First Person

The Trump Administration Is Confused About Meals on Wheels. My Grandma Could Teach Them A Thing or Two.

Last week, White House budget director Mick Mulvaney defended the Trump administration’s proposal to cut funding for Meals on Wheels by arguing that the program is “just not showing any results.”

That claim is objectively false.

Meals on Wheels serves more than 2 million seniors every year who aren’t able to shop and cook for themselves. Research on home-delivered meal programs shows that they improve diet, nutrition, and quality of life, and reduce food insecurity among participants. In short, when seniors get meals, they’re healthier. My casual field research—otherwise known as every conversation I’ve ever had with my grandparents—also backs this up. If you don’t feel well, you should eat something.

I’m guessing, based on Mulvaney’s argument that cutting the program’s funding is the “compassionate” thing to do, that he hasn’t watched someone nearly die from malnutrition. But I have.

My grandmother had the dubious honor of being the only person to check into her hospice house two separate times.

The second time she was admitted, she spent a month fighting off the beleaguered staff’s attempts at kindness while she settled into an uncharacteristically peaceful death. She wasn’t an easy woman to care for during her life, and she wasn’t any different when she was dying. Once, when a hospice worker took her outside to spend some time in the sun, she dismissed the house’s small garden as “prissy bullshit.” When a volunteer dropped a curler during an attempt to wash and set her hair, she snapped that she “didn’t have that much time left, and didn’t want to waste it fumbling around.” When a grief counselor asked her what she’d miss about her life, she answered “gimlets and a fucking cigarette.”

We held her memorial service in the same room that she died in—another first for the house’s staff. When the nurse leading the service offered us the opportunity to share a warm memory about her life, we all shifted uncomfortably in our seats as we struggled to think of one. My aunt finally broke the silence with a long story about my grandmother’s legendarily mean tortoiseshell cat, Cleo, who lashed out at anyone within striking distance.

My aunt didn’t mention her plan to have Cleo euthanized shortly after the service.

I hope Meals on Wheels would have been there to show a mean old lady some compassion.

Two years earlier, when my grandmother was admitted to that hospice the first time, she only stayed for two weeks. What we had been convinced were signs that she was nearing death—exhaustion, weakness, confusion—turned out to be malnutrition. After a few healthy meals, they sent her back home, and we made sure someone went to her trailer at least once a day to check that she ate and to ration out just enough scotch to keep her withdrawal tremors at bay.

My grandma survived those two years between hospice stays because my aunts split up the responsibility of taking care of her. If they hadn’t been able to do that, I can only hope that Meals on Wheels would have been around to help her before she slipped back to the place where hunger made it impossible to finish a sentence, or stand up from the kitchen table, or put in her dentures.

In other words, I hope Meals on Wheels would have been there to show a mean old lady some compassion.



Why Immigrants in California Are Canceling Their Food Stamps

What if you had to make a choice between hunger or deportation?

As the Trump era unfolds in California, fear of an Immigration and Customs Enforcement crackdown is disrupting the daily lives of immigrants and their families. In a state with 5.4 million non-citizen residents—and where nearly half of all children have at least one immigrant parent—the president’s promise to increase deportations may already be affecting the health and livelihoods of families, even those here legally, by discouraging them from turning to public-assistance programs or from working.

At the Alameda County Community Food Bank in the San Francisco Bay area, 40 families recently requested that their food stamps be cancelled, according to Liz Gomez, ACCFB’s associate director of client services. Another 54 Spanish-speaking households that pre-qualified for the Supplemental Nutrition Assistance Program turned down the opportunity to apply. Gomez says that the combination of a leaked draft executive order suggesting that legal immigrants could be deported for turning to public assistance within their first five years of arrival, as well as local ICE sweeps—and stories about raids and arrests elsewhere—are making immigrants afraid to give their information to service providers.

ACCFB has one of the largest SNAP outreach programs among food banks nationwide. It also provides enough food for 580,000 meals each week through food pantries, soup kitchens, child-care centers, senior centers, after-school programs, and other community-based organizations.

“We are concerned that some people are hesitant to visit a food pantry out of fear that ICE could show up,” said Gomez.

