The Health of Arkansas

Yesterday, Arkansas Governor Asa Hutchinson beamed as he announced a drop in the number of state residents receiving health insurance through Medicaid.

Today there are fewer Arkansans on Medicaid than when I took office in January 2015, while our state’s population continues to increase. In the last year alone, the rolls have decreased by 117,000 (10%). Because of the reduction in Medicaid enrollment, DHS is now projecting that it will spend roughly half a billion dollars LESS (taxpayer money) on Medicaid in SFY’19 than anticipated in the biennial budget.

Perhaps to some, this is great news. We’re saving money! Woopee! All those freeloaders out there sucking on the government teat are now out in the cold where they belong.

But wait. We’re talking about medical care here, people who are sick or disabled or otherwise unable to obtain health care because they can’t afford to buy insurance. By his own numbers, our governor just celebrated the fact that 117,000 people of Arkansas are no longer able to obtain health care.

Now maybe that’s not exactly true. Maybe some of those folks got well from cancer or liver failure or whatever caused them to qualify for Medicaid. Maybe some of them got great jobs and have insurance now through their employers. Maybe some of them became the sudden beneficiary of their Aunt Tilley’s fabulous estate. Or won the lottery.

Or maybe not.

The reduction might have something to do with the federal government’s deep cut in advertising about how to sign up for health care. Or the federal government’s reduction in the sign-up time period. Or the state’s questionable method of deciding who to remove from the program—the electronic data system currently in use automatically deletes anyone who doesn’t respond to a request for income information. As in, one lost piece of mail. One overlooked letter amid a pile of unpaid bills. One person’s inability to comprehend what is being asked of him as he undergoes chemotherapy.

Last year, the governor looked for all the ways he could reduce the amount of money Arkansas pays for health coverage. As reported in the Arkansas Times in the May 2, 2017, edition, the governor’s goal was to lower the income limits.

As part of the Affordable Care Act, Arkansas expanded Medicaid via a unique policy known as the private option, which uses Medicaid funds to purchase private health insurance plans for low-income Arkansans. The concept was later re-branded as “Arkansas Works” by the governor. The expansion covers adults who make less than 138 percent of the federal poverty level — that’s $16,400 for an individual or $33,600 for a family of four.

The governor’s proposed changes to eligibility remove anyone who makes more than the federal poverty line (that’s $11,880 for an individual or $24,300 for a family of four) from the Arkansas Works program. Only people who make less than the poverty line would qualify going forward. That includes not just the beneficiaries who are covered by private option plans but also those who were deemed medically frail under Arkansas Works (the 10 percent of beneficiaries with the greatest medical needs, who are currently routed to the traditional Medicaid program rather than private option plans).[1]

So just to be clear, any single person earning more than $990 per month or head of household with spouse and two children earning more than $506 per person would no longer qualify for government assistance in gaining health insurance. This hasn’t yet been implemented because the federal government has not yet responded to Gov. Hutchinson’s request for the change. But really, governor?

Even the 138% of poverty level leaves lots of people without access to care. In 2013, 21% of Arkansas adults went without health care because of the cost. Do bragging rights automatically come to Gov. Hutchinson because that number dropped to 15% by 2016? What is 15% anyway, besides a seemingly small number?

The state’s estimated population is 3,004,279. Take away 23.6% of that for people below 18 years of age (non-adults). That leaves 2,295,270 adults. Fifteen percent of that equals 344,290 adults in this state without health care. That’s a lot of friends and neighbors.

In a November 2017 report, the Arkansas Times explained another proposed part of Hutchinson’s Medicaid ‘reform.’

Those between the ages of 18-49 would be required to work 80 hours per month; if they were not working, they would have to participate in job training programs or certain approved volunteer activities. Beneficiaries must be in compliance for nine months out of the year or they would be removed from the program for the duration of the year. Beneficiaries 50 or older would not be subject to the work requirement; exemptions would be available for others who met certain criteria, such as caring for dependent children.[2]

Studies have examined the realities of financial need in the United States and have come up with a set of numbers that reveal just exactly how morally bankrupt is the governor’s reasoning (along with the increasingly evident moral bankruptcy of the entire Republican party).

