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National bail fund to expand in the Deep South

A national effort helping to bail poor and low-income people out of jail formally announced on Tuesday its expansion into the Deep South.

"Bail Out the South " is the next phase of The Bail Project's plans to secure freedom for thousands of people over the next few years, organizers told The Associated Press. Although larger criminal legal systems throughout the country have begun doing away with cash bail for certain low-level, nonviolent offenses, the South continues to have the highest jail incarceration rates and the starkest racial disparities among those imprisoned pretrial.

"When I think about our work around social justice and racial justice, you simply can't talk about those issues without dealing with what's happening in the South," said project CEO Robin Steinberg.

The project expansion includes opening offices in Mississippi, Florida, South Carolina and Alabama this year, which doubles its reach in the region through partnerships with local organizations. The bail fund will work in concert with advocacy campaigns to ultimately end the imposition of cash bail, Steinberg said.

"We, the bail fund, can't put ourselves out of business fast enough," Steinberg told the AP. "That is the ultimate goal here. But as we know, systems don't go down without a hell of a fight."

The national Bail Project, which helps low-income defendants get out of jail by bailing them out as their criminal cases progress through the courts, was founded three years ago, following a successful 10-year campaign led by Steinberg and the Bronx Defenders in New York City.

Data collected over that 10-year period show that 95% of people helped by the project returned to court for every appearance. It also showed that, when people could get out of jail, the majority were ultimately not convicted of a crime.

Since its launch in 2018, The Bail Project said it has paid $41 million to bail out more than 15,500 people in more than 24 cities. That prevented more than 100,000 days of incarceration, and reduced the collateral consequences such as loss of jobs, housing and child custody.

According to The Bail Project, when ranked by state, seven of the 10 states with the highest incarceration rates in the U.S. are in the South. And Black Americans bear the brunt of incarceration in the region. Of all Black Americans in jail in the U.S., nearly half are in Southern jails, The Bail Project said. Many prisoners are also saddled with fines and court fees that can lead to reimprisonment if they go unpaid.

Letitia Sanabria still weeps when she thinks about the days last winter that she spent in a Louisiana jail because she couldn't afford to post bond on $5,000 bail. It was only recently, said the adult group home supervisor, who is Black, that marks left on her wrist and hands from the tightness of the arresting officers' handcuffs faded away.

But the trauma of the ordeal is still fresh.

"It caused chaos, and it was the worst experience ever," said Sanabria, who was arrested in Baton Rouge in December for allegedly interfering in a custody dispute involving her grandchild. Before that day, the 54-year-old had never been jailed in her life.

A Louisiana branch of The Bail Project bailed her out after three days. She would have been out earlier, but there was an outstanding traffic ticket on her record.

Sanabria said she didn't disclose to the child's father where her grandchild was because she felt it was unsafe. So she was taken into custody, even though she explained to police that she was the only person on shift at the group home. It was so abrupt, Sanabria said, that she wasn't allowed to finish passing out medication to group home residents before being led away.

The ordeal got worse at the East Baton Rouge Parish Jail, she said. Sanabria was denied the use of a toilet during jail intake, although she suffers from diabetes and high blood pressure, which she says require her to be near a restroom.

She had to relieve herself where she sat on the jail floor, she said. Sanabria also went without access to her own medications while in jail.

To top it all off, she said, one of the group homes that she works for put her on leave indefinitely while her case makes its way through the courts. She has been able to continue working for another group home but, four months since her arrest, Sanabria is struggling to stay afloat financially.

"We've got so many people going through the same situation that I went through," Sanabria said. "It makes you really wonder what kind of world we have, what kind of society we have, as far as our governments."

Collateral consequences of incarceration, often preventable and unnecessary, drive socioeconomic and racial disparities nationwide, advocates say. And according to recently published papers on criminal justice reform policies by the American Enterprise Institute and the Brookings Institution, both nonpartisan think tanks, pretrial release and sentencing policies continue to be root causes of mass incarceration in the U.S.

