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THE ROOSEVELT REVIEW

OF THE ROOSEVELT INSTITUTE AT


COLUMBIA UNIVERSITY
TABLE OF CONTENTS
Democratic Access
8 Prisoner Voting Rights in New York
By Tanisha Aggarwal
10 Increasing Accountability in the House of Representatives by Limiting Fundraising
By Emma Cloyd
12 Local Office, Local Money
By Marion Gibson

Economic Development
16 Targeting Opioid Addiction Where it Begins: The Behavioral Economics of Prescription
By Stephanie Grove
18 Community-Targeted Solutions to Food Deserts in NYC: Strengthening the Healthy Bodegas Initiative
By Ji-Hoon Ko

Education
22 Recess: More Then Just Fun
By Emma Cloyd
24 Federally Funded, Locally Distributed Fully Universal Pre-K
By Carolyn Kelly
26 Providing Better Support for Columbia College & Engineering Students: Guaranteed Housing and Tak-
ing a Leave of Absence
By Shirley Tan

Energy and the Environment
30 Climate Change and the Grid: Addressing Texas’ Utility Grid Vulnerabilities
By Ricardo Jaramillo
32 Decarbonize to Demilitarize Local Law Enforcement Agencies
By Morgan Margulies
34 Give Them Some Space: Banning the Intense Confinement of Animals in American Food Production
By Arianna Menzelos
36 Redirecting RGGI: Increasing Energy Efficiency in the Granite State
By Eric Scheuch

Foreign Policy
40 Reducing Maritime Transportation Pollution: A Template For International Collaboration on Sectoral
Emissions Reduction?
By Connor Haseley

Healthcare
44 Decriminalizing Overdoses: Saving Lives by Protecting the Rights of Parolees
By Francesca Barasch and Augusta Owens
46 Medi-Cal and Work Requirements
By Juliet Emerson-Colvin
Roosevelt Review
48 Expanding Access to Life-Saving Hepatitis C Treatment: Removing Discriminatory Sobriety Restrictions
By Sinead Hunt
50 Protecting Healthcare Access in the Age of Trump: A Proposal for a State-Based Individual Mandate in
New York
By Sinead Hunt
52 Amending the Federal Controlled Substances Act: Fostering Public Health Innovation at the Local Level
By Sinead Hunt
54 Parity Delayed is Parity Denied
By Alex Siegel

Human Rights
58 Marriage for All: Repealing the Same-Sex Marriage Act in Nigeria
By Dotun Adegbite
60 Homemakers: Creating a Guaranteed Right to Housing Counsel
By Justin Holiman

Technology
64 Electronic IDs: Physical Protection for Metaphysical Data
By Emma Cloyd
66 Governing CRISPR: Effectively Regulating Gene-Editing Technologies
By Meredith Harris
68 Tackling Interoperability of Health Information Technology
By Sarah Lubin
70 China’s Great Firewall as an Economic Threat
By Christopher Philogene
Letter from the Editor
Dear Reader,

Welcome to the 11th annual edition of the Roosevelt Review published by the Columbia University Chapter of the
Roosevelt Institute! I am excited that you have found our journal. Whether you are a perspective member, Roosevelt alum,
parent, or professor, I am sure that you will find our proposals to take an innovative approach to some of our generations
most pressing issues. This year, our journal includes 25 policy proposals all written by members of the Columbia University
Undergraduate community. Our authors — and by extension all members of the Roosevelt community — come from a
wide range of backgrounds, from political science majors to engineers, but all come together behind the same goal: gener-
ating progressive solutions to the issues that matter most to them.

While Columbia has many political organizations campus, the Roosevelt Institute is unique by focusing on the
tangible solutions, rather than the theoretical conversations. While there are many topics that require extensive discussion
in our community, the Roosevelt Institute is dedicated to discussing the feasible next steps to improve outcomes on the
school, city, state, country, and global level. Since it’s inception, the Roosevelt Institute has had weekly discussions in which
students are able to take a multi stakeholder approach to developing policy changes, exposing them to the perspectives of
others and how said views and biases are developed as a result of personal backgrounds. While the Roosevelt Institute is
a non-partisan organization, our discussions always focus on progressive policies with the aim of developing a society in
which all individuals are treated equally.

In addition to our weekly meetings, the Roosevelt Institute runs eight policy centers, which act as a framework
to address problems within our community. As a result of the ever changing political landscape, this year the Roosevelt
Institute introduced a Technology Center to discuss the intersection between tech and policy. This year, our Human Rights
center ran a successful campaign against Aramark Dining services on Barnard’s campus. Our Energy and Environment
center wrapped up their carbon neutrality campaign with Columbia committing to ad- dressing the issue in their 2020 sus-
tainability plan. Our Economic Development and Education centers presented a proposal to the Barnard Student Govern-
ment Association asking for the creation of an Advisory Committee on Socially Responsible Investing and are preparing
for a meeting with the Board of Trustees.

Serving as the Editor-in-Chief of the Roosevelt Review has been a great privilege, and the perfect way to wrap up
four years on the board of this organization. Seeing the way that our group has evolved in response to the increased attacks
on human dignity in our country and beyond, and the passion with which members address the issues that matter most to
them has made me truly thankful to call this organization my home for the past four years.

To the writers, center directors, and initiative organizers, thank you for your help making this journal a reality. To
the executive board, it has been an honor to serve with you, whether you have been by my side since I joined Roosevelt the
first week of freshman year or entered my life a few months ago. To Connor, my life-saving Deputy Editor, thank you for
your relentless line editing, we are all better writers for it. And to the Future of Roosevelt… may the odds be ever in your
favor.

With gratitude,

Emma Cloyd
Editor-in-Chief of the Roosevelt Review

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Roosevelt Review

MASTHEAD
The Executive Board

President - Ricardo Jaramillo


Vice President - Sarah Lubin
Journal Editor - Emma Cloyd
Deputy Journal Editor - Connor Haseley
Outreach Director - Justin Holliman
Treasurer - Lindsay Meyerson
Secretary - Shirley Tan

Center Directors

Democratic Access - Marion Gibson


Economic Development - Cameron Davis
Education - Carolyn Kelly
Energy and the Environment - Arianna Menzelos
Foreign Policy - Meher Malik
Healthcare - Sinead Hunt
Human Rights - Maeve Flaherty
Technology - Christopher Philogene

Initiative Organizers
Economic Development - Stephanie Grove
Energy and the Environment - Meredith Harris
Human Rights - Ji Hoon Ko

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Roosevelt Review

Democratic Access
This year, the Democratic Access center partnered with several other organizations on
campus to create an iniative called CU Votes, aimed at increasing voter registration
and particpation across Columbia’s campus.

In May of 2019, CU Votes was recognized as it’s own entity, allowing the Democratic
Access center focus it’s efforts beyond the Columbia campus in the upcoming academ-
ic year while continuing a strong working relationship with the iniative.

-- Marion Gibson, Center Director

7
Prisoner Voting Rights in New York
By Tanisha Aggarwal

Introduction Obama took the state with less than v. Dulles: “Citizenship is not a right
Ex-felons should be able to vote, 250,000 voters over his rival John that expires upon misbehavior.” The
yes. But so should prisoners them- McCain while George Bush won supreme court importantly decided
selves. On April 18, 2018, Governor the state – and hence the presi- that prisoners cannot have their citi-
Andrew M. Cuomo signed an ex- dency – with just 573 votes over Al zenship stripped as punishment for a
ecutive order restoring the right of Gore in 2000. Florida is one of the crime. Subjecting prisoners to a type
prisoners to vote immediately after most contested states in presidential of “social death” runs antithetical to
release for most New Yorkers who elections and the fact that African the goals of successful rehabilitation.
are on parole following felony incar- Americans tend to vote democratic As things stand, prisoners already
ceration. Moving forward, the Gov- has long presented a political motive retain certain civil rights such as the
ernor’s office will individually review behind felony disenfranchisement freedom to worship, organize, pro-
cases of inmates who are released to and criminalization of black folks test, and to some extent, free speech
community supervision in New York in southern states. Almost 8% of (such as writing for newspapers and
and will issue a partial executive adult African Americans are ineligi- magazines). Thus, voting would
pardon that restores each approved ble to vote because of convictions, simply be an extension of these
person’s ability to register and vote. compared to 1.8% of the rest of the existing freedoms. Furthermore,
On May 22, 2018, the Governor adult population. Florida’s lifetime contrary to popular belief, Section 2
issued the first set of 24,086 con- ban on voting rights for felons was of the Fourteenth Amendment does
ditional pardons, restoring voting finally lifted on November 16th not endorse the disenfranchisement
rights to more than two-thirds of the 2018. [2] of convicted criminals, it simply
New Yorkers currently on parole. does not prohibit the practice. It is
However voting rights can still be New York’s decision in fact, is in line currently up to the states themselves
revoked if a person is re-incarcerat- with a larger recent trend towards to decide which crimes, if any, could
ed either due to a violation of parole felony enfranchisement. Between be grounds for disenfranchisement.
or a new conviction, a condition 1996 and 2008 twenty-eight states
known as recidivism. [1] Reinstating changed their laws on felon vot- In the global context, in Hirst v
voting rights after release simply ing rights, mainly to restore rights United Kingdom (No 2) the Court
isn’t enough. post-incarceration or to simplify the in 2005 ruled that automatic disen-
process of restoration. Additionally, franchisement resulting from con-
Background Maine and Vermont are two states victions to be against human rights.
The government necessarily cannot that already allow prisoners to vote This ruling applied equally for
expect ex-convicts to once again via absentee ballots. prisoners and for ex-convicts. [3].
use these rights after however many Moreover, many countries such as
years of social exile. In fact, many Prisoner voting rights has strong Canada, Croatia, Czech Republic,
ex-felons don’t ever realize their legal precedent nationally and Denmark, Finland, France, Germa-
rights have been reinstated upon re- internationally. The main argument ny, Israel, Kenya, Netherlands, Nor-
lease. Felony disenfranchisement has for felony disenfranchisement rests way, Peru, Poland, Romania, Serbia,
important implications during key on the outdated and draconian Sweden, and Zimbabwe already
elections. Florida holds the special notion of “Civic Death.” Civic allow their inmates to vote.
title of the nation’s capital for dis- Death refers to the loss of all or
enfranchisement. The state stripped most civil rights by a person due to Recommended Action
over 1.5 million people of their vot- reasons that include the conviction New York must take advantage of
ing rights due to a criminal record, of a felony. This is a notion that has the momentum set by Governor
that is, 10% of all adult Floridians. been on the decline. As Justice Earl Andrew Cuomo and work towards
In comparison, in 2008, Barack Warren wrote in the 1958 case Trop introducing a bill that restores vot-
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Roosevelt Review
ing rights to prisoners while they are cannot vote, they are often counted Argument 4: One common argu-
in prison, heeding the model set by in the population for the legislative ment is that those who are convict-
Vermont and Maine. This would re- district of their prison, influencing ed of electoral offenses should be
store voting rights to the over 51,000 the state’s number of representa- barred from voting to maintain the
citizens currently behind bars in the tives and its presidential electoral integrity of the democratic process,
New York state. votes. This current practice bears but since over 99% of incarcerated
an uncanny resemblance to the persons have not been convicted of
Argument 1: The prison popula- notorious 3/5ths compromise that such an offense this would have an
tion in the U.S. has been on an ex- was rendered obsolete by the 13th insignificant impact, if any, on the
ponential rise over the past 40 years amendment. composition of the electorate. [8]
and criminal justice reform has been
moving to the forefront of party Argument 3: Allowing prisoners Argument 5: Finally, allowing
platforms. Felony disenfranchise- to vote has a rehabilitative function. prisoners to vote is not only polit-
ment barred 1.17 million citizens Suffrage in prison allows incarcerat- ically expedient, but economically
from voting in 1976 and 6.1 million ed individuals to maintain valuable responsible. Citizens who have their
in 2016, including 3 million who links to their communities, which eligibility to vote restored are far less
have already served their sentences can help ease the process of re-entry likely to reoffend and re-enter the
yet are still denied their constitu- into society after imprisonment. [5] criminal justice system, according
tional rights. [4] If not reversed, Denying prisoners the right to vote to recent studies by the Office of
this trend will only create an ever is likely to undermine their respect Offender Review and the Florida
increasing constituency of 2nd class for the law, as citizens who cannot Parole Commission. [9] As recidi-
citizens in the United States. It is in participate in democratic processes vism rates are lowered, New York
the nation’s best interests to allow will be less inclined to recognize taxpayers would pay less for prison
those affected by the criminal justice their authority. Allowing them to and court costs. According to a 2014
system to represent themselves and vote would strengthen social ties report released by the state Depart-
take part in national political dis- and instill a sense of civic duty and ment of Corrections and Communi-
course to amend the system. Under legal responsibility in civil society. ty Supervision: of the 24,605 former
our current justice system, ending [6] Furthermore, felony disenfran- inmates who were tracked over three
abuses in prisons requires years of chisement goes beyond prison walls, years, 42% of parolees were taken
costly litigation as prisoners sue for it also has a tendency to depress back into custody, 32% for violating
maltreatment and prisons adjust to political participation among friends, parole terms and 9% for committing
the rulings accordingly. Allowing families, and communities of incar- a new felony. [10]
prisoners to vote would benefit pris- cerated individuals. At the Maine
ons by streamlining the process of State Prison in Warren and in other In fact, Andrew Cuomo’s Executive
creating a political constituency of correctional facilities, the NAACP Order No. 181 already recognizes
prison voters who are well equipped has been holding voter education many of the arguments put forth
with the knowledge and expertise and registration drives for the past above.
through their personal experiences 10 years. Inmate political engage-
to vote on and inform policies that ment has been on a rise: in 2016 Conclusion
can improve our criminal justice sys- about 400 inmates participated. One Given the precedent and Governor
tem. Prisoner voting rights ties into of the voters was Doug Burr, an in- Cuomo’s Executive Order, now is
the larger issue of mass incarcera- mate serving a 60-year sentence for the time to pass legislation ensuring
tion – a prison population constit- murder. He had been following the that prisoners have voting rights.
uency is a prerequisite to voting on presidential election pretty closely, Expanding voting rights treats
policies and bringing more national “I look at it like, OK, it could affect prisoners justly and allows for the
awareness to the issues of over-im- my family, could affect people I care state to have a more representative
prisonment. about. So I show interest in it, I get democracy.
involved. I read a lot. I watch the
Argument 2: Even though the news so I try to stay up, as much as References
vast majority of states prisoners possible, anyways.” [7] At end.
9
Increasing Accountability in the House of
Representatives by Limiting Fundraising
By Emma Cloyd

Introduction which included a breakdown of A restriction on the amount of


Unlike candidates challenging an how members were expected to time incumbents can spend fund-
incumbent or running for an open spend their days. [4] Of the nine raising to ensure that it is not their
seat, incumbents in the House of to ten hours they allocated for, only priority in office
Representatives cannot take time three to four of hours were recom- An increase to the amount of time
off for their campaign as they are mended for the activities people spent meeting with constituents
elected to do a job for a two year often think of as being the primary and working on legislation
period, at the end of which voters responsibilities of representatives:
can decide how they fared. Despite constituent visits and spending One policy alternative that has
this duty, many incumbents fund- time on the floor or at committee been used in other countries is a
raise extensively throughout their meetings. [5] Of the remaining shortened election cycle. In Can-
term, diverting their time from the time, four hours were expected to ada, there is no official length of
legislative process. go towards fundraising, one for the election cycle but it begins
meet and greets and press events, when parliament is dissolved and
Background and one hour of recharge time. [6] must last at least 36 days until the
In 2016, $1,049,773,181 were Both the Democratic and Repub- next general election, [9] France’s
spent on House Campaigns, [1] lican parties have call centers, lo- National Assembly has a 20 day
the average “cost” of winning a cated a few blocks from the Capitol election period, Australia who has
seat was over $1.5 million, [2]with that members go to for their call a six week election period, and
the average incumbent raising time. [7] At the National Repub- Israel who has a 101 day period.
$1,590,607, challengers averaging lican Congressional Committee [10] While these are dramatically
$231,727, and candidates run- (NRCC), there are rows of small shorter than the House’s current
ning for an open seat averaging offices with a phone and computer two year long election period,
$636,381. [3] From election day where members can use provided instituting a one year election cycle
to election day, a representative they pay their dues, which is the where all candidates whether they
must raise $2,054.79 a day, which money they raise for the party in are incumbents, challengers, or
equates to nearly one maximum addition to themselves. [8] running for an open seat can only
donation ($2,700) from an individu- announce their candidacy, adver-
al as defined by the Federal Elec- Recommended Action tise their platforms, and solicit and
tion Commission (FEC). The time Considering the exorbitant amount accept for 365 days before the elec-
and mental capacity incumbents of time required to to complete tion date would allow legislators to
must dedicate towards raising such such fundraising, it is imperative able to spend more time legislating
a large sum of money detracts from that measures are taken to ensure and meeting with constituents with
other work they could be doing. that members of the House of the express purpose of improving
The burden fundraising places on Representatives do the job they their district and country, rather
members of the House interferes were elected to do: serve the public. than vying for reelection.
with legislative duties of representa- To effectively devise and implement Less time would go into fundrais-
tives. In 2017, the Huffington Post a policy to address the issue of ing as a result of it being illegal for
uncovered a PowerPoint presenta- reelection campaign fundraising, the first year of the two year term.
tion the Democratic Congressional the following two criteria will be While the overall impact of forcing
Campaign Committee (DCCC) considered when analyzing policy a member of the House to spend
gave to incoming representatives proposals: more time doing the job they were

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Roosevelt Review
elected to do is unknown, it is The FEC would oppose shortening
reasonable to assume that it would the election cycle because it would
give incumbents increased oppor- increase regulations to ensure that
tunities to meet with constituents illegal is not happening. Parties
and create legislation. A potential would strongly oppose this policy com/2013/01/08/call-time-con-
consequence of this policy is that because it would hurt their fund- gressional-fundraising_n_2427291.
members may try to circumvent raising plan regardless because they html.
its intentions to minimize the would not be able to fundraise one 5. Ibid.
amount of time spent fundraising year of the election cycle. 6. Ibid.
and increase their efforts during Considering the bipartisanism, the 7. “Are Members of Congress
the year it is allowed. Additionally, most important part of the passage Becoming Telemarketers?” CBS
this policy would create additional would be minimizing the impact of News. Accessed September 23,
work for the FEC to ensure that parties. Introducing legislation early 2018. https://www.cbsnews.
under the table campaigning is not in a cycle before campaigning is com/news/60-minutes-are-mem-
happening. Ultimately, this may in full swing but after party assign- bers-of-congress-becoming-tele-
be hard to regulate as candidates ments have been made to minimize marketers/.
could get individuals to commit party impact would be key. In order 8. Ibid.
to making contributions once to push through legislation with 9. Kurtzleben, Danielle. “Cana-
allowed, but the added difficulty strong congressional support, they da Reminds Us That American
would at least reduce the time could also add it to the budget to Elections Are Much Longer.”
spent fundraising for one year of overpower other stakeholders. NPR, NPR, 21 Oct. 2015, www.
the election cycle. npr.org/sections/itsallpoli-
References tics/2015/10/21/450238156/
Conclusion 1. “24-Month Financial Activity of canadas-11-week-campaign-re-
Operating within the institution House Candidates (2002-2016),” minds-us-that-american-elections-
of Congress, representatives have Federal Election Commission, are-much-longer.
a strong influence which may be April 7, 2017, , accessed Septem- 10. Atwill, Nicole. “Campaign
stifled by party leadership who ber 23, 2018, https://transition. Finance: Comparative Summary.”
depend on their fundraising. The fec.gov/press/summaries/2016/ 11. Campaign Finance: Compar-
FEC’s influence would be strong tables/congressional/ConCan- ative Summary | Law Library of
because they are the experts in this d3_2016_24m.pdf. Congress, 1 Apr. 2009, www.loc.
campaign finance, but not strong 2. “Table 2-1: The Cost of Win- gov/law/help/campaign-finance/
enough to counteract represen- ning an Election, 1986-2016.” comparative-summary.php#dura-
tatives since they amend FECA. Campaign Finance Institute. tion.
A portion of the representatives Accessed September 23, 2018. 12. Hulse, Carl. “Steve Israel of
would be in favor of this given the http://www.cfinst.org/pdf/feder- New York, a Top House Dem-
complaints about the fundraising al/2016Report/pdf/CFI_Feder- ocrat, Won’t Seek Re-election.”
expectations. [11] Representatives al-CF_16_Table2-01.pdf. The New York Times. December
who are not strong fundraisers 3. “Incumbent Advantage.” Open- 21, 2017. Accessed September
would strongly support the policy Secrets.org. Accessed September 23, 2018. https://www.nytimes.
because it would increase their 23, 2018. https://www.opensecrets. com/2016/01/06/us/politics/
chances of receiving a better org/overview/incumbs.php?cy- steve-israel-house-democrat-new-
committee position. [12] NGOs cle=2016. york.html.
would favor this policy because 4. Grim, Ryan, and Sabrina Sid- 13. Friedman, Uri. “American Elec-
legislators would spend more time diqui. “Call Time For Congress tions: How Long Is Too Long?”
legislating, rather than soliciting Shows How Fundraising Dom- The Atlantic. October 06, 2016.
contributions. The public would inates Bleak Work Life.” The Accessed November 07, 2018.
support this policy as 60% find the Huffington Post. December 07, https://www.theatlantic.com/
constant election coverage to be 2017. Accessed September 23, international/archive/2016/10/us-
exhausting. [13] 2018. https://www.huffingtonpost. election-longest-world/501680/.
11
Local Office, Local Money
By Marion Gibson

Introduction donations. This means that can- but San Francisco should raise the
For the most part, American politi- didates can still primarily rely on matching ration to 6-1 ratio rather
cal campaigns are privately funded. larger donations from Silicon Val- than a 2-1 ratio. This amplifies the
This forces political candidates ley residents while participating in power of small dollar donations
to independently raise funds, and the public financing program. The and encourages candidates to seek
fundraising often takes up a signif- public financing program should out those donations rather than
icant proportion of their time in only be available to candidates who larger ones.
office. Politicians focus their energy are fully accountable to the resi-
on meeting donors rather than lis- dents of San Francisco. Conclusion
tening to their constituents. Mean- San Francisco must reform its pub-
while, income inequality is rising Recommended Action lic financing program to better in-
in the United States, which allows San Francisco is not the only city to centivize small dollar donations and
individuals who are already more institute city-level campaign finance soften the influence of Silicon Val-
economically powerful to have laws. New York City matches the ley in city politics. By implementing
greater say in the political process. first $175 donated to a candidate a more stringent publicly-funded
by a New York City resident a a six- campaign finance program mirror-
Background to-one ratio if the candidate agrees ing New York City’s, political can-
San Francisco is the most unequal to tougher disclosure and spending didates in San Francisco can focus
city in California , largely due to caps. Candidates must demonstrate on the needs of city residents rather
the growth of the technology in- broad support to be eligible. Under than the desires of billionaires from
dustry. [1] Silicon Valley technolo- this system, it is better for a cam- outside of the city proper. This can
gy giants funnel money into tech- paign to raise $175 from a New be done through simple alterations
nology-friendly political candidates, York resident than $1000 from in the current program, such as
who may in turn worsen inequality a Connecticut resident. [4] This only matching donations under $50
by failing to adequately regulate the policy has worked well in New York rather than a grand total raised
tech industry. [2] While San Fran- City, which is also home to extreme and by limiting all donations to San
cisco boasts a robust public-financ- wealth both within the city proper Francisco residents.
ing program, this program does not and in the surrounding region. Campaign finance reforms are
adequately encourage small-dollar A New York-style public financing needed throughout United States.
donations. A mayoral candidate program would be more effective at Cities can take the lead, experi-
must raise $50,000 in donations encouraging local donations in San menting with innovative public
ranging from $10 to $100 from Francisco because it only matches financing programs that can later
San Francisco residents to apply for small dollar donations from the city. be implemented on the state and/
public financing. The threshold is Certain aspects of the New York or federal level.
higher for incumbents to account City public financing program can
for incumbent advantage. [3] be applied to San Francisco’s to References
Not all of the donations received make it more equitable. The San 1. Frederick, Kuo. “San Fran-
for a specific candidate need to be Francisco requirements need to cisco Has Become One Huge
from San Francisco residents. San be altered to explicitly forbid any Metaphor for Economic In-
Francisco matches all funds raised contributions from residents outside equality in America.” Quartz,
as long as the threshold for San of the San Francisco city proper in June 21, 2016. https://
Francisco residents is reached, not order to receive public financing. qz.com/711854/the-inequali-
just those funds raised from San The program should keep the same ty-happening-now-in-san-francis-
Francisco residents and not just donation value match to donations co-will-impact-america-for-genera-
those funds raised by small-dollar under $100 as it currently has, tions-to-come/.
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Roosevelt Review
2. Robinson, Melia. “The Tech 1
Millionaire Moguls Most Involved
in San Francisco Politics.” Business
Insider, June 5, 2018.
3. “Public Financing Program –
San Francisco Ethics Commission.”
Accessed April 22, 2019. https://
sfethics.org/compliance/cam-
paigns/candidates/public-financ-
ing-program.
4. “How It Works | New York
City Campaign Finance Board.”
Accessed April 22, 2019. https://
www.nyccfb.info/program/how-it-
works/.
“The San Francisco requirements
need to be altered to explicitly for-
bid any contributions from resi-
dents outside of the San Francisco
city proper in order to receive public
financing.”

