First-person essays and interviews with unique perspectives on complicated issues.
Each week, spend an hour and a half helping fill bags with frozen meat, cans of soup, boxes of mac and cheese, and handfuls of fruit for clients at my agency on Chicago’s North Side. For many of the clients at my food pantry internship, this limited assistance is the difference between unbearable hunger and just being able to scrape by.
Now, I’m worried I’ll see busier pantry days. In December, the US Department of Agriculture approved new rules that will require able-bodied adults without children to work 20 hours a week, or participate in a job-search program, in order to receive SNAP benefits. This is expected to remove 700,000 people from the federal food stamp program. Many social service organizations are already feeling the strain as more people seek services due to the triple whammy of low wages, rising rents, and a stream of cuts to social welfare programs. My concern isn’t just for my clients: I know firsthand how cruel this change in policy is. As a graduate student in social work, I have experienced it personally.
So much of our public discourse about SNAP misses the mark because we only see one facet of the hunger crisis in America. When the argument about who “deserves” financial assistance in order to eat — something we must all do to live — is framed as “lazy slacker living off the system” versus the “deserving poor,” we forget all the invisible people in the middle of this spectrum of stereotypes: the teacher who has a second job just to make ends meet, the newspaper reporter with an overdrawn bank account, or the social work intern who only got a decent winter coat because her friends and synagogue raised the money.
These are people who do vital work in our society, yet they are often compensated very little and face food insecurity as a result. While many of these people might meet the new work requirements, they could lose benefits in the future if policymakers continue to go down this path of restricting SNAP eligibility by increasing qualifying criteria.
Then there are the part-time social services workers — graduate students like myself — who could be disqualified from SNAP. In 2017, I enrolled at my local community college so I could take social science classes in order to gain admission to a master of the social work program. I was working 15 hours a week at an after-school program and barely managing to pay my rent and bills on time. Shortly after the beginning of the semester, I received a worrying notice from the Michigan Department of Health and Human Services: My SNAP benefits would be eliminated if I did not work at least 20 hours a week.
When I called my caseworker to explain my situation, I got a disheartening response: I did not meet the limited eligibility requirements for college students to receive SNAP — which includes working 20 hours a week and/or caring for dependents, or receiving other types of assistance — and my benefits would be cut. My desire to get more education so I could enroll in graduate school left me scrambling to figure out how to replace $160 in my already disastrous monthly budget. I still do not qualify for SNAP now as a graduate student (my current internship is unpaid), so I am back doing that awkward dance of trying to navigate a messy patchwork of food and nutrition resources.
Even more complicated is having to contend with the contradictory norms and codes of ethics of the social work profession that interfere with needing assistance. A Seattle social worker recently posted on the popular /r/legaladvice subreddit that her boss threatened to fire her because some of her clients saw her receiving services at the local food bank they frequent. In her post, she stated that she makes $29,000 a year, and that she and her husband live paycheck to paycheck. Her boss was concerned that she was “gaming the system” by using community resources for her family during a financial crisis and that it was unethical for her to be going to the same food pantries she refers clients to (which she points out are “pretty much all of them in the city”).
I ran into this ethical dilemma when I faced a major financial crisis near the end of the semester, just as it was starting to get cold in Chicago, and i badly needed a winter coat. A friend earnestly suggested I contact a popular social service agency in my area. It was the same one many of my clients go to, funded in part by my agency’s parent organization. What if I ran into a client? Would this be a conflict of interest?
My colleague Alex Kelley, a social worker and community organizer based in Michigan, shares my concerns and frustrations. “There’s a fundamental misinterpretation in prohibiting social workers from seeking services themselves. In many communities, the same risks happen at grocery stores, doctor’s offices, etc. If risks to confidentiality can be mitigated there, they can be mitigated at a food bank,” he said.
