Analysis

There’s a Huge Racial Gap in Cervical Cancer Deaths. Repealing Obamacare Will Make it Worse.

| Eliza Schultz
(AP Photo/Lynne Sladky)

When epidemiologists at the Johns Hopkins School of Public Health recently recalculated cervical cancer mortality rates, they found that black women were nearly twice as likely to die from the disease as we previously thought. What’s more, the researchers found that black women die from cervical cancer at rates more than double those of white women—a gap that is also twice as large as earlier estimates.

The study revealed that, among black women, there are 10.1 cervical cancer deaths per every 100,000 individuals—versus just 4.7 per 100,000 white women. Previously, these figures were believed to be 5.7 and 3.2, respectively.

It’s hardly a secret that socioeconomic status and racial discrimination greatly impact patients’ health outcomes in the United States. Low-income patients with diabetes are 10 times more likely to undergo limb amputation than affluent ones, black women are 41% more likely than white women to die from breast cancer, and even though African Americans are more likely to have elevated blood pressure than white Americans, they are 10% less likely to be screened for high cholesterol. The list goes on.

But what makes the recalculated cervical cancer death rates stand out is that the disease is preventable as long as it is detected early and treated appropriately. The low fatality rates among white women by and large reflect that fact. Black women, however, die from cervical cancer at rates comparable to those in sub-Saharan Africa.

One of the factors behind the disparity is that black patients face inferior access to quality detection services and follow-up care (the root cause of which is, of course, racial discrimination). Another recent study of patients with advanced-stage cervical cancer found that a majority received substandard care, and that those patients were more likely to be black and low-income.

How do we get adequate preventive care to all people?

As Dr. Otis W. Brawley, the Chief Medical Officer for the American Cancer Society, said in response to the Johns Hopkins study, “When we look at the difference between black and white, and rich and poor, we find the same disparity. The quality of assessment and follow-up treatment can be the difference. The question becomes: How do we get adequate preventive care to all people?”

But unlike the medical community, whose goal is to expand care, Congressional Republicans’ relentless attacks on the Affordable Care Act and Planned Parenthood will dramatically reduce it—and worsen the racial disparities that have killed so many black women.

The Affordable Care Act mandated coverage of cervical cancer detection services—along with all preventive care—at no cost to the patient. But the Republican-controlled Congress and White House have already taken steps to dismantle the ACA, and the fate of preventive care is uncertain as a result. (Conversations between House and Senate Republicans reveal that there is no consensus around how best to replace the healthcare law.) If racial disparities in cervical cancer death rates boil down to unequal access to quality detection services and subsequent treatment, then patients who struggle to afford care are bound to be worse off under repeal.

The proposal to roll back the Medicaid expansion, backed by many Congressional Republicans, threatens to strip coverage—and thereby the ability to obtain detection services and treatment—from the patients who arguably need it the most. Some 11 million low-income individuals will lose access to Medicaid under this proposal, and black women are more likely to be affected. Moreover, the proposal to turn Medicaid into a block grant will cut between 14 million and 20 million patients from the health insurance program.

Furthermore, Congressional Republicans continue to target Planned Parenthood, a core provider of reproductive and sexual health services—cervical cancer detection included. If they defund Planned Parenthood, the health care provider will be stripped of more than one-third of its budget. Low-income women and women of color, who are disproportionately represented among its patients, will likely suffer worse medical outcomes as a result. And if Congressional Republicans follow through with plans to slash Title X—the nation’s only federal source of funds for reproductive health clinics—patients will find cervical cancer detection services (and other vital healthcare) even further out of reach.

Racial disparities in medical outcomes are completely avoidable—particularly when the disease in question is as preventable as cervical cancer. While the medical community rallies to address these differences in mortality rates, efforts to rectify them will only be stymied by Congressional Republicans. But the cost, in this case, is people’s lives.

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Analysis

Trump’s Supreme Court Nominee Rules for Corporations, Not People

| Rebecca Buckwalter-Poza
President Donald Trump shakes hands with 10th U.S. Circuit Court of Appeals Judge Neil Gorsuch, his choice for Supreme Court associate justice in the East Room of the White House in Washington, Tuesday, Jan. 31, 2017. (AP Photo/Carolyn Kaster)

Last night, President Trump announced that he is nominating Neil Gorsuch to be a Supreme Court justice. Like the rest of Trump’s nominees, Gorsuch is a millionaire who consistently sides with corporations and institutions rather than people—including children.