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Roosevelt Review

Economic Development
This year in the Economic Development center partnered with the Education Center to
establish an Advisory Committee on Socially Responsible Investing (ACSRI) at Barnard
College. The primary goal of the campaign was to increase transparency and account-
ability with Barnard’s investments moving forward. The centers successfully presented
before the Barnard Student Government Association (SGA) and will be meeting with
the Board of Trustees in the near future.

Economic Development center at the Roosevelt Institute has always been committed to
discussing the economic issues that are not always at the forefront of economic debates
and the center was proud to continue these endeavours this year.

-- Cameron Davis, Center Director

15
Targeting Opioid Addiction Where it
Begins: The Behavioral Economics of
Prescription
By Stephanie Grove

Introduction address the issue that 1) people are This behavioral economic theo-
Behavioral economic theory pro- not educated on this. And 2) opi- ry supports the assumption that
vides a good explanation for the oids are the default option. Policy changing the default-option will
overprescription of opiods through- should consider how the default result in the reduction of pre-
out the United States. Currently, in options and education are import- scription of opioids. Reduction of
many states, opiods are the default ant in the protection of the right to prescription of opioids is expected
option for extreme pain response, freedom from addiction. to reduce the frequency of addition
leading to over presctiption, over- in two major ways, both relating to
use, and addiction. Recommended Action the fact that prescribed pain-kill-
In order to adequately address the ers are the most common gateway
Background opioid crisis, the State of Michigan drug to opioid addiction. Firstly,
Like other places in the country, should enact a law setting non-opi- if fewer patients being treated for
Michigan has a huge Opioid prob- oids as the default option for medi- pain are prescribed opioids, their
lem, ranked 14th highest state in cal conditions related to lower-level chance of becoming addicted to
the country. A new law went into pain and pain caused primarily by opioids will be reduced. Secondly,
effect March 28 that provides the swelling, with the option of switch- if doctors prescribe fewer opi-
option for patients to pre-emptively ing to opioids. oids, and to the patients that need
tell their doctors that they don’t them the most, then the chance of
want to be prescribed opioids, and Roy Soto, M.D., President of opioids being taken by non pa-
would like to be proscribed alter- Michigan Society of Anesthesiolo- tients living with the treated person
native pain medications. It intends gists supports the idea that non-opi- also decreases. Research demon-
to strike a conversation between oid painkillers are, in many cases, strates that this is one of the other
doctors and patients, and to change viable alternatives [1]. Some alter- most common pathways to opioid
the default option for patients that natives include anti-inflammatory addiction, the sharing or stealing
are unconscious. The lack of a drugs to reduce swelling as well as of a proscribed-person’s painkill-
central database for these advance targeted numbing [2]. ers within a household. If opioids
directives, prevents a new medical are prescribed only to those who
provider to the patient from access- Economist Richard Thaler (hails suffer from the most severe pain
ing the patient’s advance directives from Columbia) is big on this. that cannot be treated by alter-
filed with previous providers. Behavioral economics studies the native medication, those treated
While this law provides a poten- way that “nudges,” or policies that persons will have a larger incentive
tially-effective way for patients to inform the outcome of a decision to prevent the sharing or stealing
preemptively dissent prescription without restricting or determining of medication because they rely on
of opioids, it 1) doesn’t adequately it, make people more or less free. the medication. There will be fewer
protect the patient’s freedom to Changing the “default option” or doses left over from the patient,
prevent prescription and potentially “top choice in a list” have been regardless of their efforts to prevent
unconscious administration of the shown to drastically influence a sharing/stealing. In many cases as
addictive drugs. And 2) person’s choice of medical services of now, many patients are left with
Even if it were successful in accom- or medical providers. many more doses than they require,
plishing its aim, it would do little to and do not dispose of them respon-
16
Roosevelt Review
sibly.

Conclusion
The enactment of this policy will
require more research to determine
the boundary for what defines
“lower-level pain” versus more
intense pain that requires opioids.
Doctors are still foggy on this. Until
then, a network of civil society,
NGO, policy activists and state leg-
islators will have to work together
to raise attention to this bill.
“This behavioral economic theory supports the assumption
References
1. “Alternatives for Managing Pain that changing the default-option will result in the reduction
that Aren’t Opioids,” Roy Soto, of prescription of opioids. Reduction of prescription of
M.D., President of Michigan Soci-
ety of Anesthesiologists. Beaumont opioids is expected to reduce the frequency of addition in
Hospital Health & Wellness News. two major ways, both relating to the fact that prescribed
2019.
2. “Alternatives for Managing Pain pain-killers are the most common gateway drug to opioid
that Aren’t Opioids,” Roy Soto, addiction. Firstly, if fewer patients being treated for pain
M.D.
are prescribed opioids, their chance of becoming addicted
to opioids will be reduced. Secondly, if doctors prescribe
fewer opioids, and to the patients that need them the most,
then the chance of opioids being taken by non patients
living with the treated person also decreases”

17
Community-Targeted Solutions to Food
Deserts in NYC: Strengthening the Healthy
Bodegas Initiative
By Ji Hoon Ko
Introduction with bodega owners in food deserts, expenditures incurred from pur-
“Food deserts” are areas character- encouraging them to offer addition- chasing healthy food inventory and
ized by low concentrations of busi- al fresh produce and other healthy related products. The credit would
nesses selling healthy foods and high foods in their stores. Additionally, it cover fresh produce, transportation
concentrations of fast-food restau- engages with the surrounding com- costs, produce displays, and refrig-
rants. [1] There are many food munity through outreach events, eration systems. This would address
deserts in New York City, primarily advertising campaigns, and part- the financial concerns voiced by
located in low-income and predom- nerships with local organizations to owners participating in the HBI and
inantly minority neighborhoods. To ensure residents patronize healthy incentivize continued cooperation.
address this issue, New York City bodegas. [9] Accordingly, the HBI The HBI has been effective because
has launched various programs to has demonstrated tangible success. it addresses both the supply and
expand access to healthy foods in Of participating stores, 45% report- demand sides of the food desert
food deserts, such as the FRESH ed an increase in sales of 1% milk, problem. The proposed tax rebate
program, [2] which offers tax in- 32% reported an increase in fruit would ensure this program’s con-
centives for developers building new sales, and 26% reported an increase tinued operation, expansion, and
supermarkets, and the Green Carts in vegetable sales. [10] Much of success.
program, [3] which funds street this program’s effectiveness can
carts selling fresh produce. While be attributed to two factors: one, The HBI has significantly improved
these programs have fostered eco- the HBI emphasizes community the amount of healthy foods pur-
nomic growth, their effectiveness in involvement and nutritional edu- chased in its target areas, with its
improving locals’ dietary practices cation; two, the HBI utilizes the success being a result of its com-
has been questioned, as they strug- bodega, where residents already buy munity-based approach. Bodegas
gle to motivate residents to regularly food. Because bodegas are usually compose more than 80% of food
patronize businesses associated with personalized towards the needs of a sources in New York City’s food des-
these programs. [4, 5] Additional specific neighborhood and maintain erts, [12] so this program increases
research indicates that expanding a close bond with the community, the accessibility of healthy foods
healthy food availability in food residents may feel most comfortable through sources already familiar to
deserts does not necessarily lead to shopping there. Thus, increasing the local consumers. Due to poor fund-
healthier diets for residents, [6] as supply of healthy foods in bodegas ing, this program cannot currently
nutritional education appears to be may be more effective in appealing offer bodega owners any financial
the primary determinant of food to residents than inserting a new incentives, limiting the HBI to part-
choices. [7] and unfamiliar business into a com- nering with bodegas that already
munity. However, the success of this stock some healthy foods and own
Background program has been hampered by a existing infrastructure to store fresh
A successful program addressing lack of funding, [11] mostly because produce. [13] Moreover, bodega
food deserts must expand access it cannot provide financial incen- owners voiced concerns about “high
to healthy foods while providing tives to bodega owners. prices”, “low demand”, and a lack
nutritional education to residents of “space (refrigerated or otherwise),
and appealing to residents’ unique Recommended Action: to introduce a new and perishable
shopping habits. The Healthy Bode- New York City should allow bode- product” [14] in regards to the HBI,
gas Initiative (HBI) addresses all of ga owners participating in the HBI indicating that significant financial
these factors. [8] The HBI partners to claim a tax credit of 50% of all aid is needed to make healthy food
18
Roosevelt Review
products and related storage more munity, which is also an HBI target expansion-to-support-health-fresh-
accessible to bodega owners. area. The first step in building a program.
coalition of support would be to 3. “Green Carts,” Official Web-
The proposed solution would take work with pre-existing community site of the City of New York, NYC
the form of a standard small busi- outreach programs and student Health, accessed November 20, 2018,
ness tax rebate. This rebate would groups. These groups may have an https://www1.nyc.gov/site/doh/
satisfy bodega owners currently interest in this policy due to its focus health/health-topics/green-carts.
participating in the initiative and on the development of the Harlem page.
may also attract new bodega owners community. Campus groups focused 4. Cheryl Naa-Lamiokor Lamptey,
in target areas. To date, the HBI on community development, and “Comparing Policy Environments
has worked with 520 bodegas, en- Columbia Community Impact, the between NYC Green Carts and Phil-
couraging them to stock 15 specific nonprofit organization that coor- adelphia’s ‘Get Healthy Philly’ Ini-
healthy foods. The relatively small dinates community service activi- tiative: Two Cities Combating Food
number of participating bodegas, ties for the university, would make Deserts and Obesity” (M.P.H., Icahn
even factoring in an expansion of excellent coalition partners. With School of Medicine at Mount Sinai,
the program, means that the to- their support, the coalition could 2014), https://search.proquest.com/
tal cost of the rebates would not expand to involve church organiza- docview/1625988151/abstract/
be prohibitively expensive. [15] tions, youth groups, and commu- F297CFE532194A96PQ/1, 23-25.
However, very few statistics about nity alliance groups. Together, this 5. Batya Ungar-Sargon, “Have
inventories in bodegas presently coalition would launch an advocacy City Subsidies to Supermarkets
exist. [16] A comprehensive study campaign focused on lobbying city Made NYC Healthier?,” City
of bodega inventories is needed to council members, specifically those Limits, April 5, 2016, https://
properly estimate the annual cost of who represent communities in food citylimits.org/2016/04/05/
the proposed program. deserts, to formally propose this have-city-subsidies-to-supermar-
policy. A petition and a letter-writ- kets-made-nyc-healthier/.
Next Steps ing campaign would form the 6. Hunt Allcott, Rebecca Diamond,
In order to improve this policy pro- core of this project, and would be and Jean-Pierre Dubé, “The Geogra-
posal, local community members accompanied by additional grass- phy of Poverty and Nutrition: Food
would be interviewed to provide roots outreach. Finally, influential Deserts and Food Choices Across
new insight into the food desert representatives and leaders from the United States,” Working Paper
problem and the potential of the the community could meet with city (National Bureau of Economic Re-
HBI. Additionally, representatives council members to further advo- search, December 2017), https://doi.
of the Department of Health and cate for this proposal. org/10.3386/w24094, 33-34.
Mental Hygiene (DOHMH) and 7. Allcott et al., “The Geography of
Small Business Services (SBS) would References Poverty and Nutrition,” 34.
be contacted. DOHMH, which 1. Cynthia Gordon et al., “Mea- 8. “Healthy Bodegas Initiative,” 1-3.
administers the HBI, is a valuable suring Food Deserts in New 9. “Healthy Bodegas Initiative,” 11
source of further information and York City’s Low-Income Neigh- 10. “Healthy Bodegas Initiative,” 13.
a potential coalition partner. Sim- borhoods,” Health & Place, 11. “Healthy Bodegas Initiative,” 18.
ilarly, as any rebate (if authorized) Geographies of Care, 17, no. 12. “Healthy Bodegas Initiative,” 4.
would be coordinated in conjunc- 2 (March 1, 2011): 696–700, 13. “Healthy Bodegas Initiative,” 8.
tion with SBS, this department https://doi.org/10.1016/j.health- 14. “Healthy Bodegas Initiative,” 8.
could provide greater detail on place.2010.12.012, 699. 15. Rachel Dannefer et al., “Healthy
the institution of a tax rebate for 2. “Food Retail Expansion to Bodegas: Increasing and Promoting
bodegas. Support Health (FRESH) Program Healthy Foods at Corner Stores in
- NYC Business,” Official Website New York City,” American Journal of
As Columbia University is located of the City of New York, NYC Public Health; Washington 102, no.
in Harlem, students have direct Business, accessed November 20, 10 (October 2012): 27–31, 27, 29.
involvement in improving and 2018, https://www1.nyc.gov/ny- 16. “Healthy Bodegas Initiative,” 14.
advocating for the Harlem com- cbusiness/description/food-retail-
19
20
Roosevelt Review

Education
This year, the Education Center partnered with the Economic Development Center to
undertake a year-long campaign to establish an Advisory Committee on Socially Re-
sponsible Investing (ACSRI) at Barnard College. Propelled by the belief that an ACSRI
would promote transparency and accountability in the management of Barnard’s en-
dowment, members of the Education Center collected hundreds of student signatures,
met with Barnard administrators, and presented before the Representative Council of
the Barnard Student Government Association (SGA). The Center secured a meeting
with the Barnard Board of Trustees and continues to build momentum towards the
establishment of the committee.

While this year’s initiative centered mainly around the financialization of higher educa-
tion, the policies contained in this year’s journal tackle a wide range of education policy
issues. The Education Center Director wrote about universal access to childcare, and
others tackled issues like medical and family leave from higher education.

-- Carolyn Kelly, Center Director

21
Recess: More Then Just Fun
By Emma Cloyd

Introduction recess a day which former Gover- impact on students ability to main-
Despite the fact that recess is nor Chris Christie said “That was tain relationships. Furthermore, a
known to bring extensive benefits a stupid bill and I vetoed it.” [4] lack of unstructured time in school
to elementary school students, New Having a system where such behav- further contributes to cliquey and
York City has not adopted a policy iors towards finding 20 minutes for exclusionary behaviors because
aligned with the students best inter- children to have command of their children will be less likely to try to
ests. A blind eye has been turned to own minds and bodies is hindering make new friends because they just
the physical and mental health of us in our efforts to become a first aren’t given the time.
children in an effort to drive up test class education system. Mandating
scores and academic achievement. 60 minutes of recess a day for all There is also research that indicates
While the New York City Wellness elementary school students in New having time for recess and play
Code acknowledges that students York City will set a precedent for improves children’s behavior in the
should be receiving 60 minutes the country, showing that the city classroom. [7] A study found that
of physical activity a day, it lacks cares by putting the students and even a meager 15 minutes of recess
a specific plan for children to get academic research first. a day significantly improved the
this and only encourages schools to way teachers scored eight and nine
have 20 minutes of recess on most Providing children with unstruc- year olds behaviors. [8] Another
days. [1] tured time during their school day study compared what happened
also provides them with an oppor- to second through fourth graders
Background tunity to develop their social skills. on days where they had recess and
There are multiple things that As a woman who grew up in the days that they did not, and found
created a society where children Chicago Public School system said, that their behavior was markedly
can no longer play and be creative recess taught her how to get along improved by having recess. [9] Of
and are forced to standardize their with people from different back- the students observed, including
minds for performance based edu- grounds and without it everyone four with ADD, all of them worked
cation and tests. Since 2001, it has just pairs off into their groups. [5] more and/or were less fidgety on
been found that 62% of elemen- A Position Paper of the Council on days where they had the ability to
tary schools increased the amount Physical Education for Children play outside. While critics could
of time students learned language And The National Association for argue that adding recess is only
arts and math while 20% of them Sport and Physical Education advo- necessary for those who have “too
cut down on the time children cated for increased recess time that much energy” or are “a bit more
are given for recess. [2] Currently, is distinctly separate from physical rambunctious” the externality
recess is seen as an afterthought education to allow children to have negative behavior can cause im-
rather than something essential to time to hone their interpersonal pacts all students. It doesn’t matter
children’s development. In 2017, skills, including conflict resolu- how much time our kids spend in
several states passed laws man- tion, cooperation, and respecting the classroom if it is not produc-
dating that children be given 20 rules. [6] When children spend tive learning time, so the trade off
minutes of recess a day, which is a their entire day sitting in a class- between additional recess for the
meager amount considering many room, rather than conversing and slight shortening of classes seems
are in school from around 8:30am interacting with their peers, they like a logical choice to make.
to 3:00pm and at times it was faced lose their ability to foster connec-
with resistance. [3] The New Jersey tions. Failing to understand other Above all else, school is for students
state legislature passed a bill that people and how to converse and to hone their academic ability and
would have required all students work through potential conflict at school policies must be designed
to receive at least 20 minutes of a young age could have long term with that in mind. There is a direct