Samantha Greene, a licensed clinical social worker working independently in Texas, mentioned how location can also exacerbate these conflicts. “In rural communities, where resources tend to be less, this puts an extra strain on social workers who may find themselves needing a service only provided by one entity in the area.”
Economic insecurity among social service workers is one of those things people talk about at length privately, but the profession fails to address it publicly. Fellow social workers in the field talk about how low wages have personally impacted them, or how their coworkers are all independently wealthy “because how else could you afford to work here with this salary.” The median social work salary in 2018 was $49,470, according to the most recent data from the Bureau of Labor Statistics, which includes high-income regions such as the Bay Area. We also can’t forget that most agencies, hospitals, and clinics rely on social work interns who get paid nothing to provide vital services to clients and communities.
(Unfortunately, there is no research or data devoted to SNAP enrollment among social workers, or financial backgrounds of social workers or social work students. It’s almost as though the entire field has built its own wall of silence around this issue.)
In his essay “Social Services or Social Change?” writer, activist, and violence prevention specialist Paul Kivel described how social service workers are designed to be a “buffer zone” between poor people and those who control unjust systems. Creating a field of professionals to be that barrier prevents social workers and clients from seeing how much they have in common with each other — and how politically aligned they could be. Establishing and respecting appropriate boundaries is important to keep both social workers and clients safe, but the social work field must also contend with these broader issues within the profession.
We need to rethink why our state and federal policies around programs like SNAP are designed to subdivide recipients based on completely ridiculous standards of “deservingness.” We need to be willing to confront the complex web of social, cultural, and political attitudes that motivate this cruelty and exacerbate our nation’s failure to end hunger for all. Before making judgments about SNAP recipients, consider that the person in front of you buying their groceries with SNAP could be someone working to make these programs better.
Elena Gormley is a master of social work candidate at the University of Illinois-Chicago Jane Addams College of Social Work. Her work can also be found on Vice, Alma, JTA, and Jewish Currents.
Blue tarps still dot rooftops, homes lack electricity needed to refrigerate medicines, and clinics chip away at debts incurred from running generators. Yet despite these residual effects from last year's devastating hurricanes, Puerto Rico is moving ahead with major cuts to its health care safety net that will affect more than a million of its poorest residents.
The government here needs to squeeze $840.2 million in annual savings from Medicaid by 2023, a reduction required by the U.S. territory's agreement with the federal government, as the island claws its way back from fiscal oblivion.
Overall, Puerto Rico faces a crushing debt of more than $70 billion — much of it due to the territory's large Medicaid expenses. That's on an island where the average household earns $20,000 annually and diabetes and hypertension are widespread.
But physicians, health insurers and former government officials say the drastic cuts demanded provide far too little money to care for a population still traumatized by Hurricane Maria.
The cutbacks do nothing to address the underlying fiscal imbalance at the root of Puerto Rico's health care woes, which stem from the fact that the federal government already contributes a much smaller fraction of the U.S. territory's Medicaid budget, compared to what it contributes to the 50 U.S. states.
"We are rearranging the chairs on the Titanic," says Dr. Jaime Torres, whose jurisdiction included Puerto Rico when he served as a regional director of the Department of Health and Human Services.
"These people who have been under our service for the last four or five years — all of a sudden I have to abandon them," says Dr. José Joaquín Vargas, president and chief medical adviser for VarMed, the Bayamon-based company that operated the program that employed Calderón.
Health care crippled by debt
If Puerto Rico were a state, the federal government would pay 83 percent of its Medicaid costs. (It pays upward of 70 percent of Medicaid expenses in 10 states, according to a formula that takes a state's economy into account.) But because of a 1968 law capping the amount of Medicaid money Washington sends to U.S. territories, the federal government pays only about 19 percent of Puerto Rico's Medicaid costs, and as a fixed annual payment, or block grant.
