This Fall’s Horror Story? Lack of Police Decertification

By Juliana Keeping, communications manager
 

High health care costs are at the heart of families’ economic pain points, like ruinous medical debt, skyrocketing private insurance premiums, and wage stagnation. At this critical juncture, experts, including Mark E. Miller, the executive vice president of health care for Arnold Ventures, convened to discuss what’s driving costs higher and what policy levers can be pulled to bring relief.
 

Why it Matters: Nearly nine in 10 Americans say a candidate’s plan to lower health care costs is important to their midterm election vote. Economic issues are a key issue for voters, according to recent polling from the Kaiser Family Foundation. In 2022, only four in 10 Amercians could cover an unplanned $1,000 expense. 
 

What’s Next: There are a myriad of ways to tackle rising health care costs. At the discussion, Miller and other experts discussed one solution in particular that could save billions of dollars: capping what hospitals can charge private insurers. On average, private health plans pay hospitals 224% more than what Medicare would pay for the same services at the same facilities. 
 

“There are large savings to employers and families if you were to curtail [hospital] prices at 200% of Medicare,” Miller said. “And at 200% of [what]  Medicare [reimburses hospitals for services] there's still a huge $900 billion in savings over 10 years to employers and families.” 

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Related: The people want lower health care prices. Significantly, almost 40% of Americans may vote for an opposing candidate if lowering health care costs is a top priority, according to the West Health - Gallup 2022 Health Care in America Report.

By Lauren Gill, Arnold Ventures contributor

When Tiffany Fair enrolled at Walden University, a for-profit online school, she hoped that earning a doctorate degree in business administration (DBA) would give her an edge to advance in her career in the U.S. Army. But over four-and-a-half years, Walden would upend Fair’s life as she knew it. She racked up tens of thousands of dollars of unplanned debt as she fought Walden’s inexplicable delays in the completion of her degree, and her relationship with family suffered.

What Happened: Lawyers representing Walden students reviewed the school’s advertising spending databases and marketing materials and determined that it was intentionally trying to recruit Black and female students. In 2020, Walden focused 90% of its local advertising budget at places with higher than median percentages of Black residents. In 2015, that figure was 99.8%, according to the lawsuit. Targeting students based on race or gender at predatory institutions is called “reverse redlining.”

Why It Matters: One of the many consequences of reverse redlining is that it deepens already existing racial disparities in student loans across the county. Black doctorate recipients take on an average of $88,000 in debt, while white doctorate recipients have just $31,000.

What’s Next: Fair said that she hopes her lawsuit will result in new regulations for Walden’s DBA program so that future students don’t have to go through the same struggles.

“On the one hand you feel accomplished that you've completed such a major goal that not a lot of people are fortunate enough to do, but on the other hand, it's tainted, and it’s a terrible feeling to have to carry that burden," she said. “It can't be resolved from a lawsuit. What would help is for Walden to be held accountable for their actions.”

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By Michael Friedrich, Arnold Ventures contributor
 

Millions of people face challenges accessing prescription birth control. Now advocates have hope of gaining federal approval for an over-the-counter birth control pill under consideration by the Food and Drug Administration (FDA).

What’s Happening: Organizations including Ibis Reproductive Health, through its Free the Pill campaign, and the Contraceptive Access Initiative are working to gain approval for a non-prescription birth control pill, which would drastically expand contraceptive access. Oral birth control is safe and effective and has the endorsement of clinicians, pharmacists, and researchers.

Why it Matters: Almost a third of women of childbearing age report problems in accessing birth control prescriptions or refills, with harmful effects on their bodily autonomy and overall health. Common issues include provider shortages, costs, transportation, and childcare. These barriers have the worst effects on people in Black, Latinx, indigenous, Asian American, Native Hawaiian, Pacific Islander, and rural communities, as well as LGBTQ+ folks, immigrants, people with disabilities, and those working to make ends meet.

What’s Next: Soon, the FDA is expected to hold an advisory committee hearing to review an application from a pharmaceutical company for the first over-the-counter birth control pill in the U.S. The committee will make a recommendation to the FDA about whether to approve the drug, which could be available as early as next year. Advocates say the drug would be a game-changer, providing critical reproductive health care to those who  need it and reducing the risk of unintended pregnancy.

