’The President Said We Can Call Our Kids — Why Is He Lying?’

It was sometime in the middle of June that Ofelia Calderón’s uneasiness hit its peak. Like other immigration lawyers around the country, Calderón, a founding partner at Calderón Seguin PLC, in Fairfax, Virginia, had been monitoring Attorney General Jeff Sessions’s “zero tolerance” policy, trying to figure out how the practice of prosecuting all individuals entering the country illegally would be implemented in reality. It was starting to become clear, to Calderón and her fellow lawyers, that it was playing out in unprecedented ways: Stories had begun leaking that migrant children were being separated from parents as soon as they crossed the border, with some infants even being ripped from their mothers’ arms while breastfeeding.

Calderón is on the board of Dulles Justice Coalition, a group of lawyers who first organized in the early weeks of Trump’s presidency to go to D.C.’s airports to help represent immigrants being turned away or detained following Trump’s Muslim ban. They had stayed together as a group because “it became apparent that there might be a need for rapid legal responses in the next four years,” Calderón says; the migrant children crisis, she says, “seemed like the kind of situation where we could deploy a rapid response.” And so on June 19, Calderón and two other Dulles Justice board members headed to south Texas to see how they could help.

That Friday, two days after Trump signed his executive order that ended the separation of families at the border while doing nothing to reunite those families already torn apart, the lawyers arrived at Port Isabel Detention Center, near the remote town of Los Fresnos, Texas. More than a thousand immigrants were being held following their prosecution for illegal entry at Port Isabel — a detention center the ACLU has said “looks and operates like a jail.”

Lawyers cannot just enter such detention centers and start talking to the people held there about their legal rights — “you have to know that someone’s there, you have to know their name, you have to know their alien registration number,” says Calderón. So they obtained entry through a local nonprofit that aids immigrants seeking asylum and that already had an agreement allowing volunteers into Port Isabel.

In the seventeen years Calderón has been practicing immigration law, she says, she’s heard horrifying stories from clients fleeing violence in countries like Guatemala and El Salvador. In Port Isabel, she interviewed a woman who had been raped repeatedly by the gang member in charge of her hometown in Honduras, a man who she feared would never face prosecution because he buys off the police. But she and her fellow lawyers were still not prepared for what they encountered that weekend in south Texas.

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“When I initially walked into the room of men to give them their legal-rights orientation, I noticed they all had red eyes,” says Eileen Blessinger, another D.C.-based lawyer with whom the Dulles Justice Group worked at Port Isabel. “I started the orientation and kept receiving the same questions: ‘When will I see my child?’ ‘Will I ever see my child again?’ ‘Do you know where my child is?’ ‘Do you know if my child is OK?’ ‘The president said we can call our kids — why is he lying?’ ”

“I kept asking, ‘Where did you last see your child?’ ” remembers Calderón. “They would tell me, ‘Hielera.’ For the first five interviews, I literally thought Hielera was a place. It wasn’t. Hielera is an ice box. It is a freezer. What they were describing was a large holding room kept at subzero temperatures where they were all held with their children.”

“I saw desperate women hysterically crying, begging senators and congressmembers to help them see their children again,” says Blessinger. “In their desperation, these parents wrote letters to their children, but they didn’t know how to get the letters to them. These letters are some of the saddest things I’ve ever seen. They said, ‘Be strong,’ ‘I love you,’ and ‘Believe in God because He will bring us together again soon.’ ”

Over the course of that weekend, Calderón interviewed more than forty men and women. Each had endured some form of persecution in the town they’d left behind, and all had come to America with their children. None had had any idea that their children would be taken from them, even when the separation actually occurred: They were told that they needed to leave their children while they went through some additional legal processing and that they’d be right back.

“I tire of people telling me, ‘This is a consequence of their actions and they knew it was going to happen,’ ” says Calderón. “They didn’t know it was going to happen. I think it’s supremely inhumane of people to think that way.”

In the days and weeks since they’d been separated, Calderón says, 70 percent of the people she spoke with had had no contact of any kind with their children. The remaining men and women had received a phone call or two, each lasting between one and five minutes. But even most of those parents still did not know where their children were; the only information they were able to obtain was through the children themselves, who, if old enough, could tell their parents what little they’d been able to glean about their surroundings. One of the few women Blessinger encountered who’d spoken with her child told the lawyer that, during her phone call, she could only hear her son crying, “asking why she didn’t love him and why she left him.”

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Blessinger, who spent ten-hour days with the men and women in Port Isabel, says she was so traumatized by what she experienced that she had difficulty sleeping afterward. Upon returning to work, she says, “Someone asked me how I was doing and I just broke down crying. That was pretty much my entire day. If it is this hard for me to recover from being in these circumstances for five days, I don’t know how these parents or children can ever recover.”

Reports now estimate that nearly 3,000 children were separated from their parents in the weeks between April 6 and June 20. Although some of them have since been reunited with their parents — including some of the youngest, who were returned earlier this week — more than 2,000 have yet to be located and returned. Calderón is now representing one of the women she met at Port Isabel, a mother who is lucky enough to know where her child is, with a foster family in Texas.

Now, instead of phoning Calderón to prep for her upcoming interview for asylum, her client is calling to talk about how worried she is about her daughter. She is concerned she’s not happy at the foster family’s; there’s another child there who’s been hitting her. “I’ve called the social worker daily for the last three days,” says Calderón. “No response.” Now she’s worried too.


