Researchers Quantify the Role of the Pandemic in the 2020 U.S. Elections

In the media, a prevalent narrative is that Donald Trump lost the 2020 elections because of the way he handled the COVID-19 pandemic. Several researchers determined that Trump would have won the electoral vote and lost the popular vote, as he did in 2016, if the pandemic had not occurred or if it had been mitigated.

Interestingly, not all the evidence supports the thesis that the handling of the crisis hurt Trump’s re-election, and quantitative evidence to support this narrative is limited.

In a new paper, Quantifying the role of the COVID-19 pandemic in the 2020 U.S. presidential elections, in the European Physical Journal, a team led by Maurizio Porfiri, Institute Professor at the NYU Tandon School of Engineering, put forward a spatial, information-theoretic approach to critically examine the link between voting behavior and COVID-19 incidence in the 2020 presidential elections. While they concurred with prior research that there were correlations between the two factors, they found that such an association points in the opposite direction from the accepted narrative: in counties that experienced fewer COVID-19 cases, Trump lost more ground to Joe Biden.

“A tenable explanation of this observation is the different attitude of liberal and conservative voters toward the pandemic, which led to more COVID-19 spreading in counties with a larger share of Republican voters” said Porfiri.

Key to the analysis is a way of quantifying uncertainty in statistical models. By using a novel spatial data modeling approach, and computing conditional mutual information between two processes (a target process like voting behavior and a second process, in this case, COVID-19 incidence), Porfiri, et. al., were able to infer spatial (geographic) connections.

This approach enabled them to determine the influence that epidemiological and economic processes might have had on voting behavior, as well as the spatial interactions that encapsulate the social and political fabric of the country.

From the analysis of county-level data, the investigators, including Pietro de Lellis of the University of Naples Federico II and Manuel Ruiz Marín of the University of Cartagena, Spain, uncovered a robust association between voting behavior and prevalence of COVID-19 cases.

The researchers determined that COVID-19 cases were negatively associated with the variation in the total vote count, whereby a larger increase in participation was observed in counties that were less affected by the pandemic, and a smaller increase in those that suffered the most from COVID-19. When it comes to the difference in votes between the two parties, they found that Biden’s margin was higher in the counties that suffered the least from COVID-19. However, counties where Biden gained the largest margin were not identified by COVID-19 prevalence.

They also found that there were more likely to be large increases in the electoral participation and in Biden’s margin in counties that suffered more job losses; likewise, they found less participation and more support for Trump in counties that experienced smaller increases in unemployment rate.

“Our work demonstrates the value of spatial information-theoretic tools towards uncovering the mechanisms underlying government elections and, more generally, the socio-political fabric of a country. This is critical to support decision-making processes in urban sciences, in a context where our cities face dramatic changes due to environmental and sociotechnical stressors, such as climate change and social justice,” added De Lellis.

The research was partially supported by the National Science Foundation. It was also part of the collaborative activities carried out under the programs of the region of Murcia (Spain): “Groups of Excellence of the region of Murcia, the Fundaci ́on Seneca, Science and Technology Agency.” De Lellis was supported by the program “STAR 2018” of the University of Naples Federico II and Compagnia di San Paolo, Istituto Bancodi Napoli — Fondazione, project ACROSS. M. Ruiz Mar ́was supported by Ministerio de Ciencia, Innovaci ́on y Universidades.

The Presidential Debate, the Supreme Court, and What it Means for the Affordable Care Act

On October 7th, 2020, President Donald Trump went head to head against former Vice President Joe Biden, marking the beginning of the election season and the first debate of 2020. Amongst ongoing chaos, with COVID-19 and racial unrest, this election could make or break the season finale of a monumental year. During the debate, candidates discussed many of the key topics that are at stake during this election, including the open seat in the Supreme Court.

Following the death of Ruth Bader Ginsburg, a feminist icon who has paved the way for women, minorities, and the LGBTQ community since 1993, the Court requires a new member, and whether that takes place before or after this upcoming Presidential Election is up for debate. RBG’s final statement was delivered publicly, days before her passing, “My most fervent wish is that I not be replaced until a new president is installed.”

Breakdown of the Candidate’s Segments:

After nominating Amy Coney Barrett the weekend prior to the debate President Trump vouched for her on stage, stating, “I will tell you very simply; we won the election. Elections have consequences – we have the Senate, the White House, and we have a phenomenal nominee respected by all.” Trump asserted that his remaining months in the White House would allow him to appoint Associate Justice Barrett to the empty Supreme Court seat. In his short response, President Trump expressed that her position and academic background qualified her for the seat, and reasoned that if it were up to the Democratic party, they, too, would push to elect someone of their choice for the empty seat.

Vice President Joe Biden argued that Trump’s stance on this matter is unconstitutional, stating that the “American people have a say in who the Supreme Court nominee is. And that say occurs when they vote for United State Senators and for the President of the United States; they are not going to get that option now. The election has already started.  Tens of thousands have already voted and the thing that should happen- is that we wait. We wait and see what this outcome is.”  Vice President Biden expressed his fear that that the nominee for the Supreme Court, who has written against the Affordable Care Act (ACA) and deemed it unconstitutional, would place the ACA in jeopardy. He raised concerns about the impact this will have on women’s rights, those with pre-existing health conditions, and the overall reasonableness of healthcare expenses. Biden summarized his thoughts, stating that this matter should be decided on after the election in February of 2021.

Fact-Checking: What is True About Their Statements?

According to the Chicago Tribune, Amy Coney Barrett has not, as Biden claimed, stated that the Affordable Care Act is unconstitutional. Barrett has been vocal about her view of the ACA and the laws that upheld it in 2012, but she has not spoken out about whether or not is it constitutionally right within the law.

