First Person

Home Visiting Helped Me Learn How to Parent. Congress Is About to Let It Expire.

In the summer of 2003, at the age of 18, I gave birth to my first child. A week after her birth, I learned I would have a harder path ahead than I had expected: The doctors told me that my daughter was born with a rare genetic condition called medium chain acyl CoA dehydrogenase deficiency. My heart sunk—14 years later, those words still ring in my ears.

I was scared. I worried that other things might go wrong with her after I learned about her medical condition. I started to look for resources, anything that would help me learn to be a good mother. I started a “baby and me” class at the hospital, and I was eventually referred to Parents as Teachers, an evidence-based home visiting program where a trained professional visited my home every week.

My home visitor helped with every aspect of parenting—connecting me to a dietitian who could treat my daughter’s disorder, helping me access WIC so that my baby and I could afford to eat, and helping me learn about my baby’s development.

My baby’s metabolic disorder required her to be fed specific macronutrients every 2 hours. She required breast feeding until she was 16 months, and as she grew older I had to count calories, plan her diet, and account for every gram of fat she ate to keep her blood sugar balanced. It was a lot for me, as a young mother with a husband in the military. But my home visitor was there for me in a way that no one else was—she had time to listen to my feelings, and to talk through everything that was going on with my daughter.

I participated in Parents as Teachers for four months until my husband went back into the military and our little family moved from Idaho to Kansas. Even in that short period of time, I felt like I had learned so much about parenting.

My home visitor was there for me in a way that no one else was

Not long after we moved to Kansas, my husband was injured in combat during Operation Iraqi freedom. Then, in the spring of 2006, our second child was born. That pregnancy had a lot of complications that put me on bed rest, until I went into preterm labor 11 weeks before my son’s due date. There were a lot of shots, appointments, and a couple of hospital stays. But this time, I was able to participate in a local health district home visiting program during my pregnancy. I learned a lot about fetal development, and felt much more prepared for baby number two than I was for baby number one.

2007 brought baby number three, my second son, into our lives. He had a lot of age delays; he was hardly talking when he started Head Start at age 4. One day, his home visitor showed me that he was tongue tied. No doctor had mentioned that before—they’d all missed it. But she spent enough time with him to notice it, and she had the experience to know what it was. When he got his tonsils removed, they clipped his tongue to fix the problem, and his language development came quickly after that.

The thing about home visiting is that it’s not just about children. My home visitors made sure my kids were developing, but they helped me grow, too. We made family goals, and I found myself on the path to higher education. I knew that going to school was my only chance at a future where I could make enough money to support our little family.

So in 2010, when baby number four graced us with his presence, I went to college. I was accepted to the University of Idaho and granted an Operation Education Scholarship, which paid for the rest of my college education as well as living expenses so I would be able to focus on school and raising my children.

When I graduated, I became an Early Head Start teacher. Now I’m a home visitor with Parents as Teachers.

I’ve had 11 different home visitors as a mother. Being able to do the same work that I’d found so valuable makes me feel accomplished. But now, funding for home visiting—Maternal Infant Early Childhood Home Visitation grants (MIECHV)—is about to run out, and Congress’s plan to renew it would come at the expense of hundreds of thousands of people who depend on Social Security.  That violates the entire spirit of the program, which is designed to support families and communities.

The bottom line is, we know home visiting works. It makes sense for taxpayers, since research shows that every taxpayer dollar invested in home visiting programs can return up to $5.70. And as a mother who relied on home visiting, and a home visitor myself, I know how impactful it can be. It changed my life and my children’s lives, and if home visiting is expanded the right way, it has the ability to uplift an entire generation of American families.



Study Shows Kids’ Test Scores Drop When Their Food Stamps Run Out

Last week, researchers released a new study that confirms what every student, teacher, parent, and human being with a stomach already knew: It’s harder to think when you’re hungry.

The study’s authors matched up the timing of math tests in South Carolina to the dates when low-income students’ families received monthly Supplemental Nutrition Assistance Program benefits (or SNAP, formerly known as food stamps). They found that kids’ test scores dropped at times of the month when nutrition benefits had run out. Put another way, access to SNAP substantially improves students’ academic performance—but only when there are actually enough benefits for families to be able to eat.

Running out of SNAP benefits isn’t an anomaly—nearly half of participating families run out before the end of the month. That means many students who receive SNAP see their academic performance dip every single month, and then rebound once their families receive more benefits. That’s not surprising, since SNAP benefits average just $1.40 per person per meal; it’s such a gross underestimation of food cost that nearly 80 percent of benefits are spent in the first two weeks. School meals provide a little bit of a buffer—in fact, kids get as many as half their calories from the National School Lunch and School Breakfast Programs—but these programs aren’t designed to provide all the food a child needs to survive. Plus, they can’t reach kids on weekends or during the summer months.

