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June 1, 2023 | Volume 27, No. 4| Archives
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| In This Issue:
- Budget & Debt Ceiling Debacle
- Medicaid Work Requirements Don't Work
- Medicare for All Legislation Re-Introduced!
- A CLOSER LOOK: Three Kinds of Murder...
- SUD Research in the News
- COVID Corner: C19 No Longer an Emergency
- What We're Reading
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| Budget and Debt Ceiling Debacle
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After much political wrangling, the House passed a bill to raise the debt ceiling last night, with the Senate poised to vote by the end of this week. With the country likely to default on its debt on June 5, Congress and the Biden Administration are trying to come to agreement on a deal to move forward. Last month’s Mobilizer gave an overview of the $130 billion in cuts to non-defense discretionary funding as well as work requirements in many public assistance programs (e.g., TANF, SNAP, and Medicaid) that House Republican leadership was demanding in exchange for raising the debt ceiling.
The current deal agrees to raise the debt ceiling for 2 years (pushing it beyond the 2024 Presidential election), keeps non-defense discretionary spending nearly flat in FY2024 (rather than the $130 billion cut), caps spending FY2025 to 1%, claws back about $28 billion in COVID-19 relief funds from states, expands work requirements in SNAP and TANF (but not Medicaid), cuts some of the funding for the Internal Revenue Service, restarts student loan repayments, makes no changes to the climate measures passed last year in the Inflation Reduction Act, and expedites a natural gas pipeline in West Virginia.
The clawback of COVID funds could undermine public health efforts, and a flat-funded non-defense discretionary level is still a cut given the impact of inflation. See the statement from our partners at the National Low Income Housing Coalition for what this means for housing funding. The expansion of work requirements in SNAP is particularly outrageous. While the deal exempts people experiencing homelessness from the work requirement, it expands the age requirement from 49 to 54 and will certainly mean that fewer people are able to receive food assistance. A CBO analysis found that “Overall, the increase in total earnings from TANF’s work requirements is about equal to the reduction in benefits. In contrast, work requirements in SNAP and Medicaid have reduced benefits more than they have increased people’s earnings.” (More information here on the provisions of the work requirements being proposed for SNAP and TANF.)
You can find the full bill text here. It’s ridiculous that Republican leadership is holding the nation’s economic well-being hostage to a partisan political agenda in the first place. While the deal avoided the worst of the proposed cuts and any work requirements for Medicaid, this issue isn’t going away (see below for more on this).
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| Medicaid Work Requirements Don't Work
Republicans in Congress continue to push for work requirements across key federal assistance programs for basic needs (TANF, SNAP, and Medicaid). No matter how the debt ceiling and budget conversations shake out, this utterly cruel, ineffective policy will continue to be a central part of the conservative agenda. Every credible evaluation conducted on Medicaid work requirements shows they don’t work (see below for the latest in research).
Most recently, the Congressional Budget Office (CBO) did an analysis of the Medicaid work requirement contained in the Republican budget—the Limit, Save, Grow Act of 2023—and found “federal costs would decrease, the number of people without health insurance would increase, the employment status of and hours worked by Medicaid recipients would be unchanged, and state costs would increase.” Specifically, the CBO estimates that 1.5 million Americans would lose federally funded Medicaid coverage. However, this is likely a conservative estimate. Because the policy specifically targets the “single adult” population that became eligible for Medicaid under the Affordable Care Act, the Centers for Budget and Policy Priorities (CBPP) has estimated that 10 million people would be at risk of losing coverage under the policy. Further still, an HHS analysis found that 21 million people could lose access to health insurance coverage under the policy. Whether it’s 1.5 million or 21 million (or somewhere in between), work requirement policies are designed with no other purpose than to deny poor people health care—and that ain’t right!
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Take Action on the Medicaid Work Requirements: - Call your representatives and senators and tell them to OPPOSE Medicaid work requirements—this time and every time!
- Ask them: if they don’t want people using public benefits, why don’t they support livable wages for all people?
