Opioid Crackdowns Punish Chronic Pain Patients Without Fixing the Crisis

When Emma Stern’s private insurance changed two years ago, so did her pain management plan. The Oregon resident has insomnia and a painful chronic kidney condition that require careful medication. Stern’s new internist said the Drug Enforcement Agency (DEA) stripped her license for “overprescribing” opioids, so she could not provide Stern with necessary prescriptions. Instead, she referred Stern to a pain management clinic.

During a recent visit to her pain clinic, Stern’s pain management doctor informed her that her treatment plan was going to need to change again: Now, she would have to choose between taking Xanax and taking hydrocodone (also known as Vicodin). The doctor was not concerned that she was misusing her medications, but that law enforcement would come after him if “something happened to [her].” So, Stern had two options: medicate her pain, or get enough sleep. She chose the latter.

While Stern’s story may seem extreme, her experience is representative of many chronic pain patients who have come up against various barriers that have been set by state governments, the medical field, and corporate pharmacies. According to recent CDC findings, 50 million Americans have chronic pain; although chronic pain affects people from all economic backgrounds, it tends to hit those in poverty the hardest. People in chronic pain tend to experience greater poverty, and struggle with the cost of medications and frequent pharmacy or doctor’s visits. The treatment of chronic pain also has major disparities when it comes to race, and black women in particular have suffered the consequences of those disparities.

Many of these access issues stem from a response to the opioid addiction and overdose crisis, declared a public health emergency by the Department of Health and Human Services in 2017. However, early response efforts have increased chronic pain and its consequences, leading to worse outcomes for chronic pain patients that should be addressed as a new public health crisis.

This crisis accelerated when the Centers for Disease Control (CDC) released their set of guidelines on opioid prescribing, intended for use by primary care providers, in 2016. The CDC has since clarified that the guidelines were recommendations, not strict policy, but the harm to many chronic pain patients like Stern has been done.

“The only treatment available [for my condition] at this point is treating the pain and the chief of urology at OHSU instructed my primary care doctor to allow me to have a monthly supply of opioid pain medication,” Stern said, but the results of opioid scaremongering have left her in agonizing pain instead. Part of the CDC’s 2016 guidelines, under the heading “Assessing Risk and Addressing Harms of Opioid Use,” stated that “[c]linicians should avoid prescribing opioid pain medication and benzodiazepines concurrently.” For someone with complex medical issues like Stern, this guideline is not useful.

Some government agencies are starting to recognize the consequences of cracking down on pain patients’ opioid prescriptions; the Food and Drug Administration (FDA) recently released a safety alert on the negative effects of sudden discontinuation or abrupt tapering of opioids, which can include “serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide.”  The authors of the 2016 CDC guidelines for opioid prescribing also recently clarified how its guidelines are meant to be used as a response to widespread misapplication of those guidelines.

Very few opioid addictions begin with a patient who has a doctor’s prescription.

The misconception that opioid prescriptions lead to opiate addiction has been widespread, and overarching state and federal measures to combat the opioid overdose crisis are reaching a fever pitch. There’s the Oregon Health Authority’s (OHA) now-tabled proposal to force-taper all Medicaid patients on opioids for certain chronic pain conditions; Senators Kirsten Gillibrand and Cory Gardner’s controversial proposal to limit all acute pain medication prescriptions to a seven day fill, which sparked massive pushback from the chronic pain and disability communities; and Ohio Senator Rob Portman, who favors a three-day fill limit. In contrast, the American Medical Association (AMA) has come out against arbitrary pill limits, as has a group called Health Professionals for Patients in Pain (HP3).

Very few opioid addictions begin with a patient who has a doctor’s prescription: Up to 80 percent of people with an opioid addiction illegally obtained pills from another source like a friend or relative first. While the opioid overdose epidemic from illegal heroin and fentanyl is a serious problem, federal and state actions to decrease the number of opioid prescriptions and/or pills in circulation overall will have — and are already having — a hugely negative impact on chronic pain patients who take opioid medications. While the number of pain prescriptions has declined since 2010, the number of deaths due to overdoses involving heroin and synthetic fentanyl has increased.