Hillary Clinton Warns of Creeping Authoritarianism in America

For journalists worldwide, 2017 ranks as one of the most dangerous on record: Eighteen journalists were killed, according to Freedom House, while 189 currently languish in prisons around the world. Here at home, meanwhile, the safety and sanctity of journalism is threatened by a president who regularly attacks the press, handpicks which organizations can attend White House briefings, and compulsively sells falsities as reality.

Such was the crux of Hillary Rodham Clinton’s speech Sunday night at the Cooper Union, which closed out the weeklong PEN World Voices Festival. Joining the ranks of past speakers such as Salman Rushdie, Christopher Hitchens, Umberto Eco, and Sonia Sotomayor, Clinton had been chosen to give this year’s annual Arthur Miller Freedom to Write Lecture — which traditionally addresses current challenges to free expression — based on her work defending human rights and free speech as secretary of state. Said PEN CEO Suzanne Nossel in her deeply personal introduction — Nossel served under Clinton as a deputy assistant secretary of state — the efforts of the former secretary had “helped secure the freedom to write for tens of millions worldwide.”

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Clinton used her 45-minute speech to sound the alarm that freedom of speech and expression is currently under attack here in our own country. The target of a Russian-led disinformation campaign during her 2016 run for president, Clinton was a fitting choice to talk about the new dangers facing not just those in this country who report the news, but also those of us who read and absorb it. She spoke of the election as “a case study in the weaponization of false information and outright lies against our democracy,” detailing foreign agents’ use of social media to plant false stories and sow not only distrust in her candidacy, but division throughout the country. And she stressed the danger we face living under a president who “seems to reject the role of a free press in our democracy” and who distorts facts and continually lies, even about things as obvious as, say, the size of an inaugural crowd.

“When leaders deny things that we can see with our own eyes,” she said, “it’s not just frustrating to those of us who try to live in a fact-based universe. It is the beginning of the end of freedom. And that’s not hyperbole. It’s what authoritarian regimes throughout history have done.” To drive her point home, she noted that earlier this month, the Department of Homeland Security announced it would begin monitoring the activities of reporters and media professionals.

Clinton ended her speech with a call to action, not just for the writers in the room but for the American people at large. “We have to find our voice, in whatever way we are comfortable, to speak out,” she said, later adding: “Everyone’s voices need to be raised at this time.”

“Do not grow weary — be sustained by the energy that the truth can give you,” she continued. “I have no doubt we will get our country back on the right track.”

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The Q&A that followed with Chimamanda Ngozi Adichie — the author of the award-winning novel Americanah, and herself the Arthur Miller Freedom to Write speaker in 2015 — was warm and engaging in covering a variety of topics, from the personal to the political, from Clinton’s decision to run for office to her passionate hopes for how we can conquer the divisiveness currently plaguing the country. But the themes of free speech and vigilance against its suppression resurfaced time after time. Clinton spoke again of the weaponization of misinformation that occurred during the election — and continues today — noting how the false stories that were circulated during her campaign were so credible because they were delivered in a way, via social media, that looked like news.

“You have to wonder: How do we stop this?” she asked. “Because we’re living in a time when information can be so powerful, and if it’s wrong, or it’s intended to influence you to do something that is not reality-based but based instead on propaganda, that’s a problem that we have to deal with going forward.” When Adichie asked if this is why she has chosen to keep speaking post-election, Clinton nodded and said that it was.

She and Adichie also discussed how free speech has been a central cause for feminism, with Clinton noting the “long, long history of trying to silence women.” She cited recent instances of attempts to shut down the voices of powerful political women — from Elizabeth Warren, who was removed from the Senate floor as she attempted to read Coretta Scott King’s letter denouncing Jeff Sessions (a letter that was then read out loud to completion by male colleagues), to Kamala Harris, who was told to stop talking during her questioning of Sessions in his Senate hearing on Russia’s involvement in the Trump campaign.

“In my case, it was also because a lot of those same people who said, ‘Don’t talk,’ they did not want to face what happened in the 2016 election,” she later said, addressing Adichie’s question about calls, from both the right and the left, for her to remain quiet following her presidential defeat. But, she said, “I come at it very differently: If we don’t try to understand what happened in that election, we are doomed to see it repeated in future elections.”


Fear of a Cough in the Night

There’s a certain cough, common among children under five, that can be particularly terrifying for parents. It sounds like a seal’s bark, and it’s a telltale sign that the child has croup, a virus that causes children’s airways to constrict.

It’s a cough that Libby knows well. Her son, now seven, struggled with respiratory problems from ages one and a half to five, and had what she calls “massive croup” all the time. Libby, a fortysomething woman in south Brooklyn who declined to give her last name to the Voice, spent countless nights with her son in the bathroom, the door shut and the hot water running in the shower, trying to create a steam bath to ease his coughing.

Then came the night, in 2014, when her son simply couldn’t breathe. Libby and her husband called for an ambulance, which came and took their then-four-year-old son, on oxygen, to the local emergency room, where he stayed, still on oxygen, for hours, until he could breathe normally again.

Libby, who works two days a week doing administration work for an architecture company, recalls another ambulance ride, this one for her husband in 2005, when he was hit on a subway platform. That one cost a couple of thousand dollars, even though her husband was insured. But because their son has insurance through Child Health Plus, New York State’s program for low-income children who don’t qualify for Medicaid, his ambulance ride cost nothing more than the low premium Libby pays each month — as did the oxygen he received, and his ER stay.

