Tapped: The Prospect Group Blog

Veterans Face Another Round of Threats to Health-Care Networks

In September, The American Prospect reported that budget cuts at the Veterans Health Administration would have eliminated the system’s ten Patient Safety Centers of Inquiry. After protests from leading patient safety experts and members of Congress, the centers were saved. But late last month, brand new threats emerged that could jeopardize the VHA’s ability to serve mentally ill, homeless, and female veterans; prevent veteran suicide; and increase access to needed services.

An internal VHA memo signed by Poonam Alaigh, then acting under secretary for veterans affairs for health, informed VHA deputy under secretaries, chiefs of staff, and network directors that they are free to shift almost $1 billion in funds allocated to specific VHA programs either to their general operating budgets or to finance Veterans Affairs Secretary David Shulkin’s five new VHA priorities. Shulkin’s priorities include outsourcing more care from the VHA to private-sector hospitals and doctors as well as creating more suicide prevention programs.

The memo obtained by the Prospect has caused a stir at the agency’s downtown Washington headquarters and the funding transfers were temporarily put on hold.  But after agency officials conduct a detailed review, some cuts may still go forward.

Homeless veterans advocates are deeply disturbed that the list of targeted programs includes more than $265 million in spending for the Housing and Urban Development’s VA Supportive Housing (HUD/VASH) program’s social workers who work with homeless veterans. The HUD/VASH program “is the chief strategy to reduce veteran homelessness,” says Randy Shaw, who directs the Tenderloin Housing Clinic in San Francisco.

“The HUD/VASH program has allowed VHA case managers to work in partnership with local and municipal homeless programs to reach chronically homeless vets,” says Michael Blecker, the executive director of Swords to Plowshares, a San Francisco veteran service organization. “Allowing the program to literally be zeroed-out sends the worst message to all the VHA partners who have helped make the program so successful.” Anything that jeopardizes HUD/VASH social workers or vouchers, Shaw agrees, would be “disastrous.”

Other programs on the chopping block include $30 million in additional mental health initiatives and $21 million for coordinators who help Iraq and Afghanistan veterans transition to civilian life. Potential downsizing or elimination of the delivery of mental health and rehabilitation services, suicide research, and myriad of other programs jeopardize the secretary’s stated commitment to preventing veteran suicide among veterans.  

The new shifts in funding also target funding for spinal cord injury programs, rehabilitation programs, and amputation care for those who have suffered disabling injuries on and off the battlefield. The plan also includes trimming almost $26 million allocated to Mental Illness Research Education and Clinic Centers. These Centers do pioneering research on the causes and treatments of mental disorders and translate this new knowledge into routine clinical practice with veterans. 

Almost $23 million in funding for occupational health and safety programs could be eliminated and some training programs for VHA staff have already been canceled. These programs teach staff how to safely lift and handle vulnerable veterans in VHA hospitals and nursing homes as well as how to deal with “disruptive” veterans who are a danger to themselves as well as those who care for them. Programs to prevent workplace violence have also been targeted. After much prodding from women veterans and groups like the Iraq and Afghanistan Veterans of America (IAVA) the VHA initiated many programs to better serve women veterans. Potential cuts, however, include $6 million devoted to women’s health.

Although the secretary insists he wants to increase veterans’ access to needed services and recruit staff to fill the VHA’s 34,000 vacancies, potential shifts in funding away from primary and geriatric care, and telehealth, will also affect access. If the secretary is really committed to expanding access to VHA services, why is the VHA’s “Educational Debt Reduction” program, used to provide incentives to recruitment in rural areas, on the list?

The memo tries to soften the blow of these proposed cuts by suggesting that giving medical and regional directors the flexibility to use funds allocated for specific programs as they see fit won’t “completely eliminate” specific programs. This optimistic assessment ignores current fiscal reality at the VHA. The cost of outsourcing VHA care to the private sector, has, according to another internal VA memo been a “major driver, in budget shortfalls for VHA facilities across the country.”

Medical centers and regional offices have been strapped for cash to fund operating expenses. Without additional infusions of funding, directors will be very tempted to use these newly available funds to pay for day-to-day operations.

VHA officials would not have to resort to the types of choices that could inflict more pain on the men and women who have fought in the country’s wars, if President Trump backed adequate funding levels for the agency. Ken Watterson, president Dallas Veterans Resource Center and founder of Homeless Veteran Services of Dallas, says Washington needs start listening: “It’s time for veteran service organizations— and veterans—to make it clear that balancing the budget on the backs of veterans is not the choice they want.”

