To Win, Democrats Must Focus on Accountability

Many election analyses in the Trump era pose false choices for Democrats seeking to gain control of the U.S. Congress. That’s especially true in the abundant category of commentary and analysis asking: “What should Democrats do?”

Consider some of the classics of the “advice” genre: “Democrats should focus on health care, not Russia” or, “Trump’s appeal was based on economics, not racism.”

In other words, authors posit overly provocative dichotomies or one-size-fits-all answers when the reality is that most of these “different” strategies are either complementary or at least not mutually exclusive.

That might be why the Democratic party is managing to do two things at once, but not necessarily in a good way. On the one hand, Democrats are running energetically. Charismatic first-time candidates, innumerable volunteers, and an increase in grassroots donations are features of races across the country. On the other hand, the party itself is in passive mode, having largely failed to offer any shared message beyond “Republicans will take away coverage for people with pre-existing conditions.” What’s happening on the ground appears to be in spite of the lack of party leadership, not because of it.

Protecting people with pre-existing conditions is obviously a powerful and authentic message with real-life consequences. All candidates ought to discuss how Republicans are an existential threat to health care, including individuals with pre-existing conditions. But as a message, protecting Obamacare and its protections is not expansive enough to attach to each day’s news hooks.

Yes, you can argue that it is challenging to create a broad national message because Trump is at the center of all political conversation, the Democratic Party lacks trusted leaders, the party’s diversity makes a single theme difficult, and the media environment is too splintered for a single message to resonate.

The one thing many leading commenters and consultants do agree on is that we are in a “populist moment,” even as the way they use the term “populism” often obscures more than it reveals; “populism” has become a mashup of distinct and discordant historical tropes.

But understood in its best sense, there is nothing more populist than using democracy to try to hold the powerful to account. Thus the populist moment suggests a campaign theme is possible, one that ties many issues together and can galvanize voters: Corruption and accountability.

Democrats should run on ensuring accountability for the rich and powerful, and then it should actually hold those actors accountable.

Such a theme is not just well-suited for elections in 2018, but for Democrats in Congress in 2019 and 2020, a Democratic Party presidential candidate in 2020, and a potential Democratic president taking office in 2021.

Accountability is a theme that connects Brett Kavanaugh’s confirmation and powerful men getting away with assault to private equity eviscerating iconic American companies (and the workers who actually made them great) like Toys “R” Us and Sears.

It taps into workers’ anger at bosses getting away with looting companies, the unsafe drinking water in Flint and elsewhere, the botched response to Hurricane Maria in Puerto Rico, the role of Wall Street in fueling the Great Recession, and so much more.

Even “Russiagate” fits within this roomy theme by arguing that no one—not even the president, or the valedictorian of Georgetown Prep—should be above the law. The rich and powerful should be held accountable every time they behave egregiously.

It’s an argument that the biggest problems in our country are not created by the weakest amongst us but by the most powerful. It centers a critical question: If things are broken, who had the power to break them?

That means that the rich and powerful should face more than just derision or handwringing—whether they are guilty of tanking the world’s economy by fraud in the housing market or of conspiring with the Russians to cheat in an election, jail should be a possible outcome.

That means when police abuse their power, we as a society will act as if Black Lives Matter and hold police to account when they break the law.

That means that we should listen to the voices of #MeToo and #BelieveSurvivors while punishing the powerful men the movement has exposed.

This is not to suggest that punishing law-breaking and immorality should be a partisan issue. It has not always been one. George H.W. Bush’s Justice Department was far more aggressive prosecuting the banksters of the 1980s “Savings and Loans” crisis than Barack Obama’s Justice Department was during the Great Recession. And of course, Democrats have also been guilty of their fair share of corruption.

For now, we face an enormous threat. It is not clear that there is any precedent in United States history for how completely the Republican Party has become the party of the rich and powerful and is covering up for rampant corruption and rampant abuses of power.

A former Chuck Grassley (R-IA) staffer who spent 34 years doing congressional oversight work for Republicans in Congress declared in a must-read essay that “oversight by Congress is a lost art. What Republicans have wrought is downright destruction. If Democrats retake either chamber of Congress in November, they are obligated to resuscitate that function Republicans have allowed to atrophy in service to their president.”

There are currently no congressional Republicans suing the president to prevent his alleged continued acceptance of bribes, otherwise known as “emoluments,” a fancy term in the Constitution that essentially means taking money from foreign governments to do their bidding, including, for example, Saudi Arabia.

Elected Republican oversight of the Trump administration has been essentially non-existent, and the key institutions of the far right (Fox News, talk radio, Breitbart) are no better.

Marginal Trump supporters and voters skeptical of both parties distrust absolute power in the hands of someone as obviously venal and histrionic as Trump. Running on the need for oversight of the excesses of Trump—as well as the excesses of plutocrats, polluters, and the like—would be responsive to real concerns.

And yet veteran Democratic pollster Celinda Lake cannot secure funding to poll whether Democrats should be discussing the Trump-Russia story and, if so, how they should make it meaningful to voters. That anecdote fits within a general lack of appreciation for oversight by the Democratic Party’s leadership. As the Los Angeles Times observed, “Democrats have occasionally sold themselves as a counterweight to Trump in Washington, but they’ve talked little about how, if they retake control of the House of Representatives, they could quickly rev up congressional probes that have withered under Republican leadership.”

That indifference to oversight is a mistake. Democrats should run on oversight of the powerful—and then, if they are accorded the majority, they should act on that promise by performing oversight of not just how Trump avoids paying taxes, but of how the rich in general do the same, as well as an array of other topics ranging from the Trump-Russia connections to how financial companies take advantage of the working poor in sectors ranging from housing and automobiles to for-profit higher education and payday lending.

Such oversight by Democrats would inform the platforms of presidential candidates and lay the groundwork for a potential administration in 2021 significantly more dedicated to reining in law-breaking elites than the Obama administration was.

Democrats should run on bringing accountability to the rich—and then do it. As Republicans seek to contest the mantle of “populism,” let’s have that contest be about a truer and purer form of populism—holding the powerful more accountable for their failings, rather than letting them behave with impunity.

Because in the long run a successful democracy cannot function if accountability for elites is a partisan issue.

Anti-Choice Activist Pleads Guilty to Defrauding Obamacare

The founder of a radical anti-choice organization known as Survivors of the Abortion Holocaust pleaded guilty last week to defrauding the Affordable Care Act (ACA) marketplaces of at least $27 million.

The U.S. Department of Justice (DOJ) announced the guilty plea on October 12, detailing the charges against Jeff White, a longtime anti-choice activist based in California, and his son, Nicholas White. The Whites, according to the DOJ, conspired to defraud ACA marketplaces “by fraudulently enrolling individuals in ACA plans in states where the individuals did not live.”

Jeff and Nicholas White created “phony residential leases using fictitious landlords in various states” to defraud the ACA, also known as Obamacare, according to the DOJ. They used an online application to secure “false cell phone numbers for the individuals with area codes that made it appear that the individuals lived at the fictitious addresses, and provided the false cell phone numbers to the ACA plans.”

The Whites were paid thousands for each referral to an addiction treatment program, while they “enrolled the individuals in ACA plans in states that paid the highest amount for substance abuse treatment, even though the individuals did not live in those states,” according to the DOJ. 