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When it comes to navigating the health care system, more isn’t always better. The low-income seniors and people with disabilities who rely on both Medicare and Medicaid are faced with a bewildering number of systems to navigate. That’s where “one” comes in. 

Integrated Medicare-Medicaid programs have the potential to improve and simplify care by ensuring that people have just one health insurance card to present at the doctor’s office. One network of providers who accept your plan. One place to go for complaints or to resolve problems. That is the Complex Care team’s vision for the 12+ million people across the country enrolled in both Medicare and Medicaid.
 

At present, 90% of people in both Medicare and Medicaid are not enrolled in integrated care. As a result they are sicker, and their health care is more costly. Integrated programs that put the person at the center will course-correct this problem, explained Arielle Mir, AV’s vice president of health care, who leads the Complex Care team, this week at a panel hosted by The Duke-Margolis Center for Health Policy.

“Today, the most direct route to advancing integrated care is through the states,” she said.
 

This week, Duke-Margolis released a new report that lays out a whole-person care vision for North Carolina’s 275,000 dual-eligible beneficiaries. The North Carolina team honed in on its vision by engaging stakeholders, including people who would use the program, alongside data and evidence.
 

North Carolina is just one example of a state building an integrated care program. Momentum across the country continues to grow. Currently, eight states are set to participate in a learning collaborative to build capacity in Medicaid programs to better integrate care; California’s innovative initiative would better integrate Medicare-Medicaid for the 1.4 million residents who rely on both programs; and Indiana continues work to fulfill its mandate to improve its long-term care system that so many dually eligible individuals rely on.

Criminal Justice

• A new essay in Slate, co-authored by the executive director of the Texas Jail Project, an AV grantee, describes how the Harris County jail suffers from "even worse conditions than at Rikers."
   
• Marijuana legalization is on the ballot this November in Arkansas, Maryland, Missouri, North Dakota, and South Dakota, the Associated Press reports.
   
• A new report by a federal monitor found that requiring body-worn cameras resulted in better, more civil interactions between police and communities.
   
• Law enforcement in Texas are warning that a law allowing unlicensed carry of firearms is leading to more spontaneous shootings, The New York Times reports. (free link )
  
  Related: Read AV’s new Federal Funding for Gun Violence Research Issue Brief
   
• The 6th Amendment Center has released two new reports about indigent defense in Michigan and New Hampshire. 
   

Health Care

• A new report from Source on Health, a project of UC Hastings Law, lays out policy options for states to address egregious prices from increasingly consolidated hospitals and physicians. 
   
• How can we achieve equitable care for low income adults and people with disabilities in rural areas? A new piece in Health Affairs Forefront offers ideas.
   
• The last few decades saw antibiotics withdrawn from the market due to concerns over efficacy and uptake. The Pioneering Antimicrobial Subscriptions to End Upsurging Resistance, (PASTEUR) Act would pay drug makers billions to perpetuate the same broken system. This Bloomberg Law article shares the perspective of Dr. Reshma Ramachandran, of AV grantee Doctors For America, that the potential risk to patients is concerning, especially if the new drug could be slightly worse than existing drugs, and that Congress must go farther to develop better policy and FDA action that improves antibiotic drug development. 
  
  Related: Read AV’s new Antimicrobial Resistance (AMR) Issue Brief.

Higher Education

• Senators Jeanne Shaheen and Todd Young reintroduce a bipartisan bill to address the student debt crisis by increasing institutional accountability. The Student Protection and Success Act, first introduced in 2015, would enact a series of measures requiring higher education institutions to be held accountable and share responsibility for student success. 
   
• The Washington Post reports that an appeals court has temporarily halted Biden’s student debt relief program. The 8th Circuit Court of Appeals granted an administrative stay while it considers a request for an injunction filed by a coalition of six Republican-led states seeking to block the forgiveness program. Six states jointly claim that the Education Department is overstepping its authority by creating the debt relief plan and that it will harm their states’ finances. The case was dismissed due to the states’ lack of standing before being brought to the federal appeals court. (free link)
   
• There are at least three more high-profile lawsuits still pending, which include a lawsuit from The Cato Institute arguing that the relief plan could undermine the Public Service Loan Forgiveness (PSLF) program as a recruitment tool for the organization, a lawsuit from two Texas borrowers who aren’t eligible for the full $20,000 of debt relief possible under the loan forgiveness plan and believe it should be enjoined as arbitrary, and a lawsuit from the Arizona attorney general that argues, among other things, that the relief will undermine PSLF as a recruitment tool, have negative economic effects on the state, and increase state law enforcement costs.
   
