ACE

Category: ACE Research

  • The Pros and Cons of the Honor Our Living Donors Act

    The Pros and Cons of the Honor Our Living Donors Act

    Introduction to Organ Donation

    As of September 2024, more than 100,000 individuals nationwide were on the waiting list for organ transplants. Despite the fact that over 46,000 organ transplants were performed in the U.S. last year, thousands of Americans still die annually waiting for a new organ. While some believe financial incentives for living donors may improve the organ shortage crisis, any type of direct monetary transaction for an organ is punishable under the National Organ Transplant Act (NOTA) of 1984. NOTA prohibits the sale of human organs and tissues, with fines up to $50,000 and/or 5 years of imprisonment, citing altruism as the sole permissible motivator behind organ donation in America. 

    However, some living donors are eligible for reimbursement under the National Living Donor Assistance Center (NLDAC). NLDAC covers up to $6,000 of a living donor’s donation-related expenses such as traveling or lodging. Living organ donors may only be eligible for reimbursement if their organ recipient’s income does not exceed 350% of the HHS Poverty Guidelines, or $52,710 in the U.S. mainland. In September 2020, former President Donald Trump issued an executive order that expanded covered expenses to lost wages, childcare, and eldercare on top of travel and lodging costs. Today, many legislative efforts to mitigate the organ shortage crisis have been entertained by Congress, including the Honor Our Living Donors Act. 

    What is the Honor Our Living Donors Act?

    The Honor Our Living Donors (HOLD) Act was introduced to the House on October 24th, 2023 by Representative Jay Obernolte [R-CA-23]. The bill proposes that donation-related reimbursements for living donors should be considered based on the organ donor’s income rather than the organ recipient’s income. The latest action on the bill was on July 23rd, 2024, when it was placed on the Union Calendar. 

    Arguments in Favor

    Proponents of the HOLD Act argue that potential donors may be more inclined to help patients on the waiting list when they incur less costs related to organ donation. In the status quo, economic barriers deter low-income individuals from donating organs, as the average donation requires $5,000 in out-of-pocket expenses. Thus, organs are disproportionately donated by those with high median household income. If enacted, supporters argue, the HOLD Act would render organ donation a cost-neutral endeavor and thus increase the pool of potential donors. 

    Those in favor of the bill also claim that the HOLD Act may decrease government expenditures on organ-related healthcare. Currently, Medicare allocates $150 billion—or roughly 18% of the program’s total spending—on individuals who suffer from kidney diseases. If the organ shortage crisis improves with the help of the HOLD Act, proponents believe less money would have to be allocated toward curative or diagnostic care, saving the government billions of dollars in the long run.

    Arguments in Opposition

    Critics of the HOLD Act point to ethical and legal issues with the HOLD Act’s reimbursement system. Opponents believe that financial incentives may deter living donors from donating out of altruism, taking away from what they argue is the core tenet of organ donation. They point to research on the overjustification effect, a phenomenon in which individuals become less compelled to exhibit an intrinsically-motivated behavior when external rewards such as money are offered. Critics worry that reimbursements for organ donation might induce this effect and deter altruistically-motivated donors from giving. They also warn that potential donors may avoid donating due to a fear of being perceived as financially desperate rather than generous. 

    Opponents of the HOLD Act also argue that the bill does not adequately address the core causes of the nationwide organ shortage crisis. They believe that Americans do not donate their organs due to several reasons including a lack of information, religious exemptions, and fear of objection on top of financial inability. Critics also argue that the Act’s expanded coverage of donation-related expenses does not provide enough financial relief to spur organ donation nationwide. 

    Conclusion

    Given the HOLD’s Act current bipartisan support and President-Elect Trump’s previous executive order to expand reimbursement for living organ donors, the bill is likely to receive both congressional and presidential support during Trump’s second term. As the HOLD Act moves forward, the debate over the root causes of America’s organ shortage crisis will continue.

  • Pros and Cons of the SUPPORT Act of 2018

    Pros and Cons of the SUPPORT Act of 2018

    Background

    The opioid epidemic has emerged as a major public health issue in the United States. Beginning with a surge in opioid prescription in the 1990s and followed by waves of addiction to synthetic opioids such as fentanyl, the crisis has grown and morphed since its inception. Since 1999, there have been more than 600,000 opioid-related deaths in the U.S. and Canada. Over the years, U.S. lawmakers have responded to the opioid epidemic with several policies including the Comprehensive Addiction and Recovery Act (CARA) and the 21st Century Cures Act, which both laid a promising groundwork for prevention and treatment but had limited outreach and funding. In 2018, Congressed passed the SUPPORT Act with the goal to tackle the crisis in a new way.