“This case is believed to be the first of its kind involving fraudulent enrollment of individuals in ACA plans on a national scale,” U.S. Attorney John H. Durham said in a statement, adding that fraud schemes can result in higher insurance premiums in the ACA marketplaces. 

Jeff White, who has railed against Obamacare in online posts, claimed in a recent Facebook post that the reason he defrauded the Obamacare marketplace was to help addicts receive medical care. Writing that he placed more than 300 people into addiction treatment through the defrauding scheme, he claimed the ACA fraud did not “line my own pockets.”

“It was a criminal conspiracy I owned up to and, therefore, I freely entered a plea,” he wrote on Facebook.

The Whites, who were released on bond, face up to ten years in prison. Their sentencing is scheduled for January 4.

According to the Survivors of the Abortion Holocaust website, Jeff White was a member of Operation Rescue—an anti-choice group with a long history of encouraging violence against abortion care providers—from 1988 to 1998. He founded the American Anti-Persecution League, which provides legal help to anti-choice protesters, according to the organization’s website. 

 Editorial and Research Associate Laura Huss contributed to this report. 

New York Governor Cuomo Should Not Play Politics With Black Maternal Health

Shortly after the very first national Black Maternal Health Week, founded and led by the Black Mamas Matter Alliance, New York Gov. Andrew Cuomo (D) announced his intentions to address high rates of maternal mortality and morbidity among Black women in New York state. The comprehensive initiative includes an expansion of Medicaid coverage for doulas, reducing the out-of-pocket costs for what is often life-saving care for low-income families.

On April 22, the New York Times reported that “the design of the doula pilot program will be finalized by the state’s Health Department within 45 days, and the program will start immediately thereafter.” But 45 days have long come and gone and, despite launching a task force, the New York State Department of Health still has no solidified program plan or a launch date to begin implementation.

In an election year that will determine whether the political tides will change, advocates are wary of empty promises to address racial disparities in maternal health. Gov. Cuomo shouldn’t play politics with Black maternal health. Rather, the governor should let New York state be the example the United States needs by getting doula Medicaid reimbursement right. Now.

New York has the opportunity to implement a successful Medicaid program where other states—like Oregon and Minnesota, the only other states to allow Medicaid reimbursement for doulas—have fallen short. In Minnesota, a low reimbursement rate and oversight requirements for doulas have hindered implementation.

New York can start with prioritizing the participation of community-based doulas who center Black women in their work in the Medicaid reimbursement program. To truly address Black maternal health, the New York Department of Health must invest in Black women’s maternity care work.

Community-based doulas, who typically serve low-income Black and Latinx women who would otherwise go without doula care, provide culturally relevant and holistic care in communities with the greatest need—often while under-resourced and overlooked by state and city officials looking for solutions to problems when those solutions may be right in front of them. Doula care in general has been associated with a lower likelihood of medical interventions during birth and cesarean section, reductions in complications, shorter labor, lower preterm birth rates, and a reduced likelihood of a low-birth weight infant. Doula care is also associated with higher breastfeeding intention and initiation. Community-based doulas go beyond birth work and lactation support to help their clients navigate various social and economic barriers to good birth outcomes.

Brooklyn-based Ancient Song Doula Services recently launched the campaign #BeyondBirthWork to explain the role of community-based doulas in reducing racial disparities in maternal health outcomes, and to organize support for their inclusion in the New York state doula Medicaid pilot program.

Evidence shows that community-based doulas, who come from the communities they serve, take on roles akin to social workers, health care and education advocates, sexual health educators, and health systems navigators. These doulas help their clients with their social and nonmedical needs and, in doing so, help address socioeconomic and racial disparities. New York City’s By My Side Birth Support Program provides free access to doula support to birthing Black and Latinx parents and in high-poverty neighborhoods. A study of the program shows clients have benefited from emotional, informational, and social support. The study concluded that the program could help address inequities in birth outcomes.

Chanel Porchia-Albert, founding executive director of Ancient Song Doula Services, knows that Black community-based doulas provide a holistic model of care that meets client needs and advocates for a shift in the health-care system. “In order to effectively address racial disparities of Black women within reproductive health, the current system needs to move from its prototype of care that does not incorporate community and nontraditional care providers as active stakeholders,” Porchia-Albert said. “Our culture of care must move in a direction that actively centers the pregnant person and understands the intersectional needs of that community.”

At least two studies have found that matching birthing parents to same-ethnicity doulas contributes to better maternal health and birth outcomes. In Minnesota, 92 percent of Black Medicaid clients with doula support initiated breastfeeding compared to 70 percent of the general Medicaid population. That study’s authors concluded that culturally appropriate doula care, ethnic concordance between doulas and clients, and nonmedical support offered by racially diverse doulas may increase the likelihood of breastfeeding initiation. Also in Minnesota, researchers found that a program training Somali women to serve as doulas for other Somali women reduced cesarean section rates and increased confidence among hospital nursing staff who had worked with Somali doulas. In this case, same-ethnicity doulas helped bridge cultural and ethnic divides between their clients and hospital staff.

Furthermore, Black women-led models of care have been proven to reduce racial disparities in maternal health and birth outcomes and help improve Black maternal health. For example, The JJ Way client- and community-centered model of care, founded by midwife Jennie Joseph, provides culturally relevant care that is shown to eliminate racial disparities in preterm birth and low birth weight.

If New York state is to make improvements in Black maternal health and reduce racial disparities—changes it desperately needs—it must prioritize the leadership of Black women-led models of care. This requires the elimination of barriers to Black doulas’ involvement in the Medicaid pilot program. Appointing Black women-led doula organizations as program implementers, setting fair and livable reimbursement rates, and easing the reimbursement process can help ensure that Black community-based doulas can utilize the reimbursement program to help Black birthing parents thrive.

First, appointing Black women-led doula organizations as implementers of the program can help the health department reach its intended goals of reducing poor outcomes among Black birthing parents. Black women-led doula organizations, like Ancient Song Doula Services in Brooklyn and Village Birth International in Syracuse, provide culturally relevant care that helps to mitigate the effects of racial discrimination and implicit bias. “When you trust Black women-led organizations in facilitating that care, you are not only investing in that organization, you are shifting a paradigm towards the healing of a community and actively dismantling racism within the health-care system,” said Porchia-Albert.

Additionally, investing in existing models of care that serve Black birthing parents to help them expand their services could go a long way. Financial investments would facilitate the training of more doulas from low-income communities. Doula training can cost up to $1,200, an expense that is unaffordable for many people from low-income communities.

Even after being trained, some doulas find they are unable to make a career out of being a doula. In Oregon, the standard doula reimbursement is only $350 total for two prenatal visits, support on the day of delivery, and two postpartum visits. In Minnesota, the standard reimbursement is slightly higher at $411. Shafia Monroe, a midwife based in Oregon and founder of the International Center for Traditional Childbearing, says a $1,000 reimbursement is more ideal but acknowledges that having reimbursement at all is a success. “The fact that Medicaid reimbursement for doulas is in place is a win. Now, a doula who was helping her friends for free is at least getting paid $350,” Monroe said.

Paying doulas a living wage under the Medicaid reimbursement program is critical. Asteir Bey, founder of Co-Mothering Syracuse and co-director of Village Birth International, says community-based doulas have struggled to make ends meet and provide services. “Doulas serving birthing people in their own community struggle to do so while sometimes maintaining full- or part-time employment and tending to the needs of their own family in low-resourced communities. And despite reducing death and illness for birthing people engaged in doula care, community-based organizations have struggled to expand services to the women who need it most due to lack of funding,” Bey shared. “Medicaid reimbursement that provides a true living wage by compensating full spectrum doula care and the range of services provided is essential to the success of the program in New York state.”

