Statement on big brutal bill

 The American Friends Service Committee issued this statement on the occasion of the signing of the federal bill that will cut taxes for the wealthy and take food and health care away from millions of low-income and working class Americans.

Today, President Donald Trump signed a bill that will initiate one of the largest ever transfers of wealth from the working class to the rich. It will strip health care coverage from millions of low-income people, deprive children of food, accelerate climate change, and funnel billions to military contractors for weapons that threaten human survival. 

To say we oppose this legislation is an understatement. As a Quaker organization, we believe all people contain the Light of God within us. These policies abandon our fundamental commitment to caring for all people and the Earth that we share. If unchallenged, this legislation will directly and indirectly contribute to the suffering and death of so many people in the U.S. and around the world. 

The bill includes:

The largest cuts to public health care in U.S. history, leaving an estimated 17 million people without health coverage and causing an estimated 51,000 premature deaths per year.

New restrictions on SNAP and other anti-hunger programs, which will deprive millions of children of basic nutrition and the opportunities they need to succeed.

Trillions of dollars in tax cuts that provide almost nothing for the poor and working class, while showering the wealthiest households in the U.S. with massive benefits.

New subsidies for fossil fuel corporations while slashing tax credits for renewable energy projects.

More than $150 billion on the Pentagon for its forever wars and wasteful projects.

Billions for cruel anti-immigrant policies that tear our families and communities apart, including expanding detention centers and adding thousands more ICE and Border Patrol agents.

We cannot and will not accept this anti-human framework as the new status quo. Our government should provide for public needs, not transfer billions from the poor and working class to the rich. Already, protests and acts of resistance have been taking place across the country in response to the anti-democratic, anti-working class, anti-immigrant policies of the Trump administration. As the impacts of this legislation are felt nationwide, this resistance will only grow. 

Everyone deserves access to health care, housing, freedom from violence, and the ability to participate in the decisions that impact our lives. While Congress, the courts, and the president have chosen to pursue policies that harm our communities, we can care for and defend one another. We call on all people – in the corridors of power and in every corner of this country – to reject and resist these policies and to work for the future we all deserve. 

The American Friends Service Committee (AFSC) promotes a world free of violence, inequality, and oppression. Guided by the Quaker belief in the divine Light within each person, we nurture the seeds of change and the respect for human life to fundamentally transform our societies and institutions. We work with people and partners worldwide, of all faiths and backgrounds, to meet urgent community needs, challenge injustice, and build peace.

Big bad ugly bill

 British author and poet George Orwell wrote in his 1946 essay Politics and the English Language, “In our time, political speech and writing are largely the defense of the indefensible.”

While confronting the monstrosity of the so-called “big beautiful bill” that recently passed the House of Representatives, one might imagine Orwell hollering at us from the past, “Did I call it or what?”

If this bill didn’t have life or death implications for millions of Americans, we could almost laugh at the recent image of moneyed politicians, victorious after the bill narrowly passed the House, their pockets lined with corporate cash, standing behind a sign that reads: “One Big Beautiful Bill Act.”

But nothing funny nor beautiful can be found in a bill that adds trillions of dollars to the national debt, strips health care and food assistance away from millions of Americans, all to pay for an extension of tax cuts, the lion’s share of which benefit the wealthiest one per cent. 

How could we be fooled into not seeing that this budget bill is what economics columnist for the Washington Post Catherine Rampell calls “a transfer of wealth from the poor to the rich”?  

At over 1,000 pages, I’ll concede that the bill is big, which is by design.  The sheer volume of it, the number of programs and tax policies it touches makes it difficult for most of us to understand all the implications of a budget bill this size.  My friend and colleague with American Friends Service Committee Rick Wilson has often quipped, “Taxes and budgets are boring. Breathing is boring too until someone starts choking you, in which case it’s fascinating.”

We should be fascinated – and equally horrified - by what is in this bill. According to Urban-Brookings Tax Policy Center, two-thirds of the proposal’s tax cuts benefit only those earners in the top quintile of income brackets.   

Cuts to the corporate tax rate, which decreased from 35 per cent to 21 per cent after the tax cuts were originally passed in 2017, would be made permanent.  Those corporate tax cuts have helped drain our federal coffers.  From 2018 to 2021, according to an analysis from the Institute on Taxation and Economic Policy, the top corporations in the US saved a combined $240 billion in taxes.

This massive transfer of wealth from the poor to the rich is made plain by the fact that the tax cuts would be paid for largely by cutting people off Medicaid and SNAP.  

Words like “waste, fraud and abuse” hide the bill’s true aims.  Stereotypes of an unworthy poor person are updated.  President Ronald Reagan used the racialized trope of “welfare queen” to defend welfare reform in the 1980’s.  Today Speaker Mike Johnson describes “29 year old males sitting on their coach playing video games” to gin up anti-poor resentments and peddle the myth that food and health care are luxuries only for those who are deserving.

Political dog whistles are used to support radical changes to the Medicaid program via “Medicaid work requirements” that would, by design, drown people in bureaucratic paperwork.  Quite cynically those who support this bill are not hiding the math: the tax cuts will be offset in part by the number of people projected to be cut off Medicaid.   

The Congressional Budget Office’s latest cost estimate shows that the Medicaid provisions would increase the number of uninsured people by 7.6 million. Over 90,000 people in West Virginia would eventually lose health care coverage.  

When Arkansas instituted work reporting requirements, more than 18,000 people lost Medicaid coverage, mainly due to failure to regularly report work status or document eligibility for an exemption. 

The hypocrisy of the proposed reporting requirements is staggering.  As New York Times columnist Ezra Klein points out, so-called work requirements are “an effort to weaponize the very bureaucratic inefficiency that they otherwise pretend to condemn and root out — against the weakest and most powerless segment of society: people who do not make enough money to get health insurance.”