CNN reported Biden’s concerns about eliminating the ACA would leave approximately 20 million people from having access to affordable health insurance are true. While this appears to be true, and even more so during a global pandemic, the effect of various events of 2020 may have inflated this number. According to a study conducted by the Urban Institute in Washington, which calculated and measured the impact that changing the policy would have on Americans, 20 million people would be without insurance but CNBC reported in August that “up to 12 million Americans may have lost their employer-sponsored health insurance during the pandemic.”

A final point was brought by President Trump about his Supreme Court Nominee, stating that “some of her biggest endorsers are very liberal people.” For example, Barrett has been endorsed by Noah Feldman, a liberal law professor at Harvard as well as some support from former professors of Notre Dame. However, according to Inside Highered, these endorsements sparked a petition from faculty stating, “Many members of the faculty are strongly opposed to Amy Barrett’s nomination,” the letter said. “Many of us do not know her, but she seems to be a kind, decent, and intelligent person. However, we are strongly opposed to her views — as reflected in her writings, opinions, and dissents,” the letter said.

How Will This Impact Americans?

The Supreme Court will eventually be deciding on matters as impactful as the 1973 Roe V Wade decision, which granted women legal access to abortions. Not only does the future of the ACA lie in the hands of the Supreme Court, so do basic civil and human rights. If the ACA overturned, millions of Americans will be left abandoned in the middle of a pandemic with no replacement plan in place. The remaining options of either buying into another insurer with unreasonably heightened prices, or risking getting sick with the coronavirus with little to no support, would no doubt have massive negative impacts on Americans.

Overturning the ACA would also leave the elderly to struggle to pay for their prescriptions, as the ACA currently covers much of the expenses for seniors’ medications. This would also leave women at risk of experiencing gender-based discrimination from insurers who would charge women more than men on insurance coverage. This could lessen women’s job outlooks because businesses with company-covered insurance would view women as more expensive.

On top of impacting various vulnerable populations, America’s current recession may also be worsened if ACA is done away with. Pre-existing health conditions would once again not be covered, and preventative care will need to be paid out of pocket. Among the pandemic, Black, Latinx, and Native Americans are struggling more than ever with the systemic racism that hinders them from receiving care. If ACA is thrown out, this would leave people of color open for further discrimination by insurance companies to higher rates or denial of coverage.  

The Supreme Court has recently made decisions on sex-based discrimination, religious discrimination, and immigration law. With justices’ life-long terms, this could impact the American people for decades. The current Supreme Court balance has five conservative justices and three liberals, so this next nominee could sway the Supreme Court vote to either side, and that will ultimately impact what is brought to the Supreme Court. With all of this in mind, it is imperative that Americans utilize their right to vote during the election.

Amy Comey Barrett was confirmed by the Senate on October 26th, and the Supreme Court will be voting on the constitutionality of the Affordable Care Act on November 10th, 2020.

The Woman Beside Me – Living in the Era of Trump

At the gym, MSNBC plays on my treadmill monitor. Coverage of the shootings in El Paso and Dayton have been nonstop, and I watch compulsively, trying to find a way to understand this horrific violence. My search for answers yields nothing but a mounting sense of helplessness.

Beside me, a woman younger than I am has on Fox News, which covers Trump’s response to the shootings. She glances over at me, sees what I’m watching, and a quick look of disdain passes over her face. My face may be doing the same thing.

I consider starting a conversation. “How is your channel spinning the news? Where are Fox newscasters directing their outrage? Who are they vilifying?” Yet I sense she wouldn’t be receptive.

During a commercial, I check my phone. The Facebook feed includes links to multiple statements by politicians and other leaders, voicing their outrage about the attacks. Several include links for me to make a donation. I used to take this bait, but I don’t anymore. I’ll donate where I want later; I won’t cave in to any manipulation of these tragedies for someone’s benefit. Neither will I sign any of the petitions to end gun violence that arrives in my email. I’ve come to believe signing on-line petitions convince people they’ve DONE SOMETHING when in fact, they haven’t.

I wonder if the woman beside me is getting petitions, too. Maybe hers have a different slant: “Sign this to tell the President you have his back!”

Does she click the link to sign them? I’d like to know, but I don’t ask her. I don’t bridge the eighteen inch- gap between our treadmills.

Have I already given up on her? Has she given up on me?

What happens if we don’t have these conversations? She stays on her treadmill and I on mine, safe in our political silos. She watches only the shows that agree with her point of view, just like me. Does she don self-righteous indignation the way I do?

I think about Facebook friends who have issued edicts on their pages: “If you still support this racist president then unfriend me right now!” I cringe when I read these statements, yet they appear more and more, borne of frustration and pain. We cast the President in the role of Racist-in-Chief, because it’s easier to see him as THE problem rather than a SYMPTOM of the problem. I’ve come to believe he is the latter, and that if we don’t acknowledge it, the problem will continue and grow. Trump isn’t just supported by his rally-attending, MAGA hat wearing base—he has vast numbers of people who may be quiet in their support, who are so frustrated by their own circumstances or the tone of today’s politics that they hold their nose and pull the lever for Trump because “he’s not like all the others.”

Is the woman beside me among those voters? Maybe she doesn’t see herself as a racist at all. Maybe she’d resent like hell any implication that she was, yet she will continue along her Trump-supporting path because, in her silo, we are the wrong ones. We are the liberal snowflakes who have been manipulated by the liberal media and “fake news.” Perhaps she knows she is right, just as I know she is wrong.

This kind of thinking from both of us only widens the gap between us and makes us easy prey to those wanting to exploit our divided loyalties. Alt Right or Alt Left: skew the truth and profit from it.

As I watch the news, I ache to do something about the shootings. I’m a social worker: DOING something is in my DNA. I could go to a special prayer service at my church or attend a protest at the statehouse. I could send another donation to groups working with immigrant kids at the border. Would that be DOING something, or just make me feel better? (I’m desperate to feel better.)

Does the woman beside me feel that same despair? Has she come up with an answer?  Here’s where I feel a thrust of anger at her. Her party is in power. Her candidate is in the White House. There IS something they can do, but they won’t, because, per her president, “there is no political appetite” for banning assault weapons.

