North Carolina Legislators Want to Add Tax Breaks for the Rich to the State Constitution

North Carolina Republicans have been on a mission over the last few years to remove every shred of progressivity from their state’s income tax. They’ve largely succeeded, passing several rounds of tax cuts since 2013 that, among other changes, turned the income tax from one with a progressive structure into a flat tax.

So now it’s time for the coup de grace: An amendment enshrining those tax breaks for the state’s wealthiest residents into the state constitution.

In November, North Carolina residents will be voting on a ballot initiative that would amend the state’s constitution to cap its income tax at 7 percent, down from a current cap of 10 percent. Considering that North Carolina’s income tax currently tops out at 5.499 percent, and is scheduled to fall further to 5.25 percent next year, that may not seem like a big deal. But it is.

First, the background. The change to a flat tax helped those at the top of the income scale, who saw their rates drop the most. Along with a host of other tax cutting measures, including a corporate income tax reduction, it cost the state a big chunk of money.

“Since 2012, when Republicans took full control of the legislature and governorship for the first time in modern history, they’ve been on a tax cutting rampage,” said Meg Wiehe, a North Carolina native and deputy director of the Institute on Taxation and Economic Policy. “The state will be about $3.6 billion shorter in revenue than it would have been otherwise, which is a pretty significant difference in a state with a general fund of just around $21 billion.”

By pushing a cap on the income tax into the Constitution, lawmakers hope to lock those reductions in, making future legislators go through the same long amendment process in order to raise taxes or add progressivity back into the code. (Amendments to the North Carolina constitution are placed on the ballot via a three-fifths vote of both houses in the state legislature and require approval by voters, whereas legislation can be passed by a simple majority of lawmakers.)

As recently as 2013, the top income tax rate in North Carolina was 7.75 percent, so it’s not out of the question that lawmakers would want to implement an increase from today’s levels. Even setting the cap at 7 percent was a compromise of sorts among the Tar Heel State’s Republicans: Many wanted to cap the income tax at its current level, or even below that, forcing a constitutionally-mandated tax reduction.

A cap poses several problems, in addition to the simple unfairness of leaving such a low tax rate on the wealthy in a state where more than 100 percent of the income gains since 2009 have gone to the richest 1 percent of the population (meaning those at the other end of the income spectrum actually lost ground). For starters, it could undermine important state investments, as Alexandra Forter Sirota, director at the North Carolina Justice Center’s Budget and Tax Center, explained.

“To maintain current service levels for our population, we won’t have enough revenue under our tax code in 2019,” she said. “So they’ll have to either cut services or raise revenue or some combination of both.” And those cuts tend to fall disproportionately on low-income communities and people of color, she said, as will potential revenue raisers if the state has to resort to fees or sales taxes in lieu of being able to raise income taxes.

Since 2012, when Republicans took full control of the legislature and governorship for the first time in modern history, they’ve been on a tax cutting rampage.
– Meg Wiehe

Already, that dynamic has been evident in the state. As the Center on Budget and Policy Priorities noted recently, spending on public colleges in North Carolina is still nearly 20 percent below where it was before the 2008 recession. Previous rounds of tax cutting have made it so that North Carolina can’t raise K-12 education funding, which is already among the lowest in the nation.

This problem will be magnified when another economic downturn inevitably comes. “There have been key times even in recent history when the state, in an emergency situation, has relied on the wealthiest taxpayers to pay more to help ensure that critical services don’t have to be deeply cut,” explained Wiehe. “Future lawmakers who maybe would prefer to use the income tax as their tool wouldn’t have that available to them.”

Case in point, the state enacted a temporary top tax rate of 8.25 percent on the state’s richest residents in response to the Great Recession – helping to preserve funding for public schools and public health programs like the Children’s Health Insurance Program – a  move which would be rendered much more difficult if lawmakers needed to spend time getting voters to approve a new amendment.

North Carolina has been a political battleground in recent years, the quintessential “purple” state that is home to the weekly Moral Mondays march, but with a state legislature controlled by conservatives. In addition to the tax cap, voters there will be assessing amendments that would restrict voting rights and remove some of the (currently Democratic) governor’s powers. Locking in tax cuts for the wealthy fits right in.