According to Thomas Kline, MD, a physician in North Carolina who maintains a list of chronic pain patients who committed suicide after being forced off of their medications, the anti-opioid hysteria that has taken root in the medical field and the federal government has resulted in “people [being] killed.”

Senators and state representatives are not medical doctors, and overarching government intervention of the kind that we are witnessing in private medical treatment can and does have consequences that are bad for chronic pain patients.

A one-size-fits-all policy, whether at the state or federal level, when it comes to chronic pain and opioids may have unintended consequences for chronic pain patients. Dr. Kline puts it more starkly: “Limiting the number of pills [that patients can get] is not going to work. All it’s going to do is screw people.”



2.2 Million Americans Are Behind Bars. That’s More Than The Prison System Can Handle.

Sam was no stranger to arrest. Since becoming addicted to methamphetamine after moving to Hawaii for a chef position, he spent years bouncing between jails, rehabs, and the streets. But when his module caught fire during a riot at the Maui Community Correctional Facility, he found himself faced with an impossible choice: Go back inside the burning building, or extend his sentence.

The conditions that led to the riot were nothing new. MCCC was designed to hold 301 people, but at the time was packed with over 400. The jail has a history of chronic overcrowding; in 2016 the American Civil Liberties Union of Hawaii filed a complaint that named MCCC as the most “egregiously overcrowded” on the islands, to the point that it was unsafe. Among other issues, the report notes that it was common for three, four, or sometimes five people to be placed into cells designed for two, forcing them to sleep on the floor among roaches and rats, sometimes with their heads beneath the toilet.

Tempers were strained by other issues, as well. Anonymous whistleblowers told The Maui News about undersized, nutritionally insufficient meals, and last year, the facility was fined more than $16,000 for failing to maintain a functioning fire alarm system. The phones — which often serve as the sole connection to incarcerated people’s children, partners, and other family — were chronically broken. “And mail,” Sam said, “we’d get [letters] that were weeks and weeks and weeks postdated, or never, ever get them; they’d just get sent back.”

On March 11, 2019, some of the people detained at MCCC began complaining to the guards. It started as a typical, minor confrontation, but this time they’d had enough of being ignored. When a guard ordered everybody back to their cells, several detainees refused. And then they did more than refuse. They began by throwing chairs at windows, smashing computers, and stacking together toilet paper rolls and other flammable items. Overbooked and understaffed, the situation quickly became more than the guards could control. Soon, there was a fire. Detainees report being locked in cells while the module burned, their guards nowhere to be seen. Fire sprinklers worked only sporadically. Smoke filled the cells, blindingly thick. Sam said he was able to escape to an outdoor recreational area, but when he and several others arrived, police negotiators yelled at them to go back inside and leave through the emergency exit, or face escape charges. But according to Sam, those emergency exit doors were jammed.

Eventually the fire was doused, but detainees then had to contend with police in riot gear, who were beating people, sometimes after zip-tying them, according to the reports given to The Maui News. Once the riot was settled, people jailed in the facility were sent back to the same cells that had just been trashed. Many had no access to working toilets. Sam’s mattress was gone. Eventually he passed out on the concrete floor, succumbing to sheer exhaustion.

In the month after the riot, two inmates escaped from the facility through a broken door. MCCC has not stopped housing people, not even for repairs, which include fixes for smoke-stained walls and replacement beds, chairs, tables, and kitchen equipment. One module had to be decommissioned due to the damage; the people housed inside were relocated to other areas of the facility, which are now even more crowded than they were prior to the riot.

When asked for comment, a prison official told TalkPoverty “The disturbance at the Maui Community Correctional Center (MCCC) is under investigation and internal review by the Department of Public Safety. There is nothing further we will be discussing about the on-going investigation at this time.”

The damages are expected to cost 5.3 million dollars, much more than it would have cost to fix the phones or provide sufficient meals to the people housed in the facility. National estimates place the cost of feeding incarcerated people at around $2.62 per person per day; raising that figure by a full dollar would not bring MCCC’s food budget, at capacity, to even half a million dollars. And phone calls, which cost money to detainees and their families, are a highly profitable industry in the corrections world, which means those phones essentially pay for their own repairs. What happened at MCCC is an extreme, dramatic example of the deleterious effects of overcrowding within correctional facilities, but the core issue is one that quietly affects pretrial jails and prison facilities across the nation.