“The times when I’ve needed to go to the ER for myself, I’ve called a cab,” says Libby, who put her son on Child Health Plus because her company provides insurance only for its employees. (Her husband, a freelance writer, currently purchases his insurance through the New York State health exchange.) But for her son, she says, the ambulance “showed up and they saved his life and we went to the hospital and everything was great, and it was nine dollars a month.”

For the past 27 years, Child Health Plus has been providing parents in New York with the peace of mind that no matter what is going on in their lives, or with their children’s health, they will be able to get care for their kids. Now, that peace of mind is gone, replaced by anxiety over whether their children will remain insured in a few months’ time. On September 30, Congress failed to renew funding for the national Children’s Health Insurance Program, or CHIP, which funds state programs like Child Health Plus. And even though the House finally passed a bill on November 3 reauthorizing the program for five more years, the bill is so partisan in nature that Democrats are vowing it won’t pass the Senate. Meanwhile, the delay in funding is leaving parents uncertain about how to proceed as open enrollment for 2018 health insurance begins, and has states scrambling to make contingency plans for what to do should their CHIP funds run out before federal funding is renewed.

Teresa, a 34-year-old woman living in Brooklyn whose two sons are on Child Health Plus, has been following the news about CHIP closely. “I’m honestly very confused,” she says. “They’re making it very hard to find answers, which is kind of infuriating.”

Though no state has yet shut down its CHIP program, for some that scenario is not far off. According to a report by Georgetown University’s Center for Children and Families released late last month, at least six states will exhaust their CHIP funds by early January. This means they will either have to find funds within their own budgets to make up for those lost federal dollars, or — the more likely scenario, considering the numbers can run into the hundreds of millions — close down their CHIP programs.

New York has already notified the federal government that it will close Child Health Plus should funding not be renewed by the time its CHIP reserves run out early next year. The delay “is needlessly increasing pressure and uncertainty on the state as it begins the process of crafting next year’s budget,” says Ben Anderson, director of health policy at Children’s Defense Fund–New York. The state had planned its 2018 budget assuming CHIP funds would be in place; as those funds totaled $1.1 billion last year, their sudden loss would leave a giant budget hole that the state, already facing a $4 billion deficit, would be hard-pressed to fill.

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“If Congress doesn’t figure this out soon,” says Anderson, then even though CHIP reserves are projected to last into the first quarter of next year, “New York will have to start dedicating more time and energy to contingency planning, which can be an expensive undertaking.” That includes sending notification letters to enrolled families, something states are trying to put off for as long as they can, to avoid unnecessarily causing alarm. But Colorado and Utah have already indicated they may start sending out those letters this month.

CHIP, which requires periodic reauthorization from Congress, currently provides insurance for nearly 9 million children nationwide; some states’ CHIP programs, such as Minnesota’s, also cover pregnant women. CHIP was created in 1997 through bipartisan legislation, and it continues to have bipartisan support today. Even the federal government, which has not been particularly healthcare-friendly, has been facilitating its existence over the past month; the Centers for Medicare and Medicaid Services — an agency of the U.S. Department of Health and Human Services that works with states to administer CHIP funds — last month reallocated a total of $230 million in unspent CHIP funds from previous years to nine states whose reserves were in dire straits.

Yet CHIP’s looming renewal got lost earlier this year in Congress’s repeated attempts to repeal the Affordable Care Act. In the month since the deadline passed, the renewal bills that were approved by committees in both the Senate and the House in early October were promptly back-burnered in favor of tax reform.

The bill that passed the House, in a largely party-line vote of 242-174, still makes renewal unlikely in the near future, partially thanks to partisan disagreements over how the government would offset the program’s funding. Democrats have been protesting provisions that would help pay for CHIP by cutting subsidies to Medicare recipients who make more than $500,000 a year — cuts that could cause those recipients to leave the program, thereby weakening Medicare’s risk pool. The bill is also unpalatable to Democrats because of a punitive provision regarding the Affordable Care Act: Low- and moderate-income ACA enrollees who receive subsidies would see their three-month grace period for late premium payments reduced to thirty days. The nonpartisan Center on Budget and Policy Priorities estimates the provision would result in up to 688,000 people losing their insurance.

“If the House had negotiated agreement on the offsets with the Democrats, [the bill] could have gone straight through” to the Senate, says Joan Alker, executive director of Georgetown’s Center for Children and Families. As is, she says, there is little likelihood the bill will gain the necessary sixty bipartisan votes to pass the Senate. Reports are now suggesting that funding may instead get renewed via an omnibus spending bill at the end of the year. By then, Washington and Virginia will have already sent out letters notifying families of possible changes in coverage, and Arizona, whose funds run out this month, will have been forced to close down its program.

This apparent congressional impasse comes just as enrollment has opened for 2018 on the health exchange, which could lead newly eligible families to not enroll their children, says Alker. Some of those children “will end up in very inadequate coverage, or private coverage that’s very expensive that will have high deductibles,” she says. “Some will end up uninsured.”

Teresa, who declined to give her last name to the Voice, had planned to renew her family’s coverage on November 1, as soon as open enrollment started. (She and her husband, who run a branding and graphic design shop, get their insurance through the exchange.) But when she asked her sons’ insurer, right before enrollment began, whether their usual plan would be available next year, the representative she spoke to could only say she didn’t want to give her misleading information — leaving Teresa uncertain as to how to proceed.