Indeed, Heidi McHugh, community education and outreach coordinator at Food for People in Humboldt County, says they have seen a decline in Latino clients at some sites. The organization runs 14 community food programs including meals for seniors, food pantries, school meal programs, and a mobile produce pantry that travels throughout the county to distribute vegetables. This month, when it stopped in a community that historically turns out 20 or 30 Latino households, only five Latino households showed up.

“We had previous customers drive by without stopping,” said McHugh. “Our pantries in the communities with high proportions of Latino residents say that they are seeing fewer people coming for food.”

At a food bank in the San Francisco Bay Area, 40 families recently requested that their food stamps be cancelled.

Qualifying for Medicaid, SNAP, or WIC can’t currently be used as legal cause for deportation or denying someone citizenship. But people are still afraid, Gomez said, even immigrants with legal status. Given the leaked draft executive order, providing personal information feels risky, at best. “They fear it will be shared,” said Gomez. “But it’s important for people to know that information like immigration status is not collected by pantries or meal programs—they’re simply there to help people who need food.”

About 45 percent of immigrant-headed families with children use food assistance programs. While undocumented immigrants are not eligible for food stamps, many families include children who are US citizens, and parents may apply on their behalf. Immigrants are more likely to be poor and to experience food insecurity than other groups of Americans; still, there is evidence that they’re already less likely to use public assistance than native-born citizens.

The economic impacts of forgoing benefits ripple to the surrounding community: Gomez said that the 40 households that canceled SNAP benefits and the 54 households that didn’t apply adds up to $630,000 annually in lost stimulus to the local economy. “And that’s just one example from our own work,” she said. “What’s the economic impact in communities across the country?”

Given recent ICE activity around the country, it’s not hard to see why immigrants might worry about the risks of using social support programs. Recently, ICE agents entered a courthouse in El Paso County, Texas and arrested a domestic violence victim who was trying to get a restraining order against her alleged abuser. In Alexandria, Virginia, there was a report of homeless people being interrogated by ICE at a church where they’d taken shelter from the cold. And in Los Angeles, a father was arrested by ICE immediately after dropping off his 12-year-old daughter at school.

Last month, two California state legislators sent a Freedom of Information Act request to the federal government seeking information about reported ICE activities in “sensitive locations” like “schools, hospitals, medical clinics, community centers, courts, government offices or churches.” Assembly Speaker Anthony Rendon and Senate President Senate President pro Tem Kevin de León wrote that “the fear of possible ICE enforcement activity in sensitive spaces prevents Californians from accessing services, including educational, medical, and law enforcement assistance.”

At a recent press conference in Fortuna, a small northern California city where nearly 20 percent of residents are Latino, members of the community talked about how the presence of ICE agents had disrupted their lives, including their ability to work. Jorge Matias, a community health worker, said there are parents who are “afraid to leave their homes to go to work or to go to their children’s schools for fear of being deported.” A woman named Karina Coronel said her children, ages four and six, have recently been bullied at school by students and a teacher, and that she has been shoved in stores and repeatedly told to “Go back to Mexico.” Coronel said, “Right now I am very fearful to even leave my home.”

“What gets me is that our people were already struggling,” said Gomez, noting that a 2014 study conducted by ACCFB showed that half of the food bank’s clients were already forced to make impossible choices between food and things like rent, utilities, transportation, and medicine. “People are literally now making the choice not to eat or to sacrifice their health because they are so invested in being an American,” said Gomez.

Author’s note: Join millions of people around the nation to protect immigrants and refugees and stand up for the values of love, compassion, and family in the #HereToStay campaign.

This article was originally published on The Nation.



Why Won’t Ben Carson Speak Out Against HUD’s Budget Cuts?

When Dr. Ben Carson was nominated to be Secretary of the Department of Housing and Urban Development, many progressives were distraught. Dr. Carson’s lack of experience with housing policy, paired with his limited interest in running a federal agency, did not inspire much faith in his ability to manage an agency with a $47 billion budget that is tasked with supporting 31 million Americans.

By the time Carson was confirmed last month, there had been a shift. Media coverage softened, as some newspapers moved from being incredulous about his qualifications to arguing that his health background made him uniquely suited to running the department. During his confirmation hearing, Carson made that case himself by noting “good health has a lot to do with a good environment.” Some housing advocates, in turn, were hopeful he could be a good partner to their communities.