    What is the SUPPORT Act of 2018?

    The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act of 2018 was signed into law by former President Trump on October 24th, 2018. The bill aimed to address the opioid epidemic through prevention, treatment, and recovery, with emphasis on law enforcement and provisions to Medicare & Medicaid. Its core provisions are as follows:

    • Prevention: The Act includes a set of policies that aim to reduce the incidence of cases related to opioid use and addiction. The bill expands public health education, implements opioid stewardship in hospitals and clinical settings, and promotes the use of alternative pain management theories.
    • Treatment and Recovery: The Act expands access to medication-assisted treatment (MAT), building on top of the work of the TREAT Act and the Addiction Treatment Access Improvement Act. Expansion of MAT will allow administrators of MAT — doctors, nurse practitioners, physician assistants — to combine medications with therapy to address the biopsychosocial aspects of opioid addiction. 
    • Emphasis on Law Enforcement: The Act emphasizes the importance of law enforcement in limiting the distribution of synthetic opioids. The Act also connects law enforcement to healthcare systems in hopes of monitoring the trafficking of opioids. 
    • Provisions to Medicare & Medicaid: The Act expands Medicare and Medicaid to cover a wider range of treatments related to substance use disorders including MAT, therapy, and counseling.

    Arguments in Favor of the SUPPORT Act

    Supporters of the Act emphasize its role in expanding Medicare and Medicaid coverage. They highlight the expansion of coverage including new medications, outpatient services, and health home programs under both Medicare and Medicaid. Proponents believe that the growth of access to treatment allows patients in both residential facilities and outpatient programs to have greater access to treatment. In the past, Medicare has been criticized for its limitations on coverage for substance abuse treatment, so proponents believe that the SUPPORT Act was a crucial intervention to reimburse older patients for medicated treatments, behavioral therapies, and counseling.

    Proponents of the SUPPORT Act also applaud the Act for expanding and developing the healthcare workforce; they hold that it eliminated some systemic barriers to care like long waitlists that previous bills did not address. According to the Department of Labour, the SUPPORT Act piloted several grant programs to “deliver training and employment opportunities to encourage more individuals to enter professions that could address the crisis”. Proponents believe one pilot grant program through the Employment and Training Administration  allowed more people from under-resourced communities join the healthcare workforce and tackle the epidemic in their own communities. Proponents highlight that in addition to providing grants to expand the opioid response workforce, the bill also established funds to respond to economic harm in towns whose workforces are impacted by opioid addiction. 

    Finally, proponents applaud the SUPPORT Act for increasing the authority of healthcare workers and hospital systems in administering substance abuse treatments. Proponents believe medication-assisted treatment, or MAT, is especially important in the fight against the opioid epidemic as it combines the use of medications like buprenorphine and counseling, addressing the physical and mental aspects of opioid addiction simultaneously. The Act gained support from several healthcare advocacy groups for giving registered nurses, nurse practitioners, and physician assistants the ability to prescribe buprenorphine once they obtain certification. They argue that this provision increased access to MAT nationwide. Proponents also praise the Act for its funding of health education programs that educated patients on the dangers of opioid misuse, preventing health consequences early-on. 

    Arguments Against the SUPPORT Act

    Opponents of the bill cite concerns over sustained funding and support from the federal government. The American Hospital Organization raises the issue that Medicaid and Medicare rarely cover the full cost of hospital expenses, leaving a $75.8 billion annual gap that falls on hospitals and other patients to close. With the Act’s expansion of Medicaid and Medicare coverage for substance use treatments like MAT, they argue that hospitals became even more overburdened with costs. The SUPPORT Act provided $6 million for health centers and $2 million for rural health centers for buprenorphine treatment, which critics argued was not enough to sustain the number of patients that need to be served. Similarly, critics contend that the Act did not account for the long-term sustainability of its workforce expansion goals, since the end date for most of its grants was set to January 2023. 

    Critics also emphasize how the SUPPORT Act failed to fully address the housing crisis, one of the socioeconomic factors underlying the opioid epidemic. Mimi Walters, former United States Representative, flags a provision of the SUPPORT Act that provided grants for temporary housing but only extended this funding to 50% of states. She warns that inconsistent funding like this only worsens the ongoing challenge of ensuring that people with substance use disorders secure housing. 

