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It’s a Matter of Life and Death: Insurers Must Cover Language Services

A 14-year-old girl accompanies her Somali-speaking father to his medical appointment. Because the clinic doesn’t provide an interpreter, the girl has to inform her own father than he has been diagnosed with cancer. She remains his interpreter through eight years of treatment, sometimes hiding information to protect him from the bad news.

A group of Spanish-speaking farmworkers enters a pesticide-laden field and soon, sickened and vomiting, must rush to the hospital. No medical interpreters are provided, and one of the farmworkers must handle communications between her coworkers and health care providers – while she is suffering from her own symptoms.

A Vietnamese-speaking woman is admitted to the hospital. When doctors or nurses need to talk with her, they call in an orderly with no training as an interpreter and no familiarity with medical terminology.

Cases like these are far from isolated. Every day, children, other relatives, friends, and even untrained hospital staff are asked to step in to do a job only competent, professional medical interpreters should be performing.

These dangerous practices persist despite federal law requiring hospitals and other health care providers to offer language services.

These institutions should be meeting their obligations. But it’s also long past time to require insurance companies to make medical interpretation available just as they cover exams, prescription drugs, and other health care essentials.

So far, we’re not holding insurers to that kind of requirement.

As we continue transforming our health care system through the Affordable Care Act (ACA), we need to incorporate professional medical interpretation into those efforts. The federal government should require insurance companies to make medical interpretation available to all patients who need and want it in their course of care.

Letting insurance companies off the hook puts people’s health at risk, allowing insurers to deliver substandard care to people whose health they’re supposed to protect.

Ample research shows that medical interpretation is a necessary component of health care for people with limited English. Without proper interpretation, doctors can misunderstand patient complaints, inaccurately diagnose their conditions, and prescribe inappropriate treatments. Patients receive medications but may not know how to take them.

Often, patients with limited English don’t even make it to the doctor’s office at all. Studies show that patients with limited English are less likely than other patients to have a regular source of health care.

Thanks to the ACA, insurance companies are signing people up in record numbers. They’re marketing health plans to many new enrollees in languages other than English. They’re also enrolling new patients in languages other than English. They should also be able to make health care available in those languages – rather than just pocketing the premiums from those enrollees.

The ACA gives us new tools for holding insurers and providers to their language services responsibilities. We need to do a better job of using all of these tools.

In early September, the federal Department of Health and Human Services (HHS) proposed long-awaited rules to implement the ACA’s ban on discrimination in health care, including discrimination faced by patients with limited English proficiency.

The proposed rules make it clear that oral interpretation is key to combatting that discrimination. They also establish that the new anti-discrimination rules apply to health insurers offering coverage through the ACA. And they require entities covered by the rules to make sure they’re relying on qualified interpreters.

With this language, HHS is building on longstanding civil rights law recognizing people’s right to oral interpretation. But HHS is also building on a history in which that right has been violated, again and again, with violators abetted by inadequate enforcement mechanisms. Patients still are receiving substandard care because of the language they speak.

In a health system increasingly concerned about quality, insurers should make sure all their patients are receiving good health care.

There’s precedent for requiring insurers to step up. Under California’s SB 853, insurers must provide language services at all access points, including the doctor’s office. And, in many states, Medicaid pays for interpretation to help make sure providers are offering it.

If Medicaid programs can cover medical interpretation, so can private insurers. The federal government shouldn’t be letting insurers off the hook while also letting them collect premiums. Patients with limited English have a right to quality health care – and we need to make sure they’re getting it.

(This article was originally published in Huffington Post.)

Defending Planned Parenthood is Essential for the Whole Progressive Movement

(This opinion by LeeAnn Hall was originally published in Common Dreams)
Planned Parenthood is an easy target for rage and righteousness as we saw too plainly in the shootings in Colorado Springs late last month.
The ongoing conservative attack on Planned Parenthood funding depends on the same extreme rhetoric but, it’s also part of a broader trend, a strategy by the right to dismantle progressive infrastructure.
As destructive as we know right-wing operatives to be, we shouldn’t be surprised by their tactics – and we can’t allow ourselves to be divided or defeated by them, either.

Progressive groups and our members must reach across our issue silos, and our membership bases, whenever one of us comes under attack. Our support of Planned Parenthood provides a good example of how we can and should support each other.