For a family with two adults and two children, the average cost of living in the United States hovered around $65,000 per year in 2015. The figure excludes discretionary spending on nonessential goods and services, such as leisure, entertainment and luxury items.[3]

To be fair, another source gathering economic data specific to locations gives credit to a lower-than-average cost of living in Arkansas. For a family of four in Little Rock, the average monthly cost is $2876.46. For an individual not paying rent, the monthly cost is estimated at $819.24.[4] However, in the governor’s proposed lower income limit, in neither case is there any ‘leftover’ income adequate to buy health insurance. In case you didn’t notice, the estimated average cost of living for Little Rock is $400 MORE than the cutoff income level for those seeking Medicaid coverage under the governor’s preferred income guidelines.

It’s no secret that Arkansas is one of the unhealthiest states in the nation. We rank 48th. We have higher rates of diabetes, cardiovascular disease, cancer, and general poor health both physically and mentally. In particular, according to a January 1, 2018, report published in the Arkansas Democrat Gazette, from 2013 to 2016, “the percentage [of Arkansans] who reported that their mental health had not been good in 14 of the past 30 days rose from 14.7 to 16.4 [percent.]”

The report I’d like to hear from Gov. Hutchinson would show data about the number of marginally-employed people who have gained better-paying jobs. It would show how many of those suffering mental or physical illness have gained any improvement in their health. I’d like to hear that Arkansas is spending more, not less, on health care not only in direct services but in education—I’m talking about nutrition education, cooking lessons, and everything else humanly possible to teach people how to eat healthy—which, tragically, probably doesn’t include toaster pastries for breakfast.

I’d like to hear the governor talk about how vouchers and private schools won’t be allowed to siphon money away from public schools. I’d like to hear his analysis of how inadequate education leads to poor self-esteem and how a positive self-image is key to a person’s ability to pay attention to diet and exercise. I’d like to hear him talk about how a person who doesn’t feel good either mentally or physically is a prime candidate for substance abuse.

I’d like to hear the governor discuss the abysmal status of substance abuse treatment options in the state, a crushing health care issue that gets short shrift in public discussion. More on that in another blog.

The governor needs to say that fundamentals like good health and proper education make all the difference in how a person participates as a vital member of society or how he/she gains and maintains sufficient employment. He needs to say, again and again, that a person who is well, who has learned how to reason, and who recognizes the responsibility of self-care and citizenship is the kind of person we absolutely must gain a lot more of in this state.

