A Juneteenth to Remember

On Thursday afternoon, with the stroke of a pen, President Joe Biden enshrined Juneteenth as a federal holiday. Slow and steady bipartisan efforts to add the commemoration of emancipation onto our nation’s shared civic calendar broke into an unexpected sprint this month. The holiday specifically recognizes Union Army General George Granger arriving in Galveston, Texas on June 19, 1865, and reiterating the command of the Emancipation Proclamation: All people enslaved in the rebelling states were now free.
 
Why It Matters: Gen. Granger’s order said that freedom meant “absolute equality of personal rights,” but that fight for equality is still a work in progress. Galveston specifically has been grappling with a criminal justice system that violates people’s constitutional rights. The county is currently being sued by the ACLU for relying on a wealth-based detention system. And the Galveston Police Department recently underwent a policy review after images of a black man arrested by officers on horseback made international news due to distressing parallels with slave patrols.
 
What’s Next: The fight for justice continues across the country as advocates try to reform our courts, jails, and law enforcement agencies, and Juneteenth remains a reminder of how often that fight involves bridging the gap between promise and fulfillment. As President Biden said: “All Americans can feel the power of this day, and learn from our history, and celebrate progress and grapple with the distance we’ve come but the distance we have to travel.”

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By Rhiannon Meyers Collette, Communications Manager

The FDA's approval of a pricey new Alzheimer's treatment exposed a raw nerve in the national debate about the dysfunctions of the U.S. drug market. Aducanumab — which will be sold under the brand name Aduhelm at $56,000 per year — sparked scrutiny of the FDA's decision to greenlight a drug with inconsistent results and serious side effects and raised concerns about the impact of the drug's hefty price tag on patients, their families, and U.S. taxpayers, who will foot Medicare's portion of the cost. “This is precisely the scenario we’ve sought to avoid,” says AV’s Mark Miller. “There’s no evidence, the price tag is high, and a lot of people are eligible for this. If this a precedent, then we have a problem.”

Why It Matters: The drug represents myriad failures in the way pharmaceuticals are approved and marketed — trial data was inconsistent, the drug poses risky side effects, and the FDA approved it for wide usage in a move that's expected to stymie further clinical trials as patients opt to take the available drug rather than risk getting a placebo. The price tag set by the manufacturer will create a staggering expense, especially for Medicare, which is already facing budget constraints, and Medicare beneficiaries, who will face higher out-of-pocket liabilities and premiums.

Bottom Line: “This is terrible for Alzheimer’s patients who get their hopes up and get nothing except delusions and brain swelling,” says Diana Zuckerman of the National Center for Health Research. “This is terrible for our health care system, and it’s unbelievably awful for Medicare. It’s awful on every level, and it sets a precedent that will be very hard to undo unless somebody, such as President Biden, Secretary Becerra, or a new FDA commissioner, is brave enough to address these failures.”

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Listen: Tune in to the Tradeoffs podcast next week for a special four-part segment on the implications of Aduhelm's approval, featuring AV's own Mark Miller.

Related: Medicare must study the expensive and unproven aducanumab, write Peter Bach and Craig Garthwaite in Bloomberg. 

Related: Aducanumab could hammer Medicare, Politico reports. “It would be better for Congress to act now than to look back and realize that this was a watershed movement and they didn’t act.” 

By Rhiannon Meyers Collette, Communications Manager

When Congress passed the landmark No Surprises Act in December, lawmakers took an enormous step toward ending the predatory practice of surprise medical billing that has left countless families in debt. The law is set to take effect Jan. 1 — and regulators are currently working to iron out the finer details of the new rules — but careful consideration is needed to ensure the law goes far enough in protecting patients and lowering health care costs.

What’s Happening: The federal law bans surprise billing in most instances — and removes patients from the middle when providers and insurers can't agree on payment — but it requires payment disputes to be resolved in an "independent dispute resolution" process, commonly known as arbitration. Some states with surprise billing bans have relied on similar approaches to address payment disagreements; however, early evidence shows that arbitration can actually drive up costs, rather than lower them. 

What’s Next: In a two-part series, AV's commercial sector pricing team outlines considerations for implementation to ensure that the law realizes its promise of generating billions in federal savings and lowering premiums.

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By Evan Mintz, Communications Manager

The topic of criminal justice reform and racial inequity dominated this year’s Pulitzer Prizes. Especially notable was the Pulitzer board’s special citation to Darnella Frazier, the then-17-year-old girl who recorded on her phone the murder of George Floyd by Minneapolis police officer Derek Chauvin. Her courageously recorded 9 minute, 29 second video, according to the Pulitzer board, “spurred protests against police brutality around the world, highlighting the crucial role of citizens in journalists' quest for truth and justice.” 

Why It Matters: “The world needed to see what I was seeing,” Frazier said in an interview with the Minneapolis Star-Tribune. And the people did see it. Her video received more than 1.8 million views on Facebook, and over the following month an estimated 20 million people joined protests that covered nearly half of all counties in the United States. 