According to a recent Elon University poll, 56 percent of North Carolinians support the tax cap amendment as written, with 15 percent opposing it. However, after being provided an explanation that includes the amendment’s possible adverse effects, the gap falls to 45-27. That has Sirota optimistic that voters grasp what’s at stake.

“I think that North Carolinians are incredibly smart about this issue right now,” said Sirota. “They understand that since 2013 the vast majority have not seen a big difference in their taxes, but they have seen their communities struggle with having to figure out how to meet needs.”



Ben Carson Wants HUD to Stop Fighting Housing Segregation

Today, a child born to a low-income family and raised in the Tremé neighborhood of New Orleans will have beaten the odds if they live past age 67. They can also expect to make just $20,000 a year by the time they reach their thirties.

Just a 20-minute drive away, in the Uptown/Carrollton neighborhoods near Tulane and Loyola Universities, that same child could expect to live 20 years longer and take home roughly $53,000 more in annual salary.

These communities are just six miles apart, yet designed and resourced in such a way that there’s a world of difference between the lives their residents can hope to have. Being raised in different neighborhoods can determine everything from the jobs you have access to, the schools your kids attend, and the groceries you can buy.

In 2015, the Obama administration created the Affirmatively Furthering Fair Housing rule to fix this disparity. But Department of Housing and Urban Development Secretary Ben Carson has moved to indefinitely delay implementation and is proposing drastic changes that analysts predict will all but gut its efficacy.

Why this matters.

While the idea of furthering fair housing appears in the 1968 Fair Housing Act, it wasn’t meaningfully enforced over the last half century. So under the 2015 rule, communities that receive funding from the Department of Housing and Urban Development are required to develop action plans to not only remedy their existing racial and ethnic segregation and neighborhoods of concentrated poverty, but to also ensure that every U.S. community is equipped with the resources and opportunities to meet their residents’ housing needs.

As nationwide data released this month grimly reinforced, the neighborhood or ZIP code you grow up in, more than ever, has a dramatic impact on whether you earn more or less than your parents did. Researchers found this impact is particularly acute for black boys who, regardless of their families’ income, face the worst outlook for escaping poverty, building wealth, and doing better than their parents.

This is merely one aspect of a racial wealth gap that has persisted since the formal founding of this nation. Today, a typical black family with an income of $50,000 lives in a poorer neighborhood than a white family earning $20,000. Government-sponsored public policies intentionally crafted to hold back people of color and cut off their communities from wealth-building opportunities, through practices like segregation and redlining, continue to drive these disparities.

What the rule was starting to do, before HUD attacked it.

The 2015 rule was meant to begin addressing this man-made problem. And early results were promising. As Massachusetts Institute of Technology Professor of Law and Urban Planning, Justin Steil, pointed out, several municipalities were beginning to create meaningful, measurable goals as part of the new rule.

For example, New Orleans committed to developing 400 units of affordable housing in Tremé, a neighborhood near the French Quarter that is quickly gentrifying, and Seattle proposed expanding its housing affordability requirements into new areas of the city.

Other regions’ goals included increasing access to existing opportunities, such as Chester County, Pennsylvania, which committed to building 200 affordable housing units in neighborhoods already well-resourced with good jobs, quality education programs and health care services, as well as access to other essential amenities such as grocery stores, parks, and community centers. Paramount, California proposed changing its zoning codes to increase housing accessibility for people with disabilities. Wilmington, North Carolina’s goals prioritized workforce development via job training and placement programs tailored to its local economy.

America continues to grapple with the ongoing byproducts of state-sanctioned separate and unequal neighborhoods.

Dozens of communities had submitted plans under the rule. And yet HUD suddenly and without warning removed a key assessment tool from its website in May that communities were using to shape their goals.

Carson cites a “high failure rate” of analyses submitted by communities among his reasons for delaying the rule, but that justification isn’t valid. Of the 49 analyses that communities submitted to HUD between 2015 and 2018, 65 percent were accepted immediately. The remaining 35 percent were returned to communities with detailed guidance about how to fix the problems; almost all have since been corrected, re-submitted, and accepted by HUD.