Gov. Cuomo should not only prioritize setting a livable reimbursement rate, but he should ensure the program reduces administrative burdens and allows doulas to be reimbursed under a group model rather than requiring they get reimbursed as individuals. At the individual level, the administrative effort to manage all the necessary paperwork for Medicaid reimbursement could prevent some doulas from participating.

At the end of the day, New York state must do what it can so that at-risk people get the care and support they need through a sustainable model for care providers. “Families who receive Medicaid should be able to access doulas,” Monroe emphasized. By supporting Black doulas’ participation in Medicaid reimbursement, the New York State Department of Health can help families who need it most receive culturally appropriate care.

What remains to be seen is if the governor will follow through on his promises. The state is currently gathering recommendations from appointed task force members, but there are no clear plans to launch the pilot program before 2019. Gov. Cuomo should set aside his political motivations and do what he can now to follow through on his promises and address Black maternal health by prioritizing Black women-led efforts.

Mary Mayhew Attacked Health-Care Access In Maine. Now She’s Trump’s Pick to Head Medicaid.

The Trump administration announced the appointment Monday of Mary Mayhew, the former Maine commissioner of Health and Human Services, to head the federal Medicaid program. The decision shocked Maine residents and health care advocates who pointed to Mayhew’s long history of advocating for and executing deep cuts in social safety net programs and her opposition to expanding Medicaid access in the state.

“From the perspective of someone who thinks that we should be providing people with more health care, not less, it’s hard to imagine someone less suited for this job than former commissioner Mayhew,” said David Farmer, former communications director for Mainers for Healthcare, in an interview with Rewire.News. Mainers for Health Care ran a successful ballot initiative last year to expand Medicaid in the state under the Affordable Care Act, but the expansion has since been stonewalled by Republican Gov. Paul LePage.

“I can’t imagine anyone who would bring the same mix of ideological cruelty and history of mismanagement to a high-level job like this,” Farmer said. “The only way that Mary Mayhew would be a candidate for this position is if your goal is to dismantle the Medicaid program.”

Mayhew, who ran Maine’s Department of Health and Human Services (DHHS) until May 2017, finished a distant third in the state’s Republican primary for governor. Under LePage—a vocal opponent of Medicaid expansion who has continuously blocked its implementation in the state—she oversaw massive cuts to programs like Medicaid and food stamps. “She’s not just hostile to Medicaid; when she was part of Governor LePage’s administration in Maine, she was front and center in that administration’s quest to burn down pretty much the entirety of the social safety net,” said Rebecca Vallas, vice president of the Poverty to Prosperity program at the Center for American Progress. “She was a vocal proponent of taking nutrition assistance through food stamps away from people who were trying to find work or couldn’t get enough hours at their job.”

LePage lauded Mayhew when she left the department last year, saying in a statement that she “spearheaded” his efforts to make cuts to Medicaid and other social safety net programs. On Mayhew’s watch, enrollment in Maine’s Medicaid program, MaineCare, dropped by 37 percent, taking healthcare away from about 80,000 people according to the ACLU of Maine. As a result, the percentage of uninsured children has risen, and Maine dropped from tenth to 22nd in national health rankings, according to a United Health Foundation report.

Mayhew’s record of mismanagement has also alarmed advocates. In 2014, Maine’s DHHS revoked a $900,000 contract with conservative consultant Gary Alexander after he produced a heavily plagiarized report for the department. At the time, Mayhew blamed the controversy on “the media and Democrats.”

With Maine now in her rearview mirror, however, Mayhew will have broad authority to continue her track record of making deep cuts to Medicaid, though she will excuse herself from matters involving Maine. “It’s almost like the Trump administration went looking for the biggest critic of the Medicaid program and found her and then decided she should be in charge of Medicaid,” said Vallas, who pointed out that Mayhew has gone to other state legislatures to lobby against expanding Medicaid under the ACA. “She appears to hate Medicaid so much that she wasn’t just going to stand in the way of Maine expanding it and enabling more people to have health insurance, but she actually felt the need to go to Florida and Utah and tell them also not to give more people health insurance through Medicaid.”

Mayhew replaces Brian Neale as deputy administrator and director of the Center for Medicaid and CHIP Services. Before leaving his post in January, Neale rescinded a memo that protected abortion care providers from state attacks without evidence of wrongdoing and pushed to allow states to implement work requirements for Medicaid access. With Mayhew in charge, the more than 70 million people who depend on Medicaid could be at risk.

News of Mayhew’s appointment coincided with a report from Arkansas, the first state to implement work requirements for Medicaid eligibility, finding that roughly 8,500 people from the state have been stripped of their health care in the two months since the new policy was implemented.

It’s a policy that advocates worry Mayhew may try to take nationwide. “This is the very policy that Mary Mayhew wants to see in every state, in lockstep with what Trump has been trying to do,” Vallas said. “For anyone who has been still wondering what the agenda behind these Medicaid work requirements is, they need to look no further than Arkansas to see what it really is. It’s an attack on Medicaid, an attempt to drop as many people from coverage as possible. When it’s sort of thinly disguised, it doesn’t look like cuts.”

Racism Kills: What Cultural Connection Can Do About It

This is the second part of a Rewire.News series on potential interventions for the health impacts of racism. Read part one here.

Here is what we know: Racism is bad for your health. Here is what we’re exploring: possible interventions that could help ameliorate the health impacts on people of color while the broader work to dismantle racism continues. In the first installment of this series, we explored how self-regulation, a set of teachable skills and behaviors that help us cope with stress, could be a key to reducing or eliminating the impacts of racism and discrimination. But there are other areas of research that show some potential. One such area social science researchers have explored is how racial identity, cultural connection, and conversations with kids about race might improve resiliency in the face of racism and systemic bias.

In part two, we’ll take a closer look at this research, and how a person’s relationship to their racial and ethnic community shapes their experience with discrimination. While there is still more research to do in this arena, certain behaviors and attitudes have been found to promote resilience in the face of discrimination for people of color. These findings lend themselves toward certain interventions, both on the individual and community level, that could potentially improve the health of people of color.

We should also note that any interventions regarding racial and ethnic identity are complicated by the nature of race and ethnicity itself—fluid constructs that are very much shaped by power and structure, and do not always offer individuals easy or accessible routes toward identity or connection. This can be particularly true for people with more than one racial identity or ethnicity and people who are disconnected from their communities or practices for a whole host of reasons. That said, when it comes to people who have a strong cultural connection and whose parents talk to them about race, the opportunities for intervention are clear, based on the research that is currently available.

Three Factors

Enrique Neblett, a clinical psychologist at the University of North Carolina at Chapel Hill, began his career as a counselor working with Latinx and Black youth. In a phone interview with Rewire.News, Neblett shared: “I was just really impressed with how [among the young people who] experienced racial discrimination, some kids were really impacted by it but others weren’t.” That observation, Neblett explained, led him to his research interest: “I wanted to understand why some kids were resilient and some weren’t.”

In a 2012 review of the existing literature of the factors associated with positive development of youth of color, Neblett and his colleagues Deborah Rivas-Drake and Adriana J. Umaña-Taylor identified three factors that previous researchers have found to be associated with better outcomes: racial and ethnic identity, racial socialization, and cultural orientation.