This week I joined with a hundred other community leaders, organizers, and small business owners to place an advertisement in The Hill to tell lawmakers directly that we stand with Planned Parenthood. This followed a day of solidarity on December 5, when organizations and individuals around the country stood up for Planned Parenthood.

By speaking up and speaking together we are helping build a new kind of solidarity essential for today’s progressive movement.

A right to an abortion was upheld by the highest court of the land and is supported, in some or all circumstances, by 80 percent of the public. But abortion rights, and women’s health more broadly, are under greater attack today than ever. Why?

Many states have created bureaucratic hurdles and funding schemes that have made clinics that provide abortions and other essential women’s health services harder and harder to find. At the federal level rhetorical and policy attacks on Planned Parenthood have further jeopardized these rights.

Sure, it is largely because the rightwing politicians have been able to vilify Planned Parenthood and utilize their power at the state and federal level to limit access to abortions.

But it is also because for many years our movement for progressive social change has been too divided-up and focused internally on a narrow set of issues. We have tended to stay in our silos.

For my organization, the decision to stand up for Planned Parenthood was our first significant public foray into reproductive justice. Our decision came after a lot of discussion among organizers and grassroots leaders.

Ultimately, we knew we had to recognize the connection between attacks on women’s reproductive rights and many other issues affecting the lives of everyday people.

Low-wage workers, poor people, people of color, and immigrants depend on Planned Parenthood – 2.7 million women and men every year – for birth control, family planning and abortion services, cancer screenings, and testing and treatment for sexually transmitted disease.

At a time when working people, and especially working women, are increasingly struggling to make ends meet, Planned Parenthood and other women’s health centers are providing essential services. Seventy-nine percent of Planned Parenthood health care center patients have incomes at or below 150 percent of the federal poverty level.

It’s no accident that the same politicians plotting to defund Planned Parenthood are leading the charge to eradicate the Affordable Care Act (ACA). Last week, just days after the Colorado Springs shootings, conservatives in the Senate were still debating legislation to dismantle both health care pillars.

If the attack on reproductive justice is part of a broader right-wing agenda, the singling out of Planned Parenthood also points to a prime right-wing tactic to advance that agenda: destroy progressive institutions.

Unfortunately, the right-wing has had success in the past with this tactic.

Just a few years ago, right-wing demagoguery, distortions, and budget cuts broke up ACORN, a national network of community organizations that was one of the strongest voices of low-income people in the country. Far too many progressive groups and individuals stood on the sidelines when ACORN was under fire. We lost strength as a result.

The latest legal challenge to the right of workers to collectively bargain and build unions will be heard by the U.S. Supreme Court in January in the case of Friedrichs v. California Teachers Association which could dismantle public sector unions as we know them.

In recent weeks black student activists at the University of Missouri faced threats of violence in the wake of their successful organizing effort to unseat the University President. More recently five Black Lives Matter supporters were shot and wounded in Minneapolis by purported white supremacists.

Meanwhile, political leaders continue to make hateful comments about — and propose continued racist policy against — refugees and Muslims. Some voices may be more extreme than others, but xenophobia is widespread, as we saw in 30 governors’ reaction to Syrian refugees. Along with these rhetorical attacks, we’re seeing efforts to gut the programs that help refugees.

This is all infrastructure that we, as progressives, care about and need.

As community organizations, unions, grassroots activists, and faith leaders we must look to the shows of support for Planned Parenthood as an example of our ability to stand together. If there’s one thing we need lots of these days, it’s solidarity.

LeeAnn Hall is the executive director of the Alliance for a Just Society, a national organization that advocates for health, economic and racial justice. 

Health Insurance Is Great – Navigators Needed to Help People Use It

This spring, Adriann Barboa and her colleagues at Strong Families New Mexico went on a five-county tour, fanning out across the state to share findings from the Breaking Barriers study they’d conducted on progress under the Affordable Care Act (ACA).

The report is part of a ten-state series by the Alliance for a Just Society.

“In all the towns we went to, many people said it was great to finally have insurance, but they didn’t know how to use it,” Barboa said.

“The Breaking Barriers report recommends using navigators to help people understand what a primary care provider is, what preventive care is, and how to get those services using their insurance,” Barboa said. “Across the five counties people pointed to that recommendation and said ‘That’s what we need.'”

Since passage of the ACA, the United States has seen a record decline in the uninsured rate. In 2013, more than 13 percent of people in the country were uninsured. By 2014, that figure had dropped to 10.4 percent.

