New Jersey Is Proving That Bail Reform Works

Ever since the state of New Jersey approved comprehensive reforms to its money bail system in 2014, opponents have warned that the changes — which eliminate cash bail for people accused of low-level crimes — would lead to “dangerous and violent offenders [being] cut loose from jails and shoved into communities where innocent people suffer.”

Numerous law enforcement officials, prosecutors, lawmakers and local media outlets have been strong opponents of the elimination of cash bail, which is the payment required from a defendant in return for being released from jail as they await trial. The fiercest resistance to change has come from the powerful for-profit bail bond industry.

This $2 billion industry, which makes most of its earnings by exploiting low-income defendants stuck in desperate situations by shaking them down for steep and sometimes illegal fees in return for a loan that can be used to pay bail, has been using misinformation and fear tactics to combat cash bail reforms. One industry group even posted on Facebook that reforming the cash bail system means “every night is purge night,” an allusion to the popular horror films in which crime is legalized.

However, the results are in from the long-awaited criminal justice report by New Jersey’s Administrative Office of the Courts, and it’s clear that the Garden State did not devolve into lawless chaos because of bail reform. Instead, crime rates in New Jersey have been plummeting ever since the reforms were implemented in 2017, with violent offences such as homicide and robbery down by more than 30 percent.

The report proves that concerns about large numbers of defendants committing crimes while released and failing to show up for trial were unwarranted. State court officials say that the differences before and after the state’s bail reform are statistically insignificant — there was a 3.3 percentage point increase in the number of defendants who failed to appear in court, and a 1 percentage point increase in the number of defendants who were charged with a new crime while released and awaiting trial. The report states that that “because of certain challenges in compiling data from 2014, small changes in outcome measures should be interpreted with caution and likely do not represent meaningful differences.”

The positive impacts are much more noteworthy. According to a statement by Superior Court Judge Glenn A. Grant, acting administrative director of the New Jersey courts, “New Jersey’s jail population looks very different today than it did when the idea of reforming the state’s criminal justice system first took hold.” The state’s overall pretrial population, which consists of detainees who have not been charged with a crime, has declined by 44 percent. That amounts to 6,000 fewer people incarcerated in 2018 compared to 2012.

This means that thousands of defendants who have not been convicted of a crime and are presumed innocent under the law will be free to remain with their families and their community while they await their day in court. Under the previous system, low-income defendants would see their lives fall apart as they lost their job, housing, or even their children simply because they could not afford to pay bail.

In New Jersey, concerns about a crime explosion turned out to be nothing but fearmongering.

On the other side of the spectrum, violent yet wealthy defendants will no longer be able to use their resources to walk free when facing serious charges such as sexual assault or armed robbery, while low-income defendants facing minor charges such as possession of marijuana remain locked up. According to a statement by the Drug Policy Alliance’s New Jersey State Director Roseanne Scotti, all this proves “that New Jersey’s historic bail reform law has been a resounding success.”

It is important to note that these reforms are not a panacea. The report reveals that although the state’s jail population is dropping, “the overrepresentation of black males in the pretrial jail populations remains an area in need of further examination.” In a press release, the American Civil Liberties Union of New Jersey mostly praised the reforms but added that “a system that reduces the number of incarcerated people but does not improve racial disparities is simply not good enough. We intend to continue our advocacy efforts to reduce racial disparities in the criminal justice system.”

Although more work needs to be done to address these racial disparities, New Jersey’s reforms have been successful enough to inspire other states, including California, New York, Texas, Illinois, and Alaska. The bail bond industry has also declared war on those efforts.

The report’s findings are “an absolute refutation of the bail industry’s scare tactics” said Alexander Shalom, senior supervising attorney at the New Jersey chapter of the ACLU, in an email. “They had warned that a virtual elimination of money bail would result in no one appearing in court and massive crime increases. That we’ve seen 6,000 fewer people jailed and virtually no increase in court nonappearance or re-arrest rates debunks that myth.”