This degree of success is remarkable considering the rule was being newly implemented. And, contrary to Carson’s reasoning, the fact that a few of the initial submissions were sent back to communities for corrections signals that the new rule’s standards are exacting and meaningful, and should not be interpreted as evidence of failure.

Indefinitely suspending the rule and eliminating the federal assessment tools that have been helping local communities fight segregation as well as identify, increase and ensure fair housing opportunities for all means HUD has brought this long-overdue and much-needed progress to a halt.

What now?

America continues to grapple with the ongoing byproducts of state-sanctioned separate and unequal neighborhoods that set their residents on very disparate and divergent achievement paths. The rule that the Trump and Carson HUD aim to derail and ultimately demolish is designed to tear down those longstanding structural barriers and shrink the ever-widening gap between the haves and have nots.

It is important to keep in mind that the rule is not only focused on stopping segregation and discrimination but also on actively investing in neighborhoods where people currently live so that those communities are well resourced. The bottom line is that people should not be forced to move away from their community and existing social networks in order to access the basic supports necessary to have a good life.

The department is required to accept public comments until Oct. 15 about these proposed changes. Any member of the public — individuals, organizations, or community groups — can submit comments and let their voices be heard on the importance and fate of this equity tool.

Editor’s note: The public can submit comments on the proposed rule in the Federal Register. For additional instructions, see the guide produced by the Center for Effective Government.



Read a Book: Fall 2018 Releases for When the News Is Too Much

After I graduated from college, I stopped reading books. I still read constantly — the Internet is great at inundating us with writing — but it was always piecemeal. I’d take in a few hundred words from breaking news reports or beloved blogs, or a few thousand from think pieces. For a while, that felt like it worked.

Then the Trump administration happened. For the past two years, reading the news has felt like inviting the worst parts of humanity to practice punching me in the solar plexus. What’s worse, on days that felt comparatively slow — when we weren’t on the brink of war or gutting our health care or bulldozing our immigration law — I got anxious. I was starting to depend on the Trump administration to provide me with something to which I could react.

That mode of thinking is exhausting. Even worse, it’s limiting. Instead of focusing on what society has the potential to be, I was focused only on the depths to which I hoped we wouldn’t sink.

It turns out that books can be a helpful remedy to this problem. They provide room for writers to explore, to indulge nuance, to push on boundaries, and provide readers the time to reflect on what’s been written. And, unlike Twitter, they don’t shine a bright electronic light in my eyes when I’m trying to go to bed.

This the first in a regular series rounding up books the TalkPoverty staff loves. We’re kicking it off with new releases that are all relevant to today’s most pressing issues, but excel in delving into the shades of gray that are often missing from breaking news coverage and Twitter threads.



The Golden State by Lydia Kiesling

In some ways, The Golden State is a classic road novel: It follows its main character, Daphne, as she flees San Francisco and sets out for the high desert of California. She’s looking, like so many travelers before her, for freedom, adventure, and a break from bureaucracy. The catch is that unencumbered freedom isn’t a real option: Every point in Daphne’s journey is marked by her caretaking of her 16-month-old daughter, Honey.

Daphne’s relationship with her daughter, and with motherhood, has a fullness and honesty I’ve only seen once before (in Maggie Nelson’s The Argonauts). She loves her daughter desperately, but her exhaustion and frustration with Honey’s needs and tantrums slowly build into something like dread and rage. The result is a novel that’s both beautiful and challenging, probing ideas around domesticity and freedom of movement that, in worse books, are treated as if they are opposites.

For you if: You’re interested in experimental stream-of-consciousness works, or themes around immigration, parenting, and domesticity.


The Caregiver by Samuel Park

Park’s last novel, completed shortly before his death, is another, completely different, mother-daughter tale. It alternates between 1980s Brazil and 1990s Los Angeles while the main character, Mara, cares for a woman dying of stomach cancer who dredges up memories of Mara’s complicated relationship with her mother. It’s a story about the way Mara survived in both countries — as an undocumented caretaker in the United States and as a poor child in Brazil — that’s engaging, if slightly soapy.