“Medicaid work requirements” sound good which again is by design. The language obscures the fact that two thirds of people who receive Medicaid via expansion under the Affordable Care Act are already working full or part time.  The other third of people are not working due to caregiving responsibilities, unaffordable child care, or any number of life complications that crop up, particularly when facing economic hardship every single day.  

Orwell concludes in his essay on politics and language, “One cannot change this all in a moment, but one can at least change one’s own habits, and from time to time one can even, if one jeers loudly enough, send some worn-out and useless phrase into the dustbin where it belongs.”

I surely hope that the better and wiser angels of our nature carry the day, and that we all jeer loudly enough to send the “one big beautiful bill” into the dustbin where it belongs.  

(This op-ed by Lida Shepherd appeared in the Charleston Gazette-Mail)

Saving Medicaid: in their own words

 While going through some old files, I came across a copy of an interesting letter dated June 29, 2017, from then Governor, now Senator, Jim Justice to Senator Shelley Moore Capito. The subject was the looming threat of the repeal of the Affordable Care Act (ACA) and especially Medicaid expansion.

Here are some excerpts:

Since so many of our people count on Medicaid, any cut to Medicaid would destroy families in West Virginia. We can’t put the 175,000 West Virginians who benefit from the Medicaid expansion at risk of losing coverage. The consequences would be beyond catastrophic.

In the face of our drug epidemic, fewer people would have access to drug treatment programs under the current proposal. As the debate moves forward, I hope you and your colleagues will consider the fact that it will only make it harder to combat the drug problem that’s ravaging West Virginia.

I think he nailed it then—and his words still apply today, arguably more than ever.

To her credit, Senator Capito issued this statement on July 18 of that year:

As I have said before, I did not come to Washington to hurt people. For months, I have expressed reservations about the direction of the bill to repeal and replace Obamacare. I have serious concerns about how we continue to provide affordable care to those who have benefited from West Virginia’s decision to expand Medicaid, especially in light of the growing opioid crisis. All of the Senate health care discussion drafts have failed to address these concerns adequately.

My position on this issue is driven by its impact on West Virginians. With that in mind, I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.

I think she nailed it too.

Eight years later, we’re facing a similar threat. This time around, the issue isn’t directly repealing the whole ACA, although it might as well be. Instead, it’s a federal budget reconciliation package that would cut $880 billion from Medicaid (not to mention $230 billion in SNAP food assistance and $12 billion in school meal funding) to pay for more tax cuts for the very wealthy.

A cut that huge would truly be, as Justice said, beyond catastrophic across the US and especially in low-income states like West Virginia. Our already dismal health statistics would get worse. Minor issues will turn major. Substance use disorder will go untreated. The cost of emergency room visits and uncompensated care will grow and be passed on to others. Rural hospitals will close. Jobs will be lost. And people will die.

The margins in Congress are razor thin. Our senators’ votes could influence the final outcome, especially after the House voted to throw us under the bus. I hope they take their own advice and side with the people of West Virginia again.

(This appeared as a column in the Charleston Gazette-Mail.)

Budget bill a disaster for West Virginia

 The US House of Representatives recently voted on a proposed budget that would cut $880 billion from Medicaid and $230 billion from SNAP food assistance while also slashing other programs, including meals for school children…to give $1.5 trillion in tax cuts aimed mostly to benefit the very wealthy.

The measure passed by just a two-vote margin. Both of West Virginia’s representatives voted for it. 

If this becomes law, the damage done to West Virginians across the board would be incalculable. 

Medicaid alone provides health coverage to over 72,000,000 people nationwide and to more than 500,000 West Virginians, including working adults, children, seniors, pregnant women, people with disabilities, and people getting treatment for substance use disorder. That’s close to one out of three of us. 

We’d be hit harder by this than most other states. Nationwide, one out of five people are covered. It’s almost double that in West Virginia.

According to the Kaiser Family Fund, as of August 2024, around half of all childbirths are paid for by Medicaid here, while nearly the same percentage of children are either covered by it or the Children’s Health Insurance Program. It’s the major source of people needing long-term care, including 7 out of 9 people in nursing homes. It provides benefits for 40 percent of people with disabilities.

And while it covers many people who are too young or no longer able to work, most adults receiving it are employed.

The funding, most of which comes from the federal government, supports local economies, keeps rural hospitals open, and keeps people alive. It’s no exaggeration to say that if this goes through, people will die as a direct result. And people would lose their jobs.

If that wasn’t enough, the budget would reduce SNAP food assistance to 42 million people. As with Medicaid, we’d take a disproportionate hit here as well. Our state ranks third highest in the percentage of SNAP households, just behind New Mexico and Louisiana. Nationally, around 12 percent of people receive SNAP, while it’s 16 percent here.

According to the Food Research and Action Center (FRAC), SNAP helps 124,000 households here, or 279,000 individuals. It brings over $40 million a month to the state, helping 2,170 grocery stores and farmers markets and creating jobs. It’s estimated that each dollar’s worth of SNAP spending generates around $1.80 in economic activity.

Households receiving SNAP include children, the elderly, people with disabilities, and veterans. As with Medicaid, most SNAP households include at least one working member. And if you’re worried that these people are living high on the hog you can relax. The average daily benefit here is $4.54 per person.

On top of all that, the budget bill cuts $12 billion in funding for school breakfasts and lunches and makes sweeping restrictions to the Community Eligibility Provision (CEP), which supports meals for all. FRAC estimates this will reduce access to food in 24,000 schools with 12 million students. 

In West Virginia, we’re talking about impacts in 468 schools with over 180,000 students. This would undo years of progress at the national and state level. CEP has proven very popular in every county in West Virginia since it cuts bureaucracy, improves child nutrition and educational outcomes, removes stigma, and gives working families a break.

The combined impact of these proposed cuts would hurt people across all political and demographic lines. Fortunately, it’s not a done deal. There will be more votes on this over the next few months.  This could give time for people to voice their concerns and for lawmakers to reconsider their actions. 