    Opponents of the bill worry about the impact the SUPPORT Act has on sober homes and residential substance use treatment facilities, locations that help people in recovery transition back into their communities and avoid homelessness. The Eliminating Kickbacks in Recovery Act, a part of the SUPPORT Act, made it punishable by either a $200,000 fine or 10 years in prison for sober homes to receive monetary kickbacks. This worried critics who believe that the lack of access to housing and the overcriminalization of residents who utilize sober homes could create a cycle in which people in recovery struggle to find housing and start using substances again.

    ConclusionThe SUPPORT Act of 2018 embodies the struggles the federal government faces in responding to a healthcare epidemic as large and multi-sector as the opioid crisis. Proponents cite the role the SUPPORT Act played in expanding Medicare and Medicaid, developing the workforce, and increasing the abilities of various healthcare workers to provide treatment. Conversely, critics of the SUPPORT Act highlight the bill’s failure to provide enough funding to sustainably support its goals. Congress failed to reauthorize the Act in 2023, signaling a desire for a new approach to the opioid epidemic. Future measures to combat the crisis must learn from the SUPPORT Act’s successes and drawbacks in order to deliver long-term solutions.

  • U.S. Response to the Tigray Conflict in Ethiopia: Key Actions and Implications 

    U.S. Response to the Tigray Conflict in Ethiopia: Key Actions and Implications 

    Introduction 

    The Tigray War in Ethiopia demonstrates a complex and multifaceted conflict with various historical, political, and regional dimensions. Bordering Eritrea, Tigray is Ethiopia’s northernmost region and is home to an estimated 7 million ethnic Tigrayans. The region was governed by the Tigrayan People’s Liberation Front (TPLF), a leftist and ethnic national political party that formerly ruled Ethiopia from 1991 to 2018. It came into power when the TPLF overthrew the government of the People’s Democratic Republic of Ethiopia after mobilizing enough Tigrayans for its ethno-nationalist movement. 

    The civil war between the TPLF and Ethiopian government began on November 20th, 2020, when the newly appointed prime minister Mr. Abiy failed to uphold his promise to conduct national elections and extended his term as prime minister in June 2020. With the TPLF losing control of the national government and the belief that Abiy was attempting to centralize power, the Tigray State Council held local elections in defiance. The federal government, on the other hand, saw this as a declaration of war. The civil came to a resolution on November 3rd, 2022 through a peace agreement, with the United States (US) and other agents played a critical role. 

    US-Ethiopia Relations 

    The United States and Ethiopia have maintained diplomatic relations since 1903, fostering a long-standing and significant partnership based on shared interests in promoting peace, stability, and economic development. Ethiopia holds a unique position as the only African nation never colonized, maintaining its independence for over a millennium. The U.S. has regarded Ethiopia as a key guarantor of security in the Horn of Africa, contributing to the stabilization of countries like Somalia and South Sudan.

    As the largest bilateral donor in Ethiopia, the U.S. has provided substantial humanitarian assistance, totaling an estimated $3.16 billion, in response to conflicts and ongoing droughts. However, despite the positive government-to-government and people-to-people relations, recent mistrust has emerged due to concerns over the actions of the Abiy government. This mistrust escalated when the Biden administration declared in March 2023 that all sides involved in the Tigray conflict were guilty of committing war crimes and crimes against humanity.

    US Involvement in the Tigray War 

    The US, as a significant international player, has been involved in the Tigray War in Ethiopia through diplomatic means, humanitarian assistance, and has been pressuring parties involved to seek a peaceful resolution. The US was outspoken in its criticism of alleged atrocities by Ethiopian forces and their allies during the Tigray war, which resulted in tens of thousands of fatalities before a peace accord was reached. The Biden administration also implemented visa restrictions targeted at Ethiopian and Eritrean officials responsible for the conflict and suspended the country’s membership in the African Growth and Opportunities Act, a preferential trade pact. According to Cameron Hudson, a  former US diplomat and intelligence official, the implementation of visa restrictions is a “major strategic shift in the Horn Africa, to go from an anchor state for US interests to become a potential adversary to US interests.”

    Secretary of State Antony Blinken recently visited Ethiopia in March of 2023 to meet with government and Tigrayan officials as well as victims of the conflict.  He noted that Ethiopia “needs to make more progress implementing a peace agreement with the Tigray region before relations with the US are normalized.” While the peace agreement made at the end of 2022 between the two conflicting regions terminated the war, hundreds of thousands of people were killed and suffered massacres, gang rapes, and other abuses from both sides. Blinken made sure to explain in a gathering of Ethiopian civil society leaders that “justice and accountability would be an important part of building a durable peace.” 

