A woman holds a baby by a window

Paid Leave as a Public Health Issue

Earlier this month, Claire Cain Miller and Jim Tankersley wrote for the New York Times Upshot about Gavin Newsom’s anticipated paid leave proposal for California. Their piece highlights economic research showing that the absence of paid leave policies in the U.S. hinder women’s participation in the workforce and, in turn, hurts the U.S. economy. (For example, Miller and Tankersley cite a letter from the Federal Reserve Bank of San Francisco projecting that a national parental leave policy could result in 5 million more workers joining the labor force.)

As politicians like Newsom grapple with the question of how to pay for more robust paid leave policies at the state-level, defining the costs of our current systems will be an important part of the process.

The health costs of not providing parental leave are another—and under-explored—part of the equation. Two recently published papers point to the negative public health outcomes of our current leave policies, specifically for new mothers.

Read More

Healthcare Already Taking Center Stage in 2020 Democratic Primary Race

With Massachusetts senator Elizabeth Warren (D-MA) announcing that she was forming a Presidential exploratory committee, I suppose that means the 2020 Democratic Primary is off to the races. Joining her are some lower profile candidates, including John Delaney (former MD congressman), Richard Ojeda (WV state senator and former congressional candidate), Tulsi Gabbard (HI congresswoman), Julian Castro (former secretary of HUD). And within the last week, senators Kirsten Gillibrand (D-NY) and Kamala Harris (D-CA) put their hats in the ring.

While many issues are likely to play prominent roles in this campaign — immigration, taxes, inequality, housing, universal pre-k, college affordability, environment/climate change — healthcare is likely to play an outsized role after Democrats found it to be a winning issue in 2018.  Read More

President Trump speaks to reporters in the rose garden

Shutdown Fever: How Washington’s Standstill Impacts Health

While Federal Employees Health Benefits (FEHB) coverage will continue during the shutdown, with 800,000 federal employees going without paychecks, there are a range of fears looming in terms of health, for federal workers specifically, as well as for public health more generally.

Kaiser Health News recently reported the story of Joseph Daskalakis, a federally employed air traffic controller in Minnesota whose son was born on New Years Eve, about 10 weeks earlier than expected. The very premature baby was taken to a specialized neonatal intensive care unit (NICU) in a hospital outside of the father’s insurer’s network. Ordinarily, he would be able to file paperwork and switch insurers. But this isn’t possible during the shutdown. And while Mr. Daskalakis’ insurer and the Office of Personnel Management’s (OPM, which oversees federal health benefits programs) website have indicated that his requested change of carriers to have that hospital in his network would be effective retroactively, his family still received an initial bill of $6,000, with more charges likely yet to come. And as long as the shutdown lasts, none of those federal employees can add spouses or newborns to existing plans or change insurers in the case of unexpected circumstances.

Uncertainty surrounding medications during the shutdown can also present incredibly difficult decisions for federal workers, as it already has for Mallory Lorge, an employee of the U.S. Fish and Wildlife Service. Lorge is diabetic and began rationing her insulin because “‘the thought of having more debt was scarier than the thought of dying’ in her sleep.” Lorge went an entire weekend without using her insulin pump, experiencing skyrocketing blood sugar levels, but knowing she couldn’t afford the copay if she needed more insulin.

Read More

A pile of rotting food on a table.

Revisiting an Old Proposal on Aesthetic Adulteration of Food

This Winter Session I am enrolled in Harvard Law School’s “Food and Drug Law” course. One of the topics covered in the first week of class is “filth”—a category including natural food adulterants like mold, insect parts, and rot.

As the FDA has noted, there is no feasible way to prevent some filth from getting into practically all of our food supply. Of course, the FDA has tools to address this problem where it causes actual harm. The FDA’s poisonous and deleterious substances controls empower the agency to preempt and remediate safety risks in food. And, through its “aesthetic adulteration” standards, the FDA is also empowered to address filth in food even where it causes no direct harm to human health.

Read More

What If the President of Nigeria Had Been Cloned?

In a helpful reminder that American politics are not the world’s only ongoing farce, Nigeria’s President Muhammadu Buhari felt compelled last month to deny rumors that he had died and been replaced by a clone. “On the issue of whether I’ve been cloned or not,” he said “I can assure you all that this is the real me.”