"Part of what's happening with the cash bail reform movement is to say that the system needs to change, and overall, there seems to be some bipartisan support on that," Rashawn Ray, a David M. Rubenstein Fellow in Governance Studies at the Brookings Institution, told the AP.

"When we talk about the South, it is often a stronghold for preventing the type of reforms that people nationally think are really important," he said.

Support elsewhere for such reforms has been tempered with concerns that, amid rising crime rates in some jurisdictions, releasing more people pretrial will pose a broader threat to public safety and lead to a policy backlash.

However, Steinberg said, it's a common misconception that cash bail is a matter of public safety.

"What it currently does is criminalize poverty," she said. "It also feeds racial disparities because judges often assign higher bail to Black and brown people."

"What The Bail Project does is remove money from the criminal justice equation," she added. "We level the playing field, so the presumption of innocence actually means something and people can return to their families and get their day in court without pressure to plead guilty."

Bailouts are not the long-term solution to the problem, especially in the South, she added.

"Beyond the elimination of cash bail, we need to create alternatives to pretrial incarceration that are grounded in public health approaches to safety and investments in historically underserved communities," Steinberg said.

Hospitals will soon kick off Medicaid expansion ballot drive

A nonprofit backed by the Mississippi Hospital Association plans next week to kick off its petition drive to put Medicaid expansion before voters on the 2022 midterm ballot, hoping to override a recalcitrant Legislature and put expansion in the state constitution.

Healthcare for Mississippi next week will hold two yet-to-be announced press conferences — one in central Mississippi and one in the north — announcing the drive and naming numerous other groups that are supporting the campaign.

Tim Moore, president of MHA and a founder of Healthcare for Mississippi, said the nonprofit has inked contracts with two Mississippi companies to gather petition signatures and is “getting print materials ready, lining up speakers for next week’s opening and there will be an educational campaign starting relatively quickly.”

“I’ve been amazed at the number of people who have called, and the other groups asking how to get involved and who to give money to,” Moore said. “We’re not going to name them until next week, but we have a wide assortment of groups that are involved in this. I think the numbers are growing even faster than we expected.”

Medicaid expansion through the federal Affordable Care Act has brought heated — and most often partisan — debate in Mississippi, the poorest state in the union. Mississippi, despite its dependence otherwise on federal money, is one of just 12 states that has refused to expand Medicaid, leaving hundreds of thousands of “working poor,” uninsured Mississippians without health coverage and rejecting at least $1 billion a year in federal funds to provide it.

Proponents estimate that expanding Medicaid would provide coverage for at least 200,000 working poor Mississippians, in addition to the roughly 750,000 poor pregnant women, children, elderly and disabled people already on Medicaid.

Most of the state’s Republican leadership, starting with former Gov. Phil Bryant, have opposed expansion, saying they don’t want to help expand “Obamacare” and don’t trust the federal government to continue footing most of the bill. Meanwhile, Mississippi’s hospitals — especially smaller rural ones — say they are awash in red ink from providing millions of dollars of care each year to uninsured and unhealthy people. Hospitals pitched a plan to lawmakers to cover the state’s share of expansion with taxes on hospitals and fees for new Medicaid enrollees, to no avail.

Now, Moore said, he believes voters should take matters in hand through the state’s ballot initiative process. He believes, in part based on polling, that the push will have bipartisan support among voters.

“What do you do after a decade of waiting for the Legislature and leadership to do something and it hasn’t happened?” Moore said. “Do you wait another decade? … This shouldn’t be political. We are talking about working Mississippians who can’t afford coverage, and that shouldn’t be political at all.

“Certainly, there will be significant support from the Democratic side, but I think there is more and more support on the Republican side as well. Too many Republicans have told me, off to the side, ‘It’s time. It’s time to do something.'”

Moore and others have said expanding Medicaid by constitutional amendment is not the preferred path, and he noted that lawmakers still could tackle the issue themselves in next year’s legislative session starting in January. But should the petition drive successfully net about 106,000 signatures by October, the issue would still be on the 2022 ballot.