Last April, guards were so overwhelmed by a riot in a South Carolina maximum-security prison that they waited more than four hours to enter the building, leading to the deaths of seven inmates. A 2017 riot in Delaware that led to the death of a corrections officer has also been attributed to overcrowding and understaffing. And earlier this year, the U.S. Department of Justice deemed Alabama state prisons for men were in violation of the Constitution due to severe overcrowding that led to physically and emotionally dangerous conditions. Some evidence suggests overcrowding may even be linked to a rise in the use of solitary confinement.

What took place in Maui is only one example of a nationwide issue.

Overcrowding can manifest in everyday deprivations, like the denial of visitation, vocational and rehabilitation programs, and appropriate medical care. And it stems from laws and policies that target vulnerable populations. There are laws targeting transient and low-income people, such as panhandling, loitering, and public camping ordinances. Then there are those which could theoretically affect anyone, but somehow tend to target the poor anyway. Drug laws, for example, disproportionately affect people like Sam; addicted, cash strapped and in need of medical treatment. Sometimes people can be incarcerated for months simply for carrying a used syringe or a baggie with stray powder.

Those laws are paired with the cash bail system allows wealthier people to pay their way out of jail pending trial, and leaves those with less economic means — about 460,000 people, or one-quarter of all incarcerated people —  behind bars. People who face pretrial detention are more likely to be convicted, usually through a guilty plea.

When people are picked up on allegations that are essentially the result of deprivation — whether of food, housing, or appropriate medical care — and can’t make bail, they languish in correctional facilities until those facilities become stretched beyond capacity. Because these laws essentially target people for activities of necessity — for example, sitting on a sidewalk — they lead to overzealous arrests of people who don’t have the money to bond out. Too often, the crimes that land people in jail stem from an acute need for mental health or substance use services —the exact type of care that these facilities are unable to adequately provide.

What took place in Maui is only one example of a nationwide issue. Across the country, cash bail practices along with anti-drug user and anti-loitering laws continue to funnel people through an already overloaded system, increasing the cost demand on facilities to provide for the basic needs of the people housed inside. The result is hundreds of thousands of people crammed into jails and prisons that are unsafe, unhealthy, and, quite possibly, unconstitutional.

Editor’s note: When requested, names have been changed to allow people to talk more freely about their experiences behind bars.



Police Took My Hijab. Here’s Why It’s So Hard to Stop Them From Doing It Again.

In 2016, on the second night of Eid al-Fitr, Philando Castile was shot and killed by St. Anthony police officer Jeronimo Yanez with his girlfriend and four-year-old daughter in the car. I was involved in almost every protest after his death, including an occupation in front of the Minnesota governor’s mansion. When the occupation was eventually raided, I was among those arrested. I was the only visibly Black Muslim woman detained. I was taken to a Ramsey County facility, where my hijab was repeatedly removed in front of male officers. It’s an experience I share with many others.

Data on incarcerated Black Muslim women is slim, but reported cases of de-veiling date back at least 14 years. In 2005, Jameelah Medina was accused of being a terrorist by a Los Angeles County Sheriff and forced to remove her hijab. In 2017, Kirsty Powell settled a lawsuit with Long Beach for the “humiliation and distress” she suffered when her hijab was forcibly removed by police. Last year, the Council of American Islamic Relations in Michigan filed a civil rights complaint on behalf of Siwatu Salama-Ra, whose religious rights (including access to a hijab, Quran, and pork-free food) were violated while incarcerated.

These are only a scattering of cases, and more surely linger in the shadows. Unfortunately, not every case is reported, because doing so can lead to retaliation or long legal battles. Multiple groups have taken up fights to introduce changes across the country to address these problems, but the issue of violating Black Muslim women’s religious rights is deeper than policy.