In New Jersey, concerns about a crime explosion turned out to be nothing but fearmongering. It is now up to the rest of the nation to follow suit by looking at the facts, ignoring the bail industry’s scare tactics and taking steps to create a just, safe, and nondiscriminatory bail system.



Flint Still Doesn’t Have Clean Water. It’s Not Alone.

Today marks the fifth anniversary of when the state-controlled government of Flint, Michigan, negligently chose to prioritize short-sighted cost-savings over its residents’ health and access to clean, safe water. The toll of this state-sanctioned poisoning affected more than 9,000 Flint children under the age of six, a portion of whom are set to start kindergarten this year.

The children of Flint and another 3,000 communities across the U.S. with dangerously elevated lead levels in their blood face an uphill, lifelong road littered with lead-induced developmental challenges, caused and exacerbated by long-neglected infrastructure ill-equipped to meet their needs, and a national public seemingly reluctant (if not apathetic) to do anything meaningful about it. Infrastructure might not be the “hottest” policy issue to pursue, but the consequences of ignoring it are all too clearly costly and deadly.

Five years after Flint entered the national consciousness, the perpetrators of this man-made crisis continue to go unseen and unscathed. And Flint is just the beginning. Because of bad corporate actors, derelict landlords, and governmental neglect and mismanagement at all levels, our nation’s infrastructure has become toxic and dilapidated, in need of more than $2 trillion worth of investments and 21st century policies that prioritize the most affected and proactive prevention rather than costly yet reactionary and incrementalistic approaches that favor wealthy enclaves.

Despite declarations to the contrary, with 2,500 lead-tainted pipes still in use, Flint remains poisoned and we as a nation still haven’t put our money where our mouth is in equitably ensuring that every person has access to clean water and safe homes, free from health hazards. The last major government study conservatively estimated that more half a million kids residing throughout the U.S. have significant levels of lead in their bloodstream as a result of the more than 9 million homes, neighborhoods, and schools that still have lead paint and pipes within their walls.

While Congress banned lead in plumbing systems 33 years ago and the United States, as a whole, has made important investments in reducing overall lead exposure, federal efforts have stopped short of pursuing an aggressive and comprehensive plan to remediate the millions of affected water pipes. Though the poisoning of Flint brought crucial attention to our nation’s tainted water systems, often overshadowed in the national conversation is the fact that lead-based paint is the most common, highly concentrated poisoning source for children in the United States. Despite being federally outlawed in 1978, lead-based paint remains within the crumbling walls, windowsills, and other surfaces of more than 37 million old homes and millions of aging buildings – schools, business spaces, and government offices –  where inhabitants can easily ingest and inhale contaminated dust and paint-chips.

The cost of these man-made infrastructure crises is always more than dollars and cents ­– it’s irreversible nerve and brain damage, unexplained neurological symptoms, hookworms and “neglected tropical diseases,” in the rural South, and lives lost to severe pneumonia and raging wildfires. These, and countless other examples of lives irreparably damaged by deteriorating and ineffective infrastructure, do not exist in isolation.

Poor infrastructure impacts everyone, regardless of race and class status, but – like so many other issues in America – racial minorities and people living in poverty experience the brunt of that pain. More than half of Flint’s population is African American and slightly more than 40 percent of residents live in poverty; similar stories reported in cities like Milwaukee, in rural areas of Kentucky or Alabama, and elsewhere are often in majority black areas and/or where poverty levels are high. Members of the Navajo Tribe continue to deal with gradual poisoning as a result of uranium mining in the 1950s, and towns in Alabama have become a dumping ground for human waste because of our nation’s failing wastewater infrastructure.

When these communities are observed in aggregate, rather than as separate, local issues, we can start to see the disturbing patterns of negligence, apathy and harm. Disasters like in Flint are part of a larger national failure, and our delayed and insufficient response is a public display of a larger, more heinous truth: America still hasn’t decided that clean water and a safe environment is not a privilege, but a right. An investment in our infrastructure and a commitment to maintaining accountability and transparency, when done right, is a commitment to just and equitable policy – and an affirmation that everyone deserves to live in an environment that is safe and healthy.