Transgender Protections Rollback by Sessions Draws Scrutiny

While Americans focused on the tragedies unfolding in Las Vegas and Puerto Rico, Attorney General Jeff Sessions quietly rescinded a memorandum that protected transgender people from workplace discrimination.

Eric Holder, President Obama’ first attorney general, had issued the memo in December 2014, extending the Civil Rights Act’s Title VII protections against employment discrimination to transgender people on the basis of gender identity, a separate category from sex. Sessions’s memo, which was circulated on October 5, noted that the protections on the basis of sex “[did not] encompass discrimination based on gender identity per se, including transgender status.” A DOJ spokesman defended Sessions’s decision, saying “The Justice Department cannot expand the law beyond what Congress has provided; Unfortunately, the last administration abandoned that fundamental principle, which necessitated today’s action.”

Kris Hayashi, the executive director of the Transgender Law Center, criticized Sessions’s legal argument—that Title VII’s language doesn’t apply to “transgender status”—as a way to circumvent anti-discrimination laws: “The Department of Justice memo on Title VII tries to undo established law protecting transgender employees simply by wishing it so,” he said in a statement. “This is a vicious action intended to cause confusion where there was none.” Others, like Sharon McGow of Lambda Legal, argue that Sessions’s announcement also contradicts previous federal rulings: in 2012, the U.S. Equal Employment Opportunity Commission ruled that transgender workers are protected under Title VII. McGow told NBC News that the memo was “weak and thin in terms of legal analysis,” and that it “ignores two decades of law that have essentially unanimously concluded that discrimination against transgender people is a form of sex discrimination.”

Rescinding the Obama administration policy is yet another signal that LGBTQ rights are a low priority for the Trump administration. “Courts have repeatedly ruled that transgender people are protected by sex discrimination laws in employment, education, housing and healthcare,” said Mara Keisling, the executive director of the National Center for Transgender Equality, in a statement. “We’ll see him in court.”

Transgender people are also more likely to live in poverty than the rest of the general population. In the face of discrimination, transgender people often have had to resort to illicit work to survive. According to a 2015 survey by the National Center for Trans Equality, almost 20 percent of transgender respondents reported that they had engaged in some form of sex work for food, money, or shelter, risking disease, incarceration, and violence.

Transgender people are a highly marginalized group, even within the LGBTQ community. The Anti-Violence Project found that between January and August of 2017, 50 percent of LGBTQ homicide victims were transgender or gender-nonconforming people. Transgender women of color are killed at higher rates than other groups, and they face higher rates of domestic violencehomelessness, and unemployment than other LGBTQ people.

Democrats Ponder How to Revive Antitrust

With economic inequality soaring to heights not seen in the United States since the progressive era of the early 20th century, it makes sense that some issues on the policy agenda from that bygone age are re-emerging today. Among them: antitrust.

In recent years, the rise of corporate concentration, its negative effects on the broader economy, and the atrophy of antitrust enforcement have become the subject of increasing progressive concern. While some liberals argue that lax enforcement is the problem, a growing number contend that the statutes themselves, or at least the standards by which the consequences of concentration should be measured, need to be expanded.

On October 5, the Democrats on the House Judiciary Committee and members of the House Progressive Caucus jointly hosted a discussion of how best to revive a serious antitrust program, in which panelists offered divergent views of both the diagnosis and the cure. Diana Moss, president of the American Antitrust Institute, argued that the problem was the weak enforcement of existing law. She noted that the Federal Trade Commission has brought claims that a company has violated Section 2 of the Sherman Act—the blockbuster 1890 law that made it illegal for any person to monopolize or attempt to monopolize part of the economy—fewer than ten times in the last 20 years, but that on paper, at least, existing antitrust law like the Sherman Act and the consumer-welfare standard for merger review are sufficient to address the problem of contemporary market consolidation, if regulators are given the incentives to enforce them.

Taking a different tack, Marshall Steinbaum, the director of research at the Roosevelt Institute, contended that the consumer-welfare standard, which sees costs to consumers as the primary measure of anti-competitive behavior, has been outmoded by contemporary practices. He illustrated this with the example of Amazon’s acquisition of Whole Foods: Amazon promised to cut consumer prices in the weeks before the deal, and in turn the FTC spent less than a month reviewing the merger for antitrust concerns. Just weeks after the acquisition, however, Amazon centralized decision-making about how local suppliers would be allowed to advertise their goods in-store, a decision that may make it difficult for small suppliers to gain a foothold in stores.

