The year saw many bright spots for reform — wider access to contraception, an expansion of ranked-choice voting, and states and individuals taking action to lower drug prices, end cash bail, and improve policing. Here are some of the biggest stories of change we covered in 2021 that should help you end the year on a hopeful note.
Policies supporting contraceptive access have been under attack in recent years, and 19 million women in the U.S. today lack access to the full range of birth control methods. A unique and broad-based coalition of reproductive rights organizations, grassroots social justice nonprofits, and public health practitioners came together in Colorado for a unified campaign and expanded access in the state — and now their success offers a template for other states to follow.
Board of Elections blunders shouldn’t obscure the fact that the use of ranked-choice voting in New York City’s mayoral primary turned out more voters, incentivized consensus building, and produced the most diverse election outcomes in NYC history. More jurisdictions are catching on — the number of cities using ranked-choice voting grew to more than 50 this year. Next year, Alaska will join Maine in using the method statewide. And the idea is gaining traction, with cities including Denver, Washington, D.C., and King County (Seattle) considering adoption.
This year has been defined by deepening political divisions. Because of gerrymandering, more general elections are being determined in low turnout party primaries, which tend to attract a small group of the most strident partisan voters, thus pulling candidates more to the extreme ends of the political spectrum. Ranked-choice voting could be the answer. In our final Deep Dive episode of 2021, our co-founder Laura Arnold sat down with democracy reform scholar Larry Diamond and former presidential candidate Andrew Yang, who recently lost his bid for mayor in New York City’s RCV primary. “Take it from a guy who lost a ranked-choice voting election … ranked-choice voting is awesome. Genuinely, I love it still,” Yang said.
Bottom Line was founded more than 20 years ago near Boston to help disadvantaged high school students get into college and, crucially, get through college by supplying them with hands-on advice and help along the way. This year, a milestone study proved the program works, helping students “get in, graduate, and go far.” In fact, an impact of this magnitude on bachelor’s degree receipt has never been observed before in a well-conducted study of college prep programs, making Bottom Line the first to achieve this remarkable distinction. Get an inside perspective on how the study progressed (it’s a marathon, not a sprint), and why it was such a milestone. It’s among evidence-based college completion programs that are transforming the higher education landscape.
Over the past decade, an increasing number of students have fallen victim to predatory for-profit institutions and related companies that make false promises and award worthless degrees. With support from Arnold Ventures, several advocacy organizations like Student Defense have been on the leading edge of efforts to litigate for the discharge of loans for victimized students like LaKesha Howard-Williams, who is among the faces of the for-profit college crisis. And the U.S. Department of Education’s 2021 rulemaking sessions — known as NegReg — can make a difference for cheated students.
Illinois Gov. JB Pritzker this year signed into law House Bill 3653. While it touches on many aspects of police reform, it implements three broad policies that will help Illinois reduce or eliminate structural barriers to police reform: standardizing use of force, mandating data collection and transparency, and enhancing certification and decertification.
Year Up is a unique workforce development program that has shown promise in reducing economic inequality: Year Up graduates enjoy earnings gains of 30 to 40% annually over their peers, and those results were sustained over five years. There are currently 4,500 young adults enrolled in the program, which costs students nothing, but about 4 million who could benefit from it. That will just take convincing government agencies, which previously have funded status quo approaches with disappointing results, as well as a sometimes-skeptical public that the right programs can work.
While Congress was debating the issue of sky-high drug prices, states were taking action, passing 43 laws in 2021 to make medications more affordable. They were moved by the stories of people like Dawn, a Colorado resident who reported that her prescription drugs are “so expensive that I stopped taking my diabetes and cholesterol medications.… I often have to choose between food and medication.” Budgetary pressures also played a role. Despite stiff resistance from the pharmaceutical manufacturers, which flooded states with millions in lobbying and advertising to thwart legislation, key states such as Colorado, New Mexico, and Oregon successfully passed laws to lower drug prices.
Now Congress needs to act. Drug pricing reform is a key part of President Biden’s Build Back Better agenda — which awaits Senate approval — and failure to act on this issue would prove a historical blunder.