The book alternates between being thrilling and introspective, vacillations that are almost certainly due to Park imbuing the women for whom Mara was caring with the same illness that was killing him.

For you if: You want to a novel with compelling characters that’s heavy on plot, or themes around being undocumented or providing health care.



Give People Money: How a Universal Basic Income Would End Poverty, Revolutionize Work, and Remake the World by Annie Lowrey

Universal Basic Incomes are officially mainstream, but advocates of the policy — from Silicon Valley tech bros to libertarians to Black Lives Matter activists — are strange bedfellows with very different explanations for why we should give everyone a monthly cash sum.

Lowrey’s book walks through each group’s justification for backing the policy. She’s thorough and respectful of subjects throughout, but clear about whose arguments she is — and isn’t — buying.

For you if: You want an accessible long read on a newly-trendy economic policy.


What You Are Getting Wrong About Appalachia by Elizabeth Catte

This pocket-sized rebuttal to the oft-cited Hillbilly Elegy re-situates Appalachia as part of the United States, instead of the far-thrown Trump Country that has been the subject of media fascination.

Catte, a historian from East Tennessee, walks readers through the region’s history with industry and race, and current residents’ organizing efforts around land and labor. While the book doesn’t transform the region into a liberal paragon, Catte does portray it with the kind of nuance you would expect from a real place: one with serious problems, a complicated history, and a lot of very different people trying to figure out what to do next.

For you if: You’re still talking about Linda Tirado’s drunk reading of Hillbilly Elegy.



Heartland: A Memoir of Working Hard and Being Broke in the Richest Country on Earth by Sarah Smarsh

Sarah Smarsh has been treated as a sort of spokeswoman for the working class since her viral essay, “Poor Teeth,”  captured her family’s experience with a blend of honesty, compassion, and humor that only comes with real experience. Her memoir, Heartland, is written from the very same place as the essay that made her famous: One that has the audacity to love and respect a poor family.

The book tells stories that are equal parts joyful and horrifying, and situates her family’s life in the policies that made it impossible for them to afford health insurance or compete with agribusiness. It’s not quite perfect — the framing device featuring a non-existent daughter doesn’t quite land for me — but it’s an extremely powerful and pointed meditation on class in America.

For you if: You’re a sucker for a beautiful memoir.


Eloquent Rage: A Black Feminist Discovers Her Superpower by Brittney Cooper

Before Rebecca Traister published her much-anticipated Good and Mad, Brittney Cooper had written an entire treatise on the power in black women’s anger, and the contempt the country has for it.

Eloquent Rage focuses on the web of sexism, racism, and class, grounding Cooper’s understanding of all three in her own coming of age. And, most importantly, it takes on the current feminist movement — one often grounded in whiteness — and forces readers to recognize how that “fucks shit up for everybody.”

For you if: You prefer your life lessons delivered by someone else’s grandma.


First Person

Trump Is Rewriting Our Immigration Law To Come After Families Like Mine

Late last month, the Trump administration released a draft rule that would change the way immigration works in the United States. Under the proposal, immigration officials will try to predict whether a person applying for a green card might receive government assistance, like Medicaid or the Supplemental Nutrition Assistant Program, at any point during their future life in the United States. If it seems possible — because the applicant isn’t wealthy or has a disability — then the green card will be denied, even if the applicant has met all of the other criteria.

There have been rumors that this might happen for months. The first time I heard about it, I was sitting in my summer internship with the city of Dallas. One of my supervisors asked me if I was familiar with possible changes to the “public charge rule,” which requires immigrants to prove that they will not use government benefits before they are granted permanent status. When I shook my head no, she gave me a handout that explained who would be affected.

Individuals with visas or legal permanent residents. Check.
Individuals who have used any federal assistance programs. Check.

I held my breath when I read it, my eyes darting from line to line while I felt the walls close in. This was about my family. They were looking for me.

My parents moved to Dallas from Chihuahua, Mexico in the early 90s. My brothers and I were all born in the United States. We used Medicaid and the Children’s Health Insurance Program to get our standard vaccines as kids, and my parents got their health insurance through the Affordable Care Act. We followed all the rules and did exactly what we were supposed to do.

