Monday, November 23, 2009

No Turkey and Gravy for All


By Sarah Beth Gehl

As families gather for Thanksgiving this week, we should consider that in just a decade Georgia has deteriorated from average (ranking 22nd) to 4th highest for food insecurity in the nation.

One in seven Georgia households experienced food insecurity during 2006-2008, according to a recently released report by the USDA. The share of Georgia households lacking resources for adequate meals rose from 10.9 percent during 1996-1998 to 14.2 percent during 2006-2008.

These sobering numbers highlight the importance of focusing solutions on combating hunger and poverty in our communities.

How do we do this? Communities across the state are providing support to hungry families through local food banks and pantries to address just this issue. In metro Atlanta, for example, the Atlanta Community Food Bank has distributed 24 percent more pounds of food through October of this year compared to the same period last year to meet the growing need.

Beyond local responses and resources, another important tool is public policy. By thoughtful budgeting and policymaking, the state government and local advocates have a powerful opportunity to reduce the number of Georgians experiencing food insecurity.

For example, expanding participation rates within the federally funded nutrition programs, especially among the unemployed, should be a top priority. Food stamps, school lunches and breakfasts, and summer programs will reach more than one million Georgians this year, providing critical resources for nutritious meals. Additional benefits are available through the federal stimulus package passed by Congress and signed by President Obama in February, increasing food stamp benefits by 13.6 percent and sending more than $650 million to Georgia tables over the next five years.

However, many more families remain eligible for federal nutrition assistance but are not enrolled. Participation levels in federal food aid programs in Georgia range from only 11 percent to 68 percent, and hit children worst of all — the very people who need adequate nutrition in order to develop their brains and bodies, and the ones least able to advocate for themselves.

The state needs skilled staff to reach and qualify residents who can benefit from the millions of untapped dollars in federal nutrition assistance available to Georgians. Although the federal stimulus package includes funds for state food stamp eligibility workers, lawmakers have chosen to furlough already-stretched eligibility workers to address the daunting loss of state revenues.

Moreover, the Georgia Department of Human Services plans to lay off 733 federal benefit eligibility workers in the coming year if the governor requires an additional 3 percent cut in services, as he states in his contingency plan. As stimulus funds expire next year, programs serving the elderly such as the Meals on Wheels will also be in danger.

At a time when more families are struggling with hunger and food pantries are stressed to the limit, we must all ensure public efforts are not diminished. Donations to food pantries are an essential ingredient, but they must be combined with thoughtful public policy and budgeting. Georgia has made great strides in reducing hunger in the past — we must do so again.
Gehl is deputy director of the Georgia Budget and Policy Institute, an independent, nonpartisan organization engaged in research and education about Georgia’s fiscal health. To find county-by-county estimates of food insecurity, download the Institute’s report Reaching Georgia’s Tables at
Copyright (C) 2009 by the Georgia Forum. 11/09

By Peter Enrich

Our local and state governments provide many of the vital public structures that build strong communities and ensure opportunity for us and our children such as schools, transportation, public safety, parks, and health and social services.

Yet, the tax structures that enable us to pay the price for a civilized society suffer from two severe flaws. First, state and local taxes are exceedingly volatile, dropping calamitously during economic downturns, when the revenues are most badly needed. State and local governments, unlike the federal government, can only spend what they take in.

Second, unlike the federal income tax, state and local taxes are regressive: households with lower incomes pay a higher share of their incomes for the support of state and local government than do their wealthier neighbors. This regressivity is largely due to heavy reliance on sales taxes; even with exemptions for groceries and other necessities, lower income households spend far more of their incomes on taxable items than do higher income families. A recent study showed that low-income Massachusetts households spent 5.4 percent of their incomes on sales taxes, compared to 1.2 percent for wealthy households.

While we depend on and demand the services of state and local governments, we resist the reforms that would provide a healthy tax system. So, we find the state cutting essential services and turning to gambling, sin taxes, and gimmicks to try to pay its bills.

Instead, there are three directions in which Massachusetts should look to improve our ability to pay fairly and adequately for the service we all need:

• Follow the federal example and rely more heavily on income taxes, especially income taxes designed to require those with greater means to contribute a greater share to the common good. Even here in Massachusetts, where the constitution forbids graduated rates, personal exemptions and differential rates on investment income can build substantial progressivity into an income tax system. And small rate increases can yield impressive new revenues.

• Broaden the scope of our sales taxes to reach, not only sales of goods, but also a wider range of sales of services, such as club memberships, entertainment, personal and property care, and professional services. Many states presently tax some services, but often only a handful. Massachusetts only taxes 18 of the 168 services identified by the Federation of Tax Administrators and is the only state taxing none of 40 household service categories identified by the Center on Budget and Policy Priorities. Extending the tax to more services reduces an irrational inconsistency in the current sales tax, dramatically increases the tax’s revenue yield at a time when a growing share of household spending is on services, and diminishes both the regressivity and the volatility of the sales tax.

• Increase the share of taxes that are collected from businesses, rather than families. By one measure, businesses paid half of all state and local taxes in the 1950s, but only a quarter by the 1990s, and probably substantially less than that at present. By ending some of the tax incentives that have been shown to be ineffective in guiding business location decisions, closing the loopholes that have encouraged increasingly sophisticated corporate tax “management,” and reversing some of the rate cuts granted to businesses during better times, the state could go a long way to providing needed revenues while restoring the historical balance between taxes on individuals and businesses.