Two other panelists, Marcellus Andrews, an economist at Bucknell University, and Lina Khan, director of legal policy at Open Markets (the recently formed antitrust group that broke away from New America), both made clear the breadth of issues affected by antitrust laws. “It is difficult to overstate the effects of market concentration,” said Khan, noting that concentrated supply chains in Puerto Rico meant that damage caused by Hurricanes Maria and Irma had caused a nationwide drug shortage. Andrews played out some of the implications of antitrust for racial justice, noting that the “monopoly premium,” the additional cost of a good above the market price added on to it by a monopolizer, multiplied the impact of credit discrimination against minority communities.

Antitrust has gained more prominence since this summer, when Democrats made it a centerpiece of their “Better Deal” agenda. But coming up with specific policies to deal with the most pressing issues raised by economic concentration is no small challenge. Representative Keith Ellison, who took on role of host at the forum, also took time to plug his bill, the Independent Retrospective Merger Act, which would task the Department of Justice’s Antitrust Division and the FTC with evaluating whether a merger hurt consumers or promoted anti-competitive behavior. Ellison’s bill could help regulators respond to acquisitions like the one Amazon made, where arguably anti-competitive practices began only weeks after a merger.

Forums like these are signs that antitrust, the vogue of early 20th-century America, is back on the rise.

Americans Say Mainstream Media’s Coverage of Science Is Less Than Stellar

A September Pew Research Center poll has reinvigorated the years-old debate over how mainstream news media outlets cover science.

Pew found that even though half of Americans believe that “specialty sources” like science magazines, documentaries, or science museums present scientific information correctly, few people actually rely on them for news about science—even though they believe that news outlets often fail to present scientific developments accurately.

Most people—54 percent—regularly get their information on hot-button policy issues like vaccination, stem cell research, GMOs, and climate change from newspapers, magazines, and other general news outlets that cover a wide variety of science issues and stories. But even though only 28 percent of those surveyed said these sources “get the facts right” most of the time, just 25 percent turn to science magazines, and only 12 percent rely on science museums for information.

Not surprisingly, Americans are not pleased with this situation. When asked whether the news media did a “good job” or a “bad job” of covering science, 57 percent responded that they did a good job, while 41 percent said they did a bad job. Pew also asked respondents if problems with science coverage rested with “the way reporters cover it” or “the way researchers publish it.” More than 70 percent of respondents identified reporters as more of a problem, while only 24 percent thought researchers were at fault. (Pew conducted the poll in late May and mid-June, surveying about 4,000 adults.)

Scientists and researchers also have complained about lackluster mainstream news stories. In 2015, Harvard University PhD student and researcher Samuel Mehr spoke out about how newspapers and magazines simplify scientific findings, in response to coverage of a study he had co-authored.

Mehr and his co-authors focused on how music classes could affect the cognitive abilities of children. In the study, one group of children received six weeks of music lessons while other groups of children participated in art projects or had no organized activities. When all the children took a cognitive test at the end of the six weeks, the children in the music classes performed no better than the other groups of children.

But Mehr acknowledged that there were a number of caveats that could explain why the music classes did not seem to have an effect on the children’s cognitive test scores. Time magazine’s report on the study, however, concluded that “music may not make you smarter.” Mehr pointed out that the actual study did not measure intelligence, and that the reporter had confused correlation with causation.

Nearly a decade ago, science writer Cristine Russell offered suggestions for journalists covering climate change. Russell explained that when new findings about climate change surface, “the subtleties of the science, and its uncertainty, might be missed by reporters unfamiliar with the territory.” Because the results of one study can be contradictory to other studies, Russell said that scientists look for consistent patterns throughout multiple studies before coming to a conclusion. “Journalists should avoid ‘yo-yo’ coverage with each new study and try to put the latest findings in context,” she said.

Today, the problem that Russell identified continues to seep into mainstream news reports. According to Pew, this “yo-yo” coverage was one of the bigger issues in science news that Americans identified: 43 percent of Americans believed that the media are “too quick to report findings that may not hold up.” Another 30 percent also said the news media oversimplify research findings.