This thinking makes me want to move to a treadmill farther away from her. What stops me is this: I’m assuming she agrees with him. Maybe she doesn’t, or maybe she is beginning to question these policies. Would this be an opening to start a conversation? Can she lift her head out of the Fox News bubble long enough to talk with me?  How does she feel, deep inside, about what has happened in El Paso? Would she tell me?

My phone dings. A friend has sent me an article about a huge increase in the sale of “bullet-proof backpacks.” The smallest version is for preschoolers. I picture a four-year-old trying to protect herself from a shooter wielding an assault weapon. It’s too much. It’s just too damn much.  I look at the woman beside me and my heart hardens.

I stop the treadmill, wipe it down, and step away, without saying a word to her.

Lessons in the Current Puerto Rican Disaster

A man tries to repair a generator in the street after the area was hit by Hurricane Maria in San Juan, Puerto Rico September 25, 2017. REUTERS/Alvin Baez

Those who have worked in disaster areas know that coordination and transport can be difficult, but with the USS Comfort leaving Puerto Rico after admitting less than 300 patients when there is unmet need isn’t a great sign of success. Hurricane Maria made landfall on September 20, 2017. The Comfort, which is essentially a floating specialty hospital arrived in Puerto Rico on October 3rd.  November 8th, the Comfort was restocked with supplies but then departed shortly thereafter for “no apparent reason” after providing outpatient services to somewhere around 1500 patients, according to the DOD.

…”I know that we have capacity. I know that we have the capability to help. What the situation on the ground is … that’s not in my lane to make a decision,” he said. “Every time that we’ve been tasked by (Puerto Rico’s) medical operation center to respond or bring a patient on, we have responded (Captain of the USS Comfort to CNN).”

The death count is still hazy, and there is difficulty in confirming how many died during- or as a result, of the disaster.  One group is doing a funeral home count because information is difficult to obtain. CNN has found through a recent investigation that the death toll appears to be more than 9 times the official government report. 

Coordination on a micro, mezzo and macro level must come from multidisciplinary sectors to problem solve. There are many good people working to rebuild Puerto Rico, but there is far too much apathy, throwing up of hands, and of course, corruption.  Many of the Social Work Grand Challenges are highlighted in Puerto Rico alongside the UN Global Goals.

The Whitefish linemen are making $41-64 per hour to restore power to Puerto Rico’s Grid, but the US government is being billed for more than $319 per hour. Whitefish just called a strike because they have not been paid. This, of course, is having a terrible impact on those who are in the most need.

Where do you come in?  We tend to think of trauma on a psychological level: family members and friends who are missing, grief, anxiety, and depression due to home and job loss as well as connecting with those close to you, each processing the trauma differently.

On the mezzo level, we are working with smaller groups and institutions, of which there are many in disaster or mass casualty events.  Local churches, schools, nonprofits and local chapters of larger scale organizations attempt to unite in the local area to help speed services to those that need it most.  Often this is where many of the challenges lie.  Each organization has their own protocols which may not match up with larger scale efforts of the government or international organizations.

On a practical level, resources are often short on a disaster scene- there are not enough clinicians to meet with clients individually, at least not for more than a few minutes at a time. We revert to what the American Red Cross refers to as “Psychological First Aid”.  Human networks through nodes (like shelters) provide a sense of community and belonging when all is lost, with individuals acting as brokers between networks that previously didn’t have ties.

Ground efforts can be supported by a drone equipped with a camera to see if there is a possibility of reaching a scheduled neighborhood by car, saving countless minutes that matter.  The aerial shots from 3 days ago may no longer be relevant. The water may have receded but now a home has landed there, blocking road access.

The volunteers mapping from satellite images can instantly beam their work from anywhere (tracing homes, schools, possible military vehicle parking areas or temporary helipads) while teams on the ground stare at a water covered road, unsure of what is beneath. Life saving choices are made with options and all levels working together. This is how neighborhood Facebook groups saved lives- they were the eyes on the ground in their own neighborhood that identified who was in the most danger.

Facebook may no longer be the hippest new technology (we are nearing the decade and a half mark) but it is arguably the most ubiquitous and well supported (crashes rarely). Many survivors could make a post but were unable to call or text from the same device. An important component to the multi-level view is the understanding that macro tools like mapping serve micro and mezzo levels.

Being a survivor in an active disaster can quietly morph into anxiety, depression and survivor’s guilt.  Being able to participate in practical support efforts can boost the well being of survivors as well. Friends of friends of friends and influencers in social networks have proven to be incredibly powerful.  It’s what happens when “mixed networks” collide.

As we move to a macro level, there’s a realization that there is a great deal of organic movement in even the best planned days for rescue effort workers.  Do you stop here where the need is great (and went unreported) even though it’s blocking you from reaching the mapped area that your team has already scheduled? This is where technology for good can make the difference.  Depending on your training and background, you may make a different choice.  Who is in charge of the government response, and how do we help change course if it is failing?  How do we know if the efforts match our resources?

The simple answer is that we are there to communicate it with others, on all levels—including the virtual one. This may mean volunteering for rescue efforts, collecting tampons in your hometown, or using your own technology for good by mapping for workers on the ground that are not sure what lies beneath—you are helping to ensure their safety and mental well being.  In turn, you get to pass that knowledge into your own networks.

The Presidential Policy Series: Women’s Reproductive Health

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Sex has been a major talking point for this presidential race, from the unprecedented situation of the first female candidate from either major party running for President to the numerous accusations regarding Donald Trump’s treatment of women. But how do the candidates differ on issues related to women’s reproductive health? Women’s reproductive health has historically been a particularly divisive issue between the Democrats and Republicans.

Women’s Reproductive Health in the United States

World Health Organization’s definition of women’s reproductive health relates to “adequate sexual health, available contraception methods, and treatment for sexually transmitted diseases.” Women’s reproductive healthcare includes preventative services, testing and treatment for STIs, contraceptive use, well-woman gynecological exams, assisted reproductive technologies, abortions, prenatal care and hysterectomies. The most serious complication of women’s reproductive health is maternal and infant mortality.

