The Shriver Brief : Poverty Law Commentary & Insights : Sargent Shriver National Center on Poverty Law : Affordable Housing, Healthcare Reform

What’s most important to sustaining human life? Arguably it’s water. In fact, the United Nations recognized the human right “to safe and clean drinking water” through a resolution in 2010.

California law recognizes the right, too—sort of. The state requires water systems to provide a “reliable and adequate supply of pure, wholesome, potable, and healthy water,” but some residents of rural areas in the San Joaquin Valley, where high poverty rates abound, must pay up to 20 percent of their income for drinkable water. In the unincorporated town of Lanare, for example, residents pay $54 per month for tap water that is contaminated with nitrates (which have been linked to cancer and blue-baby syndrome), arsenic, and other toxic substances, forcing them—at least those who can pay—to spend an additional $35 per month for bottled water. In contrast, the residents of nearby Riverdale, a larger town, will build a new $5.4 million arsenic water treatment plant after passing a bond issue and obtaining a $500,000 grant from the state.

The struggle for safe water isn’t limited to California. Although the federal Safe Water Drinking Act requires most water providers to meet drinking water standards, funding realities dictate that access to safe drinking water too often depends on a community’s wealth . Most states have taken over enforcement of the Safe Drinking Water Act but, unlike under the Clean Water Act, which deals primarily with discharge of pollutants into surface water, states don’t get much federal funding to help meet drinking water standards. This lack of funding at every level complicates enforcement efforts.

This reality may be shifting in California, where California Rural Legal Assistance (CRLA), using a combination of litigation and legislative advocacy, has changed the legal landscape when it comes to low-income residents’ access to safe water.

California implements the federal Safe Drinking Water Act through its Health & Safety Code, which requires the Department of Public Health to develop a Safe Drinking Water Plan every five years. In recognition of gaps in the knowledge and enforcement capacity of the state’s myriad small water systems, the plan focuses on analyzing the water quality and service of water systems with fewer than 10,000 connections. But it’s been nearly 20 years since the Department obeyed the statutory mandate and submitted a plan—decades during which many rural Californians have been drinking water laced with arsenic.

CRLA sued on behalf of residents of the San Joaquin Valley and a grassroots organization, La Asociación de Gente Unida por el Agua (the AGUA Coalition), asking the court to order the California Department of Public Health to prepare the required plan. After an appellate court reversed a dismissal of the suit (Newton-Enloe v. Horton) in April, the parties settled the case in November. The department will submit a Safe Drinking Water Plan—a detailed five-year implementation plan—within three years of the settlement. And, most important to CRLA, the department must comply with the state statute and investigate the water quality and service of water systems throughout the state with fewer than 10,000 service connections. In doing so, the department must report on and take into consideration, and attach as an appendix to the plan, any data that CRLA collects on small water systems.

On the legislative front, CRLA and other advocates helped achieve passage of a package of seven drinking water bills that, among other things, provide grants to small communities to upgrade their water systems and create a revolving fund to make “severely disadvantaged communities” (median household income less than 60 percent of the statewide average) eligible for grants covering the full costs of water treatment projects.

This advocacy dovetails with the earlier visit of Caterina de Albuquerque, the Special Rapporteur on the human right to safe drinking water and sanitation, at the invitation of the U.S. government. Between February 22 and March 4, de Albuquerque undertook a fact-finding mission with stops in Washington, Boston, Sacramento, and to the Winnemem Wintu in northern California; she issued a formal report in August contending that “States’ obligation with regard to the right to safe drinking water and sanitation requires that water and sanitation be available, accessible, affordable, acceptable and of good quality for everyone without discrimination.” She noted that “existing federal laws generally focus on maintaining water quality rather than ensuring access for all citizens.”

While federal progress toward a right to water seems unlikely at the moment, as CRLA has shown, changes may be possible at the state level. For more on CRLA’s fight to give low-income residents access to safe drinking water, see Furthering the Fight to Make Clean Water a Right in California, in Clearinghouse Review’s September-October 2011 issue, Human Rights: A New (and Old) Way to Secure Justice.

For more information on homelessness and the right to water and sanitation see, Toward a Human Rights Framework in Homelessness Advocacy: Bringing Clients Face-to-Face with the United Nations, by Mona Tawatao and Colin Bailey and Opening the Door to the Human Right to Housing: The Universal Periodic Review and Strategic Federal Advocacy for a Rights-Based Approach to Housing, by Eric Tars and Déononné Bhattarai in the same publication.

This blog post was coauthored by Kathleen Donahue McNally.

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The Consumer Financial Protection Bureau (CFPB) has been hard at work despite some lawmakers’ efforts to block the confirmation of Richard Cordray, President Obama’s nomination as director of the CFPB. The CFPB has rolled out a series of Know Before You Owe topics in order to best hear consumer complaints, answer concerns, and make appropriate policy changes. First the CFPB recently published a report on consumer credit card complaint data. 

The report summarizes information collected from the first three months of the CFPB’s Consumer Response office’s complaint system. When the CFPB officially launched in July of this year, its Consumer Response office’s first focus was on credit card inquiries and complaints. Consumers were encouraged to submit inquiries and complaints to the CFPB in a variety of consumer-friendly manners, including by mail, fax, telephone and the CFPB’s website. The CFPB’s call centers, for example, provide services for the hearing- and speech-impaired and can assist consumers in 191 different languages. Through these mechanisms the CFPB received over 5,000 comments on credit card issues. The data collected will inform the CFPB’s future enforcement, rulemaking, research, and consumer education efforts. 

Although the majority of the comments resulted in the CFPB providing general feedback and informational resources; the CFPB also sent 84% of these concerns directly to credit card issuers to resolve and/or and respond to consumers. Thus far, credit card issuers have reported full or partial resolution of 74% of them. There were a wide range of complaint topics, however, the top five concerns related to:

1. billing disputes (13.4%);
2. APR or interest rates (11%);
3. identity theft/fraud/embezzlement (10.8%);
4. other (8.9%); and
5. closing/cancelling an account (4.8%).