22
Roosevelt Review
correlation between sitting still for have two a day. Grades could be Research Says.” Time. October 23,
long reading of times and poorer combined, for example first and 2017. http://time.com/4982061/
reading and math skills, especial- second graders, to facilitate in- recess-benefits-research-debate/.
ly in young boys. [10] This study creased relationships across class- 4. Ibid.
looked at the heart rates of chil- es and better develop children’s 5. “Recess Makes Kids Smarter.”
dren and found that a lower level essential social skills. By having two Scholastic. https://www.scholastic.
of physical activity and higher half hour breaks in the day, rather com/teachers/articles/teach-
proportions of time spent sitting than one long one, students will ing-content/recess-makes-kids-
at desks were both associated with be given multiple times to decom- smarter/.
poorer skills, especially when the press. Being in elementary school is 6. “RECESS IN ELEMENTARY
two were combined. [11] A 2010 stressful and having the opportunity SCHOOLS: A Position Paper of
report by the Center for Disease to breathe and unwind is essen- the Council on Physical Education
Control found close ties between tial for students mental wellbeing. for Children And The National
recess and academic performance Additionally, having two shifts Association for Sport and Physical
and deemed they were closely tied could allow for play time in both Education.” Nh.gov. https://www.
several policy implications. [12] the morning and the afternoon to nh.gov/gcpah/documents/recess-
The most significant was that they give the effect of making the day go inelemschool.pdf.
found an overwhelming correla- faster. 7. Barros, Romina, Ellen Silver,
tion between physical activity and and Ruth Stein. “School Recess
increased academic achievement, Next Steps and Group Classroom Behavior.”
including better grades and higher As New York City’s schools are un- Pediatrics 23, no. 2 (February
test scores and that increasing the der mayoral control, not the State 2009): 431-36.
amount of time schools give stu- Legislature’s, the Commissioner of 8. Ibid.
dents for recess directly helps their Education could make the decision 9. Jarrett, Olga S., Darlene M.
performance. [13] As the nation’s to implement a 60 minute recess Maxwell, Carrie Dickerson, Pame-
primary health protection agency, with limited external factors. To la Hoge, Gwen Davies, and Amy
the CDC would not publish this ensure durability of the policy, it Yetley. “Impact of Recess on Class-
report if they did not genuinely is essential that multiple important room Behavior: Group Effects and
believe it was important for schools stakeholders, including the may- Individual Differences.” The Jour-
to be taking such actions. They or, city government officials, key nal of Educational Research92, no.
explicitly encouraged school lead- NGOs, and teachers unions are on 2 (1998): 121-26.
ers to provide greater recess time board with the shift in school day 10. Luscombe, Belinda. “Boys
for students as it does not have any schedule. Who Sit Still Have a Harder
negative side effects. [14] Time Learning to Read.” Time.
References December 02, 2016. http://
Recommended Action 1. “New York City Depart- time.com/4588035/sitting-exer-
The New York City DOE should ment of Education Wellness cise-reading/.
make their students’ best interests Policy.” https://cdn-blob-prd. 11. Ibid.
the priority in setting the curricu- azureedge.net/prd-pws/docs/de- 12. Ibid.
lum and mandating that all schools fault-source/default-document-li- 13. “The Association Between
have 60 minutes of recess a day. brary/2017-wellness-policy-english. School-Based Physical Activity,
An initial concern may be that the pdf ?sfvrsn=cbc47378_40. Including Physical Education, and
infrastructure to have hundreds of 2. “NCLB Year 5: Choices, Chang- Academic Performance.” Center
children playing at once may not es, and Challenges: Curriculum for Disease Control. 2010
exist, however that can easily be and Instruction in the NCLB Era.” 14. Ibid.
mitigated by staggering the recess The Center on Education Policy.
so different students are outside https://www.cep-dc.org//display-
or in the gymnasium at different Document.cfm?DocumentID=312.
points in time for half an hour 3. Reilly, Katie. “Is Recess Im-
long shifts; each student would portant for Kids? Here’s What the
23
Federally Funded, Locally Distributed Fully
Universal Pre-K
By Carolyn Kelly
Introduction choices about what to do with their systems, Oklahoma provides 90%
The cost of childcare in the United children while they are at work. of its preschool through public
States is rapidly rising, particular- Children are deprived of quality schools. Oklahoma’s program costs
ly for children with special needs care and time to learn and grow. less and enrolls more students. In
who require home and community Parents are spending $5,000 to addition, Oklahoma has strict stan-
based services (HCBS) like speech $15,000 -- sometimes up to 40% of dards for preschool teachers, pay-
therapy. Caring for any child is their income -- on care. ing them the same as other K-12
an expensive and lengthy process, Right now, children with special teachers and requiring certification
and this is only exacerbated by needs are isolated from other to teach. Schools in Oklahoma can
lack of access to affordable quality children and unable to learn in and also partner with existing Head
childcare. Caring for children with adapt to a classroom environment. Start Programs, private centers,
special needs can be a significant This hurts the social and emotional and churhes to provide care, giving
financial strain, often amounting to learning skills of children with spe- more options to parents. Oklaho-
30-40% of a single parent income. cial needs, and the learning skills of ma has shown that preschool gives
Parents of children with special their peers without special needs. kids a leg up in school and in life,
needs often need to quit their job Exposure on both sides is key to en- teaching essential skills like problem
or work nights to make ends meet. suring children with special needs solving and working with others.
Children need to be cared for, live happy and healthy lives.
particularly the most vulnerable Children with special needs are fed-
children among us. The United Recommended Action erally mandated to receive HCBS
States should pass a universal The United States should imple- from the age of three, with federal
childcare program by expanding ment a federally funded, locally dis- and state funds matching local ex-
public K-12 education to three tributed universal pre-K program penditures. It has been shown that
and four year olds, including those which expands access to pre-K receiving these in schools with oth-
with special needs. This should through existing public-school er peers helps students. By having
be accomplished by emphasizing systems. This will provide a cost ef- preschool integrated into the fold
the educational benefits of early ficient solution for parents, quality of existing school systems, children
childhood education and providing care for children, and an appropri- with special needs have access to
preschool through already existing ate place for children with special better trained staff and more re-
public school systems. needs to receive HCBS. sources that would not be provided
in a private care center.
Background Georgia, Oklahoma and Florida
Currently, wage growth is not all offer universal pre-K to four- Next Steps
keeping up with the rising cost year-old children. Georgia provides Traditionally, universal pre-K has
of childcare. In more and more vouchers for students to seek care. been seen as a pet project of Dem-
families, both parents work and Georgia spends $341 million a ocrats, but the states with the most
thus require childcare of some sort, year on its preschool program and robust and long-standing programs
but it is expensive and difficult to 55% of four-year olds are enrolled. are all conservative states. Oklaho-
find quality child care that meets Oklahoma spends $167 million a ma, Florida, Georgia, West Virgin-
this need. In addition, children year on its program and has 71% ia, Iowa, and Wisconsin all have
with special needs require access of four-year olds enrolled. Unlike largely expanded pre-K programs
to HCBS. Right now, families all Georgia, which provides 20% of enrolling over 50% of four-year
over the country are making tough preschool through public school olds. Each state achieved this by fo-

24
Roosevelt Review
cusing on on expanding education States-Fund-Pre-K_A-Primer-for-
and the benefits reaped by children Policymakers.pdf.
who attend preschool. By tying
universal pre-K into existing public United States, Department of
schools and their budgets, universal Education. “A Matter of Equity:
pre-K can be passed on a federal Preschool in America.” April, 2015
level. The federal government has
already taken on an expanded role
in education with the passage of
No Child Left Behind and other
programs, and a bipartisan univer-
sal pre-K program even passed the
house and the senate in the 1970s
only to be vetoed by President
Nixon. By advocating for universal
pre-K through education, parents
and children, including those with
special needs, can bring about a
solution to the current crisis of
rising childcare costs. “The United States should implement a
References
federally funded, locally distributed univer-
Bassok, Daphna, and Luke Miller. sal pre-K program which expands access
Florida’s Voluntary Pre-Kindergar-
ten Program: An Overview of the
to pre-K through existing public-school
Largest State Pre-School Program systems. This will provide a cost efficient
in the Nation. ED Policy Works,
2014, Florida’s Voluntary Pre-Kin-
solution for parents, quality care for chil-
dergarten Program: An Overview dren, and an appropriate place for children
of the Largest State Pre-School
Program in the Nation.
with special needs to receive HCBS.”
Bassok, Daphna. “Does State
Preschool Crowd-out Private Pro-
vision? The Impact of Universal
Preschool on the Childcare Sector
in Oklahoma and Georgia.” Jour-
nal of Urban Economics , 2013.
Khimm, Susan. “Is Oklahoma the
Best Model for Universal Pre-K?”
Washington Post. Feburary, 14,
2013.

Parker, Emily, et al. How States


Fund Pre-K A PRIMER FOR
POLICYMAKERS. Education
Commission of States, 2018, How
States Fund Pre-K A PRIMER
FOR POLICYMAKERS, www.
ecs.org/wp-content/uploads/How-
25
Providing Better Support for Columbia College &
Engineering Students:
Guaranteed Housing and Taking a Leave of
Absence
By Shirley Tan
Introduction Background Limiting their experiences might
Universities are founded on philos- Currently, CC and SEAS’s vol- disadvantage them compared to
ophies of learning and growth. As untary leave of absence policy their peers upon graduation Two,
such, university administrations does not offer students guaranteed if a student needs to take a leave
should be expected to continuous- housing upon their return [3]. The of absence for familial circum-
ly support students in achieving current policy, last updated in 2015, stances, having to worry about
these goals inside and outside the places students at the bottom of finding housing upon their return
classroom. If universities want the waiting list for housing, making is an unnecessary stressor which
successful students, they ought to it necessary to look for off-campus would add to an already taxing
support students’ mental health in lodging. The average price of an situation. Three, the current policy
addition to their academic pursuits one-bedroom apartment in Man- discourages students from taking a
[1]. Many students are best served hattan is $3,100 while a studio leave of absence for mental health
by temporarily taking time off averages at $2,550 a month [4]. purposes. This is cause for concern
from school, whether for job op- Columbia Housing offers lodging because anxiety and depression
portunities, family circumstances, at under $1,000 a month [5]. As rates amongst college students have
a desire to travel, or mental health such, students who take a leave of consistently risen over the past two
purposes. Jointly, Columbia College absence can expect to pay more decades [7]. Columbia is not im-
(CC) and Columbia’s School of than double what they would for mune to this phenomenon, in fact
Engineering and Applied Sciences on-campus housing. For many it is renowned for “stress culture.”
(SEAS) offer students the option to lower-income students who depend Particularly for low-income and/or
take a voluntary leave of absence, on financial aid to meet their needs, first-generation students, adjusting
but their return policies, including this is a serious burden. The diffi- to an elite college can be a daunt-
the revocation of guaranteed hous- culty of finding off-campus hous- ing challenge which may inspire
ing [2], discourage students from ing is worsened by the mounting feelings of anxiety or depression.
taking necessary leaves of absence housing crisis in New York City, as Sometimes, a semester off can
and are discriminatory. Particular- landlords exploit a broken system relieve these feelings and leave
ly for lower-income students, the to diminish affordable housing [6]. students better prepared upon their
additional financial and emotional NYC’s housing crisis coupled with return. Yet, the financial burden
stress of looking for off-campus Columbia’s non-guaranteed hous- of non-guaranteed housing would
housing in New York City upon ing policy effectively limits leaves exclude the very ones who may
their return will be difficult. If CC of absence to students who have need it most from taking a leave of
and SEAS are dedicated to the the financial means. Disincentiv- absence.
wellness and growth of all students, izing students of disadvantaged
they need to ease the leave of backgrounds from taking a leave Recommended Action
absence return process by stream- of absence harms them in three Given the potential benefits of
lining procedures and guaranteeing particular ways, reinforcing a cycle taking a semester off through a
housing for students who choose to of inequality.. One, it prevents voluntary leave of absence, it is
take time off. students from taking opportunities crucial that the process of doing so
that could foster personal growth, be made as accessible as possible,
such as a job or travel opportunity. with as much support from the uni-
26
Roosevelt Review
versity’s administration as possible. mester. The space for each student tember 30, 2015.
Policies which deter students from was available upon their admission 3. Ibid.
4. Quintana, Mariela. “Average Rent
considering the option ought to be to the university, when they were NYC: Here’s What You’ll Pay in Rent
reconsidered and altered. first guaranteed housing. If Co- | Naked Apartments.” Ground Floor.
First and foremost, CC and SEAS lumbia is committed to the growth September 26, 2018. https://www.
should guarantee students who and advancement of its students, nakedapartments.com/blog/average-rent-
take a voluntary leave of absence it ought to follow in the footsteps al-prices-nyc/.
5. “Rate Structure.” Columbia Housing.
housing upon their return. Upon of Harvard in regards to leaves of https://housing.columbia.edu/hous-
admission to the colleges, students absence by creating easier processes ing-options/residences/rate-structure.
are guaranteed housing for eight and guaranteeing housing. 6. Barker, Kim. “Behind New York’s
semesters, and they typically only Housing Crisis: Weakened Laws and
lose housing as punishment—rang- Next Steps Fragmented Regulation.” The New York
Times. May 20, 2018. https://www.
ing from disciplinary procedures to Columbia University is renowned nytimes.com/interactive/2018/05/20/
a failure to meet deadlines [8]. By for its brilliant faculty and students. nyregion/affordable-housing-nyc.html.
stripping students of guaranteed Its administration ought to do all 7. Boncy, Alexis. “Under Pressure.” Co-
housing after a leave of absence, it can to continue nurturing this lumbia College Today. January 25, 2018.
then, suggests that they are violat- talent and ensuring students are https://www.college.columbia.edu/cct/
issue/winter17/article/under-pressure.
ing school policy rather than taking able to perform at their best. This 8. “Assignment Policies.” Columbia
initiative to practice a potentially means relaxing voluntary leave of Housing. https://housing.columbia.edu/
beneficial behavior. absence policies and guaranteeing room-selection/tips-and-tools/assign-
Revoking guaranteed housing housing for students upon their ment-policies.
after a voluntary leave of absence return. While the policy change 9. Abrams, Abby, Sariel Friedman, Jenna
Beers, and Tiffany Lee. “Absent, Alone,
certainly impacts student behavior. must be officially approved by the Apart.” The Eye.http://features.colum-
Each year at Columbia, around 5 administration officially, students biaspectator.com/eye/2015/03/04/ab-
to 20 students take time off across should also speak up about the sent-alone-apart/.
CC, SEAS, and the School of issue by establishing contacts with 10. “Leaves of Absence.” Harvard College
General Studies, which has its own Columbia Housing, Residential Handbook for Students. https://hand-
book.fas.harvard.edu/book/leaves-ab-
housing policies [9]. Meanwhile, Life, and Columbia Psychological sence#six.
Harvard, which has guaranteed Services to push for the change to 11. Narayanan, Menaka V. “Number of
housing after a voluntary leave of occur. By making these changes, Students on Leave of Absence Increases.”
absence [10] has over 200 stu- Columbia can make a statement to The Harvard Crimson. https://www.
dents take leaves of absence each students of their commitment to thecrimson.com/article/2016/5/4/
leaves-of-absence-increases/.
year—their administration strives bettering educational experiences 12. Schugart, Annie E., and Emma C.
to create a wide-open policy in on campus and an announcement Scornavacchi. “Putting Harvard on
order to allow students “to use to the greater public about the val- Hold.” The Harvard Crimson. https://
their eight semesters most effec- ue of self-care and self-exploration. www.thecrimson.com/article/2017/3/2/
tively” [11]. Many students who As a leading educational institution, putting-harvard-on-hold/.
took leaves of absence at Harvard Columbia has a responsibility to its
reported satisfaction with their students and to the public to pro-
decision, stating that it was a good mote such positive messages.
way to reevaluate, recenter and
gain new experiences [12]. While References
some might argue that Columbia’s 1. Hazard, Laurie. “Cultivating the
location in New York City makes Habits of Mind for Student Success and
Achievement.” Research and Teaching
space far more sparse than at in Developmental Education 29, no. 2
Harvard, guaranteeing housing to (2013): 45-48. http://www.jstor.org/sta-
a student returning after taking a ble/42802413.
semester off is not much different to 2. Columbia College and Engineering.
guaranteeing housing for students Voluntary Leave and Readmission Policies
& Procedures. PDF. New York, NY, Sep-
who have studied abroad for a se-
27
28
Roosevelt Review

Energy and the


Environment
In the 2018-2019 year, the Energy and Environment center continued to pursue its
carbon neutrality campaign at Columbia through a combination of research, petitions,
letter writing, events, and presentations. On Earth Day 2019, the University announced
its formal commitment to carbon neutrality. Yet the contents of this journal reach be-
yond campus decarbonization into the Texan electric grid, the sustainability and de-
militarization of government vehicles, and the improvement of conditions for animals
in factory farms. All seek to push the envelope on American environmental policy in
aspiring to a cleaner and more just collective future.


-- Arianna Menzelos, Center Director

29
Climate Change and the Grid: Addressing
Texas’ Utility Grid Vulnerabilities
By Ricardo Jaramillo

Introduction ities resulting from flooding and technologies


Climate change is a pressing and high temperatures.
urgent issue worldwide. The reali- Neither PUC nor ERCOT current-
ties of climate change in Texas are ly has a mandate to promote cli-
not being adequately addressed Background mate resiliency in Texas’ electrical
despite its vulnerability: rising Texas has a Deregulated Electricity grids. Given the expected impacts
sea levels will exacerbate coastal Market of climate change on Texas’ grid,
flooding, longer droughts will put the Texas legislature should man-
a heavier strain on Texas’ water Texas has two main regulatory bod- date that that PUC incorporate
resources, and higher temperatures ies that oversee its electricity mar- the effects of climate change on
will increase the frequency of wild- ket: the Public Utility Commission the grid in its regulatory frame-
fires and have adverse effects on of Texas (PUC); and the Electric work and promote investment in
cattle ranching and agriculture. [1] Reliability Council of Texas (ER- grid hardening technologies. This
According to the “Billion Dollar COT). Unlike other states, Texas means understanding the ways in
Weather and Climate Disasters” has a deregulated electricity market which temperature increases will
database run by the federal gov- which means that private retail affect energy consumption and also
ernment, Texas has already expe- electricity companies choose where making the grid more physically
rienced more expensive disaster they buy their power from and how resistant to natural weather effects.
events than any other state, with a to market it to consumers. [5] The The PUC was given a mandate to
total of almost 100 events inflicting main purpose of both the PUC “protect customers, foster compe-
more than $1 billion. [2] and the ERCOT is to promote tition, and promote high quality
The resiliency of Texas’ electric competition within the electricity infrastructure”. [9] And yet, a
grid is under-addressed. Hurricane market. Their focus on promoting search for “climate change” on the
Harvey showed a power grid woe- competition has resulted in con- PUC’s website only pulls up four
fully unequipped for the expected tentious debates about the actual results, the most recent of which is
increasing intensity of natural benefits for Texas consumers amid from 2011. The Texas Legislature
disasters. In the aftermath of the talk of dubious regulatory assess- should pass a law clarifying that
hurricane, 280,000 Texans were ments meant to promote expanded “promoting high quality infra-
left without power due to outages power generation. [6, 7] Many structure” includes a mandate to
caused by flooding and high winds, critics argue that the ‘deregulation’ prepare Texas’ infrastructure for
and utility companies were left of the Texas electricity market has the effects of climate change. Other
scrambling in an attempt to restore not resulted in more simple regula- regulatory entities and power utili-
power. [3] Moreover, storm related tions but rather an artificial market ties, for example in New York City,
damages to Texas are projected based on esoteric and obtuse rules have already begun to incorpo-
to increase by $650 million a year determining the price point of rate climate change predictions in
due to climate change, resulting in electricity. [8] planning for the future stability of
a total annual cost of $3.9 billion. the power grid. [10] Requiring the
[4] In response, many worried PUC to consider climate change is
about climate change have pointed Recommended Action the first step on the road to a broad
to grid hardening – the process of Require that the Public Utility scale ‘grid-hardening effort’ that
improving the physical readiness of Commission of Texas consider the would include refitting transmission
the electrical grid – as policy which effects of climate change and pro- lines to go underground, investing
could mitigate climate vulnerabil- mote investment in grid hardening in physical flood protection infra-

30
Roosevelt Review
structure around power generation climate-change-may-bring-texas- legal-planet.org/2018/03/26/
plants, and investing in storm pre- longer-droughts-heavy-rains-120- the-paradox-of-electricity-deregu-
paredness training. temps-august-within-25-years. lation/.
3. DiChristopher, Tom. 2017. 9. “ About The PUCT - Mission
Next Steps “Texas Utilities Struggle To Re- & History “. 2018. Puc.Texas.
Building Political Support store Power As Harvey Hampers Gov. Accessed November 26 2018.
Progress”. CNBC. Accessed No- http://www.puc.texas.gov/agency/
In the 2018 midterms, Democrats vember 26 2018. https://www. about/mission.aspx.
picked up two seats in the Texas cnbc.com/2017/08/28/tex- 10. Columbia Law School Sabin
State Senate and 12 seats in the as-utilities-struggle-to-restore-pow- Center for Climate Change Law.
Texas House. [11] Although Re- er-as-harvey-hampers-progress. 2017. “In Florida And Texas,
publicans still have control over all html. Keeping The Lights On Means
three branches of the government, 4. Texas Tribune. 2015. “Texas Planning For Climate Change”.
these recent gains might create op- Facing Major Climate Change Im- State Of The Planet. Accessed
portunities for compromise. While pacts, According To New Study”. November 26 2018. https://blogs.
the oil lobby is in Texas is strong The Texas Tribune. Accessed ei.columbia.edu/2017/09/15/
and historically opposed to climate November 26 2018. https://www. in-florida-and-texas-keeping-the-
change policies, their energy trans- texastribune.org/2015/07/28/ lights-on-means-planning-for-cli-
mission lines also rely upon a safe study-climate-change-big-threat- mate-change/.
and secure grid. While the phrase texas/. 11. “Texas 2018 Mid-Term Elec-
‘climate change’ will be controver- 5. Baddour, Dylan. 2016. “Texas’ tion Round-Up: Texas House,
sial, many groups in Texas, par- Deregulated Electricity Market, Senate & More - Texas Coalition
ticularly business advocacy orga- Explained”. Houstonchronicle. For Affordable Power”. 2018. Texas
nizations (such as the Advanced Com. Accessed November 26 Coalition For Affordable Power.
Power Alliance), support renewable 2018. https://www.houstonchron- Accessed November 26 2018.
energy and energy efficiency poli- icle.com/local/explainer/article/ https://tcaptx.com/press-releases/
cies because they result in cheaper texas-electric-deregulation-ER- blog-texas-election-round-up.
power. Climate activists and con- COT-TCAP-7971360.php.
sumer-advocate groups should 6. Sixel, L.M. 2018. “Trying To
build a coalition to make this policy Hold Electricity Deregulation To
a part of the conversation during Its Promise”. Houstonchronicle.
the next legislative session. Com. Accessed November 26 2018.
https://www.houstonchronicle.
References com/business/energy/article/
1. Environmental Protection Agen- Trying-to-hold-electricity-deregula-
cy. August 2016. “What Climate tion-to-its-13016922.php.
Change Means for Texas”. EPA. 7. Blum, Jordan. 2016. “Power
Gov. Accessed November 26, 2018. Company Sues Grid Operator
https://www.epa.gov/sites/pro- Over Demand, Supply Projec-
duction/files/2016-09/documents/ tions”. Houstonchronicle.Com.
climate-change-tx.pdf Accessed November 26 2018.
2. “Climate Change To Bring https://www.houstonchronicle.
North Texas Longer Droughts, com/business/energy/article/
Heavy Rains, 120-Degree Power-company-sues-grid-op-
Temps Within 25 Years | Cli- erator-over-demand-7122935.
mate Change | Dallas News”. php?t=17b2015ab8.
2018. Dallasnews.Com. Accessed 8. Dan Farber et al. 2018. “The
November 26 2018. https:// Paradox Of Electricity Deregu-
www.dallasnews.com/news/cli- lation”. Legal Planet. Accessed
mate-change-1/2018/10/12/ November 26 2018. http://
31
Decarbonize to Demilitarize Local Law
Enforcement Agencies
By Morgan Margulies