There is a legal precedent for allowing Muslim women to wear hijab while incarcerated. Along with the First Amendment guaranteeing religious freedom, Congress passed the Religious Land Use and Institutionalized Persons Act (RLUIPA) in 2000, which included protecting the religious rights of incarcerated people. However, that precedent has been difficult to apply to incarcerated Muslims due to Islamophobia embedded within the carceral system. As noted by CAIR Michigan staff attorney Amy Doukoure, there is no uniform policy across facilities regarding the right to wear hijab. Instead, Doukoure said, “When it comes to county facilities and state facilities, every county and every city has their own policy. Or a lot of them still have a lack of policy.”

This lack of policy leaves a lot up to discretion, which poses unique issues for Black Muslim women. Although Black Muslims make up a fifth of all Muslims in the United States, we occupy a tumultuous space. Black Muslims experience an anti-Black extension of Islamophobia rooted within the “afterlife of slavery”. Theorized by African-American literature professor Saidiya Hartman, it refers to the continued devaluation and dehumanization of Black lives, accomplished through a “racial calculus and political arithmetic that were entrenched centuries ago.”

In some cases, the removal of Black Muslim women’s hijab is also linked to public shaming tactics. Educator and activist Angela Davis noted in “Are Prisons Obsolete?” that Black women are subject to regimes of punishment that differ greatly from those experienced by white women. Part of that includes publicly shaming or humiliating Black women, which is seen time and time again throughout the criminal justice system. The very existence of online mugshots and media usage of them is a great example and, for Black Muslim women, poses a unique concern.

In Maine, the Cumberland County Sheriff’s Office opened an internal investigation in 2016, after at least one Black Muslim woman — who was arrested at a protest — had a mugshot without hijab released to the media. In the opinion of other protesters, the decision to release the mugshots online was intentional.

When working on developing a policy in LA county, Margari Hill, co-founder and executive director of the Muslim Anti-Racism Collaborative, noted that law enforcement tried to slip in vague wording to leave things up to their discretion, and advocated for having dual mugshots: one with hijab and one without.

That “dual mugshot” policy also exists in Michigan, where Doukoure said women are often told they can’t wear headscarves for identification purposes, adding, “You’re allowed to wear them in your driver’s licenses and you’re allowed to wear them in your passport photos, so why does the Michigan Department of Corrections need a higher standard than every other state and federal government agency?” Despite the Michigan Department of Corrections having a policy around hijabs in general, there is no rule preventing those photos from going online. If they do, it’s essentially impossible to remove them due to the difficulty of communicating with online search engines and convincing them to take the photos down, and the department itself.

The issue of having a mugshot without hijab going online is one I’m familiar with. According to a Ramsey County Public Information Officer, the county’s official policy since March 2014 has been, “We exchange [their hijab] for one of ours (to avoid any contraband issues). We take two pictures, one with and one without. The one without is confidential and never released.”

But similar to the Black Muslim women in Maine, I was arrested while protesting the police. While I was detained, I was told by a male officer that I needed to remove my hijab for my mugshot. I complied, because the process of getting booked and released takes hours. I was too tired to argue. Despite Ramsey County’s own policy, it was the only picture taken. That mugshot was later released online.

In some cases, the removal of Black Muslim women’s hijab is also linked to public shaming tactics.

Groups have attempted to address the lack of policy within their own regions, which illuminated other factors at play. For instance, cultural ways of wearing hijab that are dominant in Black communities are not considered markers of one’s Muslim faith in the same way that they are for other communities.

In the 1960s, the repeal of the National Origins Act and Asiatic Barred Zone led to an influx of Muslim immigrants, which led to the American public beginning to explicitly code Muslims as Arab. As a result, Hill shared that she would often have to demonstrate to law enforcement different ways to wear hijab and the various materials it could come in. She noted that if a Black Muslim did not have the proper “markers” to be considered “legitimately” Muslim — such as an Arabic name or a particular phenotype — then the reaction was accusations that “Oh, you’re wearing [a scarf] for fashion” and “You’re not a real Muslim, you’re a Moos-lim.”

