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Tag: Robert Greenwald

Don’t repeat the mistakes of 1918

via Boston Globe

by Carol Rose and Robert Greenwald

A positive COVID-19 serological test at a laboratory in Colmar, eastern France, on April 14, the 29th day of a strict lockdown in France to stop the spread of COVID-19.

A positive COVID-19 serological test at a laboratory in Colmar, eastern France, on April 14, the 29th day of a strict lockdown in France to stop the spread of COVID-19.SEBASTIEN BOZON/AFP VIA GETTY IMAGES

During the 1918 influenza pandemic, local governments in the United States placed special placards on the doors of homes where sick people were subject to quarantine. The measure was an attempt to contain the spread of a virus that ultimately killed nearly 700,000 people in the United States alone. Sadly, this well-intentioned move backfired: Many doctors chose not to report cases in order to prevent homes from being quarantined. Families of sick people sought to evade the stigma of a placard on their homes by not seeking medical attention.

In light of today’s coronavirus crisis, it’s useful to recall this history and to avoid repeating the mistakes of the past. Yet in an executive order dated March 18, the administration of Governor Charlie Baker directed local boards of health to submit to first responders the home addresses of people who have tested positive for the virus. The idea is that police, fire services, and EMTs should know which homes have COVID-19 cases so that responders can adequately protect themselves.

Protecting the health of first responders is certainly an important priority that the state needs to address; however, some public health experts have noted that disclosing addresses does not ensure a first responder would be safe from exposure from asymptomatic people or from those who are infected but remain untested. It may seem counterintuitive, but this order could indeed do more harm than good.

This truth is that we do not know — and at this point cannot know— who has COVID-19 and who does not. Recent estimates are that as many as 1 in 4 cases may be asymptomatic. Thousands of people who have fallen sick and who may have the virus have been unable to obtain a test, and so won’t appear on any list of homes provided to responders. Providing the addresses to first responders of people who have tested positive thus makes no sense — from either a public health or patient privacy perspective. To protect public health, we cannot create lists that give our responders a false sense of security and instead they must treat everyone as a potential carrier of the virus.

First responders deserve the best equipment, and the best policies, to ensure their safety. But the harsh reality is that our first responders continue to lack sufficient personal protective equipment and, system-wide, we don’t have enough COVID-19 tests. Emergency medical technicians, paramedics, firefighters, and police officers — like our doctors, nurses, and other front-line essential workers — are being asked to continue to do their jobs amid acute conditions, without the equipment they need to keep themselves safe.

Thankfully, government officials in Massachusetts are taking important steps to address the lack of PPE and tests for front-line workers. The Baker administration and Mayor Marty Walsh of Boston announced plans to set up additional testing sites that give priority to first responders. These sites should be open to all workers who are putting themselves at risk, whether they are first responders or grocery store workers.

Ultimately, we must listen to public health consensus during public health emergencies. And the public health experts are clear: The twin threats of community-level transmission and a lack of wide-scale testing make the use of home addresses dangerously ineffective. Worse, since screening is critical to slowing the spread of the disease, disclosing addresses of confirmed cases will undermine public health efforts by deterring some people from seeking testing and treatment — just like during the 1918 influenza.

Sometimes public health needs overtake our normal expectations of privacy or other civil liberties. But disclosing the home addresses of people who have tested positive is not one of those cases. First responders, like all of us, should treat every person they interact with as a possible COVID-19 patient. Relying on the training of our first responders, not the home addresses of those stricken by the virus, is the best way to ensure public health and safety for everyone.

Carol Rose is the executive director of the ACLU of Massachusetts. Robert Greenwald is a clinical professor of law at Harvard Law School and the faculty director of the Law School’s Center for Health Law and Policy Innovation.

HLS clinics and students fight for the most vulnerable amid COVID-19

via Harvard Law Today

by Brett Milano

Computer screen showing Zoom session between three people

Zack Manley ’21 (upper left) and Norah Rast ’21 meet with Clinical Professor Sabi Ardalan ’02 (upper right), director of the Harvard Immigration and Refugee Clinical Program, to discuss legal strategy to get their client, an asylum seeker, out of Stewart Detention Center, where several employees and immigrants have tested positive for COVID-19. They recently won a stay of their client’s deportation and are appealing his case to the U.S. Court of Appeals for the Eleventh Circuit.

For the Clinical Program at Harvard Law School, the past weeks of the COVID-19 pandemic have been a time to mobilize. As the clinics have moved to working remotely, their work has continued with new urgency—and often, with new challenges as well.

“The Law School’s clinics and student practice organizations have been incredibly nimble in their ability to continue to advocate for their existing clients and also to take on the emerging legal needs of community members related to the COVID-19 outbreak,” says Dan Nagin, Clinical Professor of Law and Vice Dean for Experiential and Clinical Education. “Clinical directors and supervisors and their students are using a variety of technology—from Zoom to FaceTime to telephone—to be accessible to each other and to their client communities, and to meet the pressing legal needs of the most vulnerable. Many courts and agencies have ongoing and active dockets and are conducting hearings remotely, and students, staff, and faculty at clinics and student practice organizations across HLS are continuing to do critical work in a variety of legal areas.”

“This work also includes absolutely vital policy advocacy by clinics to ensure that governmental responses to the pandemic take into account questions of equity and access to healthcare, financial assistance, and other supports,” Nagin added.

Each clinic has also adapted to working online. “Zoom is our new best friend,”  says Clinical Professor Robert Greenwald, faculty director of the Center for Health Law and Policy Innovation (CHLPI). “I’ve learned to teach online, and I’m now a savant at Google Docs. I have AirPods attached to my head for 12-15 hours each day. But we’ve adjusted.”

CHLPI, he says, remains on the front line of advocating for the care and treatment of low-income populations. “We are working to secure testing and treatment, as well as all other necessary health care, for those who are most vulnerable, including many people living with AIDs, racial and ethnic groups that are historically disenfranchised, and the growing number of people who are uninsured.”

The work involves numerous efforts on both the local and national levels. They have called on the Trump administration to use its emergency authority to allow for early and extended drug refills, and to fill gaps in the next stimulus package, including an increase in Medicaid funding and an extension of no-cost testing and treatment. They are also working with several partners, such as Feeding America and the national Food is Medicine Coalition, to address the food and nutrition needs of vulnerable populations. And they are working to promote equal health access within Massachusetts, calling on Governor Charlie Baker to collect and publish testing data related to race and ethnicity to identify the hardest-hit groups.

Robert Greenwald as seen through a video conferencing screen

Robert Greenwald, faculty director of the Center for Health Law and Policy Innovation, has shared his public health expertise with multiple national media outlets during the COVID-19 crisis, including in an April 8 interview with WNBC on privacy concerns with police departments maintaining a list of addresses of confirmed coronavirus cases.