Racial and ethnic identity is defined in the paper as “youth’s attitudes and behaviors that define the significance and meaning of race and ethnicity in their lives.” One study they cite from 2003 that addresses this factor looked at self-esteem among Mexican American youth and the impact of both ethnic identity and discrimination on that self-esteem. What they expected to find was that a stronger ethnic identity would be connected to higher levels of discrimination and lower self-esteem. Instead, they found that while yes, the youth with a positive feeling about being Mexican-American did experience more discrimination, they also had stronger self-esteem than their counterparts who didn’t have such positive feelings about their ethnic identity. Another study found that for Black youth, positive connection to their racial group was associated with better academic achievement and fewer problem behaviors (such as skipping class, getting into fights, or cheating on exams).

Racial socialization is defined as “a process through which caregivers convey implicit and explicit messages about the significance and meaning of race and ethnicity, teach children about what it means to be a member of a racial and/or ethnic minority group, and help youth learn to cope with discrimination.” Neblett himself looked at this factor in a 2008 study, which he says is his most useful and exciting finding to date. That study surveyed Black adolescent youth in the Midwest, ages 11 to 17, and compared a number of measures of well-being—depressive symptoms, stress, problem behaviors—alongside experiences of discrimination and racial socialization messages. What the study found is that for the adolescents whose parents were talking to them about race, as well as integrating culturally relevant activities, their stress levels did not increase as they experienced higher levels of discrimination. “The data shows that it’s not just what parents are saying, it’s in tandem with buying books and toys that reflect the cultural background,” explained Neblett. “In addition, for the young people whose parents weren’t talking about race at all, or who were saying negative things about being Black, when they experience discrimination, their depressive symptoms were off the charts, they were getting in trouble in school, etc.”

The research review explains the impact of this socialization, arguing that it enables “youth to think more positively about themselves and equip[s] them with specific strategies and skills to successfully negotiate the challenges they encounter.” The idea here is that being educated about racial and ethnic identity helps young people feel good about themselves and gives them skills to deal with the problems they might face in the future.

The third factor shown in the research to improve outcomes, cultural orientation is explained as “youth’s orientations toward mainstream culture and their ethnic culture and has often been indexed by youth’s endorsement of particular cultural values.” Neblett investigated this question of cultural orientation in a 2012 study with colleague Sierra Carter, now a professor of psychology at Georgia State University.

They compared blood pressure and certain measures of identity and worldview in a group of 200 African American college students. Researchers asked the students to fill out a survey that evaluated their experiences with racial discrimination, their racial identity, and their relationship to an “Africentric worldview.” “In contrast to a European worldview,” the paper explains, “an optimal Africentric belief system is characterized by a nonmaterialistic, holistic, and communal orientation.” So things like being more oriented toward community and putting emphasis on things other than amassing material possessions are part of this worldview. That orientation, as well as the other elements in the study, were measured via a survey that included questions like, “If I just had more money, my life would be more satisfying; If I were better looking, my relationships with others would be more satisfying; and I feel badly when I see friends from high school who have better cars, clothes, or homes than I do.”

The study essentially compared three things: experiences of discrimination, blood pressure, and identity and worldview factors referenced above. Researchers found that among some of the participants who had experienced high levels of historic discrimination, the lowest blood pressures were among those “who felt that others viewed African Americans less favorably and who endorsed the uniqueness of the African American experience.” They also found that the individuals whose well-being was tied to more materialistic things had higher blood pressure in relationship to experiences of discrimination. “In other words, greater prior racial discrimination experiences were associated with greater [blood pressure] for individuals whose positive well-being was based on material possessions such as money, appearance, and clothing.”

This study illustrates what is reinforced in the broader literature, which is that having an attitude that is grounded in your specific cultural context is associated with resilience in the face of discrimination. That echoes similar findings from Monica Tsethlikai on Native communities, referenced in the first installment of our series. Tsethlikai found that Native children who were engaged in activities based in their tribal communities had better cognitive skills, skills that are part of the skill set needed to cope with stress. “It’s a really tough place for ethnic minorities, and the more grounded they are in cultural traditions and spirituality, the better off they will be,” she explained.

Health Disparities

A bulk of the existing psychology research on racial and ethnic identity focuses on indicators of emotional well-being, not physical health. “Clinical psychologists don’t tend to study physical health,” Neblett said. But he, and others, have been exploring these linkages. “I became interested in that because wow—how do we understand these blatant physical health disparities?” Neblett is referring to the racial disparities in health outcomes, especially for African Americans, who have high rates of heart disease, asthma, maternal mortality and diabetes among a host of other problems. In addition to the blood pressure study referenced above, Neblett and his colleagues have been trying to paint a more complete picture of the impact of discrimination on well-being by including psychological measures.

Another such study from 2013, conducted with Steven O. Roberts, a psychology professor at Stanford University, measured nervous system responses among African American students, ages 18-29, while listening to (and being asked to imagine) scenarios that evoked varying levels of discrimination. For example, one scenario is described as “a police officer unjustly pulls someone aside and uses a racial slur to denigrate the individual’s race.” The study then looked at how the subjects’ nervous systems responded to survey questions about their racial identity and how African Americans are perceived. Overall, Neblett said, they found that “identity is influencing how your body is responding to racial stimuli.”

They found that participants who “felt really positively about being African American had a more kind of flight-or-fight response when [they] imagined a vignette with a white perpetrator.” The flight-or-fight response refers to activation of the sympathetic nervous system, which kicks in when we are facing a perceived threat. It’s associated with certain physiological changes, which Neblett’s study measured. Those who didn’t have the same level of positive feeling about being African American showed less or more muted responses to the same vignettes.

This study isn’t the first to look at racial identity and find what could be considered mixed results. More activation in response to stimuli among those with positive feelings about being Black actually goes against what some of the earlier findings, in particular what Neblett and his co-authors found in the review of the literature, imply about strong racial identity as a protective factor.

A more recent study Neblett conducted that has yet to be published found something along similar lines. From 2014-2017, Neblett surveyed a group of Black students, ages 18-22, at the University of North Carolina (UNC) at Chapel Hill. The students were surveyed three times over that period. For the students who said that being Black was really important to them, Neblett found that their level of vigilance went up the following year, and that increased vigilance was correlated with a more negative mood.

The big question here is why these findings differ from previous research. Neblett’s theory is that context plays a big role. Neblett said that the study was conducted during a tense time on the UNC Chapel Hill campus, when debates where raging about whether to remove a confederate statue on campus, and rumors about an potential Ku Klux Klan rally on campus. “So if being Black is a central part of my identity, and I’m in a context where all of this is going on, it’s a lot, and you might experience more distress,” explained Neblett of the results. So he is now embarking on more research, building off of this study.

He and Camara Jules P. Harrell, a professor at Howard University, were recently awarded a National Science Foundation grant to replicate the study at Howard University. “I don’t think our ultimate conclusion is that racial identity is bad for you,” explains Neblett. “There is just going to be some nuance, and it’s going to take some time to figure that out. We think it may be the context you’re in—a place like UNC or someplace where you’re not thinking about race every day.” Neblett and Harrell will be exploring the hypothesis that students at Howard, a historically Black university, might respond differently because of their environment. “Identity will be protective in a context like Howard, where you aren’t dealing with things like the KKK,” said Neblett of their hypothesis. They will also be adding in physiological measures into this next phase of the study.

