April Showers Bring Second Chances

Rural health care is vitally important — and that includes health care for women. One of the ways women are able to access health care, no matter their income, is through federally funded clinics. These clinics are often the first line of care for people for miles around. How do they do it?

What's Happening: Arnold Ventures spent some time at Greene County Family Planning, a federally funded clinic in New York, to get to know the clinicians as well as the patients.

Why It Matters: Patients come from several towns away to get the care they need; it’s one of the only providers where a low-income and underinsured population can get a same-day appointment, birth control device, or prescription.

What's Next: As states and the nation look at how to support contraceptive care and access, Title X continues to do the daily work of taking care of thousands of patients, despite its historically flatlined budget. Biden's recent budget proposal, however, does include a 79% increase relative to current funding.

Arizona Gov. Katie Hobbs’ executive order gives a new independent oversight commission unprecedented access to struggling prisons in the state, and advocates hope it will help overhaul the system’s harsh conditions for incarcerated people, families, and staff.

What’s Happening: Arizona’s new independent prison oversight commission — which will include state lawmakers as well as formerly incarcerated people, corrections staff, advocates, and mental health professionals — will visit prison facilities and talk with staff and incarcerated people. The commission will monitor such features as health care, cleanliness, security, staffing, program access, and the grievance process.

Why It Matters: Arizona’s prison system, like many others across the U.S., fosters an unsafe environment. Its 33,800 incarcerated people and 9,550 staff members suffer from poor medical care, rodent infestations, toxic water quality, overheating, and pervasive violence. Advocates have long argued that independent prison oversight is necessary in order to preserve the safety of staff and incarcerated people alike.

What’s Next: In November of this year, the commission will issue a preliminary report with findings and recommendations. Watchdogs believe that the commission’s activities could spur policymakers in the legislature to enact further reforms.

Medicare continues to face financial pressures that put the critical program on a path to fiscal insolvency, according to the latest Medicare Trustees report. Failure to improve the financial outlook will place a greater strain on taxpayers, beneficiaries, and the federal budget.

What’s Happening: Medicare spending is expected to grow rapidly across all parts of the program due to rising per-capita health care costs and baby boomers aging into the program, with Medicare costs projected to increase from the current level of 3.7% of GDP in 2022 to 6% in 2047. Increasing enrollment into Medicare Advantage, a privately-run alternative to traditional coverage, is also expected to exacerbate growing costs.

Why It Matters: Medicare’s hospital insurance trust fund is projected to reach insolvency by 2031, at which point Medicare hospital insurance payments will immediately face an 11% cut.

What’s Next: The trustees conclude that their projections “indicate a need for substantial changes to address Medicare’s fiscal challenges,” and they urge Congress and the president to work together quickly to enact meaningful reforms to shore up the program for the 65 million Americans who depend on it. Improving Medicare’s fiscal outlook will require a comprehensive and balanced approach that reduces wasteful spending and strengthens the program’s financing.

Last week the Biden administration announced that it will phase in its proposed reforms to the Medicare Advantage program over a three-year period rather than immediately.

What’s Happening: Medicare Advantage insurers have been engaging in inappropriate — and sometimes even fraudulent — billing practices. These coding abuses have led the independent Medicare commission (MedPAC), which was created to advise Congress, to call for a ​‘major overhaul’ of Medicare Advantage policies.

Why It Matters: Medicare Advantage plan enrollees cost the government 6% more than similar beneficiaries enrolled in traditional Medicare — costing taxpayers a projected $27 billion in 2023 alone.

“The Congress and the administration need to demonstrate that they can stand up to special interests and take real steps to eliminate fraud and abuse from Medicare and to put the program on a path of long-term sustainability,” said Mark E. Miller, executive vice president of health care for Arnold Ventures, in a statement.

What’s Next: The finalized changes are an improvement, but more must be done. Delaying full implementation gives Medicare Advantage plans more time "to exploit the flawed system," Miller said in Axios. "Congress and the administration need to come together and address abuses in the Medicare program."

• In the Star-Ledger, former Burlington county prosecutor Scott Coffina says that in his experience, New Jersey's risk-based bail reform works and should not be reflexively amended "in response to transitory crime trends and fickle political sentiment."
   
