Tools
Politics | The Atlantic
Politics | The Atlantic
How the ‘African Ban’ Ripped a Family Apart
A January immigration ruling didn’t cause as much of a stir as the 2017 Muslim ban. But it upended countless families’ plans.
theatlantic.com
Life in the Shadow of ‘Clean Coal’
When Donald Trump took the oath of office on a gray January morning in 2017, he laid out his vision for the United States under his leadership. “We stand at the birth of a new millennium, ready to unlock the mysteries of space, to free the Earth from the miseries of disease,” he said. “A new national pride will stir our souls, lift our sights, and heal our divisions.” The gulf between how liberals and conservatives imagined this vision would play out was wide. Nearly four years later, the divide in how we view the consequences of his first term remains large. But the nation is undeniably changed: Children have been separated from their parents at the border. Major American cities, roiled by protests, have been labeled “anarchist jurisdictions” by the Department of Justice. The stock market reached record highs just months after unemployment grew to levels not seen since the Great Depression. A global pandemic is hitting the U.S.—home to 4 percent of the world’s population but about 20 percent of its coronavirus deaths—particularly hard. Whether he’s reelected or not, President Trump will leave behind a legacy, one that includes normalizing corruption and misinformation, directing government offices and resources to serve his reelection campaign and settle personal scores, gutting nonpartisan federal agencies of expertise, and undermining some of the most basic principles of American democracy. And the decisions of this president and his administration have transformed countless lives. We are telling the stories of seven individuals—a mother of five young kids navigating virtual schooling, a young judge given a lifetime appointment, and a survivor of white-supremacist violence in Charlottesville, among others—living with the consequences of Trump’s first term. You can read the rest of the stories here.In the late 1980s, Barbara Szalai moved to Springdale, Pennsylvania, a little borough along the Allegheny River, northeast of Pittsburgh. She was in her 50s, newly divorced, and looking for a place to live. Springdale made sense: She had been born in the region, and though she had moved away as a child, many of her family and friends still lived in the area. She wasn’t too concerned about living just upriver from the Cheswick Generating Station, its smokestacks periodically belching puffs of white steam into the air. But once she moved in, the plant began to loom large in her life. Sticky black dust blanketed her home and patio furniture. She repeatedly hosed down the exterior of her home and wiped down the furniture, but it wasn’t enough. “Wherever the rain doesn’t hit the surface of the house, there’s black soot,” she said. “It looks like ants.”Since the early 1970s, the Cheswick coal-fired plant has provided power for homes in the region. When it first opened, it was considered state-of-the-art tech: It was among the first generating stations in the nation to install scrubbers that purport to reduce emissions. But it still pumped massive amounts of pollution into the air and surrounding waterways, at a high cost to the more than 30,000 people living within three miles of the plant. Allegheny County, where the plant is located, ranks in the top 2 percent of all counties in the United States for cancer risks from air pollution and has consistently received an F grade from the American Lung Association for both high-ozone days and particle pollution.[Read: Life in the sickest town in America]At 2.5 microns in diameter or smaller, coal soot can lodge deep in the lungs when inhaled. Studies have linked it to heart and lung disease, respiratory illnesses, premature births, and premature deaths. But the particles are invisible, and their effects on any one individual are difficult to prove. Szalai, a retired dialysis technician and home health-care worker, gets frequent headaches and has allergies. It’s hard to say for certain whether they’re connected to the plant, but Szalai suspects they might be, and she says she has seen countless examples of friends and neighbors suffering from cancer and breathing issues. “It’s not a healthy place to live in,” she said. Over the years, she noted, the plant has tried to clean up its pollution with new scrubbers and the addition of a second smokestack. But “coal is coal,” she said. “You can only make it so much cleaner.”A 2019 draft report on coal-soot emissions by scientists at the Environmental Protection Agency indicated that tightening regulations even slightly could save thousands of lives. In a preliminary study from April, researchers at Harvard University found that those living in areas with long-term exposure to the fine particulate matter were more likely to die from COVID-19 than those who lived in less polluted areas. One week after the preliminary findings of the Harvard study came out, the Trump administration announced its decision to not tighten regulations on industrial soot emissions.