Tapped: The Prospect Group Blog

Maryland Bills Mandate Better Health Care for Pregnant Inmates

Last week, the Maryland General Assembly approved a bill that would require all state correctional facilities to have written medical-care policies for incarcerated pregnant women—the first of its kind in the country, according to NARAL Pro-Choice Maryland.

Under the new legislation, which goes into effect in October, all facilities must submit to a legislative commission—and, importantly, to incarcerated patients—a written policy regarding things like prenatal care, abortion access, and labor and delivery. Incarcerated women are often afraid to ask for needed care like pregnancy testing or emergency miscarriage management, says Diana Philip, the executive director of NARAL Pro-Choice Maryland, or they might not even be aware of their rights. The requirement of a written policy clarifies for both patients and prison employees what kind of care pregnant inmates are entitled to receive. “I think one of the great things about this bill is that the person who is pregnant will be handed that policy,” Philip told the Prospect.

The state legislature also passed a bill that would provide inmates with free menstrual hygiene products. “Incarcerated women have limited resources and are often forced to deal with poor conditions,” Philip said in a statement. While she acknowledges that there remains the challenge of monitoring facilities’ adherence to policies, “[b]oth of these bills take a step in the right direction to ensure their basic needs are met.”

As states across the nation try to handle their growing female prison populations, reproductive-rights advocates have been shining a light on the treatment of detained and incarcerated women who are pregnant. According to New York magazine, six states (Georgia, Indiana, Kansas, Nebraska, South Carolina, and Utah) still allow the shackling of female inmates while they’re in labor, a practice that the American College of Obstetricians and Gynecologists says “may not only compromise health care but is demeaning and rarely necessary.” North Carolina recently revised its policy on restraints, prohibiting the use of leg or waist restraints when the inmate is in labor, and Connecticut lawmakers have introduced a bill that would bar such restraints during pregnancy or the postpartum period, and prohibit the use of any restraints during labor. The Connecticut bill would also require the state to provide incarcerated women with menstrual hygiene products free of charge.

Pregnant women in immigration detention have also struggled with lack of quality medical care, their numbers having risen since the Trump administration’s decision in December to reverse the federal policy of releasing pregnant women from custody. Immigrant-rights and reproductive-rights groups have expressed concern about inadequate medical care, and advocates have sounded the alarm about Scott Lloyd, the director of the Office of Refugee Resettlement, who has repeatedly attempted to prevent undocumented pregnant teenagers from seeking abortions.

Welfare Drug Testing Promotes Stereotypes, Not Efficiency

Despite a clear lack of evidence of significant drug use among welfare recipients, lawmakers in at least two states are moving forward with plans to require drug screening for individuals seeking assistance. State legislators in Illinois and Iowa have introduced bills that would make drug testing a prerequisite for Temporary Assistance to Needy Families (TANF), the U.S. cash assistance program for very poor families. If passed, the states would join more than a dozen others in mandating drug testing for welfare applicants.  

But the outcomes of those existing state testing programs contradict the harmful and racist stereotype of the drug-addicted welfare user.

Over the past several years, proposals to drug test the poor applying for or receiving TANF have been quite popular among a number of conservative states—and some states have begun attempting to expand drug testing into other assistance programs, too. Wisconsin drug tests not just TANF applicants, but has moved forward with a plan to also test Supplemental Nutrition Assistance Program (food stamps) applicants (without federal approval, which may be illegal). Wisconsin’s Republican Governor Scott Walker even wants to drug test those who apply for Medicaid—potentially barring people from health care when they could perhaps need it most.

The Illinois bill would also require that SNAP applicants be drug tested, pending federal approval. (Not being a conservative stronghold, it’s probably unlikely that the Illinois proposal will pass.) And the Iowa bill proposes drug testing all recipients of public assistance.

However, the results of these drug-testing initiatives have amounted to a wasteful use of funds when one considers how few welfare recipients actually test positive for drugs. An analysis by ThinkProgress found that, in 2016, 13 states spent $1.3 million on welfare drug testing, with just 363 people testing positive.

Since the data don't exactly justify the expense of these programs, one should consider other reasons that conservative legislators keep advancing legislation like this—namely, to attempt to justify a certain narrative. Without “immorality” and other individual characteristics to blame for poverty, what’s left? A systemic canker—that threatens the American narrative of hard work and equal opportunity.