Less than a month into his tenure as HUD secretary, Carson is already beginning to undercut this argument. The Trump administration’s FY 18 budget, released today, proposes a $6.2 billion cut to the HUD budget—targeting programs that keep families housed and healthy.

Today’s “skinny budget” was light on detail, so it didn’t account for all of the resources that would be slashed as a result of the 13.2 percent cut to HUD’s funding. According to earlier documents, about $1.5 billion of the cuts would come from the funds local governments rely on to clear public housing of mold and lead. That would add to the backlog of major repairs needed for public housing, which already stands at  $26 billion. The budget does propose a $20 million increase in funding specifically for lead remediation, but that restores less than 1 percent of what is being cut.

The budget also cuts programs that help prevent and alleviate homelessness, which is associated with health problems due to weather exposure, untreated conditions, and inconsistent medical care. About 200,000 low-income households could lose the rental assistance they need to afford housing, and the development funds that local governments use to prevent homelessness stand to be gutted. These programs have reduced homelessness by 10 percent since 2010— including a 15 percent reduction in family homelessness, and a 33 percent reduction in veteran homelessness.

The cuts also eliminate programs that support entire communities in their effort to provide a healthy environment for children. Community Development Block Grants (CDBG) and Home Investment Partnership (HOME) grants build and fix affordable housing, finance health care centers, and create community centers that give children safe places to play. In 2013 alone, 9.8 million people lived in areas that benefited from CDBG-funded projects, and HOME grants have helped build or saved 1.2 million affordable homes since the program was created in 1990.

Sec. Carson knows that living in poverty makes children sick.

Sec. Carson knows that living in poverty makes children sick. Living in structurally unsafe, substandard housing places children and families at a higher risk for fire-related injuries, asthma, and lead poisoning. It is also responsible for more than 18,000 preventable deaths each year. Carson has acknowledged this time and time and time again over the years. And, in one of Sec. Carson’s first messages to staff and the housing community last week, he pledged to “use every fiber of [his] being to work to improve America’s neighborhoods.” So, where is he this week when communities and families need him to defend the vital dollars they rely on?

During his confirmation hearing, Carson told U.S. senators, under oath, that he no longer supported the extreme cuts he had once campaigned on for President. He called such cuts “cruel and unusual punishment.” His support of this budget breaks his oath to Congress, and it calls into question the ethical oath he swore to live by when he became a physician: to do no harm.

Carson’s decision to support the current budget would dishonor his lifetime Hippocratic creed to uphold the human dignity of the people he serves—the people, families, and communities that rely on HUD. They deserve housing that keeps them safe from winter storms and summer heat. They deserve roofs without leaks, paint without lead, and walls that aren’t bubbling with black mold. They deserve to be able to turn the stove on without worrying if the apartment will catch fire.

They deserve to be healthy.



HHS Secretary Tom Price Invited Governors to Gut Medicaid Protections

As House Republicans deliberate over their efforts to ram through a repeal of the Affordable Care Act that slashes $880 billion from Medicaid, one might be forgiven for believing that the only threat to the health care of low-income Americans and people with disabilities is coming from Congress.

No such luck.

Tuesday night, Secretary of Health and Human Services (HHS) Tom Price and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma issued a letter to the nation’s governors laying out their vision for Medicaid. In the letter, they indicate a willingness to waive longstanding rules that are designed to protect low-income Americans from coercion, poverty, and exploitation.

Price and Verma assert that “rigid and outdated implementation and interpretation of federal rules” hinder the Medicaid program from accomplishing its goals. They reiterate a popular (and false) conservative talking point that by providing states additional funds to expand Medicaid, the Affordable Care Act discouraged them from addressing the needs of people with disabilities on traditional Medicaid. Finally, they lay out HHS’s willingness to grant almost every ill-advised “flexibility” request in the right wing’s wish list on Medicaid—many of which place people with disabilities, seniors, and low-income Americans at extraordinary risk.

Making Medicaid Harder to Access

The letter indicates the Trump administration would be willing to let states introduce premiums and higher cost-sharing for Medicaid beneficiaries.  These measures were rejected under the Obama administration, since they interfere with the program’s ability to serve low-income people. But based on Price’s letter, they now look likely to sail through.