Introduction violence in black communities [1]. Fremont, California shows that


For years, the United States Federal Three, the militarization of police buying electric police vehicles can
Government has given inactive mil- vehicles has increased greenhouse be environmentally beneficial and
itary-grade vehicles and weapons gas emissions within municipali- economically feasible.Fremont’s
reserved for warfare to local law en- ties. MRAP vehicles average about current fleet produces 980 metric
forcement agencies free of charge. 3 miles per gallon (MPG) while tons of CO2 a year, and an entirely
This militarization of local law armored trucks average 5 mpg [3]. electric fleet will reduce emissions
enforcement agencies has failed to Additionally, MRAP vehicles are by 10% throughout the entire mu-
reduce crime, increased the use of exempt from diesel engine emis- nicipality [5]. Additionally, normal
force, and damaged local commu- sion standard requirements meant police cars can be retrofitted to run
nities [1]. Additionally, the military to protect local air quality [4]. In on fuels like propane and natural
vehicles are unregulated emitters general, police vehicles often emit gas which are better for the envi-
that release massive amounts of a lot of carbon due to high rates of ronment. These alternative fuels
greenhouse gasses into the atmo- idling and gasoline demand. still emit CO2 but at much lower
sphere. While the movement to rates than regular gasoline. Burn-
demilitarize local police agencies is Recommended Action ing these alternative fuels would
mostly based in community safety, Policy to address militarization of also reduce tailpipe emissions by
the problem of militarized police local law enforcement agencies 20-30%, saving up to $1 per gallon
vehicles intersects with the decar- must take environmental justice [6]. This approach is a positive first
bonization movement. A multifac- into account. Only federal action step towards the demilitarization
eted approach is the best way to is capable of halting militariza- of police forces, which has caused
challenge this problem. tion across all municipalities, since many local problems, and a mas-
military vehicles are property of sive investment in transportation
Background the federal government. Congress decarbonization that is feasible
Since 2006, the federal government could tackle this through a double nationwide.
has distributed 865 mine-resistant pronged policy. First, a mandatory
ambush protected (MRAP) vehicles buyback initiative where munici- Conclusion
and 335 armored trucks to local palities and police departments can Only broad uniform action by the
law enforcement agencies[2]. The exchange local military vehicles federal government can reverse
militarization of police forces has for federal categorical grants could the trend towards militarization
proven detrimental to local com- remove military vehicles from local and carbonization of local law
munities for three reasons: One, a communities. Second, the categor- enforcement agencies. Right now,
recent study from the Proceedings ical grant should be used to buy the number of militarized police
of the National Academies of Sci- electric police cars and other low departments is only increasing,
ence reports that police militariza- carbon alternatives. demonstrating that certain politi-
tion fails to reduce crime rates and cal groups support militarization.
increases tension amongst the com- Removing military grade vehicles . However the current approach
munity [1]. Two, police forces dis- from the control of local police has proven ineffective, detrimental,
proportionately militarize in black agencies along with increased and a threat to local air quality
communities, and militarization investments in decarbonization and global climate change. This
increases the likelihood that police initiatives would dramatically approach can be changed: local de-
will use force, so militarization decrease local police greenhouse militarization and decarbonization
contributes to problems with police gas emissions. A pilot program in can be enacted by changing the

32
Roosevelt Review
way the federal government invests buffalo-grove/community/chi-ugc-
in local law enforcement. article-police-agencies-can-save-fu-
el-reduce-emissio-2015-04-16-story.
References html.
1. Mummolo, Jonathan. “Mili- 7. Garrett, Jerry. “A Green, Mean
tarization Fails to Enhance Police Fighting Machine? Well, It’s Defi-
Safety or Reduce Crime but May nitely Mean...” The New York
Harm Police Reputation.” PNAS, Times, The New York Times, 7
National Academy of Sciences, 11 Nov. 2008, wheels.blogs.nytimes.
Sept. 2018, www.pnas.org/con- com/2008/11/07/a-green-mean-
tent/115/37/9181. fighting-machine-well-its-definitely-
2. Andrzejewski, Adam. “Track- mean/.
ing Military Weaponry and War
Machines Flowing to Ameri-
ca’s Local Police Departments.”
Forbes, Forbes Magazine, 1 Sept. “Removing military
2017, www.forbes.com/sites/ad-
amandrzejewski/2017/08/31/
grade vehicles from the
tracking-military-weapon-
ry-and-war-machines-flow-
control of local police
ing-to-americas-local-police-depart- agencies along with
ments/#3e827fbd2b63.
3. Prospective Technology In- increased investments
corporated. Army Programmatic
Environmental Assessment of the in decarbonization
Mine Resistant Ambush Protected
(MRAP) Vehicle Program. Dec. initiatives would dra-
2010, apps.dtic.mil/dtic/tr/full-
text/u2/a578517.pdf.
matically decrease
4. Gansler, Jaques. ACQUISI-
TION OF MINE ACQUISITION
local police greenhouse
OF MINE -RESISTANT, RESIS- gas emissions”.
TANT, AMBUSH -PROTECTED
(MRAP) VEHICLES: PROTECT-
ED (MRAP) VEHICLES: A CASE
STUDY . University of Maryland,
May 2010, apps.dtic.mil/dtic/tr/
fulltext/u2/a529404.pdf.
5. Plautz, Jason. “Fremont, CA
Pilots Electric Police Vehicle to
Reduce Emissions.” Smart Cities
Dive, 28 Jan. 2019, www.smartci-
tiesdive.com/news/fremont-ca-pi-
lots-electric-police-vehicle-to-re-
duce-emissions/546915/.
6. Koenig, Joe. “Police Agencies
Can Save Fuel, Reduce Emissions,
Save Money by ‘Going Green’.”
Chicagotribune.com, 16 Apr. 2015,
www.chicagotribune.com/suburbs/
33
Give Them Some Space: Banning the
Intense Confinement of Animals in American
Food Production
By Arianna Menzelos
Introduction verely that they cannot turn around and ban by 2030 of intensive con-
Most Americans are unaware that while in confinement.[8] These finement of farm animals in CA-
no federal regulations protect ani- practices include mother pigs in FOs.[11] In modeling the successful
mals in agriculture practices. [1] In gestation crates, veal calves torn policy precedent established by CA
the United States, over 95% of ani- from mothers, and egg-laying hens Proposition 12, the most ambitious
mals raised for the purpose of agri- confined in battery cages, which are farm animal protections legislation
culture are reared in factory farms. unitary crates meant to maximize in the United States to date, this
[2] Factory farms are also called egg production on factory farms. policy proposal would entirely ban
concentrated animal feeding oper- the sale and production of:
ations (CAFOs), of which there are CAFOs have many negative ef- • Eggs (shell and liquid) produced
20,000 in the United States alone. fects beyond their harm to animal by hens (including turkey, chick-
[3,4] This is a global problem as welfare. The stress of animals in en, goose, duck, or guinea fowl)
well; worldwide, 42% of eggs, 55% CAFOs can increase susceptibility that are not in cage-free laying
of pork, and 72% of poultry come to disease. [9] Collectively, the agri- facilities ( United Egg Produc-
from CAFOs. [5] These institutions culture system in the United States ers’ 2017 cage-free guidelines).
maximize output at the cost of alone daily administers antibiotics • Veal meat (whole) taken from a
health, safety, and animal well-be- to farm animals, amounting to 20 calf confined to a usable floor
ing. They employ rearing practices million pounds of drugs–or 80% space of less than forty-three
that use gestation crates and bat- of all antibiotics sold in the United square feet.
tery cages, which damage animal States–in 2014. [10] This trend has • Pork meat (whole) that was
welfare. [6] In order to carry out led to antibiotic-resistant bacte- born from a breeding pig
their basic functions, animals must ria contaminating water sources, confined to a usable floor space
be able to engage in social behav- causing cancer, foodborne illness, of less than twenty-four square
ior and have enough space to turn and leading to infections that cause feet.
around. For example, pigs that do about 23,000 deaths per year.[11, The United States Food and Drug
not have enough space to give birth 12, 13] Additionally, since CAFOs Administration would be responsi-
sometimes crush their piglets in do not allow for the natural fer- ble for implementation and en-
their pens. [7] These close confines tilization of pastures, solid waste forcement. A violation of this law
also have serious implications on produced in animal-rearing pol- would be a federal misdemeanor
human health and safety, both for lutes the air and the water. CAFOs (as well as state, in the cases of
those who consume the product have other societal repercussions existing state animal confinement
and for those who experience the as well, including the depression laws), warranting an $1,000 fine
externality of CAFO pollution. of property values, the threatening per animal violated. The revenue
The basic rights of the animals as of small businesses and farms, and generated from these fines would
well as legitimate safety concerns a lowered quality of life in rural then be directed to subsidies spe-
necessitate that farm animals must areas.[14] cifically established for members
be granted more room in which to of the clean meat and plant-based
be reared. Recommended Action meat industries.
Following the recommendation of
Background the Pew Commission on Industrial Twelve individual states have im-
Common CAFO practices restrict Farm Animal Production in 2009, plemented similar policies.[12] In
the movement of animals so se- there should be a federal phase out 2016, Massachusetts passed a ballot
34
Roosevelt Review
measure that banned gestation chase these vegan substitutes, which farms.[22] Through public aware-
crate, battery cage, and veal crate do not contribute to animal rights ness campaigns, these sources of
use as well as the sale of animal violations, which have lower green- opposition can be overcome by the
products produced using these house gas emissions, and which use popular vote.
mechanisms.[13] In 2018, Califor- less water, energy, and land. [18]
nia passed Proposition 12, which References
strengthened cage-free require- Conclusion 1. Pew Charitable Trusts, and Johns
ments for laying hens, veal calves, This policy will have the greatest Hopkins Bloomberg School of Public
and mother pigs, and banned the chance for legislative success if it Health. Putting Meat on the Table:
sale of veal and pork reared in is sponsored by a reputable animal Industrial Farm Animal Production
in America. Accessed April 18, 2019.
cages. [14] rights organization such as the
http://www.pewtrusts.org/~/media/
Humane Society, which sponsored assets/2008/pcifap_exec-summary.
Opponents of this policy fall into California Proposition 12 in 2018. pdf.
two major camps: PETA opposed Through lobbying activities of this 2. “Farm Animals Need Our Help.”
Prop 12 in California due to their organization and public support ASPCA. Accessed April 18, 2019.
belief that such a bill enables an in- from the League of Conservation https://www.aspca.org/animal-cruel-
herently flawed animal agriculture Voters, an organization that en- ty/farm-animal-welfare.
system and does not go far enough dorses environmentally-friendly 3. USDA. “Animal Feeding Opera-
in protecting animal rights. Other candidates and legislation, this tions.” Natural Resources Conserva-
opponents, such as the Association policy could gain the attention of tion Service. Accessed April 18, 2019.
of California Egg Farmers, argued a national Congressperson, who https://www.nrcs.usda.gov/wps/
portal/nrcs/main/national/plantsani-
that food prices would rise. [15] would then co-sponsor a bill to pass
mals/livestock/afo/.
As individual states adopt higher nationwide. 4. Lehner, Peter, and Nathan A. Ros-
standards, CAFOs that do not berg. “Legal Pathways to Carbon-Neu-
adhere to them will be left out of No current legislation in Congress tral Agriculture.” Env. L. Rep. 47, no.
major markets within the country. addresses these goals directly. The 10845 (2017).
[16] For example, California is the 2008 CAFO rule addresses dis- 5. Wasley, Andrew, Malden Davies,
fourth-largest beef-producing state charge from CAFOs specifically. David Child, and Fiona Harvey. “Rise
in the United States as well as a [19] Considering the recent success of Mega Farms: How the U.S. Model
major meat market. of Proposition 12 in California as of Intensive Farming Is Invading the
While the transition to less severe well as the bipartisan nature of World.” The Guardian. Last modi-
confinement practices will be costly, animal protection issues in Con- fied July 18, 2017. Accessed April 18,
2019. https://www.theguardian.com/
amounting to billions of dollars for gress, this bill would have a high
environment/2017/jul/18/rise-of-me-
the cage-free egg market alone, the likelihood of passing.[20] Addition- ga-farms-how-the-us-model-of-inten-
negative externalities of current ally, both red and blue states have sive-farming-is-invading-the-world.
farming practices conceal hidden passed farm animal confinement 6. Pew Charitable Trusts, and Johns
costs that manifest in costs for legislation, including California, Hopkins Bloomberg School of Public
health or safety. [17] Though price Massachusetts, Kentucky, and Health. Putting Meat on the Table:
increases will be reflected at the su- Ohio. Finally, the general public Industrial Farm Animal Production
permarket, the costs of antibiotics has expressed discomfort with the in America. Accessed April 18, 2019.
given to the animals will likely de- current animal agriculture system, http://www.pewtrusts.org/~/media/
crease, as will negative externalities with 49% supporting a full ban on assets/2008/pcifap_exec-summary.
to humans in areas such as public factory farming for animals.[21] pdf.
7. Gonchar, Michael. “Should Farm
health. Furthermore, the transition Opposition comes from a small yet
Animals Have More Legal Protec-
to more humane farming practices powerful portion of society and is tions?” The New York Times. Last
would improve the price compet- amplified by the strong agricultural modified February 18, 2018. Accessed
itiveness of clean and plant-based lobby, which pushes for Ag-Gag April 18, 2019. https://learning.blogs.
meat industries. The comparability laws, which legally conceal unjust nytimes.com/2015/02/18/should-
of prices (and of tastes) over time animal treatment through special farm-animals-have-more-legal-protec-
will incentivize consumers to pur- protections granted to factory tions/.
35
Redirecting RGGI: Increasing Energy
Efficiency in the Granite State
By Eric Scheuch
Introduction house Gas Initiative (RGGI), a ergy efficiency programs, in order
Although it has one of the lowest regional cap and trade program to should serve New Hampshire’s
unemployment rates in the coun- to reduce carbon emissions from economy, environment, and most
try, New Hampshire’s economy is power plants. The proceeds from vulnerable. The legislature should
plagued by two serious, long-term RGGI’s auctions are distributed increase the amount of money cur-
policy challenges related to en- among the states, which are then rently allocated to programs serv-
ergy and the environment: high free to spend the money as they ing low-income ratepayers from $1
energy costs and climate change. see fit. Currently, New Hampshire per ton to 35% of RGGI proceeds,
These challenges disproportion- spends $1 per ton auctioned on en- while dedicating any surplus reve-
ately affect the Granite Staters who ergy efficiency programs, then gives nue to help finance energy efficien-
can least afford to deal with them, the rest back to taxpayers through cy projects in needy municipalities
eating up the paychecks of low a rebate. Those energy efficiency and school districts. This change in
and middle-income residents while programs are incredibly popular -- the RGGI funding formula would
threatening the service and tourism 10,000 low-income households are help reduce the crippling energy
industries that provide for so many on the waiting list for a program bills faced by low-income ratepay-
of those same citizens. that serves about 100 per year. [2] ers and cash-strapped localities.
RGGI-funded energy efficiency
Background programs are beneficial in three This proposed policy change will
New Hampshire has some of the ways: they create jobs in construc- use an existing policy framework,
highest energy costs in the United tion and other industries, cut car- the RGGI rebate program, to tack-
States -- the average resident spent bon emissions, and reduce energy le high energy costs and climate
nearly $4,000 on energy in 2015, costs for low-income ratepayers. change, at the same time. This ap-
and many low-income Granite While a dollar spent on a ratepayer proach has a number of advantag-
Staters consistently spend more rebate saves that ratepayer a dollar es. Every year, millions of dollars
than a third of their income just on their energy bill, a dollar spent leave New Hampshire to buy fossil
to heat their homes and keep the on funding the existing energy fuels from out of state sources. By
lights on. [1] Energy costs vary efficiency programs administered cutting energy use, energy efficien-
across New Hampshire based on by New Hampshire’s government cy can keep those dollars in the
the energy efficiency of homes and provides energy savings of $4.70, state. Additionally, those hit hardest
schools, thus energy costs rarely making funding energy efficiency by high energy bills -- the low-in-
correlate to individual financial re- programs the most efficient way to come and elderly -- would be first
sources. For example, a Pittsburgh reduce energy prices. Those pro- in line to receive energy efficiency
who heats her home with heating grams are poised to support 1,200 funds under this policy. Meanwhile,
oil spends far more on heating than jobs and reduce emissions by 2.8 by increasing energy efficiency,
a young professional in Manchester million tons over the next three local governments and school
who lives in a modern apartment years. [3] The New Hampshire leg- districts will save taxpayer dollars.
with central heating. Likewise, old, islature and governor decide how Finally, increased energy efficiency
rural high schools which cannot to spend RGGI proceeds. helps mitigate the effects of climate
afford upgrades are far less energy change, which poses a grave threat
efficient than newer high schools. Recommended Action to our air quality and the health of
New Hampshire’s legislature should our mountains.
Since 2008, New Hampshire has repeal the RGGI rebate and redi-
participated in the Regional Green- recting the revenue to funding en- Conclusion

36
Roosevelt Review
Changes to the RGGI funding November 28, 2018. https://www.
formula must originate with the concordmonitor.com/Biparti-
legislature. A similar policy, HB san-compromise-needed-on-ener-
559, passed the State House last gy-efficiency-14759209.
year but was defeated by the State 3. Ropeik, Annie. “N.H. Senate
Senate. However, new Democratic Defeats Bill To Funnel RGGI
majorities in both houses make this Funds Into Energy Efficiency.”
policy passable during the current New Hampshire Public Radio.
legislative session. A new bill should April 26, 2018. Accessed No-
originate in the State Senate since vember 28, 2018. http://www.
that is the more contentious cham- nhpr.org/post/nh-senate-de-
ber, and Dan Feltes, who co-spon- feats-bill-funnel-rggi-funds-ener-
sored HB 559, is now the Senate gy-efficiency#stream/0.
Majority Leader. 4. NH General Court: “House
Ideally, any new bill to change Bill 559-FN”, NH General “New Hampshire has
the formula would consult with Court, March 06, 2018. Accessed
regional groups like the Conser- April 9, 2019.www.gencourt. some of the highest en-
vation Law Foundation and the
Acadia Center, which have already
state.nh.us/bill_status/billText.
aspx?sy=2018&txtFormat=htm-
ergy costs in the United
performed extensive research on
the topic. Input from Republican
l&v=HA2&id=476.
5. Sanders, Bob. “NH’s RGGI Deal
States -- the average
legislators and the Governor’s Of- Maintains State’s Energy Course.” resident spent near-
fice of Strategic Initiatives should New Hampshire Business Review.
be incorporated into the bill, since August 24, 2018. Accessed No- ly $4,000 on energy
right now the bill would need either
the Governor’s support or Republi-
vember 28, 2018. https://www.
nhbr.com/Sept-1-2017/NHs-RG-
in 2015, and many
can votes for a veto override. Given
that efficiency is a stated goal of
GI-deal-maintains-states-energy-
course/.
low-income Granite
the Governor’s energy strategy, Staters consistently
Republican cooperation is possible.
Though this might require com- spend more than a third
promises to the proposed funding
formula above, that would be a
of their income just to
small price to pay for immediate
action to deal with pressing energy
heat their homes and
and climate crises. keep the lights on.”
References
1. “NH 10 Year Energy Strategy.”
NH Office of Strategic Initiatives.
April 15, 2018. Accessed No-
vember 27, 2018. https://www.
nh.gov/osi/energy/programs/
documents/2018-10-year-state-en-
ergy-strategy.pdf.
2. Richardson, Herb, and Dan
Feltes. “Our Turn: Bipartisan
Compromise Needed on Energy
Efficiency.” Concord Monitor
Online. January 09, 2018. Accessed
37
38
Roosevelt Review

Foreign Policy
While foreign policy and international affairs topics never fail to attract attention and
debate, proposing policy on these issues presents many challenges. More holistically,
the Foreign Policy center focused on developing the ability to look at incredibly com-
plex issues of global proportions and discern tangible, focused policy outcomes that
identify actors in the position to make a difference. The nuance of foreign policy, as
seen in the piece in this section, makes it something incredibly difficult to discuss and
write about. However, the interconnectedness of our society makes it of the utmost
importance that we continue to have these discussions.

-- Meher Malik, Center Director

39
Reducing Maritime Transportation Pollution:
A Template For International Collaboration on
Sectoral Emissions Reduction?
By Connor Haseley

Introduction (soot) also contributes to climate vulnerable to the effects of climate


Maritime transportation industries change by decreasing the earth’s change, black carbon emissions,
currently emit some of the dirtiest reflectivity. and oil spills, yet heavy fuel oil
transportation fuels on the plan- constituted 75 percent of the mari-
et, contributing to pollution and The International Maritime Or- time transportation fuel used in the
anthropogenic climate change. ganization (IMO), a United Na- Arctic, by weight. [5]
Maritime emissions have steadily tions specialized agency in charge
grown faster than land-based emis- of regulating shipping, recently The IMO currently bans the use
sions. [1] International cooperation called for a 50 percent reduction in of heavy fuel oils in the Antarctic.
to end the use of the dirtiest fuels greenhouse gases from the shipping The IMO has the opportunity to
in Arctic maritime transportation sector by 2050. [3] This is a big issue regulations banning the use
operations is not just a feasible way commitment with the potential for of heavy fuels in the Arctic at the
of effecting serious change but tangible effects: Emissions from Pollution Prevention and Response
also can increase goodwill between maritime transportation consti- subcommittee meeting, scheduled
states and set an example for future tute 2.5% of global greenhouse to take place in 2020. The ban
international cooperation on other gas emissions and are estimated to would take effect in 2023. The
climate change issues. increase 50 to 250 percent by 2050 subcommittee will do so only if
under a business as usual scenario. there is unanimous support from
Background [4] Arctic member states. Right now,
Heavy fuel oil, also commonly the ban is supported by the United
called bunker fuel, emits upwards In order to achieve this goal, coun- States, Finland, Sweden, Norway,
of 95% more black carbon, sulfur, tries must work together to regulate Denmark, and Iceland. Russia and
nitrogen oxides, and other pol- maritime transportation emissions. Canada currently do not support
lutants compared with other fuel This regulation is politically and the ban, though neither has cate-
oils, as well as around 10% more practically feasible and thus rep- gorically refused withhold support
carbon dioxide than other fuel oils. resents an invaluable opportunity in the future. [6]
Spills of heavy fuel oils are more for states to collaborate in reduc-
damaging to the environment and ing greenhouse gas emissions at a
several times more expensive to small but still important scale, in The political costs of banning
clean than other oil spills. Maritime such a way that it might serve as a heavy fuel oils from the Arctic
transportation companies generally template for international cooper- would be low, particularly com-
use heavy fuel oil instead of green- ation on sector-by-sector emissions pared with the political costs of
er alternatives because heavy fuel reductions. other climate-related policies such
oil is 60% cheaper. [2] as closing coal-fired power plants.
Recommended Action The burden would largely be borne
Greenhouse gases from transpor- Banning the use of heavy fuel oils by private companies, and since the
tation are a primary contributor in Arctic maritime transportation same regulations would bind each
to anthropogenic climate change. should be the next step toward company, it is unlikely that one
Greenhouse gases must be reduced reducing emissions and pollution state’s shipping industry would ben-
in order to avoid the worst effects from the maritime transportation efit at the expense of others. Some
of climate change. Black carbon sector. The Arctic is particularly shipping companies have already

40
Roosevelt Review
begun to phase in lower-emissions ronment. Web. Accessed April 19,
fuels in anticipation of a stricter 2019.; The Engineering Toolbox.
regulatory environment. [7] “Combustion of Fuels - Carbon
Dioxide Emission.” Web. Accessed
Conclusion: April 19, 2019.
United States support for any cli- 3. International Maritime Orga-
mate action during the Trump ad- nization. “UN body adopts climate
ministration is hard to come by, but change strategy for shipping.” Web.
the United States supports this ban. Accessed April 19, 2019.
United States diplomats should 4. European Commission. “Re-
pressure Canada and Russia to sup- ducing emissions from the shipping
port this ban as a way of restarting sector.” Web. Accessed April 19,
United States-supported climate 2019.
coordination. Securing their sup- 5. “7 Reasons.”
port will require skilled diplomatic 6. McKenna, Phil. “Global Ship- “International cooperation
negotiation but given the rapid
recent shift in consensus towards
ping Inches Forward on Heavy Fuel
Oil Ban in Arctic.” Inside Climate
on maritime transportation
prioritizing emissions reduction News. Web. Accessed April 19, is straightforward since
within the maritime transportation
industry, achieving this cooperation
2019.
7. Ibid.
maritime transportation is
is well within reach. on its face an international

International cooperation on mar-
issue. If the ban on heavy
itime transportation is straightfor- fuel oils in the Arctic is a
ward since maritime transportation
is on its face an international issue.
success, the next step would
If the ban on heavy fuel oils in the be expanding the coalition
Arctic is a success, the next step
would be expanding the coalition
of countries within the
of countries within the maritime maritime transportation
transportation sector willing to ban
heavy fuel oils, the goal being a
sector willing to ban heavy
worldwide ban on the use of heavy fuel oils, the goal being a
fuel oils. Going further, interna-
tional cooperation on emissions
worldwide ban on the use
reduction in the maritime transpor- of heavy fuel oils.”
tation industry will contribute to
the body of knowledge on how to
reduce emissions within a specific
sector, paving the way for better
cooperation on sectoral emissions
reductions.