Even five years later, the Flint water crisis remains a crucial talking point for those looking to highlight the many inadequacies in government responses to disasters. It’s been highlighted by celebrities, Miss America pageant contestants, presidential candidates, and Twitter users expressing their frustration towards what they perceive as less important funding priorities, but that righteous anger hasn’t translated to a fury scaled for the national catastrophe we’re heading towards.

Clean water and a safe environment is not a privilege, but a right.

It’s not that the public is wholly apathetic to the dramatic consequences of a lack of investment in our country’s infrastructure. Poll after poll actually indicates that voters support federal spending on infrastructure improvements. In the 2016 and 2018 elections, there were local ballot measures that centered the need for more funding for infrastructure priorities – and many of them passed with voter support. However, that intensity of local support across the nation was focused on transportation issues rather than issues of water and sewage systems, broadband or electric utilities, of which privatization can further complicate matters. And even as voters express support for infrastructure measures, their higher priorities often still lie in policy areas such as the economy, health care, and education — all issues that can feel more immediate and pressing despite their inextricable links to the basic facilities and systems that America relies on.

To ensure that our infrastructure stops poisoning us today and in the future, we must redress the public policies and actions that segregate and neglect communities as well as earnestly hold accountable public officials, corporations, and landlords who put and keep people in harm’s way. And, ultimately, we must prioritize preventing these transgressions in the first place. Government, at all levels, must comprehensively support and provide restitution for the individuals and families poisoned for life because of lead and other preventable toxicant-exposures born from our compromised infrastructure.

Ultimately, Congress must seek to go beyond just getting out of our nation’s $2 trillion repair funding hole or fulfilling the hollow infrastructure promise of the current commander in chief. To truly end the ongoing poisoning and ensure that no community has to ever again suffer from this type of preventable, man-made infrastructure crises, the federal government will need to enact a full-scale, innovative package of national investments that helps harmed communities remediate and rebuild, improves the nation’s standard of living, restores public oversight and reasserts local control over the vital building blocks that make healthy, just, and thriving communities. Without that commitment, we’ll watch crises like Flint continue to unfold across the nation – and this time, we won’t be able to feign surprise. The lives of residents in Flint, and the thousands of other communities just like it, depend on it.



Meat Processing Is A Dangerous Job. It’s About to Get A Lot Worse.

About three and a half seconds. That’s how long inspectors currently have to check a pig carcass for lesions, hair, infected organs, or fecal matter before it’s sent whirring to workers, who slice up the roughly 250-pound animals in a freezing room, side by side, for eight to 10 hours a day, churning out more than 1,000 pigs an hour.

If a new pork inspection rule recently highlighted by the Washington Post passes next month, the lines will run even faster and plant employees will have to take responsibility for this visual inspection, putting workers and eaters at risk.

Though this might sound like another Trump-era regulatory rollback, it’s actually the final step in a drawn-out food safety debate that’s spanned four administrations.

The changes are part of a double-acronym mouthful, the Hazard Analysis and Critical Control Point (HACCP)-Based Inspection Model Project (HIMP). These new inspection methods have been quietly piloted at a select number of pork and poultry plants for some 20 years, with the basic goal of reducing USDA inspector spot checks and moving more safety testing offsite. Big meatpackers and the U.S. Department of Agriculture Food Safety Inspection Service claim these “modernizations” will improve safety and address inspector shortages, without harming workers.

But accounts from workers and investigations by government watchdogs and advocacy groups tell the opposite story. By speeding up processing lines and allowing meatpackers to police themselves, HIMP plants pose serious risks for food safety and increase already hazardous working conditions.

While the Trump administration faces blowback for giving plant employees greater oversight of hog slaughter, the Obama administration passed similar food inspection changes in the poultry industry in 2012, known as the New Poultry Inspection System.

