At a time when drug use is causing devastating consequences for our communities, we need to do everything we can – as advocates, community members, family and friends, to support those impacted by addiction. A key message of this movement: Recovery is possible.  In fact, over 23 million Americans are currently in long-term recovery from addiction.

People in recovery and their allies gathered on the National Mall on the evening of October 4th to UNITE to Face Addiction. Tens of thousands of advocates from across the country and around the world joined the rally to draw attention to this public health crisis and to remind the world that people do recover from addiction. Those of us attending on behalf of Community Catalyst’s Substance Use Disorders team were proud to be among them!

The rally kicked off with a fun lineup of musical super stars—Steven Tyler, Sheryl Crow, and The Fray, just to name a few! During their sets, the musicians shared stories of how addiction has touched their lives. In between musical acts, political figures from all branches of government addressed the crowd to voice their support for people living with substance use disorders and those in recovery.

Current and former senators and leaders from various federal agencies, such as the Substance Abuse and Mental Health Administration, Food and Drug Administration, and Health Resources and Services Administration, acknowledge the importance of addressing this national epidemic. Surgeon General Murthy used the rally as an opportunity to announce for the first time his plan to release a groundbreaking new report on substance use and health in 2016.

Throughout the evening, dozens of speakers shared powerful personal stories, all met with cheers and encouragement from the crowd. Rally organizers called upon attendees to honor lives lost to substance misuse and to chart a path forward, emphasizing the prevention of substance use disorders, affordable options for addiction treatment and recovery supports, and access to the opioid reversal medication Naloxone.  Advocates also urged members of Congress to improve addiction policy to expand the resources available to individuals with substance use disorders, their families, and their communities.

Community Catalyst has been a supporter of UNITE to Face Addiction since last spring, when we joined a coalition of leading organizations serving the substance use disorders and recovery community on a working group of organizations helping to plan and promote the rally. The movement has grown from there. Facing Addiction Inc., the organization behind the event, is now an independent nonprofit organization that has mobilized a strong national grassroots presence.

Community Catalyst was proud to participate in the effort to elevate the conversation about substance misuse at the national level. We see this public dialogue on addiction and recovery as deeply connected to our mission and our work over the past five years in the area of substance use disorders.  Increasingly, this work necessitates comprehensive approaches to address the opioid epidemic that has swept the United States over the past few years. From prevention efforts targeted at youth to ensuring consumers have access to adequate treatment and peer support, Community Catalyst is working with a network of consumer health advocates across the country to support states and communities seeking to prevent more overdose deaths and offer hope to those impacted by addiction.

Children need healthy food to learn, grow and thrive. Unfortunately, our researchers and pediatricians at Children’s HealthWatch encounter families every day struggling to afford enough food for all family members to lead active, healthy lives – a condition known as food insecurity. The impact of food insecurity, even at its mildest levels, is written on the bodies and brains of young children with compromised health and development.

Solutions to food insecurity are within reach through the comprehensive set of food and nutrition programs available in the U.S. We at Children’s HealthWatch often compare food assistance programs to vaccines – they keep children healthy, decrease their risk for developmental delays, and benefit whole communities by ensuring parents can go to work because their children are healthy and focused in school supported by the nutrition necessary for learning.

The Child Nutrition Act Reauthorization, which authorizes child nutrition programs, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the National School Lunch Program, National School Breakfast Program, the Child and Adult Care Food Program (CACFP), and the Summer Food Service Program, is set to expire on September 30, 2015. These programs are proven ‘vaccines’ for children from birth to high school graduation. Improving them to ensure all children have access to enough of the vital nutrition they need will enable children to grow up healthy and strong.

As Congress considers key changes to child nutrition programs, we hope that they will consider the following evidence-based solutions that will improve the health of young children and their families including proposed improvements to WIC, CACFP, and summer food programs.