At any cost.

~~~

[1] https://www.arktimes.com/ArkansasBlog/archives/2017/05/02/governors-proposed-cuts-to-medicaid-eligibility-will-increase-costs-for-working-poor-likely-to-increase-uninsured-rate

[2] https://www.arktimes.com/arkansas/state-still-awaiting-federal-approval-on-medicaid-expansion-changes/Content?oid=11322951

[3] Cost of Living https://www.investopedia.com/terms/c/cost-of-living.asp#ixzz53JNGsNLI

[4] https://www.numbeo.com/cost-of-living/in/Little-Rock

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The Poverty of Conservatism

 

A continuing crisis plagues Arkansas. Like a snake eating its tail, poverty, addiction and mental illness, teen pregnancy, sexual violence against women, and low educational achievement perpetuate themselves as a result of entrenched conservative thinking. Costs for addressing these problems continue to skyrocket while the state’s earning power lingers near the bottom.

Where do we cut the snake?

Arkansas ranks 48th out of 50 states in terms of poverty. In 2015, 19.1% percent of the state’s households—one fifth—have incomes below the federal poverty line of $24,250 for a family of four.[1]  For 2016, the state’s population of 2,887,337 included 550,508 people living in poverty.[2]

In a direct correlation to the poverty rate, the state ranks 39 out of 50 states in how well students are educated.[3] The state slips further down the scale for persons 25 years of age when considering the following factors: Only 84.8% graduate high school. Only 21.1% obtain a bachelor’s degree, a ranking that puts Arkansas at 48th out of 50. And only 7.5% obtain graduate degrees, a rank of 49 out of 50.[4]

We hover near the bottom at 46 in terms of mental illness in a compilation of 15 factors including all ages, availability of treatment, and addiction rates.[5] Between 2010 and 2014, over one third of teens in need of mental health treatment did not receive it while over 53% of adults did not. Only 20% of Arkansas residents with drug dependence and 10% with alcohol dependence received treatment.[6]

The state consistently ranks in the top five for teen pregnancies with up to 80 births per 1000 occurring among teen girls ages 15 to 19. Of these, 60% are white, 27% are black, and 11% are Hispanic. Counties with the highest rates included Sevier, Nevada, Arkansas, St. Francis, Mississippi, Jackson, and Randolph.[7]

According to a 2014 report by the National Conference of State Legislatures:

Children born to teen parents are more likely to enter the child welfare or juvenile justice systems and to become teen parents themselves. Every year, thousands of young Arkansans enter one or both systems. Research shows that, nationwide, the children of teen mothers are twice as likely to be placed in foster care as their peers born to slightly older parents. Sons of teen mothers are 2.2 times more likely to be incarcerated than the sons of mothers aged 20 to 21.[8]

The crisis becomes most apparent in the number of Arkansas children in foster care. From March 2015 to March 2016, the total number of available and in-use beds in foster homes increased from 2,801 to 3,306, but the number of foster children also increased, from 4,178 to 4,791. A 2016 report states that substance abuse by caregivers accounts for over 50% of children in foster care.[9]

Despite such high rates of teen pregnancies, many Arkansas school districts do not provide any sex education. Many others offer abstinence-only education including a virginity pledge (14 districts[10]), a ridiculous non-starter since census records show that over 52% of Arkansas teens are sexually active. Only seven school districts provide comprehensive sex education addressing contraceptives, sexually transmitted infection, abortion, and sexual orientation.

The Centers for Disease Control report that 37.4% to 38.5% of women in Arkansas experience at least one event of sexual violence during their lifetimes. These experiences include rape, sexual coercion, and/or unwanted sexual contact.[11] Among sexually active teens, 18% of females report acts of violence (being hit, slammed into something, or injured with an object or weapon on purpose by someone they were dating) and 16% reported being raped.[12]

Are Arkansas citizens somehow genetically predisposed to suffer these conditions? Is it something in the water? Or might the answer be found in the conservative mindset of a majority of Arkansas citizens?

Arkansas ranks 5th in the number of churches per capita. Seventy percent of adults define themselves as ‘highly religious’ with 65% saying they pray daily and 77% saying they believe in God with absolute certainty.[13] The predominant religion practiced in Arkansas is Southern Baptist, a conservative Protestant sect which believes in a literal interpretation of the Bible.

Predictably, any push for sex education and contraceptives in public schools provokes conservative outrage. By religious thinking, unwanted pregnancies serve as punishment for illicit sex. The burden borne by women in unwanted pregnancy, childbirth, and childcare is God’s retaliation for the sins of Eve. As stated in Southern Baptist doctrine, “A wife is to submit herself graciously to the servant leadership of her husband.”[14] Prevention either through birth control or abortion upends the natural order of things as ordained by God.

The prevailing idea of conservative parents is that talking about sex and especially advocating for birth control of any kind creates a permissive attitude wherein teens are more likely to have sex. Data clearly dispute this belief. But the refusal to accept widely accepted evidence about the effectiveness of sex ed fits perfectly with the greater mindset of religious conservatives: willful ignorance about any and all information that doesn’t square with religious teachings.

Under the belief that addiction or non-marital sexual activity are moral failings, many efforts to address non-marital sex, sexual abuse or substance abuse rely on faith-based programs. Yet as noted by a counselor with twenty years in faith-based addiction treatment, “Often times, Christian programs view the secular approach to recovery as counterproductive to their message and will often discredit and even disregard medical or empirical based advice to addiction recovery.”[15]

While embracing some aspects of modern science and the advances of civilization such as automobiles, cell phones, DVRs, and medical progress, conservatives refuse to acknowledge other key findings of our times. Early religions strictly regulated a woman’s sexual activity out of concern for proving paternity and reducing conflict between competing males, among other things.  None of that matters today. Genetic testing quickly solves questions of paternity. But religion has become so institutionalized its practitioners can’t back up far enough to consider its origins or usefulness.

There’s a blind adherence to the tradition of making babies as the primary goal in life.

It doesn’t take a genius to figure out that teen pregnancy leads to lack of education which in turn leads to poor employment opportunities, or that a state with a high rate of poorly educated adults won’t attract many employers. It also doesn’t take a rocket scientist to understand that poorly educated people with poor job opportunities are more likely to turn to drugs or alcohol or suffer other forms of mental illness. Inadequate nutrition also plays a role, another cause and result of mental illness and poverty.

Further, an embattled position in poverty with subpar education leads people directly to unreasoned fear of Other—xenophobia and racism.

We have to start with the head of the snake. If we hold any hope of interrupting this vicious cycle, our state and national educational standards must require sex education. Such requirements must be imposed even in private, religious, and home school settings.

The requirements can’t stop there. All children must be required to learn the basics of science, history, political science, and other fields that serve as major elements in critical thinking about the modern world. While the state cannot dictate whether someone embraces any particular religion, we can dictate that our children are adequately prepared to make an informed choice about what to believe.

We cannot allow reactionary religious beliefs and tribalism to undo what civilization has achieved thus far.

The hue and cry against such reforms in education will be loud and long. State and federal legislators will be hard pressed to maintain a firm stance in the face of entrenched dogmatic beliefs. It will take true leaders to enact reforms in a time when leadership seems missing from public life. That means we must elect educated progressives who will carry the weight. The future of our nation depends on it.