A Failed Fight for $8.50 Energizes the Fight for $15 in Louisiana

When a bill to raise the Louisiana minimum wage by just $1.25 failed, advocates didn’t reduce their demands—in fact, they did the opposite.

On Tuesday, the Louisiana Senate voted against a bill that would have raised Louisiana’s minimum wage to $8.50 an hour by 2020. “Not advancing this legislation is a step backwards for our families and our children who live in poverty but want to work,” said Democratic Governor John Bel Edwards.

But just two days later, supporters of a $15-an-hour bill introduced by State Representative Joe Bouie testified in a hearing before the House Labor and Industrial Committee—a bold statement given the clear leanings of the legislature. The committee unsurprisingly rejected the bill, but the hearing was an opportunity for advocates to make their case in front of committee members.

“Can any of you live on $290 a week?” said Ben Zucker, co-director of advocacy organization Step Up Louisiana. “Too many of these low-wage workers working for multinational corporations ... making record corporate profits come into our state and pay our workers so low they can’t afford to eat,” Zucker said, as reported by New Orleans’s Gambit. Louisiana is one of five states without a state minimum wage, so the federal minimum of $7.25 is in effect.

State Senator Troy Carter of New Orleans, who sponsored the $8.50 bill, has sponsored minimum-wage legislation for the past three years, but each attempt has failed. He has also sponsored a bill that would allow voters to determine whether to pass a constitutional amendment raising the minimum wage. (As of 2016, 76 percent of Louisianans support raising the wage.) Bouie’s bill was the first $15 minimum-wage legislation introduced in the Louisiana legislature.

One in five people in Louisiana lives in poverty, and the state has one of the highest poverty rates in the country, as do Tennessee, Alabama, South Carolina, and Mississippi, which also don’t have state minimum wages. Sixteen other states have wage floors that match the federal minimum of $7.25.

Senate Democrats Warn Mitch McConnell: Don’t Try to Weaken the ADA

On Thursday, 42 Senate Democrats joined Senator Tammy Duckworth of Illinois to pledge to block a vote on the ADA Education and Reform Act (H.R. 620), a House bill that would gut the 1990 Americans with Disabilities Act by weakening enforcement provisions that ensure accessibility in public accommodations.

In a signed letter to Senate Majority Leader Mitch McConnell, the Democrats noted that the supposed purpose of H.R. 620—to prevent “drive-by” lawsuits—is not actually addressed by the bill, since the ADA does not permit monetary relief in the form of damages or settlements. Instead, H.R. 620 gives businesses 120 days to make “substantial progress” toward complying with the law, and only after the business has received written notice from an affected person with a disability. When the ADA was passed, as the letter says, “[t]he expectation was that businesses would make themselves accessible before people with disabilities showed up … rather than waiting until receiving a notice that people with disabilities have been excluded before starting to think about complying with the law.”

Duckworth, who lost her legs while serving in Iraq, wrote a Washington Post op-ed in October 2017 condemning H.R. 620, and spoke against it on the House floor in February, just before it passed that chamber on mostly party lines. Proponents of H.R. 620 include the U.S. Chamber of Commerce and the retail and hotel industries, which claim that the bill protects businesses from complaints over minor ADA infractions. “We reject in the strongest terms,” wrote the senators, “the offensive suggestion by supporters of H.R. 620 that a civil rights violation denying access to a public space could ever be ‘minor.’”

Disability-rights groups have been vocal in their opposition to H.R. 620, which McConnell could bring up for a vote at any time. The letter, signed by 43 Democratic senators (all except Joe Donnelly of Indiana, Heidi Heitkamp of North Dakota, Joe Manchin of West Virginia, and Bill Nelson of Florida) signals to McConnell that the coalition has enough votes to filibuster any attempt to bring H.R. 620 to the floor.

Why the Kerner Commission Didn't Move the Needle on Racial Justice

Five decades after President Johnson convened the Kerner Commission to investigate the roots of racial discrimination and violence in urban America, remarkably little has changed. That’s the conclusion of a new book co-authored by former Senator Fred Harris, the sole surviving member of the commission. Organized in the wake of deadly riots in more than 100 cities in 1967, the commission offered a grim assessment of the stark inequality, police brutality, and endemic discrimination fueling racial violence. “We are moving toward two societies,” the commission warned, “one black, one white, separate and unequal.” On the 50th anniversary of the Kerner Report, Senator Harris writes that the United States has largely failed to confront those issues head on.