These changes shift some duties from federal food safety inspectors to plant employees. Previously, federal inspectors visually checked every chicken or hog carcass for things like infected organs, fecal contamination, and other signs of diseases or defects. The new systems put plant employees in charge of those checks. For pork, large plants currently must have seven USDA inspectors; under the new rules, they would have three. For poultry, the number of required USDA inspectors shrunk from four to one.

USDA and industry groups often say that the HIMP pilot programs in both pork and poultry have proven just as, if not more, safe than the current system. But additional accounts suggest otherwise.

A 2013 inspector general report argued that the USDA “did not provide adequate oversight” of the HIMP pork pilots, and that the agency could not determine whether the pilots improved food safety. In fact, the inspector general said “HIMP plants may have a higher potential for food safety risks.”

The advocacy group Food & Water Watch also uncovered that the new salmonella testing program was flawed for all poultry plants prior to a protocol change in July 2016, bringing the HIMP poultry pilot findings into question as well. The group also obtained inspection documents for 14 HIMP pilot poultry plants through a Freedom of Information Act request, and found widespread instances of company employees routinely missing defects.

Politico reported that several poultry plants enrolled in the new poultry processing program have already failed necessary food safety testing to increase their line speeds. Food & Water Watch also revealed that these poultry plants also “fail the agency’s salmonella performance standard at a greater rate than those that have not opted into the new system.” In fact, one of the original poultry pilot locations operating at faster line speeds was forced to suspend operations in May due to food safety violations.

When it comes to pork, there are only five HIMP pilot plants, but of the top 10 pork plants nationwide with the most food safety violations, three participated in HIMP. This includes the worst performing plant, which racked up nearly 50 percent more citations than the next most dangerous plant over the course of three years.

More fundamentally, having plant employees check carcasses amounts to self-regulation and presents a clear conflict of interest. Simply put, plant owners profit more the less they stop the line, making them more reluctant to address quality concerns than federal inspectors. In a public comment, one concerned USDA inspector said, “the bottom line is that a company is out to make money and they can not do that if the line is not running. Even if it means letting something go down the line and ultimately out the back door that is not fit for human consumption.”

“If this proposal goes through and inspectors are cut, I would not feel safe enough to feed [poultry] to my family,” she added.

When a handful of powerful meatpackers ramp up line speeds, the risks extend beyond food safety to the workers who face the physical toll of processing more animals in less time.

As it stands, the USDA only assesses line speed increases for food safety outcomes. The agency is quick to note that it does not have jurisdiction over worker safety, and that the Occupational Safety and Health Administration (OSHA) protects workers. But OSHA has been derelict in its duty to prevent workplace injuries directly tied to increased line speeds.

Historically, poultry lines ran at 70 birds per minute. Today they’re up to 175.

While OSHA has set maximum operating speeds in some industries, such as grain processing, it has not done so for meatpacking. In fact, OSHA denied a 2013 petition requesting that the agency set slaughterhouse speed standards on the grounds that it did not have the resources to study the issue.

In absence of worker-safety informed limits, line speeds continue to increase. Historically, poultry lines ran at 70 birds per minute. Today they’re up to 175, after the poultry industry petitioned the Trump administration to revoke an Obama-era decision to keep the speeds at 140. The new pork rules would lift processing speed limits entirely, and the Post reports that line speeds could increase from 18 hogs per minute to 20. In four independently conducted surveys by the Southern Poverty Law Center, Midwest Coalition for Human Rights, Nebraska Appleseed, and Human Rights Watch, workers cited increased line speeds as the top or most notable complaint in regard to workplace safety.