It’s important to also urge our senators to put the brakes on this. To her credit, Senator Capito said back in 2017 “I didn’t go to Washington to hurt people,” when huge health care cuts were on the agenda. As governor, Jim Justice expanded food aid to low-income children when school was not in session and established the Jobs and Hope program.

Before it’s over, I hope at least some of our representatives will put the people of West Virginia above all else.

(This appeared as an op-ed in the Charleston Gazette-Mail)

Political blackmail

 The U.S. House of Representatives recently voted on a bill that will, if enacted, will bring nothing but misery to thousands of West Virginians and millions of people across the country. It passed by a two vote majority. 

To quote a former occupant of the White House, “SAD.” 

The so-called Limit, Save, and Grow Act, which I like to think of as the Retch, Croak, and Die Act, will force automatic and devastating cuts in discretionary federal spending that would overwhelmingly hit working class and low-income people. And it will probably hit West Virginia harder than any other state. 

It’s a classic example of political hostage taking by either forcing massive across the board cuts to programs that help families, seniors, kids, and just about everyone else OR creating a global financial crisis if the U.S. defaults on debt payments. Either way, everyday people will be hurting. 

Rather than proposing an unpopular specific budget that its supporters would have to own, the bill would set spending limits that would make the cuts automatic. 

According to the DC based Center on Budget and Policy Priorities, “The agenda represents failed trickle-down economics at its worst and would narrow opportunity, deepen inequality, and increase hardship.” Specifically, they report that “The bill would make severe cuts – $3.6 trillion over the next decade – to the part of the budget that funds child care and preschool, schools, college aid, housing, medical research, transportation, many other national priorities.” 

For starters, cuts for the next year would mean that more than 900,000 low-income people lose housing assistance and 200,000 children would lose access to Head Start, along with a reduction by $1,000 to the maximum Pell grant that makes higher education more affordable. The only real trickle down that will happen will be a loss of up to $1.3 trillion to state and local governments in federal grants to fund services. 

Pentagon spending would be left untouched, and the bill would also make it easier for wealthy people and corporations avoid paying their fair share of taxes. 

Among the bill’s poisoned pills are the kind of failed bureaucratic reporting and paperwork requirements for SNAP food assistance and Medicaid that West Virginia’s Republican supermajority wisely rejected in the regular 2023 session, but on a massive scale. Such provisions do nothing to promote work but have the effect of increasing hunger and decreasing health coverage due to paperwork and bureaucratic hurdles. 

The U.S. Department of Health and Human Resources has estimated that the proposed requirements would jeopardize coverage for 21 million people on Medicaid, the majority of whom are either already, working, dealing with disabilities and serious health conditions, caring for family members, or are in school.  

The SNAP changes would fall hardest on older Americans by raising more hurdles for those between age 50 and 55, a group more likely to be subject to age discrimination and/or health issues that affect employment. 

Those changes come in the wake of a decrease in funding for Medicaid and SNAP as the official COVID-era public health emergency ended. It’s probably no accident that the cuts to Medicaid, SNAP, and TANF over the next decade are almost identical to the amount of unpaid taxes rich people and corporations would save due to cuts in IRS enforcement.  

For West Virginia, this would also mean cuts to things like rail safety inspections (what could possibly go wrong there?), mine safety, opioid treatment, air traffic control, preschool and child care enrollments, WIC food aid for mothers and young children, and more. 

Fortunately, that’s not the end of the story. The bill has pretty much zero chance of passing the senate in its present form. Once again, in a closely divided senate the votes of our Senators Capito and Manchin will be crucial. 

I’m hoping they will weigh the house bill’s impact on West Virginians and just say no. West Virginians deserve better. 

(This ran as a column in the Charleston Gazette-Mail.)

Too good to be true?

 A month or so back, I spoke with New York Times reporter Jason DeParle, who was working on a story about child poverty in West Virginia. That article came out yesterday (or was it the day before?) and it had some surprising conclusions, the biggest one being that child poverty declined dramatically in the US over the last few decades and that this change was even more dramatic in West Virginia:

 Child poverty has plunged over the last generation, and few places have experienced larger declines than West Virginia, a state that once epitomized childhood deprivation. Poverty among the state’s children fell nearly three-quarters from 1993 to 2019, according to a comprehensive analysis by Child Trends, a nonpartisan research group, conducted in partnership with The New York Times. That compares to a 59 percent drop nationwide.

If West Virginia’s child poverty rate was as high now as in 1993, nearly 80,000 additional children would be poor, a population larger than the state capital, Charleston.

That was news to me, especially considering that these changes didn't include the vast influx of COVID related federal aid from the CARES Act and the American Rescue Plan. It kinda sounds too good to be true, although my WV comrades have worked on that issue for years and years.

Just when I was beginning to think my life wasn't a total waste, a friend--we can call him Mr. Buzzkill--sent me this response to the national poverty numbers in the Times article. Short version: different poverty measures show vastly different results.

However that data fights wind up, I did find some encouragement in the story itself, which profiles some West Virginia families living in or near poverty. It showed how years of undramatic grunt work on policy at the state and even county level can eventually show some real positive changes for real people. 

I'm talking about things people worked on here, offensively and defensively, like EITC (Earned Income Tax Credit) outreach, defending SNAP, advocating for access to education for people in the "welfare" system and challenging its more draconian aspects, supporting state adoption and expansion of the Children's Health Insurance Program to 300 percent of the federal poverty level over13 years, Medicaid expansion, free school breakfast and lunch, defending child care, support services for people on or leaving TANF, raising the state minimum wage and such can really make a difference in the lives of real people.

I think at least those programs and policies that so many West Virginias have fought for made things less bad than they would otherwise have been. I'll take that.