In 2004, the parents of a then-ten-year-old boy known only as “Luke P.” enrolled him in a residential school. Luke, who was diagnosed with autism at age two, had been unable to carry over the functional behaviors and skills he learned at school to other environments. Although he was toilet trained at school, when he was at home he spread bowel movements around his room. And in some respects, he was actually regressing: an occupational therapist observed that school staff were even inadvertently reinforcing negative behaviors.

But Luke’s home school fought his parents’ request that his residential placement be covered by the district under the Individuals with Disabilities Education Act (IDEA), an education law that guarantees students with disabilities “a free, appropriate education” that is tailored to their needs. Jeff and Julie P. took on the district and won repeatedly, in Colorado administrative proceedings and then in federal district court.

Then they reached the Tenth Circuit and went before Judge Neil Gorsuch.

Gorsuch reversed the district court, holding that the IDEA only required a school to provide a “basic floor of opportunity,” and nothing more. Even though a residential program obviously provided far more benefits for Luke, Gorsuch ruled that his parents were not entitled to reimbursement for the additional cost because Luke had no right to an education that would allow him to function in environments outside of school.

Again and again, Gorsuch has acted against individuals’ rights and interests—usually to the benefit of big businesses. As a trial lawyer, Gorsuch represented a billionaire suing a company for a massive payout—at the expense of the Teachers’ Retirement System of Louisiana. On the bench, he’s ruled against workers again and again—most famously in the Hobby Lobby case, which held that for-profit companies can force their religious views on their employees. When there’s a choice between placing a burden on a corporation or institution and protecting people, Trump can count on Gorsuch to toe the line.

Gorsuch’s fondness for corporations is anything but subtle.

Gorsuch’s fondness for corporations is anything but subtle. One of his most troubling views has to do with the rules and regulations agencies make to implement critical laws like the Clean Water Act (or, say, IDEA). In short, he’s against them.

Gorsuch has been a vocal opponent of the 1984 Supreme Court decision that requires courts to defer to agencies when it comes to interpreting the laws they’re charged with enforcing. According to Gorsuch, that complicates life for businesses who may want to resist regulations. “Who can even attempt” to fight a rule, Gorsuch asked in a 2016 opinion, “without an army of perfumed lawyers and lobbyists?”

If it were up to Gorsuch, courts would be able to overrule agencies. That would be a massive blow to the means by which our government regulates businesses and protects Americans’ health and safety. People without the means to challenge corporations in court when they pollute or after financial institutions exploit them rely on government—on agencies like the Environmental Protection Agency—to keep them safe.

Gorsuch’s anti-regulatory stance is just another way he’s in line with Trump and his congressional allies. Trump has issued a sweeping freeze on regulation, and he’s signed an executive order creating new obstacles to rulemaking and suggesting agencies have to repeal two rules to make one new rule—with the explicit purpose of giving businesses a boost. Meanwhile, the House has passed a trio of bills that would let Congress and the courts strike hundreds of critical regulations—including fair pay and sick leave guarantees, nutrition standards for public schools, and limits on corporate pollution and contamination—and make it next to impossible for agencies to enact new protections.

It’s easy to paint Gorsuch’s nomination as “more of the same” from the Trump administration, but this nomination is different. The judiciary is supposed to be impartial. Gorsuch’s job as a justice on the Supreme Court would be to serve as an independent check on the other branches of government—a role that’s more important than ever in the wake of the recent spate of extreme executive actions that challenge the separation of powers.

But Gorsuch won’t check the Trump administration—he’ll aid and abet it.

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Analysis

Trump Considering Cuts that Would Create a “Perfect Storm” for Domestic Violence Survivors

| Anusha Ravi
Susan Contreras sits on her bed in a Phoenix-area shelter for victims of domestic violence on Wednesday, Aug. 3, 2016. Contreras is part of a unique program at the Barrow Neurological Institute in Phoenix that aims to assist abuse survivors who have suffered head trauma. (AP Photo/Beatriz Costa-Lima)

According to The Hill, the Trump transition team has proposed cuts similar to those found in a Heritage Foundation budget blueprint that would eliminate $10.5 trillion in federal spending over the next 10 years.