These gains were achieved thanks to the ACA’s Medicaid expansion and subsidies for coverage through state and federal marketplaces. The new law made millions of people eligible for health coverage when they’d been shut out in the past.

But, even with these changes, it took real people to get so many new enrollees through the door – these are the navigators mentioned by Barboa.

In the first open enrollment period alone, navigators and other enrollment assisters helped more than 10 million people apply for coverage. These navigators provided information about plans, assisted people with forms, helped them submit documents, and showed them how to make their payments.

This help was – and continues to be – key to the ACA’s success, which is why the federal Department of Health and Human Services is increasing its investment in navigator programs.

We all know how apt the term “navigator” is, since the process of enrolling in health insurance is so complicated. But those complications don’t end once you’re signed up for insurance and have sent off your first premium payment. Using health insurance can be very confusing, too.

Many of us have had questions about our coverage. How do I select a doctor or other practitioner from my health plan’s list of providers? What kind of care comes free of additional costs, and when may I be charged out-of-pocket payments – and how much will those payments be? How do I find out what services or prescriptions are covered? If I’m denied a service, what are my rights to challenge that denial?

These questions are hard enough when you’ve had health insurance your whole life. It’s that much harder if you’re getting coverage for the first time. In that case, you’re entering a new world of formal terminology, provider lists, and paperwork.

That’s why navigator-type programs should be there for us after we enroll, too.

Without an effort to make sure coverage translates into care, we run the risk of missing out on the promise of health reform – which, we should remember, is about transforming our health sector so people can get the care they need. Enrolling all those millions of formerly uninsured people is just the first step.

As the Alliance for a Just Society’s recent Breaking Barriers reports show, many people – especially people of color and low-income people – still aren’t getting into the doctor’s office even after they have coverage.

Some community-based organizations provide good models for how an integrated assistance program can help people move into coverage and then turn that coverage into care.

The Community Service Society of New York (CSSNY) provides one such model. Drawing on funding from New York State, CSSNY has established an innovative coverage-to-care approach – using both a navigator network and a community health advocates program – that helps people obtain coverage and put their coverage to use.

A New Yorker needing help can call CSSNY’s toll-free helpline, where advocates connect people to enrollment assistance, answer questions about coverage, or help troubleshoot insurance issues (such as coverage denials or billing problems). Using a hub-and-spoke structure, CSSNY also works with a broad, statewide network of community group and small business groups, offering help in almost 200 languages.

We need more programs like this one if we hope to truly transform our health care system and make it work for everyone. We need to make sure a person’s insurance card is worth much more than the plastic it’s printed on. Good coverage-to-care navigator programs are key to achieving that goal.

Take Down the Confederate Flag – And Raise Up Medicaid Expansion

This opinion piece by LeeAnn Hall was originally published in Huffington Post.

It’s tempting, this summery week, to sit and savor the sweet victory that was handed us by the Supreme Court in late June with the King v. Burwell decision. The court’s ruling protected the health care subsidies that allow 6.4 million people to afford their health insurance.

Many of those are people who have health insurance and routine health care for the first time in their lives because of the Affordable Care Act. Now they can breathe a little easier, knowing they can go to the doctor when they are sick, get immunizations, medications and preventive care.

The Supreme Court’s ruling came a week after the horrifying news that nine people were killed while praying inside the Emanuel AME church in Charleston, South Carolina.

One of those killed was Rev. Clementa Pinckney, a South Carolina senator who was a tireless advocate for Medicaid expansion in his state. Some called him the “moral conscience of the South Carolina legislature.”

The killings in Charleston spurred the long overdue call to remove the Confederate flag from public buildings and from license plates. Removing the symbols of racism and inequity is a significant step. Just as critical is the need to remove racist barriers to quality health care.

We must continue to fight for the nearly four million people who still don’t have access to health care because of their state lawmakers’ refusal to expand Medicaid. Nearly 90 percent of those in the health care coverage gap live in the South, and they are disproportionately people of color.

It’s time to stop debating the right to health care – that discussion is done. Now it’s time to make quality health care a reality for everyone. The Affordable Care Act is here to stay.

Billions of dollars in federal funding is in place for legislators to extend health care to everyone in their states. Yet, lawmakers in 19 states have refused to accept that funding – 13 of those states are in the South.