According to the Department of Labor, meat processors get injured five times more frequently than other workers, and are nearly 20 times more likely to develop carpal tunnel syndrome. True injury rates are likely even higher: Another study by the Government Accountability Office found that federal data likely does not capture all meat processing injuries, especially because immigrants and refugees, who comprise 28 percent of meatpacking workers, are less likely to report injury or workplace misconduct due to fear of retaliation or deportation. OSHA also admits that workers with limited English proficiency “often do not get the necessary safety training on the job and do not know their rights under the OSHA law.”

No matter how you slice it, faster line speeds line meat processors’ pockets at everyone else’s expense. Their costs per animal go down the faster lines run, churning out more product per worker and per plant. The one leg meat corporations have left to stand on is the argument that they’ll pass their savings onto consumers, but recent price fixing cases prove those talking points are hogwash. The only real winners are corporate packers and their shareholders, while workers and eaters pay the price.



Fining Poor People for Walking Won’t Stop Pedestrian Fatalities

In March, three Michigan cities began cracking down on pedestrian violations. The stated goal of the week-long effort was to reduce the significantly high pedestrian traffic casualties in those municipalities by getting pedestrians to obey traffic laws. In at least two of the targeted Michigan cities, jaywalking tickets run more than $100 apiece.

But targeting walkers doesn’t do anything to address the actual problem: that roads and sidewalks aren’t safe and accessible for all users. Instead, what this enforcement does is punish vulnerable people, contribute to an already-existing social mentality that blames pedestrians for their own demises, and send a clear message that safe streets are only a priority for people who drive.

According to the Detroit Free Press, Kalamazoo, Detroit, and Warren, the Michigan cities that participated in the pedestrian enforcement campaign, targeted jaywalkers — in particular, those who failed to cross streets at an intersection, who failed to follow traffic signals, who didn’t walk on the sidewalk, who didn’t walk facing traffic when on a roadway, and who didn’t yield to vehicle traffic with the right of way.

In order for traffic to flow smoothly and for people to stay safe, it is reasonable to expect everyone to follow the rules of the road. But when the road isn’t made for you, those rules can be tricky to follow, and in fact, even when they are followed to a T, walkers and bikers are no match for a two-ton vehicle whose driver is unaware of how to share the road with pedestrians — or simply doesn’t care.

From 2008-2017, according to a report from the Governor’s Highway Safety Association, pedestrian deaths increased by 35 percent. In 2018, the report estimated that there were 6,227 pedestrian fatalities in the U.S. —  the highest number since 1990.

When bicyclists are included, those figures are even higher. And unlike motor vehicle fatalities, which are declining, pedestrian and bicycle fatalities are increasing.

The report cites things such as population growth and the shift in vehicle-buying from passenger cars to SUV’s as major factors that contribute to pedestrian fatalities. As city populations grow and as pedestrian commuters increase, car-centric street designs are increasingly dangerous.

Enforcing fines on pedestrians doesn’t fix these issues, it just sends an overt message that streets aren’t for pedestrians; they’re solely for people who drive. Meanwhile, it’s low-income people who are least likely to own a car and to have to walk on unsafe roads.

In addition, in communities that have targeted pedestrians with citations, trends have shown that marginalized people are the most impacted. For instance, in December of 2017, ProPublica reported that in Jacksonville, Florida, black pedestrians were disproportionately targeted with pedestrian tickets. Not only did black pedestrians there receive more tickets (55 percent of tickets went to black people even though they make up only 29 percent of the city’s population), they also were most affected by driver’s license suspension for failure to pay those tickets. A similar trend was noted in Seattle.

But there are alternatives, such as developing Complete Streets policies, which are designed to make streets safe for all users, including pedestrians, bicyclists, car drivers, and transit riders of all abilities. The model focuses on reducing pedestrian risk by placing physical barriers between cars and pedestrians, redesigning intersections and sidewalks, and modifying traffic flow. More than 1,400 Complete Streets policies have been passed in the United States. That figure includes 33 states that have adopted some form of a statewide policy.

However, that doesn’t mean those communities and states have full and adequate protections for pedestrians and bicyclists. A Complete Streets Atlas shows large swaths of the U.S. without any Complete Streets model at all, and of those that have adopted some policies, most do not have full bike and walking path protections.