In March, Alex Berezow of the American Council on Science and Health, along with editors from RealClearScience, ranked mainstream news outlets’ science coverage using two criteria: How much of the coverage was based on evidence, and how compelling the science stories were. The highest-ranked sources were niche publications like the weekly science journal Nature and Science Magazine. However, a few general news outlets like The Atlantic, Vox, and The Guardian ranked highly. (Two outlets that Berezow writes for—The Economist and the BBC—also did well in the rankings.)

However, NPR, The Washington Post, MSNBC, and CNN fared relatively poorly. Berezow was particularly critical of The New York Times, which he said frequently gives a platform to “fringe” doctors, “pseudoscientific claims,” and discredited studies.

Though Berezow’s rankings are based on only two criteria and include just a fraction of news sources, his findings also highlight some of the mistakes many journalists frequently make. The warning signs include: failing to explain a study’s methodology or using technical terms (which suggests that the writer didn’t understand the original report); failing to include any “limitations on the conclusions of research” and making sweeping conclusions based on a single study; or trying to connect the results of a single study to larger, unrelated issues.

Berezow concluded that inaccurate reporting not only mars the reputation of an individual reporter and his or her outlet, it damages the credibility of journalists everywhere.

Latino Voting Rights Groups Gear Up for 2018

Encouraged by Donald Trump’s poor approval ratings and an unproductive Congress, Democrats believe that they can make up some ground in the 2018 midterms. But if the party wants to make waves, they will need to get Latinos, one of their key voting blocs, to the polls. Nearly 70 percent of Latinos voted for Clinton in 2016, but Latino electoral power has been hamstrung by low voter turnout. In the 2014 midterms, only 27 percent of eligible Latino voters went to the polls, a record low.

Voting rights activists are working to shake up that dynamic. During Hispanic Heritage Month (September 15 to October 15), three of the largest Latino civic engagement organizations, Voto Latino, iAmerica, and Mi Familia Vota launched the “Register, Ignite, Strive, and Engage” (RISE) voter registration campaign. The campaign aims to shift the heritage month’s focus from cultural celebrations to political organizing.

Jessica Reeves, the chief operating officer of Voto Latino, points out that Latinos would suffer disproportionately under Republican proposals like repealing the Affordable Care Act. Prior to the passage of the ACA, 40 percent of working age Latinos were uninsured; by 2016, only 24 percent lacked insurance, a number that would certainly spike if the ACA went by the wayside.  

Latinos have been one of President Trump have been favorite targets. His signature campaign promises included building a border wall and portraying Mexicans as criminals. ICE arrests of undocumented people, which have had a particularly devastating effect on Latino communities, have increased under Trump. The president has also promised to end the Deferred Action for Childhood Arrivals (DACA) program next year unless Congress passes a new version of the bill. Nearly 80 percent of DACA “total potentially eligible” youth are from Mexico or Central America, according to the Migration Policy Institute, a Washington-based think tank.

RISE aims to use these issues as political organizing tools in Latino communities. The campaign has partnered with more than 200 local and national organizations, such as Planned Parenthood and the Environment Defense Fund, to help them engage with Latino voters on specific topics. The group is especially keen to get out the youth vote. Nearly one million Latinos turn 18 every year, but only 15.2 percent of millennial Latinos voted in the 2014 midterms. (Reeves notes that young Latinos are more likely to be key decision-makers in their households at earlier ages than their white peers, but are less likely than older Latinos to vote.) RISE has also been reaching out to LGBTQ people, Afro-Latinos, and indigenous communities that tend to be overlooked.

Many House and Senate races will be a tough slog. If Democrats hope to topple Republicans like Jeff Flake of Arizona and Dean Heller of Nevada, turning out Latinos voters who make up a large share of the electorate in those two states is critical.

Getting Latinos to the polls to big numbers in 2018 is one way to check Trump’s bigotry. “Latinos have been in the crosshairs of the Trump administration,” says Reeves and the RISE coalition intends to help “the community to come together.”  

New Police Crimes Database Provides Law Enforcement Accountability Tool

In September, Bowling Green State University in Ohio published the country’s first online police crime database. It’s a small but noteworthy milestone for groups like Black Lives Matter who have called for greater law enforcement accountability as police brutality and the shootings of African Americans by officers have continued to dominate headlines.

The Henry A. Wallace Police Crime Database covers a seven-year period from 2005 to 2012 in all 50 states and the District of Columbia: 8,006 cases were brought against 6,596 officers from 2,830 municipal departments nationwide. There are 18,000 police departments and 1.1 million sworn officers in the United States.