Under the Heritage plan, the cuts would be dramatic. They would reduce funding for the Departments of Commerce, Energy, Transportation, Justice, and State, and eliminate funding entirely for the National Endowment for the Arts, the Corporation for Public Broadcasting, the Paris Climate Change Agreement, and the Office of Energy Efficiency and Renewable Energy.

The cuts would negatively impact low-income people, people of color, and many other groups in terrifying ways. But there is one specific group that would be caught in a perfect storm of slashed services: survivors of sexual and domestic violence, who rely on many government services that would be on the chopping block.

The proposed cuts would eliminate grants from the Violence Against Women Act (VAWA), which funds services for survivors like transitional housing, legal assistance, law enforcement training, and support for people who have been sexually abused within the prison system. These grants have been incredibly effective—since the passage of VAWA in 1994, intimate partner violence has decreased by 64%. That success is due, at least in part, to the fact that they work in tandem with other programs, like Community Oriented Policing Services (also slated for elimination under the Heritage Foundation proposal), to make sure police have the staff, technology, and training they need to properly respond to survivors.

These cuts would also eliminate the Legal Services Corporation (LSC), which is the single largest funder of civil legal aid. The most important legal actions that survivors take often happen in civil, not criminal, court—civil court is where they file for divorce from abusive partners, seek custody of their children, and apply for protective orders.

According to Lisalyn Jacobs, Vice President of Government Relations at Legal Momentum, “civil litigation can be a battle of who can wear down who first, and the survivor is far more likely to have less resources to stay in court for a long time.” Survivors are disproportionately likely to be low income, and have almost always been subjected to financial abuse that leaves them with limited access to cash. That makes it harder for them to afford a lawyer or endure a lengthy civil legal case—hence the need for civil legal aid.

The direct elimination of federally-funded support services and legal aid would create an extremely hostile climate for survivors, and the Heritage proposal would hurt this group in other ways as well. It would reduce funding for the Department of Justice Civil Rights Division, which in turn could affect funding for housing discrimination cases. Survivors are particularly vulnerable targets of housing discrimination—landlords often evict survivors or deny them housing specifically because they’ve been abused in the past. The DOJ Civil Rights Division currently extends legal protections to survivors to prevent this, and holds landlords accountable for any instances of biases or discrimination. This cut, then, would immensely weaken protections that survivors rely on in order to achieve safe housing and distance from an abuser.

The overarching conservative argument behind the Heritage proposal is that it’s the responsibility of the states, not the federal government, to protect survivors. But states do not have the finances, leverage, or incentive to provide the same level of service. For example, if victims or their abusers regularly cross state lines—like many people in the DC metro area do simply to commute to work—then state-level policing efforts to enforce protective orders would fall tragically short. Survivors’ mobility often relies on the portability of their protective orders, and only the federal government has the wherewithal to ensure interstate cooperation on these orders.

Each one of these proposed cuts individually would place survivors at increased risk, but combined they would leave survivors without police, housing, and legal protections that they desperately need. That paints a very dark picture for survivors—one that legislators should be mindful of when they draft the federal budget in April.

Editor’s Note: This post has been updated for clarity so that no readers are under the impression that the Trump Administration has released a formal budget proposal.

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First Person

The Speech from the Women’s March You Needed to Hear

| Angela Sutton
(AP Photo/Sait Serkan Gurbuz)

Editor’s Note: The text below is a modified version of a speech that Angela Sutton gave at the Philadelphia Women’s March that took place on January 21, 2017.

I am a black woman, a mother of two beautiful black boys, and I live in Northeast Philadelphia.
I have lived in poverty, in Philadelphia, my whole life.

Philadelphia has the highest poverty rate of any large American city. The face of that poverty is most likely a black mother, like me.

For me, being a woman has always meant being strong and never showing weakness.
I have always had to be superwoman, and the women around me have had to be the same.
As a single mother of two boys, I have to play both roles and every day, I do what I have to in order to take care of my boys the best way I know how.

I, too, am a woman.

I am the woman you don’t see when you walk down the street sipping your Starbucks coffee.
I am the woman you don’t see standing in line at the local food pantry.
I am the woman who remains invisible in spaces and at events like the Women’s March.