We may be disappointed, but we should not be surprised. Appointing commissions to study the causes of racial violence was the standard American response to racial turmoil in the 20th century—typically with limited results. Starting with the riots in East St. Louis in 1917 through the Harlem riots of 1943, at least 21 commissions were appointed in the United States to make recommendations to prevent the recurrence of riots. In the 1960s, at least 13 riot commissions were appointed to respond to race-related civil unrest.

The best of these reports provided fair pictures of endemic racial biases and disparities. None proved to be a blueprint resulting in progress.

The Kerner Report was unique only because it raised the profile of racial unrest to the national level. But it wasn’t unique for long. Three months after it was released in February 1968, riots sparked by the assassination of Dr. Martin Luther King Jr. (as well as the shock of the assassination of Senator Robert Kennedy) prompted Johnson to once again appoint a commission to investigate.

Interracial violence has taken various forms over the years—whites attack black communities, blacks respond to police violence, for example. But despite this variation in the forms of interracial conflict, appointing commissions to study riots has been the norm. To what end?

The primary purpose of riot commissions, as David J. Olson and I concluded in our book Commission Politics: The Processing of Racial Crisis in America (1977), has been to allow political leaders to give the appearance of responding to crises without having to make any consequential decision in the heat of the moment. The commissions, comprised of high-status individuals with strong ties to existing institutions, instead report some time later, when the immediate crisis has cooled and normal political processes can prevail. In short, political leaders buy time. 

The Kerner Commission differed from other riot commissions not only because its scope was national rather than local, but also because its report was soon followed by the riots that occurred after Dr. King’s death, in a sense continuing the urgency underlying the origins of the report. 

As has been widely reported, President Johnson was disappointed that the Kerner Commission did not give more credit to his domestic policy agenda. And it’s possible that the president’s embrace of the report might have led to greater progress on the report’s recommendations. 

A reading of the history of riot commissions in America, however, would temper this conclusion.  Riot commissions have typically functioned to dampen demand for change and restore the status quo. However well-intentioned, the Kerner Commission was hardly an exception.

Studies Show Private-Sector Providers Are Not Ready to Care for Veterans

As Congress moves ahead with plans to outsource more and more veteran health care to the private sector, three high-profile studies should urge lawmakers to pump the brakes. The studies, published in recent weeks by RAND Corporation, Federal Practitioner, and the National Academies of Science, Engineering and Medicine, spotlight serious flaws in private-sector veterans’ care compared with the VHA, from suicide prevention to overall health care. In so doing, the reports underscore a critical fact: Despite their best intentions, few private-sector physicians, hospitals, mental health, and other health-care professionals have the knowledge, experience, and skill to provide the level of care veterans need and deserve.

Perhaps the most damning of those studies comes from the RAND Corporation. In a report entitled “Ready or Not?” researchers examined whether private-sector health professionals in New York state had the “capacity” and “readiness” to deal with that state’s 800,000 veterans in need of care. Such patients, the study noted, are on average older, sicker, poorer, and far more complex than the ordinary civilian-sector patient.   

The conclusion? Only 2 percent of New York state providers met RAND’s “final definition as ready to provide timely and quality care to veterans in the community.”

While the majority of providers said they had room for new patients, less than 20 percent of them ever asked their patients if they were veterans. Fewer than half used appropriate clinical practice guidelines to treat their patients, and 75 percent didn’t use the kind of screening tools commonly deployed in the VHA to detect critical problems like PTSD, depression, and risk of suicide.

Most providers had no understanding of military culture and less than one-half said they were interested in filling such knowledge gaps. Mirroring a similar study conducted by the VA and Medical University of South Carolina in 2011, RAND found that New York state providers had little understanding of the high quality of VHA care. Informed by media reports rather than medical journals, they had a negative view of the VHA and would be unlikely to refer eligible veterans to the VHA for needed care in programs in which the VHA actually excels.