Each of these steps will demand courage on the part of political leaders and education of citizens about the workings of the tax system. Most importantly, they will require a revived recognition by all of us that taxes are an investment in, not an obstacle to, our shared future prosperity.
Enrich is a professor at Northeastern University School of Law, specializing in issues of state and local governance and finance, and a former general counsel to the state’s Executive Office for Administration and Finance under both Gov. Dukakis and Gov. Weld.
Copyright (C) 2009 by the Massachusetts Forum. 11/09

Friday, November 20, 2009

Keep Religion Out of Health Care Reform

By M. Patricia West, MSSW

Elected officials' religious views should be their own private affair, neither imposed by them upon the nation, nor imposed by the nation as condition to holding public office. This means their private religious views should not be imposed via the current debate over health care reform.

Important life decisions are responsibilities of individuals and families, not of government or religious groups. On that, most of us can agree. There is also a strong history of separation of church and state in America, and one of our founding principles is of freedom from religious intolerance. That's why I was deeply offended when Roman Catholic Church bishops lobbied Congress on health care reform in order to deny millions of women access to abortion.

As an American I am proud of our constitutionally guaranteed right to worship or not as one sees fit, and of our prohibition of government-imposed state religion. But what started out to be about health care for all has morphed into a referendum and debate on abortion unduly influenced by the church. Health care legislation passed by the House of Representatives compromises our personal choices and subverts the principle of abortion neutrality.

The Stupak-Pitts amendment potentially goes farther than any other federal law to restrict a woman's access to abortion. By prohibiting women who receive partial federal subsidies from buying insurance plans that cover abortion, the Stupak amendment bans abortion coverage by any insurer participating in the health exchange. The amendment favors one religious view of abortion and enlists the federal government as enforcer. As such, it is an egregious assault on the rights of women and an enormous step backward for those who believe in separation of church and state.

President Obama has said, "If you're happy and satisfied with the insurance that you have, it's not going to change." But this House proposal potentially reduces health care coverage for the more than 80 percent of typical employer-based insurance plans that now cover abortion.

Women supposedly will be able to obtain abortion coverage by purchasing a separate, single-service "rider." However, according to the National Women's Law Center, in the five states that currently require a separate rider for abortion coverage, there is no evidence that plans offer such riders. Furthermore, women are unlikely to buy a rider to cover abortion, because they do not plan for unplanned pregnancy or one that is needed for medical or health reasons.

A number of national polls have shown that Americans strongly believe health insurance should include complete women's reproductive health services and that women have a full range of choices offered. A recent poll commissioned by Moving Forward, a values-based research initiative developed by the Women Donors Network and the Communications Consortium, found that a majority, 56 percent, believe those receiving subsidies should be able to purchase a health insurance plan that covers abortion. The House proposal does not reflect that view.

Meaningful reform has the potential to bring health care to more American women and their families than ever before. But Congress should not be in the business of restricting choices for women, particularly for religious reasons. As presidential candidate, John F. Kennedy said, "I believe in an America where the separation of church and state is absolute ... where no public official either requests or accepts instructions on public policy from the pope, the National Council of Churches or any other ecclesiastical source -- where no religious body seeks to impose its will directly or indirectly upon the general populace or the public acts of its officials ..."

Instead of kowtowing to Catholic bishops, Congress should stand up for what the majority of Americans want in health care reform -- and they want choices, not limitations.
West is a public health consultant who lives in Philadelphia. She is a member of the Women Donors Network and involved with their Moving Forward initiative.
Copyright (C) 2009 by the American Forum. 11/09

By Robin Baker

The excise tax on so-called “Cadillac” plans is a central feature of the Senate Finance Committee's health proposal. Most often, Cadillac plans are described as the "overly generous" or "gold-plated" plans offered to Wall Street types.

In theory, levying a tax on these gold-plated plans will encourage lower spending and help slow the growth rate of health insurance and health care costs.

In addition, the revenue generated from the tax on insurers would provide a significant source of funding for subsidies to help families with low to moderate incomes afford health insurance. The Congressional Budget Office (CBO) estimates revenues will be about $5 billion in 2013 and increase to $53 billion by 2019.

At the outset, most Americans would not be affected by the tax, but that could change over time.

The Senate Finance Committee's proposal would impose an excise tax on employer-sponsored insurance beginning in 2013 for plans with costs above $8,000 for an individual and $21,000 for a family. In Colorado, the average annual premium cost in 2008 for an individual was $4,900 and $11,952 for a family.

It seems like a reasonable plan, but like so many other pieces of health care, it's complicated.

A brief by Milliman Inc., the world's largest independent actuarial and consulting firm, notes that high-cost plans have as much to do with the beneficiary's geographic location, profession, age, gender and health status as with the richness of benefits.

Milliman uses the example that a typical employer-sponsored plan for a family of four in Miami in 2009 is $20,282. In comparison, the cost of plan for a similar family in Phoenix is less than $15,000. Given that the medical costs have grown between 7 percent and 10 percent over the last few years, it is possible that benefits in some geographic areas could exceed the tax trigger by 2013.

Those in high-risk professions, such as firefighters and coal miners, have higher utilization costs and would easily be subjected to the excise tax. A new provision, however, would increase the allowable benefit amount to $9,850 for an individual and $26,000 for a family.

Age and gender also make a difference in the cost of premiums. Milliman notes that the national average per-member, per-month cost for a 30-year-old male is $155 per month – less than $2,000 per year. But the cost for a 60-year-old female is $717 per month, or $8,604 annually, which exceeds the tax threshold.

Age is a significant factor, especially with the percentage of workers 55 and older increasing and remaining in the labor force longer. It is estimated that 93 percent of the growth in the labor force from 2006 to 2016 will be among workers ages 55 and older.

As people age, health care premiums increase and it is possible that those that did not exceed the threshold in 2013 may be taxed in the future. The cost of plans could become a problem for employers with an older workforce.