The database includes information about individual police officers who have been arrested—sometimes by their own departments—on felony and misdemeanor charges ranging from disorderly conduct to aggravated assault. But it is short on details, only identifying each officer by his or her badge number. There is little information about officers who were put on probation or served time in prison.

According to Phil Stinson, the Bowling Green State University professor of criminology and  former police officer who created the database, many officers who are caught committing a crime are given the option to resign quietly instead of facing a trial. “Granted, because everyone who is in the database has been arrested or charged,” Stinson says, “we don’t know a lot about the misconduct of police officers if it doesn’t result in them being brought into the criminal justice system or some other formal way.”

Moreover, police departments are notorious for being reluctant to disclose evidence relating to alleged officer misconduct. In October 2014, a Chicago police officer shot 17-year-old Laquan McDonald when they were called to his neighborhood after getting reports of a black teenager wandering around with a knife. It took more than a year and countless hearings for McDonald’s family to get access to the dashboard video that depicted the shooting that cost McDonald his life. A nearby Burger King surveillance camera also recorded the shooting, but before the McDonald family or media could access the video, police officers deleted the video.

Jason Van Dyke, the officer who shot McDonald, had 20 previous complaints filed against him from citizens who complained about him using excessive force but had never been convicted of any crimes.

In its continuing push for police accountability, the BGSU database may prove to be a powerful tool for the Black Lives Matter movement. Launched after Trayvon Martin’s death in 2012, BLM has sparked a national debate about policing in African American and other minority communities. Their activism has led to certain reforms, such as the use of body cameras to record interactions with civilians, and the incremental scaling back of “broken windows” policing tactics.

The database demonstrates that crimes committed by police officers are not “one-off situation that [don’t] happen very often,” Stinson says. “People across the country, every day, are reading reports of [police officers] being arrested.” Indeed, tracking felonies and misdemeanors committed by police officers helps raise awareness of a key issue: the tendency by some police officers to treat every person of color as a potential suspect rather than as a citizen who deserves fair treatment and protection. 

Target Takes the $15 High Road. Where’s Walmart?

Target, one of the largest retail employers in the country, announced Monday that it will raise its minimum wage for employees to $11 an hour starting in October, and gradually increase it to $15 an hour by the end of 2020. The new standard applies to Target’s 323,000 regular employees as well as to the 100,000 seasonal workers it plans to hire for the holiday season.

Clearly, Target realizes that the way to attract workers (and reduce turnover) in a tight labor market is not to gripe and moan about a supposed labor shortage but to bump up pay. As the Federal Reserve of Minneapolis President Neel Kashkari put it, “If you’re not raising wages, then it just sounds like whining.”

Walmart’s decision to raise its pay to $10 an hour last year prompted Target to follow suit. Company officials initially required new employees to complete a six-month “training” period before receiving that wage rate. After intense public criticism, they shortened that period to 90 days. Other employers took to the high road years ago. Costco has for several years now paid a starting wage of $11.50 an hour with average wages reaching $21 an hour. The retailer also offers health care to most employees.

But Walmart has more power than any American company to lift up wage standards across the economy. With nearly 1.5 million employees in the United States, Walmart is the largest employer in the country. Yet, Walmart has thus far resisted calls to go higher than $10 an hour. It is nearly impossible to make a living on that kind of wage, especially if you’re working part-time—as many Walmart employees do.

The retail behemoth’s low wages, which force its employees to rely on public assistance programs, cost taxpayers an estimated $6.2 billion in 2013. Employers who insist on taking the low-wage road act as parasites and end up costing taxpayers $152.8 billion every year, according to a 2015 study by the University of California, Berkeley Labor Center.

Target is taking a step in the right direction by getting on a path to $15 an hour. Walmart should follow suit. It can certainly afford to pay its workers more money. In recent years, the company has bought back about $50 billion of its shares, funneling those profits into the Walton family fortune rather than into workers’ pockets. 

By paying at least $15 an hour, the company would not only be treating its own employees fairly; it would be lifting up wage standards throughout the economy. To focus the minds of company officials at Walmart and elsewhere, a group of House Democrats have kickstarted an idea: levy a fee on companies equivalent to the amount of public assistance its employees are eligible to receive, since their employers can’t be bothered to pay them fairly in the first place. 