From 1900 to today, there have been major advancements in women’s health. In 1991, Congress passed the Women’s Reproductive Health and Medicine Act of 1991. However, women’s reproductive health remains a hotly contested subject. From how to conduct sexual education for adolescents to the national debate on abortion, the United States government does not take a progressive approach to making holistic women’s reproductive healthcare available for all women. Many low-income women, those with limited education, and people of color are disproportionately more likely not to have adequate access to women’s reproductive healthcare. The implementation of the Affordable Care Act significantly expanded coverage for reproductive services for many American women.

Clinton’s Policies on Women’s Reproductive Health

Hillary Clinton has advocated on behalf of women her entire political career. As President, she will work to ensure that Planned Parenthood is fully funded so that the “essential health and reproductive care that Planned Parenthood provides women” continues to be available for women across the socioeconomic spectrum. Secretary Clinton also supports abolishing the Hyde Amendment that prohibits the use of federal funds for abortions. Clinton co-sponsored the Freedom of Choice Act, that sought to declare “that it is the policy of the United States that every woman has the fundamental right to choose to bear a child; terminate a pregnancy prior to fetal viability; or terminate a pregnancy after viability when necessary to protect her life or her health” (Congress.gov). Clinton also advocates instituting mandated 12-weeks paid leave for both parents to stay with their newborn (or adopted) children once they join the family.

Trump’s Policies on Women’s Reproductive Health

Trump’s main policy point on health care is to repeal the Affordable Care Act. On July 22nd, 2015, Trump came out to the Christian Broadcasting Network in support of the Pain-Capable Unborn Child Protection Act that bans abortions after 20-weeks (Christian Broadcasting Network). In 1999, he made a contradictory statement saying that he is “very pro-choice”. In the third presidential debate, Trump most clearly outlined his current views on women’s reproductive health. He supports federal ban on partial-birth abortion and stated that “in the ninth month, you can take the baby and rip the baby out of the womb of the mother.” This description has widely been discredited as inaccurate by the Guttmacher Institute.

One of the few policy agreements between Trump and Clinton is to implement mandated paid leave for new families. Trump and Clinton disagree about the amount of time: Trump promotes a six week paid leave “for new mothers before returning to work” while Clinton promotes 12 weeks of paid leave.

Conclusion: Clinton Champions Women’s Reproductive Health

Clinton has established herself as a champion of women’s reproductive health, both by supporting the availability of a variety of women’s health services and by encouraging increased federal and state funding for the services. Trump does not have a detailed policy plan for women’s reproductive health.

The Presidential Policy Series: Combatting Drug Abuse

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The Presidential Policy Series has been exploring where the Democratic and Republican nominees, Hillary Clinton and Donald Trump stand on a variety of healthcare policy issues. We examine how already the presidential nominees plan to address our country’s largest healthcare epidemic—addiction.

Across the country from small, rural towns to large cities, drug abuse has been on the rise. The most recent National Survey on Drug Use and Health in 2013 estimated that approximately 22.7 million Americans needed treatment for a drug or alcohol problem, yet only 11% of these people were able to actually receive treatment. Nearly eight out of nine people who are struggling with addiction fail to gain access to the care they need. It’s a frightening statistic, especially as 7,800 individuals above the age of 12 try a new drug every single day.

While drug use has long been an issue, it has gotten worse in recent years. More people died from drug overdoses in 2014 than in any other year on record. The majority of those drug overdoses were the result of opioids, prescription painkillers, or heroin.

What policy proposals have the two candidates announced to address America’s drug epidemic?

A ‘Bold Plan’ to Tackle Drugs

Hillary Clinton is proposing a “bold plan” to prevent, treat, and support recovery from drug abuse. As part of her plan, Secretary Clinton vows to launch a $10 billion initiative that will work with state and local governments to focus on prevention and educate communities on how to intervene early to prevent addiction. She has also announced new initiatives to work with providers to aid prevention and ensure that opioid painkillers are being administered more appropriately by requiring new training and monitoring programs.

For those suffering from addiction, Clinton wants to expand inpatient and outpatient services, increase the number of specialty-trained providers, and ensure insurance is not a barrier to receiving treatment. She also plans to make naloxone, the rescue drug for opioid overdose, accessible to every first responder. Finally, she plans to increase investment in programs that divert people to rehabilitation instead of prison for low-level and non-violent drug offenses.

Stronger Borders to Decrease Drug Availability

To date, Donald Trump has expressed no discernable, coherent policy around resolving the drug crisis. He has mostly focused his attention on calls for tighter border security; one of the side effects, ostensibly, being a reduction in the availability of drugs that are being illegally smuggled into the country. To our knowledge, his only stated position on prescription drug reform has been a liberalization of pharmaceutical overseas imports, which we will cover in the next article in the series.

Traditionally, the GOP has supported stricter drug legislation with many legislators at the national level opposing the legalization of marijuana and speaking out against the improper prescription of painkillers, which often leads to the opioid abuse. Many Republicans support in-school education programs targeted at preventing and delaying substance abuse among children and adolescents. Unlike Democrats, who have come out strongly against the War on Drugs, the GOP continues to support harsher penalties, such as jail time and mandatory minimums, to deter drug use.

The growing drug epidemic across the United States is a serious domestic issue that the next President will have to address. In our opinion, opioid and prescription drug abuse is one of the most troubling drug crises our nation has ever faced and poses a more insidious threat than drugs illegally smuggled across our borders. Healthify encourages continued, bi-partisan efforts to educate, prevent, and delay drug consumption among children and seek to promote greater access to rehabilitation and treatment for substance abusers.

The Presidential Policy Series: Prescription Drugs

Hillary Clinton and Donald Trump are tightening their grips on the Democratic and Republican presidential nominations.
Hillary Clinton and Donald Trump are tightening their grips on the Democratic and Republican presidential nominations.