 

Not all bad

 Whenever there's a bit of good news on the economic justice front, admittedly not an everyday occurrence, I try to notice it. Here's the latest:

According to the Centers for Medicare and Medicaid Services (CMS for short) a record number of Americans now receive health insurance through the Affordable Care Act (ACA)...and what a fight it was to enact and protect it all these years. Specifically, more than 35 million people are either covered through the health exchange or marketplace, expanded Medicaid (21 million in states that expanded Medicaid as WV did in 2013), or basic coverage.

That's more than one out of ten Americans in a total population of around 332+ million. It's an even bigger achievement when we factor in who got that coverage. The US health care system does a pretty good job of covering the elderly via Medicare. Close to 95 percent of children are covered via CHIP, traditional Medicaid or their parents' insurance. Low income people with disabilities are likewise often covered by traditional Medicaid. Those covered by the ACA, on the other hand, are working age adults not eligible for other kinds of insurance--and those most likely to lack coverage before the ACA. 

The percent of uninsured Americans is now at an all time low of around 8.8 percent. Still too many by far, but it shows the benefits of this signature legislation of the Obama administration. And a lot of people in West Virginia worked hard to make that happen here. I hope the 12 holdout states--Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming--see the light and expand Medicaid soon (did anyone else notice that eight of those were also part of the Confederacy?). I know lots of people in those states are working on it. 

This may not last forever the way things are going, but I'll celebrate this for now anyway.

Not surprised

 I can't say I was bowled over with surprise when I saw this CNN news story about how badly health care in the US compares to other economically advanced countries.

To wit, 

The US once again ranked last in access to health care, equity and outcomes among high-income countries, despite spending a far greater share of its economy on health care, a new report released Wednesday has found.

The nation has landed in the basement in all seven studies the Commonwealth Fund has conducted since 2004. The US is the only one of the 11 countries surveyed not to have universal health insurance coverage.

Commonwealth Fund  president David Blumenthal was quoted as saying "In no other country does income inequality so profoundly limit access to care as it does here. Far too many people cannot afford the care they need and far too many are uninsured, especially compared to other wealthy nations."

However, if you want to look at it from a slightly more optimistic angle, think how much worse all that would be if the Affordable Care Act had been repealed or if the many attacks on Medicaid and other programs had succeeded. All those things were real possibilities not so long ago--and fighting them off took a LOT of work from a LOT of people.

One step at a time I guess.

Long strange trip

 I've been wracking my brain trying to think of what to say about the events of the week and the years that went before it. For most of the fall, I've been very concerned about the possibility of a coup, quasi-legal or otherwise. I'm still wondering what kinds of violent stunts white nationalist groups may unroll and what other long term damage has been done to the democratic process, imperfect as it is. 

I'm hoping that the nation's flirtation with fascism or at least authoritarianism is at least waning.

Aside from issues of authoritarianism, the last four years have involved a lot of defensive fights, mostly revolving around health care (food security too, but that's another story). If there's been a central theme of my nearly 32 years at AFSC, health care would be it.

My first big fight was the Pittston strike, which was mostly about retiree health and pension benefits. These were also factors in the 1990 teachers' strike and the 1990-92 Ravenswood lockout. Ditto the fights about "reforming" workers compensation that lasted for a decade between the mid 1990s and 2000s. 

The coming of welfare "reform" in 1996 started another decade or so of sporadic fights related to Medicaid. These included issues like transitional coverage for people leaving cash assistance, the possibility of block grants, waivers and such. 

Then came efforts to get the state to implement the federal Children's Health Insurance Program in 1998 and then to expand eligibility for it, eventually up to 300 percent of the federal poverty level by 2011. My late co-worker Carol Sharlip was a major player in building support for this in the early years.

In 2009-2010 came the push to enact what eventually became the Affordable Care Act. I remember going to public hearings around the state and witnessing the WV version of the birth of the white backlash and the Tea Party. These included paranoid ravings about the World Health Organization taking over and someone heckling a priest during an opening prayer. And, yes, people who wanted to keep the government's tentacles off Medicare. There were street actions, press conversations, calls, emails, op-eds, bus trips to DC, and all that. Then lots of outreach and education when it passed.

(There were some serious debates within AFSC about whether to sign on in support of the bill. Some didn't think it was good enough. I may or may not have stopped talking with some people after that.)

The version we got was the Senate's rather than the more generous House version in March 2010. Here's a blog post I wrote about it at the time. Then the 2012 US Supreme Court decision which let it stand but made Medicaid expansion--the real public option--a state decision. The biggest social justice victory of my lifetime was then-Governor Tomblin's decision to expand it. Here's a report we published in an effort to nudge the governor in 2013. My retired colleague Beth Spence did the interviews and photography.

I would never have guessed the state would do such a great job at enrolling people. At it's peak around the time of the 2016 election, the expansion covered nearly 180,000 West Virginians (after four years of assaults by the Trump administration, I think enrollment is around 160,000 now). The new president, aided by WV's attorney general, promised to do away with the whole ACA as soon as he came into office.

It was an all-hands-on-deck moment. Health advocates scrambled to the defense. My co-worker Lida Shepherd and I worked with Cabin Creek Health Systems to interview people covered by the ACA and publish the results and generate other media, including a widely seen video report in the New York Times. Given that WV has been ground zero for the opioid epidemic, protecting the ACA, which opened up recovery to thousands, was critical.

We worked with allies to do all the usual stuff. Some friends of ours, nicknamed "the Capito six," were arrested for sitting in at the WV Republican senator's Charleston office. I remember protesting outside WV's giant Boy Scout center when the President spoke. People put lots of effort into bolstering Senator Manchin's support for the ACA. He eventually came around to a "fix, don't nix" position. In a closely divided Senate, WV was in a critical spot, with a conservative Democrat and fairly moderate Republican. People hit it with all they had.

The critical moment came in July 2017 when a dying John McCain cast a deciding vote after returning from hospital treatment for brain cancer, basically saving the day. Here's a post on that occasion that includes his eloquent statement.

