A Hidden Change in the CARES Act Undermines Privacy for Addiction Patients

“You’ll hear people say, ‘that violated HIPAA.’ Actually, it violates Part 2, and it’s now gone,” lamented Zac Talbott, president of the National Alliance for Medication Assisted Recovery (NAMA Recovery) about a recent change made to addiction treatment patient privacy protections. The change took place quietly, passed as a rider to the Coronavirus Aid, Relief, and Economic Security Act (CARES Act); or, as Talbott described it, “under cover of darkness, in the midst of a national crisis, with a stimulus bill that no one could vote against.”

The rider is named after Jessica Grubb, a Michigan woman who died at age 30 after being prescribed oxycodone for postoperative pain while only a few months into recovery from a seven-year heroin addiction. The Protecting Jessica Grubb’s Legacy Act was sponsored by Democratic Senator Joe Manchin III and Republican Senator Shelley Moore Capito, both from West Virginia, one of the states hit hardest in recent years by an influx of illicitly manufactured fentanyl. Currently, under 42 CFR Part 2, patients engaged in substance use disorder treatment programs that fall under federal purview — which essentially includes any program that utilizes opioid agonist pharmacotherapy like methadone and buprenorphine — must provide informed consent each and every time their records are shared. So when a patient authorizes a methadone program to share medication information with their primary care doctor, that provider can’t disclose the information to a specialist unless the patient signs a new, specific consent. When the act goes into effect in 2021, patients will only have to provide consent once. After that, their records can be re-shared in perpetuity by any health care entity who receives them.

The changes reflect the way privacy and consent are handled for most of health care. The act is effectively changing records disclosure consent rules to match those of the Health Insurance Portability and Accountability Act (HIPAA), except that it still preserves the initial consent required by 42 CFR Part 2.

Despite popular belief, HIPAA allows health care workers to share patient records without their consent for a number of reasons related to health care operations. “HIPAA is not a [patient] privacy protection. It’s actually an authorization to share your info as broadly as a health care payor believes they need to share it, which I will tell you is very broad,” explained Danielle Tarino, president and CEO of Young People In Recovery, who previously worked at the Department of Health and Human Services and, while there, drafted the 2017 revisions to 42 CFR Part 2.

Now, instead of special protections for patients undergoing addiction treatment, these programs will have the same privacy standards as all of health care.

The fight for privacy rights has divided key players in the addiction treatment community, many of whom are otherwise aligned. Proponents of the changes include the National Council of Behavioral Health, the American Society of Addiction Medicine (ASAM), the Substance Abuse and Mental Health Services Administration (SAMHSA), Shatterproof, and several other prominent treatment and health care voices. Those who oppose it, a group that includes the National Alliance for Medication Assisted Recovery, Legal Action Center, Young People In Recovery, and Faces and Voices In Recovery, have successfully thwarted similar proposals in the past.

“It’s just really disappointing to see that bill go through when the political will was, year after year after year, it’s not going to pass because people don’t want it to pass,” said Tarino.

Discrimination against substance use disorder patients is not a thing of the past.

Those who favor the changes say that not only will this make it easier for health care providers to share patient records, it will also allow these programs to be used in the electronic health records programs that are currently designed to meet HIPAA standards. Senators Manchin and Caputo argued that this kind of care coordination would prevent patients like Jessica Grubb from being “thrown back into the nightmare of addiction,” and insinuated that these privacy changes could have prevented Grubb’s death by ensuring all of her caregivers were informed about her addiction history. “There’s emergency glass that could be broken if someone was not able to disclose,” countered Talbott. “The notion Part 2 could cause what happened to Jessica Grubb to happen is outrageous…She disclosed [her addiction status], as most people do with their treatment providers.”

“42 CFR Part 2 said ‘if you go to treatment, we will give you the security and confidence to work on your issues,’” said Westley Clark, Dean’s Executive Professor in the Department of Psychology at Santa Clara University and the former director of the Center for Substance Abuse Treatment (CSAT) within SAMHSA. “Why would I go to treatment if they are going to blab my business all over town? We have a conundrum: We want people to go to treatment, but we are going to discourage people from seeking treatment by telling them ‘your privacy is irrelevant.’”