As part of the Dodd-Frank Wall Street Reform and Consumer Protection Act the CFPB was given authority to enforce the CARD Act. The CARD Act, which was signed into law by President Obama in May 2009, was designed to be a “credit card bill of rights” intended to end interest rate hikes, hidden fees, and other abusive practices in the credit card industry 

The CFPB also recently held a conference marking the one-year anniversary of the enactment of the CARD Act that included presentations and reports on the credit card industry’s progress in complying with the Act. This progress, however, is mixed. Overdraft fees have virtually disappeared in the credit card industry. Similarly, prior to the CARD Act, approximately 15 percent of credit card accounts were re-priced over the course of a year; today that number is under 2 percent. Yet, while only one of the nine major credit card issuers has a usual practice of periodically reviewing the APR on existing accounts and raising interest rates for new purchases, five others have increased, or plan to increase, interest rates on new purchases for customers who are delinquent on past balances. 

On another front, the CFPB is currently seeking consumer comments on mortgage application forms. Presently the forms to apply for a mortgage are very complicated. The CFPB has created a prototype of a simpler credit card agreement that clearly spells out the terms for the consumer. Use of the form is not mandatory; however, the CFPB hopes that financial institutions will adopt it. The public is being encouraged to visit the mortgage section of the CFPB’s website and compare two versions of a mortgage disclosure form the CFPB has developed that describes loan terms and closing costs. Consumers can choose which one is easier to read and that they prefer. Consumers can also compare the proposed form to their mortgage company’s current forms.

Clearly, the CFPB is working hard to protect consumers from predatory lending and deceptive practices, as well as actively hearing and responding to public comments. We only wish that the Senate would be as responsive and listen to the public’s desire to have Cordray’s nomination confirmed so that the CFPB can continue and expand this good work.

Learn more about the findings of the surveys included in the CARD Act: One Year Later conference.

Learn more about the Cordray nomination proceeding.

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In this era of justified public cynicism about our political process, let’s give the politicians credit when they get it right. The Illinois General Assembly got it right last week when it voted to double the state’s earned income tax credit (EITC) as part of the tax package. Governor Quinn got it right when he insisted on this.

The EITC, a refundable tax credit to low- and middle-income workers, is critical for achieving tax fairness. It is also one of the best ways to stimulate economic growth and job creation. Given the anemic performance of our economy, nothing is more important than that.

The EITC is a cost effective way to stimulate economic growth and job creation because businesses grow and hire new workers when they see increased demand for their products. Wealthy people, given an extra dollar, are likely to save it, while low- and middle-income people are much more likely to spend it. This spending increases demand, spurs economic growth, and creates jobs. That’s why the non-partisan Congressional Budget Office estimates that providing refundable tax credits like the EITC for low- and middle-income households creates two to three times more jobs and economic growth than extending the Bush II tax cuts.

Increasing the EITC also makes our tax system fairer. Over the past 30 years, the wealthiest 20% of Americans have seen their income grow by 95% compared to only 25% for everyone else. For the wealthiest 1%, it’s even more dramatic—their income has grown by 281%, and they’ve gotten 58 cents of every dollar of economic growth generated over the past 30 years.

The last thing our tax system should do is make income inequality worse. But due to our over-reliance on sales taxes and other factors, low-income people in Illinois spend over 13% of their income on state and local taxes, while upper income people spend less than 6%% of theirs. Increasing the EITC helps redress this imbalance.

It is unconscionable that nearly 100,000 people in Illinois who work full-time, year-round still live in poverty. The EITC is a cost-efficient way to encourage work and help these and other low-income workers make ends meet. It also lifts more children out of poverty than any other tool.

Now that CME and Sears have demonstrated that holding a gun to the politicians’ heads works, we can expect a parade of “too big to leave” companies to visit Springfield with their hands out. Maybe some, unlike CME, will say thank you and promise not to take the money and run. We can also expect a new round of across-the-board corporate tax giveaway proposals. Perhaps the taxpayers will even be asked to subsidize multi-millionaires directly, such as by the increase in the estate tax exemption included in this week’s tax package.

The important thing to remember, though, is that George Bush I was right when he called this voodoo economics. The EITC is not just about fairness, lifting full-time workers and children out of poverty, and reversing the 30-year trend of greater income inequality. It’s also about tax policy that will lead businesses to grow, create jobs, and make the economy work for all of us.

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This is the second post in a weekly “Did You Know” blog series that will highlight important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health. 

Did you know that insurance companies will soon be required to cover women’s preventive health services like birth control and annual gynecological visits free of co-pay?

The Department of Health and Human Services (HHS), under the guidelines of the Affordable Care Act, announced this summer that starting in August, 2012 (for new or “non-grandfathered” plans), insurance companies will have to cover a set of women’s preventive health services free of cost-sharing (i.e., co-payments, deductibles, or the use of co-insurance). These services are in addition to the set of preventive benefits for all adults that health insurance companies are already required to cover without cost-sharing in the private market (at least those with “non-grandfathered” plans), all thanks to the Affordable Care Act.

The women’s preventive health services included in the rule are:

• Well-woman visits
• Screening for gestational diabetes
• HPV DNA testing for women 30 years and older
• STI counseling
• HIV screening and counseling
• FDA-approved contraceptives and contraceptive counseling
• Breastfeeding support, supplies, and counseling
• Domestic violence screening and counseling

There are a couple of important exemptions that come with this new rule. Insurance plans with “grandfathered” status will not be required to cover these benefits free of co-pay in 2012. The rule only applies to new plans, or those that have lost their “grandfathered” status. If you are unsure whether or not your plan is new or grandfathered, ask your insurer or your employer if you have coverage through work. You can find more information on grandfathered vs. non-grandfathered plans online.