But I am here.

You must see me.
You must acknowledge me.
You must include me.

We must continue the fight—and that means all of us.

Because I am the woman who fights every day.
I am the woman who understands inequality.
I am the woman who advocates for the rights of women and children living in poverty.
I am the woman who wants a better life.

The new administration scares me, but I know I have to continue to fight.
Not just for me, but for the others who come after me.
For our children.
For our future.

We can’t accept what we are given.
We must continue the fight—and that means all of us.
Let’s hold each other accountable and unite.

Sonia Sanchez said, “in order to be a true revolutionary, you must understand love.”
I do what I do out of love.
We will win because of love.

But first you need to see me.

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Analysis

Our Financial Aid System Keeps Rich Kids Rich and Poor Kids Poor. Here’s One Way to Fix It.

| William Elliott
(AP Photo/Butch Dill)

In some ways, my story embodies the American success story. I climbed out of poverty, earned a PhD, and am pursuing my life’s work as a member of the academy. But at age 46, security still eludes me. I still lose sleep over just how far my own success will stretch—over whether my three children will have a secure economic future, too.

Growing up poor didn’t just mean that I entered college less academically up to speed than my peers. It also meant that my family had limited financial resources to help pay for college. So, I depended on student loans. I earned a bachelor’s degree—and $40,000 of debt to go with it. I managed to pay it off during my service in the military, so I went to graduate school. In record time, I earned a PhD—and another $100,000 of debt.

I’m one of millions on the debt-dependent path to the American Dream. Our journey stands in stark contrast to those who had financial support. My colleague, for example, received her graduate degree from the same university that I attended—but she had help from family. She graduated without student debt, and started building home equity before she turned 25. She even had enough to spare that she was able to take advantage of employer retirement benefits, too. Her four kids will likely have their college paid for before they finish high school.

My colleague still had to work hard. She studied, saved, and scrimped when she had to. But her path was eased because wealth was passed down at critical stages along the way. For most Americans that just isn’t an option, and it contributes to growing economic inequality in our nation. It also undermines the oft-repeated promise that a college degree is a catalyst of economic mobility and equal opportunity.

Our current debt-based system widens the gap in educational attainment by race and class, reduces graduation rates among students who make it to college, distorts career choices, constrains entrepreneurship, delays people from buying homes and building families, reduces retirement savings and overall net worth, and lengthens the time it takes to reach median wealth in the United States. In short, it asks students to compromise their long-term economic well-being for a chance at a higher education that is supposed to safeguard them from poverty (with mixed results).

It wasn’t always like this. The GI Bill—signed into law after World War II—made higher education possible for millions of veterans. Returning veterans presented a crisis, because they needed a college education to be able to re-enter the workforce and contribute to the economy. The GI Bill was a policy pivot. It prioritized veterans’ long-term needs and reframed higher education as a broadly-shared good, rather than an exclusive purview of the privileged. Within eight years it returned every dollar invested nearly seven-fold.

Now it’s time for another pivot. We need a financial aid system that performs to the standards of our American values—where the effort we put in and the ability we possess determine our economic outcomes.

Now it’s time for another pivot.

During the 2016 presidential campaign, Bernie Sanders and Hillary Clinton proposed policies that would make college free for many low-income and middle class students. While those policies have been put on hold, another proposal that could move us in the right direction is creating Children’s Savings Accounts (CSAs) nationwide. Today, there are 42 CSA programs in 29 states that open accounts for children at birth or in kindergarten, endow them with an initial deposit (financed by public or philanthropic sources), and supplement families’ savings through matching grants.

A family’s CSA savings might be modest in total dollars, but they are significant nonetheless. For example, the average out-of-state cost of a four-year degree at a public university is about $34,000. Every student could accrue that sum by age 18 if they had a CSA that received an $8,400 deposit at birth invested in stock/bond portfolios, plus an additional deposit of $5 per month by the family. This would cost an estimated $34 billion annually—less than the $74 billion in government costs for student loan forgiveness projected for 2017.

CSAs are not a silver bullet for disparities in education writ large. Even so, they could help to build an accessible education pipeline that would make it possible for more people to make it through college without crippling debt. That can begin to even out the returns that two students—one poor and one privileged—get from the same credentials.

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