~~~

 

[1] https://en.wikipedia.org/wiki/List_of_U.S._states_by_poverty_rate

[2] https://talkpoverty.org/state-year-report/arkansas-2016-report/

[3] https://www.usnews.com/news/best-states/rankings/education  The

[4] https://en.wikipedia.org/wiki/List_of_U.S._states_by_educational_attainment

[5] http://www.mentalhealthamerica.net/issues/ranking-states

[6] https://www.samhsa.gov/data/sites/default/files/2015_Arkansas_BHBarometer.pdf

[7] “Say no to sex, most state districts teach,” Ginny Monk. Arkansas Democrat Gazette. Sunday September 24, 2017. Page 1.

[8] http://www.ncsl.org/research/health/teen-pregnancy-in-arkansas.aspx

[9] “Children in foster care in Arkansas reaches all-tine high.” Brian Fanney. Arkansas Democrat-Gazette, August 22, 2016. Online access October 18, 2017

[10] “Say no to sex, most state districts teach”

[11] https://www.cdc.gov/violenceprevention/pdf/NISVS-StateReportBook.pdf

[12] https://www.hhs.gov/ash/oah/facts-and-stats/national-and-state-data-sheets/adolescent-reproductive-health/arkansas/index.html

[13] http://www.pewresearch.org/fact-tank/2016/02/29/how-religious-is-your-state/?state=arkansas

[14] http://www.sbc.net/aboutus/basicbeliefs.asp

[15] http://www.addictioncampuses.com/resources/addiction-campuses-blog/3-reasons-christian-rehabs-dont-work-according-to-a-pastor/

 

On Legalizing Drugs

“Americans must confront the reality that we are the market,” Secretary of State Rex Tillerson said this past Thursday. “We Americans must own this problem.”[1]

Meeting with his Mexican counterpart, Tillerson acknowledged the role of American drug consumption in the proliferation of violent Mexican drug cartels. Citing the enormous demand for heroin, cocaine, and marijuana by Americans eager to get high, he argued that “drug trafficking had to be addressed as a ‘business model,” attacking cash flow, gun procurement, production and distribution.’”