CHLPI has also taken on the challenge of preserving the Affordable Care Act. Two students, Isaac Green ’22 and Will Dobbs-Allsopp ’20, are currently working to get the Trump administration and 18 state attorneys general to withdraw from a Supreme Court challenge to the ACA. Though the administration seems determined to overturn the act, Dobbs-Allsopp says, grassroots efforts on the local level could make the difference. The clinic is planning to work with community health groups in different states.

“At the end of the day, attorneys general are politicians who respond to political pressure. People’s interest in universal health coverage has picked up, and you’re going to see some interesting polling in the next few weeks,” Dobbs-Allsopp says. “They’re realizing that getting rid of this law means the disease will persist and the economy will get even worse.”

In addition to the work we’re doing with individual clients, we are asking what work we can be doing to fight the systemic causes of poverty, so that these issues don’t keep coming up.

Kiah Duggins ’21, Harvard Legal Aid Bureau president

The Harvard Legal Aid Bureau (HLAB) correctly predicted that the virus would disproportionately affect minority and impoverished communities—an idea that is only now beginning to hit the mainstream. HLAB’s President Kiah Duggins ’21, who works closely with HLAB Faculty Director Esme Caramello ’99, cites the inaccuracy of New York Governor Andrew Cuomo’s reference to the virus as “the great equalizer.”

“The narrative is that anyone can get the virus, which is true. But low-income workers are either on the frontlines without adequate protection, or they’re disproportionately in danger of losing their jobs,” Duggins says. “And as the numbers come out, we’re seeing that black people are dying at disproportionately high rates.”

She adds, “This has raised interesting discussions about our mission, because a lot of the issues that Americans are facing because of the crisis have been faced by lower-income people forever. The crisis has elevated that in the public consciousness. So, in addition to the work we’re doing with individual clients, we are asking what work we can be doing to fight the systemic causes of poverty, so that these issues don’t keep coming up.”

This, she says, includes working with Greater Boston Legal Services and City Life/Vida Urbana in Jamaica Plain.

“Even before the crisis we were trying to promote racial and economic justice, to empower those communities directly,” Duggins says. “And the crisis has made it clear how the causes and consequences of poverty affect these communities. So we’re now able to get things done, like an eviction moratorium or rent suspension. People who weren’t supportive before are supportive now because it affects a broader swath of people.”

A group of HLAB members standing in front of MA House of Representative steps. Many are holding signs or banners.

In early March, the Harvard Legal Aid Bureau, Greater Boston Legal Services and City Life/Vida Urbana organized a rally in front of Boston Housing Court to make the case for a complete halt to any evictions while the state of emergency in Massachusetts remains in effect. On April 2, the Massachusetts House of Representatives passed legislation based on HD.4935, an act providing for a moratorium on evictions and foreclosures during the COVID-19 emergency.

HLAB has also been working to help the University support lower-income Harvard students who were approved to continue living in on-campus housing. “Many of the members of HLAB are lower-income and people of color, so the worlds are more interconnected than you might think. We want to make sure we’re creating healthy lawyers,” Duggins says.

The Harvard Immigration and Refugee Clinic (HIRC) is continuing its mission of advocating for immigrant justice. And it’s now, more than ever, trying to respond to the health-threatening conditions within immigration detention centers.

“We’re continuing our work on behalf of clients, including litigation and policy advocacy,” says HIRC Director and Clinical Law Professor Sabrineh Ardalan ’02. “We’re focusing on getting clients out of immigration detention, given the conditions and risks of being detained right now due to COVID-19.”

One of the HIRC clients, she notes, is an asylum seeker detained at the Stewart Detention Center in Georgia, where conditions are dire. “He sleeps in a room with more than 60 people in bunk beds, so there is no social distancing. At meals, they sit four to a table and he works in food prep, where there are 30-40 people who work the shift. Very few guards have protective gear, and there are documented reports of officials and immigrants with COVID-19 in the facility.”

Circumstances in Massachusetts detention facilities, Ardalan says, are also dismal. The Crimmigration Clinic, directed by Phil Torrey, has filed habeas petitions to seek the release of two immigrant clients detained at the Franklin County House of Correction in Greenfield, Mass. The petitions argue that these individuals are being held in violation of their Fifth Amendment rights and both have lodged claims concerning potential COVID-19 exposure. Sarah Libowsky ’20 and Michael Hur ’20 are tentatively scheduled to argue one of the habeas petitions on April 16 before Judge Mark G. Mastroianni, in the U.S. District Court for the District of Massachusetts.

Similarly, the Harvard Immigration and Refugee Clinic at Greater Boston Legal Services, led by Nancy Kelly and John Willshire Carrera, joined the American Civil Liberties Union of New Hampshire in filing an emergency federal habeas lawsuit on behalf of an indigenous Guatemalan asylum seeker detained in Strafford, New Hampshire, and managed to secure his release from detention.

HIRC attorneys and its social work team are also trying to respond to the needs of immigrant clients who are not detained, but who are in precarious circumstances due to COVID-19. “Some are worried about how to pay rent and feed their families. Others are still going to work, because remote work isn’t an option, and their health is at risk because of it,” Ardalan says. Immigrant families may be afraid to access the health care and services they need, due to concerns about immigration enforcement.

HIRC has joined the Massachusetts Law Reform Institute and Prisoners’ Legal Services of Massachusetts, among dozens of other organizations, in submitting a letter to Immigration and Customs Enforcement (ICE) and local county sheriffs and jail wardens of the facilities that contract with ICE, urging them to cease local immigration enforcement operations and arrests and release immigrants in custody in light of the pandemic.

“It has been very difficult. A variety of lawsuits have been filed across the country with mixed results,” Ardalan says. One encouraging sign, she says, is that some local courts and officials have proved willing to step in and order immigrants’ release from detention. “I hope that all our advocacy efforts will bear fruit, because circumstances are so dire.”

Screenshot shows a Zoom meeting with 9 women holding signs that read 'free her'

The Harvard Prison Legal Assistance Project is advocating for immediate release of vulnerable inmates who pose no public risk to protect the incarcerated community from COVID-19.

The Harvard Prison Legal Assistance Project (PLAP) has also been working to keep incarcerated people safe from COVID-19. PLAP hosted a Zoom phone bank on April 3 as part of the Massachusetts week of action, organized by Families for Justice as Healing and the National Council for Incarcerated and Formerly Incarcerated Women and Girls. PLAP is calling on district attorneys, sheriffs, the governor, elected representatives, and the Massachusetts Department of Corrections to demand immediate release of vulnerable inmates who pose no public risk to protect the incarcerated community from COVID-19.