After a pause to catch our breath, WV health care advocates turned next to fight off bad state legislation regarding work reporting requirements for Medicaid expansion that would have kicked tens of thousands of low income West Virginians off the program in 2019 and 2020. I'm hoping that COVID-19 has shown this to be a Really Bad Idea.

By the time of the 2020 election, the ACA was battered but still afloat, although it wasn't clear if it could survive another four years of federal assaults. Then there was the added wrinkle of the US Supreme Court taking up another repeal attempt with three Trump appointees. The decision is expected as soon as this spring, but early deliberations seem promising.

So I guess this is another catch the breath moment. We're still far from universal care, but it's been a long hard fight to get as far as we have. I'm grateful to the many friends who have been in the fight from the beginning. Like the ACA, we're battered but still around.

So many bad ideas, so little time

One of my favorite WV legislators has been known to call the state capitol the "bad idea factory." If that's the case, then the White House these days is more like the bad idea Death Star.

 No doubt the Gentle Reader is aware of the disastrous impact of COVID-19 on the economic well-being of millions (make that billions) of people. And, most likely, of the lack of agreement on a meaningful response from Congress to deal with the problem.

What we have instead, so far anyhow, are executive actions from the Trump administration that don't do a lot of what needs to be done and does some things that shouldn't be done. 

As Robert Greenstein of the DC-based Center on Budget and Policy Priorities argues here, the executive act doesn't adequately address any number of problems, including public health, unemployment, evictions, fiscal aid to states, and food assistance.

As if all that wasn't bad enough, the actions include cutting the payroll tax, which would be a major hit to Social Security and Medicare, which are more needed now than ever.

Here's his conclusion:

To all of these shortcomings and gaps, add the enormous uncertainty that the executive actions will create because they are legally suspect and because of serious questions about whether the Administration actually can implement aspects of them.

There simply is no shortcut to the hard work of crafting a bipartisan economic relief package that meets the needs of a reeling economy, struggling families, and cash-strapped states and localities. And under our constitutional system, the President and Congress together — not the President acting alone — have the power to appropriate funds and decide how to use them. The President cannot substitute executive actions for congressional action and cannot, acting unilaterally, provide the strong help that families and the economy need.

To help a nation suffering through one of its gravest crises in many decades, the White House should withdraw the executive actions, return to the negotiating table, and do what’s needed to reach the deal that our nation so badly needs.

Speaking tooth to power

Sometimes I’m kind of slow on the uptake. That statement probably won’t come as a surprise to anyone reading this.

One of many examples of this has to do with oral health. I used to think of this mostly in terms of things like abscesses and toothaches, two treatable maladies that can get serious if untreated. The former can kill you, while the latter can make you wish you were dead.

As I’ve eventually learned, that’s just the start of it. Poor oral health is associated with serious and even potentially fatal diseases, like endocarditis (an infection of the inner lining of the heart chambers and valves), cardiovascular disease, kidney disease and pneumonia, as well as pregnancy and childbirth complications. On the flip side, diseases such as diabetes and osteoporosis can affect oral health.

There’s also a big connection between oral health and mental health, aside from the obvious fact that constant pain is a downer. Embarrassment over one’s teeth can lead to social isolation. There’s even a connection between poor oral health and memory loss.

This is a particularly serious problem in West Virginia. In 2014, a survey found that people here who earned below the federal poverty level were nearly 20 percent less likely to receive dental care than people who weren’t poor.

In 2018, the Centers for Disease Control and Prevention found major disparities in accessing dental care along lines of race, income and educational attainment in the Mountain State. Around 45 percent of adults hadn’t visited a dentist in over a year and 22 percent had gone more than five years without a dental visit.

Specifically, 68 percent of people earning less than $15,000 hadn’t had a visit in over a year, compared with 26 percent for people earning more than $75,000. In terms of race, 55 percent of black West Virginians had gone more than a year without a visit, while, for white residents, it was 44 percent.

Huge gaps in accessing dental care can also be seen when we look at educational attainment. Sixty-eight percent of people who had gone a year or more without visiting a dentist didn’t graduate from high school. That number was 50 percent for high school graduates, 40 percent for people who attended some college or technical school and 23 percent for college or technical school graduates.

There’s another way in which West Virginia is an outlier: According to the West Virginia Center on Budget & Policy, the state is one of only 16 that doesn’t offer dental coverage to adults receiving Medicaid, beyond extractions — and those are limited to two per year. Most others offer a range of coverage that can include preventative, restorative and periodontal services, as well as things like dentures, oral surgery and orthodontia.


This lack of coverage is expensive in more ways than one. For one thing, dental problems make it harder for people to gain and keep employment. For another, the diseases associated with poor oral health are way more expensive to take care of than an occasional but regular trip to the dentist.

According to one study, regular oral care led to a 40 percent reduction in diabetes-related costs for type 2 diabetes patients and a 73 percent reduction of related costs for individuals with coronary artery disease.

Then there’s this: People without dental coverage wind up in hospital emergency rooms for treatment and pain control associated with these problems. Hospitals generally aren’t set up to deal with them, and what help they give is often 10 times more expensive than a trip to a dentist.

Adding oral health coverage to the state’s Medicaid program would also be a smart investment. For every such state dollar invested in the program, West Virginia would receive around $3 in federal funding. For the state’s Medicaid expansion program, the return on investment is even better, bringing in $9 federal dollars for each dollar in state investment.

It would be hard to find that kind of payoff these days for any investment. Especially a legal one.

We can and should do more for oral health in our Medicaid program than just pay for extractions. Let’s face it, we’re not exactly running a tooth surplus in this state.

Covering oral health would reduce unnecessary suffering, help more people enter and stay in the workforce, bring in more dollars to the state’s economy and save money in the treatment of serious chronic diseases.