1.       Increase eligibility for WIC to age six to close the gap between turning five and entering kindergarten to more fully support the health of this nation’s children:

Many children experience a gap in nutritional support between turning five and entering kindergarten, where they are then able to participate in the National School Lunch and School Breakfast Programs. Increasing WIC eligibility to age six would close this gap and improve the health of young children before they enter school. Continuous access to nutritious foods supports healthy child growth and development and prepares children to enter kindergarten ready to learn. WIC provides children with foods that supply key nutrients, nutrition education, and clinical care from birth to their fifth birthday, during a time of critical brain and body growth.

2.       Strengthen CACFP to address the financial and administrative needs of child care settings  and thus better provide millions of infants and children with access to nutritious food to set a trajectory for lifelong health and well-being.

While CACFP has a relatively small but growing evidence base demonstrating its importance for young children’s diet quality, weight status, and overall health, more research is needed to explore these connections thoroughly and to continue to strengthen the program. Proposed changes to improve the program include:

  • increasing reimbursement rates
  • allowing three meals a day to be reimbursed for children in care for long hours
  • reducing area eligibility tests in order to streamline access to the program
  • decreasing administrative burdens and paperwork
  • continuing to fund CACFP at adequate levels

3.       Enhance efforts to expand the reach of the Summer Food Program and providing low-income families with children an electronic benefits transfer card (EBT) to purchase food during the summer.

During the summer months, children ages 0-18 living in low-income families may be eligible to participate in programs that seek to alleviate food insecurity in households with children, including families with young children. Proposed improvements that will increase access to food for children during summer months include:

  • improving area eligibility tests to allow community-based organizations to participate in the Summer Food Service Program
  • allowing local government agencies and private non-profit organizations to feed children year round through the program
  • providing funds for transportations grants to provide innovative approaches and mobile meals for summer meals
  • allowing all Summer Food Service sites to serve a third meal
  • providing Summer EBT cards to families with children

Children’s HealthWatch is committed to informing public policy conversations related to nutrition programs that affect the health and well-being of young children. Our research and the research of others show that child nutrition programs improve the food security, health and development of young children. We hope that Congress will use this research to inform and invest in policies that support the well-being of our youngest citizens, and in doing so, strengthen our future.

Author: Allison Bovell, MDiv
Research, Policy, and Communications Coordinator
Children’s HealthWatch

Well, really it’s not just PhRMA, it’s the generic manufacturers, as well. Normally there is a special room deep underground below the capitol where ideas to control excessive prescription drug prices go to die. The drug industry casts a long shadow over policymaking in Washington regardless of which party is in control of the White House or Congress. But with rising voter concerns about prescription drug costs -- fueled by a combination of expensive new drugs, price increases for old drugs, and insurance plans increasingly relying on high cost-sharing to hold down premiums – perhaps  that is about to change. The Center for American Progress and both of the leading Democratic candidates for president are out with policy proposals to restrain drug prices.  States are also trying to tackle the issue, with a number of states debating legislation to increase the transparency of drug pricing.

The drug industry is clearly feeling some heat and is trying to get on top of the debate, but even a PhRMA-sponsored poll showed only 51 percent of likely voters opposed to drug price controls. A number of commentators have suggested that the poll was probably biased and that support for price controls is actually much higher.

Does the drug industry have anything to worry about? Won’t any effort to control drug prices get bogged down in a divided and seemingly ever more dysfunctional Congress? Perhaps, but what is probably worrying industry most is rumors that HHS is looking at ways to use its existing regulatory authority to hold down drug prices. If the administration is seriously looking to use its existing authority, it could start by making sure any new trade agreements don’t undermine efforts in the US and internationally to hold down costs. On top of that, there are some ideas in the CAP proposal that could be implemented without legislation. Will the outrage over rising prices turn into serious remedies? It’s too soon to tell, but certainly this is a good time to be pushing.

More on Mergers: When No Is Not Enough

Insurance industry executives have been up on the Hill facing scrutiny over proposed mergers among some of the largest insurance companies in the nation. Unfortunately, the debate over the mergers is missing some essential elements. Would the mergers cause premiums to rise? Both economic theory and the available evidence suggest that the answer is yes. But if the mergers of insurers are blocked, while provider consolidations continue on, then premiums will also go up.

