My colleague Juliana Keeping writes this week on the crisis of health care affordability:
Milk in the fridge vs. gas in the car. Time for myself and my family vs. night and weekend shifts at a restaurant, on top of a full-time job. Care for the kids vs. shoes for the kids.
Those were some of my choices in the not-so-distant past. My family had private health insurance.
Any time our plan turned over or my son, who has a genetic condition called cystic fibrosis, needed serious care, medical debt threw us off balance.
Those struggles are not the result of some moral failure on our part.
Health care prices are far too high.
The average family insurance premium costs $22,221 a year — as much as a new car. As health care prices rise, wages are stagnating. And despite major expansions in health insurance coverage in the past decade, nearly 1 in 5 adults in the U.S. owes medical debt. That burden is not equally distributed: Black Americans, individuals with disabilities, and those living in the South are most likely to face significant medical debt.
The whole country is square in the midst of a massive system failure, and millions of people are facing hard choices that will require big solutions to set right.
I’m glad that policymakers at both the state and federal levels are increasingly considering and adopting solutions to lower prices in the commercial market — including making prices transparent, limiting further consolidation and improving market competition, and directly limiting excessive prices.
But progress needs to move faster. We aren’t just getting poorer — we’re getting sicker. One in 11 U.S. adults is reporting delaying or forgoing care due to cost.
The confirmation of Ketanji Brown Jackson to the Supreme Court of the United States marks a high point for a growing bipartisan movement of appointing current and former public defenders to the bench. For too long, political norms almost exclusively prioritized candidates whose résumés included time as prosecutors, in academia, or in private practice. But that is starting to change.
What's Happening: Since his election, President Biden has focused on appointing former public defenders to the federal bench. In 2021, around 40% of his nominees for the federal judiciary had served as public defenders at some point during their career.
This marks a major shift in federal courts. As of 2020, only 7% of all federal judges were former public defenders, and on the federal appellate bench the margin was even slimmer, with just 1% of judges having spent the majority of their careers as public defenders or legal aid attorneys.
Why It Matters: Appointing criminal defense attorneys brings an important and underrepresented viewpoint to the bench. Because they have worked directly with clients, former public defenders bring a unique understanding of the stories of the accused, their humanity, and the massive toll the criminal legal system can take on them. They also bring trial experience, which many judges lack.
“Having members of the court who have been in the real world when it comes to the practice of law is invaluable to their understanding of facts and legal arguments, as well as the impact that their decisions will have,” said Zeke Edwards, AV’s vice president of criminal justice for pretrial.
What's Next: This trend of public defenders joining the bench isn't unique to federal courts. States like Texas, Louisiana, and California have seen their bench makeup change in recent years — and experts are hoping this broadening of perspective will expand beyond courtrooms.
“People are paying attention to public defense,” said Ilham Askia, executive director of Gideon’s Promise, an organization that educates public defenders on providing justice for marginalized people. “And if they're doing it in the judicial branch, then hopefully that will spill over into areas of the criminal legal system.”
By Rhiannon Meyers Collette, communications manager
It's no secret that newsrooms nationwide have been shrinking — laying off reporters and cutting beats. Nowhere has that been more apparent than in state capitols, where legacy commercial newsrooms facing financial pressures have scaled back coverage and, in some cases, shuttered capitol bureaus. But a new report out this week by the Pew Research Center and supported by AV finds fresh signs of hope as nonprofit news outlets — a growing force in the journalism ecosystem — have helped fill voids left behind by their commercial counterparts.
What's Happening: Since Pew's last grim report on statehouse coverage eight years ago, a new trend has emerged — growth. The total numbers of journalists covering statehouses since 2014 has actually increased by 11% due in large part to the influx of nonprofit news outlets like the Texas Tribune, CalMatters, Montana Free Press, and VTDigger that committed resources to covering their state legislatures.
Why It Matters: As state lawmakers pursue increasingly ambitious and sweeping policy reforms that intersect with some of the nation's most intractable problems, statehouse journalism is more important than ever. And while nonprofit newsrooms have made significant headway into expanding coverage, the need for more journalism in this space remains just as urgent.