I always follow the rules. I just started my senior year of high school, and I have my days completely packed with extracurricular activities. That means debate on Mondays and Wednesdays, LULAC meetings Wednesday mornings, mock trial on Tuesdays, We Fight Fear meetings after school, volunteering Saturdays and Sundays, and SAT prep in between. I don’t climb back into bed until 12 a.m., after finishing homework, sending emails, and setting up meetings.

I’m not just doing these things because I like them. I’ve never felt I have the option to turn down opportunities, because if I push myself hard enough to get a scholarship then all the late nights will be worth it.

I’m in the process of setting up my Common Application profile for college. I always knew that my parents wouldn’t be able to afford my tuition, and that I would have to cobble together grants and scholarships to pay my way. So it’s up to me to prove to colleges that they should pay for me to attend.

But when I heard about the new immigration rule this summer, I had to second-guess the one thing I was most certain about: going to college. If I applied for Pell Grants to cover tuition, was that going to count against my parents? If their income dipped below the threshold in this new immigration rule, would I need to stay home and get a job to ensure they weren’t targeted? If I followed through on my dreams, and on all the work I’ve put in, would I be betraying my family?

If I applied for Pell Grants to cover tuition, was that going to count against my parents?

I’m not the only one who is scared. Once my mom found out about the rule, she told me she wasn’t comfortable continuing my little brother’s Medicaid coverage. He’s only 3 years old, and he has so much growing left to do. The government knew it would create this risk when it announced the new rule: Documents from the Department of Homeland Security predict that people will receive less health care, and that disease rates will increase for U.S. citizens who have not been vaccinated yet.

Those documents are talking about my little brother.

When the rule finally came out last week, and I got to look at real words on paper instead of wading through a swirl of rumors, I got a tiny taste of relief. This version of the rule won’t apply to people who already have green cards, and my mom just renewed hers. For now, I can daydream about college, and my parents can sign my brother up for health insurance.

Just a short while ago, we wouldn’t have made the cut. There are hundreds of thousands of people who still won’t. Those people, and those families, will see the opportunities they’ve worked so hard for finally within their children’s reach, only to be forced to wave them away, in case it costs them everything. They’ll do exactly what we did: pass on health insurance and decline the few extra bucks to make sure we didn’t go to bed hungry. What else are we supposed to do when the government forces us to choose between our families and our future?

Even though I’m safe for now, I don’t feel like I’ve won. This isn’t a game. Not to me, not to my brothers or my parents.

But as I sit here and contemplate which college campus I’ll be walking onto this time next fall, if I get to go to one at all, that’s what it feels like. It feels like they’re using children as chess pieces in a twisted political contest to force immigrants into the shadows of a nation we helped build.



Hepatitis C Patients Are Being Forced Into Underground Buyers’ Clubs

Lisa Kaye Gray has been tired since she was 26 years old. Now 52, and a grandmother with rust-red hair and a lilting Louisiana accent, she is finally gaining the energy to help her grandson chase squirrels through the backyard. But her voice still breaks as she recalls decades marked by fatigue and muscle aches; early symptoms of hepatitis C.

“I missed out on so much,” she mourns. “Just being tired, not able to enjoy life.”

Gray acquired hepatitis C in 1991, and spent more than twenty years living with the virus’s effects. Though she didn’t begin to experience symptoms of major liver damage until 2015, she says she spent most of her life feeling fatigued, sometimes to the point of being bedridden, and nauseated.

Interferon treatment, the first available treatment for chronic hepatitis C, was introduced in 1996, but the cure rate was low; around 30 percent for genotype 1, the most common form of the virus in North America. It was also difficult to administer, requiring self-injection into the stomach, and came with a host of side-effects, ranging from nausea and muscle aches to long-term autoimmune dysfunction. The full treatment course lasted six months to a year. Gray tried interferon treatment for a month, but discontinued it when she learned she was pregnant.

“I’m glad I did,” says Gray. “I’ve heard horror stories about people who took it for the year.”