The Presidential Policy Series share where the Democratic and Republican nominees, Hillary Clinton and Donald Trump, respectively, stand on healthcare policy.

This presidential campaign season, there has seemingly been more discussion about the perceived health of each candidate than their actual views on healthcare. The focus on healthcare policy has been unfortunately limited, except for one issue—the rising costs of prescription drugs.

Last year, Turing Pharmaceuticals, a New York-based pharmaceutical company founded in 2015, ignited uproar when the company raised the price of a 62-year-old drug from $13.50 to $750 per tablet, overnight. The company’s CEO Martin Shkreli rose to notoriety not only for his tone-deaf defense of the price increase but also for his thoroughly unedifying testimony in front of the House Committee on Oversight and Reform earlier this year. More recently, the makers of the EpiPen have been under fire for raising the price of their life-saving allergy treatment from $100 to $600 over the course of the past decade.

Drug prices are rising to new highs despite displeasure from insurance companies, consumers, and lawmakers alike. In fact, pharmaceutical prices have risen nearly 10% on average in the past year. With the rising prices of prescription drugs, more patients are finding it challenging to manage their chronic conditions and pay for their necessary medications. According to a Consumer Reports survey, “one of out every four people facing higher drug costs were also unable to afford medical bills or medications; one in five said they missed a payment on a major bill.”

Both Republicans and Democrats agree that action is required to control prescription drug hikes, but they can’t quite agree on how to go about it. The 2016 candidates’ plans highlight the difference in party views.

Increased Regulation

In general, Hillary Clinton’s prescription drug plan calls for increased regulation. Clinton plans to use the government’s bargaining power to lower drug costs and promote competition. As part of her plan, Secretary Clinton will make drug companies accountable to lower costs. She plans to fine manufacturers that raise prices dramatically and vows to put a stop to excessive marketing and profiteering by denying tax breaks. Instead, she wants funds devoted to research and development and will incentivize companies to do so with taxpayer support.

To improve competition, Ms. Clinton wants to help bring more generic drugs to the market. Her plan states she will work with the FDA to clear out the backlog. Recently, application backlogs have led to the delay of up to three or four years before generic manufacturers can even win approval to make generic versions of drugs without patents. Hillary Clinton will also work to prohibit delay arrangements that protect patents and keep generics off the market, and she supports importing drugs from abroad.

Finally, Ms. Clinton plans to cap what insurers can charge consumers in out-of-pocket costs for medications. Under her plan, insurance companies will be forced to abide by a monthly limit of $250 on covered out-of-pocket prescription drug costs.

Increased Competition

Most Republican’s had the same reaction to Clinton’s plan on prescription drugs, “more regulation, more controls, more restraints,” according to Senator Orrin Hatch, chairman of the Finance Committee, which holds jurisdiction over many of the drug pricing issues.

In principle, Republicans are opposed to creating more government regulation. Rather than putting constraints on the private sector, the G.O.P. believes the key to solving the drug price issues is through initiatives that help to drive competition and improve the speed to which new drugs can enter the market.

Donald Trump echoes those beliefs. In his healthcare plan, he vows to remove the barriers to entry that prevent manufacturers from providing safe and cheaper products. Specifically, he notes that allowing consumers access to imported prescription drugs from abroad will bring more options to enhance competition. Mr. Trump also believes that to make any significant positive changes in addressing these issues, lawmakers need to step away from special interests.

While both candidates agree something must be done, the main difference separating Clinton and Trump is just how far they believe the government should go in controlling the costs of prescription drugs. We mind there are many causes behind the increase in prescription drug prices. We applaud efforts to make generics and prescription imports more widely available to consumers. One of the biggest impediments, however, to negotiating prescription drug prices is Medicare, which is prohibited from negotiating drug prices by an act of Congress.

The Presidential Policy Series: Disability Rights

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The Presidential Policy Series covers where the Democratic and Republican presidential nominees, Hillary Clinton and Donald Trump, respectively, stand on healthcare policy issues.

Although it seems like our country’s two main political parties are as polarized as can possibly be, there actually has been a few health issues that both Republicans and Democrats have historically agreed on. Disability rights have traditionally been one such example.

Going back to 1990, the monumental Americans with Disabilities Act (ADA), which was authored by Democratic Senator Tom Harkin, passed by an overwhelming margin in the Senate and the House. President George H.W. Bush, a Republican, signed the act into law and applauded the bipartisan effort of Republicans and Democrats. Eighteen years later, President George W. Bush, also a Republican, followed in his father’s footsteps when he signed expansions of the ADA into law after receiving approval a Democrat-controlled Congress.

However, this long-standing trend of bipartisanship support has been questioned of late. In 2012, Senate Republicans blocked the United Nations Convention on the Rights of Persons with Disabilities treaty, despite a broad, bipartisan coalition. Republicans were split, and the Senate was unable to obtain the necessary two-thirds of votes to ratify the treaty. On top of that, this presidential campaign has only added to the uncertainty. Hillary Clinton has made disability rights a focus of her campaign, promoting her policy agenda in speeches and commercials. Whereas Mr. Trump has been criticized for making insensitive remarks and actions of those with disabilities, calling for less “political correctness.”

While disability rights are taking center stage with the two main candidates presenting different views, future bipartisanship still remains a likely outcome based on previously recorded party positions.

Republicans call for policy that supports the inherent rights of individuals with disabilities. The G.O.P. platform vows to support those rights by guaranteeing access to the necessary tools and education to “compete in the mainstream of society.” Republicans support increased access to education and competitive employment, and vehemently oppose non-consensual withholding of care or treatment of those with disabilities.

Democrats’ position on disability does not differ all that much from Republicans. They support “equal access, equal rights, and equal opportunities to make a life for themselves and to contribute to their communities.” Democrats support Secretary Clinton’s agenda, which vows to fulfill the promise of the ADA and continues to expand the opportunities for individuals with disabilities, especially improving access to meaningful and gainful employment, as well as housing in integrated community settings.