Teresa says that Child Health Plus has been a “game changer” for her family since she first put her sons on it in 2016. While her older son, now nine, is what she calls a “textbook kid,” going to the doctor only once a year, her younger son, now seven, has struggled with health issues since he was born five weeks premature — including unilateral hearing loss that had progressed to both ears by the time he was five. The family went from one specialist to another, trying to determine the cause without luck, until last year a new pediatrician suggested genetic testing. Based on her previous experience with commercial insurance, Teresa assumed they’d have to pay out of pocket for the testing, and had no idea how the family would afford it. (Genetic tests can cost up to $2,000.) But Child Health Plus covered the test — and, when that test didn’t turn up anything, it covered a second, more in-depth one, which did: They learned that their son has a rare genetic condition that causes, among other things, progressive hearing loss.

Beyond the relief it gave Teresa and her husband to finally know what was going on with their son — “to have that clarity was worth a million bucks,” she says — Child Health Plus also provided coverage for the hearing aids they decided to get him. The devices can cost between $1,000 and $4,000, and most insurers don’t cover them. “It would have been a huge hit on our family,” Teresa says. But Child Health Plus “made available to our kid something that he clearly needs for every day.”

She adds, “My kid was born this way. Kids shouldn’t be penalized for being born with this condition or that condition. They should be supported so they can thrive.”

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Child Health Plus “allows kids who would otherwise be outside the medical system to get care, go to a pediatrician, have a place to go to coordinate vaccines, get healthcare, 24-7 access to a doctor,” says Dr. Steven Goldstein, president of the New York State American Academy of Pediatrics Chapter 2, which represents Brooklyn, Queens, and Nassau and Suffolk counties. Prior to the existence of Child Health Plus, says Goldstein, the children it now covers “had to just go to a hospital.” The program was first enacted in 1990 and expanded seven years later when CHIP funding became available; it now offers comprehensive coverage to children in families up to 400 percent of the poverty level, or $81,684 for a family of three, and, along with Medicaid, it has reduced the uninsured rate of children in New York to 2 percent.  “Now they basically get treated like they have private insurance,” says Goldstein, whose offices in Williamsburg and Kew Garden Hills, Queens, mostly treat Medicaid and Child Health Plus patients. “Their lives have been changed.”

Child Health Plus has seen a spike in enrollment, increasing 17 percent statewide between July 2016 and July 2017, culminating in a total of 347,855 children. (Because children dip in and out of the program, based on changes to their parents’ incomes and life circumstances, nearly twice that number of children are covered by the program at some point during any given year.) The report speculates that this increase may be due to the rollout in 2016 of the state’s new Essential Plan, which provides coverage to non-Medicaid-eligible adults up to 200 percent of the federal poverty level — the exact demographic whose children would benefit from Child Health Plus and yet who might not have previously known it existed.

“When we were looking for insurance for [my husband], I was like, ‘Why can’t we all just buy Child Health Plus?’ ” says Libby, who knows several other kids on the plan, including her sister’s two children upstate. She says it would be a “devastating loss” if the program were shuttered. Should that happen, she would most likely pay to put her son on her employer-sponsored plan, increasing her premiums from $9 a month to $500 a month and doubling her $2,000-a-year deductible. “I’m sure we would do it, because the child is top priority,” she says. “But something else would have to get cut back.”

Teresa — whose household is already facing a 20 percent increase in premiums for next year — says she would put her sons on one of the marketplace’s family plans. But she estimates the cost of those premiums would be $1,000 to $1,500 per person — which for her family of four, she says, would be “kind of like another mortgage.”

“It’s kind of the gray spot, where we are,” says Teresa, whose income lands her in the higher range of what Child Health Plus covers. “We make too much money to qualify for certain things, but $1,300 premiums” — which is what she and her husband will be paying next year — “that’s also too much money. That’s why this program is so great, because it does make it possible to have access to amazing care that you couldn’t afford.”

For now, Teresa must wait and hope that Congress will act before the program disappears. “I know firsthand what it’s like to be a self-employed person who doesn’t have a lot of choices for insurance in the first place, and then be in the position of trying to get care for your child, and you might not be able to get the answers you need or the support you need,” she continues. “I don’t understand why they would not be able to continue these plans. Every kid deserves this.”


A Cartoon Future History of Life Under Trumpcare



A Cartoon Future History of Life Under Trumpcare

Click here for mobile version.



If Congress Doesn’t Act Fast on Children’s Health Insurance, Millions Could Be at Risk

Last Tuesday, the Senate Finance Committee announced it had reached a bipartisan agreement to extend funding for the national Children’s Health Insurance Program for five more years. The announcement, coming after months of pressure from children’s advocacy organizations, marked the first step toward renewing funding for the program, which provides health insurance for nearly nine million low-income children.

The catch: That funding runs out on September 30. So unless Congress can draft, pass, and reconcile the actual legislation in less than two weeks, families nationwide may be at risk of losing health coverage entirely for their children or facing soaring premiums.

“Here in New York, we’re all waiting with bated breath, because there would be an awful lot of work that would need to happen at the state level” should the funding not be renewed, says Ben Anderson, director of health policy for the Children’s Defense Fund–New York, one of the organizations that has been campaigning for an extender bill. “The deal that was announced sounds promising, but there’s still a lot of work to be done” before the deadline.

