What does health care reform mean to you?

Erica Sackin

No matter what the result of health care reform, our lives will be profoundly affected. So how do we make sure our voices are heard, and that things essential to our health aren't left behind? Why through photos, of course.

Health Care Reform Sign The debate around health care reform can very easily devolve into chaotic, and over the past few months it’s gotten diffiuclt to follow just what’s on and off the table — let alone how it might negatively or positively affect our future.

 

One thing we can do is make sure our representatives know exactly what we want to see happen. I, for instance, would like to make sure that birth control is covered, as is maternity care, and that things like C-sections aren’t considered pre-existing conditions. 

 

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October 20 is the National Health Care Day of Action, and I’m happy to spread the word that Planned Parenthood of New York City is joining other Planned Parenthood affiliates across the country in holding a photo petition for real health care reform. PPNYC is asking folks to photograph themselves holding up signs asking for what they want to see included in health care reform, and then send them in. The organization will then post those online and send them into our Congressional representatives.

Because what’s more powerful than a constituent staring you in the face, asking you to make sure health care reform doesn’t leave her worse off than she was before? 

Commentary Politics

Is Clinton a Progressive? Not If She Chooses Tim Kaine

Jodi Jacobson

The selection of Tim Kaine as vice president would be the first signal that Hillary Clinton intends to seek progressive votes but ignore progressive values and goals, likely at her peril, and ours.

During the 2016 presidential campaign, former secretary of state and presumptive Democratic presidential nominee Hillary Rodham Clinton has frequently claimed to be a progressive, though she often adds the unnecessary and bewildering caveat that she’s a “progressive who likes to get things done.” I’ve never been sure what that is supposed to mean, except as a possible prelude to or excuse for giving up progressive values to seal some unknown deal in the future; as a way of excusing herself from fighting for major changes after she is elected; or as a way of saying progressives are only important to her campaign until after they leave the voting booth.

One of the first signals of whether Clinton actually believes in a progressive agenda will be her choice of running mate. Reports are that Sen. Tim Kaine, former Virginia governor, is the top choice. The selection of Kaine would be the first signal that Clinton intends to seek progressive votes but ignore progressive values and goals, likely at her peril, and ours.

We’ve seen this happen before. In 2008, then-presidential candidate Barack Obama claimed to be a progressive. By virtue of having a vision for and promise of real change in government and society, and by espousing transparency and responsibility, he won by a landslide. In fact, Obama even called on his supporters, including the millions activated by the campaign’s Organizing for Action (OFA), to keep him accountable throughout his term. Immediately after the election, however, “progressives” were out and the right wing of the Democratic party was “in.”

Obama’s cabinet members in both foreign policy and the economy, for example, were drawn from the center and center-right of the party, leaving many progressives, as Mother Jones’ David Corn wrote in the Washington Post in 2009, “disappointed, irritated or fit to be tied.” Obama chose Rahm Emanuel as Chief of Staff, a man with a reputation from the days of Bill Clinton’s White House for a reluctance to move bold policies—lest they upset Wall Street or conservative Democrats—and a deep disdain for progressives. With Emanuel as gatekeeper of policies and Valerie Jarrett consumed with the “Obama Brand” (whatever that is), the White House suddenly saw “progressives” as the problem.

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It became clear that instead of “the change we were hoping for,” Obama had started on an impossible quest to “cooperate” and “compromise” on bad policies with the very party that set out to destroy him before he was even sworn in. Obama and Emanuel preempted efforts to push for a public option for health-care reform, despite very high public support at the time. Likewise, the White House failed to push for other progressive policies that would have been a slam dunk, such as the Employee Free Choice Act, a major goal of the labor movement that would have made it easier to enroll workers in unions. With a 60-vote Democratic Senate majority, this progressive legislation could easily have passed. Instead, the White House worked to support conservative Democrat then-Sen. Blanche Lincoln’s efforts to kill it, and even sent Vice President Joe Biden to Arkansas to campaign for her in her run for re-election. She lost anyway.

They also allowed conservatives to shelve plans for an aggressive stimulus package in favor of a much weaker one, for the sole sake of “bipartisanship,” a move that many economists have since criticized for not doing enough.  As I wrote years ago, these decisions were not only deeply disappointing on a fundamental level to those of us who’d put heart and soul into the Obama campaign, but also, I personally believe, one of the main reasons Obama later lost the midterms and had a hard time governing.  He was not elected to implement GOP lite, and there was no “there, there” for the change that was promised. Many people deeply devoted to making this country better for working people became fed up.