At the tail-end of 2020, Congress banned the predatory practice of surprise medical billing — but the work didn’t end there. In 2021, regulators began working out the details of how the ban will be implemented when it goes into effect on Jan. 1, 2022. This rulemaking process determines the strength of the law’s patient protections, its impact on consumer premiums, and overall savings to the health care system.
There is more work to be done to lower health care prices for Americans, and that means addressing the wildly irrational prices hospitals charge for their services and the lack of competition in the market. Learn more in the two videos below, the first in a series on high health care prices, and what they mean for consumers, employers, and taxpayers.
The Obama, Trump, and Biden administrations have all taken significant steps to reduce our nation’s organ shortage, and a new federal oversight rule finalized in March creates tougher quality and transparency requirements for organ procurement organizations — the regional monopolies responsible for recovering organ donations — many of which have demonstrated a history of “greed and incompetence,” with lavishly paid CEOs and a poor record of delivering life-saving organs. But OPOs that don’t meet performance standards won’t risk losing their contracts until 2026. That’s too long to wait for patients like La Quavia Goldring, who has already been waiting for a new kidney for seven years. Any further delays in holding OPOs to account could lead to tens of thousands of unnecessary deaths.
A Historic California Supreme Court Ruling Said Judges Must Consider a Person’s Financial Conditions When Setting Bail
Kenneth Humphrey’s case reformed bail practices in California and underscores the need for high-quality public defense in America’s courtrooms. He was accused of entering a neighbor’s home, threatening the elderly man, and stealing a $5 bottle of cologne. Under California’s three-strikes law, Humphrey was facing up to life in prison and had languished in jail for nearly a year, unable to afford his $350,000 bail — originally $600,000 — that would buy his freedom as he awaited resolution in his case. His public defense attorney Anita Nabha took the case on and won. It’s a prime example of the power people hold — whether incarcerated or not — when they have quality attorneys representing them. In the United States, not everyone benefits like Humphrey from having adequate representation in the courtroom. But groups like Bronx Defenders, Gideon’s Promise, Deason Criminal Justice Reform Center at Southern Methodist University, and Zealous are working to change that, reshaping the public defense system for the better.
Lawmakers on both sides of the aisle in Ohio are working to dismantle the state’s cash bail status quo and taking lessons from other states to get there by bringing law enforcement and judges to the table. Both chambers in the Legislature introduced bills earlier this year to fundamentally reshape a system of wealth-based detention that treats people unequally based on their financial resources while doing little to promote community safety. It’s an effort that builds on the state’s history of bipartisan criminal justice reform. While fear-mongering about bail reform has ramped up in 2021, pretrial reform measures across the country have been shown to promote public safety, improve fairness, and uphold constitutional rights.
In January, advocates in the Driven by Justice coalition — led by the Bronx Defenders, Fines and Fees Justice Center, National Center for Law and Economic Justice, and the African-American Health Equity Task Force — celebrated New York Gov. Andrew Cuomo’s decision to green-light the Driver’s License Suspension Reform Act, which officially ended driver’s license suspensions for unpaid traffic fines and fees in the state. “This legislation will allow hundreds of thousands of New Yorkers to regain their driver’s licenses — and with it their access to work and other necessities,” said a statement from the coalition. New York joined nine other states and the District of Columbia that have passed similar laws in the past three years. Next steps are ensuring the law is implemented as intended.
Behind prison’s steel doors, a staggering number of people are held in isolation for months, years, even decades. It has long been proven that solitary confinement — where an incarcerated person is locked up alone, typically in a cell the size of a parking space, for at least 22 hours a day — is not an effective form of punishment, and many will leave broken in mind and body. Now, more states are taking notice of research and survivor testimonials and are working to curb long-term solitary confinement. Unlock the Box, which launched less than three years ago, has quickly gone from supporting three state campaigns to 18, supporting grassroots efforts, and centering the voices of solitary survivors and their families. Last year, 26 states introduced 63 pieces of legislation to restrict or prohibit the use of solitary, with seven states passing reform. And this year, 75 pieces of legislation were introduced in 32 states. The fight, however, is far from over.