Part of what made these protections so strong was the re-disclosure rule eliminated by the Jessica Grubb’s Legacy Act. If a patient signed a consent so that their treatment provider could share pertinent care records with their insurance — a requirement in order to have insurance pay for treatment — then those records could only be shared with the insurance provider. Now, a patient’s insurance can re-disclose those records in perpetuity for a number of reasons, including for the vague and effectively ubiquitous use of “health care operations.” This likewise applies to anyone to whom a patient has granted consent.

The language of the new law explicitly states that patients have the right to revoke consent at any time. The problem is that patients must know they need to do this, and also, once records have been shared widely enough, it becomes virtually impossible to communicate and enforce that revocation. Privacy proponents worry that this re-disclosure license will deter patients from seeking treatment, and could lead to harm for those who decide to engage anyway.

“Some insurers have discriminated against substance use disorder patients, and substance use disorder patients have not gotten life insurance or other key insurance like that because they found out,” said Deborah Reid, senior health policy attorney with Legal Action Center, emphasizing the fact that discrimination against substance use disorder patients is not a thing of the past, but a very real problem her office deals with regularly. She argued that lessening privacy regulations for these patients is likely to increase the problem. Other examples of potential bad case scenarios resulting from the relaxed consent rules that she and her co-worker Jacqueline Setz provided were child custody cases, information spread through small town communities, and law enforcement gaining access to the records.

The new law includes anti-discrimination language, which proponents like Shatterproof say is a big win. “Certainly the illegal nature of using drugs should never be a barrier to someone accessing emergency help or medical care when they need it. That’s something we should hopefully all be working toward. This legislation is consistent with existing federal protections around the treatment of addiction,” said Kevin Roy, chief public policy officer at Shatterproof. Currently, the Americans with Disabilities Act (ADA) covers discrimination against substances use disorder patients — but only if they are not currently using illegal substances. If a patient is engaged with treatment but struggling to maintain total abstinence or does not seek total abstinence as a goal, they are not protected against discrimination by the ADA. But opponents say that the new anti-discrimination language won’t be enough to offset the dangers caused by allowing this sensitive information to move more freely. “It’s in there, you can’t discriminate, but if you do — who’s gonna be able to enforce that? With no patient first right of action, patients can’t stand up for themselves unless they have resources to retain counsel and sue in civil court,” said Talbott, adding, “even the parts that sound good, upon further reflection and digging, seem to be paper tigers.”

Although those who have been involved in the fight for years were disappointed that these changes were slipped through alongside the unrelated coronavirus stimulus bill, they say the fight isn’t totally over yet.

“We still have initial consent…it didn’t remove the complete foundation of Part 2, but it will be a different struggle now,” said Talbott, explaining some early-stage strategies NAMA-R and other groups are discussing in order to ensure addiction patients can still have robust privacy protections in the future.

Then, with a note of sadness, he added: “The 10 year battle to preserve privacy protections in Part 2 is over.”

“These are people’s lives we are talking about,” summarized Tarino. “There are very deep implications to people losing rights and privileges because of their participation in something that was supposed to help them.”

Like many of the 1,800 New York City cable technicians who walked off the job after negotiations with Charter Communication — which operates as Spectrum Cable — broke down in March 2017, David Papon, a plant engineer, assumed the strike wouldn’t last too long. As a 27-year veteran of the company, with a wife and four children to provide for, he was uneasy about being out of work for an extended period of time but felt like the company left the union little choice.

After acquiring TimeWarner Cable in 2016, Spectrum began an attempt to replace its union health insurance and pension plans with a company-run 401(k) pension account and health plan. The International Brotherhood of Electrical Workers (IBEW) Local 3 objected to the plan as “substandard,” preferring to hold on to its existing pension plan, which for decades has been run by an independent board of trustees. Union officials feared that if they gave Spectrum control of their pension fund and health care, they would forfeit any leverage they had in future negotiations. With families to support, workers like Papon couldn’t afford to lose everything they worked so hard for.

“The strike caught everyone by surprise but my main concern at the time was maintaining our medical and our pension. That was our main goal and something that Spectrum definitely wanted to eliminate. If they wanted to take that away, we had no other choice but to go on strike.”

What Papon and his fellow IBEW Local 3 members couldn’t anticipate was that more than three years later, they would be part of one of the longest strikes in American history. As the strike dragged on, developing into a bitter war of attrition between Charter Communications — which is the largest provider of cable TV, internet, and telephone service in New York State as well as the second-largest cable provider in the country — and Local 3, workers like Papon struggled to make ends meet.