Harvard’s Federal Tax Clinic has remained busy even as the IRS itself has largely shut down. That means pressing forward with cases that were underway before the pandemic hit. “We deal with people having some kind of problem with the IRS—either they owe and they need to work out payments, or the IRS says they owe more than they think,” says Clinic Director T. Keith Fogg. Clients are currently having difficulty reaching anyone at the IRS—which has closed its last operating service center, causing cases in the administrative stage to be put on hold. Yet cases in court are still moving forward remotely, so there is still plenty of work for clinic students.

The clinic is also working with direct consequences of the pandemic, including laying some groundwork for the post-recovery era. For one thing, Fogg says, we can probably expect a shift to more email filing and electronic signatures in the future. And the recent implementation of the CARES act, which provides a $1200 rebate to some workers, has also opened work possibilities.

“We’ve been talking a fair amount to people at the IRS about implementing their procedures during the crisis, and explaining to the community what new provisions mean,” Fogg says. The clinic is already engaged in advocacy to reduce the number of people who need to file a tax return to receive the rebate (the IRS has already exempted regular social security recipients). Advocacy efforts are ongoing to exempt recipients of Supplemental Security Income and Veterans benefits who desperately need the financial help.

Faculty and students at the Food Law and Policy Clinic (FLPC) have also stepped up their work during the pandemic, writing briefs aimed at saving tons of food that could feed the hungry, and working to inform the response to COVID-19, including congressional legislation. In the early stages of the crisis, FLPC acted quickly to outline avenues for donating excess food in the wake of campus and business shutdowns to help feed the hungry. Since then, the clinic has developed and amplified several other resources on using food donation to support food banks and other food recovery organizations, which are facing both an increase in demand and limited resources.

“There are already so many people who were in vulnerable situations,” says Emily Broad Leib ’08, director of FLPC and deputy director of the Harvard Law School Center for Health Law and Policy Innovation. “The crisis has exacerbated food access challenges for those people, and it has added so many more individuals and families in need. Workers are losing jobs, especially those doing hourly work—many, in fact, who work in the food industry. We are going to see a huge increase in people who suddenly need help getting basic needs met, especially food.”

Screen shot of Emily Broad Lieb speaking on a podcast about food law

On “Food Talk with Dani Nierenberg” on March 25, Emily Broad Leib, director of HLS’ Food Law & Policy Clinic, talked about food law and policy concerns in the COVID-19 crisis, including protecting and promoting better wages for food workers.

The FLPC has also responded to new concerns about food safety by preparing an issue brief with recommendations for federal and state governments to facilitate food delivery during the crisis using existing food assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

They also have come up with proposals for getting food from food banks and other organizations delivered directly to people’s doors, and for getting Congress to  support these community-based food delivery organizations. Their recommendations include investments in technologies that connect food donors to recovery organizations.

“We make the point that these technologies can be really responsive to the challenges of the moment,” says Broad Leib, “but most of them have been developed by small nonprofits. Helping them scale up quickly to meet the needs of the growing number of people who need food support is going to require an investment.”

Pro Bono Week 2019 Recap

Every year, the Office of Clinical and Pro Bono Programs (OCP) at Harvard Law School (HLS) participates in the American Bar Association’s National Celebration of Pro Bono. Held from October 21st – 25th, 2019, Pro Bono Week serves as a time where HLS celebrates and reflects on the pro bono work that staff, faculty, and students do throughout the year.

The theme of this year’s Pro Bono Week, Stand Together, Stand for Justice, emphasized the importance of collaborative advocacy and how lawyers working together with clients, partner organizations, and communities can inspire change that positively impacts public interest. In line with Stand Together, Stand for Justice, OCP hosted a series of panels featuring attorneys and experts from a variety of fields to speak about their work.

 

Yee Htun (left) and Nadia Aziz (right) during their conversation on combating hate speech and hate crimes in communities.

 

Stopping Hate: A Conversation with Yee Htun and Nadia Aziz

Yee Htun of HLS’ International Human Rights Clinic and Nadia Aziz of the Lawyer’s Committee for Civil Rights Under Law shared a conversation on topics surrounding hate speech and hate crimes. Aziz, who currently serves as the Interim Co-Director and Policy Counsel of the Stop Hate Project, spoke about the project’s work to create strategies on how to combat hate in local communities. The Stop Hate Project manages a resource and reporting hotline for hate incidents, works collaboratively to enhance the response of law enforcement and community organizations to hate crimes, and engages in the public interest sphere. Additionally, she spoke about her work on the lawsuit against The Daily Stormer representing Taylor Dumpson; as well as how hate speech and hate crimes have evolved over the past decade given the presence of social media.

 

Tony Marino (left), Dr. Fiona Danaher (middle), and Robert Greenwald (right) after their discussion on reinstating care for critically ill immigrants.

 

A Critical Win: The Fight to Reinstate Care for Critically Ill Immigrants

HLS Clinical Professor Robert Greenwald hosted a discussion with Tony Marino, the Director of Legal Services at the Irish International Immigrant Center, and Dr. Fiona Danaher, a pediatrician with Massashusetts General Hospital (MGH) and co-chair of the MGH Immigrant Health Coalition. Both were involved in the fight to reinstate the Medical Deferred Action program, which allows immigrants to remain in the U.S. while they or their relatives receive life-saving medical care. Marino and Danaher spoke about how the partnership between lawyers and medical professionals developed around this issue, with Marino also mentioning the role of the press and public outcry. Both Marino and Danaher emphasized the necessity of working together to create a space where advocacy can be effectively accomplished and how important inclusive legal work is.

 

Kendra Albert (left) and Ria Tabacco Mar (right) as they speak about cases regarding LGBTQ discrimination.

 

LGBTQ Discrimination before the Supreme Court: Reflections from Employees’ Counsel

In light of the October 8th Supreme Court cases regarding LGBTQ discrimination in the workplace, Kendra Albert, Clinical Instructor with the Cyberlaw Clinic, hosted a conversation with Ria Tabacco Mar, a senior staff attorney with the National ACLU LGBT & HIV Project. Tabacco Mar discussed her experiences with litigating on issues of LGBTQ discrimination and spoke about her work on LGBTQ Title VII discrimination cases before the Supreme Court as well as her previous work on Masterpiece Cakeshop v. Colorado Civil Rights Commission. She also spoke more broadly on challenging pre-existing notions of how concepts such as gender and sexuality are used and interpreted in law. She also touched on the necessity of considering intersectionality when dealing with issues surrounding identity, particularly those relevant to the LGBTQ community.

 

CHLPI’s Robert Greenwald Quoted in Bloomberg Law Article on HIV Drug Coverage

Via The Center for Health Law and Policy Innovation

A February 22, 2019 article from Bloomberg Law includes an interview with CHLPI’s Faculty Director and HLS Professor Robert Greenwald. The article, Trump’s Call to End HIV at Odds With Silence on Coverage Woes, written by reporter Jacquie Lee explores the tension between the President’s pledge to end HIV in the United States in the next ten years and the administration’s silence on discriminatory drug coverage within Medicaid.