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| Medicare for All Legislation Re-Introduced
On Wednesday, May 17, Congresswoman Jayapal, Congresswoman Dingell, and Senator Sanders introduced the Medicare for All Act of 2023 bills in both the House and Senate. (Watch the 45-minute press conference here.) H.R.3421 has 112 co-sponsors in the House (though the Senate bill has yet to be assigned a bill number).
How does Medicare-for-All benefit the HCH Community? Our issue brief explains how it would:
- Help prevent and end homelessness
- Benefit non-profit community employer
- Benefit individuals experiencing homelessness
- Benefit clinical providers
- Benefit everyone and is the right thing to do.
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Take Action on Medicare for All: - Call your representative and senators and ask them to co-sponsor the bill.
- Schedule an in-person meeting with your representative and with each of your senators—or with a health policy staffer at their district office.
- Write an op-ed or letter to the editor supporting the Medicare for All Act.
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| A Closer Look: Three Kinds of Murder...
By Barbara DiPietro, PhD, Senior Director of Policy
I can’t stop thinking about Jordan Neely—who was killed by another rider on a New York City subway car in the middle of the day on May 1 in full view of others. One witness joined in the killing, while others stood by and filmed it. No one stopped it; many simply fled.
Jordan’s crime? He raised his voice, said he was hungry and thirsty, and threw his coat on the floor of the subway car. He was also Black, homeless, and struggled with mental health issues. Apparently he was also “acting erratically.” None of these are crimes, of course, but his killer not only felt justified in killing him, but he was then lauded as a hero. It required days of public pressure before charges were brought against him. Jordan’s murder happened after local elected officials spent months criminalizing the presence of homeless people in the subway system. Jordan’s death was yet another example of how poor people—often Black, Brown, and Indigenous people—are murdered every day through various forms of violence.
But let’s take a closer look at the concept of murder. Seems to me there are three kinds of murders that happen to poor and/or BIPOC folks in this country:
- Deaths from direct physical violence
- Deaths from indirect policy violence
- Deaths from silent assent violence
Murder #1: Direct physical violence
This is most clear-cut type of murder. These murders are committed through police violence (e.g., Tamir Rice, Eric Garner, Breonna Taylor, George Floyd, Tyre Nichols, James Boyd—just to name a few.). They happen through vigilante executions (e.g., Jordan Neely, Trayvon Martin—just to name a few). Or they happen simply through the pervasive community violence that increasingly targets BIPOC and/or homeless people (e.g., Ahmaud Arbery, Patrick N. Shenaurlt, Morgan Holmes—just to name a few). This is why violent death among people experiencing homelessness is much higher than the general public (e.g., death reports from Los Angeles County, Minnesota, and Seattle-King County—just to name a few).
I asked our consumer and clinical leadership for their thoughts on this, and here’s what they said:
“People fear what they don't understand and it seems so much easier for them to kill than to learn. I have dealt with mental wellness issues my whole life and I truly understand the feeling of discrimination because of it—on top of being homeless. Those that suffer from mental wellness issues are the most misunderstood individuals and for some reason people hate us, fear us, run from us, and kill us. Maybe it's like looking in a mirror and it's too hard for them to see so they would rather kill the reflection.” ~ Deidre Young, Chair, NHCHC National Consumer Advisory Board (NCAB)
“There is a constant threat of physical violence—as well as actual violence—perpetrated against people experiencing homelessness. The vigilance required to stay alert to protect oneself takes a toll on the body, not to mention the enduring trauma after someone has been assaulted. Unhoused people are much more likely to be the victim of a violent crime than to be the perpetrator—so much so that in DC, an act of violence against someone experiencing homelessness is a designated hate crime.” ~ Catherine Crosland, M.D., Chair, NHCHC Clinicians Network Steering Committee
Murder #2: Indirect policy violence
This type of murder is also committed by members of the general public who financially support and vote for these elected officials. Votes are conscious choices that can either cause death—or enhance life.