Tax Cuts for the rich. Deregulation for the powerful. Wage suppression for everyone else. These are the tenets of trickle-down economics, the conservatives’ age-old strategy for advantaging the interests of the rich and powerful over those of the middle class and poor. The articles in Trickle-Downers are devoted, first, to exposing and refuting these lies, but equally, to reminding Americans that these claims aren’t made because they are true. Rather, they are made because they are the most effective way elites have found to bully, confuse and intimidate middle- and working-class voters. Trickle-down claims are not real economics. They are negotiating strategies. Here at the Prospect, we hope to help you win that negotiation.

Senator Cassidy’s Home State of Louisiana Gets Hit Hard by the Doctor’s Bill

The Graham-Cassidy bill is atrocious. “Shifting of responsibility” for health care to states simply means fewer federal dollars for most states—but that’s not unexpected. Many Republicans have made it clear that their main focus is to get rid of President Obama’s Affordable Care Act by any means necessary. Unfortunately, this particular proposal doesn’t just repeal the ACA (and with it, its marketplace subsidies and many protections for those with pre-existing conditions), it also includes massive cuts to Medicaid. For the thousands of people that gained health-care coverage through the Medicaid expansion, it’s going to hurt.

And it’s going to particularly hurt people in Senator Bill Cassidy’s home state of Louisiana.

The poverty in Louisiana, as it is across the South, is devastating—and Louisiana consistently ranks at the bottom in just about every measure related to economic hardship and its effects—it has the second highest poverty rate, second highest income inequality, third highest infant mortality rate, and the fourth lowest median household income. The rates are even starker for African Americans and other people of color. (The expression “Thank God for Mississippi,” is mean-spirited, but it does speak to a sad reality: If it weren’t for Mississippi, Louisiana and some other southern states would often be dead last in such rankings.)

When Louisiana voters elected Democrat John Bel Edwards as governor last year, the first thing he did was to expand Medicaid to thousands of Louisianans. Not only does Graham-Cassidy end the Medicaid expansion by 2020, but it also caps and cuts Medicaid funding for vulnerable populations like families with children, the elderly, and people with disabilities.

The proposed block grants are structured so that states that expanded Medicaid are effectively punished. Louisiana stands to lose $7.2 billion in federal funding by 2027—when the block grants dry up completely.

But Medicaid expansion was a lifeline to many in Louisiana. By June 2017, one year after coverage began for the expansion population, more than 433,000 Louisianans gained health insurance. The uninsured population, which was a staggering 21.7 percent in 2013, dropped to 12.1 percent. Thousands were able to access preventative care and screenings.

Senator Cassidy, a physician who treated poor people in the state’s charity hospital system, will not only vote to ruin the health and well-being of Louisiana residents—he helped write the prescription.

Rebekah Gee, Louisiana’s health secretary, sent a letter to Cassidy (which she shared on Twitter) decrying the proposed bill, noting that it “gravely threatens health care access and coverage for our state and its people.” She said that ending Medicaid expansion is “a detrimental step backwards for Louisiana.” The New Orleans Times-Picayune editorial board also criticized the bill, noting that a doctor like Cassidy shouldn’t be party to such “a dramatic erosion of coverage.”

In 1935, Huey Long, the legendary Louisiana governor and U.S. senator, told his critics, “All I care is what the boys at the forks of the creek think of me.” Today it seems that Senator Cassidy just wants to send his constituents down that creek without a paddle.

Graham-Cassidy: Republicans Kill Parents, Complain They’re Orphans

“Right now, 37 percent of the revenue from the Affordable Care Act goes to Americans in four states,” Louisiana Republican Senator Bill Cassidy, coauthor of the Republicans’ last-gasp effort to repeal the Affordable Care Act, said on Monday. Cassidy’s culprits—the four states at the center of this cosmic injustice—are California, New York, Massachusetts, and Maryland.

“That is frankly not fair,” Cassidy complained.

Well—whose fault is that? California, New York, Massachusetts, and Maryland are among the 31 states (32, if we count the District of Columbia) that agreed to accept federal funds made available by the ACA’s expansion of Medicaid; California and New York are by far the most populous of those 31 states, with nearly 60 million residents combined. Nineteen states, however, chose not to accept the federal funds that would expand their Medicaid rolls. In each of the 19, the decision not to accept the funds was made by the state’s Republican governor. This Republican impulse to discipline the poor, lest they loll around in the comfort of hospital emergency wards, is also reflected in the lower levels of Medicaid benefits that Republican-controlled states generally set.