Following each pedestrian accident, the comment stream centers blame on the victim. “Why were they crossing there?” “Were they wearing bright vests?”

Redesigning streets to accommodate all users requires traffic studies, planning, and redesigning, all of which come at a cost. But when cities are grappling with high rates of pedestrian casualties, they should invest time and money in that crisis. The Michigan cities that participated in the week-long enforcement period targeting pedestrians were each awarded grants to cover overtime for their police officers. Instead of investing in addressing the structures that lead to pedestrian casualties, they took the short-term, punitive approach — an investment that could never produce the kinds of benefits that structural changes to road design could.

In the mid-1980s, Florida adopted a statute requiring that roadway design accommodate walkers and bicyclists from the beginning. A study published in the American Journal of Public Health estimated that in the three decades following, more than 3,500 lives were saved as a result, with pedestrian lives among the most likely to be saved.

Other cities have not only implemented ordinances that protect pedestrians; they center their enforcement of those ordinances on drivers. In Ann Arbor, Michigan, for instance, an ordinance requires drivers to stop for a pedestrian approaching a crosswalk. This is more stringent than the state requirement that a driver stop for a pedestrian in a crosswalk. The city did targeted enforcement of the ordinance between 2017 and 2018, and during that time police issued more than 800 tickets to motorists who violated the city’s pedestrian law.

As much as our culture loves to blame the victims, pedestrians aren’t responsible for their own demise. Still, following each pedestrian accident, the comment stream centers blame on the victim. “Why were they crossing there?” “Were they wearing bright vests?” Instead of focusing on the structural problem of roads with increasingly heavy and fast-moving traffic or the lack of safe pedestrian paths, the culture at large points fingers at the road users who are most in danger. Ticketing pedestrians reinforces this norm.

But punishing pedestrians won’t change the stark reality that walkers, wheelchair users, and bikers must navigate spaces that weren’t designed for them to maneuver safely. Municipalities must grapple with this safety crisis and recognize that punishing those who are most in danger while using the road isn’t the answer; safer streets are.



When Americans Get Their Tax Refunds, They Go to the Dentist

Megan, who currently lives in Pittsburgh, was hospitalized in September for pneumonia. It was just a one-day stay, and she had health insurance, but even so, the bills piled up, eventually totaling $6,500.

The only thing that made paying them realistic, she said, was that she received a $4,200 tax refund this year.

“I would have put off my medical payments [without the refund],” she told me via email. “Between rent and day to day expenses, I don’t have the income to pay both. … Even with insurance the numbers seemed insurmountable until I got my refund. If it wasn’t for that I would have had to reapply for payment plans with the risk of being sent to collections.”

Tax returns were officially due this week, which means that the roughly 80 percent of filers who receive refunds will soon have their money, if they don’t have it already. The average tax refund so far this year is $2,995, which is roughly in line with last year. For the average family that receives a refund, the amount is equal to nearly six weeks’ income. And a big proportion of the money Americans receive during refund season, like Megan’s, goes to pay for health care.

According to a report from the JP Morgan Chase and Co. Institute, families who receive a tax refund increase their out of pocket health care spending by 60 percent the following week. Spending on health care remains higher than normal for 75 days post-refund.

“The cash infusion represented by a tax refund payment allowed more people to make more purchases of healthcare goods and services, but, even more consequentially, it facilitated larger payments,” the report said. “This implies that the cash infusion generated by a tax refund payment triggered additional spending on large healthcare ticket items that consumers could have least afforded out of their pre-refund cash flow.”

“100 percent of ours is going to pay for prenatal care and the birth of our second child, due in June,” said Molly, who received a refund of around $2,000 for her family’s state and local taxes. “Our first child’s 2017 birth was uncomplicated and routine, and while I don’t remember what we paid out of pocket versus what insurance covered, the birth, the epidural anesthesiologist, the recovery, and a one-day stay in pediatrics (due to jaundice, probably the most common newborn treatment there is) was a little over $20,000. So we’re counting on the 2019 refunds going to paying off this birth as well, as we will easily hit our deductible.”