In February, Congress approved $4.8 billion in additional funds to help pay the island's Medicaid bills. But the additional payments are widely viewed as a stopgap measure; health economists say that extra money is likely to run out in September 2019, a grim estimate shared by the territory's fiscal oversight board. That's a federal control board established by Congress in 2016 to oversee Puerto Rico's budget, negotiate with its creditors and help restructure at least some of the island's debt.
Gov. Ricardo Rosselló's administration aims to reduce Puerto Rico's Medicaid spending and improve access to care by putting an end to years of regional monopolies by private health insurance companies. The insurers have locked patients into narrow networks of health care providers. Later this year, under Rosselló's plan, the companies will be forced to offer island-wide insurance plans and compete for customers.
"We do not have the luxury" of continuing to spend inefficiently, says Ángela Ávila Marrero, executive director of Puerto Rico's Health Insurance Administration.
If Rosselló's overhaul fails to achieve adequate savings — as most observers predict — drastic cuts are in the offing. Among those cuts: Some 1.1 million of the 1.6 million Puerto Rico residents on Medicaid are at risk of losing coverage next fall, their health held hostage to the island's need to pay back its crippling debt.
Puerto Rico's government effectively defaulted on more than $70 billion in debt. Economists blame a decades-long recession, a corporate tax break that ended in 2006,and reckless spending by a bloated government.
But also to blame, they say, and largely unnoticed in discussions of the debt, is Puerto Rico's staggering Medicaid burden.
Poverty is so pervasive here that nearly 50 percent of residents qualify for public health insurance; Medicaid expenses in 2016 totaled $2.4 billion.
Residents suffer from higher rates of chronic conditions like diabetes and asthma, and the percentage of people who are elderly is quickly rising.
Footing medical bills without the kind of federal assistance dispensed to states has effectively doomed the island's fiscal health, health economists say.
Researchers of health care say that, putting aside interest on Puerto Rico's debt, the territory's primary fiscal deficit would have been erased had Congress paid the same share of Medicaid bills that it pays the 50 states and Washington, D.C.
"The main issue is that we are not yet a state," says Rep. Jenniffer González-Colón, the territory's nonvoting member of Congress. The island must pay for Medicaid, she adds, "with local funds that we don't have."
Battered even before the storm
Puerto Rico's health care system was already convulsing in September 2017 when Hurricane Maria struck. The federal government had issued warnings that the island would soon run out of additional Medicaid funds provided by the Affordable Care Act, and that 900,000 Puerto Rican residents would lose coverage.
Insurance companies, hospitals and physicians complained that the government was chronically late paying its bills. That frustration forced hospitals to defer maintenance and investments in new technology, and fueled the exodus of thousands of physiciansto the mainland in search of better incomes.
Today, Medicaid patients face long waits to see doctors on the island.
"If your kid needs a neurologist, for example, the waiting period is around six to 12 months," says Dr. Jorge Rosado, a pediatrician in San Juan. "For a genetics specialty, it's two to three years."
The $4.8 billion in relief funding from Congress is propping up Medicaid while the Rosselló administration negotiates new contracts with health insurance companies and enacts other measures mandated by the fiscal oversight board. Those include a new Medicaid fraud detection system and enhanced data collection.
There is little time to waste
Barring the unlikely passage of bills that would eliminate the cap on federal Medicaid spending in Puerto Rico, the disaster relief fund is projected to run out in the fall. González-Colón also hasauthored a bill calling for statehood, which would eliminate the federal government's unequal treatment toward the island's Medicaid program.
The fiscal control board established by Congressopenly acknowledges the impending disaster. In an April 19 report (p. 97 of "New Fiscal Plan For Puerto Rico: Restoring Growth and Prosperity") the board projects monthly costs per Medicaid patient will rise nearly40 percent over the next six years, barring any changes, and that Puerto Rico "will hit a 'Medicaid cliff.' "
Beginning this fall, Medicaid patients in Puerto Rico will be able to pick from at least four insurers, instead of being assigned to the one that had covered their ZIP code.