This process of facilities taking it upon themselves to determine who is a legitimate Muslim — and excluding Black women from that — was also noted by Doukoure. In 2018, at the same time CAIR Michigan filed a civil complaint against the Michigan Department of Corrections on the behalf of Ra, the organization filed a second on the behalf of Marna A. Muhammad, who was illegally denied clergy status.

“We believe that because she was an African-American woman serving an African American community, they didn’t find her to be what they consider to be a stereotypical Muslim,” Doukoure shared. Muhammad was with Masjid Wali Muhammad, the oldest masjid in Michigan. “And therefore, they refused to recognize that someone like her could be a religious, spiritual leader that could have clergy status.”

Through the dehumanization of Black people — and our subsequent removal from the religious, as outlined by Delice Mugabo — Black Muslims are rendered invisible within mainstream discussions around Islamophobia, but still perceived as an inherent threat. This anxiety is transferred from colonial times, such as Charles V of Spain’s attempts to exclude “slaves suspected of Islamic learnings” after a revolt. Black Muslims as a threat to social order are well documented within the criminal justice system, where Black militant became synonymous with “problem” and then interchangeable with Muslims. The de-veiling — and general maltreatment — of incarcerated or detained Black Muslim women is a symptom of wider issues relating to anti-Black Islamophobia. Black Muslim women are regarded as inherent threats due to both their Blackness and their Islam.

The issue of de-veiling Black Muslim women within detention facilities cannot be read as simply an issue with policy implementation. Even when the right policy exists in writing, experiences like mine reveal that it is not actually implemented as a standard practice. Instead, people must reckon with the deeper, systemic issues leading to the simultaneous delegitimization and criminalization of Black Muslim women.



Disabled Students Are Left Behind In School Shooting Responses

On a below-zero January day in early 2018, Katie Shelley was working on the fourth floor of a building on her college campus in Northwest Ohio when the fire alarm went off. She proceeded to work through the conflict she has faced her whole life: How to get out of the building as a wheelchair user. No plans were in place for her evacuation. Growing up in the aftermath of events like the Columbine shooting and 9/11, she was used to having to worry about whether or not she’d be safe in a school emergency.

This April marked the 20th anniversary of the Columbine school shooting. In the weeks following the anniversary, three deaths and numerous injuries were caused by two shootings on school campuses. Despite whatever fervor Columbine may have stirred 20 years ago to address school shootings, they have become a common part of the U.S. news cycle and school shooting drills a regular part of a student’s education. However, no matter how common these events are, safety drills and strategy have not adequately developed inclusive safety measures for students with disabilities.

This is not a trivial problem: 14 percent of students have a disability.

The current approach regarding active shooter events is the “run, hide, fight” strategy, the response recommended by the Department of Homeland Security, which calls for running away when possible, hiding somewhere safe when you can’t run, and fighting the shooter if running or hiding are not options. For students with disabilities who may not be able to run, employment of the “hide” aspect of the “run, hide, fight” strategy often calls for waiting in areas such as libraries, bathrooms, and classrooms for response personnel to assist them — even if these areas aren’t very accessible or safe. The fight strategy is the last option, one that no parent or teacher wants a student, disabled or otherwise, to have to do, and a strategy that has left two young students dead in the last several weeks. However, if schools have not provided sufficient options for students to respond, they may be left with few other choices than to charge or thrown items at an attacker.

Plus, tools like door barricades and lockdown plans designed to keep children safe often ignore the needs of students with disabilities, who in addition to mobility disabilities may have adverse reactions to alarms that overwhelm senses, difficulty processing instructions, or an inability to remain still or quiet.

Using a classroom as a refuge area was the solution Katie’s school decided to use when she was in fifth grade. “I just (in theory) had to wait in a burning building until someone came to get me. Even at 10 years old, I knew this was a horrible plan and I was not a fan,” she said.

While Katie was raised in Michigan, these issues are national. A settlement in a Newark, New Jersey, high school district was reached in 2017 after it left at least one disabled student in the school when an unplanned alarm went off.  The school “did not have policies for evacuating students with disabilities,” according to federal officials. More than 20 years ago, the City of Alexandria, Virginia, school board was sued twice regarding evacuation and school safety of students. Despite laws and litigation establishing accessibility requirements that go back decades, much has remained the same in evacuation plans for students with disabilities.