For the benefit of the more than 50 million Americans with disabilities, let’s hope we follow in history’s path with policy that both parties can agree on.

Disability Law, Policy and Civil Rights Movement

The Presidential Policy Series: Affordable Care Act

Hillary Clinton and Donald Trump clinched the Democratic and Republican presidential nominations.

In less than 18 months, the field of candidates vying to win the 2016 presidential election has narrowed from over two dozen contenders to two major opponents. Now, with fewer than two months before Election Day on November 8th (remember to vote!), we’re exploring the Republican and Democratic candidates’ positions on healthcare policy.

The Presidential Policy Series, we will share where the Democratic and Republican nominees, Hillary Clinton and Donald Trump, respectively, stand on healthcare policy. In this post, we will be discussing the most divisive healthcare issue, the Patient Protection and Affordable Care Act, commonly referred to as the Affordable Care Act (ACA).

The ACA, colloquially known as Obamacare, has been hotly debated for over six years. Advocates and opponents of the law often fall along party line. The law, which represents the largest regulatory change to the industry since Medicare and Medicaid were introduced in 1965, was designed to bring quality and affordable health care to everyone by transforming delivery to focus on value and expanding insurance coverage.

Budget Busting

From a party standpoint, the Republican Party platform views the plan as a “Euro-style bureaucracy to manage unworkable, budget-busting, conflicting provisions.” Many conservatives believe it has raised insurance premiums, increased deductibles, and inflated drug prices while limiting an individual’s access to care within narrow provider networks. Republicans have long called for the law to be repealed, and Mr. Trump, despite previously expressing support for the individual insurance mandate, has fully endorsed a repeal of Obamacare.

In the Trump healthcare plan, he vows to repeal the ACA during his first day in the Oval Office and work with Congress to implement reforms that follow free market trades. He’s specifically mentioned modifying the existing law that inhibits the sale of health insurance across state lines, implementing health savings accounts and individual deduction for health insurance premium payments, requiring full price transparency, and letting states control Medicaid.

Rather than expanding Medicaid, Trump says he’d like to focus on policy that grows the economy and provides more jobs. As his health plan currently states, “the best social program has always been a job – and taking care of our economy will go a long way towards reducing our dependence on public health programs.”

Not Far Enough

Secretary Clinton, on the other hand, has vigorously defended the ACA and has expressed a desire to work with Congress to get legislation passed that would expand aspects of the ACA. Like most Democrats, Clinton believes the health law has been an important step toward the goal of universal health care, for which she has been a longtime advocate.

She introduced the unsuccessful Health Security Act in 1993, which was a comprehensive plan to provide universal health care to all Americans. She later helped create and pass the Children’s Health Insurance Program in 1997, which now provides coverage to more than 8.4 million children.

In the Clinton healthcare plan, she vows to continue these efforts to improve healthcare access.  Clinton plans to work with governors to continue the expansion of Medicaid on the state level and enroll more eligible Americans. She wants to further enact policies that will expand access to affordable health care regardless of immigration status.

Clinton has also called for the funding of primary care services at community health centers to double over the next decade and has expressed support for President Obama’s charge to triple funding for the National Health Service Corps, the government program that aims to address physician shortage in areas around the country. To address health costs, Clinton supports authoritative action to block or modify premium increases, capping prescription drug costs, and limiting excessive out-of-pocket costs for families.

Finally, Clinton has stated that she will pursue efforts to make a “public option” of healthcare possible, and expand Medicare by allowing individuals above the age 55 being able to buy into Medicare program.

Center for Migration Studies Refutes Claims that Undocumented Immigration to the United States Surged in 2014 and 2015

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New York, NY – The Center for Migration Studies of New York (CMS) today issued a detailed analysis of immigration to the United States in 2014 and 2015. CMS’s analysis, authored by Robert Warren, CMS’s Senior Visiting Fellow and former director of the Immigration and Naturalization Service’s Statistics Division.
 
After closely examining a report by the Center for Immigration Studies (CIS), CMS concluded the following:

  • Any increases in arrivals and foreign-born population growth in 2014 and 2015 are well within the bounds of normal annual fluctuations observed in Census Bureau survey data over the past 15 years.
  • Any increases were the result of: (1) an increase in temporary admissions, mostly students and temporary workers and their families; and, (2) the arrival of immigrants (overwhelmingly those with legal status) who resided in the United States in previous years, left for some period, and returned. The movement of the latter group is quantified in the CMS report for the first time.
  • Legal immigrant arrivals accounted for all of the reported increase (by CIS) in total arrivals in 2014, and therefore undocumented immigration has remained unchanged.

Earlier this year, CMS reported that the total US undocumented population fell below 11 million in 2014 for the first time since 2004. CMS also offered evidence that the Mexican-born undocumented population continued to decline, falling by more than 600,000 between 2010 and 2014. The CMS paper is available at p/jmhs/article/view/58.
 
“CMS’s most recent analysis demonstrates that the gradual increase in the number of arriving immigrants in each of the past few years is accounted for by arrivals of legal non-immigrants (admitted temporarily) and of returning (legal) immigrants,” said Donald Kerwin, CMS’s Executive Director. “At a time when Republican presidential candidate Donald Trump is claiming that the US undocumented population could be as large as 30 million persons, it is important to emphasize that this population of 10.9 million is not growing and, in fact, has declined by one million persons since 2007.”

The Center for Migration Studies (CMS) is a New York-based educational institute devoted to the study of international migration, to the promotion of understanding between immigrants and receiving communities, and to public policies that safeguard the dignity and rights of migrants, refugees, and newcomers. For more information, please visit www.cmsny.org.