Puerto Rico has long capped the monthly payments insurers receive for Medicaid patients regardless of how many medical services they use — a form of managed care. But the government in San Juan believes that the insurers — without their regional monopolies — will be forced to compete, offering better care and more efficient delivery. They could save money by reducing unnecessary emergency room visits or hospital stays and by negotiating discounted payment rates to providers.
The island's government has vowed to pay private insurers extra money to care for those patients that have expensive or chronic medical conditions. Insurers have cautiously welcomed the changes.
"I support the government on what they're trying to do, but they didn't price it properly," says Dr. Richard Shinto, the president and chief executive of InnovaCare, an insurance company that sells plans in Puerto Rico.
"The oversight board is fixated on cuts," he says, "but we're never going to improve health care unless more money is put into the system."
Government health officials argue that their changes mean Medicaid patients, especially those outside the San Juan metropolitan area, will gain access to more specialists, who are concentrated in the capital. But staff at the island's clinics and hospitals fear they will be squeezed by insurers seeking to reduce costs, even as the clinics are still reeling from hurricane-related expenses.
For example, Hospital General de Castañer spent $5,000 every five days for gasoline to power the generators at its three sites for seven months; Health Pro Med, a community health center, spent at least $2,000 a day in added expenses, including private flights to ferry doctors to the storm-battered island of Vieques.
Many experts are skeptical that managed-care companies will hire the army of social workers and nurses needed to trudge up hillsides, knock on doors and do the tedious work that entails solving the daily problems of poverty.Viewed through a narrow lens, with an eye for cutting expenses, such problems can seem far outside the purview of medicine.
Many people displaced by the storm haven't yet been able to return home, and that, too, can complicate health care delivery. Carmen Ramos, executive director of Redes del Sureste, a conglomerate of 22 medical groups in Puerto Rico, says 60 percent of the letters she recently sent to patients on her mailing list were returned.
"The managed-care companies need to produce revenue," says Victoria Sale, a senior director at Camden Coalition, a pioneer of social and health programs for the chronically ill. "That's a setup for concern."
Bottom line? The economic overhaul doesn't rectify Puerto Rico's fundamental problem — it can't sustain its Medicaid program so long as Congress treats the territory differently than it treats states.
"Next year, we will go back to Congress demanding the funding we deserve as U.S. citizens," says Torres. But, he adds, "it's time the local government started thinking about a Plan B."
Looking at this budget it will remind some of the budgets of a nation on a major war or a totalitarian government in which the money goes for weapons and for judges to jail people in this case is to kick people out of the country, not for a strong society but the opposite with a government not accountable to anyone. Adam
President Donald Trump proposed a budget on Monday that calls for cuts in domestic programs and seeks a sharp increase in military spending and funding for a wall on the Mexican border.
Presidential budgets are rarely enacted by the U.S. Congress, which controls federal purse strings, but they allow the White House to lay out its priorities for the year.
In a bid to show conservatives that the administration is embracing some fiscal discipline, the plan calls for deep cuts in non-military spending that would lower the federal budget deficit by more than $3 trillion over 10 years.
But those cuts fly in the face of a two-year budget deal passed last week by Congress that raised spending limits on both military and domestic programs by $300 billion.
That agreement makes the president’s budget request even less relevant than it would be normally because Congress has already locked in its own spending priorities.
The Trump administration says, however, that Congress need not spend all of the money called for by the deal, particularly with regard to domestic spending.
The budget plan calls for spending $57 billion less in the fiscal year 2019 than the bipartisan agreement allows. If ever brought into force, the cuts could slash programs for the poor that provides housing and healthcare.
The proposal also calls for overhauling Medicare and Medicaid, two government-funded healthcare programs that are widely popular. Trump vowed on the campaign trail to leave them untouched, but the budget plan argues they can be made more efficient without harming recipients.
The proposed cuts drew a rebuke from the top Democrat on the House of Representatives Budget Committee, John Yarmuth.