When it comes to students with disabilities, organizations such as Safe and Sound Schools and the ALICE Training Institute recommend the use of Independent Emergency and Lockdown Plans, or IELPs. These protocols hook into Individualized Educational Plans (IEPs), a federal requirement for special education students, which are detailed and routinely updated plans to accommodate students with disabilities; or a student’s 504 Plan, which ensures access to certain accommodations, such as extra time on tests.

Students continue to face dangers due to inaccessibility nearly 30 years after the ADA.

While IELPs can be a great way to address a child’s specific needs, learn the problem areas of the school, and connect with disabled students and their parents, it is a dangerous disservice to everyone on a school campus to relegate inclusive solutions to these problems to just one student and their specific IEP or 504 team. It does not seem feasible that a school administration could efficiently respond to the individual IELPs of each student and keep all students safe in the event of a real emergency.

Relying on individual plans also represents a missed opportunity for universal design and inclusion, which could benefit the campus as a whole. Universal design of safety plans would produce plans that are created with the flexibility and intention of being used by the largest number of students possible, based on a recognition of varied needs, rather than amended later for individual students as needed.  Additionally, IEPs and 504 Plans are a federal requirement that does not apply equally to private schools, which do not have a requirement to provide IEPs to students with disabilities.

In 2019, schools should be beyond a “separate but equal” approach to students with disabilities. Disabled students spend on average more than 60 percent of their time in a general classroom. It is dangerous and lazy not to integrate identified safety needs into school response plans, which should be accessible and account for the many needs of all children attending the school. For instance, investments in tools like noise canceling headphones, or cue cards for the classroom, may help students handle loud noises and follow the steps in a lockdown procedure.

The requirement for inclusion in the classroom and in emergency preparedness is not just fanciful suggestion, but the law. The Americans with Disabilities Act, passed in 1990, applies to places open to the public, governments, and schools. A recent ADA-based lawsuit against the New Rochelle, New York, school district, which failed to evacuate two students during a fire and did not include students using mobility aids in drills, ended in a payment of $26 million dollars to a student who uses a wheelchair.

With the innovation that has taken place in the last several decades, people like Katie often wonder why there haven’t been improvements to school emergency plans and why students continue to face dangers due to inaccessibility nearly 30 years after the ADA and hundreds of school shootings later.  While school safety has turned into a billion dollar industry, efforts such as metal detectors or adding police are not creating safer school campuses. Funds could be used for more comprehensive alarm systems, evacuation chairs, additional training and drills, and emergency elevator systems that will allow all students to be less passive in an emergency situation.

Inclusion is planning for everyone from the beginning. The onus for creating an effective response to an active shooter should not reside with the student, teachers, or parents, but with school systems using the knowledge and input of those parties. IELPs are a conversation we need to be having for K-12 students with disabilities, but they are only a beginning step for making our schools truly accessible and as safe as possible for anyone that may be on campus in an emergency. School districts have spent far too long avoiding true integration in school emergency plans, and it puts students’ lives at risk.



Trump’s Plan to Lower Poverty by Redefining It, Explained

Yesterday, the Trump administration proposed changing how the official poverty measure (OPM) is adjusted for inflation. The Office of Management and Budget is describing the policy change as an opportunity to consider “the strengths and weaknesses of different indexes” and “best practices for their use.” However, this seemingly technical distinction would artificially decrease the count of people living in poverty, laying the groundwork for cuts to dozens of programs, such as Head Start, school lunch, energy assistance, and legal services.

To understand how this proposal would work, it’s worth starting with how the Census defines poverty in the first place. The OPM was first created in the 1960s by Mollie Orshansky, an economist working for the Social Security Administration, who proposed poverty thresholds related to the cost of food: Any family earning less than three times the USDA estimate for the subsistence food budget is considered poor. Those thresholds have remained in place over the last half century, virtually unchanged other than by cost-of-living adjustments. Right now, according to the OPM, a family of three (with two adults and one child) counts as poor if their income amounts to less than $20,212 per year.