The other exemption to this new rule, which is still being considered by HHS, involves religiously affiliated places of work and the mandate to provide coverage for birth control. Controversial in nature, the proposed religious exemption has recently become the center of debate. The exemption would allow religiously affiliated institutions that oppose birth control and offer employer coverage to refrain from providing contraceptive benefits. This means that millions of women working for religiously affiliated institutions, including places of work like hospitals and schools, may face barriers to accessing affordable FDA-approved family planning methods, which is a concern for women’s rights advocates across the country.  

Quick Fact: Speaking of women’s preventive health, did you know that health reform is already working to increase women’s access to ob-gyns?  Thanks to the Affordable Care Act, women no longer have to get a referral from their doctor before seeing a gynecologist no matter what kind of insurance they have! This consumer protection applies to all women and has been in effect since September 23, 2010.

This blog post was coauthored by Rachel Gielau.                                      

Interested in an in-person presentation on how health reform is rolling out in Illinois and what it means for individuals?  Are you a direct service provider or advocate for vulnerable populations and interested in how the Affordable Care Act will impact the population you serve?  Rachel Gielau, health policy expert at the Shriver Center, is giving free in-person presentations to Illinois audiences on how health reform is affecting individual and families in Illinois. Contact Rachel Gielau at 312-368-1154 to set up a presentation for your organization!

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Family holiday dinners can be wonderful, warm times to bond, or they can devolve into intense full-contact debates. We’ve all been at the table when Uncle Steve wants to debate politics or Cousin Liz is in the mood to talk about religion. A little friendly debate over crescent rolls can bring a family closer together and enlighten people, or it can make for a really uncomfortable holiday. 

This year, I’m predicting the federal Affordable Care Act (ACA) to be a hot-button topic as relatives spar over the universal mandate, death panels, and whether or not Grandma’s Medicare will be rationed. (Hint: it won’t be.) Research shows that about half of uninsured people who will benefit from the ACA are really in the dark about healthcare reform; some of them are probably going to be sitting around the table with you. We would like to remind our readers to take advantage of this great opportunity to enlighten (in a positive, respectful way) family and friends on the many ways the ACA is helping Americans get affordable healthcare. Once people know about the many benefits of the ACA, they are far more likely to support it.  

Here are a few tips to make sure this holiday season doesn’t end in frustration for anyone.

1.     Most importantly, take ownership of the ACA. You like this legislation—tell people why!

I know I’ll be telling my own family how thrilled I was that my young adult sisters and I could remain on my parents’ very good insurance (along with 2.5 million other young Americans) rather than purchase overpriced, low-quality plans on our own before being eligible for employer-provided insurance.  

Or maybe you have diabetes and are looking forward to the day (January 1, 2014) you won’t be denied the ability to purchase insurance for your preexisting condition, or you would like to provide health insurance to maintain your best employees and are excited about the tax credits you will receive. Whatever part of the ACA you are excited about, share it with your family over dinner. Positive stories create positive impressions of the law.

2.     Know what you’re talking about. Have reliable information ready to refute your dad’s claim that small businesses will be going under in droves or your sister’s statement that sick people won’t be readmitted to the hospital. We suggest using the official website, The Kaiser Family Foundation, and the new interactive game “Thanks Obamacare!”  for helpful facts. Misinformation absolutely will not help the cause of broadening public support for the ACA. 

3.     Mention the most popular provisions of the ACA, like closing the Medicare donut hole and requiring health insurance companies to sell policies to all people (even people with preexisting conditions); research shows that most Americans feel “very favorable” about these provisions.

4.     Don’t be insulting. Your aunt’s unwavering stance on death panels may make you twitch with anger, but don’t ever attack her personally. She’s still your family and you still have to finish the evening with her. Address her misinformation calmly and with facts rather than focusing on her propensity for exaggeration or gullibility.      

5.     Call a truce if the discussion gets intense. Don’t make discussing the ACA a battle during your dinner. Agree to continue the discussion via an email chain, where you can include citations to reliable information, and then everyone can focus on enjoying dessert and family. 

Of course, this advice doesn’t just apply to holiday dinners—everyone who supports the ACA has an important job to do in confronting misinformation that they hear about the law and in spreading the word about its positive aspects. As you do this, keep a mental note of the most outrageous or most prevalent misinformation you hear and share it with us via blog comments or email. We would love to know more about what we are up against!

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We have good news and some bad news. The good news is that, in 2010, the number of uninsured children in the United States was one of the lowest in over a decade—about 7.3 million children were uninsured. Of course, Illinois’s rates of child uninsurance are even lower, thanks to the All Kids program. The Affordable Care Act has the potential to cut the number of uninsured children even further to 4.2 million (still too many uninsured children, but improving!). The expected decreases in uninsured children depend significantly on the states’ continuation of Medicaid and Children’s Health Insurance Programs (CHIP) coverage. 

The bad news is that some lawmakers are proposing legislation that will eliminate or greatly reduce Medicaid and CHIP. Without this coverage,  the level of uninsured children might actually rise—the exact opposite of what the Affordable Care Act is intended to accomplish. Eliminating Medicaid and CHIP for families above 138% of the federal poverty level would gut the Affordable Care Act’s goal of insuring our nation’s children—these programs must continue in full force in order to offer affordable insurance to young Americans. 

Under the Affordable Care Act, children and families with incomes under 138% of the federal poverty level will be covered under expanded Medicaid eligibility provisions. dults over the Medicaid threshold will be expected to obtain coverage for themselves through either the benefits exchanges or traditional employer-provided coverage and will be provided tax credits to make coverage more affordable. 

However, as the law currently stands, children in families between 138% and 400% of federal poverty level will continue to be eligible for Medicaid and CHIP due to congressionally mandated “maintenance-of-effort” (MOE) requirements. These requirements dictate that states maintain their existing eligibility, application, and renewal procedures requirements for children until October 1, 2019. his means that states cannot scale back coverage in order to save money, nor can they enact more onerous enrollment procedures.