References
1 AirClim. “Air pollution from
ships.” Web. Accessed April 19,
2019.
2. Harun, Kevin, and DJ Tyson.
“7 Reasons to Ban Heavy Fuel Oil
From the Arctic.” Pacific Envi-
41
42
Roosevelt Review

Healthcare
At the Healthcare Center of the Columbia University Roosevelt Institute, we believe
unequivocally that healthcare is a fundamental human right. In this vein, our Center’s
bi-weekly discussions centered around pragmatic solutions to some of our nation’s
most pressing health policy challenges, including the opioid epidemic, racial disparities
in maternal morbidity and mortality, and the spread of chronic hepatitis C. Beyond
these discussions, we also undertook a letter writing campaign to expand access to
direct-acting antivirals--a novel hepatitis C medication--in New York State. Through
a combination of discourse and activism, our group sought to promote an enhanced
awareness of health policy problems within the Columbia community.

This year’s writers chose to tackle an impressive array of issues, ranging from Medic-
aid work requirements to expanded coverage for mental health disorders. The policies
contained herein are united by one common goal: to expand access to high-quality and
affordable healthcare for all Americans.

-- Sinead Hunt, Center Director

43
Decriminalizing Overdoses: Saving Lives
by Protecting the Rights of Parolees
By Francesca Barasch and Augusta Owens
Introduction drug offenses. This population has said that they would be more likely
Drug overdoses are becoming in- high recidivism rates, and people to summon emergency personnel
creasingly common throughout the on probation and parole who over- during an overdose if the state
United States. Decriminalization dose are criminalized. In 2017 New adopted overdose Good Samaritan
policies, however, are not are not York State arrested 1,512 parolees laws that would protect them. If
moving at equal rates. Other states and 1,432 people on probation due the same policy were adopted in
are facing similarly high numbers to drug related offenses. New York it would likely save lives
of drug related arrests of parolees and be economically beneficial for
and people on probation. However, Recommended Action the state. When a parolee overdoses
18 out of 50 states recognize that The New York State Congress and consequently are assigned a
relapse is sometimes a part of re- should amend Controlled Sub- court date this wastes overload-
covery, and that parolees and peo- stance Offenses Laws, section ed judges and public defenders’
ple on probation who are enrolled 220.78: Witness or Victim of Drug time, adding to their caseloads
in drug rehabilitation programs or Alcohol Overdose, to protect and detracting from their ability to
should be protected from drug parolees who overdose from legal devote adequate time and resourc-
related charges under the law. The repercussions if they are seeking es to each case. Ending the opioid
majority of these states have passed drug treatment. In response to the crisis and drug-related deaths is
laws protecting parolees who opioid crisis, Member of New York not possible with one policy. How-
overdose from legal repercussions State Congress write and imple- ever, protecting parolees from the
since 2011, in response to the spike ment a first-degree amendment to political ramifications of seeking
in opioid use and related deaths, as section 220.78 of the Controlled medical attention during an over-
they want to encourage people to Substance Offenses Laws. This dose is an important step in destig-
still seek medical attention if they will act to expand New York good matizing and decriminalizing drug
overdose and not worry about legal samaritan laws to protect the rights addiction, and will increase use of
ramifications. of parolees and people on proba- medical attention, allow people to
tion in the event of an overdose stay in treatment, and ultimately
Background if they are seeking drug rehabili- save lives.
New York State faces an epidemic tation. Of the 18 other states that
of drug overdoses. The numbers have these laws, the majority of Conclusion
of deaths caused by opiods in New them have passed through first-de- For previous drug users on parole
York has doubled since 2009. Fur- gree amendments to existing state or probation, seeking medical
thermore, 20-25% of high school laws. Opioid overdoses claim tens attention during an overdose can
students report being offered, giv- of thousands of American lives ev- endanger their standing in the
en, or sold illegal drugs. The drug ery year, and many of these deaths Justice System, making them less
crisis not only affects the number would be preventable through the likely to call emergency services in
of deaths in New York, it relates life-saving measures of emergency the event of an overdose. Relapse is
to the number of people impris- responders who carry an opioid often a stop on the road to recov-
oned due to drug related charges. antidote, naloxone. Decriminalizing ery and criminalizing addiction is
47% of inmates in federal prisons a parolees overdose if they are seek- harmful to the health and lives of
are incarcerated due to drug law ing drug treatment will save lives New Yorkers. The New York State
violations in the United States. In at virtually no monetary cost. In a Legislature needs to be the agent of
New York over 10% of the prison Washington state survey of drug this important change and pass an
population is incarcerated due to users, 88 percent of those surveyed amendment to Section 220.78 of

44
Roosevelt Review
the Controlled Substance Offens- and continue to engage the cam- October 2018. https://docs.google.
es Laws. Various rights advocacy pus community to promote direct com/document/d/1JmjMjC3k8ze-
groups would likely get involved, contact with representatives. wXPjiTgf96pxWwkuBa9VdJE-
as they have in other states that E1XSOnEOY/edit. P. 3.
previously lacked inclusive good In December, we will create a 3. “Percentage of high school
samaritan laws, including the petition for the New York State students reporting having been
ACLU and the Osbourne Center. Legislature to pass this amendment, offered, sold, or given an illegal
Additionally, activist organizations and have people include their zip drug on school property during the
like Rise and Resist, the Urban code and address on the form, so past 12 months by grade level, New
Justice Center, and A More Just we can reach out to them later and York State.” New York State Opi-
NYC would get involved, giving help them directly contact their oid Prevention Program. July 2018.
the cause more lobby power and state congress members. In Janu- https://www.health.ny.gov/statis-
putting more pressure on New York ary, we will begin a direct contact tics/opioid/data/pdf/p10.pdf. P. 1.
State congress members. We would campaign, encouraging people to 4. “The Drug War, Mass Incar-
organize a group of students invest- reach out to their congress mem- ceration, and Race.” Drug Policy
ed in activism by paternering with bers via phone and mail. In Febru- Alliance. January 2018. http://
interested clubs such as Amnesty ary, we will lobby at the offices of www.drugpolicy.org/sites/default/
International, CUDemocrats, and New York State Congress Members files/drug-war-mass-incarceration-
Barnard Criminal Justice Initiative. that have district offices in Man- and-race_01_18_0.pdf. P. 1.
We would meet with the heads of hattan: Dan Court, Linda Rosen- 5. Wager, Peter and Wendy Saw-
clubs to see if they would promote thal, Nathalia Fernandez, Maritza yer. “Mass Incarceration: The
our events and join our fight. The Davila, and Carmen E. Arroyo. Whole Pie 2018,” Prison Policy
group would then write and ac- The New York State Legislature Initiative, 14 March 2018.
quire signatures on a petition to NY has the most session days in March, 6. “Parolee/ Probationer Arrest
congressmen by conducting a social making it the best time to lobby. We Percent of Total Within County.”
media campaign on Instagram would organize a trip and set up a Division of Criminal Justice Ser-
and Facebook and tabling across meeting with the staff of the Chair- vices Crimestat Report. March
campus. Social media posts would woman of the Standing Committee 2018. http://www.criminaljus-
include information about our pol- on Alcohol and Drug Abuse, Linda tice.ny.gov/crimnet/ojsa/parol-
icy, such as statistics on drug over- Rosenthal, to discuss implementing ee-and-probationer-arrest.pdf. P. 3.
doses in New York and the amount this policy. Following our lobby trip, 7. “LEGAL INTERVENTIONS
of parolees affected by our policy. we would continue to advocate for TO REDUCE OVERDOSE
We would feature student voices these policies based on what our MORTALITY: NALOXONE AC-
on this page, asking them why this congress members say about what CESS AND OVERDOSE GOOD
policy is needed. The social media we can do to most effectively sup- SAMARITAN LAWS.” The
pages would include the times and port this policy. Network of Public Health Law. July
locations of our events including 2017. https://www.networkforphl.
tabling for petition signatures. Later References org/_asset/qz5pvn/network-nalox-
in the semester, we would organize, 1. “LEGAL INTERVENTIONS one-10-4.pdf. Ibid.
through facebook event, trips to TO REDUCE OVERDOSE 8. Banta-Green, C. Washington’s
the Manhattan district offices of MORTALITY: NALOXONE AC- 911 Good Samaritan Overdose
members of the standing commit- CESS AND OVERDOSE GOOD Law: Initial Evaluation Results
tee on Drug and Alcohol Abuse to SAMARITAN LAWS.” The (Nov. 2011), available at http://
lobby, creating connections with the Network of Public Health Law. July adai.uw.edu/pubs/infobriefs/
key actors in our policy. Finally, the 2017. https://www.networkforphl. ADAI-IB-2011-05.pdf
semester would culminate in a lob- org/_asset/qz5pvn/network-nalox-
bying trip to Albany to meet with one-10-4.pdf. P. 12.
congressmen to advocate for our 2. “New York State - County
policy. We would follow up with the Opioid Quarterly Report.” New
connections made from this trip York State Department of Health.
45
Medi-Cal and Work Requirements
By Juliet Emerson-Colvin
Background policymakers seem to interpret vehicle, and/or have not received
Many agree that Medicaid as a the objective of Medicaid, at least their high school diploma. [7]
whole has been a monumental- in part, as pulling individuals out Similar barriers prevent even those
ly successful program. It has not of poverty, implying that people who are working to report their
only achieved its fundamental goal should work in order to receive this work and comply with eligibility
of providing health insurance to coverage and then eventually earn requirements. Medicaid’s objective
low-income populations but has enough to no longer qualify, thus of providing healthcare to low-in-
also improved health outcomes, re- saving the government money and come individuals implies that the
ducing the infant mortality rate by pulling themselves out of poverty. least well-off individuals are given
8.5% with expansions in the 1980s. assistance by gaining health insur-
[1] Assessed on this criterion alone, Recommended Action ance coverage. The most vulner-
Medicaid paid for itself several In order to promote the well-being able Medicaid recipients—those
times over, as it cost $1 million to of Californians, it is not recom- who are unable to work—stand to
save each of these lives, while each mended that the state of California lose the most from this program.
is statistically worth $3-7 million. follow suit by establishing work
This general satisfaction led to a requirements for Medi-Cal. The effect of the work requirement
widespread Medicaid expansion would be to kick people off the
through the Affordable Care Act. These new eligibility criteria reveal Medicaid rolls who are unable to
California adopted the expansion a misunderstanding of the popu- qualify for exemptions, including
in 2014 with 3.8 million more lation of Medicaid recipients. The those who may struggle to formally
becoming eligible for the Medi-Cal vast majority of those not working verify their disability. The stan-
program, causing the uninsured are justifiably unemployed: caregiv- dard work requirement for states
rate to drop from 17.2% to 7.2% ing for a dependent minor, caregiv- proposing this change is 80 hours
between 2013 and 2017 [2], where- ing for a disabled person, or having per month, [8] so people who are
as the average uninsured rate for a disability or serious medical not working enough may lose their
non-expansion states was 18.4% in condition themselves. The majority Medicaid coverage as well. Many
2018. [3] of those who can work are working working recipients have part-time
full-time, full-year. [5] In fact, of and/or part-year jobs and would
In response to the increased costs the non-disabled, non-elderly adult face the instability of inconsis-
of new expansion enrollees and a population receiving Medi-Cal, tent Medicaid coverage. It may
strong belief in motivating work, 62% are working and 84% are in even force those who are working
some states, including Kentucky, working families. [6] Therefore, the enough, but have difficulty report-
Arkansas, Ohio, Utah, and Wis- implementation of a work require- ing their work, to lose coverage.
consin, decided to establish work, ment would not motivate signifi-
school, or volunteering activities cant numbers of current Medi-Cal 16,000 Arkansans, about 3% of
(later simply referred to as “work”) recipients to work or increase hours those covered by Medicaid in the
as an eligibility requirement for of work. state, have lost coverage after the
Medicaid. [4] This policy has been establishment of work require-
advertised as a means of advancing Even if exemptions to the work ments. [9] This effectively means
the overarching goals of the pro- requirements were established, as that about 16,000 Arkansans have
gram while reducing costs. How- they must be, there are significant become uninsured, because they
ever, these requirements serve to barriers for these individuals to likely cannot afford insurance on
fundamentally undermine access to secure exemptions. For instance, the non-group private insurance
healthcare for low-income popu- many of those not working who market if they are not working and
lations, which is antithetical to the should qualify for exemptions lack may not receive group insurance
very purpose of Medicaid. These Internet access, lack access to a through their low-wage, low-bene-
46
Roosevelt Review
fit, likely part-time job. Thus, while that the work requirements policy Medicaid Eligibility of Pregnant
reducing the number of uninsured cannot claim. It is also worth not- Women.” Journal of Political
Americans may not be a direct ing that comprehensive reform of Economy 104, no. 6 (1996): 1263-
goal of Medicaid, it is certainly a these other segments of the health 296. http://www.jstor.org/sta-
consequence of providing generous insurance market might make cov- ble/2138939.
insurance to low-income individu- erage more affordable for some of 2. Norris, Louise. “California and
als who could not afford insurance the current higher-income Medic- the ACA’s Medicaid Expansion: El-
otherwise. aid recipients. Once those reforms igibility, Enrollment and Benefits.”
are fully successful, a conversation Healthinsurance.org. November
A larger uninsured population can could begin about moving current 29, 2018. Accessed April 16, 2019.
have a variety of negative conse- Medicaid recipients to the private https://www.healthinsurance.org/
quences. This population is more insurance market. california-medicaid/.
likely to use expensive, inappropri- 3. Keith, Katie. “Two New
ate emergency care rather than less Conclusion Federal Surveys Show Stable
expensive, appropriate preventive Evidence from the contested rollout Uninsured Rate.” Two New
and primary care. This can neg- of the Arkansas Medicaid work Federal Surveys Show Stable
atively impact these individuals’ requirement policy shows that Uninsured Rate | Health Affairs.
health and have a cost-shifting losing health insurance forced some September 13, 2018. Accessed
effect, a process where hospitals’ individuals to stop working alto- April 20, 2019. https://www.
provision of uncompensated care gether. [11] While we have yet to healthaffairs.org/do/10.1377/
to low-income individuals leads see if these effects would be more hblog20180913.896261/full/.
them to increase prices, which are far-reaching with the rollout of 4.”Medicaid Waiver Tracker: Ap-
then passed on the insured pop- other states’ programs, it is logical proved and Pending Section 1115
ulation through higher insurance that losing coverage for any of the Waivers by State.” The Henry J.
premiums. aforementioned reasons could lead Kaiser Family Foundation. April
to worsening health, which could, 18, 2019. Accessed April 19, 2019.
A primary rationale for the estab- in turn, lead to an inability to work https://www.kff.org/medicaid/
lishment of work eligibility criteria altogether. In this way, the imple- issue-brief/medicaid-waiver-track-
is that the decreased number of mentation of work requirements er-approved-and-pending-section-
Medicaid recipients would reduce may act in opposition not only to 1115-waivers-by-state/.
costs for state governments. Indeed, the goal of Medicaid by decreasing 5. Garfield, Rachel, Robin Ru-
Medi-Cal is expensive, costing Cal- the health insurance coverage of dowitz, MaryBeth Musumeci, and
ifornia $36 billion in 2017. How- low-income Americans, but also to Anthony Damico. “Implications of
ever, the majority of the Medi-Cal its own goal of motivating work. Work Requirements in Medicaid:
expansion has been covered by the What Does the Data Say?” The
federal government, increasing Fortunately, California’s recent ef- Henry J. Kaiser Family Founda-
state spending on Medi-Cal by forts at Medicaid reform, including tion. July 23, 2018. Accessed April
only 2.8%. [10] There are much the Section 1115(a) Waiver (known 19, 2019. https://www.kff.org/
more effective ways of addressing Medi-Cal 2020), have focused on medicaid/issue-brief/implications-
the overarching problem of exorbi- further decreasing the uninsured of-work-requirements-in-medicaid-
tantly high federal healthcare costs, rate and integrating patients into what-does-the-data-say/.
including reforming the individual managed care, [12] in contrast 6. Stremikis, Kristoff. “Medi-Cal:
private insurance market, which to the kinds of misguided work A Program and a Population That
would actually decrease the num- requirements policies enacted by Work.” California Health Care
ber of uninsured individuals. This other states. Foundation. January 17, 2018.
may be a more complex policy Accessed April 19, 2019. https://
issue to solve than simply tactful- References www.chcf.org/blog/medi-cal-pro-
ly reducing Medicaid rolls, but it 1. Currie, Janet, and Jonathan Gru- gram-population-work/.
would have real positive impacts ber. “Saving Babies: The Efficacy
on health outcomes and coverage and Cost of Recent Changes in the
47
Expanding Access to Life-Saving
Hepatitis C Treatment: Removing Discriminatory
Sobriety Restrictions
By Sinead Hunt
Introduction tant DAA prices have caused many lates the statutory requirements of
Hepatitis C virus infection (HCV) state Medicaid programs to limit section 1927 of the Social Security
is the most common chronic their availability through a variety Act.[24] These sobriety restrictions
bloodborne infection in the United of bureaucratic restrictions. Cur- serve to unreasonably curtail access
States.[1][2] Left untreated, it can rently, New York State’s Medicaid to life-saving medication for people
lead to cirrhosis, liver cancer, and program impedes many New York- who inject drugs.
death.[3] HCV disproportionately ers from accessing these life-saving
impacts historically marginalized medications by employing bureau- Recommended Action
populations, including, people who cratic sobriety restrictions.[14] The To expand access to direct-acting
are homeless,[4] people who are NYS Medicaid Fee-For-Service antivirals (DAAs), the New York
incarcerated,[5] and people who (FFS) pharmacy program requires State Medicaid Drug Utilization
inject drugs.[6] Injection drug use screening for substance and alco- Review Board should eliminate
is the single greatest risk factor hol use to determine “treatment sobriety restrictions for the Med-
for HCV infection in the United readiness”,[15][16] and five major icaid FFS pharmacy program.
States.[7] In New York, an estimat- Medicaid managed care organi- Thirteen states have already re-
ed 70% of the over 200,000 HCV zations likewise employ sobriety moved sobriety requirements from
patients are people who inject restrictions.[17] As a result of these DAA pre-prescribing guidelines,
drugs.[8][9] Because people who bureaucratic restrictions, thirty-five and several states, including New
inject drugs are disproportionately percent of Medicaid recipients with Mexico, Michigan and Virginia,
impacted by hepatitis C, argu- hepatitis C are routinely denied specify that a patient cannot be de-
ably they should be prioritized for coverage for their prescription nied treatment for the sole reason
treatment. Paradoxically, the New treatment.[18] of substance use.[25] New York
York State Medicaid pharmacy should follow suit and reform its
program presently excludes people Proponents of these restrictions FFS pre-prescribing guidelines to
who inject drugs from accessing argue that injection drug users expand access to hepatitis C medi-
life-saving treatment through the should be excluded from antiviral cation for people who inject drugs.
use of sobriety restrictions. This therapy because they are unlikely to
practice is plainly antithetical to the adhere to treatment.[19] In reality, Some argue that because people
overarching goal of the New York there is mounting evidence that who inject drugs are unlikely to
State Medicaid program: to pro- sobriety is a poor indicator of psy- adhere to treatment, providing
vide healthcare to low-income and chosocial treatment readiness, and them with direct-acting antivirals is
historically marginalized popula- that when people who inject drugs an inefficient use of public funds.
tions.[10] are provided with adequate social However, there is a growing body
support, they just as likely to adhere of evidence that people who inject
Background to DAA treatment regimens as their drugs are just as likely to adhere to
Direct-acting antivirals (DAAs) are abstinent counterparts.[20][21] treatment when they are provided
promising new drugs that target the [22] According to official guidance with appropriate social supports.
specific proteins of the hepatitis C provided by the Centers for Medi- [26] Moreover, because people
virus to disrupt its replication.[11] care and Medicaid Services,[23] who inject drugs constitute 70
Because these medications boast by “imposing conditions for cover- percent of HCV-infected Medicaid
cure rates of over 90%,[12] they age that may unreasonably restrict recipients,[27] the use of bureau-
have been hailed as a cure for hep- access to these drugs,” New York’s cratic sobriety restrictions actually
atitis C.[13] Unfortunately, exorbi- use of sobriety restrictions vio- impedes the majority of hepatitis
48
Roosevelt Review
C patients from seeking out the an interferon-based treatment, 16;144(10):705‐14.
treatment they need. Without the DAA treatment strategy is 2. Chen SL, Morgan TR. The Nat-
access to appropriate treatment, significantly cheaper—$58,085 ural History of Hepatitis C Virus
these individuals may develop per sustained virologic response (HCV) Infection. Int J Med Sci
serious health complications that (SVR) versus $101,849.[33] The (2006) 3(2):47‐52.
will require even greater healthcare societal value of antiviral therapy 3. “Hepatitis C.” HHS.gov. April
expenditure down the line (i.e. liver ($197,574) far exceeds its sticker 10, 2018. Accessed November 03,
transplantation).[28] price.[34] 2018. https://www.hhs.gov/opa/
reproductive-health/fact-sheets/
Seventy-six percent of NYS Med- Conclusion sexually-transmitted-diseases/hepa-
icaid hepatitis C patients receive As Governor of the State of New titis-c/index.html.
treatment through managed care York, Andrew Cuomo has ded- 4. Nyamathi, Adeline M., Elizabeth
organizations, not the Medicaid icated prodigious resources to- L. Dixon, Wendie Robbins, Cyn-
FFS pharmacy program.[29] As wards eradicating hepatitis C. His thia Smith, Dorothy Wiley, Bar-
such, any proposed effort to amend administration’s “first-in-nation bara Leake, Douglas Longshore,
Medicaid prescribing guidelines approach” to ending the hepati- and Lillian Gelberg. “Risk Factors
for DAAs must be enforced among tis C epidemic aims to “improve for Hepatitis C Virus Infection
managed care organizations. Prior the health of…those battling drug among Homeless Adults.” Journal
attempts by activist groups to addiction” through upstream inter- of General Internal Medicine17,
reform restrictive DAA prescrib- ventions, including expanded fund- no. 2 (2002): 134-43. doi:10.1046/
ing guidelines demonstrate that if ing for harm reduction programs. j.1525-1497.2002.10415.x.
standardized DAA authorization [35] While these efforts are laud- 5. Hammett, Theodore M., Mary
criteria are not enforced across FFS able, they ignore the needs of the Patricia Harmon, and William
and managed care organizations, over 200,000 New Yorkers already Rhodes. “The Burden of Infec-
such reforms are, at best, symbolic. infected with the virus, who require tious Disease Among Inmates of
[30] Transparency and enforce- costly medications that they simply and Releasees From US Correc-
ment across managed care organi- cannot afford. Although Gover- tional Facilities, 1997.” American
zations will ensure DAA coverage nor Cuomo is ostensibly devoted Journal of Public Health92, no.
parity across FFS and managed to improving the health of people 11 (2002): 1789-794. doi:10.2105/
care programs.[31] with substance use disorders, whom ajph.92.11.1789.
he describes as “the most vulnera- 6. Hagan H, Pouget ER, Des Jar-
Expanding access to antiviral ble among us,” his administration’s lais DC. A Systematic Review and
therapy would actually reduce policies systematically exclude peo- Meta‐Analysis of Interventions to
healthcare expenditure by averting ple who inject drugs from accessing Prevent Hepatitis C Virus Infection
HCV-driven liver disease. Liver cir- life-saving treatment.[36] Thus, in People who Inject Drugs. J Infect
rhosis accounts for over two-thirds in order to improve the health of Dis (2011) Jul 1;204(1):74‐83.
of the $4.3 billion to $8.3 billion people who inject drugs and reduce 7. “ Who’s at Risk for Hepatitis C”.
annually spent caring for people long-term Medicaid pharmacy New York State Department of
with hepatitis C.[32] Thus, by expenditure, Governor Cuomo Health. Accessed April 05, 2019.
decreasing the incidence of severe should remove sobriety restrictions https://www.health.ny.gov/diseas-
liver disease, direct-acting antivirals from DAA pre-prescribing guide- es/communicable/hepatitis/hepa-
actually reduce the lifetime treat- lines. titis_c/whos_at_risk.htm.
ment costs associated with hepatitis 8. Hart-Malloy, R, Carrascal, A,
C. Moreover, direct-acting antivi- References DiRienzo, AG, Flanigan, C, et al.
rals are cost-saving when compared 1. Armstrong GL, Wasley A, Si- (August 2013). Estimating HCV
to the existing standard-of-care mard EP, McQuillan GM, Kuhnert Prevalence at the State Level: A
treatment: interferon therapy. For WL, Alter MJ. The Prevalence Call to Increase and Strengthen
instance, when you compare Gra- of Hepatitis C Virus Infection in Current Surveillance Systems.
zoprevir/Elbasvir, a direct-acting the United States, 1999 through American Journal of Public
antiviral, to Pegasys/Ribavirin, 2002. Ann Intern Med (2006) May Health, Vol. 103, No. 8.
49
Protecting Healthcare Access in the Age
of Trump: A Proposal for a State-Based
Individual Mandate in New York
By Sinead Hunt
Introduction tions of the ACA, guaranteed issue mates that average premiums in the
On December 22, 2017, President and community rating, [7] threaten individual market will increase by
Donald Trump signed major legis- to inflate exchange premiums and about 10 percent and increase the
lation that eliminated tax penalties destabilize individual healthcare number of uninsured individuals
associated with the Affordable Care markets. [8] Community rating, by 13 million by 2027. [14]
Act’s individual mandate, thereby which prohibits price discrimina-
repealing the requirement that tion on the basis of underlying In New York, the effects of the
Americans maintain health insur- health status, [9] raises premiums federal individual mandate penalty
ance. [1] The individual mandate, for young, healthy people, thus dis- repeal are already being felt. On
also referred to as the “individual suading these low-risk consumers June 1st, 2018, insurers in New
shared responsibility provision,” from purchasing health insurance. York submitted their 2019 pro-
required that Americans maintain Guaranteed issue, which requires posed health insurance premium
health coverage or face tax penal- that insurers provide coverage to rates to the Department of Finan-
ties of $695 per individual or 2.5 anyone wishing to purchase it, [10] cial Services. [15] On average,
percent of household income. [2] further reduces healthy people’s insurers requested a 24 percent
Among the most philosophical- incentive to proactively maintain premium rate increase in the indi-
ly contentious provisions of the insurance by promising them cover- vidual market, approximately half
Affordable Care Act, [3] the man- age if and when they should fall of which is directly attributable to
date engendered significant de- ill. Low-risk consumers respond to the Trump Administration’s repeal
bate about the appropriate role of these market forces by dropping of the individual mandate penalty.
government in the lives of individ- coverage and entering the market [16] These proposed rate increases,
uals. Opponents of the Affordable only when they fall ill, resulting in which incited indignation on the
Care Act argued that it infringed an increasingly risky pool of enroll- part of consumers,[17] are pre-
on personal liberty by requiring ees. [11] This process of adverse dicted to destabilize the New York
that Americans purchase health selection invariably drives up pre- individual healthcare market and
insurance, a commercial good. [4] miums, [12] resulting in a “death increase the number of uninsured
Irrespective of its relative unpop- spiral” in which only the very sick New Yorkers.
ularity, [5] many health policy purchase insurance at exorbitant
experts argue that the individual prices. [13] Recommended Action
mandate is an unavoidable desid- In order to rein in premiums and
eratum of healthcare reform, an The elimination of the individual maintain widespread access to
essential “leg” of the “three-legged mandate penalty is predicted to affordable healthcare, New York
stool” of the ACA. [6] Thus, the trigger a mass exodus of young, should enact a state-based individ-
Trump administration’s decision healthy enrollees from the individ- ual mandate. This would remedy
to repeal the individual mandate ual healthcare market. According the negative consequences of the
penalty seriously imperils the future to prevailing economic wisdom and federal mandate repeal by prevent-
of healthcare affordability in the evidence from past policy exper- ing the departure of young, healthy
United States. iments, the loss of these low-risk enrollees from the actuarial pool,
consumers from the actuarial risk controlling premium increases. Ac-
Background pool will wreak havoc on state- cording to an analysis conducted by
In the absence of an individual based marketplaces. The Congres- the Urban Institute, the implemen-
mandate, the two signature protec- sional Budget Office (CBO) esti- tation of a state-based individual