In 2014, the taxable amount would increase by inflation as measured by the Consumer Price Index for Urban Consumers (CPI-U). The problem is that heath care inflation has grown at a faster pace than general or consumer inflation for more than a decade. In 2008, CPI-U actually decreased 1.5 percent while health care costs increased 7.4 percent -- the lowest increase in five years.

Because health insurance premiums will outpace the tax threshold, more plans will be subject to the excise tax over time.

The Milliman report argues that the dramatic increase in the CBO's estimates of the tax revenue in a six-year period – from $5 billion in 2013 to $53 billion in 2019 – suggests that the excise tax will "dip substantially further into the mainstream of health plans."

This isn't necessarily bad. The existence of a ceiling will likely encourage insurers to create products that are under the cap. Insurers though may look to create a plan that does not exceed the threshold but instead increases co-pays, co-insurance or deductibles based on minimum benefit levels. How benefits are put together and the ratio of benefit value to the total cost (actuarial value) is something to watch.

In the end, we must ask if we have a societal responsibility to protect the health and well-being of our fellow citizens – this includes making health care accessible and affordable for all. To do this we need to cover the cost. There may be other ways, but an excise tax on insurers offering high-cost plans can provide a significant source of funding for subsidies.
Baker, is a senior policy analyst and director of the health project at the Bell Policy Center, a nonprofit, nonpartisan policy research center.
Copyright (C) 2009 by the Colorado Editorial Forum. 11/09

By Amy Hinton and Lamar Davis

On November 5 a shooting spree at the Fort Hood Soldier Processing Center in Killeen, Texas left 13 soldiers dead and another 29 wounded. Subsequently, the shocking revelation that the alleged perpetrator was an active duty Army psychiatrist seemed to defy belief.

The recent actions attributed to Major Nidal Hasan have been subject to intense media coverage. Few, however, have questioned how such a deeply troubled individual could avoid detection while working in the very mental health system that was intended to be the safety net for our returning troops.

A 2008 RAND Center for Military Health Policy research study reported two significant challenges that face the military mental health system. First, the mental health system has difficulty responding to the treatment needs of soldiers in a timely manner. This is likely due to the intense and pervasive stigma about mental illness that often prevents people from seeking mental health treatment, particularly in the military. Second, the limited availability of mental health resources – services, providers and dedicated funding -- essentially determines access to and quality of treatment. Arguably, the most serious deficiency driving these challenges is the grossly inadequate number of qualified, credentialed mental health professionals available to meet the current demand.

A recent New York Times article noted the U.S. Army currently employs just 408 military, civilian and contract psychiatrists to provide critical mental health treatment to the approximately 553,000 active-duty troops stationed around the world. The astonishing patient caseloads – some providers routinely see as many as 10 seriously mentally ill soldiers in an eight-hour workday – should give serious pause to every American. In a recent CNN interview, Army Chief of Staff General George W. Casey Jr. noted the Army, like most other military and civilian mental health service providers, has ongoing difficulties hiring sufficient numbers of treatment professionals from such a limited labor pool.

The shortage has far reaching implications. To date, approximately 34,000 soldiers have already been diagnosed with post-traumatic stress disorder (PTSD), a serious anxiety disorder requiring early identification and immediate treatment. RAND reports that 18.5 percent of active duty troops returning from Iraq and Afghanistan have PTSD and that the estimated 50 percent of active duty service members who report seeking treatment for PTSD receive “less than adequate” care. These numbers represent only active duty military personnel. More than 255,000 National Guard troops and approximately 202,000 Reservists have been deployed to Iraq and Afghanistan since 2001, but are not included in these estimates.

Upon their return, many will suffer debilitating physical injuries or traumatic brain injury, as well as a host of related disorders that often result in profound, protracted psychological distress. These will need timely diagnosis, intensive treatment and access to the most appropriate medications. Presumably, they also will need ongoing mental health treatment.

But who will serve such a large population? And, perhaps more importantly, what is the potential impact on the existing military mental health system from such a large influx of troops? Who bears responsibility for ensuring the mental health of the mental health treatment providers? Who counsels the counselors and provides therapy to the therapists? Are we comfortable assuming military mental health providers will seek their own needed treatment as the demands of their work escalate? How can such an understaffed and overwhelmed system ensure an appropriate and coordinated response to mental health crises among their own treatment providers?

As the Fort Hood investigations continue, alleviating the critical shortage of qualified, credentialed mental health professionals in both military and civilian settings – must be elevated to the top of President Obama’s domestic health policy agenda. We need deliberative, proactive solutions to address shortages of qualified mental health personnel. We must also ensure widespread availability of mental health resources for treatment providers and determine the extent to which traditional military values and culture may stigmatize mental illness and discourage troops from seeking needed treatment.

These issues have yet to be fully explored with the intensity they deserve. If the extreme nature of the Fort Hood tragedy fails to generate the necessary political will to direct the time and attention to military mental health policy that is clearly needed, the entire nation must be willing to accept collective responsibility for the consequences.

By Liz Forrestal and Caroline Ishida

We are gratified that Gov. Jay Nixon has returned Mark Templeton to his job as Director of the Missouri Department of Natural Resources (DNR). Templeton was an unfortunate victim of the recent controversy over elevated levels of the bacterium E. coli in the Lake of the Ozarks. But this flap has distracted from a far more troubling problem: the insufficient monitoring of ALL Missouri waters.

Along with many others, our organizations were dismayed to learn of the serious oversight and bungling of mid-level officials in both the DNR and Governor’s office. The miscommunication between these two offices was inexcusable and deserved to be investigated. Moreover, we completely agree that the lake’s beaches should have been closed to protect public health. But the origins of E. coli in the lake -- and what that says about the water quality monitoring and enforcement program at DNR – should be front and center in this discussion. Furthermore, a large-scale cleanup at the lake like the one Nixon announced is merely a band-aid solution to a larger water quality monitoring and enforcement problem all over the state.