Gray is not the only hepatitis C patient who chose decades living with the virus over attempting interferon. David Cowley of Wales lived with hepatitis C for 35 years, refusing interferon because of its side effects and low success rate. But Gray and Cowley share something else in common: neither has hepatitis C anymore.

One day in 2015, Gray’s boss noticed that she looked, she recalls, “as yellow as the walls.” Because jaundice (yellowing of the skin and eyes) in patients with hepatitis C is a sign of serious illness, she immediately went to her doctor and learned that she had liver cirrhosis. She applied for disability benefits, and while waiting for a determination, began undergoing the testing procedures that would allow her to take a new kind of medicine, one with a much higher success rate and far fewer side effects.

Gilead initially set the price for full treatment between $74,000 and $94,000

Sofosbuvir is a direct acting antiviral (DAA) medication sold by American biopharmaceutical powerhouse Gilead Sciences under the brand names Harvoni, Sovaldi, and Epclusa (Harvoni and Epclusa also contain other drugs, making them single-pill regimens, while Sovaldi requires a second drug to be prescribed with it). These drugs have a 90 percent or higher cure rate across a variety of genotypes (for genotype 1, the cure rate closes on 100 percent), and Harvoni in particular boasts only mild, short-term side effects like fatigue. All three medications are consumed orally and take 12 weeks to complete. In comparison to the old treatments, these DAAs function like a miracle. Gilead initially set the price for full treatment between $74,000 and $94,000 for patients in the United States.

Medicaid covers the treatment — but there’s a catch. There are 3.5 million people in the United States living with hepatitis C, and state Medicaid programs find it difficult to afford to treat patients at the prices Gilead set. (Rough math says curing all current cases would cost Medicaid half of its annual budget). Most state Medicaid programs initially dealt with the shortfall by limiting treatment to people who meet their criteria. In 25 states that criteria includes abstinence from illegal substances, even though most new hepatitis C infections in the United States are the result of injection drug use.

In 32 states, patients must also have liver damage. Newly-infected patients, or those whose disease hasn’t progressed far enough, must wait until they suffer potentially irreversible liver damage before they receive coverage for their treatment. In addition to more time living with the symptoms, this also increases the risk of complications like liver cancer and decreases the effectiveness of treatment. In one study of economically disadvantaged patients, only 82 percent of patients with decompensated cirrhosis (a severe form of liver damage) achieved viral elimination.

Medication access is not only an issue for chronic hepatitis patients in the United States. Other countries have been battling high drug costs as well, including Australia and the United Kingdom. David Cowley was fortunate — and tenacious — enough to get into a 2013 drug trial for Harvoni in the UK. When he learned about the trial, which required a weekly trip to an office that was 200 miles from his home, he called and “pestered them for weeks” until he got in. Within months of beginning treatment, he was cleared of the virus that had been slowly killing him for 35 years. Then the drug that saved his life hit the market, and he learned the price tag.

“I was disgusted by the prices,” he says. So he decided to travel to Bangladesh to get hold of generic versions of the medication for distribution to other patients in need. Cowley was not the only person with that idea.

James Freeman, a doctor who runs a telehealth program in Australia, and Greg Jeffreys, a historian and author also based out of Australia, run what each hesitantly call “buyers’ clubs” for hepatitis C medications. Cowley, Freeman, and Jeffreys all know each other, though they operate separately. The clubs function under the same essential premise: That hepatitis C medication should be available at free or low cost to everyone who needs it. They help patients acquire the generic drugs, offering full 12-course treatments for around $500-$1000, and sometimes less based on need and availability.

“It’s pretty simple,” says Jeffreys of his service. “Someone contacts me, I ask for some kind of medical report to show they actually have hep C, I explain what it costs, they send me a copy of their report, their shipping address, their contact phone number, a payment method — whatever that might be — and two weeks later they have their medicine.”

These buyers’ clubs operate by taking advantage of personal importation laws, which vary by country. For the U.S. that means buyers must import less than a three-month supply, and they cannot sell or distribute the medication. An added provision that a medication must be unavailable domestically leaves the legality of these practices in somewhat of a gray area .

