When an Insurance Card Isn't Enough: The Need for Enabling Services

Americans are demanding, more than ever, change in our health care system.  We want meaningful reform that means that we will be able to get the care we need, so that we can be healthier and productive as individuals, families, communities, and as a nation. But when the health care reform debate is narrowed to a discussion of insurance coverage, rather than actual ability to access quality care, the discussion falsely considers health care to be a commodity, like Nintendo Wiis.

But surely we as a country value health more than our gaming consoles; indeed, we believe as a nation that health care is a right stemming from our basic human dignity and America's promise of opportunity, in the same manner as access to our interstate highway system or the protection from disaster provided by our firefighters.  True reform of health care in the United States requires a recognition of the wisdom of the adage, "If you don't have your health, you don't have anything."  Providing real access to necessary care should be the central mission for how we redesign the broken health care system in America, a system that finds over 1 in 5 Americans unable to pay the bills for necessary medical care or prescription drugs, and 1 in 4 Americans who have put off necessary care in the past year.

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Healthy San Francisco Clears Another Hurdle

Access to quality health care isn't something that affects us as individuals; it impacts us as families, friends, neighbors, and coworkers.  Health care is fundamental to the well-being of us as persons and equally fundamental to the well-being of communities, cities, states and the country.  It was with this understanding that the City and County of San Francisco undertook a bold and audacious effort to ensure that everyone in the City By The Bay has not just the promise of health care in the form of insurance, but actual, delivered health care.

The program, Healthy San Francisco, currently provides health care to over 27,000 uninsured San Franciscans, including an estimated 37% of the City's uninsured adults, and looks to triple in participation by the end of 2009.

The program is funded in part by a per employee health care tax, levied by the City upon local businesses, requiring them to spend a certain amount on employee's health care or to pay into a City fund if they spend less than the requirement.  By establishing a tax rather than creating a "mandate" for employers to provide health care to their, Healthy San Francisco avoids a federal law--the Employee Retirement Income Security Act of 1974, known by the acronym ERISA--that prohibits states and localities from regulating or interfering with employer-based health insurance or pension benefits.

As with any innovative program, however, Healthy San Francisco faces some challenges to its continuation, one being the question of whether the program does actually escape running afoul of ERISA.  Yesterday, the entire federal Ninth Circuit Court of Appeals (the federal appeals court that includes California) upheld the ruling of an earlier panel of the appellate court's judges, finding that Healthy San Francisco can continue without running into ERISA problems.

The case will now likely go before the U.S. Supreme Court.  The decision by the Supreme Court may have a major impact on the ability of states and cities to attempt health care reform absent Congressional action.

The case is Golden Gate Restaurant Association v. City and County of San Francisco, No. 07-17370 (9th Cir. Mar. 9, 2009).

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Thursday Immigration Blog Roundup

Here are a few stories that were covered by blogs this week:

Articles on Polish and Italian migration show that closing the border slows return migration.  AP reports on the ICE detention system which holds five times the number of people it housed in 1994, including asylum seekers and immigrants whose applications were lost or mishandled.  The system is budgeted to hold 33,400 people every night, at a cost of $141 per detainee, when cheaper alternatives are available.  LatinaLista reports that about 10 percent of immigrant women in ICE detention are pregnant by rape and not given the option to terminate the pregnancies.

Conservative think tanks estimate that up to 300,000 construction jobs in the federal stimulus package could go to illegal immigrants, but the study has been debunked for using outdated data.  Immigration advocates point out that "if there were a legalization program...you can narrow the focus of immigration enforcement.  Then enforcement can really focus on the actual violent criminals."  A new study also finds that undocumented immigrants are paid less than legal immigrants.

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The Urgency of Now

Last week, President Obama hosted a health care summit, initiating a process to fulfill a key campaign promise: fixing our broken health care system.  Critics, and more than a few allies, wondered aloud whether he is taking on too much at once in pushing for health care reform while restarting the economy and repairing our banking system.  To the contrary, the question is whether he will take on enough.

Virtually all of America’s leaps forward in opportunity and economic security have emerged from crises that laid bare longstanding flaws in our national or international systems.  The Civil War produced Reconstruction and the Equal Protection Clause of the 14<sup>th</sup> Amendment.  The Great Depression produced Social Security, child labor laws, and worker protections.  World War II produced the GI Bill, while the horrors of the Holocaust led to the Universal Declaration of Human Rights.  And the direct action and constitutional crises of the civil rights movement produced a social and legal shift that has helped expand opportunity across lines race, gender, class, disability, and sexual orientation.

In each case, the underlying problems—slavery and racism, poverty and child exploitation, oppression and economic insecurity—had existed long before.  But the extreme urgency of the moment made transformative action possible.

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Come Fly With Me

The eye is one of the most complex organs in the human body. What was millions of years ago a simple concave receptor sensitive to ultra low frequencies of light has not just become an advanced organ that utilizes one-third of the nerve endings in the human body, but it has also become one of the most powerful influencers in the craft of rhetorical persuasion.  So much, that those who lack this basic faculty of perception face great obstacles in the pursuit of opportunity and equality.

I've been stewing over this for several days now, after learning of Pavel Obiukh, a Russian advocate who was denied access to a flight leaving Moscow the other week, after the flight crew learned that he was a patron who was blind.  The air carrier, S7, said it was in compliance with Russian law, which can deny access to a person with special needs if that person doesn't notify the carrier of such needs. Pavel did, in fact, notify S7, which failed to inform the flight crew, who then refused Pavel's entry onto the aircraft.