Even after their prison sentence is over, people with criminal convictions continue to be punished in America, subject to tens of thousands of restrictions that serve as a barrier to building a better life and staying out of the prison system. Known as “collateral consequences,” these barriers pop up when they’re applying for jobs, renting homes, enrolling in classes, even volunteering at their children’s schools. Advocates like Sheena Meade of the Clean Slate Initiative, of which AV is a member, are lobbying lawmakers, filing lawsuits, launching campaigns, and plying business owners with data to show that not only do many people with convictions do well when given a chance — they thrive. To shine a light on these efforts and fund promising reforms, AV this year formally launched its own portfolio devoted to reintegration. It’s critical, leaders say, to eliminate collateral consequences and create more opportunities for people to put the past behind them.
Across the country, victims of police violence are speaking out in an effort to stop an epidemic that takes the lives of more than 1,000 people each year. As protesters nationwide called for accountability in the wake of George Floyd’s death last year, lawmakers from coast to coast moved policing reform bills. Some states saw those bills die in committee or get watered down, rendering them ineffective. But others — like Colorado, which essentially ended qualified immunity — passed sweeping legislation that has the promise to change how police operate. To keep that momentum going and make it easier for states to pass comprehensive reforms, AV has expanded its policing work and is diving deep into state advocacy, working with grantees on model legislation, funding research to test policies, and equipping advocates with the resources they need.
Practically since the birth of Congress, redistricting has been used by parties to press their own advantages. But it doesn’t take career lawyers at the Justice Department to smell something fishy happening with many of this year’s redistricting plans. Across the country, more citizens are engaged in the redistricting process than ever before — lobbying, protesting, testifying and creating their own maps. They’re able to show what fair maps would look like — and issue specific criticisms of legislative proposals — thanks to the availability of far more powerful online tools than were available in previous decades.
In March, Congress passed a Biden administration proposal that made new funding available to expand treatment for opioid use disorder — a critical lifeline at a time when drug overdose deaths are soaring. The American Rescue Plan, a $1.9 trillion federal response to the COVID-19 pandemic, increased block grants to state and local governments by $3 billion to address substance use disorder and mental illness, with additional funding for behavioral health services. When combined with $4 billion for those services in the prior relief package and the billions from settlements with prescription opioid manufacturers, it raised federal spending for opioid treatment by around 25%. That flood of cash also presents challenges: Experts say it will take careful spending by states on evidence-based strategies to save lives.
For decades, the federal government neglected to fund gun violence research. Under former President Donald Trump, Congress appropriated $25 million for the CDC and NIH to restart gun violence research, and renewed the funding this year. Also this year $21 million in investments were made into the National Collaborative on Gun Violence Research, which is supported by Arnold Ventures, funding 47 research projects. There is still work to do: A 2021 report from AV and the Joyce Foundation found that the government needs to spend between $587 million and $639 million over five years in order to collect and research the comprehensive, transparent data that could help stem this public health crisis.
The American public received innovative COVID-19 vaccines in record time — a testament to the power of government intervention and negotiation, said Mark Miller, executive vice president of Arnold Ventures and the former executive director of MedPAC, and Richard Frank, the Margaret T. Morris Professor of Health Economics in the Department of Health Care Policy at Harvard Medical School, in this May op-ed. “The traditional American approach to drug purchases works for some drugs. But what we’ve learned from this pandemic is that like the COVID vaccine, when large amounts of prescription drugs are needed to treat a public health crisis like insulin for diabetes, or PrEP for HIV, government intervention can facilitate both innovation and access.”
This year was the first our country collectively commemorated the end of slavery in the United States by observing Juneteenth as a national holiday. The long overdue recognition — 156 years later — was a response to Americans reckoning with the atrocities of racial injustice after the deaths of George Floyd, Ahmaud Arbery, Breonna Taylor, and so many others. “The promise of equality is not going to be fulfilled until we become real, it becomes real in our schools and on our main streets and in our neighborhoods,” Biden said as he signed the bill.