At the root of the problem is that funding for DNR’s water quality monitoring and enforcement program is completely insufficient to protect the health of our waters. General revenue support for DNR was gutted by the Blunt administration, and permit fees have not been raised in more than a decade, even for inflation. These are the problems that should be at the center of the E. coli discussion, and they started well before the arrival of Templeton.

Missouri Coalition for the Environment has commented on hundreds of industrial and point-source pollution discharge permits in the state in the past few years, and a few glaring themes have become obvious about the DNR that Templeton inherited. First, different DNR regions set different limits for dischargers, oftentimes the pollution limits in permits are not adequate to protect water quality, and there is inadequate DNR enforcement of permit limits, renewal, and water quality violations. Second, there is also inadequate enforcement of non-point source pollution, like stormwater runoff from parking lots, building sites, and homes (a large source of E. coli at the Lake).

Gov. Nixon has pledged to undertake and follow-through on the cleanup effort at the Lake of the Ozarks, but we urge him to make this the beginning of a larger cleanup of the water program at DNR.

Missouri must provide adequate funding to the permitting program, take a serious look at septic systems and stormwater runoff, and ensure that permit writers and monitoring and enforcement officials are doing a thorough job upholding Missouri’s Clean Water Law and the federal Clean Water Act.

The Lake of the Ozarks is far from the only water body in this state that needs serious attention from DNR. Without resolving some of the systemic problems, a piecemeal solution that just focuses on the lake alone, is not truly going to protect Missouri citizens or give them confidence that their state officials have public and environmental health and well-being at the center of their agendas.
Forrestal is the executive director for Missouri Votes Conservation. Ishida is staff attorney for the Missouri Coalition for the Environment.
Copyright (C) 2009 by the Missouri Forum. 11/09


By Kathie McClure

It can be challenging to find an organ donor for someone who needs a transplant.

But when a donor and desperately sick person are matched up, living donors should not be “punished” for their gift, especially by the health insurance industry.

This is a little-known aspect of the health care debate that should be brought to light -- the fact that there is nothing that prevents health insurance companies from either denying coverage or charging higher premiums to those who donate an organ by categorizing them as people with “pre-existing conditions.”

This lack of regulation makes it potentially difficult for donors to get health insurance after giving the gift of life.

Here is my story. I met Dan Krinsky and his wife in 2000 when they opened their restaurant in our neighborhood. My husband and I loved their wonderful cooking and over the years we bonded and became good friends.

Shortly after hearing in 2008 that he had developed polycystic kidney disease I ran into Dan at our local taco stand. I could see instantly he was deathly ill and needed a kidney transplant, I told him then and there I would give him one of mine.

Of course even though I was serious, I wasn’t sure I was a match.

But on July 14, after two days of extensive medical tests, I was pronounced 100 percent healthy and able to donate a kidney to my friend.

There was a long silence at the other end of the phone when I told Dan that I had been approved to give him a kidney. He could hardly find words to express his gratitude, amid his relief that after two years on the transplant list and a year on dialysis, the wait for a healthy organ was over.

Yet the very next day I was given good reason to rethink my decision when I read a report in the Los Angeles Times that despite my perfect health, donating a kidney could put me at risk for being denied health insurance or charged more because insurers may consider organ donation a “pre-existing condition.”

Deterring potential donors from giving the gift of life is deadly business. According to the National Kidney Foundation, demand for kidneys far outstrips supply.

More than 80,000 people are waiting for a kidney, of which about 4,500 die each year. Living donation rates have declined recently, with only about 6,000 donations last year.

By threatening potential donors with a lifetime of increased premiums health insurance companies have stooped to a new low of corporate self-interest. For them, the profit motive clearly reigns supreme.

Whatever health-care reform is enacted, we need to ensure that all Americans, including living donors, are not charged higher premiums or denied coverage by insurance companies for having pre-existing conditions.

The National Kidney Foundation’s “End the Wait” Campaign includes additional proposals to protect living donors as part of a broad array of recommendations to increase donations, improve transplant outcomes, and improve the transplant system throughout the country.

Steadfast in my promise to Dan to give him a kidney, I have redoubled my fight to protect organ donors and ordinary Americans from discrimination by health insurance companies. It’s past time we put a stop to these abuses.

McClure, an Atlanta attorney and the founder of, successfully donated a kidney to Dan Krinsky in August.
Copyright (C) 2009 by the Georgia Forum. 11/09

By Don Baylor

Commercial innovation remains at the heart of the American tradition. However, innovation should be used to increase American wealth, not destroy it.

Leading up to the financial crisis, gaps in our financial monitoring system unleashed a financial virus still worming through the American economy. Products like overdraft fees, payday loans, and “pick-a-payment” mortgages all damaged our economy. The resulting system crash led to historic levels of foreclosures, lost wealth and chronic unemployment.

As new, complex financial products enter the marketplace, our regulatory firewall must be able to detect toxic financial products and safeguard Americans from financial harm. We need a national solution that honors state authority in order to protect American wealth from future meltdowns. The proposed Consumer Financial Protection Agency (CFPA) would help avoid repeat financial disaster by ensuring that all “off-the shelf” financial products can be monitored by one inspector with a clear code book.

The financial crisis taught us several lessons. First, banking regulators are ill-equipped to be consumer watchdogs. Second, when financial institutions can shop around for the “regulator of least resistance,” Americans get the short end of the stick. Finally, economic crises transcend state lines, so we need a national standard for financial product safety and a strong watchdog entirely focused on consumer protection.

These lessons indicate the need for a better firewall to protect us from financial “malware.” Our federal regulatory structure stretches across seven agencies attempting to enforce 20 statutes. As a result, no one agency is accountable for financial product safety, and many consumers do not know where to file an effective complaint about financial services.