Excerpt from the article:

“The Trump administration is promising to end AIDS within 10 years at the same time it’s staying silent on complaints accusing insurers of unfair HIV drug coverage.

Complaints protesting HIV drug coverage in Obamacare plans in counties where the infection rates are growing the most have gone unanswered by the Department of Health and Human Services for years.”

 

Read  Trump’s Call to End HIV at Odds With Silence on Coverage Woes in full.

People in Puerto Rico Can’t Get the Same Hepatitis C Meds as Other American Citizens Do

Via Tonic

Source: Flickr

By: Carmen Heredia Rodriguez

Drugs that can cure hepatitis C revolutionized care for millions of Americans living with the deadly liver infection. The drugs came with a steep price tag—one that prompted state Medicaid programs to initially limit access to the medications to only the sickest patients. That eased, however, in many states as new drugs were introduced and the prices declined.

But not in Puerto Rico: Medicaid patients in the American territory get no coverage for these drugs.

The joint federal-territory healthcare program for the poor—which covers about half the island’s population—does not pay for hepatitis C medications. They also do not cover liver transplants, a procedure patients need if the virus causes the organ to fail.

The Puerto Rico Department of Health created a separate pilot project in 2015 to provide hepatitis C medications to those sickened by the liver infection who also have HIV, but expanded the program later to those with only hepatitis C. However, according to the Office of Patient Legal Services, an official territorial agency that advocates for consumers, the program ran out of funding and is no longer accepting patients only with hepatitis C.

The Puerto Rico Health Insurance Administration (ASES), which oversees Medicaid, says it is working with a pharmaceutical company to create a cost-effective system to provide these medications.

“Definitely, they need to be given coverage,” ASES director Angela Ávila Marrero says. “They need to be given care.”

The Department of Health did not comment.

Hepatitis C, a bloodborne infection, increases the risk of cirrhosis, liver cancer, and death. Poor screening led many to contract the disease through tainted blood and organ transplants through the early 1990s. Today, intravenous drug use drives most of the new cases in the United States.

William Ramirez, executive director of the American Civil Liberties Union of Puerto Rico, says he is considering filing suit against Puerto Rico for failing to cover the cost of these medications for people enrolled in Medicaid.

You’re holding back medication and thereby allowing certain people to die,” Ramirez says.

That reality is clear for Hector Marcano, 62, who stopped working roughly six years ago because of the illness. After recovering from a drug addiction, he was a case manager who worked to connect drug users to health resources.

His liver disease is leading to overall deterioration. He struggles with walking. A bout of pneumonia that left him hospitalized lingers in his racking coughs. He spends his days reading, listening to the radio, and praying for the strength to keep searching for the cure.

He doesn’t understand why the government does not provide hepatitis C medications, he says, especially as there are so many people in need of them.

“So what are we waiting for?” asked Marcano. “For a pandemic to happen?”

Medicaid costs drive island’s debt crisis

Approximately 3.5 million people in the United States have hepatitis C. The virus can silently corrode the liver for years without causing symptoms.

Because of the condition’s stealthy nature and the absence of recent data, the number of people in Puerto Rico living with the virus is uncertain. Researchers on the island in 2010 estimated that 2.3 percent of 21- to 64-year-old residents had the virus.

Documents provided by the Center for Health Law and Policy Innovation of Harvard Law School show medical providers reported more than 11,000 hepatitis C cases to the Puerto Rico Department of Health from 2010 to September 2016.

Cynthia Pérez Cardona, an epidemiology professor at the University of Puerto Rico and an author of multiple studies involving hepatitis C in Puerto Rico, says she is uncertain of how widespread the virus is on the island. But other statistics present a worrisome sign: A report from the island’s cancer registry found the number of new liver cancer cases increased an average of 2.1 percent annually among men and 0.7 percent among women from 1987 to 2014. Hepatitis C can cause such cancers.

Despite these warnings, Puerto Rico has fewer resources than most of the nation to care for its impoverished.

Unlike states, Puerto Rico’s federal funding for Medicaid is capped. Historically, these federal dollars have fallen far short of covering the program’s costs on the island. The territory’s crushing Medicaid expenses helped drive the island into its $70 billion debt crisis.

Under these financial constraints, says Matt Salo, executive director of the National Association of Medicaid Directors, Puerto Rico’s officials are left with a difficult choice when considering covering hepatitis C drugs.

“Rather than blowing through their cap in six months,” Salo says, “they’d blow through their cap in one month.”

Pilot project falls short

In the health department’s pilot project, patients with certain conditions like uncontrolled diabetes or an active mental health condition or those who could not prove they had been sober for six months were barred.

Such restrictions rankle patients and their advocates. “You know, we do not deny lung cancer treatment for a person who smokes or diabetes treatment to a person that doesn’t eat well,” says Robert Greenwald, a professor at Harvard Law School and faculty director of the Center for Health Law and Policy Innovation.

José Vargas Vidot, a member of Puerto Rico’s Senate and a physician, submitted a petition in 2017 to various territorial agencies questioning Medicaid’s coverage of hepatitis C medications.

The Office of Patient Legal Services responded to Vargas Vidot in a letter this year confirming that the island’s Medicaid program did not cover these drugs. It also noted the health department pilot project closed its wait list after reaching 100 patients because of a lack of funding. In November, Vargas Vidot submitted legislation to require that hepatitis C medication and treatment be part of basic coverage for insurance plans and Medicaid.

Ávila Marrero says ASES is in talks with a drugmaker to create a network separate from the Medicaid program to provide medications to the patients. She is hoping the arrangement would allow the government to get lower prices for the drugs. But no agreements have yet been reached for such a program.

Despite its success in states, suing to get coverage may not be the best option for Puerto Rico because the debt rescue package passed by Congress in 2016 includes a provision that bars creditors from taking legal action to collect from the territory.

That could apply to a lawsuit filed against the territory for not covering hepatitis C treatment in its Medicaid program, says Phillip Escoriaza, a health and federal grants law attorney in Washington, D.C., who practiced in Puerto Rico.

And even if the case can go forward, it would enter the docket for a special bankruptcy court with more than 165,000 other claims, as of January 2. It may be in the Puerto Rican government’s interest for things to take a long time, Escoriaza says. Once there, it could stall for years—time hepatitis C patients such as Marcano might not have.

Obamacare architect: Dire consequences for Massachusetts

Via The Boston Herald 

By: Jordan Graham

The architect of Obamacare warned the Affordable Care Act could die if the U.S. Supreme Court backs a ruling by a Texas judge calling the law unconstitutional — a decision that would force Massachusetts to strip coverage or pay astronomical bills.

“It’s got very important financial implications for Massachusetts,” said Jonathan Gruber, an economist who has been described as the engineer of the law. “If the Affordable Care Act goes away, it means Massachusetts will have to bear all the costs of covering these people.”