Standing up for progressive principles is not so hard, if you actually believe in them. Sen. Elizabeth Warren (D- MA) is a progressive who actually puts her principles into action, like the creation against all odds in 2011 of the Consumer Finance Protection Bureau, perhaps the single most important progressive achievement of the past 20 years. Among other things, the CFPB  shields consumers from the excesses of mortgage lenders, student loan servicers, and credit card companies that have caused so much economic chaos in the past decade. So unless you are more interested in protecting the status quo than addressing the root causes of the many problems we now face, a progressive politician would want a strong progressive running mate.

By choosing Tim Kaine as her vice president, Clinton will signal that she values progressives in name and vote only.

As Zach Carter wrote in the Huffington Post, Kaine is “setting himself up as a figure willing to do battle with the progressive wing of the party.” Kaine is in favor of the Trans-Pacific Partnership (TPP), a trade agreement largely negotiated in secret and by corporate lobbyists. Both Sen. Bernie Sanders, whose voters Clinton needs to win over, and Sen. Elizabeth Warren oppose the TPP because, in Warren’s words, it “would tilt the playing field even more in favor of … big multinational corporations and against working families.”

The progressive agenda includes strong emphasis on effective systems of governance and oversight of banks and financial institutions—the actors responsible, as a result of deregulation, for the major financial crises of the past 16 years, costing the United States trillions of dollars and gutting the financial security of many middle-class and low-income people.

As Warren has stated:

Washington turned a blind eye as risks were packaged and re-packaged, magnified, and then sold to unsuspecting pension funds, municipal governments, and many others who believed the markets were honest. Not long after the cops were blindfolded and the big banks were turned loose, the worst crash since the 1930s hit the American economy—a crash that the Dallas Fed estimates has cost a collective $14 trillion. The moral of this story is simple: Without basic government regulation, financial markets don’t work. That’s worth repeating: Without some basic rules and accountability, financial markets don’t work. People get ripped off, risk-taking explodes, and the markets blow up. That’s just an empirical fact—clearly observable in 1929 and again in 2008. The point is worth repeating because, for too long, the opponents of financial reform have cast this debate as an argument between the pro-regulation camp and the pro-market camp, generally putting Democrats in the first camp and Republicans in the second. But that so-called choice gets it wrong. Rules are not the enemy of markets. Rules are a necessary ingredient for healthy markets, for markets that create competition and innovation. And rolling back the rules or firing the cops can be profoundly anti-market.

If Hillary Clinton were actually a progressive, this would be key to her agenda. If so, Tim Kaine would be a curious choice as VP, and a middle finger of sorts to those who support financial regulations. In the past several weeks, Kaine has been publicly advocating for greater deregulation of banks. As Carter reported yesterday, “Kaine signed two letters on Monday urging federal regulators to go easy on banks―one to help big banks dodge risk management rules, and another to help small banks avoid consumer protection standards.”

Kaine is also trying to portray himself as “anti-choice lite.” For example, he recently signed onto the Women’s Health Protection Act. But as we’ve reported, as governor of Virginia, Kaine supported restrictions on abortion, such as Virginia’s parental consent law and a so-called informed consent law, which, he claimed in 2008, gave “women information about a whole series of things, the health consequences, et cetera, and information about adoption.” In truth, the information such laws mandate giving out is often “irrelevant or misleading,” according to the the Guttmacher Institute. In other words, like many others who let ideology rather than public health guide their policy decisions, Kaine put in place policies that are not supported by the evidence and that make it more difficult for women to gain access to abortion, steps he has not denounced. This is unacceptable. The very last thing we need is another person in the White House who further stigmatizes abortion, though it must be said Clinton herself seems chronically unable to speak about abortion without euphemism.

While there are many other reasons a Kaine pick would signal a less-than-secure and values-driven Clinton presidency, the fact also stands that he is a white male insider at a time when the rising electorate is decidedly not white and quite clearly looking for strong leadership and meaningful change. Kaine is not the change we seek.

The conventional wisdom these days is that platforms are merely for show and vice presidential picks don’t much matter. I call foul; that’s an absolutely cynical lens through which to view policies. What you say and with whom you affiliate yourself do indeed matter. And if Clinton chooses Kaine, we know from the outset that progressives have a fight on their hands, not only to avoid the election of an unapologetic fascist, but to ensure that the only person claiming the progressive mantle actually means what she says.

Analysis Human Rights

ICE Releases Reports for 18 Migrants Who Died in Detention, Medical Neglect Is Suspected

Tina Vasquez

Though the death reviews released by ICE provide further insight into the conditions inside detention centers, the bigger concern among researchers and advocates is what they don't know.

A new report from Human Rights Watch (HRW) documents the deaths of 18 migrants in Immigration and Customs Enforcement custody from mid-2012 to mid-2015. In some cases, the deaths were likely preventable and the result of “substandard medical care and violations of applicable detention standards.”

These are not the only deaths that occurred, however. ICE acknowledges on its website that 31 deaths have occurred between May 2012 and mid-June of this year. It is unclear whether ICE intends to release information about the additional 13 deaths that have occurred.