• With this temporary halt on the debt relief program, the Education Department announced it would make permanent the temporary changes to the public service loan forgiveness program, thereby allowing another path for loan forgiveness for students working in public service, reports USA Today.
   

Contraceptive Choice and Access

• The FDA is delaying its hearing on over-the-counter birth control, previously scheduled for Nov. 18, reports Reuters. Read the statement from Ibis Reproductive Health and others.
   
• The Center for American Progress compiles five important facts about over-the-counter birth control.
   
• Contemporary OB/GYN outlines a study in Contraception showing that people at Title X clinics receive the same quality of contraceptive health counseling as people in private health clinics.

Democracy

• John Opdycke, president of Open Primaries, talks with Chris Cuomo on NewsNation about the role of open primaries for voters, especially independents. “We can’t just be free agents, we have to be change agents,” says Opdycke. “We independents have to go change the actual rules of the political system.”
   
• In Alaska’s upcoming ranked-choice voting elections, candidates are crossing party lines in their endorsements, reports The Washington Post. “Despite being from different parties, Murkowski and Peltola are finding more things draw them together than drive them apart.” (free link)
   

Climate 

• In CNN, nine experts offer solutions to the climate crisis, including Rich Powell, CEO at ClearPath.

Journalism

• The Texas Tribune has a new CEO. Sonal Shah brings to the role experience in public service (including director of the White House Office of Social Innovation and Civic Participation) and in the private sector. "Above all, Sonal is a champion of a free, independent press who understands that trustworthy journalism is the bulwark of democracy," the Tribune's board chair wrote in the announcement.

Fiona Apple, the award-winning singer-songwriter and trained court watcher, posted a video to Twitter this week calling out Prince George’s County for limiting remote access to bail review and other pretrial hearings. “How are we supposed to have our constitutional right to observe these courts or to help these people if we can’t hear?” Apple said in her recording. Activists are saying this restriction was in relation for a lawsuit filed by local group Courtwatch PG, which claims up to one-third of the jail population is being held illegally. Of the nine plaintiffs involved in the ongoing litigation, five were separated from their children during pretrial detention, two lost their homes, and one was a teenager who may have to repeat a grade after being forced to miss school.

In this episode of the “Our Voice” podcast, hosts AV grantee Sheena Meade, executive director of Clean Slate Initiative, and Neil Volz, deputy director of the Florida Rights Restoration Coalition, welcome Brittany White, a decarceration director for Live Free, and organizing fellow at the Institute to End Mass Incarceration. White discusses her journey from prison to Harvard and the need for Clean Slate record clearance.

On Wednesday, Nov. 16, AV grantee Power to Decide is hosting a Twitter Storm for #ThxBirthControl Day. To participate, use the #ThxBirthControl hashtag between 2 to 3 p.m. ET on Wednesday, Nov. 16. This date was originally two days before the FDA's scheduled (now postponed) hearing for over-the-counter birth control. Learn more here.

• After six years of waiting, Rihanna has finally released new music for the Navy (the name of her fanbase). Her new single “Lift Me Up,” which drops today from Marvel’s blockbuster sequel “Black Panther: Wakanda Forever," is a tribute to the late Chadwick Boseman.
   
• For the fourth time in six seasons, the Houston Astros are headed to the World Series. The first game of the series is tonight. #LevelUp

The Provider Payment Incentives team, on behalf of AV grantee the Center for Health Care Strategies and in partnership with The Commonwealth Fund, is requesting applications for a new opportunity for up to five Medicaid agencies to design and implement a new primary care population-based payment (PBP) model or to improve an existing one. Medicaid Primary Care Population-Based Payments Learning Collaborative is an 18-month program open to Medicaid agencies in all states, commonwealths and territories. States participating in the collaborative will also incorporate approaches to advance health equity within their models. Applications are due Nov. 10, 2022. Details and application materials are here.

The Higher Education and Evidence-Based Policy teams have created a request for proposals for rigorous impact evaluations of programs and practices (“interventions”) to promote college success in the United States. Learn more about the RFP here.

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

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

View our RFPs here.