We should consolidate and strengthen consumer protection to prevent another viral outbreak from taking down the system and destroying American wealth. The CFPA would make this regulatory structure more efficient and effective by centralizing these functions and personnel.

We need a robust, independent body to protect consumers from unfair credit, payment and debt management products, no matter what company or bank sells them and no matter what agency may serve as the regulator. Financial institutions offering similar products should be held to the same standard for consumer safety.

The CFPA would examine commonplace checking account product “services” such as overdraft loans or fees. Most banks automatically include this “coverage” without consumer consent. Many financial institutions charge at least $35 when the customer overdraws by as little as $1, setting up a potential cascade of very expensive short-term loans. The FDIC calculates that the typical overdraft loan equates to a 3,520 percent annual interest rate. The customer is not typically given a choice to decline the fees at the time of transaction. Last year, banks made nearly $37 billion on overdraft charges, about $300 for each banking customer in the U.S.

This unfair “loan without consent” reduces consumer confidence and drives existing customers away from banks into higher cost, fringe financial markets that drain wealth. CFPA could require that issuers notify debit card users that a transaction would overdraft their account.

The proposed CFPA could also help increase the national savings rate. Over the past few decades, the national savings rate steadily declined to a point at or below zero, as recently as 2006. With the economic crisis, savings rebounded somewhat, but are still far below healthy household saving levels. The CFPA could make savings easier and more automatic so that more Americans build financial cushions and retirement security, leaving them more resilient when the economy dips. This agency would use a research-based approach to understand how Americans approach saving, investing and borrowing.

In Texas, we know a little bit about toxic financial products. With the lowest average credit scores, lax financial regulation and runaway payday loans, Texans are especially vulnerable to dangerous products that strip wealth from households and communities. Under the CFPA, many high-cost, “rinse and repeat” products like payday and automobile title loans—offered by credit services organizations—might receive increased scrutiny. That would be a welcome innovation.

Properly implemented, the CFPA will spur innovation through new asset-building products that promote a “race-to-the-top” challenge and lead to better consumer choice. The CFPA’s goal would be to ensure safety and transparency of financial products, and to detect and quarantine products designed to destroy wealth.

In other words, CFPA will help prevent another collapse of our economy due to hazardous financial products.
Baylor is senior policy analyst at the Center for Public Policy Priorities, an Austin think tank.
Copyright (C) 2009 by the Texas Lone Star Forum. 11/09

By Anne R. Davis, MD, MPH

Every day, I hear from another woman who is losing her job and her health insurance. Every day, I worry. As an obstetrician/gynecologist, I know firsthand what can happen when a woman can’t afford reproductive health care, whether she has lost her insurance or her insurance doesn’t cover women’s basic needs. Cervical cancer develops unnoticed. Pregnant women go without critical prenatal care. Sexually transmitted diseases progress unchecked. We see the results in the emergency room.

Congress must give women a better shot at staying well. Health care reform must change the rules: Health insurance must be affordable to all women, and the insurance we buy must cover our reproductive health care.

In my own life, I’ve always had good health insurance. I go to my ob/gyn each year for a well-woman exam, my birth control is covered, and my hospital bills were paid when I had my two children. These are medical fundamentals -- women’s health care 101-- yet I consider myself lucky to have them. Too many women are not as fortunate. According to the Guttmacher Institute, more than one in four women or their partners have lost their jobs or health insurance in the past year. The institute also reports that one in four women delayed an ob/gyn visit in the last year to save money.

Since the recession began, dozens of women have made emergency appointments with me because they have been laid off and are on the brink of losing their health insurance. They wouldn’t bother if they didn’t depend on the prescriptions and treatments I provide. I always talk to them about how to get emergency care if the need arises, assuring them that I will help them navigate the system. Then we cross our fingers.

Melinda came to see me just before she lost her job and her insurance. She had large fibroids—benign tumors—in her uterus that made her bleed heavily. I prescribed birth control pills, which controlled the bleeding. Then, as sometimes happens with fibroids, the pills stopped working. She bled so heavily she was dizzy and unable to walk. After seven hours of bleeding, Melinda called our office, and we advised her to get to the emergency room immediately. She was in shock; the ER staff gave her a blood transfusion that saved her life.

The next step in her care would be an operation to remove the fibroids. But once Melinda was stable, the doctors discharged her without surgery. Hospitals are required to try to keep every patient alive, but they do not have to provide non-emergency care to people who can’t pay. The staff advised Melinda to apply for Medicaid and schedule the operation once she was covered. But because she receives unemployment benefits, Medicaid deemed Melinda too wealthy for assistance.

Melinda’s bleeding will return. I am her physician, but I can’t give her the treatment she needs. This makes me furious. I am trying to work around the system to get her care, and I know many other doctors who have done the same for patients in crisis. We don’t always succeed.

Sometimes my colleagues and I find ourselves unable to help some women who want to be mothers, like Christine. Christine came in for an IUD. She is 40 and had been pregnant recently. She and her husband have two children, and they wanted to have another baby. Her doctor estimated that even an uncomplicated birth would cost thousands more than they could afford. Christine’s insurance doesn’t pay for labor and delivery, and her family’s income was too high for Medicaid. She had an abortion and then came to me for long-term birth control—neither was covered by her insurance.

Christine’s health insurance policy, like many others, seems to be based on the premise that the reproductive system doesn’t exist, that reproductive health has nothing to do with our overall health. Explain that to her and Melinda.

I am fortunate to have had insurers that cover the essentials for reproductive health. But health care shouldn’t be a matter of luck. All of my patients deserve comprehensive reproductive health services as much as I do.