    Involved Agents 

    • TPLFI: Originally formed in the 1970s as a small guerilla band in the northern region of Ethiopia, the TPLF eventually grew to provide the core of the Ethiopian government in 1991. Representing one side of the Tigray war, the TPLF succeeded in mobilizing enough troops to defend their values, territory, and people. 
    • Ethiopia: After the conflict began in November, the Ethiopian National Defense Forces quickly captured many of Tigray’s central cities, including the regional capital, Mekele, with approximately half a million people. Ethiopian Air Force also committed war crimes when it bombed a camp for internally displaced persons in Dedebit Town of Tigray with an armed drone in January 2021 and again in Tigray’s capital, killing hundreds of civilians in hospitals and schools. 
    • Eritrea: A country once part of Ethiopia, Eritrea fought and won a brutal, decades-long war of independence that ended in 1991. When the two countries went to war again in 1998 in a territorial conflict that cost an estimated 100,000 lives, Prime Minister Abiy reached out to Eritrean President Isaias Afwerki and forged a historic peace accord aimed at putting the countries’ mutual enmity in the past. Eritrean forces repeatedly aided Ethiopia in the Tigray war and demonstrated itself as a staunch ally. Eritrean troops were blamed for the mass killing at Axum, a central Tigray region in Ethiopia, in the early period of the war. 
    • United Nations (UN): The UN led a joint investigation in 2021 with Ethiopia’s state-appointed human rights commission and found that all sides fighting in the Tigray war- Ethiopian government forces, Tigray forces, and Eritrea’s military- had committed violations that amounted to war crimes. The commission also revealed that Ethiopian forces had resorted to “starvation of civilians” as a tool of war and that Ethiopia and Eritrea forces were found to be responsible for “sexual slavery”- while Tigray forces were not. 
    • African Union (AU): Former Nigerian President Olusegun Obasanjo, the African Union chief mediator, led the mediation talk in South Africa between the two parties. She said Ethiopia’s government and Tigrayan authorities have agreed on “orderly, smooth and coordinated disarmament” along with “restoration of law and order, restoration of services and unhindered access to humanitarian supplies.” While neither Eritrea nor regional forces allied with the Ethiopian army took part in the talks in South Africa, the agreement reached was praised by Obasanjo as an “African solution to an African problem” and would allow humanitarian supplies to Tigray to be restored. 

    Effects of the War 

    Refugees and others have said that forces on the ground are responsible for sexual violence, ethnic-based targeted attacks, and large-scale looting. The UN estimated that nearly three million Tigrayans urgently need assistance due to lack of access to water, food, and healthcare. The food and nutrition security issue is especially concerning, for USAID and the World Food Programme suspended aid after discovering that Ethiopian soldiers and officials were stealing massive amounts of food in May of 2023. 

    With the civil war concluding with a peace agreement, Ethiopia has a new duty to consolidate a political arrangement that accommodates its diverse population of 110 million people and ensure basic measures of security and justice. Without this new configurement, a critical voice for African interests on the global stage would be lost and external actors would be empowered to engage in conflict. 

    Conclusion

    While the Tigray War has concluded, the conflict highlights broader tensions between ethnic groups in Ethiopia and could ensure wider instability in East Africa’s most populous country. Furthermore, the war caused severe damage to essential social services, for it expanded to the neighboring regions of Afar and Amhara. This affected more than 20 million people, of which approximately three quarters were women and children, and 5.5 million people have been forced to flee their homes and take refuge in other regions within Ethiopia.

  • Understanding the Debate on Presidential Immunity

    Understanding the Debate on Presidential Immunity

    Presidential Immunity: History and Background

    Presidential immunity is the long-standing idea that the president of the United States has exemption from liability or legal proceedings for acts related to the duties of presidential office. Contrary to popular belief, presidential immunity is not explicitly enumerated in the Constitution; only sitting members of Congress are explicitly granted judicial immunity through the Constitution’s Speech or Debate Clause. Rather, the concept of presidential immunity has arisen through the Department of Justice’s longstanding policy against prosecuting presidents in office and the Supreme Court’s interpretation of Article II, which has developed through a number of Supreme Court cases dating back to 1867.