Unfortunately, some lawmakers are calling on Congress to roll back those MOE requirements. If they are successful, states looking to balance their budgets will surely be tempted to make cuts in this area and force vulnerable children off Medicaid and CHIP. This would be a disaster for the health of our nation’s children. If states are allowed to discontinue their MOE requirements, an estimated 7.9 to 9.1 million children would be uninsured.      

If this happens, some families without employer-provided coverage will be eligible for tax credits and purchase coverage for the children on the benefits exchanges. Others will be able to obtain affordable employer-provided coverage.

However, not all families will be able to take advantage of these options. Children of all ages and races will experience higher rates of uninsurance without CHIP and Medicaid, despite the availability of exchange or employer-based coverage intended to replace those programs. For various reasons, the exchanges may be too expensive or unavailable to these families, leaving children without options for insurance.

The Affordable Care Act is a vital piece of legislation that has the potential to cut the number of uninsured parents and children by millions if it is implemented properly. We cannot skimp on providing coverage for children. Although the government could save some money by eliminating Medicaid and CHIP coverage for families over 138% of the federal poverty level, a decision to do so could leave millions of our most vulnerable uninsured. Medicaid and CHIP must continue at full strength, since these are vital lifelines for millions of uninsured children and high-quality and affordable coverage for our nation’s youth.

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The name “Wal-Mart” has become somewhat of a lightning rod for those who value buying local and supporting small business and labor rights. Recently Wal-Mart has entered into an even more contentious business—the banking industry—and the lightening has increased.

As reported in a previous blog, Wal-Mart, along with other large retailers, has jumped on the bandwagon to provide financial services. Wal-Mart’s new MoneyCenters offer a variety of products, such as its prepaid  MoneyCard. Customers like Wal-Mart’s late hours, as well as the MoneyCard’s  flat $3 monthly operating fee and no overdraft fees. As one Wal-Mart executive put it, Wal-Mart has been building à la carte financial services, becoming a force among the unbanked and “unhappily banked.” The MoneyCard acts just like a credit card, except that it is prepaid, and can be used to purchase goods and services. Wal-Mart’s MoneyCenters also provide services such as check cashing, international money transfers, direct deposit, and bill paying all at a competitive rate.

In July 2005, Wal-Mart submitted an application for a bank charter with the Federal Deposit Insurance Corporation (FDIC). Subsequently, the FDIC received over 1,500 letters about the application, with the majority of respondents vehemently opposing Wal-Mart's foray into banking. Ultimately Wal-Mart withdrew its request for a bank charter in early 2007 after a great deal of opposition from banks and legislators, including Rep. Barney Frank (D-MA) who introduced a bill aimed at preventing nonfinancial commercial institutions, more specifically big box stores, from operating banks.

Wal-Mart’s financial products aren’t without faults. Customers may not realize that they may need a Social Security number to apply for the card, thereby excluding immigrant populations who rely on other forms of identification such as Matricula Consular Cards or ITINs. Matricula Consular cards are photo identification cards issued by Mexican consulates to Mexican nationals living outside the county. Individual Taxpayer Identification Numbers, or ITINs, are issued to foreign nationals by the Internal Revenue Service as a tax processing number and can also be used as a valid form of identification at some banks. For more information on ITINs, check out the upcoming issue of the Clearinghouse Review.

The MoneyCard also has hidden fees, aside from the $3 monthly rate, such as charges for balance inquiries and ATM withdrawals and other fees that are not clearly stated. These are the same types of fees and transparency issues that caused people to flee from banks in the first place. Moreover, prepaid products, such as the MoneyCard, act as electronic cash. Therefore they do not build credit, nor do they help people save or build assets. Additionally, prepaid cards, unlike credit cards, are not covered by Regulation E of the Electronic Funds Transfer Act (EFTA) and therefore often do not have the same protections as debit or credit cards, such as:

• a cap on losses when cards are lost or stolen or when unauthorized charges are made;
• assurances that missing money will promptly be re-credited; or
• clear and conspicuous disclosures of all fees before signing up.

Wal-Mart is not the only one trying to cash in on the 30 million Americans who remain unbanked or underbanked. Target recently entered the field with an American Express prepaid card, and Kmart and BestBuy have their own Visa and Mastercard prepaid cards. Target’s prepaid AmEx card has fees similar to Wal-Mart’s MoneyCard, such as a $3 fee to load money onto the card, and a $3 fee per ATM withdrawal after the first free ATM withdrawal per month. Target’s card does not, however, have a monthly fee. Thus far, Wal-Mart has the lowest monthly fee and the lowest activation fee of such retailer cards. After all, Wal-Mart’s slogan is “saving money, living better.”

While these prepaid cards may provide an easy way for people to begin accessing financial services, they do not help customers save for the future or build credit, because they are not linked to either bank or savings accounts. Instead, programs such as BankOn, which promote real savings and responsible financial education, are ultimately better options. Bank On programs are voluntary, public/private partnerships between local or state governments, financial institutions, and community-based organizations that provide low-income un- and underbanked people with free or low-cost starter or “second chance” bank accounts and access to financial education. This innovative program, which began in San Francisco, California, has spread to cities and states across the country that want to help reduce barriers to banking, such as allowing ITIN numbers to be used to open accounts, and increasing access to the financial mainstream for consumers.

Although prepaid cards like the Wal-Mart MoneyCard may, in some cases, be a good first step (assuming that fees are both reasonable and clearly disclosed), they do not encourage the same saving mentality that opening a BankOn account does. Until such a mental shift occurs, the 30 million un/underbanked Americans will still be economically disenfranchised.   

This blog post was coauthored by Alison Terkel.