To make up for his lost income, Papon took a job on construction sites, starting at the bottom of the trade union ladder. Despite taking another job, things didn’t become easier. He fought his bank’s attempt to foreclose on his home and his wife and daughter were diagnosed with lupus. His wife became so ill that she is currently awaiting a lung transplant. With legal and medical bills piling up, he quickly saw his life savings evaporate.

“I had to deplete my 401k completely in order to survive and to maintain my family,” said Papon. “That hurts. After so many years you have built this savings and this cushion so you could be able to retire later on. Now all of sudden you have this money gone which is pretty sad. Definitely it has affected me mentally.”

As if being on strike hasn’t been hard enough, the COVID-19 pandemic has forced Papon’s family deeper into crisis. With all non-essential construction suspended, Papon has found himself unemployed and without health insurance for the first time in his life.

“With the COVID, my wife and daughter can’t afford to get sick because they don’t have an immune system. So I’m really unsure on what to do.”

Papon is not alone. Troy Walcott, a 20-year Spectrum veteran and a union shop steward, has been one of the strike’s most visible leaders. With many striking workers moving on, Walcott has been desperately attempting to keep the strike’s momentum alive. But amidst a full-blown pandemic, it has felt like an arduous battle.

“Whatever people are going through before the pandemic, now times are harder for them. So it has been like that for us for basically three years. We have scraped by, barely having enough to hold on to keep going, at the bottom of the barrel, but now we get kicked in the teeth again through this pandemic.”

For his part, Walcott was forced to drive for Uber to sustain himself. Yet, without any health insurance, he can’t afford to put his life on the line and continue driving.

“Between working for Uber and pulling from my savings that has been enough to get by. Now with the pandemic it’s all savings. I know eventually it gets to the point where the balance I’m in will fall through. I’m playing on borrowed time and I can’t really do anything except keep fighting and hoping we get help from somewhere.”

Supporters of the striking workers, such as New York City Council Member Barry S. Grodenchik, are dumbfounded that, after three years, Spectrum has still refused to reach an agreement with Local 3 over their pension fund and healthcare plan, even during the COVID-19 crisis.

“I grew up across the street from the union hall, so I go way back with the union and many of the people that are unfortunately caught up with this,” said Grodenchik. “It’s very, very hard to see this at this time, especially during the pandemic. They have been trying to sustain a strike for over a three-year period of time which is quite unusual to say the least.”

It’s a money company and we are just a number to them.

Instead of negotiating with Local 3, Spectrum has hired an army of contract workers to replace the striking workers and has launched a bid to decertify the union. Voting for decertification should be led by workers who choose to either abolish a union or replace it with a different one. Local 3 contends that the vote is being pushed by replacement workers at the behest of Spectrum. In 2019, Local 3 lodged a complaint against Spectrum with the National Labor Relations Board, currently stacked with anti-labor Trump appointees, for unfair labor practices. The case has yet to be resolved. As of publication, Spectrum could not be reached for comment.

Congress, however, has signaled some support for organized labor. This past February, the House passed the Protecting the Right to Organize (PRO) Act, one of the strongest pieces of labor legislation passed in years. The act would strengthen workers’ ability to form unions by introducing penalties against businesses that block workers from forming unions. It would also require companies like Spectrum to bargain in good faith with unions as well as protect workers’ rights to strike. Unfortunately, the act is unlikely to pass in the Repulican controlled Senate.

At the local level, many New York City officials are vowing to revoke Spectrum’s municipal franchise agreement with the city, which is up for renewal in July, if the company fails to reach a settlement with the union. The agreement gives Spectrum the privilege to provide cable, internet, and other tech services to residents across the city for a fee. Across the country, cable operators pay nearly $3 billion annually in franchise fees to state and local governments. Barry Grodenchik, who sits on the New York City Council’s Subcommittee on Zoning and Franchises, has been one of the most vocal in his opposition to Spectrum.

“I stated publicly that I cannot vote to extend their franchise agreement because of how they treat their workers. There are 1,800 families in New York City that have been shown the door. That’s a lot of people.”

Even New York City Mayor Bill De Blasio has signaled his support for the striking workers. “Workers deserve a fair contract, and this Administration strongly supports the striking workers,” said Laura Feyer, Deputy Press Secretary for the Mayor. “Like all cable franchise agreements, Spectrum’s is governed by federal law, which has strict guidelines regarding when a franchise can and cannot be renewed.”