    These cases are as follows:

    • Mississippi v. Johnson (1867): When Congress passed the controversial Reconstruction Acts of 1867, the state of Mississippi attempted to block their implementation by asking the Supreme Court for an injunction against President Andrew Johnson to prevent him from enforcing the Acts. The Supreme Court held that they had no right to prevent a president from acting in their official capacity, setting the stage for future immunity rulings.
    • Nixon v. Fitzgerald (1982): Arthur Fitzgerald was an Air Force employee who testified before Congress about the Air Force’s cost overruns and technical difficulties. When he was later fired during a departmental reorganization under Richard Nixon’s presidency, Fitzgerald sued Nixon on the grounds that his firing was retaliation for his testimony. The Supreme Court held that the president has absolute immunity from civil liability arising from any official action taken while in office, officially creating the privilege of civil presidential immunity.
    • Clinton v. Jones (1997): Paula Jones alleged that Bill Clinton had sexually harassed her while he was Governor of Arkansas. The federal judge assigned the trial delayed it until Clinton was out of office under the belief that sitting presidents are immune from all civil suits. However, the Supreme Court held that the Sixth Amendment requires a civil lawsuit against a current president to proceed if it is unrelated to behavior that occurred during time in office. This is because executive immunity does not apply to actions committed outside of executive office.
    • Trump v. United States (2024): When indicted for his connections to the January 6, 2021 attack on the U.S. Capitol and his attempt to overturn the 2020 presidential election, former President Donald Trump claimed that he could not be prosecuted for his acts unless he had been impeached by the House of Representatives and convicted by the Senate. The Supreme Court held that former presidents can never be prosecuted for actions relating to the core powers of their office and that they are presumptively immune from criminal liability, in addition to civil liability, for their official acts. However, they also held that presidents have no immunity for unofficial acts and preserved the possibility of prosecuting presidents for some acts within their formal responsibilities.

    There are two important distinctions to make in examining these cases and their holdings. The first is between a civil suit and a criminal prosecution. Historically, presidential immunity has only been extended to civil suits. However, Trump’s recent Supreme Court case has now sparked a debate over the potential validity of criminal immunity. The second distinction is between an official and an unofficial, or private, act. An official act is an action taken within the scope of the president’s powers as outlined by Article II of the Constitution. All other actions undertaken by a president, even those which occurred during their term, are considered private acts. Much of the controversy around Trump’s claims of immunity arises from uncertainty as to whether his actions should be considered official or private.

    Arguments in Favor of Presidential Immunity

    One argument in favor of presidential immunity is that it prevents retaliatory and politically biased prosecutions against presidents. Without established immunity, politically biased prosecutors could unfairly target presidents for arbitrary reasons once they leave office. For example, most U.S. presidents are accused of insufficiently enforcing a federal law at least once during their term. Most of the time, these accusations go nowhere. However, without the privilege of presidential immunity, these accusations could turn into prosecutions by their political opponents.

    This contributes to another popular argument in favor of immunity — that it protects the ability of the executive branch to function effectively. Proponents argue that presidential immunity allows presidents to freely make decisions based on the public interest, rather than choosing a less optimal but “safer” option to avoid future prosecution. This protects the independence of the executive branch by giving the president free reign to exercise their powers and perform their duties without fear of the courts. Supporters of presidential immunity claim that it maintains the separation of powers between the three branches of government, allowing the president to act without excessive oversight from other branches or parties.

    Arguments Against Presidential Immunity

    Critics of presidential immunity, especially as defined in Trump v. United States, claim that it compromises presidential accountability. They state that it translates to an absence of legal consequences for the executive, and thus eliminates deterrents to breaking the law. President Joe Biden, a prominent critic of expanded presidential immunity, points to Trump’s alleged incitement of the January 6 attack as an example of something future presidents could do without legal consequences. Opponents also believe that expanded immunity empowers presidents to operate without oversight and increases the risk of corruption and abuse by shielding presidents from legal scrutiny.

    Opponents further argue that expanded presidential immunity weakens the American system of checks and balances. They claim that it eliminates a key check on executive power. Critics say that executive power has already grown out of proportion in relation to the other two branches, as seen in the increased use of executive orders in recent presidencies. They believe that expanded immunity only worsens that imbalance by diminishing the judicial branch’s ability to hold the executive branch accountable.

    Finally, critics of expanded immunity believe that it threatens democratic rule of law by placing the president above the laws that all citizens must obey. Under presidential immunity, they argue, the law is not equally applied to all. Some fear that this open exemption for the executive will cause citizens to lose faith in their ability to hold elected officials accountable, weakening collective faith in the democratic process. Opponents also believe that expanded immunity has already allowed Trump to get away with anti-democratic behavior, such as attempting to overturn the 2020 election. They claim that protecting actions such as these is a threat to American democracy.

    Conclusion

    In summary, the state of presidential immunity has changed over time due to various Supreme Court holdings. Those in favor of presidential immunity argue that it prevents retaliatory prosecutions and protects the ability of the executive branch to function. Those in opposition to the recent definition of presidential immunity argue that it compromises executive accountability, weakens checks and balances, and threatens the democratic rule of law.