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The 2010 Census data released this past September showed that the income gap between Americans is widening. More specifically, the income gap between blacks and whites widened such that the average white worker’s income was about 1.7 times higher than that of black workers, which is up significantly from the 1990s. But this isn’t the case across the whole country; the suburbs are experiencing a wave of desegregation and a closing of the income gap.

Affluent black Americans, who are leaving industrial cities for the suburbs and the South, are shifting traditional lines between rich and poor. While suburbia is flourishing amidst the new flux of diverse middle-class residents. Cities such as Chicago, Detroit, Philadelphia, and others are suffering from racial and economic inequality because, for the most part, only lower-skilled minorities have remained.

These changes in city demographics will result in political redistricting as the African American political base shifts. Chicago has had one of the biggest losses, with over 180,000 middle- and working-class African Americans leaving the city for the suburbs and the South, where housing is cheaper, schools are better, and jobs are easier to come by. Not only has such migration changed the face of major industrial cities, but it will also change the face of the upcoming elections and how candidates campaign to their new base. Once Southern red states could now become swing states or even blue states due to the influx of African Americans who have left Northern cities.

Concern and debate about wealth distribution has been the central theme of the Occupy Wall Street movement. Although many seem to write off the Occupy movement as a radical minority group, research shows that 92% of Americans are actually in favor of wealth redistribution. When survey participants were asked what they thought the wealth gap was, the majority believed that the top 20% only controlled 59% of wealth, a modest estimation. The truth, however, is that the top 20% control 84% of the wealth. When asked what the ideal distribution of wealth should be, people said that the top 20% should only control 34% of the country’s wealth. This disconnect among Americans’ beliefs about economic inequality, their self-interest, and their public policy preferences suggests that, if there were more awareness of the reality of the gap, people would be more likely to advocate to close it.

As the Occupy movement continues and grows, and more Americans become aware of the real level of wealth inequality, it is sure to be an important topic during the 2012 Presidential election. 

This blog post was coauthored by Alison Terkel.

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Editor's Note: This is the first of a weekly “Did You Know” blog series that will highlight important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health. 

Did you know that you can receive preventive health services at your doctor’s office free of co-pay?

That’s right! The Affordable Care Act is serious about changing the culture of our health care system from treating disease after we get sick to preventing disease so that we don’t fall ill in the first place. From free preventive medical services and personalized wellness plans to community transformation grants and nationwide health education campaigns, the Affordable Care Act can help Americans raise a healthy generation of kids, build a healthier workforce, and reduce the overall cost of health care. 

One of the many ways the Affordable Care Act is working already to help individuals stay ahead of chronic illnesses is by requiring health insurers, including Medicare, to offer certain preventive health services free of co-pays. This new rule has been in effect since September 23, 2010, so you may already be reaping the benefits! For private insurance, the rule applies only to new plans, or those that have lost their “grandfathered” status, meaning, if you enrolled in a new plan at work or your employer significantly changed its health plan since March 23, 2010, you can receive the following preventive services without paying a deductible or co-payment:

• Blood pressure screening
• Cholesterol screening for certain aged and high-risk adults
• Colorectal cancer screening for adults over 50
• Type 2 diabetes screening for adults with high blood pressure
• HIV screenings for people at high risk
• Depression screening
• Alcohol abuse screening and counseling
• Aspirin use for men and women of certain ages
• Immunization for adults and children (see full lists here)
• Abdominal aortic aneurysm screening for men who have smoked
• Diet counseling for adults at higher risk for chronic disease
• Obesity screening and counseling
• Sexually transmitted infection prevention counseling and screening for people at high risk
• Tobacco use screening and cessation interventions for tobacco users
• Syphilis screening for adults with high risk

There are additional preventive health services available specifically for women and for children that are also free of co-pays. Comprehensive lists of available services can be found online. Information about each of these preventive services, along with tips and resources to help you and your loved ones stay healthy, is also available.

Unsure whether or not your plan is grandfathered or if you will be able to get these services at no cost to you? Ask your insurer! They will know. You can also learn more about grandfathered plans online.

This post was coauthored by Rachel Gielau.

Interested in an in-person presentation on how health reform is rolling out in Illinois and what it means for individuals? Are you a direct service provider or advocate for vulnerable populations and interested in how the Affordable Care Act will impact the population you serve? Rachel Gielau, health policy expert at the Shriver Center, is giving free in-person presentations to Illinois audiences on how health reform is affecting individual and families in Illinois. Contact Rachel at 312-368-1154 to set up a presentation for your organization.

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States have recently begun renegotiating with banks to lower fees on electronic benefit transfer (EBT) cards after pushback from beneficiaries and growing negative press coverage over the past few months.  

EBT systems are a means of delivering government benefits to recipients electronically via a plastic debit-type card. A Shriver Brief blog post published earlier this year provided an overview of the transition from mailing checks to using EBT cards (i.e., direct deposit and closed-loop debit-type cards) to the current trend of issuing branded prepaid benefit cards (EPC). The Shriver Center also hosted a webinar on this trend and its negative impacts on low-income consumers in February of this year.

Forty-one states have switched from issuing paper checks for everything from unemployment benefits to Temporary Assistance to Needy Families (TANF) to other state public benefits to either EBT systems or, more recently, prepaid cards. All Supplemental Nutrition Assistance Program benefits across the country are paid electronically. By distributing benefits electronically, states are able to save millions on postage and printing, which is particularly attractive given states’ budget deficits.  

Banks, such as Bank of America, Wells Fargo, US Bank and JP Morgan Chase, generally provide states with EBT and EPC cards free of charge and then earn revenue on swipe fees, penalties, and other fees, such as ATM and balance inquiry fees. Such arrangements have come under fire because these same banks that taxpayers bailed out in 2008 during the economic downturn are now earning money from poor, disadvantaged people who are down on their luck and then sharing what they've grabbed with the state. Although banks do not report how much revenue they receive from these types of arrangements, JP Morgan Chase, for instance, collects around $100,000 a month from EBT card usage fees under its contract with Washington State—this is on top of the $800,000 the state pays it.