”These cuts to critical federal investments are so extreme they can only reflect a disdain for working families and a total lack of vision for a stronger society,” he said in a statement.
The budget forecasts annual gross domestic product growth of at least 3 percent over the next three years, an aggressive target that is crucial to help cover the cost of the $1.5 trillion tax cuts passed by the Republican-controlled Congress in December.
Still, given the swelling of the federal debt in the wake of the tax bill and the two-year budget agreement, Trump’s proposal notably abandons the objective of eliminating the federal budget deficit after 10 years, a longstanding goal of fiscal conservatives.
Trump’s $4.4 trillion budget proposal provides for $716 billion in spending on military programs and for maintaining the U.S. nuclear arsenal,
It includes $200 billion for rebuilding the nation’s infrastructure and outlays $23 billion for border security -- most of it for the building of a wall on the border with Mexico to stop illegal immigration.
The wall is a key item for Trump’s political base of supporters but is opposed by Democrats. The issue has become a sticking point in talks to keep alive a federal program to spare from deportation so-called “Dreamers”-- children brought to the country by illegal immigrant parents.
Also on border security, Trump’s budget calls for $571 million in additional funding to hire 2,000 more Immigration and Customs Enforcement officers and agents.
Pentagon's $686 billion budget proposal backs National Defense Strategy
Pentagon's $686 billion budget proposal backs National Defense Strategy
It also requests funding for more judges and attorneys to handle cases of illegal immigration.
In keeping with another Trump campaign promise, the budget provides for $200 billion in federal funds intended to spur $1.5 trillion in infrastructure investments with state, local and private partners over the next 10 years -- an ambitious program that will have to be approved by Congress.
The budget also seeks some $13 billion in new funding over the next two years to combat the opioid epidemic.
The proposal increases U.S. contributions to the United Nations, an organization that Trump has repeatedly criticized, by 4.5 percent. The budget explains the increase as supporting American interests, including “drug control, crime and terrorism prevention, and trade promotion.”
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GLAAD Condemns Drastic Proposed Cuts to Ryan White HIV/AIDS Program, CDC, and Planned Parenthood
NEW YORK – GLAAD, the world’s largest LGBTQ media advocacy organization, responded after President Donald Trump released the administration’s 2018 fiscal year budget, which highlights their key objectives and priorities in the upcoming fiscal year. The budget includes proposed slashes to programs and departments critical to the LGBTQ community, including Medicaid, Planned Parenthood, and the Center of Disease Control’s HIV and AIDS programs.
Further, the Trump Administration proposed additional cuts in the FY 2018 Budget that could also endanger policies geared to assist transgender women of color and their access to quality HIV-related health care.
“This budget would pull the rug from under some of America’s most marginalized communities, including transgender women of color, at a time when they need our help the most,” said Sarah Kate Ellis, President and CEO of GLAAD. “President Trump’s budget is heartless and the latest example of the Administration working to systematically erase LGBTQ Americans from the fabric of this nation.”
Moreover, the proposed budget also slashes dollars to the Health and Human Services’ Office of Civil Rights. This office is charged with helping marginalized communities, including LGBTQ Americans, gain access to health care and human services providers without discrimination. Roger Severino, who has a long history of anti-LGBTQ activism and remarks, was appointed to lead the Office of Civil Rights earlier this year.
GLAAD has been documenting the administration’s systematic erasure of the LGBTQ community and policies intended to support LGBTQ Americans. Click here to visit GLAAD’s Trump Accountability Project.