For too long, women in this country have been sicker than we should be, with far-ranging effects on the jobs we hold, the families we care for, and the society we live in. Congress now has an opportunity to improve the health of women dramatically. Our senators and representatives must put insurance within every woman’s reach.

Davis, MD, MPH, is the medical director of Physicians for Reproductive Choice and Health and an obstetrician/gynecologist in New York City.
Copyright (C) 2009 by the American Forum. 11/09

Monday, November 16, 2009

A Community Trembles in Fear

By Jan Snider

She looked so tiny holding the calloused hand of her young uncle; just five years old and excited about starting kindergarten. But as she shuffled down the polished floors of the church hallway toward our immigration legal clinic, there was worry in her big brown eyes.

She didn’t know when she would see her daddy again. He was picked up for a broken tail light and locked in detention, on track for removal from the U.S. because he was undocumented. Her mother, a U.S. citizen, had long ago abandoned the family. Her father was going to be deported and she was, most likely, going to be placed in state custody.

Suddenly, thoughts of new school shoes and fresh crayons were replaced with fear and uncertainty. These are the same feelings that so many of our clients at Tennessee Justice for Our Neighbors face every day. When Immigration and Customs Enforcement gave local law enforcement the power to act as federal immigration agents, a community began to feel hunted. A policy known as 287(g) has forced them into the shadows.

Davidson County Sheriff Daron Hall persuaded the citizenry of Nashville in 2007 that 287(g) would make us a safer community by aiding in the deportation of “criminal illegal aliens:” drug dealers, thieves, and violent individuals. But, as it unfolded, 80 percent of those processed for deportation were originally arrested for minor violations. Something as simple as fishing without a license or failure to use a turn signal suddenly resulted in deportations that ripped families apart. What was intended to be a policy to protect our citizenry from the most violent criminals has turned it into a home-grown remedy for our nation’s broken immigration laws.

Just this past month, six communities throughout the nation acknowledged the disastrous impact of 287(g) and revoked their agreements. Despite the shifting momentum, Nashville’s leadership quashed debate about this issue and voted to continue the program.

When we formed Tennessee Justice for Our Neighbors nearly two years ago, our mandate was clear. As a largely volunteer-run organization with its roots in the United Methodist Church, we provide free high-quality immigration legal services to the poorest of the poor.

When there’s a remedy, we apply it; when there’s no path to legalization we explain it; when there’s injustice, we expose it.

While our current immigration laws are convoluted and dysfunctional, the 287(g) agreement catapults our legal system to the point of actually harming people. No decent person approves of mistreating others, but for people like me, who have taken the name “Christian,” there is a stronger imperative.

In Matthew 25, Jesus tells his followers that on the day he returns, one of the questions he will ask is whether we have been hospitable to “the stranger,” which is translated as “the immigrant.” If we have been unkind, inhumane, or inhospitable, even to the immigrant that we believed deserved kindness the least, it will be as if we did it to Jesus personally.

We hear the stories of why these immigrants have come to live with us. They have often escaped persecution and abuse, or arrived here as a result of human trafficking, or fled numbing poverty. These situations are not black and white, but many shades of gray. One thing is clear: the policy of 287(g) has become a perverted version of its original intent.

As Nashville celebrates yet another year of being named the “friendliest city,” our immigrant brothers and sisters tremble in fear of being singled out for a minor infraction that should be subject to a fine but could result in their family being torn apart.

As a Christian and an advocate for social justice, I pray that no more children will suffer the fear and pain that I witnessed in the eyes of that five year old. I pray that someday our community will affirm that while we must uphold the law, we must also uphold the values of human dignity and respect for family integrity.
Snider is chair of Tennessee Justice for Our Neighbors, a nonprofit organization that provides free immigration legal services, education and advocacy.
Copyright (C) 2009 by the Tennessee Editorial Forum. 11/09

Monday, November 9, 2009

A Tale of Two Cities

By Rev. Dr. Holly Beaumont

As I follow the outrageous rumors and disturbing behavior surrounding health care reform I am reminded of an earlier health crisis in this country. The outbreak of the AIDS virus in the 1980s created similar behavior among those who listened to the fear-mongers exploiting the crisis to advance their political and ideological agendas.

One of the victims of that hysteria was a young boy from Kokomo, Indiana named Ryan White. He acquired the AIDS virus through a blood transfusion he received to treat his hemophilia. When his diagnosis was made public Ryan and his family were shunned, vilified and threatened. Classmates refused to attend the same school. Customers dropped his newspaper route. The White family fled their home in Kokomo after someone so filled with hate and fear fired a bullet through their living room window.

Young Ryan and his family moved to the town of Cicero, just 50 miles south of Kokomo. On his first day of school the principal, superintendent of schools, and a number of students greeted Ryan with outstretched hands. It was a powerful gesture of reason and compassion. The news swept the country and began to calm the hysteria.

What made the difference between these two communities that look the same in every other way? Instead of listening to rumors based on ignorance and fueled by fear, the people of Cicero turned to credible sources for reliable information on the AIDS virus, including the Centers for Disease Control and the New England Journal of Medicine. They took the responsibility to educate themselves. They learned the facts, and they realized that many of the rumors about the disease were false. By the time young Ryan arrived they were prepared to welcome him, rather than repeat the shameful mistakes of their neighbors to the north in Kokomo.

Twenty years later, we find ourselves in a similar situation with a similar opportunity. Will we allow profiteers, who will spend whatever it takes to protect their Golden Parachutes, manipulate us? Or will we seek out and listen to credible, reliable voices that have a proven record of serving rather than exploiting the people of this country?