Tiffany Yip, a professor of psychology at Fordham University, recently published a paper looking more deeply into the mixed findings on the question of racial and ethnic identity. She agrees that there are many factors that might explain the results, including context, as well as variations between ethnic groups and inconsistent methodologies. Both she and Neblett agree that rather than disregard the idea that a strong racial and ethnic identity could be beneficial, more research is needed to explain the nuance.

Next Steps

The question underlying all of this research is how it might actually be applied so that people of color can benefit from what we know can improve health in the face of racism. While these applications aren’t usually the domain of psychologists, unless they are specifically in applied psychology or public health, Neblett has been shifting some of his efforts in that direction. “With all the stuff that has been going on, I’ve been really hungry to figure out a way to get in the communities and figure out how the stuff we’re studying can benefit real people in real time.” To that end, he’s been working with a predominantly Black and low-income community in southeastern Raleigh, North Carolina, to help parents talk to their kids about race and racism. The youth have also asked for help responding to experiences of racism—like being stopped more by school security officers. It’s a slow process, he says, in part because he wants it to be informed by what community members actually want and need.

Neblett’s project is just one example of how these findings could be applied. Tsethlikai’s research on Native languages and games could be used to design (and fund) language programming and other cultural activities in communities and schools. And the researchers’ work on Africentric worldview could be turned into books and games for Black children and families aimed at strengthening cultural orientation.

At its most basic, these findings encourage people of color to resist assimilation, and center cultural practices and values. It is not an easy task given the context of racism and white supremacy in the United States, but the hope is that this kind of work will be propelled by scientific research that promotes its positive impact on health and well-being.

Maine Medicaid Hopefuls Suffer While Paul LePage Ignores Voters’ Will

Naomi Loss is a nurse in Maine who looks after a daughter, Bethany, who has epilepsy and cognitive disabilities. Bethany was covered by her mom’s health insurance until April, when she turned 26. Today she is uninsured, works low-wage jobs, and her seizure medication costs more than $2,000 a month.

Even with a pharmacy discount, Loss spends more than $1,200 per month out of pocket.

Her daughter is among the 70,000 Mainers waiting to receive health coverage under the Medicaid expansion passed by voters last November—expansion that Republican Gov. Paul LePage has refused to implement

“My concern is that I’m not going to be around forever and trying to help her be more independent is important,” Loss told Rewire.News. “It’s been a huge worry for a very long time.”

Maine Equal Justice Partners (MEJP), a group that campaigned for the ballot referendum, has sued the LePage administration for not implementing the popular law and has helped Bethany with the MaineCare expansion application and appeal so that her health costs can be covered. If the expansion is approved by the governor, it would cover her doctor visits, lab work, medications, and give her access to services like rehab and transportation that could allow her to live independently with the help of a caseworker, Loss said.

“The people of the state spoke in terms of the vote and passed the expansion. The governor refusing to release the funds to allow that to happen is really going against what the people of the state said they wanted and is really not fair,” she said. “We elect our officials to do what’s in the best interest and to follow the wishes of the people who vote them in, and when there are specific referendums like this, then it needs to happen. It takes a toll on people who need these services.”

Going without needed health care has a significant effect on peoples’ lives, said Robyn Merrill, executive director of MEJP. “It’s unacceptable and unnecessary that people who became eligible for health coverage under the law last July are still waiting for care. There is a human cost to this delay,” she said.

Almost 60 percent of voters approved the ballot initiative last November so it is the law, Merrill said. About 3,500 people have applied for coverage this year. LePage is term limited and chances are high that a new governor will implement the law once LePage’s time in office ends. Despite one of the candidates flip-flopping on the issue, all Democrats and Republicans vying for the governorship seem to be in favor of following the edict of the 2017 ballot measure, reports the Washington Post.

The LePage administration last month submitted the court-ordered documents needed to expand Medicaid but also sent a letter urging the federal government to reject it.

Meanwhile, Mary Mayhew, LePage’s former health commissioner and recent gubernatorial candidate who lost in the June primary, has been chosen to lead Medicaid nationwide after she opposed the expansion in Maine. Mayhew is known for decimating public assistance in economic austerity programs, including food stamps, and leaves behind a legacy of cuts to social service programs that will affect Maine for years, according to one former state legislator.

MEJP and the the LePage administration lawyers gave testimony at a Superior Court hearing in Portland in late September. A decision is expected by the end of the month and chances are the losing side will appeal and the matter will be referred to a higher court for a final decision, advocates said.

While the legal battle and politics play out, residents like Eric Spahn, 62, of Brunswick, are still waiting, delaying treatment for kidney disease, cataracts, diabetes, and hepatitis C.

He used to be covered until about 36,000 adults with low incomes like him were kicked off Medicaid when the LePage administration tightened eligibility requirements in 2013.

“I’m hoping I will get accepted to the program. I know it’s not going to be easy getting a kidney out of them but maybe I can get my cataracts fixed and go back to driving,” Spahn told Rewire.News. “It’s kind of controversial, but I do believe health care to be a human right.”

Scott Walker’s Path to Re-Election: ‘Muddying the Waters’ on Health Care

Wisconsin Gov. Scott Walker (R), whose effort to undercut the Affordable Care Act (ACA) has made health care more expensive and less accessible, is recasting himself as a defender of quality health-care access in his campaign for re-election.

Walker has been at the forefront of the coordinated GOP plan to ensure the ACA, also known as Obamacare, can’t function the way it was meant to when congressional Democrats passed the legislation in 2009. Walker has refused to accept federal dollars to expand Medicaid under the ACA, dismissing expansion as “welfare” for families who live just above the poverty line. His administration joined a lawsuit in February meant to remove ACA protections for people with pre-existing conditions. Walker, like Donald Trump, ran for president on a pledge to repeal the health-care reform law.

But you’d never know that today, as Walker campaigns for a third term against Democrat Tony Evers, who wants to expand Medicaid access and supports Wisconsin Democrats’ push for a public option. On the campaign trail and in interviews, Walker has said he would convene the state legislature to pass protections for pre-existing conditions if the anti-ACA lawsuit is successful—meaning the governor is pledging to protect people with pre-existing conditions while trying to undo those same protections in the ACA.

Walker has claimed that in a third term as governor, he would uphold the very pre-existing conditions protections his administration is trying to end via lawsuit.

Walker, one of the state-level Republican officials who refused billions in federal funding to expand Medicaid, hasn’t been entirely opposed to taking federal money to make health care more accessible and affordable in Wisconsin. In July, he accepted $166 million from the Trump administration to address a 44 percent increase in health-care premiums for people buying insurance on the ACA exchanges.

Health-care advocates told Rewire.News that Walker’s health-care policies have led to an ACA marketplace with monthly premiums that far exceed the national average. In neighboring Minnesota, where lawmakers and Gov. Mark Dayton (D) have used the ACA’s mechanisms to keep health-care premiums in check, you can buy a silver premium plan on the ACA marketplace for $162 less per month than you can in Wisconsin.

Walker’s economic policies, rubber-stamped by the state’s GOP-majority legislature, have led to a marked disparity in health-care access between Wisconsin residents and Minnesotans, according to an analysis released in May by the Economic Policy Institute. The analysis found that “denying low-income families in Wisconsin access to Medicaid did not appear to have led to any greater take-up of private health insurance”—contradicting a frequent claim by Walker that people can simply gain access to private insurance if they don’t qualify for Medicaid.