[Read: Trump isn’t a climate denier. He’s worse.]The Trump administration has reversed or rolled back more than 100 environmental policies governing air and water pollution, toxic waste, drilling, and more. This isn’t the first time its actions have affected the environment in Allegheny County. The Obama administration tried to compel coal-fired power plants to clean up their emissions with the Clean Power Plan. But the Trump administration terminated the Obama plan before it took effect, part of an effort to prop up a declining coal industry. “We’ve got the cleanest country in the planet right now,” Trump said in 2018 after he announced plans to dismantle the Clean Power Plan. “But I’m getting rid of some of these ridiculous rules and regulations, which are killing our companies … and our jobs.” Despite his efforts, coal-industry jobs have declined under his administration, as power companies move to cheaper, cleaner-burning natural gas.[Read: America’s coal consumption entered free fall in 2019]The administration’s refusal to listen to scientists is a “very, very concerning” trend with “detrimental consequences to public health,” said Francesca Dominici, a Harvard University biostatistician who led the study linking the coronavirus and air pollution. In a separate study released in July, Dominici and her team found that the EPA could go much further in elevating its air-quality standards in order to protect public health. Her team concluded that even a small tightening of regulations could save more than 143,000 lives over a decade.Szalai is frustrated that the administration could have improved her air quality but chose not to. “Until Trump is no longer our president, environmental issues are not going to be addressed,” she said. “His agenda is jobs at any cost. He doesn’t care about the environment.”She’s 84 now, and it feels too late for her to leave. But, after decades of living near the plant, she has regrets. “If I had my way, I would have left,” she said.
theatlantic.com
Losing Medicaid and Losing Sobriety
Anson ChanWhen Donald Trump took the oath of office on a gray January morning in 2017, he laid out his vision for the United States under his leadership. “We stand at the birth of a new millennium, ready to unlock the mysteries of space, to free the Earth from the miseries of disease,” he said. “A new national pride will stir our souls, lift our sights, and heal our divisions.” The gulf between how liberals and conservatives imagined this vision would play out was wide. Nearly four years later, the divide in how we view the consequences of his first term remains large. But the nation is undeniably changed: Children have been separated from their parents at the border. Major American cities, roiled by protests, have been labeled “anarchist jurisdictions” by the Department of Justice. The stock market reached record highs just months after unemployment grew to levels not seen since the Great Depression. A global pandemic is hitting the U.S.—home to 4 percent of the world’s population but about 20 percent of its coronavirus deaths—particularly hard. Whether he’s reelected or not, President Trump will leave behind a legacy, one that includes normalizing corruption and misinformation, directing government offices and resources to serve his reelection campaign and settle personal scores, gutting nonpartisan federal agencies of expertise, and undermining some of the most basic principles of American democracy. And the decisions of this president and his administration have transformed countless lives. We are telling the stories of seven individuals—a mother of five young kids navigating virtual schooling, a young judge given a lifetime appointment, and a survivor of white-supremacist violence in Charlottesville, among others—living with the consequences of Trump’s first term. You can read the rest of the stories here.What Megan feared most in the early fall of 2018 was that she might end up in the hospital and have to be intubated. It was a reasonable fear. Megan, who I am calling by a pseudonym so that she can discuss her medical history candidly, has asthma. When she was a child, her breathing problems were easily controlled, but in college, her condition worsened. She often had asthma attacks that took her to urgent care or the emergency room. Later, she would learn that the concentration of chicken farms in the northwest corner of Arkansas, where she lived, could be hard on people with chronic lung conditions. She didn’t know that at the time; all she knew was that she kept getting sick.She’d been intubated twice before. The first time, in 2015, was for 14 days, part of a six-week stint in the hospital. The cost for her stay approached $500,000. The second time was in April 2018. She was 26 and had aged out of her mother’s insurance coverage. She knew she couldn’t pay.Thankfully, she didn’t have to. She had just been approved for Medicaid, which paid for part of it. But by the fall of 2018, Megan had lost her coverage due to a Trump-administration decision to allow states to attach work requirements to the program. The move was part of ongoing efforts to cut the budgets of many safety-net programs, including food stamps and housing assistance, by making it harder for people to qualify.Losing her coverage meant that Megan couldn’t get the medicine she needed to control her asthma. It also meant that she could be one hospital stint away from financial ruin. “I’d pretty much already resigned myself to the fact that I’m probably going to have to file for bankruptcy one day for medical bills,” she said.