Many students who receive SNAP see their academic performance dip every single month

This new research adds to a wealth of evidence that hunger hampers kids’ ability to learn, holds back their development of social skills, and leads to behavioral problems. And it complements many careful studies that find that access to SNAP and other programs that provide basic living standards have large, positive effects on kids’ long-term outcomes.

What’s new and different about this paper, though, is that it demonstrates the immediate difference SNAP makes to kids, rather than the long-term effects. And it joins a small but growing body of research that examines how the economic insecurity many families experience on a month-to month—or even week-to-week—basis negatively impacts their lives.

This study also reveals a massive missed opportunity: For the modest cost of boosting SNAP benefits so that they’re enough to last all month—about $15 billion per year—the US could dramatically reduce hunger and significantly boost academic achievement and educational attainment for low-income students. That’s a fraction of what Trump has proposed in tax cuts: It adds up to $1 of food benefits for every $29 he wants to give to wealthy corporations and business owners.

Instead, President Trump wants to slash SNAP by a whopping 29 percent over the next decade. That could mean an average of 3.6 million families—including roughly 1.9 million families with children—would lose access to food assistance each year. Not to be outdone, House Republicans propose cutting SNAP by 42 percent between 2023 and 2027, which could leave 7 million families hungry in 2023.

The Roosevelt Institute’s Marshall Steinbaum calls out the irony here: Many elites insist—sometimes condescendingly—that education is the ticket out of poverty. If you’re poor, they imply, it’s because you should have gone to school longer to secure a higher-paying job. But while education does tend to provide some protection from poverty, this misses a key insight. Sometimes, the barrier to education is poverty itself.

It goes without saying that protecting children from hunger is far and away the most important goal of SNAP—and the only necessary one. But studies like this show that when Trump and House Republicans propose gutting programs that ensure basic living standards, they’re not just leaving kids hungry. They’re ripping away low-income kids’ chances to escape economic insecurity and experience upward economic mobility.

How can we expect our nation’s next generation to focus on a dream—especially one as ambitious as the American Dream—when they’re hungry?



Want More Americans to Work? Give Them Medicaid.

Here in the United States, we are obsessed with work. We collectively clock 25 percent more working hours every year than people in Europe. Working hard is still considered one of the top American values, even as longer hours are no longer equated with greater wealth and have been tied to significant increases in adverse health effects such as heart disease, stroke, diabetes, and depression.

This mindset is also reflected in our national politics and apparent in the rhetoric employed by the Trump administration and the GOP in their 2018 budget proposals, which would severely cut safety-net programs.

“There’s a dignity to work, and there’s a necessity to work to help the country succeed,” White House Budget Director Mick Mulvaney told CNN at the end of May. Mulvaney added that the United States should measure its success “by the number of people we help get off of those programs and get back in charge of their own lives.”

The Department of Health and Human Services has used the same rhetoric to justify specific attacks on Medicaid. Only hours after she was sworn into her post, Seema Verma, administrator of the Centers for Medicare and Medicaid Services, and her boss, Health and Human Services Secretary Tom Price, sent out letters to all the nation’s governors urging them to impose insurance premiums on Medicaid recipients and provide work incentives.

Statements like these—and other calls to add work requirements to Medicaid eligibility guidelines—ignore the realities of who the program serves and its actual impacts. For those able-bodied people on Medicaid, the majority are already working. And for the 7 million nonelderly adults with disabilities for whom Medicaid offers primary or supplemental coverage, expanded access to Medicaid contributes to higher employment rates.

Only 19 percent of part-time workers have access to medical care benefits.

I’m one of those people. Eight years ago, I completed my master’s degree with one plan in mind: to launch a successful multi-decade career in environmental policy that would require regular overtime, frequent travel, and at least eight hours a day sitting at a desk and staring into a computer. I made this plan despite a history of sporadic health issues that tended to lay me out completely for several days every month, and debilitating headaches a few evenings every week. It wasn’t until a few years ago, when new diagnoses explained my daily struggle with overwhelming pain and fatigue, that I finally admitted to myself that my health status would prevent me from pursuing full-time work. Since then, I have survived by working a patchwork of part-time positions and freelance gigs, which has lowered my income and made me eligible for Medicaid.

And I am not alone.

According to recent data from the Bureau of Labor Statistics, 34 percent of workers with a disability were employed part-time in 2016, compared with only 18 percent of workers with no disability. Part-time jobs in the United States usually pay low hourly wages and tend not to offer crucial benefits such as health insurance: only 19 percent of part-time workers have access to medical care benefits.

