness, unemployment, drug and alcohol addiction. We now understand that their experiences may have impacted these numbers. The post-Vietnam experience provides us with a vivid understanding of what happens when we don’t prepare to welcome and return our military veterans into civilian life.

This is why it is important that our policymakers and elected officials look at ways to assist our troops and their families with employment, education, training, and access to quality healthcare to facilitate their transition back to civilian life. Some areas they should look strongly at include establishing and strengthening programs that will:

• Address and eliminate socioeconomic factors to barriers in care for returning American service men and women;

• Increase mental health funding for returning troops through Medicare and Medicaid;

• Increase funding for education training, colleges and universities for American servicemen and women;

• Increase funding for families of returning servicemen and women to seek mental health counseling; and

• Ensure that disability benefits are available to military veterans and their families.

Whether we opposed or were in favor of the wars, it should not affect the way we treat our veterans. They will have to grapple with: finding employment, foreclosures, and assimilating back into family life. These struggles alone will be frustrating for those who constantly lived under the stress of war. Not having the adequate support for our troops, and their families, will affect all of us. Just as it has been the responsibility of the troops to serve in our military, it is now the responsibility of each American to protect and support our veterans as they return. It should be a priority to alleviate challenges that may prevent them from making the adjustment from chaos of war to the normalcy of civilian life.
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Madyun is division director for National Black Caucus of State Legislators and the Managing Editor for the Legislator.
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Copyright (C) 2009 by the American Forum. 3/09

By Anne Harper

Like most parents of girls, I have had the good fortune to have pretty well-behaved daughters who finished high school and entered promising career paths. But some families are not so lucky.

Their teens may be struggling with a host of problems from learning disabilities to drug dependency. Recently we have discovered some more extreme problems: as many as 300 girls are sexually exploited commercially in Georgia each month --at escort services, hotels, online and on the streets -- according to recent results of an independent tracking study. That is more than twice the number of girls who die in car accidents in a year in our state.

The Juvenile Justice Fund (JJF) has mounted a campaign called “A Future. Not a Past” to address this sexual exploitation -- seeking to demonstrate that adolescents who are sucked into prostitution are victims of adult criminal behavior, rather than criminals themselves. Georgia is considering two proposals to expand the definition of child abuse to include sexual exploitation of children by others than parents and care givers. This change will enable health professionals and other adults report to authorities any suspected prostitution of minors, thus providing a good start toward identifying girls who need protective services.

But funding those services in the current economy is a challenge. One of the proposals identifies an innovative source of revenue that will not add a penny to the state budget. The proposal includes a $5 fee on patrons of adult-entertainment venues, fees that would go to a Crime Victims Emergency Fund for restorative programs for sexually exploited minors. The rationale for this fee comes from a 2005 report published by the Atlanta Women’s Agenda which found a spatial correlation between adult strip clubs and the availability of children for hire for sex. Another study commissioned by the JJF verified these findings.

Naturally the proposal faces some opposition -- but from an odd quarter. Some Republicans have complained that this fee is a tax and, as loyal Republicans, they oppose all new taxes. Kaffie McCullough, the JJF campaign director, comments, “This will not cost the taxpayers a cent. There are 45 adult clubs in Georgia and we estimate that if each one has 100 patrons a day, this fee will raise about $8.2 million.”

While holding the adult entertainment industry responsible for the secondary effects of their services is somewhat controversial, “A Future. Not a Past” campaign advocates are determined to create a dialogue among a broad swath of business, civic and religious leaders about measures to end child prostitution, particularly focusing public attention on curbing the male demand for sex from younger victims.

The faith-based communities have stepped up their support by founding a religious coalition called StreetGRACE to link and maximize their resources across communities that are trying to meet the needs of these young teens. Parents, grandparents, aunts, uncles, and many other friends of children who want to end the sexual exploitation of adolescent children delivered 300 white roses to legislators last week, symbolizing the number of girls affected.

We must speak out now to help the many adolescent girls in our communities who have been forced into prostitution by adults seeking to take advantage of teenagers’ youthful confusion and financial vulnerability. Certainly the adult entertainment club fees are a smart first step to raise the funds to help address the prostitution of young women so that they are routed to treatment and re-started on the road to a future, not a past.
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Harper is a former school board member who leads a management consulting practice. For more information please visit

http://www.afuturenotapast.org/.
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Copyright (C) 2009 by the Georgia Editorial Forum. 3/09

By Rebecca Lightsey

As more businesses close and unemployment lines lengthen, a virtually unregulated sector of the Texas economy continues to rake in huge profits by providing high-cost payday and auto title loan services that often drag desperate families deeper into financial crisis.

A Texas-based provider of such loans recently reported record-breaking annual revenues topping $1 billion and a net income of $81 million.

So how do small-dollar loan companies make this kind of profit in the middle of the nation’s worst economic crisis since the Great Depression?

In Texas, the answer is clear: they exploit a loophole in state law that allows them to operate as unregulated “credit services organizations” (CSOs).

In 2005, there were fewer than 100 CSOs in Texas. Today, nearly 400 payday, auto title, and other lenders operate more than 2,000 CSO storefronts offering high cost small loans across the state. CSOs in Texas were originally established to control credit repair businesses; however, in the past few years, small dollar lenders are operating as CSOs under a statutory loophole that allows them to obtain “an extension of consumer credit” for borrowers.

Unlike other lenders in Texas, CSOs are not subject to any limitation on the fees they can charge. CSOs routinely offer loans with costs exceeding 500 percent Annual Percentage Rate (APR) -- making these loans among the most costly in the country.

At the same time, CSOs also are able to sidestep licensing and enforcement by the state’s Office of Consumer Credit Commissioner, which holds other Texas consumer lenders accountable.

Borrowers stung by these CSO loan deals, with high fees and onerous terms, find it almost impossible to escape a widening sinkhole of debt.

One Austin woman recently reported taking out two payday loans totaling $1,800 from registered CSOs. Because she is not allowed to pay down the principal without paying the loan in full, she must pay over $400 every two weeks to renew the loans. Despite taking a second job and already paying $600 to retire the first $1,000 loan, she still owes $1,200 on it, and the second loan, still unpaid is racking up its own renewal fees.

Texans take out an estimated $2.5 billion in loans through CSO payday lenders each year and pay an additional $500-$600 million in annual fees.

Low-income Texans, primarily working women and minorities, disproportionately use payday loans. According to a recent Texas Appleseed survey of low-income payday borrowers, 58 percent of those borrowers could not pay off their loan, plus fees and interest, by the next payday.

Financial regulators in Florida and Michigan recognized this CSO scheme as an evasion of existing laws against predatory lending, and some CSOs, still operating in Texas, closed up shop in those states.

Congress imposed a 36 percent APR rate cap in 2007 on all payday and other short-term loans to the military, and 15 states and the District of Columbia have a similar provision in place for all residents. Already, some Texas cities -- including San Antonio, Richardson and Mesquite -- have passed ordinances restricting the rapid growth of CSOs within their city limits.

Now, it is time for state lawmakers to protect Texas consumers and hold CSOs accountable to the same regulatory standards that apply to mainstream lenders. Texas has a long-held tradition of opposing usury --lending money with excessive interest rates and fees -- and CSOs should not operate as the exception to the rule.
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Lightsey is executive director of Texas Appleseed, a nonprofit public interest law center.
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Copyright (C) 2009 by the Texas Lone Star Forum. 3/09