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.)

Good news on health care

 It’s not obvious from the title, but the recently passed Inflation Reduction Act (IRA) is the biggest federal health care legislation in a dozen years, one that will directly benefit over one in four West Virginians.

For starters, the law permanently extends the Black Lung Excise Tax, which provides benefits for over 4,400 West Virginia families impacted by that terrible disease caused by breathing coal dust. Nationwide nearly 26,000 families will benefit, including over 18,000 primary beneficiaries and around 7,000 dependents. According to the Brookings Institution, Black Lung is most prevalent in central Appalachia, with 20.6 percent of miners affected. 

In the late 1960s, a historic grassroots movement spearheaded by West Virginia coal miners and supporters brought the issue to national attention and won federal legislation to establish the benefit, although its funding was in jeopardy in recent years until the bill was passed.

The IRA also extends Affordable Care Act (ACA) marketplace subsidies for three years for people who purchase insurance plans on the exchange, which will help around 23,000 West Virginians and over 14 million people nationwide.  

People who buy care through the ACA marketplace have traditionally been the hardest group to find health care since they aren’t covered by employer-based insurance and don’t qualify for public programs such as Medicare, Medicaid, Tri-Care, or VA benefits. Thanks largely to ACA subsidies and Medicaid expansion, the number of uninsured Americans reached an all time low of eight percent this summer: still too high but a big improvement.

The biggest impact of the bill will be on people receiving Medicare, which covers over 440,000 West Virginians and around 64 million Americans, although these changes will be rolled out over time. 

According to the Kaiser Family Foundation, in 2023 insulin will be capped at $35 a month on the Medicare Part D prescription drug program; drug companies have to offer rebates if prices increase above inflation; and cost sharing for adult vaccines under Part D and Medicaid will be eliminated.

The Medicare diabetes cap is a big deal, although a ruling by the senate parliamentarian blocked its application to private insurance. According to the American Academy of Family Physicians, which supported several IRA medical provisions, “More than 37 million Americans have diabetes, and an estimated one-quarter of people with diabetes in the United States ration their insulin due to costs. In 2021, U.S. diabetes deaths exceeded 100,000 for the second consecutive year.” The WV Department of Health and Human Resources estimates that 240,626 West Virginians have that disease with undiagnosed cases 65,210.

In 2024, the IRA caps Medicare premium increases to six percent a year through 2030; eliminates a part D co-pay for catastrophic coverage; and expands eligibility for the low-income Part D subsidy to 150 percent of the federal poverty level. In 2025, it caps drug costs for Medicare beneficiaries at $2,000 per year. And between 2026 and 2029, it will negotiate costs for an increasing number of expensive medicines each year.

While health care is only part of the IRA, which also addresses climate change and tax fairness, those are significant steps in the right direction and Senator Manchin was instrumental in sealing the deal. Of course, no legislation is perfect. Lots of West Virginians, myself included, worked hard on what would become the IRA for the last year or so. We didn’t get all we wanted and got some of what we didn’t, but there are still things to celebrate.

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

All talk?

 It's been a long and disappointing struggle over the last year to try to get WV Senator Joe Manchin to take positive action on human needs and climate. Now we're getting down to the wire. So many people have been let down, perhaps especially kids and parents who at least so far seem to have lost out on help with child care, paid leave, the refundable Child Tax Credit and more.

If there's any chance of salvaging anything in the federal budget reconciliation process, it might come down to coal miners. The federal Black Lung excise tax provides modest benefits for people struggling with that terrible disease--and it expired last year, leaving the long-term stability of the program in question. Extending it was part of the Build Back Better bill that got tanked by Manchin in December.

In West Virginia, politicians traditionally pretend to care about coal miners, although it seems like most of the real love goes to coal companies. Given all that rhetoric and theater, it seems like this is one thing that has to get across the line, which could open the way for more.