The current OPM has faced criticism on a number of fronts, including failing to consider geographic variation (cost of living in Missoula is very different than Manhattan), account for any of the costs families face (such as medical costs or transit costs), or provide a full picture of families’ income (criticisms the Census has attempted to address with the creation of its much more robust Supplemental Poverty Measure (SPM)). In short, the OPM is too low for most people’s understanding of poverty. It’s hard to reconcile a measurement that says only 12.3 percent of people in the U.S. are poor when more than 4 in 10 adults would struggle to come up with $400 in an emergency and 70 percent of voters have confronted a serious financial hardship in the last year.

The Trump administration’s proposal would drive the OPM even lower.

Right now, the poverty thresholds are adjusted annually by the CPI-U, or Consumer Price Index for Urban Consumers, which measures inflation by tracking the change in price for a set group of consumer goods across a range of geographic areas. Trump is proposing switching to a different measure of inflation. The proposal isn’t specific on which measure they would use, but it twice mentions the possibility of using the “chained CPI” (or the C-CPI-U) as an alternative. The chained CPI differs from the CPI-U in that it allows for substitution across similar kinds of items. For example, the chained CPI takes into account the idea that if the price of chicken is high, perhaps you switch to pork, whereas the CPI-U only accounts for substitutions within categories, such as picking a Granny Smith apple over a Red Delicious. By allowing for these additional substitutions, chained CPI shows a slower rate of inflation, but for many families who are already choosing between paying the rent and buying food, they are already living as frugally as possible.

Chained CPI would push poverty thresholds further and further down over time

In addition to being impractical, the chained CPI would push poverty thresholds further and further down over time. The chained CPI has grown more slowly than the CPI-U by about 0.25 percentage points annually. That means that every year, chained CPI will redraw the thresholds lower than the CPI-U would have, in a way that compounds over time. For example, say that inflation under the CPI-U increased by 2.4 percent a year over the next decade. That means that 2018’s $20,212 poverty threshold for two adults and one child of today would be $25,021 in 2027 (in 2018 dollars). If the chained CPI grew 0.25 percentage points less each year the poverty threshold for this family would be about $544 lower at $24,447. By 2037 the difference would grow to $1,439 less.

This change to the OPM matters way beyond just measuring who is poor and who isn’t — changing it would have a ripple effect for millions of people. The poverty thresholds the Census publishes are the basis of the poverty guidelines issued by HHS. And HHS’s poverty guidelines are the basis of eligibility for a whole range of programs that help people meet their basic needs. Making this change would have long-term echo effects, chipping away at eligibility over the years. For example, school kids qualify for free meals and milk if they are at less than 130 percent of the federal poverty guidelines, and for reduced-price meals and milk if they are at less than 185 percent of the guidelines. Children up to age 5 can are eligible to attend Head Start or Early Head Start if they are poor (as defined by the guidelines). Low-income taxpayers can receive assistance resolving disputes with the IRS if they are at or under 250 percent of the poverty guidelines. As these definitions capture fewer and fewer people due to reduced inflation increases, there will be fewer and fewer people who receive the services they need.

We have estimates of how rapidly these changes can increase from the moment earlier this decade when policymakers (including some Democrats) supported changing the cost of living adjustment for Social Security benefits to the chained CPI. Research Joan Entmacher and I did at that time revealed that while the initial impact of this cut might seem small — averaging only about 0.3 percent cut to benefits per year — overtime these cuts would compound to create real harm. For example, if the chained CPI had been substituted for a single woman with a monthly benefit of $1,100, her benefit would be cut by $56 per month at age 80. By the time she reached 95, that cut would be more than $100 a month. If she received a benefit for 30 years, her cumulative losses would be nearly $20,000.

Benefits already fall short all too often. SNAP benefits typically run out before the end of the month, and kids go hungry in the summer without the benefit of school meals. Yet rather than provide families the support they need to meet their basic needs, Trump is proposing to artificially reduce poverty while actually cutting benefits — creating the illusion of a win from his perspective that is actually a heavy loss for low-income families.