For millions of disabled people in this position, the Affordable Care Act has filled a crucial need by expanding Medicaid coverage. Medicaid expansion significantly raised income requirements (by more than double) for approximately 11 million people living in the 31 states and the District of Columbia that adopted it. It also opened up enrollment to some childless adults, and dropped stringent asset limits. This meant that many more disabled people were now able to work—or work more hours and make higher wages, as well as have more savings—than prior to the expansion.

This was confirmed by a collaborative study released earlier this year that found that working-age adults who identify as having disabilities were much more likely to be employed in Medicaid expansion states than in non-expansion states.

“Having access to comprehensive insurance without having to go through a lengthy and demoralizing disability determination process is very important,” says Jean Hall, Director of the Institute for Health and Disability Policy Studies at the University of Kansas and lead author of the study. “Medicaid expansion allows people with disabilities to work more, and accumulate assets, without fear of losing their eligibility for Medicaid coverage.”

The recently-won expansion has been under continuous threat as Trump and Congressional Republicans have tried to follow through on years of promises to repeal and replace the ACA. The most recent effort, the Graham-Cassidy bill, would slash Medicaid funding and allow insurers to charge higher premiums for those with pre-existing conditions. These changes could have particularly severe consequences for people with chronic health conditions who have Medicaid through the expansion.

'My medications would cost more than I make in a month'

Kelly O’Brien of Sandusky, Ohio, has myalgic encephalomyelitis, postural orthostatic tachycardia syndrome, and peripheral neuropathy. She works part-time in a bridal shop that offers her flexible scheduling and other accommodations while she builds up a freelance writing business on the side.

“My medications would cost more than I make in a month,” says O’Brien. “Yet without my medication, I wouldn’t be able to work at all and thus wouldn’t have any income.”

Even for those who can work full time and have access to so-called comprehensive health insurance through their jobs, the price of their co-pays and deductibles for treatments to manage their conditions can erase most—if not all—of their income gains.

Take the case of 38-year-old Valéria Souza, who recently moved from Missouri back to her home state of Massachusetts. Souza has multiple sclerosis and was spending an average of $6,000 to $10,000 annually out of pocket on co-pays and deductibles to manage her illness. This was despite having what was considered a “good” health insurance plan with her former position in academia. These expenses comprised between 30 to 50 percent of her yearly income, eventually forcing her to work several part-time jobs in addition to her full-time career and forcing her to work in excess of 60 hours a week to compensate for her financial losses.

“This situation is not sustainable for someone with MS as a long-term life plan,” says Souza. “At some point, I won’t be able to work this much.”

This is one of the main reasons why Souza moved back to her home state: Massachusetts expanded Medicaid, while Missouri did not.

“I would like to know that Medicaid is available to me if and when I need it,” she says. Though, if Graham-Cassidy becomes law, that would threaten Souza’s plans.

For those of us with medical conditions that limit our ability to work full time, Medicaid is often our only option. If our government officials want more of us to have jobs, maintaining and building on Medicaid expansion is one proven way to do that. But if they cut it or scale it back in any way, the consequences for us will be severe.


First Person

Fighting for My Life, Again, Under Trump

Content Warning: The following article contains graphic depictions of domestic violence. 

For 22 years, I did what many Americans do: I worked, I attended college, and I worked some more. I paid my taxes, I voted with my heart just as much as with my mind, and I obtained a career. I did everything right.

Then, on June 30, 2016, my fiancé shot me in the back of my head at point blank range.

As I lay dying, I watched the man I loved turn his gun on himself and take his own life. I was left for dead, but I fought for my life through unimaginable darkness, hurt, and pain. I survived. I am broken, but alive.

I think about that night a lot. I think about it because it shapes everything about my life now, and not just because the bullet fragments in the back of my head and neck leave me in pain. I think about it because the disability I have now, that I acquired with a one-second pull of a trigger, turned my life upside down.

I used to be a senior court clerk within the New York State Unified Court System. My fiancé was a New York State Court Officer-Lieutenant. Together we earned well over $150,000 per year. My career offered great benefits, a pension, and health insurance—and I was privileged enough to take them for granted.

I lost everything because my fiancé decided my life was not worth living. For the past 14 months, I fought to prove that it is: first by surviving, then by working to regain my dignity, self-worth, and independence.

Now, I find myself fighting the same battle with a different opponent. Once again, someone is deciding my life is not worth living. Except this time, it’s my president, and it’s the senators and representatives of my country telling me I have no worth.

Right now, President Donald Trump and congressional Republicans are working to pass a budget that takes desperately needed resources from the people who need them the most. In his 2018 budget, Trump proposed cutting $70 billion from Social Security Disability Insurance (SSDI), which would take away income from up to 1 million Americans with disabilities like me. The House budget, which lawmakers are trying to pass this fall, isn’t as specific but the effects could be the same.