In particular, Price and Verma suggest states may wish to apply for permission to allow “emergency room copayments to encourage the use of primary and other non-emergency providers for non-emergency medical care.” It’s a laudable goal, but in rural areas where there is a shortage of clinicians who accept Medicaid patients—a common problem due to the program’s low reimbursement rates—emergency rooms are often the only practical option for low-income people. Policies that make emergency room visits more expensive are likely to simply discourage people from seeking necessary care.

Price and Verma also suggest states explore charging Medicaid beneficiaries premiums. Such measures ignore the underlying reality that Medicaid serves the deeply poor, who cannot sustain these costs by definition. Still, the suggestion is familiar to Verma—under her leadership as a health policy adviser to then-Governor Mike Pence, Indiana introduced monthly premiums in 2015. Failure to pay them was grounds for losing coverage, or having less access to vital health care services.

This newfound flexibility would make it possible for states to enact damaging policies

This newfound flexibility would also make it possible for states to enact damaging policies that they have been requesting for years. Arizona, Indiana, Kentucky, Montana, and Arkansas have all previously requested permission from the federal government to impose work requirements on Medicaid, which would deny people access to the program unless they are employed.

Arizona is also pursuing a five-year cap on Medicaid benefits. Under the plan, an individual must either be working full time or be receiving disability benefits from the Supplemental Security Income (SSI) or Social Security Disability program in order to keep Medicaid benefits past the five-year cap.

Both work requirements and time limits are likely to disproportionately impact people with disabilities. Even though the time limit proposals provide exemptions for people who are receiving benefits through SSI,  many disabled adults qualify for Medicaid on the basis of their income—not their disability status with the Social Security Administration. That’s because many disabled people are unable to navigate the Social Security Administration’s complex bureaucracy or, particularly among people with psychiatric disabilities, may not be fully aware of their own disability. As of 2009, 1 in 5 adults eligible for Medicaid on a basis other than disability (2.3 million people) and 1 in 10 children eligible on a basis other than disability or child welfare assistance (about 3 million children) had a mental health diagnosis.

As for work requirements, people with disabilities are more likely than other Medicaid recipients to be unemployed. These measures would place them at risk of losing the health care coverage that would help them enter or return to the workforce. Indeed, where Medicaid has been expanded, research has shown that participation in the workforce for disabled adults has increased.

Weakening Protections Against Institutionalization

In their letter, Price and Verma also indicate an intent to weaken vital Obama administration protections for seniors and people with disabilities.

In 2014, the Obama administration issued a rule designed to protect seniors and people with disabilities who receive home and community based services. The Home and Community Based Settings Rule helps ensure that when states fund community services for people with disabilities, they do so in a manner that promotes integration instead of replicating the isolation and control of institutional environments.

The Settings rule requires every state to ensure that those receiving community supports have the right to do basic things like invite visitors into their own home, choose when they eat or what they do during the day, have legally enforceable rights under a lease, and possess options as to where to live other than group homes and other ‘disability-specific settings.’ States have until 2019 to comply with the Settings rule, and a broad range of flexibility to implement it in a way that best meets the needs of their residents.

The rule is designed to protect individual liberty, so that Americans will not lose control over their most basic choices by virtue of old age or disability. Prior to the Settings rule, states were moving to fund community-based services on the grounds of old institutions or by organizing segregated villages “clustering” adults with intellectual disabilities all in one place, limiting contact with the broader society. The Obama administration rightly recognized that these “gated communities” grouping people with disabilities together to get services were institutions by another name, so it limited states’ ability to fund them with scarce community services dollars.

Their letter places individuals with disabilities at greater risk of warehousing

But Price and Verma intend to move the implementation date from 2019 to an unspecified period in the future. Beyond that, their letter also calls for rolling back federal oversight, placing individuals with disabilities at greater risk of warehousing by state governments that are too often willing to defer to service providers about the level of rights their disabled residents should be afforded.

Elsewhere in the letter, Price and Verma express interest in revisiting 2016 Obama administration regulations governing how and under what circumstances states can contract out the operation of their Medicaid programs to private insurance companies, while fast tracking further state requests for “flexibility” in Medicaid.