Yet, some of the strikers are skeptical. “Many elected officials have stated that they will not vote to renew Spectrum’s franchise agreement, which has to be done as a stance against a company that is blatantly union busting in a union town,” says Walcott. “But the problem is, even after the vote, the cable company is going to lawyer up and just going to fight the city for years without a franchise agreement. So they don’t really give a shit.”

For David Papon, with all his struggles, he has lost what little faith he had in the company. “After all the years I put into the company I feel abandoned. This company pretty much has nobody’s back. It’s a money company and we are just a number to them.”

All my childhood grocery shopping memories center on being poor: Walking 10 minutes from our two-bedroom home in the Malden Housing Authority’s projects to the local Stop & Shop and filling the cart with juice, eggs, and bologna. There was the joy of adding the small amount of treats we could afford — at the time, that meant fresh bakery chocolate muffins, apple turnovers, and Gushers fruit snacks — and the embarrassment of putting some of the food back at the register when it rang up over our limit.

When your grocery budget is entirely reliant on the Supplemental Nutrition Assistance Program (SNAP), your mom’s Social Security Disability Insurance (SSDI), and other assistance programs designed for low-income disabled single parents and their disabled children, you have to be very specific about what you buy. It’s easy to spend your entire food budget before the month is over and find that toward the end of the month, you’re hungrily eating cheap cereal and off-brand white bread for every meal.

Recently, Democratic Senators Kamala Harris and Kirsten Gillibrand introduced a bill with Senator Bernie Sanders that would expand the SNAP benefit. The bill would increase the baseline for SNAP benefits by roughly 30 percent and expand benefits to those living in U.S. territories. Currently, the Families First Act is temporarily increasing SNAP benefits for households that haven’t been receiving the maximum benefit, and many states are allowing customers to purchase SNAP-eligible items online, a move that makes grocery shopping during a pandemic safer for low-income elderly, disabled, and high-risk individuals. A permanent increase to SNAP benefits and expanded delivery options would make a significant difference in the lives of many SNAP recipients, giving them the ability to purchase more food each month and making it easier for people to shop even if they can’t physically go to a grocery store.

The maximum SNAP benefit for a household of two in Massachusetts, where I live, is currently $355 per month. A 30 percent increase to that would be $106.50, bringing the total to $461.50 per month. That would mean SNAP recipients could almost afford the average cost of groceries ($489.16 per month in Boston, according to the Bureau of Labor Statistics, though the average monthly spend on food overall is $805.58 once you include takeout and restaurants). Although many families don’t receive the maximum SNAP benefit — in Massachusetts the average monthly household benefit is only $210, or $1.36 per person per meal — the proposed increase in SNAP benefits would at least bring low-income and poor Bostonians closer to being able to afford a full months’ worth of food.

I know how it feels to be able to expand your food budget, even by a little. I remember the first time my dad, who took over raising me after my mom died, had a particularly good month driving the cab. This was before the 2008 recession, and his specialty was driving kids with busy working parents to and from school. We had an unexpected, albeit small, increase to our food budget. I no longer had to survive on $1 Celeste frozen pizzas. I could get a few higher-cost pizzas, like DiGiorno. I was allowed to get inexpensive sushi at the Stop & Shop seafood counter twice a month, and we bought lobsters when they were on sale for $4.99 a pound. We kept the house stocked with sodas and Little Debbie snacks for when my friends came over.

A 30 percent SNAP expansion could change your life.

I could actually tell my new high school friends we’d feed them instead of asking them to come over “after dinner,” and we spent one New Year’s Eve trekking through a blizzard to get takeout Chinese food from the best restaurant in the city. I felt rich enough to try crab rangoon, which I’d always assumed I wouldn’t like — when you’re poor, you don’t take risks spending your limited money on food you’re unsure about and may have to throw away. The crab and cream cheese tasted like the freedom of choice and exploration, and I’ve loved them ever since. Then the recession and the rise of Uber and Lyft made it harder for taxi drivers to make money. We went back to eating cereal when we ran out of food money. I got part-time jobs and saved my birthday and holiday money to help my dad pay for groceries.

When I went to college, my food budget slowly started to increase again. It wasn’t much, but I went from being truly poor to just being broke. I’ve always defined the difference by how often the threats of eviction, running out of food, or having the electricity or heat turned off crossed my mind at any given moment. If I had enough money that those things were just background noise, I was broke. If I had so little money that I couldn’t help my dad pay down the electric bill so the power company wouldn’t turn off the lights. I was poor.