In May, the National Consumer Law Center (NCLC) published a report examining the electronic payment of government benefits in the unemployment context. This report has garnered a lot of attention and, it appears, prompted some states to take action by entering into renegotiations with the banks to lower or eliminate fees. 

After being identified as one of the states having the cards with the worst fees in NCLC’s report, Oregon renegotiated with US Bank to provide unlimited US Bank ATM and teller withdrawals and two free withdraws per month at non-US Bank ATMs (although the bank that owns the ATM might still assess a fee).  Although these fee changes are an improvement, they don’t benefit all Oregonians. Those who live in rural areas, where unemployment is especially high, have to travel over 80 miles at times just to get to the nearest US Bank ATM. This problem would have been better resolved if US Bank had agreed to unlimited withdrawals at out-of-network ATMS.

Colorado has also taken steps to save money for those receiving unemployment benefit payments by renegotiating its contract with JP Morgan Chase. The state was successful in saving card users over $500,000 a year. Some of these changes include eliminating point-of-sale fees, allowing cardholders to withdraw up to $809 in a 24-hour period, and allowing one free denied transaction. California, which was applauded by NCLC for having low fees on its unemployment benefit cards, has tried to reduce fees further. In September 2010, the California Department of Social services sent letters to companies that own and operate large ATM networks such as Wells Fargo, Bank of America, JP Morgan Chase and Cardtronics asking them to waive surcharges for EBT card users at their ATMs. Unfortunately, none of the banks complied. Interestingly, South Carolina, whose unemployment EBT cards are fraught with high fees, demanded fee reductions from Bank of America when it learned that its fee arrangement with the bank was substantially higher than the bank’s similar contracts with California and New Jersey. 

Almost all of the states’ contracts for EBT cards are up for renegotiation in 2012, either because the contract expires or because the state has an option for a one-year renewal. When renewing their contracts, states should, at a minimum, ensure that banks do not continue to earn fees off of the backs of low-income consumers and the unemployed.  

Alison Terkel coauthored this blog post.

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The 44 Republican Senators who are continuing to hold former Ohio attorney general Richard Cordray's confirmation as Director of the Consumer Financial Protection Bureau (CFPB) hostage are not negotiating. Although the CFPB has been up and running since July 21, 2011, bipartisan fighting has been going on for much longer, and seems likely to continue. In September the Senate blocked Cordray’s confirmation, and last week most Republican senators, including Illinois Senator Mark Kirk, blocked it again in a 53-45 vote.

Without a director, the CFPB cannot "exercise its full power" and fully protect American consumers from predatory lenders and other fraudulent financial products. These Republicans know it and are taking advantage of this fact. Unless and until a director is confirmed the CFPB is not able to:

• prohibit unfair, deceptive, or abusive acts;
• write rules related to model credit disclosure forms;
• define which larger non-bank financial institutions should be supervised by the agency; and
• examine or enforce laws against non-bank financial institutions such as all mortgage-related businesses, along with payday lenders, student lenders and other large non-bank financial companies.

But some legislators are insisting that the bureau first be stripped of its independence and be subject to an annual budget process sensitive to financial industry influence that is sure to slash its ability to effectively protect consumers from unsafe products and practices. Many of these senators are the same ones who send a letter refusing to confirm any nominee, regardless of his or her qualifications, unless the structure of the CFPB is changed to disperse its power and weaken its director’s role. Specifically, the letter demanded that instead of a single director there should be a board overseeing the CFPB, the CFPB should be subject to the Congressional appropriations process, and that there should be a safety-and-soundness check by the prudential financial regulators, who oversee the safety and soundness of financial institutions, on any regulations issued by the CFPB. These are the same restrictions that conservatives had originally wanted in the Dodd-Frank Wall Street Reform and Consumer Protection Act (Dodd-Frank Act), but were unable to get passed.

In mid-October, a group of 37 bipartisan attorneys general came together to support Cordray’s nomination, and they confirmed their support right before yesterday’s vote. Although they do not all agree on the Dodd-Frank Act, they do believe that Cordray is highly qualified to serve as the director of the CFPB. Moreover, they indicated that coordination between the attorneys general and the federal government is critical, a point driven home by the economic injustice protests around the country. Twenty-seven Democratic members of the House Financial Services Committee also released a letter sent to Senate Minority Leader Mitch McConnell (R-KY) calling for him to agree to a vote of the full Senate on the nomination of Cordray as Director of the CFPB. Other groups, such as the American Sustainable Business Council (ASBC), a growing coalition of responsible and sustainable businesses that sent a letter to the full Senate on behalf of more than a hundred businesses and business networks, have also called for the rapid confirmation of Cordray.  

Before the vote was scheduled, Sen. Scott Brown (R-MA) also broke from his party to endorse Cordray. This is not the first time Sen. Brown has made a break from party lines; he also broke with his party on the Dodd-Frank Act vote, and his vote (one of just three Republican votes) helped push it through. He did withhold his vote, however, until he had secured highly targeted legislative favors for hometown banking giant State Street. 

Thus, it is not necessarily impossible that that some senators may change their minds. As the House letter to McConnell said, it is “unfathomable that any federal legislator would stand in the way of ensuring comprehensive protections for military families, the elderly and all Americans.” But, so far, this is exactly what is happening, and Cordray’s nomination is still being held hostage.

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We need jobs that keep people out of poverty, not in it! Raising the minimum wage is good common sense—people who work for a living should make enough money to provide for themselves and their families. Unfortunately, that’s not the case right now. If a worker earns the minimum wage here in Illinois, $8.25 an hour, and works 40 hours a week, 52 weeks a year, he or she makes just $16,830. It’s time we raise that amount. That’s why the Shriver Center supports the Raise Illinois Campaign, and I hope you will as well. Please sign the voter petition today.