Are you listening to Rush Limbaugh, who signed a new contract in 2008 worth $400 million? According to the LA Times, “Limbaugh's annual salary is more than the combined annual salaries of the four best paid news anchors on network television.” Do you believe Sen. Chuck Grassley (R-Iowa), who made the false statement at a recent town hall meeting that “You have every right to fear…a government-run plan to decide when to pull the plug on grandma?” Grassley accepts huge contributions from the very industries that are spending millions to shut down reasoned debate on health care reform to protect their obscene profits.

If you are searching for credible, reliable voices supporting health care reform, the list is long. I would refer you to Faithful Reform, the national interfaith coalition that includes the United Methodist Church, United Church of Christ, Evangelical Lutheran Church in America, Presbyterian Church (U.S.A.), Union for Reform Judaism, Unitarian Universalist Association of Congregations, American Muslim Health Professionals and Buddhist Peace Fellowship. Other groups working for health care reform include the American Academy of Family Physicians, the American Academy of Nursing, the Children’s Defense Fund, YWCA, NAACP, AARP and the AFL-CIO. I urge you to visit their web sites.

The polls show that over 70 percent of Americans recognize the need for health care reform and support a quality health care system that serves people rather than profits.

Health care reform is the most critical issue we face as a nation. If this democracy is going to survive and thrive each of us must take the responsibility to seek reasonable and reliable sources, learn the facts, and then let our voices be heard. The choice is ours. Are we Kokomo or Cicero?
Beaumont is a legislative advocate for the New Mexico Conference of Churches.
Copyright (C) 2009 by the American Forum. 11/09

Friday, November 6, 2009

The Shadow of States' Rights

By Dan McGrath

Governor Tim Pawlenty’s call for states to stand behind the 10th Amendment to avoid federal health care reform is the latest political ploy from an ambitious politician. And Pawlenty’s call has been joined by State Representative Tom Emmer, who himself hopes to succeed Pawlenty as governor.

One thing’s for certain -- Tim Pawlenty is running for president. And, he’s willing to support some radical ideas in order to lead a crowded field of better known Republican hopefuls. But while states’ rights may be a sure winner with today’s Republican caucus goers, it was most memorably used during one of the greatest tests of our national resolve, the Civil Rights Movement of the 1960s. And its connotations are not pretty.

As with civil rights, no other issue today matches health care reform for the deep emotional response it elicits. In the 1950s and 60s, a national consensus emerged that the status quo -- segregation -- was unacceptable. Today, the vast majority of Americans agree that the current health care system is badly broken and must be fixed. Both issues raise the same moral question: is inequality OK? Is it acceptable for some to be excluded from access to health care because of cost, employment status, pre-existing condition, or the whims of the private insurance industry? If not, what are we as a society going to do about it and what is the role of our national government?

With his invocation of states’ rights, Pawlenty makes another connection between the health care debate and the civil rights movement. The same threat was tried by southern governors to resist desegregation. Arkansas Governor Orval Faubus used the 10th Amendment to resist President Eisenhower’s order to desegregate Little Rock Central High School. Five years later, Mississippi Governor Ross Barnett used the same argument to block James Meredith’s admission to the University of Mississippi. The next year, George Wallace, governor of Alabama, literally stood in the way of a federal desegregation order for the Alabama public schools. In each case, the 10th Amendment was invoked as the last defense of an unjust system against an enlightened national consensus.

Here in Minnesota, health insurance premiums for Minnesota families have increased 35 percent. Minnesota's uninsured population now stands at over 450,000. And earlier this year, Pawlenty eliminated coverage for another 30,000 of the state’s poorest adults, disproportionately impacting minorities and people of color who are overrepresented in public health care programs.

This is the track record Governor Pawlenty wants to protect from federal intervention?

We don’t know what kind of health care reform will emerge out of Washington this fall. And, we don’t know its scope. But, if President Obama’s core principles are met, we do know that more Americans will have access to the health care they need at a more affordable cost.

The late Senator Strom Thurmond, former Governor of South Carolina, ran for President in 1948 as a third-party “Dixiecrat,” using the cry for states’ rights to advance his political ambitions. Southern Democrats, alarmed that the federal government had begun the tilt toward support for civil rights, saw their way of life crumbling. Thurmond exploited this sentiment for political gain, earning only 2.4 percent of the popular vote, but mobilizing segregationists nationally.

Like Thurmond, Faubus, and Wallace before him, time will tell if Tim Pawlenty will come out on the right, or on the wrong, side of history. But in going to extremes to deny Minnesotans the ability to access the same federal health care that other Americans would have the freedom to enjoy, it’s hard not to predict the latter.
McGrath is the executive director of TakeAction Minnesota.
Copyright © 2009 by the Minnesota Editorial Forum. 11/09

By Wendy C. Wolf

One simple test could end up saving thousands of women’s lives. Yet, for those without health insurance, the test comes too late. According to the American Cancer Society, this year alone an estimated 40,170 women will lose their lives to breast cancer. Meanwhile, it is estimated that 4,000 breast cancer deaths could be prevented just by increasing the percentage of women who receive breast cancer screenings to 90 percent.

Breast cancer often can be treated with early detection. That's why health insurance that pays for mammograms is especially important. But mammography rates declined between 2003 and 2005, with a notable decrease for Hispanic women (from 65 percent to 59 percent) and African-American women (from 70 percent to 65 percent). An estimated one in five women over 50 has not received a mammogram in the past two years.

Everyone needs health insurance to keep healthy, yet women are disproportionately underinsured. An estimated 21 million women and girls went without health insurance in 2007, according to the U.S. Census Bureau. And a recent congressional report found that 18 percent of all women not eligible for Medicare are uninsured, which translates to 28 percent of 19 to 24 year olds and 26 percent of single mothers without insurance.

Why are so many women left uncovered? Perhaps it’s because many medical situations faced by women are treated as pre-existing conditions, including breast cancer. The National Cancer Institute estimated that in 2004 approximately 2.4 million women had a history of breast cancer. But without continuing coverage, cancer survivors face steep risks.