Being broke meant I could sometimes save enough money to take my girlfriend (now my wife) on a sushi date, if we kept the meal inexpensive or it was a special occasion. It meant splitting pizza delivery with my friends on Saturday nights, after we’d all had a few cheap vodka cocktails and were sitting around the dorm room laughing at weird memes. Broke was being able to get something else out of the freezer if I’d overcooked my chicken nuggets to a burnt crisp, instead of laying on my bed devastated because I’d ruined my chance to eat.

A few years ago, after my wife and I both got full-time jobs and were no longer relying on the modest budgets of grad students, we first noticed the difference at the grocery store. We were no longer poor or broke; we could get fresh salmon for dinner instead of frozen. We never had to put things back if we were over-budget, we could just have an honest conversation in the car afterward about whether we wanted to cut back the next time. I didn’t even cry when our zucchini went bad the day before we were planning to cook it, even though the child in me — the one who still remembers eating a free pizza lunch at the park with my mom on the August day that she died — was determined not to let it happen again.

That’s how a 30 percent SNAP expansion could change your life. It gets you from poor to broke. From hungry to offering to split your Caesar salad and brownie with another broke friend in the school cafeteria. It’s the bare minimum a person needs to be able to spend their days without low-level anxiety about how they’re going to survive. In the richest country in the world, the bare minimum shouldn’t be too much to ask for. We all deserve to get freshly baked muffins from the grocery store bakery every once in a while, and take the small risk of trying crab rangoon for the first time.

Located between California’s Central Valley and the Sierra Nevada foothills, the town of Placerville is a standout amongst rural California communities. With a population of 11,000, it is one of the few rural towns to see economic performance outpace the national average since the Great Recession. Like other rural California communities, however, COVID-19 has sent shockwaves through the town and the federal response to businesses struggling under the state’s stay-at-home order has been inadequate to address the distinct needs of this community and others like it.

Placerville resident and Rural County Representatives of California (RCRC) CFO and COO Lisa McCargar understands this problem all too well. Her organization advocates for broadband access, water rights, and other infrastructure resources on behalf of thirty-seven rural California counties. Now, facing the COVID-19 pandemic, the importance of RCRC’s work has never been more apparent to McCargar. With nearly all of the businesses on Placerville’s Main Street closed, she worries rural communities may not have equal access to federal government aid programs that have been touted as crucial to propping up small businesses.

Although Congress allocated more than $650 billion to lend to small businesses through the Paycheck Protection Program (PPP) that is being administered by the Small Business Administration (SBA), accessing an approved lending institution in communities like Placerville is easier said than done. Only 31 percent of the community banks chartered since 1986 remain in the rural financial sector. This has led to a significant challenge in accessing financial services, especially now. “Everyone was flocking to Citi and Bank of America to the point that they couldn’t handle it. It ended up that you needed to be a customer with an outstanding loan or at least an account,” McCargar noted.

Steve Frisch, CEO of the Sierra Business Council, is dealing with the same problem. His group, which advocates for the business community in the mountain region of California, has helped more than 500 small businesses apply for the loan program. Despite their assistance, he estimates that only 10 percent received funding. “If you already had a strong relationship with a bank and your bank was approved to lend, then you got funded. If not, you were out of luck,” Frisch said. This is partly the result of inadequate funding to smaller community banks, who despite providing capital to nearly 1.5 million small businesses in 2018, received 16 percent of second-round PPP funding.

In addition, the quick roll out of the program was a major learning curve for smaller lending institutions. Banks “got the guidelines at 3:00 p.m. and the program opened at 10:00 a.m. the next morning,” Frisch noted. This isn’t to say community banks weren’t able to process any applications. However, community banks reported that the system locked up because of the mass uploads by larger lending institutions. As a result, they had to manually enter applicant information, a process which is reported to take up to an hour.

It is worth noting that businesses owned by historically underrepresented ethnicities have been particularly impacted by these barriers. “COVID-19 exacerbated all pre-existing inequalities” Tara Lynn Gray, the CEO of the Fresno Black Chamber of Commerce said. Her group, which provides technical support to business owners of color, has helped 40 businesses through one-on-one sessions and nearly 330 businesses through webinars. “Not one business got funded in the first round, while seven got funded in the second round” she said.