Murder #3: Silent assent violence
These murders are committed by those who say and do nothing in the face of direct and indirect violence. Those who choose not to vote, those who ignore the problem, those who turn away from the conversation because it’s “uncomfortable” also cause deaths. Silence from White people (especially White liberals) is a driver of this type of murder—and possibly one that needs the greatest attention. Racism is violence. Transphobia is violence. Misogyny, ableism, and xenophobia (just to name a few) are violence. Remaining silent is the biggest enabler of the violence that is happening every day. As the (adapted) saying from Edmund Burke goes: “The only thing necessary for evil to triumph in the world is that good people do nothing.”
How often have you remained silent when you should have spoken up? How often have you turned away when you should have engaged? For those who identify as White, how often have you believed this had nothing to do with you? Standing up, ending the silence, educating ourselves, supporting constructive public policies (and policymakers), and being active in the struggle for Justice is the only way all of us will end these murders.
"Everyone in society bears responsibility because we have allowed these conditions to exist and persist for a long time." ~ Bobby Watts, CEO, NHCHC
Finally, I haven’t mentioned a fourth kind of violence: traumatic injury to the spirit and soul of all types of people. From the millions of interpersonal microaggressions, to the constant threats of violence, to the lack of even basic respect and dignity shown to fellow neighbors— our society attempts to kill the spirit and demoralize the soul of poor, homeless, BIPOC, and other people in an attempt to keep them oppressed. And that ain’t right.
It’s time for the murder to end. What will YOU do to help end it?
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| SUD Research in the News
In the ongoing struggle to achieve access to equitable, high-quality substance use disorder (SUD) treatment that adopts a harm reduction approach, a number of new studies are recently available:
Safe consumption sites: Further, the U.S. government has just awarded $5 million for a large study measuring whether overdoses can be prevented by safe injection sites. New York University and Brown University will study two sites in New York City (and one opening next year in Providence, Rhode Island) by enrolling 1,000 adults who use drugs to study the sites’ effects on overdoses, to estimate their costs and to gauge potential savings for the health care and criminal justice systems. But let’s call this what it is: stalling. People are continuing to die of overdoses while the U.S. dithers on solutions that have already been proven. It’s beyond time for the federal government to approve these sites.
An SUD Advocacy WIN: The U.S. Drug Enforcement Agency (DEA) recently proposed to restrict buprenorphine via telehealth, requiring an in-person visit before further prescriptions can be issued. We thought this was a bad idea for a number of reasons (see our letter)—and apparently lots of other people did too because the DEA received 35,000 letters (most in opposition). Hence, the DEA is now extending the existing telehealth policy (though we’ll advocate to ensure it becomes permanent).
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| COVID Corner: C19 No Longer an Emergency
May 11 marked the end of the federal COVID-19 public health emergency (PHE) declaration—ending a PHE that has been in place since January 31, 2020. With it, a number of the policy flexibilities, services, and program expansions that flourished during the last few years are now also ending. However, health centers remain places where patients can get information, vaccines, treatment, and testing for COVID-19 regardless of insurance status and/or ability to pay (though service delivery may look different than before).
The biggest impact to the HCH Community is the “unwinding” of the Medicaid continuous eligibility provision, which means everyone in the program gets redetermined for eligibility. HHS estimates nearly 15 million will lose coverage, even though nearly 7 million of those people will remain eligible. Prior Mobilizers in February, March and April have focused on this issue—and we remain concerned about how states are communicating the determination process to Medicaid recipients. A recent survey found most Medicaid enrollees were not aware that states are not permitted to resume disenrolling people. Use our Unwinding Issue Brief to ensure your clients/patients are not among those who lose coverage.
Resources:
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Did you receive Mobilizer as a forwarded email or hear about it via social media? Register now to receive our action alerts each month!
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Barbara DiPietro
Senior Director of Policy
National HCH Council
Baltimore, MD
bdipietro@nhchc.org
(443) 703-1346
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This publication and all HCH advocacy are funded by dues from Organizational Members of the Council and by private donations. Consider joining the Council to support this work.
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