There is some good news here. Senate Bill 648, which would extend Medicaid coverage for oral health, just cleared the Senate Health Committee. In a time of polarization, legislators across party lines have begun to recognize both the problem and the solution.

It may take the voices of ordinary West Virginians to help that bill cross the finish line. It would be an example of (groan) speaking tooth to power.

(This ran as an op-ed in the Charleston Gazette-Mail.)

At the WV legislature, not all bills are bad...really

It’s encouraging that some positive health-related bills and policies seem to be moving at the state Capitol.

One huge advance was announced in December, when Gov. Jim Justice directed the West Virginia Department of Health and Human Resources to study options for eliminating the waiting list for the Intellectual and Development Disabilities Waiver, or I/DD, program.

This program allows individuals with special needs to receive care in their homes and communities, rather than an institutional setting, a policy that makes sense both in terms of human needs and budget savings.

While the state has had this program for a good while, many eligible people, mostly children, weren’t getting the services they need.

Over 4,800 West Virginians were participating in the program as of November 2019. However, over 1,000 people, mostly children, have been on a waiting list to receive services, some for over four years.

That’s some good news. More could be on the way:

HB 4416 would build on legislation passed last year that extended Medicaid coverage for 60 days postpartum for women between 138 percent and 185 percent of the federal poverty level. This year’s proposed legislation would extend that coverage to a full year.

That’s a big deal, because the maternal mortality rate has been increasing in recent years. Last year, West Virginia Public Broadcasting reported that “American women are three times more likely to die during or after birth than women in Great Britain, and eight times more likely than women in Scandinavian countries.”

Fortunately, West Virginia’s rate is lower than the national average, but still, 15 women died in the first year after giving birth in 2018, with eight of those deaths related to substance use, according to Beckley’s Register-Herald. Extending coverage for a year could help ensure services for substance use disorder, postpartum depression and other complications.

SB 648 would provide dental coverage to adults on Medicaid. The bill was introduced by Sen. Tom Takubo, R-Kanawha, with several Republican co-sponsors. Oral heath goes way beyond toothaches, which are bad enough. According to the Mayo Clinic, oral health could contribute to conditions such as endocarditis (an infection of the inner lining of heart chambers), cardiovascular disease, pregnancy and birth complications, and pneumonia — all of which are way more expensive than a trip to the dentist.

Then there’s one that strikes close to home for me: HB 4543, which would cap insulin costs for West Virginians with type I and II diabetes.

My daughter was diagnosed with type I diabetes when she was pregnant with my grandson. Type I is a very scary autoimmune disease apparently caused by environmental and genetic factors unrelated to things like diet and exercise. As if that weren’t enough, my grandson was diagnosed with the same disease in middle school.

Both are very athletic and diet-conscious. My daughter has earned a black belt in karate and run several ultra-marathons. My grandson is a champion golfer.

Even with that, dealing with Type I is like having a full-time job that wants to kill you. I’d take heart disease any day.

The lifeline is insulin, which is needed just to maintain life for as long as the patient lives. Different diabetics require different kinds of insulin, and the costs can be astronomical. For my daughter and grandson, the costs of a refill that lasts for five or six weeks is $849.75.

That’s with health insurance and discount cards.

They’re not alone. According to the proposed legislation:

It’s estimated that over 240,000 West Virginian’s are diagnosed and living with type I or type II diabetes and another 65,000 are living with one of those conditions but haven’t been diagnosed. Every person with type I, and many with type II, require insulin to live.

Medical costs associated with diabetes in West Virginia are estimated to be $2.5 billion.
People with diabetes typically incur medical costs around 2.3 times higher than people without the disease.

The cost of insulin has increased astronomically, especially the cost of insurance co-payments, which can exceed $600 per month, not counting other necessary equipment and supplies.

According to national reports, as many as one in four type I diabetics underuse, or ration, insulin because of these increased costs. Rationing insulin has resulted in nerve damage, diabetic comas, amputation, kidney damage and even death.

It doesn’t have to be that way. Recently, a group of West Virginians with diabetes took a bus trip to Canada to buy insulin. Prices there are about one-tenth of what they are here, because that nation controls the price of pharmaceuticals to ensure that the price of medicine isn’t excessive and remains comparable with prices in other countries.

The proposed West Virginia legislation would do the same.

This lifesaving bill enjoys bipartisan support and has been championed by House Health and Human Resources Chairman Jordan Hill, R-Nicholas, and Delegate Barbara Evans Fleischauer, D-Monongalia.

Taken together, these measures could help a lot of West Virginia families. I’d like to see them cross the finish line.

(This appeared as an op-ed in the Charleston Gazette Mail.)

Astroturf in action

For the last several years, people here have been trying to fight off some major assaults on programs that benefit low income people, such as SNAP (formerly food stamps) and Medicaid.  These initiatives didn't bubble off from below. Rather, they've been driven by dark money, and specifically the Foundation for Government Accountability (FGA).

This article from the Center for Public Integrity shines some light on dark money, including their efforts to slam poor people in West Virginia. Wherever you are in the US, there are probably similar things going on.

Top of a good list

Most of the time West Virginia is at the bottom of the good lists and the top of the bad ones. It's always nice when that pattern reverses itself.

That's actually happened several times:

*we're a national leader in insuring children via CHIP and Medicaid;

*we're the national leader in school breakfast participation and school food generally;

*thanks to Medicaid expansion, in 2016, we had the largest drop in the number of the uninsured.

Here's the latest positive news from the Georgetown Center for Children and Families: while maternal mortality has gone up in the US as a whole (alone among advanced capitalist nations), maternal and infant help has improved considerably here in recent years the number of uninsured women of childbearing age has dropped by more than two-thirds here.

The main reason? No surprise, it's Medicaid expansion under the Affordable Care Act. In fact, the report found that "States that have expanded Medicaid under the Affordable Care Act saw a 50 percent greater reduction in infant mortality than non-expansion states."