What Will a Trump Presidency Mean for Americans

Photo Credit: www.donaldtrump.com
Photo Credit: www.donaldtrump.com

The Indiana, Nebraska, and West Virginia primaries have all ended, and Republican voters have made it clear who they want their presidential nominee to be – Donald Trump. In light of Trump’s crushing victory in the Indiana polls, Ted Cruz, a Republican senator from Texas and presidential hopeful, has reportedly dropped his presidential bid leaving Trump a clear path to earning the official Republican nomination at the party convention this June.

Seeing Trump this close to winning the Republican nomination is astounding in the least. Just under a year ago, when Trump announced his candidacy for president, various reporters, political insiders, and politicians from the right declared it impossible for this businessman from New York with no political experience to be successful on the campaign trail. Only recently have political analysts began to realize a Trump presidency could be looming in the future of the United States.

The reality of Trump being a viable presidential candidate has many social workers, counselors, physicians, and other helping professionals asking what a Trump presidency would mean for healthcare and mental health in our country. The answer to this question can be found by reviewing Trump’s views on these topics.

Trump on Healthcare

Healthcare remains one of the fastest-growing occupations in the United States with a projected total of 163,537.1 million people working in the healthcare sector by 2020. The Affordable Care Act (ACA), signed into law in 2010 by President Obama, has allowed citizens to access health services they may not have been able to afford before the legislation was made law. More people are receiving healthcare, more physicians, nurses, and other medical professionals are providing services, and employment in the healthcare sector still remains desirable as professionals continue to navigate and settle in to the new healthcare environment created by the ACA.

If elected president, Trump reportedly has plans to eliminate the Affordable Care Act (ACA) and create a new system.

“I would end Obamacare and replace it with something terrific, for far less money for the country and for the people,” said Trump

On the surface, a better system for less cost sounds great. However, in a healthcare environment still stabilizing from the most recent changes brought with the ACA, an upheaval of these new policies without a strategic replacement plan would be detrimental for professionals, their clients, and the healthcare workforce as a whole.

A quick look at Trump’s platform on healthcare policy reveals a plan to overturn the ACA, open up a free market insurance system, and allow people access to Health Savings Accounts (HSAs), but completely neglects to inform the public about how this plan will be enacted or what effects it might have on individuals and families who would lose their insurance coverage completely with the repeal of the ACA. The obscurity and lack of any evidential basis in his overall plans leaves healthcare professionals in the dark about how exactly this ‘new’ system would impact them and their clients.

Trump on Mental Health

Each year approximately 1 in 5 adults in the United States will experience mental illness. The current mental health workforce of social workers, psychologists, psychiatrists, and behavioral health specialists is unable to keep up with public need, subsequently causing 4,071 geographic areas in the country to be designated as having a severe mental health professional shortage. While many public leaders agree the deficit in the mental health workforce should be addressed, few seem to be actively doing anything to create such change.

Trump is no exception. In previous interviews and news reports Trump only brings up the lack of mental health service provision as being a significant issue in this country when addressing the wave of gun violence the country has experienced recently. If fact, the only reference Trump makes to mental health in his platform is cited in his views of Second Amendment Rights on how mental health issues should be addressed but should not impede citizens on their gun ownership rights. While Trump claims our country needs to fix the “broken mental health system”, he clearly lacks any willingness or concrete plans to do so.

So what exactly would a Trump presidency mean for healthcare and mental health professionals? From the look of it, we could expect to see (1) a significant increase in people who are uninsured or severely underinsured; (2) a decrease in access to needed health and mental health services; (3) a continued deficit in the mental health workforce; and (4) a system which overall is not adequately able to serve the people living here in the U.S.

Trump’s plan for the healthcare and mental health systems (or lack thereof) in this country doesn’t create any positive solutions to our current issues; making him unfit for the job of President of the United State of America. Our country needs a leader with a strategic plan to enact clear and concise legislation, to increase the effectiveness of our current systems, and to recognize the deficits and fill the gaps in service where needed.

As Americans who are concerned for the future of this country, we must set aside our assumptions, biases, and prior convictions to unite and vote for the candidate who is going to continue the progress we have worked so hard for. We must vote for the democratic candidate, and ensure we never have to experience a Trump presidency.

White Nationalism and The Co-Opting of Fear

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It used to be easy. The label of racist, sexist, or homophobic was a silencer on the weapon of the tongue. When a person stated views that were out of the politically correct spectrum, they paid a price professionally and publicly. However, with the rise of Donald Trump as the Republican nominee, there no longer appears to be a price for publicly embracing racist language and ideals.

Many have suggested the real problem, White Supremacy–that overt hatred for any non-white people–was institutionalized and invisible. White supremacy was lumped into the institutional mix with discrimination, prejudice, and inequality. Our policies, beginning with the civil rights act of 1964, set a precedent for addressing the institutional barriers to minorities. By 1988, the United States was addressing the individual white supremacist with censorship. But, silencing a sentiment has only resulted in the search for a new voice.

It has long been the recruitment tactic of white supremacist groups to focus on fears spawned by whatever “other” was present in a certain region. On the frontier west, the other was the Native American. In the cities, the other was the Blacks. In the southern-western border, the other was the Mexicans. But, something happened on a Tuesday night in November 2008, the worst fear came into the homes of many who had previously been silenced. It was no longer just a generalized fear of the other. It was the removal of an iconic White institution handed to a non-white. The fear moved from being offensive (in both ways) to being defensive, even despairing. Recruitment was no longer to mobilize. It was to defend against the further collapse of the Real America. Fear of the other became fear for the loss of a (White) way of life.

Empathy & Choice Architecture
The co-opting of fear changes the White Supremacist into the White Nationalist. The White Nationalist is not an institutionally-supported purveyor of hatred toward another race or creed. The white nationalist is a genuinely concerned individual who desires the best for his children and his people. Even if you are shouting for rights against the establishment, you are now the only one shouting. The rhetorical technique of the white nationalist is to claim victimization. And guess what, empathy demands that we listen.

This could be one reason for the inadequacy of our categorizations these days. The simple determination of whether a person is racist, sexist, or homophobic was never adequate as a basis for tolerance and appreciation of diversity. But, it worked in an institutional context to describe policies that systematically discriminated against specific groups based on some ethnocentric ideal.