The fight about the insurance mergers is as much a fight between large special interests over a division of the spoils rather than something that will yield an outcome that will truly benefit consumers. You didn’t really think the AHA and the AMA were leading the charge against the mergers because of their concern about rising health care costs did you? (If so, I have this bridge in Brooklyn that you might be interested in buying…). Unless we are prepared not only to block both insurer and provider consolidations but also to unwind many that have already occurred, we are unlikely to achieve a decent competitive equilibrium in much of the country. Consumers may be better served by strengthening regulatory oversight over premiums and provider prices than by an effort to close the barn door after the horses have already left the stable.

Merger Mania

The proposed mergers of several big insurers continues to be a hot topic. Unfortunately, the poles of the debate are big insurance on one side and big providers on the other, leaving consumer interests on the sidelines no matter which behemoth wins this round. The typical anti-trust argument--more insurers means more competition means lower premiums means consumers win -- is altogether too simplistic. Insurer mergers certainly could lead to higher premiums, but so too could an imbalance of power between payers and providers. More on this topic soon But, for now, the key takeaway is that to address the consumers need for quality, affordable health care, we need a broader frame than mergers--yes/no.

More Signs of Success and More Work to Do

New census data came out this week showing yet again that the ACA is reducing the numbers of uninsured Americans to historically low levels. A special round of thanks is owed to those who worked so hard for passage of the ACA, those who labored to get people enrolled and those who campaigned to undo the damage done by the Supreme Court by persuading state lawmakers to extend health insurance to the lowest income families.

While we can be proud of the success we have had to date, our work is far from over. Here are three key tasks in front of us:

  • Closing the coverage gap in the remaining states. It is clear that the biggest coverage gains have come in states that implemented ALL of the ACA, including the provisions that make all citizens below 138 percent FPL eligible for Medicaid. Twenty states still have not taken this step and it remains a critical unfinished piece of the coverage agenda
  • Making the enrollment process work for everyone. The enrollment process was much smoother during open enrollment two than it was the first time around, but there is still more that needs to be done to make the system work well. To cite just one example, it seems that many legal immigrants are getting caught up in a faulty eligibility verification process and losing access to premium tax credits that they are entitled to under the law.
  • Making coverage and care more affordable. While the coverage gains to-date have been impressive, many who remain uninsured cite affordability as a continuing barrier. Some people who lack coverage are not eligible for premium tax credits, and many with coverage find out-of-pocket costs are still a problem.  One welcome, though small, step to address the cost-sharing problem was a recently announced change in how family out-of-pocket maximums will be calculated so that the cost-sharing maximum for any person in a family plan can be no higher than the individual out-of-pocket maximum. Previously, the entire family out-of-pocket maximum could be applied to a single sick family member.

You're Not Listening...

While high out-of-pocket costs are rising to the top of the American people's concerns about health care, some political leaders have apparently not gotten the message. The House Republican leadership is continuing to press a lawsuit that would strip cost-sharing assistance from thousands of people and make it harder for them to access and afford medical care. That lawsuit got a recent boost when a judge in DC district court ruled that the House had standing to bring the suit. That ruling is likely to be appealed and ultimately overturned. Even if it were to prevail, it is not at all clear there would be any actual effect on people's eligibility for cost-sharing reductions. What is more interesting is how the concerns of the American people are failing to register with the political leadership in Washington that is still committed to an anti-ACA agenda even though the rest of the country is moving on.

Anybody, anybody...

We have just finished the second Republican Presidential Primary debate (or debatathon in the case of this Wednesday's five-hour extravaganza), and again, barely a word about the ACA. Seems like after repeated failures to upend the law and with millions of people now gaining coverage, there is less and less political mileage to be gained from ACA attacks (and "replace" seems as elusive as ever). 

When I accepted the first CEO position at the REACH Healthcare Foundation more than 11 years ago, I was introduced to the important distinction between philanthropy and charity.  While charity is critical to addressing immediate and urgent human need, I have since come to recognize the power of philanthropy to achieve its full potential—identifying solutions to address long-standing social problems and accomplish sustainable change.