Yesterday, the National Black Lung Association held a press conference at the statue honoring miners at the state capitol calling on Manchin to come through for miners and their families via the reconciliation process. Fortunately, the press showed up, including the Charleston Gazette-Mail, WV Public Broadcasting, WV MetroNews, and even The Hill. More national stories may be in the works.

It seems like there is real pressure now for actions to match words. But I've been wrong before.

Unbearable

 

It's an established fact that road trips can be good for the soul (the body is another question) and that COVID has played hell with road trips for the last few years. So I was glad to take a good one this week with some remarkable women from West Virginia. 

Styling themselves "momma bears," they came to Washington to make their voices heard on the need to preserve the expanded Child Tax Credit, which ended Dec. 15. Previously, they tried about everything they could think of. This time around they went for an unusual visual effect. 

To wit, teddy bears. Five hundred to be exact, with each bear symbolizing 1,000 West Virginia kids who will be pushed back into poverty unless the credit is renewed. The moms told their stories, then spent the rest of the day talking with congressional staff about the issue. Here's some coverage from the Washington Post and Huffington Post and here's a video of the event.

The teddy bear event was also the start of a national effort to encourage allies to connect with the "unbearable" campaign and start making noise on social media. It can be as easy as posting or tweeting about the credit with a message as simple "Make childhood bearable again" and using the hashtag #unbearable.

It's far from a certainty, but there's still the chance to get the Child Tax Credit across the line at some point.  Let's just hope not too many kids and families get hurt before that happens.

(I should warn the reader, however, that our experience is that once one goes down this path, it's almost impossible to avoid making cheesy bear puns. And if you add Spanish, there are "oso" many more.)

Lighting up young brains...literally

 My late father was a bad joke magnet. Over the course of his life, he amassed quite a collection from the coalfields of Fayette County to the Pacific Theater of World War II.

Aside from shameless puns endlessly repeated, he was fond of good news/bad news jokes of the kind that would raise expectations and then smash them. 

(For example, one of his favorites was about a general telling his soldiers the good news that they finally get to change undergarments. The bad news was they had to change them with each other…I told you they were bad.)

I thought of him when I saw a news story about a real-life good news/bad news scenario which is even less funny than any of his jokes.

A newly released study found encouraging results showing that anti-poverty measures can actually improve brain activity in one-year-old infants in ways that are associated with higher language, cognitive and socio-emotional scores later in life. That would have been the good news.

The bad news is that the expanded Child Tax Credit (CTC), a national program that could have helped millions of infants, not to mention kids of all ages, just got shut down when the US Senate failed to extend the program. 

Tens of millions of kids, and an untold number of infants, lost out when the expanded CTC ended in December 2021. And whether it will come back in any form is largely up to West Virginia’s senators.

The experiment, called Baby’s First Years, was planned long before a monthly CTC benefit became a reality. It involved a team of investigators from six universities around the country who conducted an experiment aimed at seeing whether a direct anti-poverty intervention would affect brain development in very young children.

Researchers recruited a diverse group of low-income mothers at four locations around the country. Participants were randomly placed into two groups. One received a nominal cash gift card worth $20 per month, while the other received a month cash gift of $333 dollars with no strings attached. By coincidence, that amount is similar to the CTC benefits of $250 to $300 per child, depending on age.

When the children in the experimental groups reached their first birthday, their brain activity was measured in their homes using electroencephalography, a process in which a cap is placed on the infant’s head to record brainwaves. Infants in the group that received the larger benefit had significantly more high-frequency brain activity than those in the $20 per month group.

According to neuroscientist Kimberly Noble at Teachers College, Columbia University, “We have known for many years that growing up in poverty puts children at risk for lower school achievement, reduced earnings, and poorer health. However, until now, we haven’t been able to say whether poverty itself causes differences in child development, or whether growing up in poverty is simply associated with other factors that cause those differences.”

The design of the experiment shows that we’re looking at causation here, not just correlation.

Noble said that “All healthy brains are shaped by their environments and experiences, and we are not saying that one group has ‘better’ brains. But, because of the randomized design, we know that the $333 per month must have changed the children’s experiences or environments, and that their brains adapted to those changed circumstances.”