What’s Next: If the nation is going to heed the call to action inherent in this year’s Pulitzer Prizes, then the criminal justice systems that reinforce and perpetuate racial injustice must be upended and reformed. Frazier filled her role as a responsible citizen, and she has suffered from it. On the anniversary of Floyd’s murder, she wrote on Facebook about how her family felt compelled to move because her “home was no longer safe.” Policymakers, law enforcement leaders, activists, and researchers must work together to maintain the energy and action of the moment to ensure that Frazier’s sacrifice wasn’t made in vain. We cannot let Frazier’s Pulitzer be the kicker to the story. 

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Asheley Van Ness, AV’s Director of Criminal Justice and resident gun violence expert. Last year was America’s deadliest for gun violence in two decades, and this year is on track to be even deadlier — yet “America spends more research money studying peptic ulcers than it does studying gun violence,” Van Ness says. Gun violence prevention was the focus of this year's Stockholm Criminology Symposium, where Van Ness, along with a panel of grantees from the RAND Corporation and NORC at the University of Chicago, led a discussion on the role philanthropy plays in building a body of research to support evidence-based gun policy. She talks to us about whether the growing number of firearms on our streets could be contributing to a rise in homicides, why we are struggling as a country to address the epidemic of gun violence, and 

why we don't need to wait for the "perfect political conditions" to make communities safer now.

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Also: Since last year’s symposium was canceled, this year’s event was a chance to celebrate the winners of the 2020 Stockholm Prize in Criminology, considered the “Nobel Prize” for criminologists. It was shared by AV grantee Philip J. Cook of Duke University’s Sanford School of Public Policy and Franklin Zimring of the University of California at Berkeley for their decades of work in gun violence research.

 

Related: The New York Times looks at how cities across the country are dealing with the rise in violent crime as they lift pandemic restrictions and reopen.

‘Life Without Parole Isn’t Making Us Any Safer,’ a video guest essay in The New York Times from Robert Richardson, who was sentenced to 60 years in prison without the possibility of probation or parole after an armed robbery in 1997, his first offense. Richardson takes responsibility for his actions but also makes the case that “long harsh lengthy sentences do more harm than good.” Louisiana has more people serving life without parole than Alabama, Arkansas, and Texas combined, Richardson says, and almost 75% of those people are Black. He’s asking Louisiana Gov. John Bell Edwards, who has signed major criminal justice reform legislation in the state — and granted Richardson clemency after 21 years — to go even further and put an end to life sentences without parole. Hear why from Richardson and his family in this short but powerful piece. To go deeper into their story, watch the Oscar-nominated documentary “Time.” 

Also, my colleague Steven Scarborough turned me on to the 2018 documentary “The Bleeding Edge,” a shocking exposé on the lax oversight of our nation’s powerful medical device industry. There is no robust testing and approval process to make sure medical devices are safe for patients before they go on the market — and it’s very difficult to take them off the market once they’ve been shown to be harmful or ineffective. Devastating patient stories drive home the horror: Men and women across the country are living with debilitating conditions and an endless stream of surgeries stemming from devices such as Essure, vaginal mesh, cobalt hip replacements, and robotic surgeries. It will leave you both enraged and in tears. It's streaming on Netflix now.

I’ve mentioned the Un(re)solved project from Frontline, and now the first episode of the podcast is available. Emmett Till was kidnapped and brutally murdered in 1955 at age 14. His mother, Mamie Till Mobley, is heard in archival audio: “Teachers present it almost like a fable — a story that helps illustrate just how bad life could be back then...in the segregated South. A marker of how far we like to believe we’ve progressed…even when the truth of that progress is more complicated.” His killers were never held accountable. And his story is among countless others. “The List” explores the birth of the Till Act and the quest to bring justice to the families of those victimized by racial violence.

• Meet 94-year-old activist Opal Lee, the “Grandmother of Juneteenth,” who for decades has been an unstoppable force in the movement to have the day recognized federally.
   
• I can’t find fault with this argument that nurturing dads raise emotionally intelligent kids that help make society more respectful and equitable — I see the evidence in my own home. Happy Father’s Day to all the wonderful dads out there, including my husband, my father, and the Dad Bros (you know who you are). I also recommend following @thedad on Instagram.

The Prosecution team at Arnold Ventures and the National Partnership for Pretrial Justice are accepting proposals for research on the role of prosecution and prosecutorial decisions at various points along the criminal justice process. Learn more here.

Our Complex Care team is funding research into how to improve the systems that deliver care to a population of more than 12 million people who are dually eligible for Medicare and Medicaid. Learn more here.

The Criminal Justice and Evidence-Based Policy teams at Arnold Ventures are teaming up to learn more about what works in criminal justice reform in an ongoing request for proposals for randomized controlled trials (RCTs) that will test programs and practices. There is no deadline for submissions.

The Evidence-Based Policy team invites grant applications to conduct randomized controlled trials (RCTs) of social programs in any area of U.S. policy. Details are here.

View all of our RFPs here.