“[Walker] knows darn well from polling that he’s very vulnerable on this issue,” said Robert Kraig, executive director of Citizen Action of Wisconsin, a coalition that supports progressive health-care policies and has endorsed Evers. “Quite frankly, given the narrative that came from trying to repeal the ACA, it can’t be a very positive issue for him, but muddying the waters is the approach he’s taking …. Walker’s position has been on the hard right, and he’s tried his best to soften it this year. He’s trying to have it both ways on health care.”

It’s that strategic softening, Kraig said, that might create “a far less stark contrast” between the state’s gubernatorial candidates, instead of a race defined by the very different health-care positions held by Walker and Evers.

The consequences of Republicans’ refusal to expand Medicaid under the ACA were spelled out this week in a report released by the Government Accountability Office in coordination with the National Center for Health Statistics. One in five people with low incomes in states that did not expand Medicaid say they have forgone medical care in the past year because they couldn’t afford it, according to the report. In states that did expand Medicaid, that figure is less than ten percent.

Health-care business interests have lined up behind Walker’s re-election bid, with Anthem PAC, the political arm of health insurance company Anthem, donating $51,000 to political action committees backing Walker. Anthem PAC/WellPAC Wellpoint Inc., meanwhile, has given $30,000 to Walker-backing PACs. Pfizer PAC has put $21,000 toward Walker’s push for a third term. 

The health-care industry accounts for six of the 30 biggest contributors to Walker-supporting PACs.

“Walker has spent a lot of time and money to reposition himself on health care,” Kraig told Rewire.News. “But he’s still very good at servicing the big corporate interests.”

PACs supporting Evers, meanwhile, are overwhelmingly funded by labor unions, which came under attack during the economic austerity program Walker pushed early in his first term. No health-care industry donors appear on the list of entities that have donated to Evers-related PACs.

The Walker campaign did not respond to an interview request from Rewire.News.

Evers, who emerged from a crowded Democratic primary field to take on Walker in November, has said he would work with Democrats in the legislature to make BadgerCare, Wisconsin’s health-care program for people with low incomes, available to all state residents. The “BadgerCare for All” bill is similar to proposals by some congressional Democrats to make Medicare available to anyone who wants to join the program in lieu of private insurance. 

A 40-year-old with an ACA silver plan would save around 24 percent on health-care premiums and deductibles if they were able to sign up for a Wisconsin public option instead, according to an analysis from Citizen Action of Wisconsin. Some Wisconsin residents could save up to 40 percent on premiums and deductibles.

Groups backing Evers have launched an ad blitz against Walker’s health-care policies. A Stronger Wisconsin, a group aligned with the Democratic Governors Association, released an ad in September featuring a woman with breast cancer saying Walker’s attack on the ACA’s pre-existing conditions protections would leave her unable to pay for life-saving care.

An ad released this week by A Stronger Wisconsin centers on the Walker administration’s role in the lawsuit to gut the ACA’s protections for pre-existing conditions. “Under Walker’s plan, as long as the insurance company can call it a pre-existing condition, they can drop you right when you need them the most,” the ad says.

Evers leads Walker in recent polling by as much as eight points, though Walker has the edge in a few polls.

Stigma Surrounds Addiction Treatment for Pregnant People in Indian Country

“Hey, guess what? I’m pretty badass and I can do this!” a client recently said to Julie Williams, program director of the Maternal Outreach and Mitigation Services (MOMs) program.

Based on the White Earth Ojibwe Reservation in North Minnesota, the MOMs program provides culturally appropriate addiction services to pregnant Native people. In addition to treatment and mental health services, clients receive buprenorphine, a drug used in medication-assisted treatment, to prevent opioid withdrawal during and after pregnancy.

Williams’ client, who had been receiving medication during and after her pregnancy,kept relapsing, using narcotics once every three months or so,” she told Rewire.News. “I confronted and questioned her.”

She said to Williams, “I’ve never gone more than three months without using; it’s so scary to believe in myself when everyone has told me I can never be more than an addict.”

That admission was a turning point for the woman. She has now been sober for more than one year, according to Williams.

Despite being medically approved for use by pregnant people addicted to opioids, buprenorphine and medication-assisted treatment, or MAT, has been controversial both in Indian Country, where the opioid epidemic has hit especially hard, and beyond. But for advocates, the medication is a much-needed resource, which is why some are lobbying for more investment in tribal nations through a fully funded Indian Health Service (IHS).

Anything less than that creates an endless cycle of deferral and opioid dependency, explained Sam Moose, the National Indian Health Board’s treasurer and area representative in Bemidji, Minnesota, in a written testimony to the U.S. Senate Committee on Indian Affairs in March. Moose argued that Congress’ historic refusal to fully fund the IHS has forced the agency to defer patient care and push more tribal members toward prescription opioids to treat health conditions that would otherwise have been treated with more expensive therapies.

The data on opioid dependency in Indian Country bears that out. According to the Minnesota Department of Human Services, Native American women in the state are 8.7 times more likely than non-Hispanic white women to be diagnosed with opioid dependency or use during pregnancy. Native American infants are 7.4 times more likely to be born with neonatal abstinence syndrome (NAS), a group of symptoms related to sudden discontinuation of addictive substances.

The rate of drug-related deaths among Native Americans and Alaska Natives is nearly twice that of the general population, according to data from the Indian Health Service. The Centers for Disease Control and Prevention (CDC) reports that in 2015, Native Americans and Alaska Natives had the highest rates of death from drug overdose of any ethnicity.

Tribal communities, including White Earth, have tried a number of methods to address the burgeoning rates of opioid addiction on the reservation. Indeed, the problem continues to overwhelm often already over-extended tribal health and judicial infrastructures. Some tribes rely primarily on their justice systems and criminalize drug users; some have turned to traditional sanctions such as banishment.

In The Breach, a Rewire.News podcast, host Lindsay Beyerstein recently examined laws among some tribes that allow for incarcerating pregnant people who use drugs or alcohol.

Even while testing out such methods, some tribal leaders, just like citizens in mainstream society, have remained reluctant to support medication-based treatment programs for pregnant people or drug users in general.

Regarding pregnant people who use drugs, people may have bought into the “crack epidemic” stigma reported by media in the 1990s. So-called crack babies were described as irreparably damaged, both physically and mentally, by pregnant women who used drugs during pregnancy. Subsequent studies have failed to bear out these claims.

In an interview with the Retro Report, Dr. Claire Coles of Emory University’s School of Medicine said of the national scare, “There are a whole lot of people who think if you can scare people sufficiently about something, it’s better than actually telling them the truth because fear will keep them from doing bad things.”

In her research Coles found that prenatal use of tobacco and alcohol caused the most severe damage for infants.

Williams has heard many people criticize the use of naloxone, a medication that rapidly reverses opioid overdose, to save users who overdose.

“I ask them, ‘What if it was your child? Wouldn’t you want to save her every time that you could? If it’s not your child, do you really want your friends and neighbors to mourn the loss of their child?””

“If I could save someone 100 times, I would. Maybe after that 101th time they might be ready to get help. If they die, they’ll never get that chance,” she said.

Harm Reduction

Medication-assisted treatment is part of harm-reduction addiction programs. Unlike total abstinence addiction treatment strategies, such as 12-step programs, the harm-reduction philosophy accepts that a level of drug use may continue for clients and aims to reduce harmful consequences.