Oh, please. You’d think that an administration that promised new approaches would make some tiny effort to think outside the prohibition box. But never once in Tillerson’s comments or those of his colleague Homeland Security Secretary John Kelly did a new idea appear. Never once did they hint at any effort to consider the success of other nations where various types of legalization and regulation have greatly reduced drug problems.

Take, for example, the success of states like Colorado now in its fifth year of marijuana legalization. Sales of the legal herb generated tax revenues exceeding $150 million between January and October 2016, $50 million of which the state is using to pump up its school systems.[2] Significant shares of this revenue stream will support improved drug treatment, drug education programs, and various projects targeting at-risk populations.[3] All these expenditures help increase education, job skills, and opportunity for persons who might otherwise fall victim to substance abuse.

Yes, Americans are the market. But instead of devoting resources to learning more about why Americans are uniquely prone to drug use and abuse, outdated policies continue to treat Americans as children to be scolded and punished. This attitude helps foster voters’ disgust with government.

Punishment has become increasingly more severe as subsequent generations of policymakers have embraced the government-as-nanny model. Any incremental step away from prohibition has come wrapped in controversy, implemented only in states where the voice of reason has a chance to be heard. Now with the Trump Administration and its appointment of Jeff Sessions as head of the Justice Department, we face the prospect of a full-bore return to the good old failed policies of the past.

Why is there no discussion of legalization and regulation? A modest approach might be similar to that of Portugal, who years ago legalized all drugs. “Weed, cocaine, heroin, you name it – Portugal decided to treat possession and use of small quantities of these drugs as a public health issue, not a criminal one.”[4]

While our nation’s drug warriors lament that such an approach would lead to higher use rates among the young and greater ease of availability would increase use rates, the fact in Portugal is that youth aren’t using more, adults are using slightly less, the rates of HIV and Hep C infection are down, and – hear this – hardly anyone dies of overdose.

Compare that to the alarming rise in U. S. deaths from opiates which more than tripled between 2010 and 2015.

Drug overdose is the leading cause of accidental death in the US, with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin.[5]

It’s way past time to face reality: people are going to use drugs. As far back as we can peer into human history, people have consumed everything from beer to cannabis to opium to hallucinogens. These practices are part of who we are, part of our religions, part of our ability to think outside or within ourselves.

Legitimate questions await answers about why various types of drug use throughout the millennia have transformed into today’s raging torrent of human suffering, but we’re not devoting any resources to answer those questions. Have the pressures of our fast-paced modern age forced us to seek refuge in intoxication? Is our multicultural society at fault in erasing old customs and rites of passage that could help us confront our existential crisis? Have the conveniences of our technological age created too much leisure time? What is the impact of a pharmaceutical industry’s marketing campaign flooding us with ads suggesting that the solution to every human ill is a drug?

We simply don’t know.

We should have learned a hundred years ago that criminalizing a popular intoxicant only creates bigger problems. Those who championed alcohol prohibition wanted to stamp out drunkenness. The blissful concept assumed that if alcohol were made illegal and its producers and users criminalized, everyone would simply stop drinking.

New York City Deputy Police Commissioner John A. Leach (right) watching agents pour liquor into the … New York World-Telegram and the Sun Newspaper Photograph Collection/Library of Congress, Washington, D.C. (neg. no. LC-USZ62-123257)

Far from it. For their trouble in passing the Eighteenth Amendment, the “dry” crusaders found their cities overrun by heavily armed criminals fighting over territory. People flaunted the law, patronizing highly popular speakeasies where drinking served as joyous rebellion against overweening authority.[6] No matter how many barrels of liquor were spilled into public gutters, ever more enterprising moonshiners set up shop in hidden hollows.

It took just over fourteen years for prohibition fervor to sour. Amendment Twenty reversed it in 1933.

As Lincoln famously said in 1840:

“Prohibition… goes beyond the bounds of reason in that it attempts to control a man’s appetite by legislation and makes a crime out of things that are not crimes… A prohibition law strikes a blow at the very principles upon which our government was founded.”[8]

Sadly, it seems little of this lesson actually sank in. Prohibition policies continue to frame our national approach to substance use and abuse, siphoning money into hit squads of heavily armed urban police and burgeoning prisons instead of desperately needed research and treatment of addiction.