“(Lawmakers) can take action, not take action, come up with an alternative and put it on the ballot as well,” Moore said. “I would be tickled to death if they moved forward in January of next year ... but they would have to address it early.”

Lt. Gov. Delbert Hosemann has said he’s open to discussion on the issue, one of few state Republican politicians to say so.

But House Speaker Philip Gunn has remained steadfastly opposed.

Neither Gunn nor Hosemann immediately responded to requests for comment on the ballot initiative drive kickoff coming next week.

Gov. Tate Reeves has also reiterated his opposition to Medicaid expansion, and the ballot initiative campaign is likely to face opposition from other conservative corners.

Jameson Taylor, with the conservative Mississippi Center for Public Policy, recently wrote that “Medicaid expansion is bad for Mississippi.” He said that while Medicaid is an insurance program, “Medicaid is also a welfare program. This is the root of the problem for Medicaid.”

"Unlike TANF (cash welfare) and other welfare programs, Medicaid is an open-ended entitlement,” Taylor wrote. “In order for Medicaid to work better, two things have to happen. First, Medicaid needs to begin operating like other welfare programs. This means enrollment is going to have to be limited. (Which also means expanding Medicaid to able-bodied, working-age adults is a very bad idea if your goal is to provide healthcare to those who really need it.)”

But health care, racial justice and other advocates of expansion say it would help impoverished Mississippi tackle one of the global and persistent problems that keeps it on the bottom: the unhealthiness of its people. The ACA expansion would provide health coverage for people making up to 138% of the federal poverty level, or about $17,600 a year for an individual.

Proponents say the expansion would also have pragmatic financial benefits for the state economy and state government budget. Besides helping hospitals cover the $600 million a year and rising they have to eat in uncompensated care for uninsured people, expansion would create thousands of jobs and improve the state health care industry overall.

The proposed Initiative 76 addresses some of this in its language, noting that the state would draw down at least $907 million in new federal funding in fiscal 2023, with the state share being about $99 million.

“However, an estimated 82% of these costs — or $80 million — would be offset by reductions in other state health care spending as a direct result of Medicaid expansion and the remainder more than offset by new tax revenue generated by productivity gains,” the proposed measure reads. “For example, in SFY 2023 Mississippi would save an estimated $51 million on currently eligible Medicaid enrollees, such as low-income pregnant women, becoming eligible for enhanced federal funding. The state would also save an estimated $29 million by accessing federal funding for hospital care for incarcerated individuals and mental health and substance use disorder treatment that currently is funded entirely by the state.”

It also says that, “Further, the infusion of new federal funding into Mississippi’s economy is projected to generate over $95 million in new state and local tax revenues each year. This would more than offset the remaining costs of expansion and result in a net benefit to the state budget of over $76 million.”

Besides the ACA covering 90% of the cost of expansion with federal dollars, the American Rescue Plan recently passed by Congress would further increase the federal share of the cost of traditional Medicaid for two years for any of the 12 holdout states that agree to expand the program.

The Medicaid expansion ballot initiative — and other pending ones including early voting and the state flag — face an uncertain future with a pending state Supreme Court decision. The high court has heard a constitutional challenge to the medical marijuana program voters approved in November through a ballot initiative.

The court is expected to rule soon whether the initiative was constitutionally flawed because the state’s initiative language says petition signatures must be equally gathered from the state’s five congressional districts. But Mississippi has had only four congressional districts since the 2000 census, and state lawmakers neglected to address the issue.

Moore said the Medicaid expansion initiative drive is trying to take that into account, and will try to collect enough signatures to be able to meet the thresholds for either four or five districts.

However, the Supreme Court’s ruling could also halt the state’s ballot initiative process, at least until lawmakers and voters rework state law and constitutional language.

Democrats seek narrow path to rein in cost of medicines

WASHINGTON • President Joe Biden's call for authorizing Medicare to negotiate lower prescription drug prices has energized Democrats on a politically popular idea they've been pushing for nearly 20 years only to encounter frustration.