Researcher Katherine Magnuson from the University of Wisconsin-Madison said “families are all different, and the potential promise of money as a way of directly supporting families is that it allows parents to make choices about what their children most need. Thus, there may not be just one way in which money positively affects families; money may matter in a lot of small ways.”

I have to admit I was slow in recognizing the importance of the first months after birth in shaping long-term life chances, but the evidence is clear that adverse childhood experiences, including poverty, have huge consequences. The evidence also suggests that there are critical periods in human development in which our brains and bodies are especially sensitive to outside stimuli. It seems that ground lost in those periods may not be regained later in life.

We know from stories collected from WV parents that the benefits of income supports from the CTC have helped children of all ages. Not negotiating a deal for the CTC would be very bad news for a lot of people right now, and worse news for years to come.

Now that there’s solid evidence that this kind of basic support early in life can light up developing brains, it would be a shame to let those lights go out.

That’s no joke.

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

Prophecy and hypocrisy, revisited

 Over the years, I've been to many observations and celebrations of the life and work of Dr. Martin Luther King Jr. While many of these have been inspiring, there is often the fly of what Lincoln in another context called "the base alloy of hypocrisy" in the ointment, as I noted in this post from two years ago. I still recommend checking out the lyrics there of the late Phil Ochs' song Crucifixion, which sums up this dynamic better than anything I can say.

Specifically, the hypocrisy that grates on me occurs when politicians and people in positions of power who would have feared, hated and despised everything Dr. King  stood for--especially in later years when he turned his attention increasing to issues of economic justice and opposing the war in Vietnam--speak pious words from the pulpit or podium. As Ochs sang, "the drama is distorted to what they want to hear."

This year, the King family has issued a strong statement calling for "no celebration without legislation" for voting rights. As Andrea Waters King was quoted by CBS News, "We can't celebrate Martin Luther King Jr. without having the legislation, the cornerstone of his legacy, the cornerstone of our democracy, solidified."

That message is especially relevant to West Virginia, where Senator Joe Manchin's vote, which looks like a longshot at this point, will be crucial. Ironically, after some struggle by lots of people here led by the state's Black community, Manchin helped to draft the Freedom to Vote Act, which actually  has a lot of positive provisions, especially if partnered with the John Lewis Voting Rights Act...but it looks like he won't vote for it, supposedly out of reverence for senate rules.

Whatever.

This is one of the decisive moments in US history. My advice to Senator Manchin is this: if he doesn't act decisively to protect voters' rights and democracy, don't bother showing up for these events ever again. It would just add insult to injury.

Really.

And while we're at it, please check out this op-ed from the Charleston Gazette-Mail on the same topic by Rev. David Fryson.

Quick action needed to save the Child Tax Credit

Calling all WV people! There is a disturbing article in Politico to the effect that WV Senator Joe Manchin may want to throw hundreds of thousands of WV kids--and millions from other places--under the bus by slicing the Child Tax Credit from proposed federal legislation. The expanded CTC has reduced child poverty by millions since it went into effect in July. And it dies today unless congress takes action, with Manchin being the key vote.

Manchin has been saying he's not hearing from West Virginians about this. We know that's not true but I'm hoping you can make it even less true by calling his Charleston  (304) 342-5855 and DC 202-224-3954 offices ASAP to save the program

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.

"They'd better start digging graves"

As I mentioned last week, a co-worker and I have been interviewing people who received coverage through the Affordable Care Act. Some of these got it at no cost through Medicaid expansion while others purchased it on the exchange. Some people were on oxygen, in wheelchairs, or both.

Again, the takeaway message was that even those who don't like some parts of the law or who have complaints about the cost agree on this: don't just take it away.

We had some intense conversations and lots of memorable moments, but one thing someone said stuck in my head: "If they get rid of it, they'd better start digging graves 'cause they're gonna be burying people."

Let's hope--and work hard to make sure--it won't come down to that.