Echoing the RAND study, another report by VA psychologist Russell Lemle in the Federal Practitioner warns that in the private sector, the quality of integrated mental health care for veterans lags significantly behind the VHA. Every VHA medical center, Lemle reports, has at least one trained suicide prevention coordinator who directs care for veterans at high risk for suicide. The VHA has also developed an algorithm to identify the veterans who are at the very highest risk of suicide and notifies their provider of the risk assessment, enabling preemptive intervention and expansion of services to the veteran. This and other programs explains why the rate of suicide of veterans not using the VHA increased by 38 percent between 2001 and 2014 while only 5 percent for those using the VHA. For veterans who had a “mental health or substance use diagnosis, the rate decreased by 25 percent.”

Finally, for veterans returning from the Iraq and Afghanistan conflicts, a prestigious National Academies of Science, Engineering and Medicine report released just four weeks ago found VHA mental health care to be “comparable or superior to that in the private sector.” The majority of veterans who accessed the system had “positive experiences” and appreciated VHA staff’s “respect toward patients.” This was despite serious shortages of mental health staff, as well as clinical and exam space, and confusion about how to access care—all of which could, and should, be improved. When veterans were asked whether needed services were provided in the VHA, 64 percent said they were. When they were asked about services they’d received in the private sector, only 20 percent said they got needed services.   

These studies should be a wake-up call to Congress. Countless reports have documented that there is little excess capacity—and a huge shortfall of knowledge—in the private sector when it comes to veteran health care. Until studies document the opposite—that the private sector’s doctors, nurses, hospitals and other health-care providers can match what the VHA does routinely—lawmakers should hold off on privatization efforts. Rather than spending money for more expensive private-sector care of lower quality, Congress should instead be working to strengthen the excellent care the VHA gives by providing funding to remedy any staff and resource deficiencies as well as to address management problems at the top.  

Planned Parenthood Launches $20 Million Midterm Election Campaign

On Wednesday, Planned Parenthood announced a plan to invest $20 million in the 2018 midterm elections, the organization’s largest midterm campaign effort yet.

The electoral battle plan initially targets gubernatorial and Senate races in eight states—Arizona, Florida, Michigan, Minnesota, Nevada, Ohio, Pennsylvania, and Wisconsin—with plans to expand to other states and smaller races. Of those states, the campaign’s newly unveiled website pledges to focus its energy on “key races” in Nevada, where many consider Republican Senator Dean Heller to be vulnerable; Pennsylvania, where Democratic Governor Tom Wolf faces re-election; and Wisconsin, where Planned Parenthood wants to help oust Republican Governor Scott Walker and re-elect Democratic Senator Tammy Baldwin.

Citing Democratic successes in Alabama and Virginia in 2017 that were thanks in large part to the mobilization of women voters, particularly black women, Kelley Robinson, Planned Parenthood’s national organizing director, said the organization hopes to capitalize on that political momentum and “channel the activism” of its 11 million supporters.

Recent years have seen Planned Parenthood transform itself from a woman’s health organization to a massive political force under the leadership of Cecile Richards, who announced in late January that she would be stepping down as president. In 2017, as supporters fought against efforts to repeal the Affordable Care Act and defund the organization, Planned Parenthood launched an organizer-training program, with volunteer “boot camps” intended to strengthen an activist network across all 50 states.

“This year,” Planned Parenthood Press Secretary Ben Halle told the Prospect in an email, “we’ll be turning to our volunteers to help us continue to fight against attacks against Planned Parenthood and access to health care, to work in their communities to educate and engage people on these issues, as well as help us win at the ballot box in 2018.”

West Virginia Communities Unite Behind Historic Teacher Strike

It’s day four of the West Virginia teachers’ strike, in which nearly 20,000 teachers across the state are demanding higher pay and better health insurance.

On Tuesday, union leaders finally secured a meeting with Republican Governor Jim Justice—meaning the strike could end today if demands are met. The teachers, coordinated by the American Federation of Teachers–West Virginia and the West Virginia Education Association, technically are barred from striking, so their recent approach is not only brave, but highlights the urgency of their difficulties: Many teachers are forced to take second jobs to make ends meet, and low salaries (teacher pay in West Virginia ranks 48th in the country) and inadequate benefits likely contribute to West Virginia’s teacher shortage.

Justice, a billionaire, signed into law meager pay raises last week, which prompted the walkout, had admonished the nearly 20,000 striking teachers—and 10,000 striking support staff—saying they “should be appreciative of where [they] are” and “should be back in the classroom.” Justice did propose raising the natural gas severance tax, saying the revenue could provide raises for teachers.