Related: From a harrowing podcast by Reveal examining the death of a Black high school football star killed during a routine traffic stop to Spotlight PA’s deeply reported series on the true cost of government, AV’s journalism grantees earned well-deserved accolades from their peers at Investigative Reporters and Editors. Congratulations to all.
A Law in Need of Defending
By Juliana Keeping, communications manager
No one should face financial ruin just because they need health care — yet two-thirds of bankruptcies are tied to medical expenses. On Jan. 1, the bipartisan No Surprises Act became law, protecting most insured patients who need emergency care from receiving surprise medical bills from an out-of-network hospital or doctor. Patients like Nicki Pogue, of San Francisco, know firsthand the toll an unexpected bill can take. She spent five months fending off a $13,000 surprise bill after a health emergency.
What’s Happening: Patients like Pogue have waited a long time for the protections that the No Surprises Act put in place. But powerful hospital and provider groups who have used surprise billing as a tactic to generate revenue wasted no time in trying to roll back the new protections; six provider-led lawsuits have been filed on the NSA thus far, largely centered on objections to the arbitration process intended to establish reasonable rates for surprise out-of-network bills.
Why It Matters: The NSA continues to protect patients from receiving expensive surprise medical bills. Not only are individual patients protected, but all privately insured Americans — and their employers — will feel the benefits of the law as currently designed as health care costs decrease.
What’s Next: “The goal of the The No Surprises Act was to protect consumers from high and growing health care costs by banning the egregious practice of surprise billing and reducing their premiums and cost-sharing,” said Erica Socker, AV’s vice president of health care. “Policymakers must fully implement the NSA’s important patient protections in a manner that reduces health care costs for patients and families across the country to realize the full benefit of the law.”
Jeremy Travis, AV’s executive vice president of criminal justice, co-authored the closing essay to the Brennan Center for Justice's series on Punitive Excess, titled “Beyond the Era of Punitive Excess.”
The Issue: America's criminal justice system relies on unnecessarily harsh punishments in a legacy that can be traced back to the practice of race-based chattel slavery. If we hope to shrink our reliance on mass incarceration, then the United States needs to confront the decades of harm inflicted by this status quo and begin centering community as a key decisionmaker.
"We recognize that the road to dismantling systems of injustice is long and that progress is not linear. We also believe that dismantling the sturdy architecture of punitive excess will require more than marginal reforms," Travis writes with Bruce Western, director of the Columbia Justice Lab.
What's Next: "History teaches us that a reckoning with history happens only rarely, and then often in the context of painful regime change, such as a defeat in war, a political revolution, or accumulated moral outrage," Travis and Western write.
Until then, the Punitive Excess series is being incorporated into a full-length book. Meanwhile, the series has been awarded a finalist position in the commentary category of the American Bar Association’s 2022 Silver Gavel Awards for Media and the Arts, which recognize “outstanding work that fosters the American public’s understanding of law and the legal system.”
Bloomberg looks at the economic toll of gun violence.
This interactive Hospital Cost Tool from the National Academy for State Health Policy provides insights into how much hospitals spend on patient services — and shows how those costs relate to both hospital charges and actual prices paid by health plans.
Medicare will only pay for the Alzheimer’s drug Aduhelm if a patient is enrolled in a clinical trial. "One of the implications of it is: What is the order for getting approval for a drug?" Mark E. Miller, AV's EVP of health care, told Axios. Aduhelm is a flashpoint in debate over evidentiary standards — but it is not the first. Read AV’s take.
The New York Times reports on the growing trend of advocacy groups involved in various diseases campaigning for therapies — like the embattled Alzheimer’s drug Aduhelm — despite medical experts’ concerns about insufficient data.
Dive Deeper: AV recently introduced evidence-based policy solutions that would restore the balance of access and timely confirmatory evidence required under the FDA’s accelerated approval pathway — which authorizes unproven drugs for serious illnesses with few treatment options — if that drug is “reasonably likely to predict clinical benefit.”
Navigating two systems is hard enough for people with Medicare and Medicaid. Now, understaffed state Medicaid agencies are causing life-threatening delays in coverage for people with disabilities and seniors, reports NPR.