[Read: What happens when you don’t pay a hospital bill]Medicaid had traditionally covered some of the most vulnerable adults, those with disabilities or who were very poor. The Obama administration expanded Medicaid to cover more low-income people, including the working poor. Arkansas was one of the first and only red states to accept the expansion, under its then-Democratic governor. Once Trump took office, his administration promoted attaching work requirements to Medicaid and told states it would approve their plans to do so. Seema Verma, whom he had appointed to head the Centers for Medicare & Medicaid Services, said that the Obama administration’s expansion of Medicaid had stretched the safety net too far. “The thought that a program designed for our most vulnerable citizens should be used as a vehicle to serve working-age, able-bodied adults does not make sense,” Verma said in a 2017 speech to state Medicaid directors.Conservatives argue that work requirements encourage people to find jobs and have been pushing to include them in safety-net programs since the 1996 welfare-reform law, which introduced the requirements, passed under Bill Clinton. But a review of the reform law’s effects 20 years after its passage, by LaDonna Pavetti of the Center on Budget and Policy Priorities, showed that work requirements moved people into jobs only in the short term. They didn’t reduce poverty in the long term. What they mostly succeeded in doing was cutting people off from aid.Arkansas was the first state to enact Medicaid work requirements under Trump’s new rule. Recipients had to earn at least $680 a month—roughly 80 hours at the state’s minimum wage at the time—and report their income regularly to the state. They could do so only online at first. Many of the estimated 18,000 people who ultimately lost their insurance in Arkansas in 2018 were the most at-risk: seasonal workers who couldn’t maintain the state’s $680-per-month requirement year-round, or people who didn’t have regular internet access.[From the October 2019 issue: Medicaid’s dark secret]Because she was a full-time student, in an online master’s program studying criminology, Megan thought the changes didn’t apply to her. She was also working about 14 hours a week as a server at a restaurant. The staff at the clinic where she first applied for Medicaid told Megan that college students were exempt from the work requirements, but they weren’t sure whether that applied to students in grad school, she said. “There was a lot of confusion amongst beneficiaries about whether it was going to apply to them,” said Kevin De Liban, an attorney with Legal Aid of Arkansas, who represented Medicaid beneficiaries in a lawsuit against the federal government.Megan didn’t realize she’d lost coverage until she went to a pharmacy and her insurance didn’t go through. She never found out exactly why. When programs like Medicaid require recipients to verify their income or report to the state frequently, it creates more opportunities for people to be kicked off because of mistakes or errors in the system, a phenomenon policymakers call “churn.” Megan tried to find out what had happened, but every call to the state agency took at least two hours of wait time, and she struggled to get through.Without Medicaid, Megan knew she wouldn’t be able to afford the hospital stay she feared was inevitable. Breathing problems sent her to urgent care twice in one month. Her ADHD, which she once managed with therapy and prescriptions, spiraled. “It was terrifying,” she said. In the restaurant world in Little Rock, she was surrounded by cocaine and painkillers. She started turning to them for relief. “I felt like I was functioning,” she said. And then she wasn’t. One day, she was doing laundry when her boyfriend heard a loud crash. “The dogs went crazy,” she said. “I guess I’d had a seizure.” She woke up in an ambulance.[Read: Americans are going bankrupt from getting sick]Eventually, Megan went to a detox center she’d heard about from friends. It was there, in November 2018, that she learned she was pregnant. She was then enrolled in a special version of Medicaid for pregnant women that covered more of her medical needs and exempted her from the work requirements. Her baby was born in 2019. She said she got the best care of her life. She was given buprenorphine to help wean her off the pain pills and received regular psychiatric treatment and medication. Her health problems were under control.Ultimately, the work requirements didn’t last—a federal judge overturned them last February. But Megan is still dealing with the consequences of her time without coverage. She has medical debt she can’t pay down. The worries and the problems she developed when she didn’t have insurance still haunt her, especially her problems with addiction. “I’m not saying it was because I lost Medicaid, but you know, maybe,” she said. “At the end, I was like, I’m going to die. And I didn’t want to die.”
theatlantic.com