This realization came after a series of well-intentioned but insufficient attempts by our foundation and many others to address complex health problems such as untreated oral disease and the severe lack of access to oral health care. What did we learn from those early foundation investments? That hope is not a strategy. 

We hoped that by providing funding for dental care to school nurses, nursing homes and organizations serving the disabled that we would have an impact on their oral health.  We did effect some change for a limited number of beneficiaries in critical need.  However, we also hoped that by launching a regional children’s oral health initiative that utilized extended permit dental hygienists to provide screenings, preventive care and referrals to participating dentists, and attempting to address barriers cited by dentists wanting to serve low-income populations, that our dental schools and dental provider communities would continue those collaborations and institutionalize this model of care. Many children received those services for a few years, but the maldistribution of oral health providers who accept Medicaid relative to the people who need care remained. 

Frail seniors in nursing homes, children of parents who work in jobs that don’t provide health insurance, families who live in isolated rural areas, and people residing in urban areas who lack transportation are all individuals who still need a healthy mouth in order to achieve overall health and be productive members of society.

In the United States today, all health professions have effectively incorporated other advanced practitioner providers on their teams, with one exception: dentistry. In the medical profession, physician assistants and nurse practitioners have provided safe and effective care in the United States for decades.  And if you’ve been to a vision center recently, it isn’t likely that the ophthalmologist is conducting your routine eye exam, but rather an optometrist. 

Why?  Because it doesn’t make practical or economic sense for the practice, for you, or for your insurer—if you are fortunate enough to have insurance—to have the most highly trained and compensated member of the team providing routine care that can safely be provided by another member of the team.  More importantly, your health outcomes are likely to be the same or in many cases better because those advanced practitioners are practicing a narrower scope of procedures with greater frequency.

Organized dentistry cites a number of reasons for its decision to continue to oppose the inclusion of a licensed professional commonly referred to as a dental therapist—an educated, trained oral health provider—on the dental team.  I won’t belabor their rationale.  Suffice it to say it has little to do with addressing the growing disparities in oral health care for vulnerable populations.

Six years ago, the REACH Foundation became a proponent of legislation introduced in Kansas to establish a dental therapist in our state.  We did not enter into that decision lightly; nor did we assume it would be without controversy.  Extensive research—literally hundreds of peer-reviewed, well-designed studies—on the safety, quality, economic feasibility and opportunity to reduce health disparities through the addition of dental therapists to the dental team have been conducted.  Not one study justifies organized dentistry’s ongoing opposition to this approach to care that is being used effectively in more than 50 countries around the world and now several states in our own country.

In fact, dental therapists are practicing successfully in the United States. In Alaska, dental therapists have increased access to care for 40,000 previously underserved Alaska Natives.  In Minnesota, the state dental board reported that dental therapists are improving access to care for underserved populations, reducing wait and travel times for patients, providing cost-effective care, and have the potential to reduce ER visits.  Soon, dental therapists will begin practicing in Oregon and Maine.

The evidence and growing success of dental therapists in the United States led the Commission on Dental Accreditation (CODA), the same organization that accredits dentists, to adopt standards for the education, training and practice of dental therapists last month.  The CODA decision to implement standards recognizes the need and support for the dental therapy profession and represents growing recognition that dental therapists can provide high-quality, safe and effective care. The time has come for policymakers in Kansas to do what organized dentistry has been unwilling to do, despite the science that supports the value of dental therapists—that is, create the opportunity for those dentists who do want to address unmet need and are willing to add a trained dental therapist to their team to do so.  Those who don’t see the value of having a dental therapist as part of their practice can continue to conduct their business as usual. 

REACH is one of several Kansas health philanthropies proud to stand in support of the Kansas Dental Project, a coalition of more than 50 organizations across the state that understand the benefits of adding dental therapists to the dental team.  We also stand with the growing number of dentists in Kansas who are interested in finding more economical ways to serve populations in need, but find themselves on the wrong side of their dental colleagues for their stance.  We invite them and anyone else interested in this cause to contact the Kansas Dental Project at to learn more about this model of care and how to get involved in the campaign to bring oral health care to those who need it most.

Brenda R. Sharpe
President & CEO
REACH Healthcare Foundation