The ruling by U.S. District Judge Reed O’Connor hands a victory to 20 Republican governors and state attorneys general who sued to wipe out the 2010 health care law, widely known as Obamacare. If the ACA is eliminated, Massachusetts’ requirements for insurance would be unchanged, but it would mean an end to federal contributions to states that have expanded Medicaid, as Massachusetts does.

Robert Greenwald, director of the Center for Health Law and Policy Innovation at Harvard Law School, said nothing will change immediately as a result of the decision by the Texas judge that found the law to be unconstitutional and invalid .

“This is certainly not the final word on the Affordable Care Act,” Greenwald said. “Obviously it’s going to be appealed, it’s going to be a long slog on this and other challenges to the ACA.”

O’Connor, a conservative judge appointed by President George W. Bush, had been widely expected to rule against the law, at least in part. His ruling, however, swept more broadly than many had expected, striking down the entirety of the health care law, including its provisions that have allowed California and 31 other states to expand Medicaid to 15 million Americans and the subsidies that keep insurance affordable for millions of others who do not get health care coverage through their employers.

The judge did not issue an injunction ordering the government to stop carrying out the law, however, meaning that its provisions will remain in effect pending further action.

The Trump administration had partially backed the suit by the conservative states, not endorsing their request to declare the entire law invalid. Instead, the administration had declined to defend the health care law and asked the judge to eliminate its guarantee of coverage for people with pre-existing health conditions.

A group of left-leaning states, led by California, that have stepped in to defend the health care law, quickly said they would appeal O’Connor’s ruling.

President Trump praised the judge’s ruling but health care groups denounced it. The American Medical Association said it would back an appeal, warning that the judge’s ruling would move the U.S. back toward the days when 20 percent of the population lacked insurance.

The states likely will appeal to the 5th U.S. Circuit Court of Appeals. Eventually, the case could wind up back at the Supreme Court, which has twice ruled in favor of the law.

Health Groups Upgrade R.I. Hepatitis C Medicaid Access to ‘A-’

Via the Center for Health Law and Policy Innovation

Source: Pexels

Originally published by the Providence News Journal on October 29, 2018. Written by Rob Borkowski.

The R.I. Executive Office of Health and Human Services removed all restrictions on curative hepatitis C treatments for its Medicaid patients on July 12, a move that the National Viral Hepatitis Roundtable and the Center for Health and Law Policy Innovation at Harvard Law School took note of in upgrading the state’s report card for the Hepatitis C: The State of Medicaid Access project from a “D-” to an “A-”.

Rhode Island’s decision improved access to the treatments for Medicaid patients in both its Fee-for-Service and Managed Care Organization Medicaid programs. Previously, the state restrictions on access to hepatitis C treatments were not in line with federal medical necessity requirements for Medicaid.

But the state worked in conjunction with the Center for Health and Law Policy Innovation, the Rhode Island Center for Justice and other community partners to make the policy change.

“We commend Rhode Island for expanding access to hepatitis C medications for all Medicaid beneficiaries, ensuring that more Rhode Islanders can receive curative treatments. CHLPI encourages other states to follow in Rhode Island’s footsteps and remove their discriminatory restrictions,” said Robert Greenwald, clinical professor of law at Harvard Law School and the director of CHLPI.

Rhode Island’s Fee-For-Service program previously required hepatitis C patients to demonstrate severe liver damage (a fibrosis score of F3 or greater), undergo screening and concurrent alcohol and substance use counseling for beneficiaries actively using, and obtain a prescription from a specialist that is approved by the R.I. Executive Office of Health and Human Services. With these restrictions in place, very few patients diagnosed with hepatitis C had access to treatment. Each year, it is estimated that only 250 Rhode Islanders who are Medicaid beneficiaries receive access to curative hepatitis C medications.

“After years of strong advocacy efforts in Rhode Island, all Medicaid patients diagnosed with hepatitis C can now receive access to treatment without restrictions. We continue to encourage all Medicaid patients at risk to undergo screening and learn about available treatment options,” said Tina Broder, interim executive director of the National Viral Hepatitis Roundtable.

Trump administration says it’s ending ACA ‘sabotage,’ experts say it comes at great risk to patients

Via Healio.com  

Source: Ted Eytan,  Flickr.com

By: Janel Miller

The average premium for the second lowest cost silver health insurance plans — the one used to determine final premium tax credits — will drop by a “historical” 1.5% for the first-time since the implementation of the federally-facilitated exchange in 2014, according to CMS.

However, experts told Healio Family Medicine that the agency’s actions put profit over patients and puts the well-being of many Americans at risk.

CMS claims

The average change in premium costs may not seem like a lot but is significant when put into historical context, Seema Verma, CMS administrator, said in a conference call with reporters.

“This is a very positive change from the double-digit increases we have seen over the past 2 years,” she said, noting that some states had seen increases of 200% and higher. The change in premiums was just one of the health insurance-related accomplishments under the Trump administration she lauded during the call.

According to Verma, states will soon be able to use waivers to increase their flexibility in sustaining their insurance markets. In addition, for the first time in several years, there will be an increase in insurance providers on the federal health insurance exchange market, she said.

“While some have been accusing [the Trump administration] of sabotage, the reality is we have been doing everything we can to mitigate the damage caused by Obamacare,” Verma said.

Experts weigh in

Arthur Caplan, PhD, founding head of medical ethics at New York University School of Medicine, and Robert Greenwald, JD, faculty director, Center for Health Law and Policy Innovation at Harvard Law School said in interviews CMS should not be patting itself on the back.

“The idea that the Trump administration is trying to save patients is ludicrous,” Caplan said in an interview. “It has permitted lousy cheap coverage, cheap, almost worthless policies to be sold,”  adding that is the “real reason why” CMS can make an announcement like this one.

“Putting this pig in a dress by claiming they’re helping people doesn’t make what they’re really trying to do — make the Affordable Care Act a footnote in history — go away. They’re putting money over people,” Caplan added.

“In no way does the Trump administration deserve credit for the state of the marketplace,” Greenwald agreed. “They have done everything in their power to destabilize it.”

According to Greenwald, states and insurance companies positively balanced the Trump administration’s actions by funding outreach and navigation efforts to promote the marketplace, adopting their own individual mandates to assure that there is diversity among marketplace applicants, passing laws that banned or limited the introduction of “junk” insurance plans, introducing a reinsurance system that results in lower premiums in their marketplaces, and allocating premium rate increases into silver-level plan premiums only.

Greenwald added it is not too late for clinicians and others to make their thoughts about health insurance known.

“If the American people want to see a strong marketplace this year, and the years ahead, they need to voice their opposition to efforts to repeal the Affordable Care Act and the health insurance marketplace,” he told Healio Family Medicine.