Advocates at the state level must seek to organize in order to stop the worst of these ill-advised “flexibility” requests that are emerging from state legislatures and state Medicaid agencies. And governors in both parties must be told in no uncertain terms that taking advantage of the Trump administration’s offer to allow the gutting of Medicaid will not be viewed kindly by their voters.

Though this administration fails to recognize it, the rights of people with disabilities deserve federal protection. Just as states frequently fail to protect the rights of racial and ethnic minorities, women, and the LGBTQ community (all constituencies who are also under attack by the Trump administration), so too are state governments frequently willing to compromise the rights of disabled Americans for the sake of cost, convenience, or prejudice.

We can’t afford to be flexible when it comes to freedom and basic access to health care for every American.


First Person

Trump Romanticizes the White America of the Past. It’s Time to Stop.

I’ve been reading a lot about how many of the people who ushered in the Trump era were driven by a longing for a white Christian America of the past. They harken back to a heyday when white men were the power brokers in all situations, women stayed home, and America was a stratified society where everyone knew their place.

These folks hope the new president will bring us back to this romanticized vision: the U.S. as Mayberry, the small town from the The Andy Griffith Show that has become synonymous with an idealized, folksy life.

The problem is, that America never actually existed.

At least not for my family, living in segregated Chicago in the 1940s—around the time when The Andy Griffith Show was set.  My grandparents lived in public housing. Other housing options weren’t available to them because back then, black people couldn’t just move into any home or neighborhood they wanted.

Their parents—my great-grandparents—had come north to the promised land of Chicago to escape racial violence in the South, only to find that black folks couldn’t escape America’s racist purgatory. My grandmother was born a month after the 1919 race riots in Chicago, which started when a black swimmer crossed the “invisible” color line at the 31st Street beach. My great-grandmother, eight months pregnant at the time, had to run home to escape the angry white mob—tripping and falling on her stomach heavy with my grandma inside.

Such were the experiences of oppression, violence, segregation, and opportunities denied that were passed down to my grandparents.

It’s time we see our history for what it is.

My grandmother and grandfather were janitors. In fact, three of my four grandparents were janitors. When they first started working, jobs didn’t have benefits like pensions and health care. But there was a key development in their lives that would impact my family for generations to come–they joined a union. My janitor grandparents were members of the Janitors’ Union, SEIU Local 1, at a time when racial exclusion from the labor movement was too often the norm.

Those good-paying union jobs helped my grandparents save money and buy a home on the South Side. When they bought their house in 1954, they were the third black family on a block made up of working-class Irish and Italian families. By 1960, the entire block was black.

White flight was in full swing, because white families thought the presence of black families would cause property values to plummet. The result, almost 60 years later, is segregation that still isolates my community from good jobs, good schools, and the hope for something better.

Still, those good union jobs helped my grandparents send the first person in our family to college–my mother. In 1950s America, a smart black woman had only two options: nursing school or teacher’s college. My mom chose to become a teacher, and taught in public school for more than 40 years.

It was that union job as a teacher that allowed my mother—a single parent, in a working-class neighborhood, on the South Side of Chicago—to raise two boys and have economic opportunities not available to other black men and women of her generation.

Yet as any measure will show, the opportunities for most black Americans were—and still are—much more limited compared to opportunities for whites.

If you doubt that, consider my family today. My grandparents passed down the house they bought in 1954. My mother raised my brother and me there, and my brother and his wife are now raising my 20-month-old nephew there. This past fall, they had to temporarily move out of the house because my nephew had dangerously high levels of lead from the paint and windows in the house. I imagine white families with the income to remediate the lead in aging homes never have to worry about this.

The neighborhood remains segregated, and suffers from the toxic inequality that plagues many black communities today.

That’s the kind of inequality, racial segregation, and seclusion that so many of our fellow Americans want to remain steeped in. So far, the new president has tried to ban immigrants from several Muslim-majority countries from entering the U.S.; is now trying to take away health care away from millions of Americans; and is preparing to shred the safety net that protects working people and their families when work doesn’t pay enough or they fall on hard times. Trump and Congressional Republicans are also set on destroying the very union jobs that gave families like mine a chance.

We’ve made so much progress, and still have so far to go. It’s time we see our history for what it is, and leave those romanticized notions of Mayberry where they belong—in the past.