Even so, these new findings add to a growing body of evidence showing what HRW calls “egregious violations” of medical care standards in detention centers. A February report found such violations contributed to at least eight in-custody deaths over a two-year period.

The public is just beginning to learn more about the deeply rooted problem, Clara Long, a researcher with Human Rights Watch and the lead researcher on the report, explained to Rewire. Long referenced an ongoing investigation by reporter Seth Freed Wessler at the Nation, which explores the numerous deaths that have occurred inside immigrant-only prisons.

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Though the death reviews released by ICE provide further insight into the conditions inside detention centers, the bigger concern among researchers and advocates is what they don’t know. For example, HRW worked with two independent medical experts to review the 18 death reviews released by ICE. The experts concluded that substandard medical care “probably contributed to the deaths of seven of the 18 detainees, while potentially putting many other detainees in danger as well.” Long told Rewire that the information provided by ICE simply wasn’t enough for their independent medical experts to determine that all 18 deaths were related to inadequate medical care, but that it was “likely.”

So there is the larger, systemic issue of inadequate medical care. Researchers at HRW also don’t know exactly how ICE collects information or why the agency releases information when it does. There’s also the core of the issue, as Long noted to Rewire: that the United States “unnecessarily” detains undocumented immigrants in “disturbing conditions” for prolonged periods of time.

Major Failures Lead to Death

The new HRW report identified two of the most dangerous ways ICE is failing migrants in detention: not following up on symptoms that require assistance and not responding quickly to emergencies. Both failures are illustrated by the case of 34-year-old Manuel Cota-Domingo, who died of heart disease, untreated diabetes, and pneumonia after being detained at the Eloy Detention Center in Eloy, Arizona.

ICE’s death review for Cota-Domingo suggests there was a language barrier and that Cota-Domingo was worried about having to pay for health care, which isn’t surprising given that detention centers make migrants pay for things like phone calls to their attorneys and family members. HRW asked Corrections Corporation of America, the company that runs the Eloy Detention Center, about potential fees for medical care, and it said there are no fees for such services at Eloy. For whatever reason, Cota-Domingo was not aware he had a legal right to access the medical care he needed.

When it became clear to his cellmate that Cota-Domingo was in serious need of medical attention and was having trouble breathing, the cellmate “banged on a wall to get a guard’s attention. His cellmate said he did that for three hours before anyone came to help,” Long said. The researcher told Rewire the death report outlines how investigators checked to see if the banging would have been audible to correctional officers.  It was. “Once [the cellmate] got their attention, our medical experts said this was something that should have been followed up on immediately, but the nurse decided to wait several hours before doing anything. All of these sluggish responses went on for eight hours. This is not how you treat an emergency,” Long said.

As Human Rights Watch noted in the report, “When officers finally notified medical providers of his condition, they delayed evaluating him and finally sent him to the hospital in a van instead of an ambulance. Both medical experts concluded that the combination of these delays likely contributed to a potentially treatable condition becoming fatal.”

In other death reviews by ICE, the agency’s own records show “evidence of the misuse of isolation for people with mental disabilities, inadequate mental health evaluation and treatment, and broader medical care failures.” Tiombe Kimana Carlos, Clemente Mponda, and Jose de Jesus Deniz-Sahagun all committed suicide in ICE detention after showing signs of “serious mental health conditions.” HRW’s independent experts determined that “inadequate mental health care or the misuse of isolation may have significantly exacerbated their mental health problems.”

It’s important to note that none of the death reviews released by ICE admit any wrongdoing, and that’s primarily because they don’t seek to examine whether medical negligence was at play. The reports simply present information about the deaths.

“There is no conclusion drawn, really,” Long told Rewire. “There’s one [report] in particular that even goes beyond that; it doesn’t even take into account the quality of care that led to the death, even though it’s clearly an issue of quality of care. That raises the question: What is the report for? ICE doesn’t conclude the cause. If you read [the death reviews], you can see there’s a lot of detailed information included in them that allows someone with expertise in correctional health care and who is familiar with how these systems should work, to make an assessment about whether care contributed to death, but that’s not something ICE doesat least not in the information we are able to access.”

ICE’s Murky Death-Review Process 

In a statement to Rewire, ICE explained that when a person dies while in the agency’s custody, their “death triggers an immediate internal inquiry into the circumstances.” The summary document ICE releases to the public is “the result of exhaustive case reviews conducted by ICE’s own Office of Detention Oversight (ODO), which was established in 2009 as part of the agency’s comprehensive detention reforms,” Lori K. Haley, a spokesperson with ICE, told Rewire in a prepared statement.

In fact, the ODO was created as a direct result of a series of reforms from the Obama administration after reports of human rights abuses and deaths in detention centers. The death review it produces includes a mix of findings from ICE’s own investigators and from a Beaumont, Texas-based company called Creative Corrections.