Reality is that prohibition does nothing to reduce the market for drugs, but it does create a thriving underworld where dealers make huge profits. Stamp out every drug producer/dealer in the nation and tomorrow another crop will rise to the surface. Among the poor, especially those in marginal economies of Mexico and other Latin American countries, the potential benefits far outweigh the risks. Our inner city youth’s only hope of achieving the American dream seems to lie in the profitable drug trade. It’s about supply and demand.

The economics of prohibition can’t be overstated. Trade in illegal drugs generates so much profit that gangs can afford all the expensive weapons they might ever want. The spiraling up of urban warfare now involves military gear and tactics among the police and armor-piercing bullets in automatic weapons carried by adolescent criminals. The payoff comes in fancy cars, jewelry, and a lifestyle not achievable by legal means. Tax free.

A war on drugs is, after all, a war on our people, with rising collateral damage to our cities, institutions, and most of all, innocent bystanders.

Ironically, prohibition policies fail utterly to accomplish the goal of eradicating drug use/abuse. A smattering of evidence from states with legalized marijuana shows that teen use has dropped, suggesting that by removing the ‘forbidden fruit’ aspect of the drug, rebellions teens may lose interest. Meanwhile on the black market, no ID is required for purchase, and studies have found that teenagers can obtain marijuana more easily than beer. [9]

We the people have to decide what we’re going to do about this, because our so-called ‘leaders’ won’t make the first move. We have to decide and then make our voices heard. Compare:

  • a militarized police force versus friendly neighborhood police to protect and serve.
  • urban warfare versus reclaimed neighborhoods and inner cities
  • illegal search and seizure and loss of property even you’re not convicted of a crime versus government butting out of private lives
  • an overwhelmed judicial system versus our Constitutionally-guaranteed due process
  • half of federal prisoners in jail for drugs and the fact that drug offenses comprise the most serious offense for 16% of state prisoners versus an enormous reduction of prison population
  • our ever-growing investment in prisons versus a renewed investment in schools, mental health care, and state-of-the-art addiction treatment centers.
  • taxpayers struggling under drug war costs versus a regulated, taxed drug industry ensuring purity, restricting sales to adults only, and producing substantial new revenue streams
  • American citizens treated as children by government deciding what they can do in their personal lives versus each person responsible for his/her welfare. Want to be homeless, die in a ditch? Go ahead. Ask for help, we’ll be there for you.
  • overdose of drugs like heroin often resulting from zero information about purity or strength versus a regulated market that includes labeling for purity and precautions about use.

There are no upsides to the drug war. By any tally, this approach has been an enormous policy fiasco partly responsible for the decline of inner cities and disrespect for government in general. Government has never bothered to assess the effectiveness of its policies. No one can cite data showing that getting tough on drug traders and users has reduced supply or demand.

Indeed, judging by the rhetoric of our newest batch of politicos and the news flowing to our ears and eyes on a daily basis, we can say with certainty that drug prohibition continues to be an abysmal failure.

~~~

[1] http://www.latimes.com/politics/washington/la-na-essential-washington-updates-tillerson-puts-onus-of-drug-trafficking-1495131274-htmlstory.html

[2] http://fortune.com/2016/12/13/colorado-billion-legal-marijuana-sales/

[3] https://leg.colorado.gov/sites/default/files/15-10_distribution_of_marijuana_tax_revenue_issue_brief_1.pdf

[4] https://www.washingtonpost.com/news/wonk/wp/2015/06/05/why-hardly-anyone-dies-from-a-drug-overdose-in-portugal/

[5] http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf

[6] https://en.wikipedia.org/wiki/Prohibition_in_the_United_States

[7] http://www.autofoundry.com/293/the-best-moonshine-cars-of-all-time/

[8] http://www.americanantiquarian.org/proceedings/44807229.pdf

[9] http://www.cbsnews.com/news/teens-pot-easier-to-buy-than-beer/