The Children’s Health Insurance Program, often referred to as CHIP, grants states federal matching funds to provide health insurance for children who don’t qualify for Medicaid, but whose families still don’t earn enough to afford insurance on their own. Thanks to CHIP and Medicaid, 95 percent of the country’s children are insured, according to the Georgetown University Health Policy Institute, Center for Children and Families. The program has enjoyed bipartisan support since its inception in 1997; it was authored by Democratic senator Ted Kennedy and Republican senator Orrin Hatch, the latter of whom is now the chairman of the same finance committee that just agreed to renew the program’s funding.

For the funding to be renewed, however, the following must still come to pass: The Senate Finance Committee must hammer out the particular language of the bill — it said on Tuesday that “full legislative language will be released in the coming days,” although that language has yet to surface — and then submit it to the Senate for a vote. The House must also pass a CHIP bill; if it writes its own legislation at the same time as the Senate, both bills must be reconciled. (At the time of this writing, the House is scheduled to be in session for only four more days this month.) After that, the president must sign the bill.

All of this must happen in the next two weeks. Even if an extender bill is ultimately passed after the September 30 deadline, there would still be immediate consequences for some states. Nevada, which projects its CHIP program will run out of federal funding before the year’s end, might terminate coverage on November 30; to give enrolled families thirty days’ notice, the state would have to start sending out notification letters by the beginning of October. West Virginia, which anticipates its funds will last through April 2018, is required by state statute to end its CHIP program if federal funds dip below 1997 levels. The state is trying to determine when the effective date of that dip would actually be: when the funds run out in April, or on October 1, immediately after the funding renewal deadline passes.

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New York could weather a delay in federal funding renewal, but only until the end of 2017. At that point, even though its current federal funding wouldn’t run out until March 2018, it would need to start determining how to transition affected children to other forms of coverage, because some of those efforts would require legislative actions and changes to the budget, which must be passed by April 1, 2018.

Beyond the short time frame left for passing an extender bill, uncertainty remains over how the bill will move forward in the Senate. Additional provisions on other healthcare- and Medicaid-related issues may yet be attached to the bill, which could impede a quick passage.

CHIP funding last received a two-year renewal in April 2015. That time, Congress reauthorized the renewal months before it was scheduled to expire.

“This is definitely an instance of a manufactured crisis,” says Anderson about the current last-minute rush to renew. “Congress has known that this deadline is coming for two years now, and it spent way too much time debating Affordable Care Act measures and cuts to Medicaid that were going nowhere. And as a result, over three hundred thousand kids in New York are waiting to see what their next step is.”

Those kids are covered by Child Health Plus, New York’s CHIP program. Created in 1991 — it predates CHIP and in fact served as a blueprint for the national program — it covers low-income children up to the age of 19, and also allows ineligible families to opt in to the program at a higher rate. Qualified enrollees are responsible for monthly premiums that, depending on annual income and family size, range from zero to $60. Beyond that, they pay nothing: no copays, no coinsurance, no deductible. The program offers twelve months of continuous coverage, open enrollment throughout the year, and coverage to children regardless of immigration status.

As Anderson notes, as of October 2016, New York state had more than three hundred thousand enrollees in Child Health Plus — nearly 7 percent of the state’s children. Twice that number may be covered by the program during a calendar year, though, as children enroll and unenroll following parents’ job losses, divorces, or other life events that affect their financial situations.

Although the content of a Senate bill is still being worked out, there have been hints that Child Health Plus and the rest of the country’s CHIP programs could be harmed even if funding renewal is passed. According to a statement put out by the finance committee, the proposal would, “over time, transition CHIP to its traditional federal-state partnership and provide additional protections for low-income children and flexibility for states.”

Reports have since indicated that the proposal intends to phase out additional CHIP funds the federal government has allocated to states under the Affordable Care Act. While CHIP’s original legislation granted states a greater share of matching funds than for Medicaid — on average, fifteen percentage points higher — the ACA authorized states to receive an additional 23 percentage points in funds, beginning in 2015. For New York, that means an additional $150 million in federal funds a year. The proposal announced last week would phase out these additional funds by 2021. (The original expansion mandated the allocation of the funds through 2019.)

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Republicans have chafed at this added funding in part because, thanks to the ACA, twelve states plus the District of Columbia are no longer paying anything at all toward their CHIP programs (hence the statement’s language of “traditional federal-state partnership”). But as Anderson notes, the additional funding was originally allocated to help the states transition to new health plan marketplaces and add new services made possible by the ACA — such as, in New York, the Essential Plan, the state’s basic health plan for low-income New Yorkers who don’t qualify for Medicaid.

“All of those changes require funding,” Anderson says. “And so the enhanced match was one way to help states offset that funding.”

Anderson notes that it’s always been an open question as to what would happen to CHIP funding after 2019: “We haven’t had a clear picture on what would happen, and I think that’s one of the reasons why it’s really important for Congress to figure this out quickly, so states can be in a better position to plan moving forward.”

The ACA included a maintenance of effort (MOE) provision that prohibits states from scaling back eligibility, increasing premiums, or changing enrollment waiting periods from those determined in 2010. Anderson believes the announcement’s reference to increasing “flexibility for states” signals an intention to let the MOE expire in 2019 and allow states whose current programs cover children above 300 percent of the federal poverty level to scale back their eligibility requirements. (New York’s Child Health Plus covers children up to 400 percent of the federal poverty level, the highest eligibility level in the country.)

According to the Kaiser Family Foundation, if CHIP funding is allowed to lapse, 32 states, including New York, will run out of their federal CHIP funds by March 2018.