Rochelle C. Dreyfuss, co-director of the Engelberg Center on Innovation Law & Policy at New York University, says that under patent law, buying and importing a cheaper version of the same product from another country is legal, but the addition of U.S. Food and Drug Administration (FDA) regulations make pharmaceuticals especially tricky. “I think [this] confusion is everyone’s confusion,” she notes, adding that if the FDA were to crack down, “one side will say it’s available domestically, you just have to pay more money, and the other that these patients can’t afford to buy it here.”

Although the FDA is not currently intervening in these buyers clubs, some doctors are wary and advise against importing generic drugs. After all, how can a buyer know what’s truly in them; whether they are effective or potentially dangerous?

This is a sentiment Lisa Gray understands. Jaundiced and living with disabling liver cirrhosis, Gray was eagerly awaiting her medication approval — now that she was finally sick enough to meet the criteria. But when she began receiving $1,500 monthly in disability checks after her liver damage left her unable to work, she lost the Medicaid coverage that would have paid for her treatment. (Louisiana expanded Medicaid the following year, but 17 states still have not done so). Uninsured, and unable to pay the premium and co-pay for private insurance, she began looking into alternative options.

“At first I was very skeptical,” she says of the buyers clubs. “It even went through my mind that they’ve got all these people paid to praise generics…but I found Greg Jeffreys, I talked to him, and I realized it’s not a scam.”

Gray says Jeffreys worked with her financial situation by getting his medication connection, which is based out of India, to send her a recently expired 8-week course of sofosbusvir free of cost. That left her responsible only for the other drug she needed to take with it, daclatasvir. She paid $350 for it, by credit card. When she was unable to come up with the funds for her remaining treatment, Jeffreys sent it to her free of charge.

“It was scary because you don’t know if it’s a real medication or not, but I thought what do I have to lose? I was throwing up everyday, it was horrible,” recalls Gray. “I started taking that medicine; my eyes were yellow, they got white. It was amazing.”

Gray also remembers her doctor insisting that she wait until she could find funding for the prescribed treatment course, rather than using a personal import scheme to buy generics. “My doctor literally screamed at me. [She said] ‘they’re not regulated, they could be fake.’”

But Jeffreys, Freeman, and Cowley, who now all use a shared seller out of India, insist that fear is unnecessary — at least when it comes to their medicines. Freeman reports that he has seen a 94 percent cure rate with his own patients. With the benefit of his medical background and connections with the Tasmanian government, Freeman says he’s had his drugs tested from the start, when he was importing raw materials from China, and that they are virtually identical to those found in Harvoni and other brand name medicines. Jeffreys added that the Indian connection the three use now gets the drugs directly from Mylan, who partners with Gilead Sciences to manufacture these drugs in India.

“These products are licensed by Gilead and approved by the FDA,” Jeffreys asserts. “To say they’re dangerous is crazy.”

This doesn’t mean that all buyers’ clubs are created equally. As with any unregulated enterprise, copycats have popped up on Facebook claiming to have special contracts for drugs with other countries. Although there’s no way to know for sure whether these are illegitimate, they — unlike Jeffreys, Cowley, and Freeman — did not immediately respond to inquiries for comment.

States have been slowly lifting regulations surrounding Medicaid access to direct acting antivirals for hepatitis C. As of 2017, 18 states have lifted the liver fibrosis restrictions and 22 others are granting coverage to patients with less severe liver damage; four of these require only mild fibrosis. In addition, the Department of Health and Human Services has questioned Gilead and other companies about their pricing in the hopes of being able to grant coverage for more patients. The hope is that as more drugs become available and drug costs lower, more states will lift or lessen eligibility restrictions so that patients in the United States can access these medicines through their providers.

Still, Jeffreys says he has seen no decline in Medicaid patients from the United States who need meds. “I get heaps of them,” he says about clients on Medicaid. “It’s been exactly the same for the past three years. I get probably 100 e-mails from the United States every week.”

For low-income patients like Gray, who lose or are denied coverage, these buyers clubs have become a lifeline, linking them to treatments that change their lives within months.

“It’s just an amazing feeling to know that this virus is not alive in me anymore,” says Gray, who had no detectable viral load twelve weeks after treatment. “I just get mad that my own country could not help me.”