But they still lack a clear path to enact legislation. That's because a small number of Democrats remain uneasy over government price curbs on pharmaceutical companies.

House Speaker Nancy Pelosi and Senate Majority Leader Chuck Schumer will need every Democratic vote in a narrowly divided Congress. Otherwise Democrats may have to settle for a compromise that stops short of their goal. Or they could take the issue into the 2022 midterm elections.

"There is a path," said Rep. Peter Welch, D-Vt., one of Pelosi's lieutenants. "But there's also a challenge, and the challenge is we've got razor-thin margins."

"This is not a done deal," continued Welch. "We've got a president and a speaker, but 'pharma' is very powerful." Pharma is a nickname for the industry and for its main lobbying group, the Pharmaceutical Research and Manufacturers of America, or PhRMA.

The industry thwarted President Donald Trump's multi-pronged efforts to constrain its pricing power. Even though Trump came into office accusing drugmakers of "getting away with murder" and vowing he'd put a stop to it, the companies emerged from his term with just a few nicks and cuts.

The industry lobbying group PhRMA is considered one of the most skilled operators in Washington. Its mission: to preserve a clause in the 2003 law that created Medicare's pharmacy benefit barring the government from interfering in price negotiations among drugmakers and insurers. That was enacted before $1,000 pills became old hat.

PhRMA CEO Stephen Ubl served notice after Biden's speech to Congress last week that the industry stands ready to defend its prerogative. "Giving the government the power to arbitrarily determine the price of medicines is not the right approach," he said in a statement arguing that it would stifle innovation. Such measured language belies the group's clout. It's usually among the top five spenders on Washington lobbying and networks with allied groups in the states.

"I don't think anybody is fully prepared for the onslaught we expect from PhRMA," said Margarida Jorge, campaign director for Lower Drug Prices Now, a coalition backing Medicare negotiations. "We are going to see a much bigger stepped-up game."

Pelosi put Medicare negotiations back in play with the reintroduction of an ambitious bill she powered through the House in 2019. Medicare would use an average of lower prices in other economically advanced countries to negotiate on top drugs. Companies that refused to deal would be hit with a steep tax. Drugmakers who hike prices above the rate of inflation would owe rebates to Medicare. Hundreds of billions of dollars potentially saved through the legislation would be plowed back into other health care programs. Private insurers covering working-age people would be able to secure Medicare's lower prices.

In his speech to a joint session of Congress, Biden invited lawmakers to imagine the possibilities. "The money we save, which is billions of dollars, can go to strengthening the Affordable Care Act and expand Medicare benefits without costing taxpayers an additional penny," the president said. "It is within our power to do it. Let's do it now. We've talked about it long enough."

But Republican Sen. Chuck Grassley of Iowa is urging Biden to lower his sights a bit. Grassley opposes negotiating authority for Medicare but supports requiring drugmakers to pay rebates for price hikes above the inflation rate — a potential compromise. "I hope the president reconsiders the liberal pipe dream in favor of the big bipartisan win," said Grassley.

Polls have consistently shown strong public support for authorizing Medicare to negotiate. "This is very high among the concerns of voters, and also heavily promised by Biden in the campaign," said policy expert John Rother, a longtime advocate of drug price curbs. The House Energy and Commerce Committee will hold a hearing Tuesday on the issue.

One option for Pelosi and Schumer would be to splice the Medicare legislation into a mammoth bill delivering Biden's "American Jobs Plan" promises on social programs and infrastructure. Such a vehicle would seem to offer the greatest chance to pass drug pricing curbs. But the political dynamics are different in each chamber. What might work in the House may get nowhere in the Senate.

With its 50-50 split, the Senate is looking like the choke point. The overwhelming majority of Democrats are in favor of Medicare negotiations, but a few are undeclared.

Among them is Sen. Bob Menendez of New Jersey, whose office says he believes "any drug pricing bill must deliver real savings for consumers at the pharmacy counter, not just achieve savings to the government or overall system."

"It's going to be a heavy lift," said policy expert Rother. "But I don't think you know for sure until you try it."