It’s time to end policies that perpetuate systemic racism. I ask these legislators and governors – what are you so afraid of that you would deny a mother a visit to the doctor, or a father medication he needs to be strong for his children?

Refusal to expand Medicaid and provide quality health care to all remains a stark and shameful example of our nation’s failure to overcome persistent racial disparities.

President Obama, in his elegant eulogy in Charleston, said: “It would be a betrayal of everything Reverend Pinckney stood for, I believe, if we allowed ourselves to slip into a comfortable silence again.”

We must all remain uncomfortable – and outspoken – until racism, fear and hate are erased, in our symbols and in our policies. One step must lead to the next step.

Taking down the Confederate flags would be a bold symbolic statement that reconciliation has at long last begun. Expanding Medicaid to millions of people would show that we really mean it.

LeeAnn Hall is the executive director of the Alliance for a Just Society, a national policy and organizing network that has produced pivotal reports for 20 years on national health issues.

LeeAnn Hall’s Statement on King v. Burwell (with Fred Azcarate and George Goehl)

Today is a major victory: the Supreme Court rejected King v. Burwell, an attack against the Affordable Care Act that attempted to deny quality health care to millions of people in the United States.

Together with Fred Azcarate, executive director of US Action and George Goehl, executive director of National People’s Action, I would like to share this statement with you:

“Today. The Supreme Court rejected an attack on the Affordable Care Act, our country’s health care law. Now, more than 6.4 million people, many with health insurance for the first time, can rest assured that their health coverage won’t be stripped away.

Our work isn’t done. Many people – disproportionately people of color – are still shut out of health care because of cost, the language they speak, or state lawmakers’ refusal to expand Medicaid. It’s time to stop fighting over whether people have a right to health care – and time to make quality health care a reality for everyone.

We call on obstructionists in Congress to end their assault on health care once and for all. Stop trying to repeal, defund, and undermine the Affordable Care Act.”

The Alliance for a Just SocietyUSAction and National People’s Action led grassroots organizations nationwide to fight for health care for everyone in our country. The ACA was a major victory, overwhelmingly popular, and it’s here to stay.

Want to do more?

Click the Health Care for America Now petition to tell obstructionists “Hands Off ACA!”

The law is working – now it’s time to make sure everyone has access to quality health care.

Report: Racial Health Disparities Magnified in California Under ACA

FOR IMMEDIATE RELEASE
Tuesday, May 5, 2015
Contact:
Kathy Mulady, communications director
kathy@allianceforajustsociety.org
(206) 992-8787

Breaking Barriers to Health Care Access in California

“Obamacare didn’t cause the widespread racial disparities we found,
but neither did it solve them.”

More Californians than ever before have health insurance, but coverage isn’t care, and the Affordable Care Act has magnified the deep racial, ethnic and cultural disparities in accessing quality health care in California.

Latino and African Americans especially remain heavily uninsured and struggle to receive health care.

Language and cultural barriers, lack of Internet or an email address, a lack of experience in using health insurance, a shortage of doctors and clinics in poor and rural communities, and high costs are preventing many from receiving health care and medications.

A new report “Breaking Barriers: Improving health insurance enrollment and access to health care in California,” reveals a deep divide between social class, income, culture and ethnicity emerging under the state’s Covered Care.

“It’s unconscionable that so many have been left out of something as basic as the chance to enjoy good health,” said Gary Delgado, author of Breaking Barriers. “Lack of Internet access or speaking another language is not a reason to be locked out of a health system that purports to be open to all.

“Obamacare did not cause the widespread racial disparities we found, but neither did it solve them. Now we have to take them on directly,” said Delgado.

“Breaking Barriers” s a year long study that includes a survey of nearly 1,200 low-income people in 10 states in Spanish, Cantonese, and English. They were contacted at food banks, health clinics, and homeless centers.

Alfredo DeAvila did surveys and interviews for the Breaking Barriers California report.

“If the ACA is going to be successful, we need to help people transition not only into the health insurance system, but also into the health care system,” he said. “We must invest in public education about how to get ongoing preventive care.”

The Korean America community, especially seniors are struggling because of costs, said DJ Yoon, executive director of NAKASEC (National Korean American Service and Education Consortium.)

“California can be a leader in assuring quality health care for all people. We have let people of color again slip through the cracks in our system, we can do better – and here is a roadmap for how we get there,” said Delgado.

