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How Sequester Cuts Are Undermining Tribal Health Care

Indian Health Service Director Yvette Roubideaux

The New York Times editorial board published a column Thursday slamming Congress for the disproportionate impact that sequestration will have on native tribes’ access to health care services, asserting that the “federal government cannot use its budget nihilism to avoid its moral and legal obligations.” Considering the dismal health care demographics of American tribal populations and the Indian Health Service’s (IHS) already-paltry funding, their outrage may be justified.

The IHS was formed in 1955 and tasked with overseeing health care services for American Indians and Alaskan Natives. Unfortunately, a combination of factors including anemic funds and oversight failures has left IHS in perennial disarray, prompting a 2010 Senate panel to conclude that it suffered from “chronic mismanagement,” unfilled vacancies in top positions, and subpar medical facilities at risk of losing their accreditation.

According to Indian Country Today, things began looking up in 2008 when appropriations for benefits such as the Contract Health Service — which funds medical services outside of the regular tribal health network — and the Improving Patient Care program were increased substantially, opening up tribes’ access to preventative screenings and affordable primary care, as well as boosting patient satisfaction by nearly 20 points.

Unfortunately, that all came to a screeching halt with sequestration. The budget cuts were only supposed to affect discretionary spending, while entitlements for the needy, such as Medicaid and nutritional assistance, were meant to be spared from austerity. But IHS funding doesn’t fall under this protected category. Rather, IHS believed that its funds would be shielded by a 1980s law barring Congress from cutting its budget by more than 2 percent — as it turns out, IHS was dead wrong:

IHS Director Yvette Roubideaux and her staffers had said at various tribal meetings and in letters throughout 2011 and early 2012 that “the worst-case scenario would be a 2 percent decrease from current funding levels” for IHS, rather than the 9 percent that was forecasted for most federal agencies if the sequester went into effect.

But Indian country began to learn late last year that Roubideaux’ predictions were wrong. IHS would be cut on March 1 at the same rate as every other non-protected agency. And since IHS was late to the game in planning for the larger cut, it didn’t work as aggressively at saving and protecting its resources as it could have. Also—and perhaps most egregiously—it fed tribes misinformation that cost them months of planning and advocacy time. “It’s unfortunate that we all relied on [IHS’s] earlier interpretation, because we could have addressed this earlier with the administration—especially the OMB—and the Congress,” said Jim Roberts, a policy analyst with the Northwest Portland Indian Health Board.

“Had IHS communicated the correct information in the previous fiscal year, tribal care providers that receive IHS funding would have been able to modify their budgets so they would have had more resources for this year—and thus the cuts to tribal citizens wouldn’t be as steep,” added Lloyd Miller, an Indian affairs lawyer with Sonosky Chambers who has worked on many lawsuits involving the agency. “The earlier tribal providers could have been planning for disaster, the better. In this case, tribes lost a whole year.”

Public health issues already disproportionately impact Native tribes in America. Over one third of all Native Americans lack health insurance coverage; tribes have higher rates of smoking and alcoholism than other populations; and over 13 percent of Natives self-report being in “fair” or “poor” health — a much higher figure than most other racial groups. Unfortunately, congressional dysfunction may end up adding more problems to the list.

Why Montana’s Proposal To Legalize Eating Roadkill May Not Be As Crazy As You Think

On Wednesday, Montana’s state Senate advanced legislation that “would allow people to salvage roadkill for food,” arguing that preventing the practice would mean throwing away a perfectly acceptable nutritional source. As bill supporter Sen. Larry Jent (D) put it, “It really is a sin to waste good meat.” But setting aside the inevitable jokes over the proposed “finders, eaters” law, the debate surrounding the measure’s public health implications provides a lens into America’s food safety regulatory scheme — and it’s more complicated than you might think.

Montana is hardly the first state to propose something like this. In fact, there are already roadkill-salvaging laws on the books in at least seven states — including Alaska, Illinois, Georgia, Kentucky, and West Virginia — with varying degrees of regulatory requirements. Most of these laws either require the would-be roadkill consumer to carry a permit that allows them to salvage the kill, or report the salvaging to law enforcement and state wildlife departments. While there are guidelines for how to safely consume the “smooshed meat” — for instance, almost all such laws are limited to run-over game such as elk and deer, which should be “bled, gutted, and quartered” as quickly as possible to cool off the carcass and prevent infections — there isn’t really an enforcement mechanism for them, so the consumer takes on some individual risk.