This is not the life I worked for.

Mick Mulvaney, Trump’s budget director, justified these cuts by calling SSDI “very wasteful” and suggesting that not everyone on it is “truly disabled” and people need to “go back to work.” The thing is, I’d love to. This is not a life I wanted, this is not the life I worked for. It is the life that was forced upon me. But I’m at the mercy of those who think this was a choice.

There are a lot of things about what happened to me that I won’t ever understand. I don’t understand why my fiancé got his service weapon back after he’d struggled with his mental health, or why he decided to shoot the person he said he loved. And I don’t understand why any intelligent, self-aware individual would think that my life was a choice—a choice to live a life where food is not a guarantee, where I am never quite sure if I’ll be able to visit the doctor for life-saving treatment or if I’ll have to suffer in pain forever, until the pain paralyzes me.

I live in fear every single day that the people I elected to help me, to help America, will take my life and the lives of millions of other Americans. We are failing as a nation if we continue down this path, if we take from the weakest to feed the strong.



Not Guilty in St. Louis: The Cycle of Verdict, Protest, and Police

Jason Stockley, the former St. Louis cop charged with murder for killing a suspect at point-blank range, was found not guilty on Friday. The verdict was announced at 9:00 a.m. on September 15, 37 days after the trial closed and six years after Stockley killed Anthony Lamar Smith. Protests began immediately and don’t look as though they’ll end anytime soon.

There are events morning and night: People have staged die-ins, blocked intersections, and marched for miles every day in the sweltering Missouri heat. There is always someone with water or sandwiches or voter registration forms nearby, and a volunteer medic every few hundred feet. There are legal observers and a drum line, but no hint of reconciliation in the air.

Annie Smith, the mother of Anthony Lamar Smith, gave a press conference on Friday at the site of her son’s death. “I didn’t get justice, so I can’t have any peace,” she said.

The weekend has been split, as it usually is in St. Louis, between massive demonstrations that are angry but peaceful and smaller nighttime protests that devolve into broken windows and tear gas. The property damage has been in a different section of the city every night, led by younger and angrier protesters, and there is tension between people who think breaking windows is violence and people who argue that it’s not as violent as killing people. The chant “you kill us, we kill your economy” is a two-edged sword, and in the daytime it sounds like thousands of people making commerce inconvenient and at night it sounds like dozens of people making commerce disappear.

A fully militarized police force had seized control again, chanting, 'Whose streets? Our streets!'

On Sunday morning, people gathered in the Delmar Loop, which had seen the worst of the damage, to help clean up and board up storefronts and paint murals on the plywood. Then they went to protest. That’s how St. Louis has been since 2014 at least, when this cycle ingrained itself into the city.

By Sunday night a fully militarized police force had seized control again. They chanted, “Whose streets? Our streets!” after arresting dozens of people—media, legal observers, and protesters alike. An undercover police car reversed through a crowd marching through a street in downtown St. Louis on Sunday, after which a line of riot police protected the car while protesters de-escalated the situation.

A funny thing about new normals is how easily people accept them; most people seemed upset but not shocked by these incidents. They expected the not guilty verdict and were ready for it—and for the police response. Journalists have been arrested at St. Louis protests before, the most famous example being Wesley Lowery and Ryan Reilly while they worked from a Ferguson McDonald’s in 2014. And on Saturday, a woman named Pat Washington was hit by a truck during a protest, though her injuries were minor and she finished the march. Two other times this weekend I’ve seen cars simply keep driving through the crowd.

If you are looking for a 2017 dystopia, it’s in St. Louis. It is entirely usual and patently unacceptable for the police force to do many of the things they’ve been doing on video over the last few days: firing projectiles toward residents at random, macing people who came out of a bathroom, knocking over and kicking elderly women before arresting them on spurious charges, running cars into crowds, using strobe lights on crowds of protesters at night knowing there were epileptics in the area, and putting a synagogue under siege on Shabbat. It is messy and complex here. There are shades of 2014, with the same protesters demanding the same changes and the same authorities quelling the unrest. But is it also three years later, and as a nation we are debating whether it’s appropriate to have Sean Spicer on the Emmys or whether it’s okay for the president to tweet a video of himself hitting Hillary Clinton with a golf ball.

On Monday morning, protesters arrived downtown by 7:00 a.m. Protests are expected to continue into Tuesday evening. Police and news helicopters circle above, and people wonder aloud why they don’t just admit a cop was guilty for once instead of putting everyone through all this again.

Editor’s note: This is the second in a three-part series on the trial over the killing of Anthony Lamar Smith. Read part one.