Key recommendations in the report include:

  • Improve language access. Make provider directories available in multiple languages and list addresses, phone numbers, languages spoken, hospital affiliations, and specialties.
  • Simplify the insurance-shopping experience. Make cost information transparent and communicate clearly about deductibles, co-pays, and preventive services that are included.
  • Covered California should enforce and impose penalties on insurers who do not reduce racial health care disparities within required timeframes.
  • Assure that primary care providers are within 30 minutes driving or public transit time. Enrollees who must travel further should be offered free transportation.
  • Expand school-based health centers, especially in medically underserved communities.
  • Address underlying causes of poor health, especially in poor communities, (mold, infestations, domestic violence) Expand medical-legal partnerships as an avenue toward addressing poor health in low-income communities.
  • Reinforce the ACA-mandated “well-woman preventive” care and provide education about the value of preventive care for all. Ensure that all plans include reproductive health care services.
  • Require that new enrollees are offered a free physical exam, appropriate screening tests and other preventive care within 60 days of enrollment.

Here is the link to the full Breaking Barriers in California report: http://allianceforajustsociety.org/wp-content/uploads/2015/04/BBReport_CALIF.pdf

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The National Korean American Service & Education Consortium (NAKASEC) brings a progressive voice to civil rights and immigrant rights issues and promotes full participation of Korean Americans in building a movement for social change.

The Alliance for a Just Society is a national policy, research and organizing network focused on racial and economic justice. The Alliance has produced pivotal reports for 20 years on state and national health issues including Medicaid, prescription drugs, and insurance industry practices.

 

Report Card: States Rejecting Medicaid Expansion Get Poorest Grades on Women’s Health

The Alliance for a Just Society has released a Women’s Health Report Card that reveals which states get poor and failing grades when it comes to women’s health and to ensuring access to quality, affordable and timely health care – important measures of states’ public health infrastructure.
FOR IMMEDIATE RELEASE
Tuesday, October 14, 2014
Contact: Kathy Mulady,

STATES REJECTING MEDICAID EXPANSION GET POOREST GRADES ON WOMEN’S HEALTH, ACCORDING TO NEW 50-STATE REPORT CARD

Report card highlights persistent racial disparities in women’s health in every state

Seattle, WA—Seventeen of the 21 states that rejected federal funds to expand health coverage through Medicaid received final grades of C, D or F in a new 50-state report card on women’s health – and 13 states got a D or F grade. Even in states with better overall grades, persistent racial disparities indicate that most states are failing to meet the health care needs of women of color.
States with the worst grades when it comes to women’s health are Mississippi (ranked #50), Oklahoma (#49), Texas (#48), Nevada (#47) and Arkansas (#46). States with the best rankings are Massachusetts (#1), Connecticut (#2), Hawaii and Vermont (tied for #3) and Minnesota (#5).
The Promise of Quality, Affordable Health Care for Women: Are States Delivering? is a 50-state report card on women’s health released today by the Alliance for a Just Society. The report card provides an important measure of states’ records on women’s health as politicians court women voters ahead of the November elections, and continue to debate whether to accept federal funds to expand Medicaid coverage in more than 20 states.
The 50-state report card is available at: http://www.allianceforajustsociety.org/womenshealth
“This report card shows that most of the states that are still refusing funding for Medicaid expansion have poor or failing records on women’s health. These states are failing women and the families that depend on them,” said LeeAnn Hall, executive director of the Alliance for a Just Society. “It’s time for governors and legislators in these states – from Texas to Maine and Florida to Montana – to move forward with expanding health coverage to uninsured women through Medicaid.”
Representative Jan Schakowsky (D-IL) credits the Affordable Care Act with helping improve women’s health through expanded coverage, cost-free access to contraception and other preventive health services, and the elimination of gender-based insurance discrimination.
“While many states are making critical progress on women’s health thanks to the Affordable Care Act, this Report Card underscores that we must do more, starting with getting every state to cover low-income women through Medicaid,” said Schakowsky.
States with poor records have the opportunity to improve women’s health coverage by accepting federal money to expand Medicaid, said Judy Waxman, vice president for Health and Reproductive Rights at the National Women’s Law Center.
“But if leaders in these states continue to drag their feet, they’re only going to fall further behind. No woman should be denied health care for any reason,” said Waxman.
The report card shows that all 50 states are failing to meet the health care needs of women of color. Latina women are uninsured at much higher rates than other women in almost every state. Black, Latina, Asian/Pacific Islander and Native American women have worse outcomes on key health measures in most states.
“These race-based differences are shocking – and unacceptable. These disparities make it clear that the debate over Medicaid expansion must end,” said Jessica González-Rojas, executive director of the National Latina Institute for Reproductive Health. “It’s time for politicians to stop bickering and take action to improve health for all women – including women of color – by moving forward with Medicaid expansion.”
With women making up an increasing share of primary breadwinners, women’s health is of critical importance for family economic security.
“Low-income women in more than 20 states who are doing everything they can to support their families are being denied access to affordable health care because of state leaders’ stubborn refusal to accept the federal funding to expand Medicaid,” said Yael Foa, outreach director for Working America.
“This is a national issue, and it hits working class people the hardest. In some cases, women are patching together a living through 2, 3 or 4 part-time jobs that don’t offer health care,” said Foa. “Our families and our economy depend on women. Women should be able to depend on their states for quality, affordable health care.”
The Promise of Quality, Affordable Health Care for Women: Are States Delivering? report card uses the latest available data from government and other sources to rank the 50 states on 30 measures relating to women’s health. It generates state rankings and grades in three subject areas (health coverage, access to care, and health outcomes), an assessment of race-based disparities, and a final rank and grade for every state. It includes specific recommendations for improving women’s health.
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The Alliance for a Just Society is a national policy, research and organizing network focused on racial and economic justice. The Alliance has produced pivotal reports on state and national health issues including Medicaid/CHIP, prescription drugs, and insurance industry practices for 20 years.