It's difficult to imagine such a situation happening in the United States, where an entire generation has grown up since the passing of the Americans with Disabilities Act. Yet, American perception mirrors more of Russian shortsightedness than that of America's own foresightedness in progress for people who have vision loss.

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Emerging Research on Health Care as a Human Right: They Get It

And by "they", we mean the very audiences we need in order to change the conversation about health in this country:  politically active moderates and liberals.  Recent focus groups with these audiences show an apparently growing comfort with not only declaring health as a human right, but also in recognizing what that would mean to health care reform.

These groups build on our national poll from 2007 showing that 72% of the general population believe that health is a human right.  Using the demographic data provided by the poll, our researchers at Belden Russonello & Stewart honed in on persuadable audiences to determine their receptivity to a number of human rights messages. 

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Thursday Immigration Blog Roundup

Business Week Online and the New York Times report on the Kauffman Foundation's study on the "flood" of young and highly-educated Indian and Chinese immigrants returning to their countries of origin in light of decreasing job opportunities and increasing immigration backlog in the United States.

The study, America's Loss is the World's Gain, also finds that immigrants are being pulled by increasing need for their skills set in India and China, as well as familiar social networks.  In the last 20 years, an estimated 50,000 immigrants returned to China and India, and an estimated 100,000 is projected to leave in the next 5 years.  Quote Professor Vivek Wadhwa, "We may not need all these workers in the
Read more at The Opportunity Agenda's blog.

U.S. during the deepening recession. But we will need them to help us recover from it." 

Foreign Policy also reports that 1-3 million Mexicans are expected to leave the U.S. in the coming months.

A new report by the U.S. Small Business Administration found that immigrant-owned businesses generate nearly 12 percent of all business income in the United States.  The report, "Estimating the Contribution of Immigrant Business Owners to the U.S. Economy," Immigrants are also 30 percent more likely to open businesses, and over 10 percent of these businesses generate employment.

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Investing in Early Education Equality

Education is perhaps the closest thing we have to a social panacea.  When it works, it can fuel social mobility, economic productivity, crime prevention, and personal fulfillment.  And we know that the earlier a child enters school, the more likely he or she is to have a successful academic career.  So why is it so hard to make universal preschool a national priority?

Head Start and Early Head Start, the federal preschool program for children from low-income families, provide a powerful argument for incorporating preschool into the mainstream education system and funding it fully. Implemented by a patchwork of non-profit organizations and school districts, Head Start and Early Head Start have been demonstrated to prevent grade repetition and increase the likelihood of high school completion and college attendance.  However, it is means tested, meaning that a child whose parents earn more than the poverty level but not enough to afford a private preschool will likely be left out.  Additionally, providers have consistent difficulty hiring quality teachers, as the limited funding available allows for an average salary of only $21,000, which is less than half the salary of a public school teacher.

Some states have opted to take the lead in providing universal preschool. These efforts have occured in the absence of longterm federal support, though, which has left them in a precarious financial position and too often operating as a loose affiliation of providers as opposed to a coherent network of classrooms housed within school districts.

President Obama has pledged to make early education a priority, and took a solid first step by appointing a Secretary of Education who has been a consistent proponent of it.  Let's hope that he makes good on this promise, and that our children have every opportunity to reach their full potential.

Read more at The Opportunity Agenda's blog.

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Twitter for Nonprofits?

When Nightline covers a topic, it's safe to say it's hit the mainstream.  Therefore, Twitter, on Nightline this past Wednesday has reached the public consciousness, albeit tepidly.

Even Nightline seems to have misgivings.  While one host, Terry Moran has amassed a very respectable following of 28,617 people (as of this writing) on Twitter, Martin Bashir seemed proud to announce that he doesn't Twitter.  Despite his apparent antipathy, Twitter has racked up six million users as measured by Complete.com, a website that follows such things.

Taking a step back to explain, Twitter is a micro-blogging platform.  Users publish very short missives, of up to 140 characters, and these are displayed for other users who have signed up to receive them.  You can "tweet," as it's called, from twitter.com, from your cellphone, and applications on your computer.  (Here's a guide to get started if you're interested.)

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Living Our Values

One of the themes President Obama spoke about in his speech the other night was returning to the America we grew up knowing--returning to the America which we believe in.  In addressing the nation, President Obama reminded us that "living our values doesn't make us weaker.  It makes us safer, and it makes us stronger."

With this message resonating in our ears, it's difficult to hear about what a Sheriff in Arizona has been doing recently.  Relying heavily on racial profiling, Sheriff Jeff Arpaio has been pulling over "Latino-looking" drivers have been pulled over for minor violations and asked to produce Social Security cards.  He's focused his efforts on sidewalk "crime sweeps" in low-crime neighborhoods--detaining those who cannot prove their citizenship status on spot, while ignoring the real issues our communities face.

Finally, earlier this month Sheriff Arpaio was getting ready to round up immigrant men and women and march them off to separate "tent cities" surrounded by electric fences.

Our friend's at America's Voice have a made a video detailing some of these affronts on basic human dignity.  You may view and sign a petition being sent to the Attorney General demanding an investigation of Sheriff Arpaio here.

Read more at The Opportunity Agenda's blog.

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Diaries

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