In Illinois, this year was the first year in five years that we did not raise the minimum wage. But even before this year, the minimum wage has stagnated while the cost of living continues to rise. Minimum wage earners in Illinois already have $2/hour less in purchasing power than a minimum wage earner in the late 1960s. Let’s create a fair minimum wage that’s in line with its historic level—around $10.65 an hour—and indexed to inflation.

This is the time to raise the minimum wage. Research shows, and many economists agree, that raising the minimum wage helps many workers whose income is either right at minimum, or just above it, without reducing employment. It gives a needed boost to our communities, because low-wage workers will spend the extra earnings right where they live.

Wages have fallen significantly because of the recession. The new jobs that are coming back are more likely to be low-wage than the jobs they replace. The vast majority of minimum-wage workers are adults, not teens, and many are using their low incomes to support families. If you’re lucky enough to not know what it’s like to earn a poverty-level wage, consider reading our worker stories, or this moving editorial. By helping workers have the basic necessities better covered, raising the minimum wage helps reduce employee turnover, increase worker productivity, and reduce worker’s reliance on taxpayer-funded public benefits. By raising the minimum wage, we’ll increase consumer spending, which is the driver of economic growth.

We also need to make sure more workers are even guaranteed the minimum wage. Did you know that tipped workers in Illinois currently are paid as little as $4.95 an hour? And domestic workers in Illinois have no minimum wage at all? We need to make this a just society, where hard work is rewarded with an income that can sustain a family.

The Raise Illinois Coalition has introduced a great bill into the Illinois General Assembly, SB 1565. Now it’s all of our turn to see that it passes. Please take 30 seconds to sign a petition in support of the bill and “like” the campaign on Facebook. Then get involved, get educated, tell your story, find and contact your state legislators, and advance the fight for a fair minimum wage in Illinois.

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The Low-Income Housing Tax Credit Preservation Program’s purpose is to encourage developers to build affordable residences for low-income tenants. In this program, the federal government and the states work together; the federal government gives tax credits to state governments, and the state governments give those credits to housing developers that promise to include low-income housing units in their projects. In turn, the developers sell the credits to investors. Sadly, the tenants sometimes get lost in the complicated process of financing, constructing, and maintaining LIHTC properties. 

That’s what initially happened to tenants at a 264-unit complex in Southeast Portland when the Oregon Housing and Community Services Department decided that their homes no longer met the requirements of the LIHTC Program. After the department released the complex from the program’s requirements, the project’s owner sold it to a developer, who evicted all the low-income tenants.

Under the terms of the agreement between the original owner and the department, the low-income tenants never should have been evicted. The agreement stated that the original owner would maintain 100 percent of the project as low-income housing for 30 years and that, in order to receive low-income housing tax credits, the owner (or any subsequent owner) would regulate and restrict the way the property could be used to make sure that the original purpose of the project would survive. The owner of the property entered into those restrictions—or, in legalese, recorded a “declaration of land use restrictive covenants”—and, in return, the project received more than $2 million of LIHTC tax credits.

Years later, the project was sold. The Oregon Housing and Community Services Department determined that the project was not complying with the LIHTC program, and notified the Internal Revenue Service. The department then entered into a release with the project. The release was a crucial document for the tenants of the complex, because it said that the department and the property’s owner released one another from all of their obligations but stated that the owner or any new owner could not evict a tenant of a low-income unit for three years.

After the release was entered into, the property was sold again, and the new owner evicted the tenants. This meant that the developers received all of the benefits of the LIHTC program without providing low-income housing for the original 30-year period. (And the new owner did not even have the decency to wait for the three-year safe harbor period to elapse.)

A group of tenants represented by the Oregon Law Center and two private attorneys sued the new owner and the department, but lost at the trial court. The trial court ruled that the department’s decision to end the complex’s participation in the LIHTC program and enter into the release agreement meant that the low-income tenants had no power to enforce the terms of the original declaration.

Thankfully, in Nordbye v. BRCP/GM Ellington, the Oregon Court of Appeals disagreed and overruled the trial court’s decision. In a thorough, detailed opinion, the court explained that the release that the department signed with the complex’s second set of owners did not wipe out the original declaration. Most importantly, the court emphasized that the low-income tenants had the right to enforce the original restrictions requiring that the property be used for low-income housing. Citing an amicus brief by the National Housing Law Project, the court included the following insightful language:

. . . if failure to comply with program requirements were grounds for early release from the applicable use restrictions, it would create a perverse incentive to encourage noncompliance. An owner of a property subsidized with public funds would be encouraged to violate program requirements in order to secure early release from the LIHTC program. Once released from the obligation to maintain the property as low-income housing for the stated period, an owner would be free to charge market-rate rent or to sell the project for a profit, thereby profiting from a public subsidy without fulfilling the conditions of that subsidy.

This important decision is a must-read for housing advocates, and will surely keep many low-income renters in their homes.

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Illinois Attorney General Lisa Madigan recently vowed to fight debt collectors use of arrest warrants to pursue money they are owned on credit cards, auto loans and other bills—a practice that is flourishing statewide. 

More than one-third of U.S. states allow borrowers who can't or won't pay to be jailed. Nationwide statistics aren't known because many courts don't keep track of warrants by alleged offense, but a tally of court filings in nine counties across the U.S. by the Wall Street Journal earlier this year showed that judges signed off on more than 5,000 such warrants since the start of 2010.

A debt-related arrest warrant is typically issued when a borrower who was sued for payments on an outstanding debt doesn't show up in court or fails to make payments ordered by a judge. Although debt collectors say the threat of jail is used only as a last resort, judges and consumer advocates have criticized the use of such warrants, comparing them to a modern-day version of debtors' prison. Some defendants, in fact, avoid showing up in court because they can't afford to pay and fear they will be sentenced to jail.