However, whether or not that risk is greater than the risk of eating mass-produced meats is an open question. Animal protection groups such as People for the Ethical Treatment of Animals (PETA) have actually advocated for loosening roadkill standards, claiming that “[e]ating roadkill is healthier for the consumer than meat laden with antibiotics, hormones, and growth stimulants, as most meat is today.” The historical data — and recent events — shows that there is something to that argument. American-produced meat tends to exceed acceptable levels of contamination by most countries’ standards, and the consolidation of meat resources by mammoth corporate distributors like Cargill Beef makes it so that just one contaminated batch necessitates nationwide recalls of tens of thousands of pounds of product. Many public health advocates also argue that food regulators are woefully impotent to hold the meat industry accountable for its shortcomings in the face of lax regulatory enforcement and “ag gag laws” that silence whistleblowers who expose facilities violating food safety standards.

And the argument that roadkill-salvaging laws help prevent the waste of good meat actually could be an important point for low-income communities. Some of this type of legislation is intended to address food insecurity in secluded communities. For instance, Alaska’s caribou- and bear-salvaging provisions are meant to help churches and soup kitchens distribute food to the homeless and the poor in a state where access to roads and super markets isn’t always easy to come by. Montana’s proposed law has similar intentions.

Some Montana legislators have raised concerns over law enforcement’s capacity to evaluate whether or not roadkill is safe for consumption, and the ambiguous liability laws governing shelters and food banks that might distribute such meats. “Despite its good intention, it doesn’t pass the smell test for me,” said state Sen. Kendall Van Dyk (D). But considering America’s lackluster record on meat safety and the widespread — and relatively safe — U.S. culture of hunting big game for personal consumption, those concerns might very well be overstated.

Tennessee University Caves To Fox News’ Complaints, Pulls Funding From College Sex Ed Event

The University of Tennessee (UT) is pulling state funding from a week-long sexual education event for its undergraduate students, caving to mounting right-wing pressure after Fox News suggested the funds were being used inappropriately to fund a “lesbian bondage expert” and hold a drag show on campus.

UT’s six-day “Sex Week” will include free STD screenings for students and panel discussions on topics ranging from sexual health, sexual identity, gender roles, and ways that UT can better address issues of sexual assault on campus. But Fox News radio host Todd Starnes recently raised the alarm about the university using student fees to “host a lesbian bondage expert” — referring to one of the presenters, erotica author Sinclair Sexsmith, who was invited to conduct a poetry workshop. Even though the students who helped plan the Sex Week event confirmed Sexsmith would simply discuss poetry related to sexuality and gender roles in society, and would not include anything related to lesbian bondage, the Fox News host became fixated on the fact that Sexsmith is “an expert in sexuality and leather.”

As Raw Story reports, the right-wing media attention eventually made its way to state Sen. Stacey Campfield (TN-R), who threatened to reconsider the university’s budget unless it made some changes to Sex Week. “We are not talking about health and safety to do a drag show. What are these issues so important for?” Campfield told a local news affiliate. “This is not something that the parents sent their kids to school to learn, this is not even close, we have some serious issues going on at the University of Tennessee.”

The state senator’s loud opposition to the university event perhaps comes as no surprise. Campfield has a long history of being hostile to issues of human sexuality, particularly when it comes to the LGBT community. He’s repeatedly introduced “Don’t Say Gay” bills to prevent teachers from discussing any aspects of “non-heterosexual” sexuality with public school students, and the most recent iteration includes a clause requiring teachers to inform parents if their child is gay. He’s also compared homosexuality to injecting heroin. Unfortunately, he’s hardly the first far-right Republican to attempt to block sexual education programs on college campuses.