• In The Philadelphia Inquirer, Keisha Hudson of the Defender Association of Philadelphia praises Gov. Josh Shapiro's proposed $10 million in state funding for public defense but suggests that it is just a fraction of what is needed.
   
• The Star-Ledger editorial board has commended former New Jersey Gov. Chris Christie for defending the successful risk-based bail reform approach he helped implement in the state.

• How bonkers is the U.S. system of health care prices and debt collection? A Florida toddler got a bill for care he never received — and his debt was sent to collections.
   

• AV grantee Student Defense released a legal memo this week urging the U.S. Department of Education to take a hard look at how schools and programs are complying with the Department's fiduciary standard. Without compliance (and with enforcement), schools and programs can lose access to federal student aid. “The Department should be taking accountability and oversight of these fiduciary relationships seriously,” said Student Defense Vice President & Chief Counsel Dan Zibel. “Unfortunately, the agency hasn’t done enough to prevent bad actors from abusing the system — harming students and leaving taxpayers on the hook for their misdoings in the process.”
   
• Third Way published its analysis of higher education outcomes for four-year, two-year, and certificate-granting institutions, focusing on measures of quality such as completion rates, earnings rates, loan repayment, and amount of federal financial aid distributed that year.
   

• Will Raderman writes for the Niskanen Center about gaps in our current unemployment system and nuances in the data underlying top-line unemployment numbers.
   
• AV grantee the Committee for a Responsible Federal Budget analyzes a new report from the Social Security and Medicare Trustees, which estimates that the Social Security trust fund will be insolvent by 2034.
   
• Tony Romm writes about the Small Business Administration’s stalled efforts to recollect funds owed to the government from recipients of COVID-era Economic Injury Disaster Loans for The Washington Post. (free link)

• Health Affairs reports on a study showing that among Medicaid beneficiaries, there is widespread variation in effective contraception use depending on where they live.
   

• Congratulations to The Marshall Project, whose journalists won a National Magazine Award for their unparalleled coverage of the criminal justice system.

• This "Last Week Tonight with John Oliver" clip tackles the use of solitary confinement in the U.S. prison system — how prevalent it is and how damaging it can be. In classic John Oliver style, he highlights how holding a human being in solitary confinement — people are typically locked up alone, in a cell the size of a parking space, for at least 22 hours a day — can wreak extensive damage on a human being. The United Nations’ Nelson Mandela Rules state that keeping someone for more than 15 days in isolation is considered torture and that the practice should be banned for vulnerable populations. What's worse? Most people end up in solitary confinement for low-level, minor infractions. It's a vicious and counter-productive practice that does not contribute to public safety. Luckily, many states are recognizing the harms and taking steps to limit their use of solitary confinement.
  
  Oliver ends the segment with the powerful Congressional testimony of Anthony Graves, who was kept in solitary confinement for 18 years after being wrongfully convicted. You can read more about his case in this excellent two-part series from Pamela Colloff in Texas Monthly: "Innocence Lost" and "Innocence Found."
  
  Related: "One Cell, a Lifetime of Pain: Waking to the Truth of Solitary Confinement"

• The Criminology Academy podcast features Thomas Abt for a discussion on what we know about community violence. Abt is founding director of the Center for the Study and Practice of Violence Reduction, associate research professor in the Department of Criminology and Criminal Justice at the University of Maryland, senior fellow with the Council on Criminal Justice, and the author of “Bleeding Out: The Devastating Consequences of Urban Violence — and a Bold New Plan for Peace in the Streets.” He talks about evidence-informed approaches to addressing violence as well as ways to disseminate information that might be helpful for policymakers. Listen here.

• At a recent gathering with my AV colleagues, a topic of conversation was what everyone is watching. So in no particular order, here are some recommendations — old and new — for your next binge: "Swarm," "Party Down," "Daisy Jones and The Six," "Love Is Blind," "Grimm," "Chopped," and "Succession" (Yes, we are an eclectic bunch.)
   
• Speaking of what to watch, The New York Times unpacks the phenomenon that is "Hot Ones" on YouTube.
   
• Here's a website with all kinds of fun time wasters.