Regarding pregnant people, several major medical organizations agree that exposing newborns to the risks of opioid withdrawal through MAT treatment is far outweighed by the likelihood of fatal overdose when a pregnant person goes without treatment or attempts abstinence, according to an article published by the Pew Trusts.

A pregnant person with an addiction who suddenly stops using opioids puts herself at risk for miscarriage and stillbirth.

Pregnant people who use drugs are so stigmatized by society, however, that they may be too fearful or ashamed to seek treatment, according to Williams.

“Pregnant drug users are judged far more harshly than others who use. People may look at them and say, ‘How dare she!’ ‘How awful is she!,’” Williams said.

Some may avoid prenatal care altogether for fear of sanctions by law enforcement and health-care professionals, as reported by Rewire.News in a previous article about the high rates of maternal and infant mortality among Native Americans.

“Judgment is out the door here at MOMs. We’re here to care for them while holding them accountable for their recovery,” said Williams. “In addition to taking their medication, [clients] have to participate in mental health and treatment programming, as well as life skills training.”

Women who relapse, however, are not automatically removed from the program. As mandated reporters, MOMs staff must report drug use to child welfare authorities. But if the clients “are actively seeking help, we think it’s better that we continue seeing them every day rather than having them leave,” Williams noted.

“We call people on their B.S. here; we confront them and work with them to find out what’s behind their relapse,” she added.

Since the program began on the White Earth reservation in 2015, MOMs has had 32 graduates and now has a second off-reservation location in Minneapolis.

“Rather than victimize, we help to empower. We have a community of [people recovering from addiction] who can talk and support each other; we have a family of moms who breastfeed their babies and maintain that bond with their families,” Williams said.

“Our clients are building a sober community for themselves. Since our communities are so small, even a group of five to six sober people can set an example and inspire others to get help.”

Gwayakobimaadiziwin, or “the right kind of life,” is another grassroots organization helping to build community among people who use drugs. Most of Gwayakobimaadiziwin’s clients are women; some are pregnant, many are mothers. Philomena Kebec of the Bad River Ojibwe tribe in Wisconsin and Aurora Conley, another tribal member, formed the volunteer organization in 2015 in response to suffering and death in their community from opioid addiction. Using donated equipment and funds from a series of small grants, they created a needle exchange program and provide disposal services and overdose prevention training free of charge.

Philomena Kebec of the Bad River Ojibwe tribe. (Mary Annette Pember)

Kebec and Conley grew disheartened as they saw friends and family suffer and die because of lack of resources or support.

“I’ve heard some of our tribal members say we should not treat narcotic overdoses with naloxone. We should just let those people die since they’ve chosen to abuse narcotics,” said Kebec.

“A lot of people in our community are injecting drugs; we have to meet them where they’re at by providing information, safe places, and resources for them and their families in order to reduce harm they do to themselves and others,” Conley said.

“Helping each other, harm reduction, is the traditional Native way. We wouldn’t banish someone if they had a disease like cancer; addiction is also a disease,” she added.

Unfortunately, harm-reduction treatment such as MAT is difficult to find for Bad River members; the Bad River Health and Wellness Center, a tribally run Indian Health Service clinic, only offers 12-step, abstinence-based treatment. Although Indian Health Service allows its physicians and some health-care professionals to prescribe buprenorphine, the local clinic does not offer these services.

Moose, in his testimony to the Senate committee earlier this year, pointed out that situations like this are common among many tribes. Communities lack the resources to keep up with the latest training practices for health-care providers.

As sovereign entities, tribes may not be included in state public health initiatives, such as those created by the 2016 CURES Act’s $1 billion in federal funding to states for fighting the opioid crisis. Under its current status, tribes have no direct access to the funding available under the act and must depend upon the discretion of states to include them in programming. In March, U.S. Rep. Markwayne Mullin (R-OK) introduced HR 5140, the Tribal Addiction and Recovery Act (TARA), which would grant tribes direct access to CURES Act funding. TARA has been referred to the Subcommittee on Health.

The IHS is the primary federal agency providing health care to tribes. The agency delivers services directly at IHS facilities and through tribally contracted health programs and services purchased from private providers.

In his testimony Moose wrote,The Indian Health system is chronically underfunded, understaffed and overextended. Limited tribal and IHS public health and health care resources have been further inundated by this highly deadly and superbly costly epidemic.”

Moose noted that in fiscal year 2017, national health spending was $9,207 per capita while IHS spending was limited to $3,332 per patient. He testified that due to limited funding, nearly 80,000 Purchased/Referred Care (PRC) services were denied in fiscal year 2016.

“The federal government must take concrete action to ensure Indian Country has the tools it needs to address opioid abuse and heal tribal communities,” Moose wrote.

In the meantime, however, tribal communities are taking action on their own in any way they can; one of the benefits of being a sovereign entity is that a tribe can create its own internal judicial and social service laws and practices.

“Tribes are all over the board in how they are trying to deal with addiction in their communities. Some have taken a more criminal approach, and some are seeing it as a public health issue,” said Adam Fairbanks, a public health consultant for tribes.

Fairbanks of the White Earth Ojibwe tribe helps tribes set up collaborations to help create reimbursable health-care services that cover treatment for addiction, including MAT.

“Many tribes are just trying to get questions answered about what they can do to address addiction,” he said.

Julie Williams in one of the client meeting rooms at the MOMs Minneapolis location. (Mary Annette Pember)

Since White Earth started its MOMs program, the tribal court no longer relies on the civil commitment option to force pregnant people who use drugs to enter treatment.

“The courts don’t need to use that anymore; addicted pregnant people now come forward on their own for treatment at MOMs,” Williams said.

It took a lot of hard work, however, to get the community on board with MOMS’ harm-reduction treatment model.

Williams and her co-workers hosted family nights and offered big meals for the community during which they could learn more about the program their relative was working on.

“Family members have thanked us. Parents have told us they notice a difference in their daughter, she now has purpose,” Williams said.

MOMs leaders have also created relationships with doctors and hospitals in the area, ensuring that clients following the program aren’t reported to police and that mothers aren’t separated from their babies and are allowed to breastfeed.

As reported by Rewire.News, experts support breastfeeding and keeping mother and baby together for infants with neonatal abstinence syndrome symptoms.

“Some medication may be passed through breastmilk, but MOMs has found that the protective factor of breastfeeding far outweighs the risks. Even if baby has withdrawal symptoms they are very mild; baby is comforted by mother,” said Fairbanks.

At MOMs, clients’ intimate partners can join them in getting treatment. Parents can also bring their children along to treatment sessions.

“We’re trying to create a base for our clients to go home and be successful,” Williams said.

And for its part, Gwayakobimaadiziwin holds monthly meetings within the community. We provide a meal, sharps containers for used syringes and needles, HIV testing, help with treatment or social service referrals,” Kebec said. “We are building community by helping each other.”

Volunteers also bring supplies to clients’ homes if needed. “We find that the [people who use] help each other; they provide moral support, celebrate small victories,  and keep each other safe,” Kebec said.

Most of Gwayakobimaadiziwin’s clients have a history of trauma, according to Kebec. “That’s why it’s important to be non-judgmental; the women already judge themselves so harshly,” she said. In fact, the most important element of the organization’s services is an atmosphere of non-judgment.