The Hidden Health Crisis of the Opioid Epidemic

Via Health Law and Policy Clinic

Originally published by Reuters on December 7, 2017. Written by Robert Greenwald, faculty director of the Center for Health Law and Policy Innovation of Harvard Law School and Ryan Clary, executive director of the National Viral Hepatitis Roundtable.

The American epidemic of opioid abuse is finally getting the attention it warrants. While policy solutions continue to be inadequate, the decision by President Trump to declare a national opioid emergency has helped to increase discussion about the problem and how the country can solve it. But the conversation also needs to address a dangerous—and largely ignored—interconnected public health crisis wreaking havoc among young Americans.

The problem is that more Americans than ever are injecting opioids and inadvertently infecting themselves with hepatitis C. Shared needles mean shared blood-borne infections—and that’s how the opioid crisis has created a new generation of hepatitis C patients. The number of reported hepatitis C infections nearly tripled from 2010 to 2015, with the virus is spreading at an unprecedented rate among young people under 30—who are now, for the first time, the most at-risk population for contracting and transmitting hepatitis C.

In the United States, an estimated 3.5 million people, and likely more, are currently living with hepatitis C. The virus kills nearly 20,000 Americans each year—more than HIV and all other infectious diseases combined.

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Health Law and Policy Center launches campaign to enforce health care rights for people living with HIV

Via HLS News

In the face of highly restrictive and discriminatory health insurance plans within the Affordable Care Act (ACA) Marketplaces, the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) is undertaking a new advocacy campaign to enforce the health care rights guaranteed by the ACA for people living with HIV and other chronic conditions. Drawing upon CHLPI’s extensive research and new avenues for civil rights enforcement under the ACA, the campaign aims to strengthen protections in the health insurance Marketplaces and eliminate insurer practices that prevent vulnerable patients from receiving the care and treatment they need. These discriminatory practices include refusing to cover key medications and requiring high cost sharing for all medications used to address certain health conditions.

CHLPI, along with state partners in seven states, has filed formal administrative Complaints with the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR). OCR is charged with enforcing the ACA’s new anti-discrimination regulations in state ACA health insurance Marketplaces. “CHLPI is using the OCR process to shine a light on discrimination occurring under the cloak of supposedly neutral insurance plan benefit design. When an insurer requires chronically ill patients to pay a disproportionate share of the cost of medication it violates federal law” says Robert Greenwald, CHLPI’s faculty director and clinical professor of law at HLS. “These are landmark complaints that will benefit everyone looking to receive equitable, comprehensive health care through the Marketplaces by helping to define anti-discrimination law at a time when insurers are covering less and less.”

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CHLPI Faculty Director to be Honored by Harvard Law School Student Government

Via Center for Health Law and Policy Innovation

Robert Greenwald, CHLPI’s Faculty Director and Professor of Law, will be honored by Harvard Law School’s Student Government in April 2016 with the newly created Teaching & Advising Award. The Award is meant to recognize both exemplary instruction and the ability of an instructor to inspire personal and intellectual development outside the classroom.

The criteria for HLS Student Government Teaching & Advising Award included:

  • Meaningful impact on the student experience at Harvard Law School;
  • Development of student learning outcomes;
  • Dedication to teaching and advising activities; and
  • Ability to inspire personal, professional, and intellectual growth.

Congratulations to Professor Greenwald on receiving this award.

In the Health Law and Policy Clinic, a slew of opportunities to sharpen legal and policy skills

By Kelly Jo Popkin, J.D. ’17

L-R: Kelly Jo

L-R: Kelly Jo Popkin, J.D. ’17; Robert Greenwald, Clinical Professor of Law; and Kevin Costello, Senior Associate Director and Litigation Manager

I became interested in the Health Law and Policy Clinic after solidifying my summer employment working with the General Counsel of Planned Parenthood Affiliates of California (PPAC). Unlike the Center for Reproductive Rights (CRR), where I worked as the organization’s U.S. Policy and Advocacy Analyst last summer, PPAC focuses on the legal issues affecting their seven clinics in California in the moment and on the ground. Though I had a firm grasp on reproductive legal and policy strategies thanks to CRR, I was forewarned by PPAC that I would need to know more about barriers to healthcare access, public health concerns, and health disparities writ large. The clinic seemed like the perfect way to learn about these issues while cultivating a useful skillset for my summertime employment.

In the first couple of weeks, I immersed myself into the world of health policy reform by taking a few projects with a tight turnaround time. Along with Lauren Kuhlik (J.D., MPH ’17), I assisted in drafting a  Supreme Court amicus brief re. Zubik v. Burwell, a follow-up to the Hobby Lobby decision. I also traveled to New York to visit a cancer center and assisted in launching their nonprofit lung cancer screening initiative for upper Manhattan. The excitement of the first few weeks has set the pace for the weeks to follow.

Working in the Health Law and Policy Clinic has given me exposure to a variety of public health topics, from HIV and hepatitis C, to specialty care access, to psychosocial determinants of health. The issues vary just as much as the policy tools used to address them. In one month’s time, I have drafted a policy roadmap for a community-based health organization, a preliminary injunction against a state Medicaid agency, a Supreme Court amicus brief, and an administrative complaint to the Office of Civil Rights. I have engaged in thorough legal analysis and research for all of my projects, using a wide swath of sources to evaluate case law, market statistics, and other indicators of health law and regulations as implemented in a post-Affordable Care Act landscape. I would highly recommend this clinic to any Harvard Law student interested in becoming well-versed in a variety of legal and policy strategies, whether or not they are considering a career in health law.

I would venture to say that I learned more in the few weeks working in the clinic than I had learned in my entire law school career thus far. My supervisors have provided constructive and crucial guidance every step of the way, and have gone out of their way to show how much our work is appreciated. For example, when Professor Robert Greenwald and Clinical Instructor Carmel Shachar learned that they couldn’t put our names on the Zubik amicus brief, they contacted Dean Martha Minow to acknowledge our hard work and praise us on a job well done.

While deeply invested in achieving impactful policy changes, the Health Law and Policy Clinic is equally invested in the cultivation of future policy advocates. Thanks to the clinic’s culture of mentorship, I feel competent and confident in my ability to produce meaningful work products this summer and for the years to come.

Harvard Law clinic files amicus brief defending employees’ access to no cost preventive health care

Via HLS News

Harvard Law School’s Center for Health Law and Policy Innovation (CHLPI) filed an amicus brief to the U.S. Supreme Court in Zubik v. Burwell, an Affordable Care Act (ACA) challenge set for argument on March 26. The brief asks the Court to affirm Court of Appeals’ decisions upholding the federal policy of maintaining access to free preventive care, including contraceptive services, in employer-sponsored health plans.