Should that funding expire, parents of enrollees, managed care companies, and vendors will all need to be notified. The New York State health plan marketplace will have to be modified to transition children previously enrolled in Child Health Plus into new forms of coverage. All these changes require time and money. And while states usually get two years’ notice when Congress is planning such a substantial change, now they will have none.

As Anderson says, “We’re really getting down to the last minute.” Letting CHIP funding lapse, he says, “would create a big mess in New York.”

In the nation as a whole, children currently enrolled in CHIP programs could lose that coverage. In testimony before the Senate Finance Committee on September 7, Anne Schwartz, executive director of the nonpartisan Medicaid and CHIP Payment and Access Commission, warned that, should CHIP funding run out, 1.2 million children nationwide would not be able to afford alternative insurance; 61.3 percent of those children have family incomes below 200 percent of the federal poverty level, and 53.9 percent are non-white.

Those children whose families could afford to buy other insurance, either through employer-based plans or through state marketplaces, might receive less-comprehensive coverage. (For instance, CHIP programs cover dental care, whereas on the exchange, dental is usually offered under a separate plan, with its own premiums, copays, and deductibles.) And families would face higher healthcare costs: In her testimony, Schwartz noted that parents would have to pay $600 to $800 a year for premiums alone, as opposed to $127 a year on CHIP.

Following Tuesday’s announcement, Democratic senator Ron Wyden, ranking member on the Senate Finance Committee, tweeted that we “need to get this done ASAP.” That is a gross understatement. As Congress continues to work on legislation, CHIP’s funding is set to expire in thirteen days. Meanwhile, the healthcare of nine million children hangs in the balance.


City Finally Does Something About Students Ashamed to Eat School Lunch

This week, New York City joined cities including Boston, Chicago, Detroit, and Dallas in offering free lunches to all its schoolchildren, making it the largest school district in the country to do so. The Free School Lunch for All program announced Wednesday by New York City Schools Chancellor Carmen Fariña will expand eligibility to at least an additional 200,000 students — including not just those at public schools but also charter schools and any private schools that choose to opt into SchoolFood, the city’s free meal program.

But city food advocates say it will have far broader benefits as well: Reducing stigma that currently prevents many needy students from taking advantage of free lunches, and sparing principals from having to chase down parents for lunch payments.

“As kids get older, they stop eating, no matter how hungry they are,” says Liz Accles, executive director of Community Food Associates, a policy impact group that focuses on increasing food accessibility to low-income New Yorkers. CFA is one of several groups that have advocated for years that providing free lunch for all would end the drop-off in program participation by students as they approach high school — students who may currently be going hungry out of shame or fear of bullying.

The first school lunches in New York City appeared in 1908, when a home economist named Mabel Hyde Kittredge started a school lunch program at an elementary school in Hell’s Kitchen. The following year, Kittredge founded the New York School Lunch Committee, which by 1915 was serving 80,000 free or low-price lunches annually to children in nearly 25 percent of the schools in Manhattan and the Bronx, most of them in poor neighborhoods. The city’s board of education eventually took over the program in 1920.

In 1946, President Harry Truman established the National School Lunch Program, a federally assisted meal program that continues to operate today. When it started, the program served lunches to around 7.1 million children nationwide. Last year, it reached 30.4 million children, who are deemed eligible for free meals if they already participate in other federally funded programs such as the Supplemental Nutrition Assistance Program, or if their family income is below 130 percent of the federal poverty level. (Families between 130 and 185 percent of the poverty level are eligible for reduced-cost lunch.)

One of the unintended consequences of this eligibility model is that a “poverty stigma” has grown up around the program, says Accles. And this poverty stigma has made it much less likely for the very children who need the meals provided by the NSLP to actually take advantage of the program.

With teenagers in particular, Accles says, “peer pressure is not ever to be underestimated. They’re embarrassed to eat [the free lunches], either because someone is actively bullying them, or because they anticipate that that will happen.”

In New York City, a startling number of children may be impacted by such peer pressure. As wealthy as the city may be, 75 percent of its schoolchildren are eligible for free or reduced-cost lunches based on their families’ income levels; the cutoff for eligibility for a family of four, for instance, is $45,510 a year. In a city like New York, many families who make too much to be eligible are still struggling to make ends meet. (Accles notes that not having a universal free lunch program also “puts principals in a terrible position, to try to collect fees from parents who don’t have the income.”)

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For this reason, food-policy advocates have long called for the city to adopt a universal lunch program. In 2013, Accles’s Community Food Associates launched the Lunch 4 Learning campaign, which partnered with pediatricians, school parents, teachers unions, and school workers unions to push for free lunches for all students in the city. The impetus for this particular campaign was the introduction by the federal government three years prior of the Community Eligibility Program (CEP), which offered an alternative funding model that incentivized a move toward universal school lunches. Instead of matching funds directly to individual students and their families’ income levels, CEP rules that if 40 percent of students at a school, group of schools, or even an entire school district qualify for free lunches, so does the rest of the school or district. CEP also allows schools or districts to qualify without collecting meal application forms, which can be cumbersome and intrusive, providing another impediment to eligible students participating in free lunch programs.

Still, the push toward free school lunches for all was slow and incremental. In 2014, the city implemented a universal meal program in stand-alone middle schools, but from there, efforts stalled out. City officials cited concerns that such programs would not be financially beneficial; they also feared that schools could lose their Title I funding, since the meal application forms, which are also used to measure poverty levels for other programs, would no longer be necessary — a fear that was proven unfounded by the universal meal program in the city’s middle schools. “Honestly, we have never fully understood the resistance,” Accles says.