Residents and local businesses are demonstrating their support by bringing food, water, and coffee, to the teachers, says Chad Webb, the partnership coordinator of Reconnecting McDowell, an AFT-led county revitalization initiative. “Driving through McDowell County, businesses have [signs saying] ‘We support our teachers.’”

Local support for what amounts to the largest teachers’ strike in state history—across all 55 counties—is a continuation of West Virginia’s rich legacy of labor activism, with some teachers even wearing red bandanas—an homage to the coal miners of the early 20th-century labor battles, who wore red bandanas and were thus called “rednecks.”

Just over the state border, teachers in Pittsburgh, a city that shares that same strong labor history, are planning to strike this Friday if their union and the school district cannot reach a contract agreement.

Urban Institute Study Finds Millions of Americans Live in Higher Education Deserts

Millions of American adults cannot access any type of higher education based on their location, according to a new study from the Urban Institute. Released last month, the report found that 3.1 million Americans, at least 1.3 percent of the adult population, live in a complete education desert: They have no public university available within 25 miles nor do they have broadband service to access online classes.

Although many studies have been conducted on physical access to higher education (16.3 percent of Americans do not live near postsecondary institutions), this study was the first to look into broadband’s impact on connectivity in higher education. “Complete education deserts,” according to the study, have insufficient access to the internet, defined as less than 25 megabits per second (Mbps) for downloads and three Mbps for uploads (the national average is 64 Mbps for downloads and 23 Mbps for uploads). Students in complete education deserts live more than 25 miles from a college that admits at least 75 percent of applicants.

These may be conservative estimates, the institute found. The researchers used the maximum advertised speeds from DSL providers to determine how many Americans lack internet access, even though actual speeds are sometimes half as fast. Although the study found that 2.2 percent of Americans lack sufficient internet speeds, a 2016 Federal Communications Commission report says the number is closer to 10 percent. According to the education study, two out of every three online deserts are physical ones as well, so the number of Americans living in complete education deserts is likely closer to 6 or 7 percent.

This phenomenon hits Native Americans the hardest: 11.8 percent live in complete education deserts and 22.6 percent live in physical education deserts. “This study demonstrates what many Native Americans, rural Americans, and other Americans living in education deserts already know: The internet has not untethered all of us from our geographic locations,” researchers said in the report. “As long as broadband access depends on geography, place still plays an important role in access to higher education.”

Living in an education desert affects education levels, income, and overall quality of life. The median income for an individual who does not live in an education desert was $15,000 more than a person who does not have access to higher education ($56,500 compared to $41,000).

People who live in education deserts are also 6 percent less likely to graduate from high school and 18 percent less likely to graduate from college. Only 45 percent of people in complete education deserts are currently enrolled in college, compared to 61 percent of people who live in an area with broadband and have access to local universities.

To bridge this gap, researchers suggest the federal government help increase broadband access by funding broadband deployment projects in rural areas. Once communities have faster internet speeds, colleges could help students access higher education by continuing to provide aid for books, supplies and transportation. Community colleges could also partner with selective public and private institutions in the area to create programs that allow students to ease into a four-year program after starting at a two-year college or receiving an associate degree.

Black Women Will Be Most Affected by Janus

Janus v. AFSCME could profoundly affect the ability of public-sector workers to improve their wages and working conditions. The case threatens the right of the majority of workers to bargain with their public employer, through their democratically elected union.

While the outcome of Janus will affect about 17 million public-sector workers across the country, black women in particular could be hurt by Janus, as they are disproportionately represented in public-sector jobs. They make up 17.7 percent of public-sector workers, or about 1.5 million workers.

Black women have traditionally faced a double pay gap—a gender pay gap and a racial wage gap. EPI research has shown that black women are paid only 65 cents of the dollar that their white male counterparts are paid. However, unions help reduce these pay gaps. Working black women in unions are paid 94.9 percent of what their black male counterparts make, while nonunion black women are paid just 91 percent of their counterparts.

If the Supreme Court decides in favor of weakening unions, it will impact the future of democratic decision making in the workplace and the preservation of good, middle-class jobs in public employment that have traditionally benefited African American women who have chosen to serve the public for their careers.

 

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