Research from the Center for Responsible Lending backs this up. Their recently released report notes that banks tend to lend to larger businesses with greater payrolls. Even though businesses owned by people of color employ 7.2 million individuals, the report estimates that 95 percent of Black-owned businesses, 91 percent of Latino-owned businesses, 91 percent of Hawaiian- or Pacific Islander-owned businesses, and 75 percent of Asian American-owned businesses may stand little chance of receiving a loan because of these access issues.

There needs to be a conscious attempt to address rural-centric financial issues.

Aside from the difficulty of getting a loan, no one knows how long funding will be available. To date, $669 billion has been allocated to SBA loans. That’s 19.11 percent of last year’s federal tax revenue. And with an estimated 70 percent of all small businesses applying for the program, there aren’t nearly enough funds to go around. Data from COVID Loan Tracker suggests that denial rates are as high as 90 percent, but the denial rate is likely higher in rural communities where there are fewer eligible banking institutions. McCargar and Frisch both noted that there was a lack of capital in these communities, even before the crisis. Many business owners have little more than their homes — or if they are lucky, personal savings — to rely on.

This sort of liquidity crisis has significant implications. During the last downturn and subsequent recovery, regions that had greater access to capital were able to reduce the number of layoffs and in turn, preserve the skill of their labor force. Areas that lacked access to financial resources experienced severe wage atrophy and decreased output.

Not surprisingly, it tended to be rural areas that were hardest hit by this capital disparity. The results are still obvious today. California’s three most rural counties, Alpine, Mariposa, and Trinity, have seen far slower income growth since the Great Recession began, compared to the state’s three most urban counties of Alameda, Orange, and San Francisco. Nationwide, there are 0.2 percent fewer jobs in non-metropolitan areas since 2007, and labor force participation is over 7 points lower than in metropolitan areas.

The last decade’s decline is largely the result of decades worth of underinvestment in any concerted rural economic development strategy. Now, COVID-19 is stress testing the deteriorating financial and economic infrastructure of these communities. Already, they have lost 14 percent of bank branches in the past ten years, 43 percent more than their urban counterparts. Last year, 1 in 4 rural small businesses cited capital access as one of the biggest barriers to successfully running their business. With so many communities yet to recover from the Great Recession, the shock of COVID-19 only hurts that much more.

While the government’s efforts to prop up small business are a step forward from the last recovery efforts, there still needs to be a conscious attempt to address rural-centric financial issues. Not only did communities like Placerville have less capital going into the COVID-19 pandemic, they now face additional barriers to accessing the government programs intended to help them. No plan to help America can work without supporting financial services to our rural neighbors.

Russell Lowery-Hart is the president of the community college in Amarillo, a struggling city on the vast prairie of the Texas Panhandle, halfway between Oklahoma City and Albuquerque. Among Amarillo College’s students are health aides, motel maids, and meatpacking workers — in plants now beset by COVID-19 — looking to education as their road out of poverty.

In the last few years, Lowery-Hart has risen to prominence on the basis of his rousing call to remake higher education to serve today’s typical college student: not an 18-year-old in a dorm but a mother with two part-time jobs and a pile of bills.

When the coronavirus pandemic shut down this college of roughly 10,000 students, Lowery-Hart moved his family photos and a stack of books to a circular welcome desk in the student commons. There, he greets students who don’t have a computer or reliable internet at home. He takes their temperature, asks about possible exposure to the coronavirus, and then, if they pass the screening, allows them to use a computer lab, with social distancing and constant cleaning.

I spoke to Lowery-Hart last week to explore what students in poverty are facing during the pandemic, and how colleges are trying to help.

Marcella Bombardieri: The Texas Panhandle has become a hotspot for the coronavirus. How is that affecting the college?

Russell Lowery-Hart: We’ve had a huge explosion of COVID in our community, through the meatpacking plants that now can’t close [according to an order from President Trump]. So there’s all kinds of politics that I don’t want to be involved in, I just care about the people that we’re trying to serve and the neighbors that we live with.

How many Amarillo College students work in the meatpacking plants?

We don’t have firm numbers. What I have are emails from students saying, “I tested positive, and I need help, because I can’t study for my tests and I can’t work.” We’re trying to provide emergency aid and academic support while we’re worrying about their health.