What finally allowed the city to sign on to a universal meals program was a new data matching engine that identifies eligible students through electronic documentation acquired from other government programs, such as SNAP and Medicaid. The data matching makes it easier to identify students who are eligible for free lunches — and, thanks to CEP, identifying more eligible students has allowed entire districts to qualify for free meals. Because of this new matching engine, the program is not expected to increase costs to the city, according to the New York Times.

Accles says that high school students, who endure the worst bullying, will benefit greatly from Free School Lunch for All, and from no longer standing out from their classmates for receiving free meals. But even more likely to benefit, perhaps, are the children just starting out in school, who, thanks to the eradication of the poverty stigma that this new program should bring, will never have to feel shame for getting a healthy meal at the one place they can count on it: their schools.


Why I’m Still Worried the GOP Will Take Away My Son’s Healthcare

On the night of July 27, I, like so many others, stayed up late awaiting the vote on the Senate’s “skinny repeal” bill, frantically refreshing Twitter every few seconds in hopes of a clue as to which way the vote was going to go. When tweets tallying the vote finally appeared in my feed — “MURKOWSKI VOTES NO ON SKINNY REPEAL.” “MCCAIN VOTES NO ON SKINNY REPEAL.” “COLLINS VOTES NO ON SKINNY REPEAL.” — I wept, as much from exhaustion as from relief. It was the culmination of half a year’s worth of anxiety wreaked by Congress’s attempt to repeal the Affordable Care Act — an attempt that, for me, had been very personal.

Because most of the recent repeal attempts included severe cuts to Medicaid, much has been written about how the safety-net health insurance plan is more than just “an entitlement program for the poor.” It is there for you if you or your children have disabilities. It is there for you when you can’t afford your own nursing home bills. What hasn’t been talked about as much is how Medicaid can also be there for you when you lose your job. Which is what happened to me when my son was four months old.

Two years ago I was laid off from my job at a well-known magazine, at whose parent company I had worked for over a decade. By then, I had worked my way up to a senior-level position. And I had been back from maternity leave for seven weeks. I can’t say I was entirely surprised when the editor-in-chief called me into his office and told me the news; several people had been laid off the previous week, and layoffs always went in waves at this company. Nor, despite some later moments of real panic — which manifested as what felt like an animal trying to claw its way out of my chest — was I particularly upset. I was a new mother, and a first-time mother, and, thanks to a decent severance package, I felt I had been gifted more time at home with my child, whom I had not yet been ready to leave when I went back to work twelve weeks after he was born. But I am also what’s known as a Single Mother by Choice: I chose to become a mother on my own, without a partner, and as such I am solely responsible for my son’s well-being. And so I was equally thankful that my package included health insurance.

My intention, of course, was to find a job before my severance ended. Yet when that time came, despite some interviews, and many, many more networking coffees, I had still not found full-time work, or its accompanying employer-sponsored insurance. I have had friends who, after losing their jobs, have considered letting their health insurance lapse. But I had a young child at home. Not only did I have to keep him healthy, but I myself had to stay in good health so that I could care for him. My son was only a year old then, an age at which the American Academy of Pediatrics still recommends well visits every three months. He is a very healthy child; the worst we have had of it was a two-week bout of conjunctivitis (which occasioned three visits to the doctor). But even he has been hospitalized, a prescribed precaution when children under two months spike a fever, as he did at five weeks. Forgoing insurance was not an option.

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My plan was to put myself on COBRA while getting my son coverage through Child Health Plus, a low-cost, state-sponsored plan that I knew of from friends. CHP provides insurance for children under the age of nineteen who don’t qualify for Medicaid but whose parents make less than 400 percent of the federal poverty level (parents who make more can also use the plan, but have to pay full price), and it pre-dates the ACA; created in 1990, it actually served as the blueprint for the federal Children’s Health Insurance Program (CHIP) that was enacted in 1997, during the Clinton administration. (Thanks to both Child Health Plus and Medicaid, over 96 percent of children in New York are currently insured.) After getting utterly lost trying to sign my son up for CHP through New York’s marketplace, and fearing I would miss the deadline to get him covered, I contacted an insurance navigator. She told me that I could also get low-cost insurance for myself, through the state’s new Essential Plan.

The Essential Plan, like CHP, is a state-sponsored plan, implemented through private insurers, that offers low-cost insurance to adults who make too much to qualify for Medicaid but who still live at less than 200 percent of the federal poverty level. Rolled out in 2015, the program, which was made possible through the ACA, covers all ten ACA-required “essential health benefits” such as primary care, urgent care, emergency care, and reproductive healthcare. Depending on enrollees’ income levels, monthly premiums are either $20 or free, with no deductible.

I qualified for the $20-a-month plan, and ended up purchasing vision and dental care for an additional $26.56 a month. I received this insurance through the United Healthcare Community Plan, the insurer’s Medicaid managed care plan. And I was able to get my son coverage through Child Health Plus — via the same insurance plan — which, for a $9 monthly premium, provided him with comprehensive healthcare for free. (He was also able to keep seeing the pediatrician he’d seen since birth.) Had we both gone on COBRA, I would have been paying $1,500 a month.