BACKGROUND INFORMATION: How the Trump Administration’s Proposed Budget Harms LGBTQ Americans
Health and Human Services Cuts to LGBTQ Health Care Access
Eliminates $59 million from the Ryan White HIV/AIDS Program. [Health and Human Services FY 2018 Budget, Page 24]
Proposed discontinuing the Ryan White HIV/AIDS Part F AIDS Education and Training Programs and Special Projects of National Significance. [Health and Human Services FY 2018 Budget, Page 24]
Cuts $186 million in HIV/AIDS, Viral Hepatitis, STIs, and TB prevention CDC funding [Health and Human Services FY 2018 Budget, Page 28]
Drops $6 million in funding for HHS Office of Civil Rights [Health and Human Services FY 2018 Budget, Page 95]
Cutting Medicaid Harms People with HIV and AIDS
Advocate: Trumpcare Could Bring HIV Roaring Back: “By gutting Medicaid expansion and other benefits, the proposal could complicate PrEP access and promotion in the states that adopted Medicaid expansion. If passed, the new bill will begin to eliminate money for Medical expansion in 2020, potentially blocking new applicants and access to critical medication…”
WGBH News: Trumpcare Would Harm LGBT People And Those Living With HIV: “Changes to Medicaid proposed by the AHCA would put many people with HIV at risk of losing access to life-saving medicines and treatment” […] Trumpcare would also reverse ACA-related changes to Medicaid eligibility that have benefitted LGBT people. Previously, only low-income adults with dependent children or low-income adults with a disability were eligible for Medicaid. Now people are eligible for Medicaid on the basis of income alone. Since many LGBT people do not have children, this change has made it easier for them to enroll in Medicaid.”
Defunding Planned Parenthood Harms Trans Americans
HEADLINE: Trump’s Budget Proposes Kicking Planned Parenthood Out of All Federal Programs [New York Magazine, 5.23.17]
Daily Beast: The Attack on Planned Parenthood Hurts Transgender People, Too: “But a lesser-known consequence of the attack on Planned Parenthood is its potential impact on transgender people like Burns who rely on the organization for transition-related medical care. Elizabeth Clark, Planned Parenthood’s director of health media, told The Daily Beast that health centers in 16 states—including California, Florida, New York, and Illinois—currently offer hormone therapy to transgender patients. From 2013 to 2015, she added, there was an 80 percent increase in affiliates that reported offering that treatment.”
The Guardian: How defunding Planned Parenthood could wipe out transgender healthcare; “Unbeknown to many, Planned Parenthood is one of the largest sources in the US of transgender healthcare. The embattled provider offers hormone replacement therapy, which helps a person’s body appear more masculine or feminine, at dozens of its locations, and a growing share of its staff are trained to perform routine sexual health exams for trans patients.
Planned Parenthood in recent years has sought to address that problem. And it has made its clinics a magnet for thousands with few other options. Starting with Planned Parenthood of the Southern Finger Lakes, in upstate New York, a growing number of its health centers have become places where trans people can begin to transition medically, as well as get basic reproductive services. Its centers use a newer model for gender transitioning that gives the patient input on whether to start their transition, rather than turning the decision over entirely to a psychiatrist. Some clinics have staff with detailed knowledge of how to update driver’s licenses, passports and social security cards to reflect someone’s name and gender.”
Astrophysicist Neil deGrasse Tyson believes President Donald Trump's first proposed budget could make America "weak," "sick" and "stupid."
"The fastest way to Make America Weak Again: Cut science funds to our agencies that support it," he tweeted Sunday as part of a social media rampage against the President. “The fastest way to Make America Sick Again: Cut funding to the National Institutes of Health."
"The fastest way to Make America Stupid: Cut funds to programs that support education," Tyson added. "The fastest way to thwart Earth’s life-support systems for us all: Turn EPA into EDA — the Environmental Destruction Agency."
In his first budget blueprint, the President proposed $54 billion in cuts to large parts of the federal government and popular programs big and small.
Trump's budget would cut off funding entirely for several agencies, including arts, public broadcasting and development groups, and also proposes steep cuts to agencies like the State Department and Environmental Protection Agency.
Nearly every agency will see some sort of cut, with only Defense, Homeland Security and Veterans Affairs getting a boost.