According to its website, Creative Corrections serves “local, state and federal government agencies,” offering “training, advising, professional management and consulting services” in “correctional, law enforcement, rule of law, and judicial systems.” The company contracts include the Department of Homeland Security (DHS).

“From what we can see from the documents, both ICE and Creative Corrections interview various people involved, check records, do what seems to be a pretty robust investigation for the death review,” Long said. “Unfortunately, in the set of death reviews that we used for this investigation, [the public doesn’t] have access to the Creative Corrections reports or any of the exhibits that go along with them.”

As the ICE spokesperson noted, the summary documents are typically written by ICE staff. The documents released to the public do not include medical records, full reports from Creative Corrections, or any exhibits that would provide more insight into the apparent medical neglect resulting in an estimated 161 people dying in ICE custody since October 2003. Six migrants have died in ICE custody since March 2016, two of whom died at two different detention centers in the same week. The causes of these most recent deathsand whether they can be attributed to medical neglect—is still unknown.

“If we had access to all of the information gathered during these investigations, including the reports from Creative Corrections, they would be very rich sources of information,” Long said.

Long and other researchers are also hoping for more information regarding the deaths that happen just after migrants are released from ICE custody. Teka Gulema, an Ethiopian asylum seeker detained at Etowah County Detention Center in Gadsden, Alabama, was released from ICE custody in November 2015 while in the hospital after becoming paralyzed from a bacterial infection acquired in detention. He died in January.

“One concern we have, and it’s a very big fear, is that there are multiple reports of folks who are released from ICE custody while in critical condition,” Long said. “When they die, they are no longer counted as in-custody deaths [by ICE]. We’re worried that’s a loophole being exploitedand for obvious reasons, we don’t have a number in terms of how often this is happening.”

The researcher said she has “no idea” when or why ICE decides to release information, including death reviews.

ICE did not respond to Rewire‘s request for information about its schedule or process for releasing such information.

“Maybe they released the 18 reports because they were cleared for release. Maybe a congressional office asked for them. Maybe they decided to be transparent. It could have been a [Freedom of Information Act] request from the ACLU. I wish I knew, but we really have no idea who decides—or why they decide—to release information, especially without making anyone aware that it’s been released,” the researcher told Rewire.

In April, ICE posted a series of spreadsheets about the inner workings of the detention system on their website that Long said provided a lot of information about how detention operates. The spreadsheets were removed from the site in a matter of days, too soon for many researchers—including HRW—to download them all.

“It’s a big system. We still don’t totally know how it works, which in itself is a major problem,” Long said. “One of the biggest lessons we’ve learned is to always check the ICE website. You never know what you’ll find.”

Rethinking Detention

DHS secretary Jeh Johnson is engaging in what some advocates are calling an “enforcement overdrive,” by funneling more undocumented immigrants into an already overcrowded detention system thanks to the detention bed quota established in 2009. This quota requires 34,000 undocumented migrants be locked up each day. It is in place to ensure more people get deported, though it’s costing taxpayers $2 billion a year while also creating “a profitable market for both private prison corporations and local governments,” the National Immigration Forum has said.

Reporting for the Nation, Michelle Chen recently noted that “migrants are warehoused under convoluted partnerships involving private vendors and state, local, and federal agencies. Homeland Security may contract out security duties to, or use facilities owned by, private vendors—dominated by Corrections Corporation of America (CCA) and GEO Group—with preordained headcount distributions ranging from 285 in Newark to more than 2,000 in San Antonio.”

Long told Rewire that 80 percent of migrants currently in detention are in what is considered “mandatory detention,” which, according to the Immigrant Legal Resource Center, means that “non-citizens with certain criminal convictions must be detained by ICE. People who are subject to mandatory detention are not entitled to a bond hearing and must remain in detention while removal proceedings are pending against them.” This also means that those in mandatory detention aren’t allowed to have an individual assessment by ICE of their case, “so they just sit in immigration detention indefinitely,” Long said.

“This system doesn’t work. We’re detaining far too many people for far too long and not determining on an individual level if they should be detained in the first place, taking into account all of the options available,” Long said. Options include being monitored by ICE using telephonic and in-person reporting, curfews, and home visits.

Long joins a long list of undocumented community members, researchers, organizers, activists, and other advocates pushing for the Obama administration—and whoever comes after it—to see detention as a last resort, rather than the only resort.

“We spend a lot of time talking about the disturbing conditions in detention centersthat’s what our report is about. But step one requires taking a step back and rethinking this system and how it’s unnecessary and also abuses vulnerable peoples’ rights,” Long said. “In terms of the legality of treating people this way, under U.S. and international law, people who are detained are entitled to medical treatment. The state has an obligation to provide care to this population. They are failing, and people are dying.”