It's possible that WV's numbers could even further improve due to the recent decision of the legislature to extend Medicaid coverage for pregnant women to 300 percent of the federal poverty level, as noted here.

All of which is one more reason to protect Medicaid expansion.

Four for the weekend

Two interesting reports have come out this week, both of which are worth a look. "Stumbling Blocks or Stepping Stones" looks at the impact of Adverse Childhood Experiences (ACEs) on West Virginia. It was put out by the WV ACEs Coalition.

The more I learn about ACEs and their impact over the life course, not to mention the human and other costs, the more I realize that this is a big deal with lots of implications. Things would be a lot better if we became more trauma-informed as a society.

Speaking of huge deals, WVU just released "The Economic Impact of Medicaid on West Virginia's Economy."  Condensed version (in the parlance of our time): YUGE. More on that another day.

Also, in case you missed them, here are the links to the latest episode of Wonk's World, our irreverent take on the WV legislature, and the latest Front Porch, in which we discuss the costs of the state's opioid crisis.

Out of touch

One thing that most people would agree on across the political spectrum is that West Virginia would be better off if more of us were working and earning a living wage. I know I’m down with that.

Unfortunately, some of the ways that have been proposed for working towards that goal are counterproductive and just mean. Possibly cynical, too.

For example, Seema Verma, head of the federal Medicare and Medicaid program under the current regime, recently proposed to solve that problem by clamping down on Medicaid, specifically on those millions of people who gained coverage under the Affordable Care Act. Most of whom work. Go figure.

In a speech to state Medicaid directors, she said things that have at best a tenuous connection with reality. She seemed indignant that some of those who have gained health coverage in recent years are people who “are physically capable of being actively engaged in their communities.”

Let’s start with the basics. They already are. People who gained coverage due to Medicaid expansion had to come from families that had income, although it was under 138 percent of the federal poverty level. That means they weren’t receiving TANF (welfare) or disability payments, in which case they would have qualified for traditional Medicaid.

Generally speaking, that means they work.

Let’s be more specific. These are the people who do the grunt work of society. They wait on us in stores and restaurants. They change our oil. They clean our motel rooms. They wash our dogs. They clean up our messes. And, most importantly, they take care of our children and elders.

It would take a lot to persuade me that Verma didn’t know better when she said that. But if she, and the regime she serves, didn’t, it only shows how out of touch they are with the reality of millions of working people.

According to the Center on Law and Social Policy, around 60 percent of working-age adults on Medicaid have jobs. And around 80 percent are in families with at least one worker. The few that aren’t are usually seeking work, dealing with illness or disability, or caring for other family members.

In her speech, Verma seemed to imply that people like this who get Medicaid coverage enjoy wallowing in poverty and “government dependence.”

(Ever notice that many of the people who complain about this receive some form of health care from the federal government?)

I guess one of the innumerable advantages of being well-off is being spared the knowledge that less than half of all Americans are covered by work-based insurance. According to the Census Bureau, in 2016 only 58.3 percent of West Virginians of prime working age (19-64) get coverage from their jobs.

Here’s the reality in West Virginia. Since 2001, the percentage of low-wage jobs (earning under 150 percent of the poverty level for a family of two) has grown by 14.5 percent, even as jobs in high-wage industries have declined. These jobs typically don’t offer health coverage.

Nearly one in four West Virginians works in such a job. Around 55 percent of West Virginia’s children live in a family with at least one low-wage worker. For many, low-wage jobs are no longer a temporary steppingstone to a better gig but are rather a lifetime path.

Most low-wage workers are white, although blacks make up a disproportionate share. Fifty-six percent are women. Younger workers are more likely to earn low wages, but nearly half of workers above age 35 work in low-wage jobs.

Behold the face of “the enemy.” It may look a lot like our friends, neighbors, relatives and even ourselves.

I think what’s really driving this push at the federal level to cut back on things like health care is the desire of the administration and its allies in Congress to pass a massive “tax reform” package that would give huge breaks to the very wealthy — who don’t need them — at the expense of everyone else. That $1.5 trillion giveaway to the rich has to come from somewhere.

And, under what must be huge pressure from the federal administration, there are officials in West Virginia who seem eager to push for bogus “reforms” that will ultimately reduce the number of people with health care. Cutting Medicaid rolls may seem attractive to some people, even if it means taking away coverage and increasing the costs of uncompensated care for everyone else.

Some options now under consideration include unnecessary and redundant “work requirements” for Medicaid that would wind up taking millions of dollars out of the state’s economy and harming those sectors that are actually providing and increasing jobs.

In the past, Gov. Jim Justice has eloquently defended vulnerable West Virginians. I hope he continues to hold the line.

At this point, no one can say how far these proposed changes will go. But we’d be better off if they didn’t go anywhere.

(This ran as an op-ed in yesterday's Gazette-Mail.)

That fuzzy line again

There has been story after story lately of politicians pretending to care about West Virginia's--and the nation's--opioid crisis.

Unfortunately, these are the same politicians who have been working night and day to reduce or eliminate the kind of treatment recovering addicts need by repealing the ACA and/or pushing through a #taxscam bogus tax reform bill that gives massive cuts to the rich while crowding out other kinds of federal funding. Like addiction treatment and Medicaid expansion.

Once again, I have trouble distinguishing irony and hypocrisy. But I'm leaning toward the latter.

Anyhow, here's an op-ed by a friend of mine explaining why you can't have it both ways.

Raising the floor

Recently, I worked on a report about the state of West Virginia's low-wage workers with the West Virginia Center on Budget and Policy. Some results weren't surprising. The number of low-wage jobs, defined in this case as 150 percent of the federal poverty level for a family of two ($11.59 per hour or under $24,108 per year) has grown by 14.5 percent since 2001, while employment in high wage industries has declined by 2.8 percent.