Exactly what a clone would say, no?

Although by all accounts there is (obviously) no actual evidence for what would have been a marvel of scientific achievement, what if he had been cloned? What if a sitting head of state of a constitutional democracy were replaced by a clone of himself during his tenure? Would the clone have a legitimate claim to power, or should the affair be treated as some kind of a high tech palace coup? Read More

The Non-Identity Non-Problem

Around this time last year, I wrote a blog post for the Hastings Center, in which, in the context of responding to Professor Vardit Ravitsky’s report on reproductive autonomy and public health, I made the argument that when considering the ethics of selective abortions, we do not always confront a philosophical issue of non-identity because we can, in some cases, consider two genetically distinct embryos the same person.

Nobody buys my argument. Read More

Successful HIV Criminalization Reform in California: Q and A with Sen. Scott Wiener

The majority of states have laws that criminalize activities by HIV-positive people that are not criminalized when the rest of the population engages in them.

Many of these laws improperly single out HIV over other infectious diseases and reflect a lack of understanding of both how HIV spreads and how it can be treated.

In 2017, California passed legislation which modernized and improved California’s HIV criminalization law. One of the authors of the law was State Senator Scott Wiener. I recently had a chance to ask Sen. Wiener some questions about that process.

His responses are given here in hopes of supplying useful information for legislators, lobbyists, and activists in other states who are interested in starting the reform process in their own states or other jurisdictions around the world. This interview has been edited for clarity.

Read More

Public Charge and the Expressive Effects of Immigration Law

In early October, the Department of Homeland Security published a proposed redefinition of the Immigrant and Nationality Act’s “public charge” provision, stirring serious concern among health-care and immigrant advocacy groups.

The “public charge” provision of the INA currently allows immigration officers to deny green cards to legal immigrants who are likely to become “primarily dependent on the government for subsistence.”

DHS’s proposed rule would widen the scope of “public charge” to include any legal immigrant who uses cash or non-cash government benefits. In expanding the scope of the public charge inadmissibility determinations, DHS would empower immigration officers to consider immigrants’ current or prior use of programs like Medicaid and SNAP in evaluating applications. Read More

A row of colored medical records folders

The Troubling Prevalence of Medical Record Errors

With plenty of potential healthcare concerns and complications arising out of medical diagnoses and treatments themselves, errors in medical records present an unfortunate additional opportunity for improper treatment.

A recent article from Kaiser Health News (KHN) discussed several examples of dangerous medical record errors: a hospital pathology report identifying cancer that failed to reach the patient’s neurosurgeon, a patient whose record incorrectly identified her as having an under-active rather than overactive thyroid, potentially subjecting her to harmful medicine, and a patient who discovered pages someone else’s medical records tucked into in her father’s records. In addition to incorrect information, omitting information on medications, allergies, and lab results from a patient’s records can be quite dangerous.

The goal of “one patient, one record” provides a way to “bring patient records and data into one centralized location that all clinicians will be able to access as authorized.” This enables providers to better understand the full picture of a patient’s medical condition. It also minimizes the number of questions, and chances of making errors, that a patient must answer regarding their medical conditions and history when they visit a provider.

Other benefits, such as cost and care coordination, also add to the appeal of centralized records.

Read More

Some takeaways from Montana’s Medicaid expansion ballot initiative

As Nicholas Terry wrote in his recent blog post, the 2018 midterm elections produced some big wins for Medicaid. Voters in Idaho, Nebraska and Utah decided to expand Medicaid coverage under the ACA. These states followed the lead of Maine, where Medicaid was expanded by ballot initiative in November of 2017.

One exception to this trend is Montana. On November 6, Montanans rejected I-185, a ballot initiative proposing to fund the state’s Medicaid expansion through a tobacco tax. The ballot initiative would have removed a sunset provision that automatically terminates funding for the expansion in 2019. The outcome of the initiative has not necessarily killed Montana’s expanded program. The Republican legislature may still act to appropriate funding for the program, and—given that the expansion was originally passed with bipartisan support in the state legislature—this route to securing financing is not foreclosed. In August, the oversight committee in charge of the expansion bill recommended that the state fund the program regardless of the outcome of the ballot initiative.

However, even if the future of the Montana expansion remains unclear, there are still some important immediate takeaways from the result of I-185. Read More