A recent report by the Department of Health and Human Services found that breast cancer patients with employer-based insurance had total out-of-pocket costs averaging $6,250 in 2007, higher than out-of-pocket spending for patients with asthma, diabetes, chronic obstructive pulmonary disease or high blood pressure.

Why are women falling behind in insurance coverage faster than men? According to the Department of Health and Human Services, various factors restrict women's access to health care, which include a vast array of "pre-existing conditions” such as breast cancer, pregnancy, caesarian section and domestic violence. In addition, women are less likely to be employed full time, which makes them less likely to be eligible for employer-based health benefits. In fact, fewer than half of women have the option of obtaining employer-based coverage.

Any health care reform proposal should take that into consideration and include access to comprehensive care, including preventative care such as mammograms. Americans, men and women alike, understand this need. A recent poll commissioned by Moving Forward, a values-based research initiative developed by the Women Donors Network and the Communications Consortium, found that a strong majority of voters -- 87 percent -- think insurance companies should be required to cover women’s preventive care and screenings, such as contraception, Pap tests for cervical cancer and breast cancer screenings.

Public health experts recommend health insurance coverage be universal and available to all regardless of work status, place of residence, health status or other factors unrelated to need. Reform should be aimed at achieving quality outcomes and eliminating disparities as well as at being affordable. Coverage also needs to be continuous from birth until end of life without interruptions or delays, as gaps in existing coverage allows women to fall through the cracks.

Reform will bring health care to more American women and their families than ever before in our nation's history. Women would do well to learn more about their stake in health care reform. One good resource is As we end National Breast Cancer Awareness month, the best thing we can do to end breast cancer is to make sure all health insurance coverage is universal -- not limited by exclusions due to pre-existing conditions -- and includes preventative care and basic services such as breast and cervical cancer screenings. Let's create a system that provides health care, not just sick care.
Wolf is a board member of Living Beyond Breast Cancer and Women Donors Network and leads WDN’s effort on reproductive and other health issues.
Copyright (C) 2009 by the American Forum. 10/09

By State Representatives Mike Foley and Bob Hagan

Ohio is a great, messy, complicated state. We are conservative and liberal, libertarian and socialist. We likewise have a whole bunch of moderates except for the host of issues on which they swing to the left or right. In the partisan parlance of the day, Ohio is a purple state. In a word, we are normal.

We have some real structural economic problems now, however. Problems we can only solve if we rebalance our politics and take some progressive economic actions.

First and foremost, we must deal with our budget or lack thereof. Since 2005, when Ohio enacted a dramatic tax cut, our economy has been headed for the train wreck where it ended up this year.

While Gov. Strickland should be commended for seeking a moderate solution, his hands are somewhat tied by the legislature in which we serve. Ohio needs a bold, progressive solution. In the past few years, all Ohioans have seen a dramatic reduction in the taxes people and corporations pay. This may seem popular, but these tax cuts have not only wrought enormous, unnecessary challenges; they have failed to produce any of the economic results which led to their original implementation.

The argument for these dramatic tax cuts was that it would stimulate Ohio’s economy; it did not. Rather, Ohio’s economy sank further, well before the current national economic troubles. In fact, were it not for the national crisis, Ohio would be in much bigger trouble than it currently is, thanks to federal “stimulus” funds.

We cannot make up for the harm of the 2005 tax cut policy, but we can stop it from causing further damage. We can bring Ohio back from the edge of greater decline. Rather than following the governor’s modest proposal, we should repeal much of the 2005 income tax cut and restore Ohio’s upper tax levels to those of 2005. The benefits from pursuing this policy are many. Don’t forget, the compromise budget adopted last summer left not only many people unhappy, it left far too many of our fellow citizens hurting even more.

The pain of the cuts enacted just 10 weeks ago is already being felt throughout our state. Among the Ohioans who lost out are our youngest and oldest neighbors and those most in need of help. From the Early Learning Initiative to adult protective services, programs and services geared to enable children to start school well-prepared and to ensure that the oldest among us are not abused have been eliminated and decimated by budget cuts.

Community mental health services were cut by nearly $200 million compared to spending last year. These cuts have occurred at a time of unprecedented need.

We cannot wait any longer for a bold solution. That solution is pretty obvious, it involves simply restoring tax rates for those earning more than $200,000 annually to the level prior to the 2005 cuts and creating a new tax bracket for those earning more than $500,000. Both rates are lower than the top tax rate for several years during the 1980s.

Certainly, those among us earning such high salaries at this time of crisis are willing to contribute just a little bit more, so that all of us can have a better future. One thing we know about Ohioans is that despite our flaws, we care about our state and each other.

Given our crisis, those who make more have more to contribute. They have done well by Ohio. It is not such a bad thing to require those who are doing pretty well right now, to help those who are struggling, by contributing more in taxes to the state.

We need adequate social services; we need good schools; commonsense development patterns; recreation centers and parks; clean drinking water and air; bridge inspectors; meat inspectors; colleges and universities; great transportation networks. The list goes on. But none of this happens without sharing the costs, burdens and opportunities.

We love Ohio. It has contradictions galore and a sense of absurdity that we adore. But we hate that amidst all of our history of innovation and hard work, the portion of us that is selfish has been encouraged and indulged by our state government for the last two decades.

We can extricate some of that selfishness from our tax code. It is past time. Having top income earners paying their fair share would provide Ohio’s bone-dry budget with an additional $1.4 billion just in this budget period. It’s the right thing to do.
Foley is a state representative (D-District 14). Hagan is a state representative (D-District 60).
Copyright (C) 2009 by the Ohio Forum. 10/09