Key industries employing low-wage workers include grocery stores, retail, food services and personal care for children or the elderly. Nearly one in four West Virginians works at such a job. For many, these jobs are no longer a stepping stone to a better gig but rather a lifelong path. Fifty-five percent of the state's children (200,900 in all) live in a household with at least one low-wage worker.

While most such workers in West Virginia are white, African-Americans are more likely to earn low wages. The rates are 23 and 31 percent, respectively. Fifty-six percent of low-wage workers are women. Younger workers are more likely to earn low wages than those in their prime. Rates shoot up again for workers 65 and older. Still, nearly half of all workers over 35 have low-wage jobs.

One major factor affecting wage levels is, unsurprisingly, educational attainment. Fully 44 percent of those without high school diplomas earned low wages. For high school graduates and those with some college, the rate dropped to 28 percent. Rates of low earners dropped to 12 percent for people with associate's degrees and less than 10 percent for those with a bachelor's degree or more.

One obvious policy change to raise earnings and our state's abysmal statistics would be to put more resources into affordable post-secondary education rather than unproductive tax cuts. Indeed, cuts enacted over the last 10 years were more than enough to pay tuition and fees for a public college education for every student in the state.

It's pretty clear that anything that helps people move from low to living wages - or keeps people from sinking lower -would strengthen West Virginia's economy, boost demand for goods and services provided by local businesses, and help increase the state's chronically low workforce participation rate.

Some other steps in that direction include:

*Protecting West Virginia's Medicaid program. This federal-state partnership provides care to nearly one out of three West Virginians, including 170,000 people from working families earning under 138 percent of the federal poverty level. It also supports thousands of jobs in health care and other sectors. Losing that would be a huge hit to the state's economy and drive thousands of West Virginians into deeper levels of poverty and misery.

*Enacting a refundable state earned income tax credit (EITC). So far 29 states and the District of Columbia have enacted such credits to help people build assets, pay off debts and offset the impact of regressive taxes. The EITC is a proven tool to fight poverty, increase labor-force participation and help workers in low-wage jobs afford necessities. This is no radical idea - recently, the WestVirginia Bankers Association came out in support of a state EITC.

*Protecting and enhancing child care assistance. Child-care assistance is crucial to helping low-income families maintain employment, stay off public assistance and have higher earnings. Without assistance, it is simply unaffordable, forcing workers to choose between child care and a job. Increasing the eligibility level for families from 150 percent to 200 percent of the poverty line could reduce the "cliff effect," which discourages parents from advancing in their jobs and careers.

*Raising and indexing the minimum wage. In 2014 West Virginia passed legislation to increase its minimum wage to $8.75 per hour, $1.50 more than the $7.25 federal rate. That was a step forward but is still not a living wage. It's high time for another hike, which could be phased in over several years and indexed to the rate of inflation.

*Preserving and expanding early childhood education and voluntary home visiting programs. Evidence suggests there is a critical period in early childhood, roughly equivalent to the first 1,000 days of life, which can make a huge difference in cognitive, emotional, social and physical development. These in turn can impact health and economic well-being across the lifespan.

Bottom line: Workers in low-wage jobs constitute a large and important segment of West Virginia's population. These are the people who do some of the most important work in our communities, such as caring for children and the elderly. The steps we take to help them improve their economic status is critical to ensuring a better future for all West Virginians.

(This appeared as an op-ed in Sunday's Huntington Herald-Dispatch.)

The Walking Dead, health care version: action needed

As recently as last week, it looked like efforts to repeal the Affordable Care Act--and take away health care for millions of Americans--was dead. But this is the era of zombies or walkers, when things that should long ago have been dead and decently buried shuffle around to devour the living.

The latest walker to show signs of being dangerously undead is the Graham-Cassidy bill, which is rapidly gaining momentum. It's not clear whether senators who opposed earlier repeal efforts will hold the line. And here's an added wrinkle: the window to pass this zombie bill closes Sept. 30. After that, changing the health care law will require bipartisan support, which some senators have actually been working on.

According to the WV Center on Budget and Policy, Graham Cassidy will cut West Virginia's Medicaid funding by $2 billion by 2027. It would convert funding for expanded Medicaid to a temporary block grant while also undermining traditional Medicaid. On top of that, it would further disrupt the individual market. Read more about all that here.

You probably saw this coming, but it's time once again to contact WV Senator Shelley Moore Capito and remind her of her statement that "I did not go to Washington to hurt people."

Here's how:

OFFICE LOCATIONS

• BECKLEY, WV

  220 North Kanawha Street
  Suite 1
  Beckley, WV 25801
  Phone: 304-347-5372
  Directions
 

• CHARLESTON, WV

  500 Virginia Street East
  Suite 950
  Charleston, WV 25301
  Phone: 304-347-5372
  Directions
 

• MARTINSBURG, WV

  300 Foxcroft Avenue
  Suite 202A
  Martinsburg, WV 25401
  Phone: 304-262-9285
  Directions
 

• MORGANTOWN, WV

  48 Donley Street
  Suite 504
  Morgantown, WV 26501
  Phone: 304-292-2310
  Directions
 

• WASHINGTON, DC

  172 Russell Senate Office Building
  Washington, DC 20510
  Phone: 202-224-6472
  Directions

Last chance?

Not to be too dramatic about it, but this could be the last chance to try to preserve health care for millions of Americans, including kids, seniors and working people. In WV alone nearly 300,000 kids are covered by Medicaid, which also pays for over half of births and around 70 percent of long term care. Medicaid expansion as of today covers around 171,000 West Virginians.

Last week, Senator Capito seemed to be standing strong. Today it's hard to tell. And tomorrow is show time.

What can you do? You probably saw this coming, but keep calling Senator Capito's offices (the more the  merrier) and say something like "Stay strong. Vote no on taking away health care from WV."

DC office:  202-224-6472
Beckley: 304-347-5372
Charleston: 304-347-5372
Martinsburg:  304-262-9285
Morgantown: 304-292-2310