As the unit of analysis moves to the level of the individual, categorizations will not be useful. Each individual is unique which comes with a unique set of concerns. Having children or not, levels of education, life goals, family connectedness, and a host of other characteristics form the profile of each person. Their choice architecture is built from this individualized profile, in the context of their immediate and social environment, impacted by the interactive effects that form their perception of self and the reality in which they live.

The good news is that we can mathematically map this complexity in operational research. Those may be two words that you are not comfortable applying to social science issues or social activism, but math and research are critical to interventions that promote dignity and worth of each person. It is more evident now that labeling the oppressor and demonizing the group runs counter to progress. What we have missed is that the need has shifted from the institutional level to individual level in the co-opting of fear.

The Empathy Standard
Let us first begin with a clear understanding of empathy. Empathy is defined as an ability to feel as the other feels. It is often distinguished from sympathy, which is to feel for a person. Empathy is more holistically to be distinguished from prejudices. Prejudices are characteristic means of self-protection or self-defense. More holistically, empathy is the ability to see the choices of the other as reasonable.

This definition allows social workers to work with clients whose behaviors have proven reprehensible while valuing the dignity and worth of each person. Even more importantly, this definition of empathy enables social workers to track the mechanism employed in the choice behavior. Once the mechanism is understood, the decision points can be disrupted with new information, intervention, influence, or insight. The disruption offers an expanded choice set and may result in new behaviors.

Without empathy-inspired dialogue on a topic, prejudices turn to anger and an insistence on being heard. Without empathy expect violence, disrespect, and self-promotion over others as less-than.

The Co-Opting of Fear
Which is more powerful, hatred or fear? Hatred can motivate many intentional destruction of things that are disliked. But, fear creates more things to rail against from imagined visions of even unreasonable things that may be. Supremacy groups have long used fear as a way to recruit new members. This was more of an institutional approach that reached out to individuals. It provided a target for the generalized sense of despair and hopelessness felt by the impoverished. It galvanized and educated that generalized sense into a frenzy of hate. That was the utilization of fear.

Utilization of fear was defined by Lyndon B. Johnson in 1960:
“If you can convince the lowest white man he’s better than the best colored man, he won’t notice you’re picking his pocket. Hell, give him somebody to look down on, and he’ll empty his pockets for you.” LYNDON B. JOHNSON, 1960, remark to Bill Moyers, “What a Real President Was Like,” Washington Post, 13 November 1988

We see the results in a speech by Hillary Clinton. It typically takes some version of the following form:

Let’s be honest, for a lot of well-meaning, open-minded white people, the sight of a young black man in a hoodie still evokes a twinge of fear. And news reports that poverty, crime, and discrimination evoke sympathy, even empathy, but too rarely do they spur us to action or prompt us to question our own assumptions and privilege (June 20, 2015 speech to US Conference of Mayors).

The problem is that we, as social activists or individual citizens, have not fully understood the fallacy of that “twinge of fear.” This lack of understanding is what Jeb Bush is saying he wants to work against, “I don’t think Barack Obama has bad motives,” He said on the debut of the Late Show with Stephen Colbert, “We have to restore a degree of civility.” Bush should have stopped there.

The co-opting of fear means that you are no longer dealing with institutional “other sides” of any argument or system failings. The interactions are now personal. Many in the Colbert audience noted the shift. Immediately after Jeb Bush uttered “I don’t think Barack Obama has bad motives,” a few in the audience began applause. Bush continued before the applause took hold finishing with, “I just think he’s wrong on a lot of issues.” The applause stifled. Bush turned what sounded like a conciliatory, constructive tone into a personal attack almost immediately. He could have talked about “his policies,” or better “I disagree with the Affordable Care Act,” or even better, “The Affordable Care Act has 12 provisions that limit patient choice.” In a policy discussion, the policy should reasonably be central, not the individual discussants.

Over years of political correctness, hidden resentment, and what Elisabeth Young-Bruehl calls psychologizing-sociology rhetoric has moved to individual characterization. Fear generalized at the institutional level has moved and morphed into fear personified at the individual level. The co-opting of fear has reduced policy failures to personal failures. Governance has been reduced from a sociological construct to the “liking” of one personality over another. Speaking your mind and refusing the politically-correct response is heralded as honesty and courage however ignorant and erroneous. A quick example can be shown in polls. According to a CNN poll back in 2013, 46% of people asked were against Obamacare. Only 37% were opposed to the Affordable Care Act. Same law. But, reducing policy to a “do you like this person” question creates different choice behavior.

This causes a fundamental shift in the way we work to support tolerance and move toward the celebration of difference. No longer are people simply misinformed and their generalized sense manipulated by the institution. Many are now genuinely, and individually fearful for their livelihoods, their children’s opportunity, and their freedom. Imagined or not, this new reality does not respond to institutional changes. In fact, the institutional actions to level the playing field and erase the majority advantage are seen as further disenfranchising the individual.

The Empathetic Solution

Now, that reality is individual rather than institutional, the only solution is empathy. It is to see the complaints of each individual as valid and worthy of our attention. The empathy solution ensures that each individual is heard. It maps their process of reason, and compares their experience to what our policies intended. Without this empathetic analysis, by denying the voice of those who perceive themselves to be eventual minorities, we others become oppressors. People who feel silenced and who fear extinction will revolt in discontent.

They will rally behind someone successful who speaks the fear, gloom, and despair that they feel. And, others will support this movement. Their support is not because they know the origins of supremacy and ethnocentrism that birth the movement. They support because they are empathetic to–they see as reasonable–the cries of people who have been silenced and hushed because their views were not politically correct. They support because they are tired of having to clean up their language to express overreaches and erroneous implementations of laws meant to create equality. Empathy, my fellow social workers, is not based on our agreement with the other. It is our ability to see their reason and continue the often uncomfortable conversation toward a comfortable resolution.

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