Although the tribe doesn’t currently offer MAT, several users treat themselves with buprenorphine that they obtain illegally, according to Kebec. “Nobody wants to be an addict,” she noted. “With buprenorphine at least they can function and have a life, take care of their children.”

Volunteers at Gwayakobimaadiziwin are also working on creating a survey of users needs. “Most of the big programs aimed at addressing drug addiction don’t seem to include input by users themselves,” Kebec noted.

“Abstinence based 12-step treatment doesn’t seem to work for meth and heroin [abuse],” said Conley. “Our people need wraparound services that help with housing, food, and keeping police off their backs. Going to jail all the time doesn’t help them.”

“The strength of traditional Native culture has its roots in community,” Kebec pointed out, echoing Williams, who said that while she can’t say for sure that harm reduction is a traditional value, she thinks the philosophy is influenced by Native culture and ways.

“Most of the harm-reduction programs we see have a common beginning; they start with a small group of grassroots folks dedicated to community health and preserving and revitalizing Indigenous life and ways,” Fairbanks said.

“Our ancestors have overcome so much shit,” Conley said. “We are warriors and we can survive this if we help each other.”

Gavel Drop: The Leaf Behind Another Legal Challenge to Trump’s Immigration Policy

Welcome to Gavel Drop, our roundup of legal news, headlines, and head-shaking moments in the courts.

The ACLU is filing a lawsuit against Immigration and Customs Enforcement (ICE), alleging unlawful detention of a Somali refugee in New Hampshire. Abdigani Faisal Hussein has spent the last six months in custody at a Strafford County jail due to a 16-year-old drug conviction for possession of khat, a mild stimulant that can be chewed, smoked, or brewed in tea; it’s commonly used in East Africa and the Middle East. Federal immigration law allows for the indefinite detention without a hearing—of individuals who have been taken into custody if they have past criminal records. The ACLU is arguing that the wording of the statute only applies when a person is taken “immediately” into custody following the sentence, rather than convictions from several years ago. Since the law only says that the arrest can occur “when” a person is released from custody, ICE agents have broadly interpreted the statute to mean they can target certain immigrants for years-old offenses. Hussein’s fate may depend on the outcome of a similar case being considered in the U.S. Supreme Court. Oral arguments were held last week in Nielsen v. Preap, where plaintiffs are arguing that if ICE wants to detain an immigrant without bail, they must do so at the moment of release, rather than for convictions handed out months or years ago.

The state of Alabama and the Lowndes County Health Department are facing a civil rights lawsuit over inadequate and failing sewage treatment systems, which have led to contamination and an outbreak of hookworm, a parasite long thought to have been eradicated in humans in the United States. The lawsuit, filed last month by the environmental group Earthjustice and the Alabama Center for Rural Enterprise, claims that the county and state discriminated against the predominately black community of Lowndes County by failing to provide access to modern sewage and plumbing systems. Due to soil issues in the area and state law, installing the necessary septic systems could cost residents up to $30,000. But that’s probably out of reach for many affected people; 37 percent of black Lowndes County residents live below the poverty line. Civil rights activism has a long history in the county, which was known as “Bloody Lowndes” for its history of racial violence; in the 1960s, the county was a key national battleground in the struggle for voting rights and home to a short-lived political party that provided an early foundation for the Black Panther Party.

Missouri is down to one abortion clinic after the only other clinic that provided those services failed to meet new state abortion restrictions. Missouri law requires abortion facilities to be classified as “ambulatory surgical centers” and have admitting privileges to a local hospital in case of complications. Attorneys for the Columbia Planned Parenthood earlier this month asked for a temporary exemption from the hospital privileges requirement, but no ruling has been issued yet. For now, pregnant people seeking an abortion in Missouri will either have to go to the Planned Parenthood in St. Louis or travel to another state.

The state of Indiana is still trying to stop the Whole Woman’s Health Alliance from opening an abortion clinic in South Bend. The state health department had originally denied a license to the clinic, claiming the nonprofit failed to meet requirements of having “reputable and responsible character”—though this “failure” isn’t explained in the notification letter—and that it was missing information on its application. Whole Woman’s Health Alliance appealed the decision, and an administrative law judge recommended that the clinic be allowed to open. Earlier this month, the Indiana State Department of Health announced it would be appealing the recommendation. The matter will now be decided by a three-person panel appointed by the same health department that denied the license in the first place.

A federal court has ruled that a recently passed law in North Carolina cannot be interpreted to ban transgender people from using public restrooms that align with their gender identity. The law in question, HB 142, was passed last year in an effort to repeal HB 2, the state’s discriminatory law that had restricted transgender folks from using public accommodations in accordance with their gender identity. While the ruling is promising, HB 142 still contains a provision that prohibits local municipalities from passing their own nondiscrimination policies until 2020. In the same ruling issued earlier this month, plaintiffs were given the green light to proceed with their challenge to the nondiscrimination provision.

The Arkansas Supreme Court last week upheld a voter ID law that largely mimics a law the court struck down in 2014. In the 5-2 ruling, justices said that the law requiring voters show photo ID before casting a ballot is legal. The ruling reversed a lower court’s ruling blocking legislators from enacting the law, which had been approved last year. The revised law differs from the previous version by allowing voters without photo IDs to cast provisional ballots if they sign a sworn statement confirming their identities.

The Missouri Attorney General’s Office has filed an appeal challenging a federal judge’s ruling that blocked parts of Missouri’s voter photo ID law. Senior Cole County Judge Richard Callahan struck down a requirement that a voter lacking a valid photo ID sign a sworn statement in order to cast a ballot. After Attorney General Josh Hawley’s office filed the appeal, Missouri Secretary of State Jay Ashcroft released a statement claiming the ruling had injected mass confusion into the voting process just weeks away from the election.

Florida residents who missed the state’s voter registration deadline last Tuesday due to Hurricane Michael may have to sit the midterms out, thanks in part to a ruling by a federal judge. The Florida Democratic Party filed an emergency injunction to extend the deadline by a week to October 16, citing concerns that the weather may have prevented people from registering. U.S. District Judge Robert Hinkle denied the request. According to Florida Secretary of State Ken Detzner, any county election office that was closed last Tuesday will be required to accept paper registration applications the day their offices reopen.

Trump campaign lawyers are now claiming that the use of hacked emails is actually a form of free speech. A pair of donors and one former Democratic National Committee (DNC) employee filed a lawsuit over the summer against the Trump campaign and strategist Roger Stone for allegedly working with Russia and Wikileaks to publish hacked emails, thereby violating their privacy. Trump campaign lawyers responded last week by asking for the case to be thrown out because, according to them, the First Amendment protects the campaign’s “right to disclose information—even stolen information—so long as (1) the speaker did not participate in the theft and (2) the information deals with matters of public concern.”

Three New Yorkers are suing President Trump and the federal government to block the president from using the Federal Emergency Management Agency (FEMA) alert system to send messages to U.S. cellphone users. The suit claims the presidential alert violates the First and Fourth Amendments’ rights to freedom of speech and privacy since users are unable to opt out. The plaintiffs argue the messages would allow the government “to trespass into and hijack” cellular devices without explicit consent. They further allege that the alerts turn cellphones into “government loudspeakers” and could be used to subject users to government propaganda. The plaintiffs hope to halt the initial test of the presidential alert system. While a district court judge rejected the request, the lawsuit is still pending. So don’t throw away your phones just yet.