50
Roosevelt Review
mandate in New York State would ual mandate discouraged the sale New York, consumers are already
reduce the number of uninsured of substandard coverage, including beginning feel the effects of the
residents by 142,000 in 2019 and association health plans (AHPs) and federal individual mandate repeal,
lower marketplace premiums by 9.9 short-term, limited-duration cover- as premiums rise throughout the
percent. [18] A state-based individ- age. [30] In order to protect New state. These increases are likely to
ual mandate would guarantee that Yorkers from exploitative insurer drive out young, healthy enrollees,
over 3 million New Yorkers who practices, it is recommended that and precipitate the dreaded “death
were uninsurable before the ACA New York adopts the same defini- spiral,” in which exchange premi-
have continued access to affordable tion of qualifying coverage em- ums become unaffordable for the
healthcare. [19] ployed in the 2010 ACA individual vast majority of enrollees. New
mandate. York can prevent this by instituting
There is evidence that state-level To ensure that its own individual a state-based individual mandate.
mandates are effective at curbing mandate penalty does not dispro- This would stabilize New York’s
premium increases and maintain- portionately burden already mar- individual healthcare market by
ing health insurance affordability. ginalized individuals and com- retaining low-risk consumers in
On May 30th, 2018, Governor Phil munities, New York should mimic the actuarial risk pool, thus low-
Murphy signed the “New Jersey the ACA federal mandate’s equity ering premiums and maintaining
Health Insurance Market Preserva- provisions. The ACA protected widespread access to health in-
tion Act,” making New Jersey the economically disadvantaged indi- surance. To uphold New Yorkers’
first state in the nation to respond viduals by imposing penalties that unalienable right to healthcare, it is
to federal attacks on the Affordable increased based on ability to pay essential that the state swiftly takes
Care Act with a state-based individ- while providing affordability and action to preserve its state-based
ual mandate. [20] The legislation, hardship exemptions. These ex- marketplace. If not, thousands of
which largely mirrors the now-de- emptions were designed to guaran- New Yorkers will lose access to
funct ACA individual mandate tee that the individual mandate did affordable health insurance.
in terms of tax penalties, [21] is not force poor people to purchase
estimated to have reduced issuers’ health insurance they simply could References
2019 premium requests by about 7 not afford.The affordability ex- 1. “The Tax Bill And The Individual
percent relative to what they would emption allowed individuals whose Mandate: What Happened, And What
have been without the state-based insurance costs were projected to Does It Mean?,” Health Affairs Blog,
mandate. [22] In light of New exceed 8.05 percent of household December 20, 2017. DOI: 10.1377/
hblog20171220.323429
Jersey’s resounding success, many income to claim exempt status. [31]
2. Mangan, Dan. “Trump Touts
states, including Vermont, [23] The hardship exemption allowed Repeal of Individual Mandate in
Connecticut, [24] Maryland, [25] individuals facing particular finan- ‘disastrous Obamacare’.” CNBC.
Washington, [26] and Hawaii, [27] cial, familial, or social exigencies, January 31, 2018. Accessed Decem-
are now considering implementing such as homelessness, foreclosure, ber 31, 2018.https://www.cnbc.
their own state-based individual or the death of a loved one, to com/2018/01/30/trump-touts-re-
mandates. [28] claim exemption. [32] By adopting peal-of-obamacare-individual-man-
these provisions, New York can date.html
In developing New York’s state-lev- further protect its most disadvan- 3. Von Spakosky, Hans. “Individ-
el individual health insurance taged residents from unmanageable ual Mandate Goes Against Basic
mandate, it is recommended that healthcare expenses. Freedom and Liberty.” U.S. News
& World Report. March 25, 2012.
legislators employ the now-defunct
Accessed December 31, 2018. https://
ACA federal mandate as a base- Conclusion www.usnews.com/debate-club/
line. The ACA individual mandate In light of the Trump administra- should-the-supreme-court-overturn-
integrated consumer protections by tion’s myopic repeal of the Afford- obamas-healthcare-law/individu-
clearly defining the benefits which able Care Act’s individual mandate al-mandate-goes-against-basic-free-
plans must provide in order to qual- penalty, it is imperative that state dom-and-liberty
ify as “minimum essential cover- legislatures take action to stabilize
age.” [29] In this way, the individ- individual healthcare markets. In
51
Amending the Federal Controlled
Substances Act: Fostering Public Health
Innovation at the Local Level
By Sinead Hunt
Introduction to the United States’ historically sites link their clients to a variety of
The United States is currently in punitive response to the problem of health and social services, including
the midst of an unprecedented substance misuse, [5] harm reduc- addiction treatment, [15] equip-
public health crisis: the opioid ep- tion does not seek to unilaterally ping their clients with the strategies
idemic. Opioids, which are a class impose abstinence on people who and support necessary to reduce
of drugs that include prescription inject drugs, but rather, to mitigate the harms of their drug use.
pain relievers, heroin, and fentanyl, the deleterious consequences of There is a formidable body of
[1] collectively claim the lives of their drug use. [6] Harm reduction research that corroborates the
over 130 Americans every day. [2] aims to meet people who inject efficacy of supervised injection sites
Today, it is widely recognized that drugs “where they’re at” by pro- at reducing the harms associated
the opioid analgesics common- viding them with a “spectrum of with injection drug use. Although
ly prescribed by doctors to treat strategies” to facilitate the safer use no such sites currently exist in the
chronic pain, including oxycodone, of drugs. [7] United States, there are approx-
hydrocodone, and codeine, are imately 120 supervised injection
highly addictive and dangerous. It One such strategy includes the sites operating in 10 countries
is estimated that 21 to 29 percent implementation of “supervised worldwide. [16] These existing
of individuals prescribed opioids injection sites,” also known as “su- sites have been researched thor-
to treat their pain ultimately mis- pervised consumption services,” or oughly, resulting in over 100 evi-
use them. [3] Many individuals “overdose prevention centers.” [8] dence-based, peer-reviewed studies
who are dependent on prescription Supervised injection sites are legally that support their positive impacts.
opioid analgesics eventually tran- sanctioned, medically supervised [17] Supervised injection sites not
sition to illegal drugs like heroin. facilities designed to provide a only reduce the incidence of fatal
Based on data from the Substance hygienic and safe space for people overdose in the neighborhoods
Abuse and Mental Health Services to inject pre-obtained intravenous where they are located, [18] but
Administration’s 2017 National drugs. [9] By providing their clients they also increase entry into sub-
Survey on Drug Use and Health, with sterile injection supplies, stance use disorder treatment, [19]
over 652,000 Americans are depen- supervised injection sites reduce decrease public injection, [20] and
dent on heroin. As a result of these the transmission of bloodborne reduce risky behaviors associated
alarming statistics, on October 26, illnesses such as HIV/AIDs and with the transmission of HIV and
2017, President Trump directed the chronic hepatitis C virus infection HCV. [21]
Department of Health and Human (HCV). [10] Supervised injection
Services to declare the opioid crisis sites will often provide their clients Given the well-documented success
a public health emergency. [4] with testing strips to screen their of supervised injection sites abroad,
drugs for the presence of fentanyl, leaders of cities across the county,
Background [11] a dangerously potent synthet- including Philadelphia, [22] Seattle,
In light of the unprecedented chal- ic opioid that is often mixed into [23] San Francisco, [24] Ithaca,
lenges posed by the modern-day heroin supplies. [12] In the case of [25] and New York [26] have all
opioid epidemic, leaders of cities accidental overdose, trained health announced their intention to create
and municipalities across the coun- workers stand by ready to intervene supervised injection sites. Their
try have embraced new, innovative with naloxone, [13] an overdose efforts have been hitherto thwarted
policies based on the principles antidote. [14] Through co-location by Section 856 of the federal Con-
of “harm reduction.” In contrast and referral, supervised injection trolled Substances Act, colloquially

52
Roosevelt Review
referred to as the “Crack House collectively consume drugs in the reduction policy solutions to the
Statute.” [27] Under this law, any 1980s. [34] The original authors opioid epidemic.
individual who “knowingly open[s], of the CSA never intended to in-
lease[s], rent[s], use[s], or main- fringe upon states’ historic author- References
tain[s] any place...for the purpose ity over matters of public health, 1. “Opioid Overdose Crisis.”
of...using any controlled substance” nor interfere in legally sanctioned National Institute on Drug Abuse
may face up to 20 years in prison public health interventions. [35] (NIDA). January 22, 2019. Ac-
or $500,000 in fines. [28] Thus, This is evidenced by Section 872 cessed March 17, 2019. https://
supervised injection site operators of the law, which encourages the www.drugabuse.gov/drugs-abuse/
and staff could be at risk of pros- development of novel public health opioids/opioid-overdose-crisis.
ecution and imprisonment under practices by authorizing the use of 2. ”Opioid Overdose.” Centers for
the Controlled Substances Act. [29] controlled substances in scientific Disease Control and Prevention.
Hypothetically, all that would be research. [36] However, in order to December 19, 2018. Accessed
required for supervised injection undertake scientific research involv- March 17, 2019. https://www.cdc.
sites to proceed is federal inaction. ing controlled substances, Section gov/drugoverdose/epidemic/in-
[30] The attorney general of the 872 requires that individuals submit dex.html.
United States could exercise “pros- an application to the Attorney 3. Vowles KE, McEntee ML,
ecutorial discretion” by directing General’s office, meaning that the Julnes PS, Frohe T, Ney JP, van der
local law enforcement officials to feasibility of such projects too often Goes DN. Rates of opioid misuse,
ignore supervised injection sites. depends on the prevailing political abuse, and addiction in chronic
[31] Unfortunately, this seems winds. Thus, to foster public health pain: a systematic review and data
unlikely given the current politi- innovation at the local and state synthesis. Pain. 2015;156(4):569-
cal climate. U.S. Deputy Attorney level, it is recommended that Con- 576. doi:10.1097/01.j.pa
General Rod Rosenstein has made gress repeal the antiquated “Crack in.0000460357.01998.f1.
no attempt to conceal his antipathy House Statute” of the Controlled 4. Davis, Julie Hirschfeld. “Trump
towards supervised injection sites, Substances Act. Declares Opioid Crisis a ‘Health
and has previously characterized Emergency’ but Requests No
such sites as “taxpayer-sponsored Conclusion Funds.” The New York Times.
havens to shoot up.” [32] Beyond In order to combat the devastat- October 26, 2017. Accessed March
these opprobrious remarks, he has ing impact of the opioid epidemic 17, 2019. https://www.nytimes.
also asserted that any city wishing on major American cities, poli- com/2017/10/26/us/politics/
to open a supervised injection site cymakers, activists, and medical trump-opioid-crisis.html.
can expect to encounter “swift professionals have teamed up to 5. “A Brief History of the Drug
and aggressive action.” [33] The implement supervised injection War.” Drug Policy Alliance. Ac-
ongoing threat of federal action sites in their local communities. cessed March 03, 2019. http://
has hitherto stymied public health However, the looming specter of www.drugpolicy.org/issues/brief-
officials’ plans to open supervised the “Crack House Statute” has history-drug-war.
injection sites. hitherto hampered their progress. 6. “Principles of Harm Reduc-
Luckily, lawmakers have already tion.” Harm Reduction Coalition.
Recommended Action introduced legislation to amend the Accessed March 18, 2019. https://
In order to foster public health federal Controlled Substances Act. harmreduction.org/about-us/prin-
innovation at the local level and On April 1st, 2019, United States ciples-of-harm-reduction/.
encourage creative solutions to Representative Diana DeGette (D- 7. Ibid.
the opioid epidemic, it is recom- CO) introduced H.R. 2012, which 8. “Supervised Consumption
mended that Congress immediately intends to “amend the Controlled Services.” Drug Policy Alliance.
repeal Section 856 of the federal Substances Act to provide that Accessed March 18, 2019. http://
Controlled Substances Act. Section Federal law shall not preempt State www.drugpolicy.org/issues/super-
856 was written in response to the law.” [37] If successful, this legisla- vised-consumption-services.
proliferation of “crack houses” tion will allow states and municipal- 9. Ibid.
in which people congregated to ities to enact evidence-based harm
53
Parity Delayed is Parity Denied
By Alex Siegal
Introduction incentives be restructured,which is other physical diseases. However,
In March 2019, Chief Magistrate unlikely to happen in the current the federal government found it dif-
Judge Joseph Spero of California’s healthcare insurance environment, ficult to codify that law into regula-
Northern District ruled that United or (b) that federal agencies more ac- tion—how to categorize outpatient
Behavioral Health, a subsidiary tively and vigilantly enforce existing therapy, which can be far lengthier
of health insurance giant Unit- mental health parity laws. The cur- than other outpatient services?
edHealthcare, had violated fed- rent system unfairly places the onus [10] How to ensure that carve-
eral law by discriminating against on patients to appeal their cases to outs, which are administratively
customers receiving treatment for a confusing and non-standardized separate units of insurers that only
mental health and substance abuse mishmash of federal or state agen- handle one type of policy (in this
disorders. [1] The crux of the issue cies. Unsurprisingly, relatively few case, mental health), maintain the
was, in Judge Spero’s words, “an appeals are made, and even fewer same exact standards as the other
excessive emphasis on addressing succeed. [6] branches of their parent company?
acute symptoms and stabilizing Due to these and other difficulties,
crises while ignoring the effective the final rules [11] were only estab-
treatment of members’ underlying Background lished in 2014, six years after the
conditions.” [2] Instead of proac- When institutionalized patients and bill’s passage. [12] Still, insurance
tively providing their enrollees with active-duty military service mem- companies have exploited the law’s
preventative care, insurance com- bers are included, mental disorders ambiguity and a lack of oversight
panies required that a patient ex- rank as the single largest American to develop insurance policy stan-
hibit an acute mental health crisis healthcare expenditure, accounting dards that freeze out the quality of
before their coverage could kick in. for $201 billion of a roughly $2.5 care mental health patients need,
trillion total as of 2013. [7] How- just like the crisis-centered United-
Since 2008, mental health parity— ever, mental disorders are tricky Healthcare policy that Judge Spero
the principle that mental health to visualize and can present no ruled against in March. [13]
and substance abuse disorders outward signs, so ensuring mental
should receive the same treatment health patients have equal access Recommended Action
as other physical health issues in to healthcare is difficult to legislate The good news is that, with Spe-
healthcare policy and insurance and enforce. The costs of untreated ro’s ruling, the government has
plans [3]—has been established in mental illnesses due to insurance established a clear position on the
federal law. However, due to a lack companies’ crisis-centered ap- issue of mental health insurance
of clear regulations and insufficient proach are staggering: $38.5 billion that has lasted across the Bush,
enforcement, the legislation has in avoidable emergency room care, Obama, and Trump Administra-
had a muted impact. [4] Private [8] $37 billion in avoidable incar- tions. However, the fact that it took
companies are influenced—Judge ceration, [9] and $193 billion in eight years of patient-initiated
Spero says “infected”— by profit lost productivity. litigation to achieve the preliminary
motives and a desire to keep premi- outcome of the UnitedHealthcare
ums low, [5] so they have an inter- Mental health advocate and case indicates that the government
est in manipulating parity guide- then-Congressman Patrick Kenne- needs to do a better job of enforc-
lines as best they can, contrary to dy passed the Mental Health Parity ing mental health parity. Under
the spirit of the legislation. and Addiction Equity Act (“the the MPHAEA’s final rules, enforce-
MHPAEA”) in 2008, which man- ment has mostly been devolved
That insurance companies are dated that insurers cover mental to the states, though the Centers
incentivized to evade parity legisla- health and substance abuse disor- for Medicare and Medicaid also
tion requires that either (a) existing ders in the same way that they do provide assistance. Federal en-
54
Roosevelt Review
forcement jurisdiction falls not to a 3. “What Is Mental Health Parity?” ing-for-intensive-psychiatric-care.html.
single agency but to three disjunct National Alliance on Mental Illness. 12. Abelson, Reed. “Lacking Rules,
ones: the Departments of Labor, Accessed April 16, 2019. https:// Insurers Balk at Paying for Inten-
Treasury, and Health and Human www.nami.org/Find-Support/Living- sive Psychiatric Care.” (Cases of
Services, depending on the type of with-a-Mental-Health-Condition/ Melissa Morelli and Jonathan Den-
insurance plan. [14] Understanding-Health-Insurance/ bo) New York Times. September
What-is-Mental-Health-Parity. 27, 2013. https://www.nytimes.
A single, focused authority should 4. Gold, Jenny. “Advocates Say Men- com/2013/09/29/business/lack-
preside over mental health parity in tal Health Parity Law Is Not Fulfilling ing-rules-insurers-balk-at-pay-
Its Promise.” Kaiser Health News. Au- ing-for-intensive-psychiatric-care.html.
order to provide effective enforce-
gust 3, 2015. https://khn.org/news/ 13. Centers for Medicare and Medic-
ment. That authority needs to have
advocates-say-mental-health-parity- aid Services, Department of Health
the capacity to conduct proactive,
law-is-not-fulfilling-its-promise/. and Human Services. “Mental Health
aggressive audits of insurance
5. Ibid. Parity and Addiction Equity Act
companies’ mental health policies. 6. Duong, Yen. “Mental health parity (MPHAEA).” Accessed April 10,
In this case, and in the interest of isn’t panning out for some patients 2019. https://www.cms.gov/cciio/
avoiding miscommunication, the and parents.” North Carolina Health programs-and-initiatives/other-insur-
most appropriate choice for that News. January 22, 2019. https:// ance-protections/mhpaea_factsheet.
authority would seem to be a new www.northcarolinahealthnews. html.
joint office between the Depart- org/2019/01/22/mental-health-pari- 14. Centers for Medicare and Medic-
ments of Labor, Treasury, and ty-isnt-panning-out-for-some-patients- aid Services, Department of Health
Health and Human Services, with and-parents/. and Human Services. “Mental Health
resources drawn from all three and 7. Roehrig, Charles. “Mental Dis- Parity and Addiction Equity Act
focused singularly on mental health orders Top The List Of The Most (MPHAEA).” Accessed April 10,
parity regulation. [15] Such action Costly Conditions In The United 2019. https://www.cms.gov/cciio/
can easily be justified under Con- States: $201 Billion,” Health Affairs, programs-and-initiatives/other-insur-
gress’s power to regulate interstate 2016; 35(6):1130-1135. https://www. ance-protections/mhpaea_factsheet.
commerce. [16] healthaffairs.org/doi/pdf/10.1377/ html.
hlthaff.2015.1659. 15. Per §13002 of the 2016 21st
Conclusion 8. Creswell, Julie. “E.R. Costs for Century Cures Act, CMS has been
Despite Judge Spero’s preliminary Mentally Ill Soar, and Hospitals given nominal primary enforcement
ruling, the class-action case against Seek Better Way.” New York Times. jurisdiction over MPHAEA matters,
UnitedHealthcare is still ongoing, Dec 25, 2013. https://www.nytimes. and has developed a new action plan
com/2013/12/26/health/er-costs- accordingly. I advocate that they go
meaning patients have waited a de-
for-mentally-ill-soar-and-hospitals- beyond this, as it does not provide
cade to see the results of legislation
seek-better-way.html. for sufficiently aggressive, singularly
passed under the Bush Administra-
9. Swanson, Ana. “A shocking focused enforcement. Centers for
tion. Their case is not unique, and
number of mentally ill Ameri- Medicare and Medicaid Services,
until the government can adequate- cans end up in prison instead of Department of Health and Hu-
ly enforce the 2008 MPHAEA, treatment.” The Washington Post. man Services. “21st Century Cures
more cases of postponed parity are April 30, 2015. https://www. Act: Section 13002; Action Plan for
certain to follow. washingtonpost.com/news/wonk/ Enhanced Enforcement of Mental
wp/2015/04/30/a-shocking-number- Health and Substance Use Disorder
References of-mentally-ill-americans-end-up-in- Coverage.” Accessed April 17, 2019.
1. Abelson, Reed. “Mental Health prisons-instead-of-psychiatric-hospi- https://www.hhs.gov/sites/default/
Treatment Denied to Customers tals/?utm_term=.11221ed9aed7. files/parity-action-plan-b.pdf.
by Giant Insurer’s Policies, Judge 10. Abelson, Reed. “Lacking Rules, 16. Legal Information Institute,
Rules.” New York Times. March Insurers Balk at Paying for Intensive Cornell Law School. “Commerce
5, 2019. https://www.nytimes. Psychiatric Care.” New York Times. Clause.” Accessed April 19, 2019.
com/2019/03/05/health/united- September 27, 2013. https://www. https://www.law.cornell.edu/wex/
health-mental-health-parity.html. nytimes.com/2013/09/29/business/ commerce_clause.
2. Ibid. lacking-rules-insurers-balk-at-pay-