    Given the Trump v. United States decision and Donald Trump’s recent reelection, the debate around presidential immunity is more relevant than ever. Due to his election as president, the cases against Trump will likely end, and it is improbable that we will see how far presidential immunity extends under the court’s 2024 decision. Trump’s election brings a new concern for critics, who believe that Trump may be more willing to stretch the law than he was during his first term due to the expanded immunity now afforded to presidents.
    However, expanded presidential immunity is not necessarily permanent. President Biden recently proposed a No President is Above the Law amendment, which would eliminate immunity for crimes a former president committed while in office. This is unlikely to pass in the next few years due to a Republican-majority Congress, but it does raise questions about the future of criminal immunity for presidents in administrations to come.

  • Key Trump Administration Cabinet Picks

    Key Trump Administration Cabinet Picks

    What is the Presidential Cabinet?

    The President’s Cabinet serves as an advisory board for the President. It is made up of the heads of the 15 executive departments. These members are appointed by the President and must be approved by the Senate by a majority vote to confirm the nomination. 

    Trump is currently in the process of announcing his cabinet nominations. Some of the major positions he has announced so far include Secretary of State, Secretary of Defense, Secretary of Homeland Security, Director of National Intelligence, and Attorney General.

    Secretary of State

    The Secretary of State is the head of the Department of State, whose role is to develop and implement foreign policy. The Secretary serves the President as their top foreign policy advisor and executes the President’s foreign policy. This department represents the United States in communications with foreign nations, develops foreign assistance and military training programs, works to combat international crime, and negotiates and interprets treaties and agreements.

    Marco Rubio was announced as Trump’s nominee for Secretary of State. In response to his nomination, Rubio promised to “deliver peace through strength” and to place the “interest of Americans and America above all else.” Rubio currently serves as a Senator from Florida and previously served as a member of Florida’s House of Representatives. He currently serves on the Senate Committee on Foreign Relations. Rubio has taken hard-line stances against China, stating in a Washington Post op-ed that China is the “largest, most advanced adversary America has ever faced.” He has promoted tariffs, technology restriction requirements, and trade barriers against China. On Gaza, Rubio has consistently supported “Israel’s right to defend itself against Hamas” and denied support for a ceasefire. On immigration, Rubio supports strong border protections and the deportation of illegal immigrants, claiming that America is being “invaded.”

    Secretary of Defense 

    The Secretary of Defense is the head of the Department of Defense, whose role within the Executive Branch is to bolster national security. The Department of Defense aims to protect national interest through war-fighting, humanitarian aid, and disaster relief services. The Army, Air Force, Navy, and the Pentagon all fall under the Department’s purview. The Defense Secretary is the President’s top advisor, and oversees the nation’s armed forces as. Their authority is second only to the Commander in Chief (President).

    Trump named political commentator and Fox News Anchor Pete Hegseth as his nominee for Secretary of Defense. Hegseth currently hosts the show Fox and Friends Weekend and has appeared on other Fox News daytime and primetime shows. He previously served in the Army as an Infantry Officer in the National Guard. Additionally, Hegseth formerly served as CEO of the veterans advocacy group Concerned Veterans for America. When speaking on the podcast The Shawn Ryan Show, Hegseth stated his belief that “[America] should not have women in combat roles” as he believes men are “more capable.” Additionally, he stated that he wanted to fire army generals who support “any of the DEI [diversity, equity, and inclusion]” and he supports a “frontal assault” on DEI policies. He has also stated that the U.S. military would be more effective if it were to create a “real threat of violence.”

    Secretary of Homeland Security 

    As the head of the Department of Homeland Security, the Secretary of Homeland Security advises the President on how to protect the American people from foreign and domestic threats. This department is responsible for preventing terrorist attacks, protecting infrastructure, facilitating trade and travel, responding to natural disasters, and regulating the migration of people in and out of the country. Agencies under the department include U.S Customs and Border Protection, Citizenship and Immigration Services, FEMA, and Cybersecurity. 

    Kristi Noem was recently named the nominee for Secretary of Homeland Security. She currently serves as the Governor of South Dakota and previously served as a member of the U.S. House of Representatives and the South Dakota House of Representatives. In his statement announcing Noem’s nomination, Trump stated that Noem “has been very strong on border security” and will protect America “from our adversaries.” In response to her nomination, Noem issued a statement promising to “secure our homeland” and falsely condemned illegal immigration alone for “[driving] up crime in the country” and increasing “drugs and human trafficking.”