Sex Week will still go on as planned. “This whole thing makes it more important to do this,” Brianna Rader, the UT student who led organizing efforts for Sex Week, said of the controversy. But she’s frustrated that university officials reversed their decision on Thursday about allocating state funding for the event. “People are getting upset about college kids talking about sex education? This sounds made up. This sounds like we’re in a movie,” Rader pointed out. “It was a cowardly move, and I’m disappointed in them.”

North Carolina Protesters Tell Anti-Abortion Republicans: ‘You Don’t Walk In A Woman’s Shoes’

"Not in her shoes": North Carolina rallies against abortion restrictions

In North Carolina, GOP lawmakers are pushing an anti-abortion measure that could force clinics across the state to close their doors. SB 308 would place unnecessary restrictions on abortion providers that are likely to put them out of business.

Over-regulating abortion providers — an attempt to indirectly restrict women’s access to abortion services by forcing health clinics to shut down — is a popular anti-choice tactic advancing in states like Texas, Mississippi, North Dakota, and Alabama. But women’s health advocates in North Carolina are fighting back, reminding anti-choice lawmakers that it’s not their place to interfere with women’s personal medical decisions.

At a rally against SB 308 on Wednesday in the state’s capital city, North Carolinians sent a clear message: Lawmakers don’t know why women may need to seek an abortion, and they shouldn’t continue to place restrictions on the legal medical procedure. “You don’t walk in a woman’s shoes. You don’t know what she’s going through,” Paige Johnson, representing the Planned Parenthood of Central North Carolina, said at the protest. “So don’t try to legislate her health decisions.”

As part of the protest, hundreds of women and men laid out shoes on the Halifax Mall in Raleigh, a symbol of support for every woman who wants the right to make her own reproductive health decisions based on her own unique circumstances. They also photographed messages of solidarity (all images via Planned Parenthood Action Center of North Carolina):

Agriculture Giants Use Emergency Budget Bill To Sneak In Big Gifts For Themselves

On Wednesday, the Senate passed a continuing resolution to fund the federal government through September and avoid a government shutdown — and tucked into the 587-page bill are two brief provisions worth millions of dollars for large agribusinesses. The first blocks basic protections for livestock farmers already passed in the 2008 Farm Bill, effectively giving large meatpacking corporations free rein to manipulate the livestock market. The second exempts biotechnology giants like Monsanto and Dow from judicial review, allowing them to sell and plant genetically engineered crops even if a court of law orders them to stop.

These so-called “riders” often have little to do with the bill they piggyback, but special interests deploy them to avoid the scrutiny of the legislative process. A similar rider to deregulate the biotech industry quietly appeared in the stalled House Farm Bill last year. This time, agribusinesses took advantage of the urgency of averting the impending government shutdown on March 27. No lawmaker has come forward to claim responsibility for the riders.

Sen. Jon Tester (D-MO), the Senate’s only working farmer, introduced two amendments to remove these “corporate giveaways,” but was not allowed to bring his amendments to a vote. Last week, Tester gave a fiery speech eviscerating the backdoor move to further consolidate power among a handful of corporations:

The House inserted a provision in the bill that gives enormous market power to America’s three largest meatpacking corporations while stiffing family farmers and ranchers. Family-run production agriculture faces tremendous market manipulation. Chicken farmers, hog farmers, and cattle ranchers all struggle to get a fair price from meatpackers. And if they fight back, they risk angering corporate representatives and being shut out of the market. Thanks to this provision, the Agriculture Department will not be able to ensure a fair, open market that puts the brakes on the worst abuses by the meatpacking industry. What’s worse is that the USDA took Congressionally-mandated steps to protect ranchers from market manipulation over the last few years. That’s what we told them to do in the 2008 Farm Bill. And this provision will actually overturn rules that USDA has already put in place. But apparently intense behind-the-scenes lobbying won out in the House of Representatives, and now we’re back to square one with big meatpackers calling the shots.

The second provision sent over from the House tells USDA to ignore any judicial ruling regarding the planting of genetically-modified crops. Its supporters are calling it the “farmer assurance” provision, but all it really assures is a lack of corporate liability. The provision says that when a judge finds that the USDA approved a crop illegally, the department must re-approve the crop and allow it to continue to be planted – regardless of what the judge says.