62 percent of the additional health care spending triggered by refunds went to in-person payments to health care service providers. That indicates that the higher spending isn’t limited to paying bills for past services, but that tax refunds actually led families to seek care that they had put off until they received a cash infusion. Dentists receive a disproportionate share of the additional spending: One in four adults with incomes below the poverty line skip needed dental work because of costs, and dental-related issues are responsible for about $1 billion per year in emergency room spending.

That so many Americans need a refund windfall in order to access medical care, sadly, makes sense. About one in four adults – 65 million people – reported skipping a medical treatment due to costs in the last 12 months, according to a recent West Health-Gallup survey. Last year, Americans borrowed a collective $88 billion for medical treatments, which doesn’t include the totals from the now ubiquitous medical crowdfunding campaigns that have proliferated on social media.

So tax season injects cash for those households to get the care they either would have had to delay or go into debt to obtain.

It’s worth noting that receiving a big refund means a taxpayer overpaid her taxes during the year, whether via automatic withholdings from paychecks or by paying quarterly estimated taxes (which is a requirement for the self-employed and independent contractors), thus giving the government an interest-free loan. A refund is just that overpaid amount being paid back.

However, the public doesn’t really view it that way: According to a recent New York Times poll, 77 percent of people would prefer to overpay and receive a refund come tax time, which makes sense. 40 percent of people don’t have $400 to cover an emergency cost, and the average savings amongst the poorest 20 percent of households is zero dollars, so an unexpected tax payment can deal a real blow.

One in four adults reported skipping a medical treatment due to costs.

But people also use their refund as a way to enforce savings: Paying their money to the government and then getting it back means they can’t spend it in the interim. Recent reports have shown that the Trump administration, in an attempt to inject money from its 2017 tax bill into the economy sooner, decreased withholdings so that people had less taken out of each paycheck for taxes throughout the year, meaning they were less likely to overpay their taxes and require a refund. But that ploy has backfired spectacularly. Many taxpayers were reportedly upset at getting smaller refunds than they expected come Tax Day, even if their overall bill was in many instances lower than the year before.

“We actually aren’t those types who try to have a big refund each year. We’d rather not allow the government to keep an interest-free loan all year. My husband has tweaked his withholdings so we do get more in the paycheck each week because we need it for all the copays, gas, etc,” said Lindsey Cox of Thomasville, North Carolina. Both she and her husband carry a gene for a rare disease called Van Maldergem Syndrome, which two of her three children have, while the third has severe nervous system issues. Their health care bills total hundreds of thousands of dollars annually. This year, their tax refund of $2,940 went to an array of household needs.

“Our tax return went to catch up on the house payment, electric bill, other small miscellaneous bills, and some car maintenance we had been putting off, like inspections, tire rotations, oil changes, etc.,” Cox said. “We’ve become experts at gaming our system and know for instance, we can be 60 days behind on electric before we face it being cut off. We’ve learned very well how to rob Peter to pay Paul and stay afloat in the process.”

That so many Americans need a quick injection of money in order to see a doctor or access other necessities is a problem that can be addressed by policy: Think universal health care, or the proposals to both expand the pool of those eligible for the Earned Income Tax Credit and allow low-income households to receive some of their refund early. As Bryce Covert explained, “as powerful as the EITC is, there are plenty of people who receive barely any money from it or miss out entirely.”

Tax Day should be a celebration of America’s commitment to civic responsibility and collective welfare, not a grim reminder that far too many people can’t access things that should be basic human rights. However, for too many, a tax refund isn’t just the difference between staying afloat and not, but between seeing a doctor and not, which can literally be the difference between life and death.

Editor’s note: When requested, last names have been withheld to allow people to talk freely about their finances.