    Director of National Intelligence 

    The role of the Director of National Intelligence is to advise the President, the National Security Council, and the Homeland Security Council on national security matters. Additionally, the Director oversees the Intelligence Community’s 18 agencies including the CIA and NSA.

    Tulsi Gabbard, Trump’s nominee for Director of National Intelligence, previously served in the U.S. House of Representatives and ran for the Democratic Presidential nomination in 2020 before leaving the party in 2022 to become independent and joining the Republican Party in 2024. Gabbard currently serves in the U.S. Army Reserve as Lieutenant Colonel. 

    Attorney General 

    The Attorney General serves as the head of the Department of Justice and acts as the chief law enforcement officer for the federal government. The Attorney General represents the U.S. in all legal matters.

    President-Elect Trump recently nominated Pam Bondi for Attorney General, praising her for work to “stop the trafficking of deadly drugs” and “reduce the tragedy of Fentanyl Overdose Deaths.” Bondi previously served as Florida’s first woman attorney general. She also worked as a defense lawyer for Trump in 2020 during his first impeachment trial. She currently serves as the Chair of the Center for Litigation for America First Policy Institute, a conservative nonprofit think tank. In November, she filed an amicus curiae brief to appeal the special counsel’s classified documents case against Trump, arguing that the special counsel was unlawfully appointed. 
    Before nominating Bondi, Trump had first nominated Florida Representative Matt Gaetz. Upon the news of his initial nomination, Gaetz announced his resignation from the House effective immediately. Since 2021, Gaetz has been under investigation by the House Ethics Committee on allegations that he “engaged in sexual misconduct and/or illicit drug use,” used campaign funds for personal use, and accepted bribes. Gaetz has denied all allegations. This past Wednesday, the bi-partisan ethics committee met to discuss whether or not the investigation report should be released to the public. The ethics committee could not come to an agreement about releasing the report, which may force the House to vote on its release. In light of the controversy, Gaetz withdrew from the Attorney General nomination on November 21st. He has since clarified that he does not plan on re-joining Congress.

  • Medicare-For-All Act 2023: Pros and Cons

    Medicare-For-All Act 2023: Pros and Cons

    Introduction

    Today, health insurance in America is decentralized. Private insurance companies—composed of  employer-sponsored health insurance (ESI) and the non-group market—make up 54.8% of health insurance coverage nationwide, while government-issued programs like Medicare and Medicaid cover 35.9% of the population. Private health insurance options operate as follows:

    • ESI encompasses any health insurance option selected by an employer, in which employees and their dependents can opt into the plan. Employers and employees share the cost of deductibles, co-pays, and premiums. 
    • Non-group insurance is an option for households who do not qualify for public programs or employer-sponsored healthcare. These households shop for insurance plans directly from private insurers.

    Still, 7.9% of Americans, or roughly 26 million people, remain uninsured as of 2023. Legislators have proposed insurance expansion policies such as the Medicare-For-All Act of 2023 to fill this gap. 

    What is the Medicare-For-All Act of 2023?

    The Medicare-For-All Act of 2023, commonly referred to as M4A, proposes a single-payer universal health insurance program in the United States. In single-payer healthcare systems, the government is the sole payer for the eligible population’s healthcare costs. Single-payer programs like M4A would use public funds to support Americans in accessing medical services that are provided through the private sector. M4A would expand the single-payer models of Medicare and Medicaid, government-funded health insurance plans primarily for senior citizens and low-income individuals, to all U.S. residents.

    The Medicare for All Act has been reintroduced to Congress multiple times with the backing of Senator Bernie Sanders [I-VT] and Representative Pramila Jayapal [D-WA]. The bill’s provisions include covering primary, dental, vision, mental health, rehabilitation, gender-affirming and reproductive care for all U.S. residents. Under M4A, Americans would not have to pay deductibles, co-pays, nor premiums. The program would roll out over a four-year implementation period, prioritizing senior citizens, individuals with disabilities, and children as the first enrollees. 

    Arguments For The Medicare-For-All Act of 2023

    Proponents of M4A argue that the bill will decrease healthcare costs, increase healthcare access for vulnerable populations, and increase economic mobility. 