Why did you keep one campus building open for students to use computers and get other types of help in person?

We had to protect our employees and our students, but we knew students that needed a computer [or lacked internet service]. It was really important to me that they had access to a computer, and that COVID not take their future away from them and force them to drop classes.

What are you hearing from the students who come in?

I’ve had a lot of people, they’ve lost their job, and they’re needing to apply for college. A lot of those students [have] heartbreaking stories. They were at Amarillo College, and they got a good job. So they stopped out, and took out loans that they didn’t repay that have gone into collection. And now the job they left all that for is gone. And they know that we’re the solution to their future, but they’re in this trap.

So we’re trying to create payment plans or find resources that can absolve the government money they owe, so they can access money to pay for school and living. It’s just a game of whack-a-mole in so many ways. Solving one need identifies seven other things that they’re needing.

We have students coming in because their internet went down. Or they’re really struggling with their class and they want to drop it, and I’m trying to talk them out of doing that — or talk them into doing that — depending on what’s best for them. All while taking their temperature with our thermal camera and having them bathe in sanitizer.

I talked to one student who had four or five kids at home, all between fourth grade and tenth grade. They’re all on one computer. The student is trying to do her job and her learning on the computer. And her husband’s trying to do his job on the computer. She burst into tears out of guilt that she was trying to escape her house.

Many of your students were poor before the pandemic. Do you have a sense of how much more hunger and housing insecurity your students are experiencing now?

I don’t have numbers on it, Marcella, because we made a decision that we’re not going to check for IDs and track. If you had a need, you got help. We’ve had community members come in and get bags of food. We’ve had a lot of students come in and get bags of food. We’ve gone through a lot of diapers and wipes and formula, and food items, and hygiene items. We’re not limiting the number of bags.

One of our students came in one day, sobbing. Her mother lost her job the week before, she’s got a [teenage relative] living in her house, and they’re all trying to survive now on [one] disability check. I tried to give her two bags of food. And she’s like, “I need to give one of these back. I know there are people that have greater needs than I do.”

It’s one of the things that I worry about with our students. It’s not a pride issue, it’s that they always think someone else needs it more than they do, when we have enough to help everyone.

Have you seen basic needs insecurity among Amarillo College staff, or adjunct instructors, in the past or since this crisis hit?

[Lowery-Hart got choked up as he answered.] I think it existed before, but I don’t know that I had to see it like I see it now. [One of our staff] has taken two bags of food home with her. If we hadn’t lifted the restrictions, I don’t think she would have ever asked for it. It’s one of the reasons why, with our CARES Act funds, we’re creating an emergency aid system not just for our students, but also for our employees.

You’re looking at $250 per student, and that’s not going manage a crisis

You have criticized the CARES Act for prioritizing full-time students over part-time students in the formula that determines the funds available to each college. How can we better support community colleges and today’s students?

If you want to make stimulus money have the biggest impact with the lowest level of investment, it’s community colleges. The CARES Act is helpful. I don’t want to complain about the help that we’re going to be able to give students. But that money is also going to support for-profit colleges and universities that have huge endowments.

If you look at what we could give in emergency aid to our students [from CARES], you’re looking at $250 per student. And that’s not going manage a crisis for our students.

You have been through painful state budget cuts before. What’s going to happen when the state budget crashes?

We know the cycle, right? When there’s a crisis, our budgets get cut. And then, 12 to 18 months after the crisis, our enrollment increases as we’re getting funding cuts.

You’ve told me before that it’s not enough to train students for Amarillo’s job market, when many jobs aren’t high-quality. So you want to create better jobs in Amarillo, for example in technology fields like film visual effects. Now the economy is in shambles, so what does that look like?

That’s the question that I’ve lost sleep over. We were preparing for what was going to happen when [driverless trucking means] truckers no longer drive through your community and need your hotels and your restaurants. Well, that was a seven-year-away reality that happened overnight.

We are having conversations about, maybe you can’t graduate from Amarillo College without coding skills or baseline technology skills. That’s going to be a heavy lift for us.

What else do you lose sleep over?

I’m worried about the financial health of my community that was perilous to begin with. There was a huge economic disparity, and now I’m starting to see the Lexuses needing food pantries. The reality of living paycheck to paycheck — even if you had a healthy paycheck — if you’ve lost the paycheck, it doesn’t matter what car you drive. You’re in need.

This interview was condensed and lightly edited for clarity.

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