The use of debt-related arrest warrants isn’t even the most egregious tactic employed by debt collectors. One debt collection company in Erie, Pennsylvania, actually used fake court proceedings to deceive, mislead or frighten consumers into making payments or surrendering valuables without following the lawful procedures for debt collection. In this case, consumers received letters that were often hand-delivered by individuals dressed like sheriff deputies, implying that consumers would be taken into custody if they failed to appear at the fake court. The “courtroom” that consumers were summoned to was located on the debt collector’s premises and was equipped with furniture and decorations similar to those used in actual court offices, including “a raised bench area where a judge would be seated, two tables and chairs in front of the ‘bench’ for attorneys and defendants; a simulated witness stand; seating for spectators; and legal books on bookshelves.” It is reported that, during some proceedings, an individual dressed in black was seated where one would expect to see a judge.

Last year, Illinois enacted the Debt Settlement Consumer Protection Act (Public Act 96-1420) in order to curb unfair debt collection practices. The law requires a written contract that clearly indicates the terms of the debt settlement agreement and that must be signed by both the service provider and the customer. Most importantly, the new law caps the initial fee to $50 and forbids debt settlement companies from unfairly charging customers without having done any work. The settlement fee is capped at 15% of the savings and cannot be charged until the creditor has entered into a legally enforceable agreement with the consumer. Also, debt settlement service providers must warn consumers that debt settlement service is not suited for everyone and that it may have detrimental effects on the consumer’s credit history and credit score. Finally, companies must provide detailed accounting reports, and consumers are entitled to cancel the contract and receive a refund.

As millions of consumers struggle through one of the most difficult financial times in American history, repeated reselling of debt that has already been collected upon has also become a problem. One report on the debt buying industry revealed that debt collection abuses are on the rise. More debt is being bought and sold and there has also been an exponential growth of lawsuits against debtors, many of which are filed without any proof to back up the debt collection company’s claims.

While Attorney General Madigan can't force judges to stop signing off on debt-related arrest warrants, the Illinois Department of Financial and Professional Regulation, a state agency that licenses lenders and debt collectors, said it plans to introduce a bill early next year that would ban debt collectors from seeking arrest warrants.

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The Affordable Care Act (ACA) is the name of the national health reform law, which has also become known as “Obamacare.” The ACA creates a set of tools that can significantly address the health coverage crisis now and especially over the next few years as the law phases in. 

Here are some of myths spread by opponents of the law, and the facts that refute them:

Myth: The ACA is a government takeover of health care. 

Fact: The ACA keeps the private insurance system, but strengthens the watchdog role of government to ensure that consumers get choice, control, and peace of mind. Health care itself is still private, and most individuals under 65 will continue to get insurance from their employers and private insurance companies. 

Myth: The ACA replaces Medicare or cuts basic Medicare benefits. 

Fact: False. In fact, 18.9 million Medicare recipients have received free annual checkups and preventative services, and 4 million have received Medicare prescription discounts. The ACA will eliminate the notorious Part D “donut hole” entirely.

Myth: The ACA hurts small businesses. 

Fact: Small businesses do very well under the ACA. Employers will be able to purchase insurance with large-pool savings and bargaining power. They will also receive tax credits to offset the cost of their employee premiums. Only larger companies will be fined for failure to offer coverage.

Myth: The ACA adds to the federal deficit. 

Fact: The nonpartisan Congressional Budget Office has scored the ACA to reduce the deficit. 

Myth: The ACA does not actually insure anyone.

Fact: Already a million young Americans are covered under their parents’ plans because the ACA raised the age limit to 26 for dependent coverage. After the phase-in period, well over 30 million Americans now uninsured will be covered by affordable, comprehensive private insurance or (for lowest income people) a Medicaid expansion.

The ACA contains strategies to improve the health insurance worries that afflict every American household, regardless of income. It is also a smart and crucial strategy to fight poverty, by improving lives and upward mobility.      

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The “Achieving a Better Life Experience Act” or the ABLE Act, which was first introduced in the Congress in 2009 as H.R. 1205, was reintroduced recently.

H.R. 3423 was introduced on November 15^th by Andrew Crenshaw (R-FL) and Cathy McMorris Rodgers (R-WA) and in the Senate as S.1872 by Robert Casey (D-PA) and Richard Burr (R-NC). The bill, which has bipartisan support, would amend Section 529 of the tax code to provide tax-free savings accounts for individuals with disabilities.

The 2011 version of the ABLE Act, though similar to the original version, differs slightly. Unlike the original bill, which had a maximum allowable cap of $500,000 in savings, under the 2011 version the accounts would be governed by the same regulations as 529 college savings accounts, in which amount limits are determined on a state-by-state basis. Another change is that, if an individual has an ABLE account, he or she will continue to receive Medicaid benefits, however, if the individual's ABLE account balance exceeds $100,000, his or her Supplemental Security Income (SSI) benefits, if any, will be suspended until the balance goes below $100,000 at which point SSI benefits will be reactivated without a need to reapply.

Funds in ABLE accounts can be used for “qualified disability expenses.” These include transportation, employment support, health prevention and wellness, assistive technology and personal support, miscellaneous expenses as well as housing and education. Individuals eligible to open an ABLE account are those who are receiving SSI, disability benefits, or who have been determined to have a psychological or mental impairment which results in severe functional limitations, including blindness, for a continuous, 12-month period.

The Arc, a disability advocacy group, joined the sponsors of the bill along with other advocates at a press conference on Capitol Hill on November 15^th as the bill was introduced.  As Peter V. Berns, Arc’s CEO explained:

The ABLE Act is about giving people with intellectual and developmental disabilities the opportunity to achieve their dreams. Families are looking for ways to finance things like an apartment, or a ride to work, or additional educational opportunities after high school that don’t jeopardize other necessary services provided by federal programs. This bill creates a tool for families that could lead to a more independent and fulfilling life.

To learn more about the ABLE Act and to compare both versions of the bill, please refer to this chart.

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