Currently, federal law allows employers to “opt-out” of financing access to no cost contraceptive services, provided the employers furnish notice to the government so that alternate financing can be arranged for their employees. The challengers in this case seek to foreclose this alternative access for their employees, which would force employees to pay out of pocket for contraceptive services.

The brief warns that if the Court grants a contraceptive services exception, “[r]eligious employers will continue to ‘edit’ the mandated package of preventive services, and chip away at other coverage of these conditions.” The Center said it has already received reports of employers using religious objections to avoid covering HIV medications on the health plans they offer employees.

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CHLPI’s SWOT Analysis of the Updated National HIV/AIDS Strategy is Published

Via Center for Health Law and Policy Innovation

Robert Greenwald, Director of the Center for Health Law and Policy Innovation and Professor of Law at Harvard Law School, has co-authored an editorial with David Holtgrave, PhD, Professor and Chair of the Department of Health, Behavior & Society at Johns Hopkins Bloomberg School of Public Health, on the updated National HIV/AIDS Strategy (NHAS) from the federal government. “A SWOT Analysis of the Updated National HIV AIDS Strategy for the U.S., 2015-2020″ has been published by the AIDS and Behavior Journal and will be available in the pubmed database shortly.

The original NHAS was created in 2010 to guide the country’s response to the epidemic through 2015. Since its creation and release, the original NHAS  has served as a useful guide to encourage better evidence-based prevention and care efforts. The updated strategy outlines recommendations and guiding practices to lead policy and care through 2020.

The editorial offers a strengths, weaknesses, opportunities and threats analysis with the aim of increasing discussion of ways to truly fulfill the promise of the updated NHAS and to address barriers that may thwart it from achieving its full potential. The authors highlight a small number of key factors under each element of the SWOT analysis, and conclude with overarching recommendations for next steps. They note that their purpose is not comprehensiveness, but rather to highlight a few factors seen as truly critical, and to hopefully spark further discussion and elaboration in the field.

Excerpts from the editorial praise that the NHAS “is clear that HIV care and treatment must be affordable, accessible, and very broadly defined to encompass the behavioral and ancillary services needed to address the social determinants of HIV…The updated strategy is clear that while we have effective treatments available, many people living with HIV are not able to access them.” The authors go on to highlight a major weakness of the strategy, saying that “it is essential for public health planning to estimate the scope of unmet needs, identify resources to meet those needs, and estimate…the public health and economic impact of such investments. These estimates are essential to develop so as to inform the federal action plan soon to be released.”

“Time is of the essence, for the epidemic marches on every hour of every day in the United States, and the human and economic consequences of the epidemic are enormous,” says Robert Greenwald. “Our hope is that this paper spurs conversation and updates to the strategy that further improve it.”

CHLPI Director Quoted in NY Times Article on Hepatitis C Medication

Via Center for Health Law and Policy Innovation

The New York Times released an article on August 25, 2015 on the call for increased access to life-saving medications for individuals with hepatitis C from health care experts and advocates. Robert Pear, the reporter behind “White House Is Pressed to Help Widen Access to Hepatitis C Drugs via Medicaid,” interviewed CHLPI director Robert Greenwald about the Center’s research on health insurance coverage of the Hepatitis C medication Solvaldi throughout the United States.

Excerpt from the article:

“Federal and state Medicaid officials should widen access to prescription drugs that could cure tens of thousands of people with hepatitis C, including medications that can cost up to $1,000 a pill, health care experts have told the White House.

The experts, from the Public Health Service and President Obama’s Advisory Council on H.I.V./AIDS, said restrictions on the drugs imposed by many states were inconsistent with sound medical practice, as reflected in treatment guidelines issued by health care professionals and the Department of Veterans Affairs…

…But Robert L. Greenwald, an expert on health law and policy at Harvard Law School, said: “These criteria defy clinical guidelines and best practices. Rather than recommending the exclusion of people who inject drugs, we should encourage earlier treatment as a way to prevent transmission of the virus.””

Read the full article

CHLPI launches a campaign to promote federal law and policy reforms for type 2 diabetes

CHLPI PATHS Beating Type 2 Diabetes Recommendations reportVia HLS News

As a direct response to the looming health epidemic, the Center for Health Law and Policy Innovation (CHLPI) officially launched a campaign to promote federal law and policy reforms for type 2 diabetes prevention and management on May 19. This effort is part of CHLPI’s broader, multi-phase Providing Access to Healthy Solutions (PATHS) initiative that first worked to strengthen local and state policy to address diet-related health conditions and more specifically improve type 2 diabetes treatment and prevention. PATHS is now focusing on federal law and policy reform.

The Federal Report, written by CHLPI staff and the clinic students, offers specific recommendations to decrease the incidence of type 2 diabetes and to promote effective management of the disease in those who have already been diagnosed. Beating Type 2 Diabetes: Recommendations for Federal Policy Reform builds off of the best-practices identified through years of work at the state and local level and the guidance of people living with and at-risk-for diabetes, health and social service professionals, food providers and producers, government officials and other stakeholders,” says Robert Greenwald, Clinical Professor of Law at Harvard Law School and Director of its Center for Health Law and Policy Innovation (CHLPI).

Continue reading the full story here.

Center For Health Law and Policy Innovation files amicus brief calling for preservation of federal subsidies under the ACA

Supreme-Court_488124681-2_istock-300x200Via HLS News

In an effort to support the provision of federal subsidies for purchasing health insurance by low-income individuals in all states, the Harvard Law School Center for Health Law and Policy Innovation spearheaded the filing of an amicus brief in the U.S. Supreme Court. The brief requests that the Court affirm a court of appeals decision upholding the nationwide provision of federal subsidies under the Affordable Care Act

The 46 non-profit organizations signing onto the brief, including AIDS United, HIV Medicine Association, and National Alliance of State and Territorial AIDS Directors, serve populations that are deeply affected by the ACA’s expansion of health insurance access, including over two dozen organizations dedicated to addressing the needs of people living with HIV and AIDS. The brief highlights the voices of individuals with the most at risk in this Supreme Court case — those who rely on the federal subsidies to access meaningful health care coverage.

“For many low and middle-income individuals and families the subsidies have made it possible for them to access private health insurance for the first time in their lives,”  said Robert Greenwald, clinical professor of law and director of the CHLPI. “This is particularly important as we work to create a health system that focuses on prevention and early intervention health care that both improves health outcomes and reduces costs.”

Read the full story here.

‘Food is Medicine:’ Health reform should support nutritional counseling, medical meals says HLS report

CaptureVia HLS News

The Center for Health Law and Policy Innovation (CHLPI) of Harvard Law School released the report “Food is Medicine: Opportunities in Public and Private Health Care for Supporting Nutritional Counseling and Medically Tailored, Home-Delivered Meals.”The report, funded in part by the M•A•C AIDS Fund, examines ways in which public and private health care programs like Medicaid, Medicare and new marketplace health insurance plans can support access to nutritional counseling and medically tailored home-delivered meals within their systems.