The “farmer assurance” rider addresses a 2010 controversy, in which a judge ordered a halt on planting Monsanto’s Roundup Ready beets until an environmental study could be conducted. The USDA ignored the judge’s ruling and allowed farmers to keep planting the beets without an environmental study. Nevertheless, the company unleashed a lobbying blitz of almost 6 million dollars on Washington. In summer of 2012, the farmer assurance rider popped up in the appropriations bill.

Michele Bachmann: Obamacare Will ‘Literally’ Kill People

As the country prepares to celebrate the third anniversary of health care reform, Rep. Michele Bachmann (R-MN) insisted on Thursday that the Affordable Care Act will “kill” vulnerable women and children during a speech on the floor of the House.

In a long diatribe against the law, Bachmann predicted that the American people will “pay more” and get less, before suggesting that the provisions of Obamacare will “literally” kill people:

BACHMANN: That’s why we’re here because we’re saying let’s repeal this failure before it literally kills women, kills children, kills senior citizens. Let’s not do that. Let’s love people, let’s care about people. Let’s repeal it now while we can.

Watch it:

While the main coverage expansion provisions will go into effect in 2014, the ACA has so far saved seniors over $6 billion on prescription drugs, reduced administrative overhead, deterred private insurers from requesting double digit premium increases, kept millions of young people on their parents’ health care plans, and provided 34.1 million people with Medicare preventive services without additional cost-sharing.

Moments after calling for the complete repeal of a law that will extend health care coverage to 30 million Americans, Bachmann claimed that her belief in Christ inspires her to care “for the least of those who are in our midst.” After she completed her remarks, fellow Republican Rep. Michael Burgess (TX) observed that the Minnesota Congresswoman “has a way of stating these things that none of us are capable of.”

Update

Bachmann later came back to the floor and described Medicaid — a health care program for lower-income Americans — as a “ghetto.” “Here’s the one that no American wants to be in. It’s the Medicaid ghetto,” she said. “And that’s where the lowest possible care, where very few doctors will be available available to offer this kind of care.” While the program is not without problems, a study by the Government Accountability Office showed Medicaid beneficiaries were just as happy with their health care as those with private insurance.

What South Africa’s Successful Push To Incentivize Healthy Eating Could Teach The U.S.

On Tuesday, the RAND Corporation published the results of a preliminary study on South Africa’s HealthyFood initiative, a benefit program sponsored through the nation’s largest private insurance company. The program provides some 260,000 South African households with up to a 25 percent rebate on healthy food purchases — “cash for carrots,” if you will — and the encouraging numbers suggest that similar initiatives could work right here in America.

While the study does suffer from some methodological snags — the biggest being that households’ eating habits were self-reported rather than observed — its authors conclude that the right level of rebates can be a strong catalyst for healthier eating habits. For instance, the survey of 350,000 HealthyFood participants and nonparticipants found that “a 10% and 25% discount on healthy food purchases is associated with an increase in daily fruits and vegetables consumption by 0.38 (95% CI: 0.37 – 0.39) and 0.64 (95% CI: 0.62 – 0.65) servings, respectively,” and that rebate participants were more likely to eat three or more servings of wholegrain foods daily while being less likely to eat foods high in sugar, salt, fried foods, processed meats, and fast food.

Admittedly, the report does not find that the healthier eating habits significantly reduced overweight rates or participants’ average BMIs. However, it does see a statistically significant correlation between higher discount rates and lower obesity, suggesting that the right amount of financial motivation can spur enough eating habit changes to make a dent in obesity rates on the macro level.

So could a similar program work in the U.S. — particularly for low-income Americans who struggle with food insecurity, and often have to resort to high-fat and high-calorie diets to get more nutritional “bang-for-the-buck”? There’s not a whole lot of data on the matter yet. But that will soon change, as a 2011 pilot program under the Supplemental Nutrition Assistance Program (SNAP) — the “Healthy Incentives Pilot” — mimics the HealthyFood initiative, offering inflated discounts of up to 30 percent cash back on healthy food purchases, and its results will be published later this year. If the findings track South Africa’s, then it could be a game changer for low-income communities often beset by unhealthy food habits and high obesity rates. And incentivizing healthy eating with rebates could be a more effective policy than more blunt and restrictive initiatives, like South Carolina Gov. Nikki Haley’s (R) controversial push to limit food stamp purchases to healthy items.