Cassidy’s chutzpah isn’t confined to hailing as victims the actual perpetrators of the imbalance he describes. His bill to repeal the ACA contains provisions similar to ones in the previous Republican ACA repeal efforts, which the Congressional Budget Office concluded would deny Medicaid benefits to 15 million recipients. His plan is not to erase the gap between blue states and red by expanding Medicaid to eligible recipients in all states, but by throwing millions off the rolls and reducing expenditures to the levels in the neo-Confederacy (nine of the eleven Southern states that formed the Confederacy are among the 19 that refused to accept the Medicaid expansion funds), where the impulse to discipline the poor is made steelier yet by the impulse to discipline blacks and other people of color.

Cassidy’s vision of fairness, finally, is to have no Medicaid at all. That way, the sick and the poor in blue states won’t be able to lord it over the sick and the poor in the red ones. What could be fairer than that?

VHA Budget Cuts Threaten Veteran Safety

The Department of Veterans Affairs (VA) is considering budget cuts that could jeopardize patient safety in the nation’s largest health-care system. On the chopping block are ten VA Patient Safety Centers of Inquiry (PSCIs), facilities that have long pioneered innovations to reduce injury, addiction, and suicide that have impacted patients far beyond the VA system. While the administration claims such goals are high priorities, these facilities could be shut down by September 30.   

The potential closure of these patient safety centers is part of a broader attempt to cut costs within the nation’s largest health-care system. Surging demand for services at the Veterans Health Administration (VHA) and the high cost of paying for expensive, outsourced care in the private sector through the Veterans Choice and other Community Medical Care programs has caused a significant budget shortfall in VHA facilities across the country.

Despite this shortfall, Trump refuses to go to Congress for more money than currently budgeted for the VHA. Now VA leadership is focused on shifting pots of money from what are known as specific-purpose budgets (which includes the PSCI’s small $2.5 million budget) to general-purpose budgets. In the case of these patient safety centers, this robbing-Peter-to-pay-Paul approach will hurt veterans rather than help them. Since the VHA’s leadership in patient safety extends way beyond VHA facilities and the patients served by them, this move may also impact millions of non-veterans who also benefit from VHA research and safety practices.

In a country where more than 250,000 patients die each year due to preventable medical errors (which are America’s third leading cause of death) and more than 1.5 million are seriously injured, the VHA has become a beacon of progress in patient safety. Since the mid-1990s, the VHA has been “a bright star in the constellation of safety practice, with system-wide implementation of safe practices, training programs,” according to physicians and patient safety leaders Donald Berwick and Lucian Leape.

As patient safety leaders have long documented, turning theory into safe practice involves way more than passing around scientific journal articles, or writing patient safety policies and protocols. Motivating front-line caregivers to do everything from cleaning their hands to prescribing opioids safely involves putting what is known as evidence-based medicine and best practices into actual daily use.

Today, at the veterans hospital in White River Junction, Vermont, the Patient Safety Center of Inquiry has developed tools aimed at sharing critical information about the early warning signs of suicidal behavior among veterans. Their counterparts in Durham, North Carolina, are trying to target extremely painful surgical procedures, like the knee replacement operations so common in the aging veteran, and help surgeons manage patients’ pain without overreliance on addictive opioids. One goal of this program is to keep former members of the armed forces from adding to the grim national death toll of the opioid epidemic.

At the PSCI in Tampa, Florida, VHA researchers are designing new tools to reduce the risk that older veterans will fall and break a hip, either in their own homes or an in-patient setting. Meanwhile, the PSCI in Boston is developing ways to reduce exposure to potentially fatal hospital-acquired infections like methicillin-resistant Staphylococcus aureus.

VHA safety leaders say they are stunned by the proposed closure of their PSCIs. “VA leadership is looking for easy answers and quick solutions and are not taking the time to fully understand the consequences of their actions,” a long-time VA patient safety researcher told The American Prospect. “They are so focused on issues of access that they don’t ask questions about what kind of system patients have access to.”

Doctors like Lucian Leape share these fears. In a letter to VA leadership, Leape protested the potential closure of PSCIs, praising the centers’ “important contributions,” and said he echoed the “concern of other patient safety leaders nationwide that losing the PSCI program would terminate one of the most efficient and productive translational safety programs in the VA.” Hopefully, the Trump administration will not decide to pinch pennies at the expense of veterans’ lives.

 

 

 

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