“We are at a unique point in time, when new health policy reforms, both within and outside of the Affordable Care Act, have opened the door for the inclusion of innovative services that both improve health outcomes and ultimately reduce health care costs,” said Robert Greenwald, Director of the Center.

“Through legal and policy analysis, our report identifies opportunities within our health care systems for integrating and reimbursing specific food and nutrition service interventions that can help move us toward reducing health disparities, promoting health, and reducing costs.”

Continue reading the full story here.

Robert Greenwald talks Strategies to Expand Medicaid with Houston Health Leaders

Robert Greenwald, Director of the Center for Health Law and Policy Innovation and Clinical Professor of Law

Robert Greenwald, Director of the Center for Health Law and Policy Innovation and Clinical Professor of Law

Via Houston Public Media

Under the new health law, all states had the option to expand Medicaid to insure more adults. California did it, and now that state has fewer uninsured people than Texas, which is now number one. Robert Greenwald is director of Harvard Law School’s Center for Health Law and Policy Innovation. He spoke to a group of Houston health leaders, suggesting they use new ways of framing the issue in the next legislative session. Greenwald says one major problem is refuting Governor Perry’s repeated claim that Medicaid is a broken system.

“It’s not that Medicaid is broken, it’s that Medicaid is expensive. And the reason it’s expensive especially in a place like Texas is that it’s limited to the most disabled, sickest, elderly population,” Greenwald said.

Greenwald says it would be different if Medicaid was offered to low-income, working adults. That population is relatively healthy and young. Getting them covered would not cost as much as the current program, and it would save money in the long run by keeping them healthy.

Continue reading the full story here.

Clinical Fellows and Students Collaborate on PATHS Report

Kristen Gurley ’15

By Kristen Gurley J.D. ‘15

The Harvard Law School Center for Health Law and Policy Innovation (CHLPI) recently released an insightful and action-oriented report on the landscape of type 2 diabetes in New Jersey. The report, entitled the 2014 New Jersey State Report: Providing Access to Healthy Solutions (PATHS)An Analysis of New Jersey’s Opportunities to Enhance Prevention and Management of Type 2 Diabetes, serves as a resource for diabetes advocates and offers detailed policy recommendations for the prevention and management of the disease.

The report was a product of CHLPI’s PATHS project, which aims to strengthen federal, state, and local efforts to improve the type 2 diabetes landscape through strategic law and policy reform initiatives. The PATHS project, funded by the Bristol-Myers Squibb Foundation through its Together on Diabetes initiative, consists of state-level analyses in New Jersey and North Carolina, as well as federal-level recommendations and state best practices. It is the first product of a five year grant process, written over the course of eighteen months under the supervision of Clinical Fellows Amy Katzen of the Health Law and Policy Clinic (HLPC) and Allison Condra of the Food Law and Policy Clinic (FLPC), the two divisions of CHLPI.

Fourteen students worked with staff to conduct extensive research and more than fifty interviews with policymakers, government agencies, and non-profit organizations that are playing a role in the state’s diabetes response. Their detailed findings highlight the extent of the type 2 diabetes epidemic in New Jersey and provide actionable recommendations for diabetes advocates.

Report co-authors Allison Condra (left) and Amy Katzen (right) with New Jersey Senate President Stephen Sweeney at the New Jersey Diabetes Leadership Forum on March 27, 2014

“A frightening fact is that New Jersey ranks third in the nation for obesity among low-income children ages two to five, predisposing them to a future diabetes diagnosis. Nearly three-quarters of a million New Jersey adults are currently living with the disease,” said Allison Condra. “Our recommendations should serve as a resource for diabetes advocates within the state who are already working to take action.”

The PATHS report first details the impact of type 2 diabetes in New Jersey, and includes a profile of the state’s demographics, economy, political structure, and existing institutional capacity to address diabetes. Following this assessment, the report identifies existing policies that impact diabetes through the state’s food system and health care system. The report provides numerous detailed recommendations, including: making fruits and vegetables affordable and accessible to people in many low-income communities; helping New Jersey children gain access to healthy foods at school; making communities conducive to healthy, active living; providing access to the Diabetes Prevention Program; ensuring access to diabetes self-management education, medical nutrition therapy, and diabetes equipment and supplies; and enhancing care coordination for Medicaid/Family Care enrollees. Amy Katzen, explained, “by ensuring that all New Jerseyans living with type 2 diabetes have the tools, skills, and knowledge to manage their disease, we can prevent many of the most severe complications, keeping New Jersey healthier, happier, and more productive.”

To promote the PATHS report findings, CHLPI clinicians and students traveled to Trenton, New Jersey, to release the report at the New Jersey Diabetes Leadership Forum, on March 27, 2014. As Taylor Bates, ‘15 noted, “Ever since I started working on it, the PATHS NJ project has impressed me again and again with its thorough research on diabetes in New Jersey and the innovative solutions it offers. This event showed me that the community understands this problem and has the power to solve it. New Jersey has a chance to apply well-researched solutions to its growing diabetes epidemic, and based on what I saw at this event we’ll see a lot of progress in the coming years.”

The report was very well received by state legislators, agency policymakers, and community leaders. New Jersey Senate President Stephen Sweeney addressed the Forum attendees, describing his personal experience with diabetes and telling the audience, “I’m in your corner.”

“New Jersey has a very high prevalence of diabetes, with approximately 700,000 people living with the disease,” said Robert Greenwald, Director of CHLPI and Clinical Professor of Law at Harvard Law School, in addressing participants of the New Jersey Diabetes Leadership Forum. “This number is expected to double by 2025, and it is essential that advocates, legislators, and government agencies come together and take action now. Our hope is that the report will support these efforts and provide a resource to those that are already doing great work to address the prevention and care management needs of people living with or at risk for diabetes in the state.”

Read the full report here.

Food is medicine

Cabbage is good for you.
Credit Ksenija Putilin / Flickr

Via: WGBH News
By: David B. Waters and Robert Greenwald, Director of the Center for Health Law & Policy Innovation

In the continuing debate about how to control soaring healthcare costs, poor nutrition and lack of access to healthy food are routinely ignored.

This is the case despite the fact that in a country as wealthy as the United States, one in three patients nationwide enters the hospital malnourished, adding a host of additional health challenges to patients’ prognoses and millions in additional health care costs.

Malnourished patients are significantly more likely than well-nourished patients to be re-hospitalized and suffer poor outcomes. Malnourished patients’ medications do not work as effectively. They often remain in the hospital longer and in many cases cannot continue critical treatments such as chemotherapy because they are not getting proper nutrition.

Simply put, there is a direct and important connection between nutrition and disease treatment and management. Food is medicine.

Continue reading the full article on WGBH News here.