Still, the funding element is key, as the study found that higher rebate levels were required to change the eating habits of people who were entrenched in subpar diets. The South African program offers monthly discounts of up to $500 for a family and $250 for individuals — significantly higher than the average monthly SNAP allotment, which is supposed to be a supplemental benefit (although it doesn’t actually work that way in reality). But South Africa’s example suggests that, given sufficient financial backing, cash for carrots could be a worthwhile undertaking throughout America.

Obamacare Has Helped Seniors Save Over $6 Billion On Their Prescription Drugs

As the health reform law approaches its third birthday, Obama Administration officials are noting that one of its provisions has already helped seniors on Medicare save $6.1 billion on their prescription drug costs.

Obamacare ensures that more prescription drugs are covered under Medicare by closing the “donut hole” coverage gap. Even as the cost of prescription drugs has continued to rise, the health law gives discounts to Medicare beneficiaries so seniors continue to be able to afford the medication they need — one of its most popular provisions. On Thursday, HHS Secretary Kathleen Sebelius announced that more than 6.3 million Americans in the Medicare program have saved more than $6 billion on prescription drugs.

Since the Affordable Care Act first began phasing in reforms to Medicare’s drug coverage in 2010, the recorded savings for seniors have been steadily growing. And according to new estimates from the Congressional Budget Office (CBO), it won’t cost as much to close the donut hole’s coverage gap as initial estimates predicted. Ultimately, making drugs more affordable means that people will take them more regularly, ensuring seniors stay healthy and their medical costs are lower. In fact, the estimated 90 million Americans who don’t take their medications as directed represent the biggest root of wasteful health spending in the United States.

A full 90 percent of seniors with Medicare plans are satisfied with the prescription drug coverage they can access through the program, largely because of the savings they’re now experiencing. And those savings are likely to increase. This year, Obamacare increases Medicare’s prescription drug discounts to about 52 percent of the cost of most brand name drugs and 21 percent of the cost of covered generic drugs.

As Obamacare Turns Three Years Old, Americans Still Have Big Misperceptions About What It Does

Thursday marks the three-year anniversary of Congress’ passage of the health care reform law. And although Obamacare has had a high profile throughout the past several years of political fights over health reform, that hasn’t ensured that Americans understand what the law actually does. Even after three years, many Americans are still confused about Obamacare’s specific provisions, and can’t correctly identify what is and isn’t in the health law.

According to a new Kaiser Health tracking poll, a plurality of Americans incorrectly believe the health law cuts Medicare benefits, establishes “death panels,” gives health benefits to undocumented immigrants, and contains a public option. The idea that Obamacare includes a public option is the biggest misconception about it, as 57 percent of respondents asserted that they believed the law has a public health insurance option — compared with just 28 percent who know it doesn’t:

In general, Americans are less likely to be aware that widely popular policies are included in Obamacare, like the provisions that provide tax credits for small businesses and that help make prescription drugs more affordable for seniors. On the other hand, the public is much more likely to be able to attribute the less popular aspects of the law — like the individual mandate that compels every American to purchase insurance — to Obamacare:

The discrepancies are likely because of the ongoing, politicized misinformation campaign that’s been waged against Obamacare. Previous polling has shown that accurate knowledge about the health law tends to be divided along party lines: Democrats know more about what the law actually does than Independents do, and Independents know more than Republicans do. That’s been an issue for the health reform law since its inception. Before the Supreme Court handed down its decision to uphold the law, a slim majority of Americans said they opposed Obamacare as a whole — but when they were asked about its provisions separately, most of the law’s actual policies had broad support.

The tide is beginning to turn. Whereas Obamacare used to be solely associated with the negative fearmongering surrounding it, Democrats are now beginning to tout the health reform law’s accomplishments more confidently, hoping to raise awareness about its more popular provisions. Health care reform proponents are looking ahead to 2014 and beyond, when more Americans will start feeling the positive effects of Obamacare on their own lives. But there’s still a long way to go when it comes to educating the American people about the law.

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