www.allianceforajustsociety.org

Legislators Who Block Medicaid Expansion Are Stiffing Veterans Out of Health Care

** This article by LeeAnn Hall  first appeared in Huffington Post **

r-VETERANS croppedThe scandal over long wait times for veterans in the Department of Veterans Affairs health system has grabbed a lot of headlines and elicited a lot of righteous anger – as it should. America’s veterans deserve so much better.

But as Ezra Klein pointed out in a piece in Vox, there’s another health care scandal that also deserves its share of righteous anger, and it also has a big impact on veterans with health care needs: the self-destructive refusal of lawmakers in 20-plus states to accept federal funds to expand their Medicaid programs.

Klein catalogued “24 health-care scandals that critics of the VA should also be furious about” (that is, the 24 states that have rejected the Medicaid expansion). Thanks to lawmakers’ kneejerk opposition to expanding health coverage in those states, there are huge numbers of uninsured veterans who should be eligible for coverage, but aren’t: 41,200 veterans in Florida, 24,900 in Georgia, 48,900 in Texas… and the list goes on.

All in all, about 250,000 uninsured veterans are getting stiffed out of eligibility for health coverage by lawmakers who have blocked Medicaid expansion, according to Pew’s Stateline. As it turns out, those lawmakers are also stiffing their own states out of economy-boosting jobs – health care jobs that are overwhelmingly good-paying jobs. Medicaid expansion would create thousands more of these jobs.

Read more

Who’s Really Behind the “Voice of Small Business?”

small biz calculator*This article was originally published in The Hill *

How much does it cost to rebrand a fee levied on health insurers as a “HIT on small business”?

Well, $1.593 million, according to this exposé in the New York Times a few days ago.

A little background: a provision of the Affordable Care Act levies a fee on health insurance companies.  This fee helps to fund the law’s sliding scale premium assistance for individuals, as well as tax credits for small businesses to make health insurance more affordable. It’s expected to cost the insurance industry $100 billion over the first decade.

The New York Times investigation reveals that in 2012, the insurance industry trade group America’s Health Insurance Plans (AHIP) funneled $1.593 million to the National Federation of Independent Business (NFIB) – the self-proclaimed “Voice of Small Business” – doubling down on an $850,000 dark money contribution the year before. Read more

Poor, in Prison – and Pregnant

pregnant-inmateAs poverty levels in the U.S. increase, safety nets are  slashed, and families are left with few options for survival. As a result, more people are forced into difficult economic decisions, including alternative street-based economies and crime from sheer economic desperation. Many of these people are women and mothers.

Among women who are fortunate enough to have employment – women of color, are still making 64 cents on the dollar compared to men. (For white women, it is  77 cents on the dollar.) These women are also most likely to be the primary caregivers for children. Add in the high cost of childcare and the amount of money that women have left to live on is abysmal. Read more