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Roosevelt Review

Human Rights
The Human Rights center has remained committed to addressing the complex ways in
which individual rights and freedoms are questioned each day by both public and pri-
vate powers. This year, The Human Rights Center organized a boycott of Barnard Din-
ing Services in protest of its use of Aramark, a company that profits from mass incar-
ceration. The Center’s activism led to a change in dining providers to a different dining
provider that is divested from prisons. The Human Rights Center is also working on a
long-term project exploring housing rights and housing access in the Morningside area.

The pieces in this section show the center’s commitment to protect the dignity of all
people, regardless of what systems of oppression may be fighting against them.

-- Maeve Flaherty, Center Director

57
Marriage for All: Repealing the Same-Sex
Marriage Act in Nigeria
By Dotun Adegbite
Introduction SSMA prohibits “the registration with legislation protecting same-sex
In 2013, Nigeria passed the Same- of gay clubs, societies and organisa- unions and marriages, as well as
Sex Marriage Act (SSMA), which tions,” “the public show of same- the other activities banned in the
officially criminalised homosexual sex amorous relationship directly or act, including protections for any
marriage and introduced a host indirectly,” and invalidating same- person “who administers, witnesses,
of more restrictive laws on homo- sex marriages and civil unions. abets, or aids the solemnisation of
sexual relationships. Over the last [6] The SSMA, which was first a same-sex marriage … or supports
three years, more than 100 men introduced in 2006, passed upon the registration, operation, and
have been arrested on allegations reintroduction in 2013 despite sustenance of gay clubs, societ-
of homosexual behaviour, usually condemnation from the US State ies, organisations, processions, or
in mass arrests. [1, 2] The true Department and the UK High meetings”. This is a simple pro-
number of individuals who have Commission. The UK threatened posal, and the only obstacle in its
been targeted or arrested due to to cut aid to African countries that realisation is the actions of the
allegations of homosexuality is violate LGBT rights, but ultimately Nigerian legislature. While this
unknown due to sparse media no action was taken against Nige- action would not have popular
coverage. The laws created under ria’s government. support in Nigeria - 92% of Nige-
the SSMA infringe on numerous rians polled supported the SSMA
rights within the Universal Decla- The criminalisation of homo- in 2013 [8] - Kenya has shown that
ration of Human Rights (UDHR). sexuality is detrimental to public governments can take legislative
For example, the punishment of health even beyond explicit threats action on this issue even without
anyone who “registers, operates or from law enforcement.. Surveys of public support. In 2016, a Kenyan
participates in gay clubs, societies American homosexual and bisexu- court ordered the reinstatement
and organisations” [3] is a clear vi- al individuals during a time when of three priests who were accused
olation of UDHR Article 20 (1) in gay marriage restrictions were of homosexual behaviour. At the
the UDHR, which states that “ev- increased showed a 36% increase moment, the Kenyan government
eryone has the right to freedom of in mood disorders, 42% in alcohol is deliberating on the decriminalisa-
peaceful assembly and association.” use disorders, and a 248% increase tion of gay marriage, which would
[4] In addition to discriminating in generalised anxiety disorder. make Kenya the first country in
against LGBTQ citizens, these laws [7] Additionally, criminalising gay East Africa country and the second
enable the police to make arrests marriage and LGBT associations in in Africa (after South Africa) to
based on little evidence. Repealing Africa prevents Africans persecut- decriminalise gay marriage. Nigeria
laws like this is important not just ed for their sexuality from seeking is the most populous country and
to uphold minority rights but the asylum while remaining in Africa. largest economy in Africa. If Nige-
rights of everyone unfairly targeted By having to go to Europe or North ria were to change its laws, it could
by police. America to avoid persecution, influence other countries to follow
LGBT Africans, particularly those suit, potentially paving the way for
Background with a Muslim background, risk a wave of legislative reform across
Most former European colonies entering highly xenophobic envi- West Africa and Africa as a whole.
retain colonial laws criminalising ronments.
homosexuality, and Nigeria is no Apart from politicians, Nigerian
exception. Similar to India, [5] Recommended Action religious leaders play a significant
Nigeria has recently furthered To solve these issues, the SSMA role in influencing public opinion,
these colonial-era restrictions -- the should be repealed and replaced and Nigerian religious institutions
58
Roosevelt Review
are firmly homophobic. Homo- Attitude, a charity advocating for
sexuality is portrayed as sinful and LGBT inclusion in the Church of
“unreligious,” and homosexuality is England. Grassroots activism and
widely believed to be a Western im- mobilisation, in combination with
port and a sign of malign neo-co- legislative change, can liberate
lonial influence, despite the fact Nigeria’s LGBT community and
that the criminalisation of hom- transform Nigeria into a beacon of
sexuality was first introduced by African progress.
colonial powers. Changing attitudes
towards homosexuality in some References
European countries have resulted 1. Nigeria: Fifty-Seven Suspected
in the removal of homophobic laws Homosexuals Arrested. Free Muse.
in much of Europe including the 2018. https://freemuse.org/news/
UK, which colonised Nigeria. As nigeria-dozens-of-suspected-homo-
a result, international pressure to sexuals-arrested-freemuse/ “The criminalisation of
change homophobic laws such as 2. Mass Nigerian arrests for ‘ho-
the SSMA is seen as neocolonial mosexual acts’ in Lagos State. BBC homosexuality is detrimental
meddling rather than an effort to News. 2017 https://www.bbc.com/ to public health even beyond
resolve colonial-era mistakes. In news/world-africa-40774930
order to enact the necessary legis- 3. Same-Sex Marriage (Prohibition) explicit threats from law
lative change, the idea that homo- Act, 2013. §5. enforcement.. Surveys of
sexuality is a Western import must 4. Universal Declaration of Hu-
be deconstructed, and the fact that man Rights, United Nations, 1948 American homosexual and
colonisation brought homophobic 5. India top court reinstates gay sex bisexual individuals during
laws not homosexuality must be ban. BBC News. 2013. https://
recognized. www.bbc.com/news/world-asia-in- a time when gay marriage
dia-25329065 restrictions were increased
Conclusion 6. Same Sex Marriage (Prohibi-
In order for the SSMA to be re- tion) Act, National Assembly of showed a 36% increase in
pealed, activists, members of the Nigeria, 2013, §5 mood disorders, 42% in
Nigerian legislative branch, and 7. Buffie, William C. Public Health
religious authorities must present Implications of Same-Sex Mar- alcohol use disorders, and
a united front. Major Nigerian riage. American Journal of Public a 248% increase in gener-
LGBT activists including Bisi Health no.6, 2011. pp 986-990.
Alimi, Davis Mac-Iyalla, and Miss 8. Nigerians Support Anti Same- alised anxiety disorder. [7]”
saHHara would have a significant Sex Bill - Poll. Vanguard News.
role to play in mobilising sup- 2013. https://www.vanguardngr.
port and advocating for change. com/2013/06/nigerians-support-
Alimi’s Independent Project for anti-same-sex-bill-poll/
Equal Rights could help lobby for
religious and political change. By
conducting a grassroots education
campaign to change public percep-
tion of homosexuality, these activ-
ists could counter the narrative that
homosexuality is a Western import.
They should foster links between
Nigerian religious institutions and
more tolerant religious organisa-
tions in the UK such as Changing
59
Homemakers: Creating a Guaranteed
Right to Housing Counsel
By Justin Holiman
Introduction [4]The result is an eviction factory,
Pulitzer Prize-winning author Mat- where most eviction hearings are Recommended Action
thew Desmond describes the home decided in sixty seconds, normally While not a panacea for America’s
as the “wellspring of personhood” in the landlord’s favor. [5] Without housing crisis, guaranteeing free,
or a fundamental source of human representation, most low-income legal representation to tenants
dignity. [1] The mere existence of tenants are forced to represent facing eviction would ensure that
a stable home can dramatically themselves pro se against a sea- more people would be able to stay
reduce incarceration rates, improve soned attorney; often tenants’ rights in their homes. Of course, such
physical and mental health, as well are trampled or they are persuad- counsel is not free, and efforts to
as promote civic engagement. Yet ed to sign unfair stipulations. [6] increase representation in hous-
the status of the American hous- Without universal housing court ing court must be mindful of the
ing court system ensures that for representation, due process leans upfront cost. However, New York
renting families, a stable home is decidedly in landlords’ favor. City—long on the front lines of
mere fantasy. Without a guaranteed housing rights—commissioned a
right to housing counsel, tenants The Eviction Lab at Prince- study that found providing effective
are at their landlords’ mercy. While ton University determined that housing counsel to every city res-
there is a federal right to counsel there were at least 900,000 evic- ident within 200% of the poverty
in criminal trials, no U.S. state tions judgements issued in 2016 line in a given year would actually
yet guarantees a right to housing alone. [7] The loss of a home offset the cost of sheltering people
counsel. Test cities have shown that is life-changing -- being evicted who are evicted from their homes.
providing every tenant in housing leads to increased rates of clinical [14] In fact, the project would save
court with access to a free attorney depression and serves as a major the city approximately $320 million
ensures familial stability and costs antecedent to suicide. [8] Once a annually. [15] Furthermore, the
American taxpayers far less than a tenant’s records shows an eviction, report clarified that it could not
national system of eviction. they are pushed into increasingly fully factor in the advantages of an
run-down neighborhoods to seek increase in child development, and
Background cheaper rent. This acts as a form the savings from criminal justice
In the United States, “over 1 in of de facto segregation that dispro- costs, among other benefits. [16]
5 of all renting families in the portionately affects people of color. According to another study, con-
country spends half its income on [9] This contributes to the fact that ducted in the South Bronx be-
housing,” and in much of the coun- schools are actually more segre- tween 2005 and 2008, providing
try affordable housing waiting lists gated today than forty years ago housing counsel to 1,300 families
are years long. [2, 3] Low-income because their neighborhoods are cost $450,000 upfront, [17] but
tenants face the additional prob- now more segregated. [10] Many prevented eviction in 86% of
lem of landlords being willing to students in these underfunded areas cases and saved the city more than
evict them immediately upon a late then commit crime to help parents $700,000 on welfare costs. [18]
payment because demand far ex- pay for rent, [11] contributing to Advocacy groups and legal associa-
ceeds supply for affordable housing. increases in the incarceration rate tions formed the Right to Counsel
Thus, housing court has become a and perpetuating a cycle of pover- NYC Coalition in 2014 which won
staple of lower-income America. ty. [12] Ultimately, people living in increased funding from the city
Right now, 90% of landlords are poverty have a lifespan, on average, council to provide legal assistance
represented by counsel in housing of nearly 10 years less than those to those facing eviction. [19] Since
court while 90% of tenants are not. that do not. [13] the Coalition began providing

60
Roosevelt Review
greater legal aid, eviction rates Still to Keep,” 14.
have declined by 24% and the rate References 12. Ibid., 14.
of tenants appearing in court with 1. Desmond, Matthew. Evicted: 13. Burger, Edward B. and Michael
representation has gone from 10% Poverty and Profit in the American Starbird. The Heart of Mathemat-
to 27%. [20] These statistics were City. New York: Penguin ics: An Invitation to
enough for Mayor Bill de Blasio Random House, LLC, 2016, 293. Effective Thinking. Key College
to sign into law a 2017 bill making 2. “After applying, how long will Publishing, 2005, 654.
New York the first city to establish my wait be?” Affordable Housing, 14. “The Financial Cost and
a right to counsel for those facing 2018, Benefits of Establishing a Right to
eviction. [21] While this is only one https://affordablehousingonline. Counsel in Eviction Proceedings
city, it serves as an important case com/housing-help/How-Long- Under Intro 214-A.” Stout Risius
study for future implementation. Will-My-Wait-Be Ross, Inc. 2016, 5.
New York’s example demonstrates 3. Desmond, Evicted, 303. https://www2.nycbar.org/pdf/
that upholding the right to housing 4. Franzese, Paula A. and Steph- report/uploads/SRR_Report_Fi-
counsel can save money and keep anie J. Beach. “Promises Still to nancial_Cost_and_Benefits_
families in their homes. Keep: The Fair Housing Act of_Establishing_a_Right_to_Coun-
Fifty Years Later.” Cardozo Law sel_in_Eviction_Proceedings.pdf
Conclusion Review, 2019, 7. 15. Ibid., 5.
The solution must begin at the city 5. Davis, Martha F.; Kaufman, 16. Ibid., 5.
level. Every city in America experi- Risa; and Wegleitner, Heidi M. 17. Desmond, Evicted, 304-305.
encing rampant housing shortages, “The Interdependence of Rights: 18. Ibid., 304-305.
poverty, and crime can benefit from Protecting the Human Right to 19. Capps, Kriston. “New York
the stability that comes with en- Housing by Promoting the Right to City Guarantees a Lawyer to Every
suring housing security. Early case Counsel.” School of Law Resident Facing Eviction.”
studies have demonstrated clear Faculty Publications, 2014, Paper CityLab, 2017, https://www.cityl-
socio-economic benefits to keeping 58. ab.com/equity/2017/08/nyc-en-
people in their homes. Just like New 6. Desmond, Matthew and Monica sures-
York, each city government should Bell. “Housing, Poverty, and the eviction-lawyer-for-every-
pass legislation providing funding Law.” The Annual Review of tenant/536508/
for housing court attorneys in a Law and Social Science, 2015, pp. 20. Ibid.
similar fashion to criminal public 15-35. 21. Ibid.
defenders, with the particularities 7. Badger, Emily and Quoctrung
varying by city. Bui. “In 83 Million Eviction Re-
cords, a Sweeping and Intimate
Implementing this policy would New Look at Housing in America.”
not be quick or easy. Yet, since The New York Times, 2018 ,
right to counsel legislation would https://www.nytimes.com/inter-
help those in need, cut welfare active/2018/04/07/upshot/mil-
costs, and potentially create jobs, it lions-of-eviction-records-a-
can and should garner bipartisan sweeping-new-look-at-housing-in-
support. For Americans trying to america.html
escape poverty, maintaining a job 8. Desmond, Evicted, 298-299.
and providing children with qual- 9. Rothstein, Richard. The Color
ity education is nearly impossible of Law: A Forgotten History of
without housing stability. Guaran- How Our Government
teed housing counsel is a major step Segregated America. Liveright
toward a more equitable society. Publishing Corporation, 2018, 178-
After all, sixty seconds should never 180.
determine the future of an Ameri- 10. Ibid., 179.
can family. 11. Franzese and Beach, “Promises
61
62
Roosevelt Review

Technology
The Technology Center at Roosevelt has grown considerably through it’s first year. The
Tech Center is an incredibly interdisciplinary center, uniquely qualifying us to frame
policy debates in a new way. This years conversations included the ramifications of
Amazon’s HQ2 in New York and Huawei operating within the United States, two con-
versations that are based around tech policy but have implications that impact all policy
areas.

In this section, you will find a series of pieces that touch on a wide range of issues from
privacy to the economy, illustrating the role that technology currently plays and will
continue to play in our policymaking systems.