New research in Health Affairs shows how the trend in the commercial-to-Medicare hospital price ratio varies substantially within and across states, highlighting the need to constrain both excessively high hospital prices and unsustainable price growth.
Drug pricing watchdog ICER published a white paper that evaluates reforms to the development, pricing, and coverage of orphan drugs, which treat diseases that impact under 200,000 people but where prices can exceed $1 million a year.
A study in Health Affairs shows that clinics that received Title X funding provided “52 percent more of the most effective contraceptives to women at risk for pregnancy than clinics not funded by Title X,” across all age groups. The study concluded that strengthening Title X funding should be a priority in public health policy.
LaQuayia Goldring writes in STAT News about her experience with the organ procurement system while waiting seven years for a kidney transplant. "The problem is that the federal contractors charged with recovering organs — called organ procurement organizations (OPOs) — are failing to recover as many as 28,000 transplantable organs every year."
Dive Deeper: OPOs — despite having a regulatory mandate to respond to all cases referred to them — are only half as likely to even show up if the potential donor is Black versus white. Read more about Goldring's story and the urgent need for reform.
In University Business, Chris Burt advocates for funding to implement evidence-based programs that support college completion.
This week, the Senate cut $500 million in unspent COVID-19 relief funds from higher education, reports Politico, in a bipartisan effort to create a $10 billion COVID-19 relief deal that relies on cobbling together unspent relief funds from other bills.
Software entrepreneur Vik Tantry calls for carbon pricing as a way to address climate change and protect free markets in Citizens’ Climate Lobby. “[Carbon pricing] can single-handedly reduce emissions 50% by 2030 with a moderate price, and 3,600 U.S. economists — including many fiscal conservatives like George Shultz and Alan Greenspan — have said it’s the only way that we can transition to a low carbon economy quickly and painlessly.”
What We're Watching
“Out to Vote,” a short film from Bertelsmann Foundation on efforts in Baltimore, Maryland, to educate formerly incarcerated people about their newly restored voting rights. As we talked about in this newsletter last week, more than 70 million Americans have a criminal record — and more than 5 million have been stripped of their right to vote due to a felony conviction. Thanks to advocacy from organizations like Out for Justice, Maryland restored the right to vote to formerly incarcerated people who have served their time — but many don’t know they have the right. That’s where people like Bobby Perkins come in. “I never once ever thought that I would come home and make a difference,” says Perkins, who after 37 years in prison spends his days engaging in street-level outreach to get out the vote. Advocate Monica Cooper, executive director of the Maryland Justice Project, says that to her, the vote is her voice in the fight to secure access to jobs and housing for people leaving prison. “Everything that impacts your daily life, our daily lives, starts at the polls,” she says. Perkins, Cooper, and others persist in the face of voter suppression efforts and misinformation campaigns, and their commitment to the democratic process is inspiring. It’s perfect viewing for this #SecondChanceMonth.
What We're Listening To
“That’s when they started using my head as a battering ram.”
Thus begins the preview to the latest season of WBEZ’s podcast, Motive, which explores the “hidden world of big prisons in small towns” where “everyone knows each other and difficult truths get buried.” It’s no secret that incarcerated people — disproportionately represented by communities of color — are often subjected to inhumane conditions in prison. Motive pries open the black box of the carceral system, taking the listener inside the brutality that occurs on cell blocks across the nation. Two episodes have been released so far — the first exploring the violence inflicted on prisoners out of range of the cameras, underscoring the lack of accountability in prisons, and the second examining how mental health services in prisons are not what they appear to be. Both force the listener to confront the excessive punishment meted out against prisoners that has become an accepted reality of the American incarceration system.
Also: AV Communications Manager Evan Mintz was on the CityCast Houston podcast twice this week to discuss the successful misdemeanor pretrial reforms in Harris County and new research that shows how police can reduce crime, lower the number of arrests, and improve community trust. Hear him on the episodes "What Is Bail Reform? And Why Should I Care?" and "The Hidalgo–Ogg War, Cutting Crime, and Sneaking Loquats."
Stephanie DiCapua Getman develops and executes Arnold Ventures' digital communications strategy with a focus on multimedia storytelling and audience engagement and oversees daily editorial operations and design.
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