As the weeks turned into months and I was still unable to find full-time work, this difference in cost proved crucial. Thanks to my low monthly premium payments, I was able to stretch the money I had saved from my severance — putting it toward vital items like food, mortgage payments, and diapers — for six months. Had I added insurance premiums to that list, my cushion would have been gone in two. And that’s not to mention the $3,500 deductible included in that COBRA plan. Before my son went on CHP, I paid upwards of $100 every time I took him to the doctor — for a funny-looking rash, or a fever that had lasted more than three days, or out of fear that he had hand, foot, and mouth disease because he kept complaining something was in his mouth (all examples of actual doctor’s visits we’ve had). After CHP, those visits cost nothing. And my own trips to the doctor, of which there have been many as well, have been covered by a $15 to $25 copay.

As grateful as I have been for the Essential Plan, it was humbling, to say the least, to go on it. Although I like to refer to it euphemistically as “low-income insurance,” it is in essence just a different tier of Medicaid. Growing up the daughter of a pediatrician whose practice proudly saw Medicaid patients when others wouldn’t, I have always been aware of the program, but I certainly never thought I would one day find myself benefiting from it. And I have always been aware that not all doctors will accept Medicaid, as my father did — and that remains the case today, as does the stigma surrounding the program, even in the medical community. When I called the office of a gynecologist I had seen a few years before who was listed on my plan’s website as an in-network doctor, the receptionist, responding to my query if the practice took my insurance, replied, “That’s Medicaid. No, we don’t take that.”

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This attitude is in part what led to my going to Planned Parenthood for my women’s health needs. The healthcare provider not only took my insurance, but would have seen me even if I were uninsured. And, as I continued to go to its clinics — for well woman’s visits, birth control-related visits, general women’s health visits — I discovered Planned Parenthood provided superior healthcare, even when compared to previous doctors whom I had really liked and respected. On my first visit, for an issue I’d been suffering from for half a year that neither my PCP nor gynecologist had been able to resolve, both the provider and the nurse who did my intake exam were able to pinpoint the source of my troubles within the first few minutes of speaking with me. On another visit, the provider I saw, a midwife, was able to determine the source of symptoms that another doctor — the head of his hospital’s OB/GYN department, no less — had written off as essentially being in my head. (As an ultrasound later discovered, I had an ovarian cyst — something the Planned Parenthood provider had predicted based on the same complaints the OB chief had dismissed.)

I had known since election night that the Republicans in Congress would go after the ACA, and with it my insurance; after all, this is what they’d been promising to do for the past seven years. Their attempts to defund Planned Parenthood were also nothing new. What I hadn’t entirely understood was how Congress’s attempts at repeal would affect my son’s coverage. Child Health Plus began as a fully state-funded plan that offered only care for children up to twelve years old. It didn’t become the robust program it is today until it started receiving 65 percent matching federal funds under CHIP; additional funding, which brought the total amount of matching money to 88 percent, came courtesy of the ACA. The ACA repeal bills would bring with them a loss of that extra 23 percent, meaning New York State would either have to make up the difference in funds or make some tough decisions on how to scale back the program.

It’s this aspect of the repeal attempt that has always made me feel the most impotent, and the most enraged. If the representatives and senators drafting this legislation want to do nothing to help me as I struggle to support my son while looking for full-time work — if they perhaps even judge me for being a single parent in the first place — then fine. There is nothing I can do about that. But they are trying to take healthcare away from my child. And this I find heartless, and unconscionable.

I wish I could say that, with repeal dead for now, my story has a happy ending. After all, I am finally getting back on my feet, having found just enough freelance work (thanks in no small part to the Voice, whose online content, full disclosure, I copyedit) to make ends meet. But even if the repeal stays dead, even if President Trump doesn’t stop subsidy payments to insurers or undermine the ACA in a myriad of other ways, my financial situation is such that — knock wood — I will not qualify for the Essential Plan next year. Instead, I will be stuck with the same predicament as so many other struggling families, and the one that has made the ACA, until recently, so unpopular. For while I will still qualify for subsidies for my monthly premiums — which, because of the uncertainty surrounding the ACA’s future, are predicted to spike — my deductibles may be double what I paid when I had insurance through my previous employer, when I was making twice what I’m making now. I’m encouraged by recent talk of bipartisan healthcare reform, as there is still much work to be done to make the ACA truly viable for the middle class.

And then there is Child Health Plus. In that surreal moment when the ACA repeal died, I thought CHP, for which we will still qualify next year, would be safe. But I have since discovered that it too may be in jeopardy: It seems that while the repeal effort was stalling in the Senate, so was other legislation, including the renewal of federal funding for all CHIP programs, which runs out in September. There is still time to renew this funding, but there is also the very real possibility that CHIP renewal will get held up by all the hot-button legislative issues currently swamping Congress — tax reform, the federal budget, even the new bipartisan healthcare effort itself — or get lost entirely. And even if the funding is renewed, it still might be altered in drastic ways: Some members of Congress have proposed reducing the eligibility cutoff from 400 to 250 percent of the federal poverty level, which would exclude thousands of children in New York from receiving those federal funds — including mine.

There is strong support for Child Health Plus in the New York legislature, so the state will likely try to make up any federal funds it loses. But even then, it would translate to cuts for other programs. Democratic assembly member Richard Gottfried, the chair of that body’s health committee and the sponsor of the original Child Health Plus legislation, and his Republican counterpart in the senate, Kemp Hannon, are drafting a joint letter to the New York congressional delegation urging them to support a straight extender of CHIP and to keep it intact. But for now, the future of my son’s insurance is in the hands of an increasingly dysfunctional Washington. And so, as much of the country continues to celebrate our nation’s close call, my anxiety only continues.