-- Christopher Philogene, Center Director

63
Electronic IDs: Physical Protection for
Metaphysical Data
By Emma Cloyd
Introduction to risk their confidential informa- close behind at 98%. [10] The
Electronic IDs (eIDs) increase cyber tion 2) The government is unable extent to which eIDs can be used
security by allowing individuals to to provide digital resources that varies by region and country. The
prove their identity on the Internet. could help streamline the delivery EU, for example, has required all
[1] eIDs are physical cards that can of some public services, including digital services to accept eIDs and
be used to verify an individual’s voting, Social Security information, is implementing programs for eIDs
identity that can run on any brows- and pension payments. [7] to be used across different coun-
er or device. [2] The user inserts tries within the EU. [11] Estonia
the card into a card reader plugged Recommended Action allows eIDs to be used for banking,
into their device in order to verify The United States Department of viewing medical records, and even
their identity. [3] As technology Homeland Security should design online voting. [12]
becomes more stable and secure, an eID program to provide its
many citizens prefer to complete citizens with effective digital protec- DHS should launch an eID pro-
their transactions digitally rather tion. The creation and implementa- gram by 2025, giving the agency
than in person, whether applying tion of a federal electronic ID pro- six years to develop a system. When
for a loan, shopping in a store, or gram should be nested under the developing the system, DHS must
any number of other common Department of Homeland Security prioritize the security of citizens’
activities. [4] Many of these inter- (DHS) since it addresses cyberse- data, including where it is stored
actions use highly sensitive personal curity, which is one of DHS’s key and how it is encrypted, to mini-
data, including Social Security areas of expertise. [8] The benefit mize privacy risks including threats
numbers and banking information. of this, over a social security num- from foreign hackers. DHS should
[5] By offering e-IDs in the Unit- ber which is the current standard contact governments with strong
ed States, the federal government level of proof in the United States, eID programs to figure out what
would be able to help protect their is that it would be a physical en- sort of physical characters the card
citizens’ interests online by reduc- crypted card that would be harder and card reader need to have to
ing the chances of identity theft. to steal than a security number be unique properly encrypted, and
Though both the Department of because it would have to physically impossible to forge.
State and Homeland Security have be in the users presence and if it is
operating systems in place that lost or stolen, they can cancel it the The process for citizens to receive
could be modified to provide citi- way they would a credit card. an eID will mirror that of apply-
zens with electronic IDs, discussion ing for a passport: citizens will file
of the proposal remains limited. [6] The United States is lagging be- an application, which will include
hind in the adoption of this digital proof of citizenship, a color photo,
Background policy, along with the United King- and an application fee of $110.
The lack of a clear way to protect dom, Canada, Australia, Brazil and [13] The first application will have
against identity theft in the digital a handful of countries throughout to be filed in person and locations
sphere harms many Americans. Africa and Asia. [9] Many coun- will be the same as the as the ones
There are two main implications of tries have already launched eID the Department of State uses for
not being able to effectively identify programs to protect their citizens’ people to file in person applica-
and verify who someone is: 1) Peo- sensitive information in the digital tions for passports. Once there is a
ple have to travel to physical banks, sphere. India is currently leading release date for the eID program,
healthcare providers, and other the charge, with 99% of its popu- people will be able to file an appli-
confidential offices to complete lation over the age of 18 enrolled cation up to six months in advance
certain transactions in order not in an eID program; Estonia is to avoid bottlenecking. With the

64
Roosevelt Review
first ID, individuals will also be en- ruary 07, 2019. Accessed May 10,
couraged to purchase an $80 card 2019. https://www.brussels.be/use-
reader with the recommendation eid-and-card-reader-instructions.
of having one per household. 3. Ibid.
Other departments on the local, 4. Castro, Daniel. “Explaining
state, and federal level, as well as International IT Application
private entities, will have to incor- Leadership: Electronic Identifica-
porate eIDs into their services to tion Systems.” Explaining Interna-
increase security in advance of the tional IT Application Leadership:
2025 rollout. Governments should Electronic Identification Systems.
first implement online voting due Accessed May 10, 2019. https://
to the greater ability to verify one’s itif.org/publications/2011/09/15/
identity. Private entities will have an explaining-international-it-applica-
easier time incorporating eIDs into tion-leadership-electronic-identifi-
their services -- eID verification can cation.
replace multiple levels of passwords 5. Ibid.
or security questions. The govern- 6. “Tech Policy To-Do List.” Tech
“The digital world is
ment should partner with these Policy To-Do List. Accessed May constantly growing and
entities as soon as the intricacies of 10, 2019. https://itif.org/tech-poli-
the digital infrastructure are iden- cy-to-do-list#cybersecurity.
evolving, and currently the
tified. 7. “Electronic Identities – a Brief United States has not tak-
Introduction.” Europa.eu. Elec-
Conclusion tronic Identities – a brief introduc-
en any steps to protect their
The digital world is constantly tion. citizens digital footprint.
growing and evolving, and current- 8. “CERT | United States Com-
ly the United States has not taken puter Emergency Readiness
Moving forward, Congress
any steps to protect their citizens Team.” US. Accessed May 10, and DHS must begin to
digital footprint. Moving forward, 2019. https://www.us-cert.gov
Congress and DHS must begin to /?utm_source=hp_carousel&utm_
analyze the costs associated
analyze the costs associated with medium=web&utm_cam- with implementing an eID
implementing an eID program and paign=dhsgov.
various data risks and the best ways 9. “National IDs Around the World
program and various data
the mitigate them. The United - Interactive Map.” Blog. Accessed risks and the best ways the
States should turn to countries like May 10, 2019. https://www.
Estonia who almost all of their worldprivacyforum.org/2017/07/
mitigate them.”
services available on the Internet, national-ids-around-the-world/.
however the United States must 10. Gutsol, Oleg, and Oleg Gut-
remain cautious and only use this sol. “Trends in Electronic IDs and
card as a proof of identification EIDs Integration with Consensus
so the government cannot use it as AI Network.” Medium. February
a way to acquire information on 02, 2018. Accessed May 10, 2019.
citizens. https://medium.com/consen-
sus-ai/trends-in-electronic-ids-and-
References eids-integration-with-consensus-ai-
1. “Tech Policy To-Do List.” Tech network-7899c73002e8.
Policy To-Do List. Accessed May 11. Ibid.
10, 2019. https://itif.org/tech-poli- 12. Ibid.
cy-to-do-list#cybersecurity. 13. “Getting or Renewing a U.S.
2. “Use of EID and Card Reader: Passport.” USAGov.
Instructions.” City of Brussels. Feb-
65
Governing CRISPR: Effectively Regulating
Gene-Editing Technologies
By Meredith Harris
Introduction currently widely accessible, but if do Convention, which states that
CRISPR, short for clustered regu- it is improperly regulated, it could “An intervention seeking to modify
larly interspaced short palindromic increase socioeconomic gaps if only the human genome may only be
repeats, can alter both our genes certain populations could afford undertaken for preventive, diag-
and our lives at large--from the CRISPR-modified treatments. The nostic, or therapeutic purposes and
food we consume to our genetic Office of the Director of National only if its aim is not to introduce
code. CRISPR is a gene editing Intelligence included gene editing any modification in the genome of
technology that acts similarly to a in Worldwide Threat Assessments any descendants,” which has led
word processing program’s cut- in 2016 and 2017. Thus, recogni- to restrictions on its gene editing
and-paste function, inserting new tion of the need for a close watch research. [3]
genetic codes into cells for disease on CRISPR is critical to ensuring It is critical to begin the process for
treatment. [1] Effective interna- its protection and success. regulating CRISPR, as CRISPR
tional and federal regulation of kits are available and sold online
CRISPR is critical to ensure its safe Deployment of CRISPR tech- for around $100. This accessibility
and ethical application. CRISPR nologies is already underway--as could be beneficial, as it would al-
legislation must be enacted as soon of April 2019, the University of low for increased research towards
as possible in order to direct the Pennsylvania is running the first curing generational diseases or im-
technology towards productive, in-human trial of cancer patients proving food production. However,
rather than potentially destructive, using CRISPR technologies, avoid- a lack of control over how CRIS-
goals. ing the traditional use of viruses for PR technologies are distributed
therapy and instead directly mak- and used could ultimately increase
Background ing changes to the DNA. However, socio-economic divides, as its could
CRISPR technologies must be there is currently no concrete fed- foster the creation of a designer
closely regulated because of the eral or international legislation in babies market.
both negative and positive effects place regulating CRISPR technol-
the technology could have. The ogies. As of March 14th, CRISPR Recommended Action
potentially positive effects CRISPR research on the germline level has In order to ensure proper usage,
can facilitate include editing crops been halted by the National Insti- CRISPR should be regulated
to be more nutritious, editing the tutes of Health (NIH), and inter- on both the international level,
human genome to destroy genet- national organizations such as the through a World Health Organiza-
ic diseases such as cystic fibrosis, UN’s World Health Organization tion (WHO)-led regulation process;
editing mutations linked to breast (WHO) have only discussed creat- and on the federal level, through
and ovarian cancer, and eradicating ing an international registry man- FDA oversight. WHO’s sugges-
bacteria, enabling the shift away datory for all CRISPR projects. tion that all CRISPR experiments
from the current overuse of antibi- International and federal governing should be registered through an
otics. [4] CRISPR connects directly bodies could look towards France’s online database would keep close
to political, economic, social, and current practices. In France, the watch of labs pursuing CRIS-
public health spheres, as the mod- creation of the “France Genomic PR-related research. However, this
ifications it can make can alter all Medicine 2025” Plan has stim- may be inefficient as developments
forms of life and financial markets. ulated CRISPR research and outpace regulation, and major
If the technology is used incorrect- investments through its creation companies are increasingly pat-
ly, and improper edits are made to of a sharing platform for genome enting their findings, which might
DNA, future generations will be information and technology. [2] eliminate the need for this regis-
genetically damaged. CRISPR is France has also ratified the Ovie- try. Instead, WHO should release

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Roosevelt Review
guidelines as to research that can research licensing. [6] [7] has gained national attention. Dr.
and cannot be conducted using The NIH Office of Science Poli- Sam Sternberg, biochemist and
CRISPR, and then hold member cy’s Recombinant DNA Advisory colleague of CRISPR co-discoverer
countries of the UN accountable Committee (RAC), which provides Dr. Jennifer Doudna, emphasizes
for their research by establishing a policy recommendations for the the necessity for FDA oversight sim-
global treaty similar to the WHO federal government, has reviewed ilar to current regulation surround-
Framework Convention on Tobac- American gene therapy protocols. ing disease and cancer treatment
co Control (WHO FCTC). [8] Both the FDA and RAC review as it would effectively augment the
preclinical and clinical issues, and benefits of CRISPR domestical-
On the federal level, there are cur- have approved 5 products as of ly, and transparent conversation
rently no guidelines or regulations 2019. However, while Congress amongst international actors would
for CRISPR research. The Food has prohibited federal funding for prevent an international CRISPR
and Drug Administration (FDA) embryonic research projects on the arms race.
should closely monitor develop- germline level, most gene-editing
ments and closely watch the pat- findings has not been monitored in References
ents of CRISPR products closely the US. However, federal legislation 1. Stein, Rob. “First U.S. Patients
in order to prevent an exploitative is not enough, as if it were banned Treated With CRISPR As Human
gene modifying outbreak from in the US, individuals could travel Gene-Editing Trials Get
occurring. Establishing an FDA abroad for these processes.[9] For Underway”. NPR. April 16, 2019.
committee for CRISPR oversight these reasons, legislation monitor- 2. Vogel, Kathleen M., Students
will ensure CRISPR’s usage for ing and regulating gene-editing from PLCY 306. “CRISPR goes
good and help prevent its moneti- technologies must be instituted on global: A snapshot of rules, poli-
zation. Senators Lamar Alexander the federal and international levels. cies,
(R-TN) and Susan Collins (R-ME) and attitudes.” Bulletin of the
support congressional oversight of Conclusion Atomic Scientists. June 5, 2018.
gene editing activity on consumer Sales of CRIPSR kits should begin 3. Ibid.
safety grounds. [5] to be regulated to ensure that they 4. Plumer, Brad, Eliza Barclay, Julia
are only being used in monitored Belluz, and Umair Irfan. “A simple
CRISPR is difficult to regulate and registered settings. While guide to CRISPR, one of the
because of its many different CRISPR’s potential to do good is biggest science stories of the de-
forms, and many CRISPR kits noteworthy, CRISPR could also be- cade.” Vox. December 27, 2018.
have already been sold to stake- come a weapon deadlier than soci- the biggest science stories of the
holders with all levels of expertise ety has seen before. This regulation decade.” Vox. December 27, 2018.
(from high-school biology classes should be conducted on a federal 5. “Senate Committee Holds Hear-
to major biochemical companies). level. On the international scale, ing on CRISPR Science, Ethical
However, guidelines are needed for countries should meet annually to Concerns, Regulatory
future experimentation to ensure discuss their own CRISPR develop- Approaches.” Genomeweb. No-
proper usage. In mid-March, NIH ments to ensure close watch. There vember 15, 2017.
declared a moratorium on all is not currently any existing legisla- 6. Ibid.
germline gene editing research. tion regulating CRISPR. The 21st 7. Ibid.
However, this stagnation is not Century Cures Act was enacted in 8. Curran, Kevin. “How on earth
beneficial -- Jeffrey Kahn, Director 2016 to speed up the review pro- are we currently regulating human
of Johns Hopkins Berman Insti- cess for new medical technologies, genetic modification?” Rising
tute of Bioethics explained that but it does not specifically address Tide Biology. January 3, 2019.
banning research simply leads to CRISPR. he absence of CRISPR Chen, Angela. “If someone wants
researchers conducting their work legislation provides an opportu- to create gene-edited babies, who
in other countries. Congress could nity for regulation of some sort. would stop them?” The Verge.
look towards CRISPR regulation Especially following the creation November 26, 2018.
in the UK, where strict oversight is of two CRISPR-designed babies
balanced with clear pathways for in November 2018, gene editing
67
Tackling Interoperability of Health Infor-
mation Technology
By Sarah Lubin
Introduction their organization. [6] Although standard maintained is Health
The United States ranks highest in an established right by the HIPAA Level 7 (HL7) which can be used
healthcare spending per capita, but Privacy Rule, patients often do not for EHR migrations and transi-
health outcomes do not correlate have access to their health infor- tions, data export, research, quality
with the proportion of spending. mation. [7] As of 2017, 52 percent measurement as well as patient
[1] Difficulties with electronic of patients were offered online download.
health records (EHR), including access to their medical record by
inadequate codification and poor clinicians. [8] Of this group, half The Veterans Health Administra-
usability, exacerbate this problem. the individuals viewed their medi- tion (VA) recently updated its EHR
[2] These difficulties are rooted cal records online- this population network to meet the HL7 standard,
in the lack of interoperability of represents 28 percent of the United making it one of the largest health
health information technology States. [9] Eight in ten people who information exchanges in the US
(IT) and inadequate data. Interop- did view their health records online -- it exchanges the clinical docu-
erability of health IT, according considered their record useful and ments of nine million veterans with
to the 21st Century Cures Act, easy to understand, [10] suggesting over 145 partners. [13] Evaluators
“means health information technol- that successful implementation of have found that investments in
ogy that— (A) enables the secure accessible EHR programs is possi- health IT have led to meaningful
exchange of electronic health ble. improvements. A broad analysis of
information; (B) allows for com- the VA EHR found decreased error
plete access, exchange, and use of Three types of barriers must be frequency and other improvements.
all electronically accessible health targeted to achieve data sharing in- [14] Standardized terminologies for
information for authorized use; and teroperability: [11] significant tech- codes and data models offer con-
(C) does not constitute information nical obstacles of the current EHR sistency and normalize the clinical
blocking.”[3] In the last decade, system limit the delivery of success- processes. Unfortunately, EHR
the use of certified health IT has ful healthcare outcomes; consider- data is frequently collected and
become widespread among health able funding is needed to develop, expressed in local organizational
care providers, but electronic med- implement, and optimize health codes, leading to inconsistencies in
ical records have not resulted in IT; the need for trust between all data organization and in patient
increased sharing of health data. the players (patients, providers, and classification.
payers) presents a challenge to the
Background development of health IT. Although the new HL7 standards
Most patients’ health information offer many benefits such as EHR
is recorded electronically but this Recommended Action sharing, there has been little
information is often inaccessible The United States Department of adoption to date. HHS should
between different groups including Health and Human Services (HHS) implement a timeline for pro-
physicians, payers, and patients. As should design a program for health viders to adopt the C‑CDA HL7
of 2015, 96 percent of non-federal care providers to adopt and imple- standard for their EHR systems.
acute care hospitals adopted certi- ment congruent and consistent data Hospital networks in mid-sized
fied health IT. [4] For office-based communication technology. Cur- cities with populations between
physicians, 78 percent have ad- rently, the Consolidated Clinical 200,000 and 500,000 should be
opted certified EHR [5] however, Document Architecture (C-CDA) the initial targets of the program.
only about half of these physicians is the primary standard for clinical Educational information should
exchange information with other document exchange in the US. [12] be provided to providers, payers,
health care providers outside of The latest version of the C-CDA and patients to learn about how to

68
Roosevelt Review
use the increased access to health strategic-plan/strategic-goal-1/in- tient Data.” Health Affairs,
data. Consistent and standardized dex.html. www.healthaffairs.org/doi/
training for all parties should be 2. “Health Level Seven Interna- abs/10.1377/hlthaff.2017.0546?r-
required. After developing a suc- tional.” HL7 Standards Product fr_dat=cr_pub%3Dpub-
cessful foundation for implemen- Brief - HL7 CDA® R2 Implemen- med&url_ver=Z39.88-2003&r-
tation in midlevel metropolitan tation Guide: Clinical Summary fr_id=ori%3Arid%3Acrossref.
areas, the program should be scaled Relevant and Pertinent Data, org&journalCode=hlthaff.
up and down. Implementation in Release 1 | HL7 International, 7. HHS Office of the Secretary,
larger hospital networks in expan- www.hl7.org/implement/stan- Health Information Privacy Di-
sive metropolitan areas will benefit dards/product_brief.cfm?prod- vision. “Individuals’ Right under
from preliminary trials in smaller uct_id=453.;D’Amore, John et HIPAA to Access Their Health
urban areas to hopefully minimize al. “Interoperability Progress and Information.” HHS.gov, US De-
strain in transitioning. Application Remaining Data Quality Barriers partment of Health and Human
development and implementation of Certified Health Information Services, 25 Feb. 2016, www.hhs.
should not cause undue burden to Technologies.” AMIA ... Annual gov/hipaa/for-professionals/priva-
the industry. Symposium proceedings. AMIA cy/guidance/access/index.html.
Symposium vol. 2018 358-367. 5 8. Patel, Vaishali, and Christian
Conclusion Dec. 2018 Johnson. “Individuals’ Use of On-
Much progress has already been 3. Office of the Commissioner. line Medical Records and Technol-
made to interoperability and “21st Century Cures Act.” US ogy for Health Needs.” The Office
standardization of health IT across Food and Drug Administration of the National Coordinator for
the nation. Many EHR systems Home Page, Office of the Com- Health Information Technology,w-
are certified to the HL7 standard, missioner, www.fda.gov/regulato- ww.healthit.gov/sites/default/files/
although adoption and implemen- ryinformation/lawsenforcedbyfda/ page/2018-03/HINTS-2017-Con-
tation is the greatest obstacle to significantamendmentstothefd- sumer-Data-Brief-3.21.18.pdf.
date. Another target, in addition to cact/21stcenturycuresact/default. 9. Ibid.
the technical and structural modi- htm. 10. Ibid.
fications of EHRs, should focus on 4. “2016 Report to Congress on 11. “Annual Update on the Adop-
improving patients’ and providers’ Health Information Technolo- tion of a Nationwide System for
understanding of how to use their gy Progress.” 2016 Update to the Electronic Use and Exchange
medical data. Access to healthcare Congress on the Adoption of of Health Information.” 2018 Re-
records gives patients autonomy Health Information Technol- port to Congress, The Office of the
within this system. Greater accessi- ogy, dashboard.healthit.gov/ National Coordinator for Health
bility to medical records via smart- report-to-congress/2016-re- Information Technology, www.
phones is the future of healthcare. port-congress-examining-hi- healthit.gov/sites/default/files/
Large technology companies, such tech-era-future-health-informa- page/2018-12/2018-HITECH-re-
as Apple, are increasingly using the tion-technology.php#appendix. port-to-congress.pdf.
HL7 format to aggregate patient 5. “2016 Report to Congress on 12. D’Amore, John et al. “Interop-
data for mobile devices, setting the Health Information Technolo- erability Progress and Remaining
groundwork for the actualization gy Progress.” 2016 Update to Data Quality Barriers of Certified
of this goal. [15] Interoperability Congress on the Adoption of Health Information Technologies.”
and increased access to EHR will Health Information Technol- AMIA ... Annual Symposium pro-
benefit all involved in the health- ogy, dashboard.healthit.gov/ ceedings. AMIA Symposium vol.
care system. report-to-congress/2016-re- 2018 358-367. 5 Dec. 2018
port-congress-examining-hi- 13. Lyle J, Bouhaddou O, Botts
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69
China’s Great Firewall as an Economic
Threat
By Christopher Philogene
Introduction claimed China’s “Internet regu- states to regulate economic activity
Under the Ming dynasty, the latory regime” [5] was harming that is “necessary to protect pub-
Chinese built a series of walls and Sino-American trade by interfering lic morals or to maintain public
forts to protect themselves from with Facebook, Google, and Twit- order”, which is the argument the
the Mongols to the north -- we ter, all large American companies Chinese government uses to justify
now know these monuments as that spur American innovation and the Great Firewall. Yet American
the Great Wall. Today, the Chi- growth in the American econo- government experts have long
nese are once again barricading my. A 2011 study estimated that dismissed this argument: the 2016
themselves against foreigners, this Facebook’s Platform feature alone National Trade Estimate Report
time through digital suppression created at least 180,000 American (NTER) called this blocking “arbi-
tactics like the ‘Great Firewall’. jobs; [6] Amazon has advertised its trary”, [8] and decried the CCP’s
’The Great Firewall is a new effort plan to create 100,000 jobs at its behavior as anti-competitive. For
by the Chinese Communist Party new American headquarters. example, the CCP demanded that
(CCP) to restrict its citizens’ access the American social network Linke-
to foreign media, limit freedom The international expansion of dIn not just comply with state
of speech and monitor ‘suspicious these companies allows for greater censorship activities but also relin-
activities’. Some companies, like growth and prosperity in the Unit- quish a significant share of its local
Google and Facebook, are fully ed States, and a global marketplace operations to Chinese stakeholders.
banned while others, such as Linke- allows American innovators to Forcing a company to relinquish
dIn, have adapted their platform bring foreign currency back to the shares in order to enter a market is
to suit the demands of the Chinese United States. The Great Firewall clearly a form of economic coer-
Communist Party (CCP). [1] For actively restricts companies’ po- cion that has no relation to national
years, American leaders have been tential for expansion. By limiting security, especially since LinkedIn
waiting for the internet to liberalize access to American sites, China’s had already agreed to follow local
China; [2] instead, the internet has Great Firewall is actively stymying regulations.
only reinforced existing CCP policy. the American technological field
We must recognize the immense for the benefit of Chinese com- Unfortunately, the issue of eco-
harm to American interests posed panies, many state-owned. In this nomic regulation of American tech
by the Great Firewall and active- way, it bears resemblance to a more companies is not at the forefront of
ly pursue a reformation in CCP traditional protectionist policy, as discussions on Chinese trade policy.
behavior. depriving companies of competi- The United States is currently
tion helps local industries in China. prioritizing trade deficit reduction,
Background [7] subverting the WTO in the process.
Access to critical media is un- Instead, the United States should
doubtedly a human rights issue Recommended Actions bring its case that China is violat-
[3] and by limiting such access the The US State and Treasury depart- ing WTO regulations to the WTO’s
CCP exerts a malign force on its ment must lay out a clear case for Dispute Settlement System (DSS),
own people. Experts in the field why China’s Great Firewall brings an international framework that al-
have also begun to see this as an about serious economic harm not lows for states to reach agreements
economic issue: many have asked justified under the World Trade without resorting to an escalation
whether it should be considered a Organization’s (WTO) national se- of protectionist measures.
trade barrier. [4] The 2016 Nation- curity provisions. On the one hand,
al Trade Estimate Report (NTER) the WTO recognizes the rights of Conclusion

70
Roosevelt Review
Pursuing a resolution through the References 8. Froman, “2016 National Trade
WTO offers the United States 1. Paul Mozur and Vindu Goel, To Estimate Report” pp. 91
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71
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79
Let us never forget that government is ourselves
and not an alien power over us. The ultimate
rulers of our democracy are not a President and
Senators and Congressmen and government of-
ficials, but the voters of this country.
- Franklin D. Roosevelt

80