    First, proponents contend that by covering previously uninsured residents, M4A will increase the accessibility of preventative care and thus decrease expensive late-term healthcare costs. They cite research that suggests diverting patients from emergency rooms to preventative care sites could save U.S. residents roughly $4.4 billion each year. Bill sponsor Sanders explained that the pandemic shed light on the shortcomings of healthcare in the status quo, contending that many Americans realized the benefits of preventative care, such as vaccinations, in preventing the sizable costs of hospitalization. Moreover, proponents argue that M4A’s coverage of preventative healthcare could cut the cost of all medical expenses in the long run. By increasing access to preventative check-ups, studies suggest M4A could save the U.S $450 billion each year. Proponents refute the claim that M4A would raise taxes to an extent that cancels out these healthcare savings for the average American, pointing to Sanders’ progressive taxation plan and the fact that federal taxes already fund single-payer systems like Medicaid in the status quo.  

    Supporters of M4A also praise the bill’s inclusion of all U.S. residents. Bill sponsor Senator Sanders emphasizes that M4A would provide health insurance to every person in the United States, including undocumented immigrants. This addition differs from Medicare and Medicaid programs, where “undocumented immigrants are not eligible to enroll in federally funded coverage.” Proponents of M4A argue that the bill would help the U.S. government to fulfill its duty to protect all of its residents equally, especially vulnerable populations. They contend that since undocumented immigrants pay taxes – 96.7 billion dollars in taxes in 2022 – they should not be left out of government healthcare services. 

    In addition, proponents argue that M4A will decrease job locks, the phenomenon in which workers are compelled to keep working a job they would otherwise leave due to their reliance on job- or employer-specific health benefits. Since employers can differentiate benefits of ESI plans based on the job title and seniority of their workers, a switch in careers may threaten a worker’s access to quality healthcare. In this system, proponents argue, career mobility and job searching are discouraged. With 48.6% of Americans covered by an employer-sponsored health insurance (ESI) plan as of 2023, job locks are highly influential on the U.S. economy. Proponents of M4A emphasize that workers give up shorter commute times, higher wages, or more relevant positions to maintain their healthcare, which can decrease life satisfaction and worker productivity. Under M4A, they argue, Americans would have more flexibility to seek jobs that leverage their skills without the pressure of obtaining adequate healthcare. 

    Arguments Against The Medicare-For-All Act of 2023

    Opponents of The Medicare-For-All Act of 2023 cite funding and longer wait times as concerns for the proposal. 

    Critics argue that while the prospect of a no-cost sharing health insurance program is promising at first glance, under the $30 trillion Medicare-For-All project, households and businesses will pay more in taxes than they would save in premiums and other health expenditures. To fund M4A, the government would leverage a 21.2% tax on worker’s wages while employers would undergo a 7.5% income-based premium. While Senator Sanders’ funding plan proposes a progressive tax rate, with a wealth tax on the top 0.1% of American earners, critics maintain that increasing taxes for the purpose of increasing healthcare coverage is not justifiable. In particular, some argue that small businesses, which hire within the regional economy and partner with local charities, may face closures amid M4A-related tax hikes. In turn, critics believe this may harm community identity, competition, and local employment.

    Another common critique of M4A is that the bill will create longer wait times for patients. Opponents highlight that past efforts to expand Medicaid in certain states resulted in a 10% increase in hospital wait times compared to states that did not expand the program. They argue that even though M4A will increase the number of people who can afford healthcare, the accompanying increase in wait times will render healthcare inaccessible for those whose jobs do not allow them time to wait for service. They contend that delayed healthcare is just as harmful as expensive healthcare, because both have the effect of deterring low-income populations from seeking services. Since M4A covers a range of services, critics claim that patient numbers will surge and the finite numbers of hospitals, doctors, and resources will not be able to meet the demand. Critics point to research suggesting that the expansion of Medicaid in certain states decreased hospital efficiency, arguing that M4A would exacerbate this inefficiency nationwide. 

    Conclusion 

    Healthcare in America remains a contentious topic in the domestic political climate, and the future of the Medicare-For-All Act of 2023 remains unclear. Supporters of the bill argue it will increase healthcare access and decrease job locks, boosting the economy. Opponents of the bill argue high taxation and longer wait times under M4A cancel out any potential economic or health accessibility benefits. Moving forward, legislators will continue to debate the relative importance of these factors in improving Americans’ day-to-day lives. 

  • Failures and Successes of the BRICS Alliance

    Failures and Successes of the BRICS Alliance

    Background

    Officially founded in 2009, BRICS is an informal, multilateral economic alliance between Brazil, Russia, China, India, South Africa, Iran, Egypt, Ethiopia, and the United Arab Emirates. The acronym “BRIC” (later adapted to include South Africa) was originally coined by Goldman Sachs economist Jim O’Neill in a 2001 paper wherein he highlighted the potential for Brazil, Russia, India, and China to eventually rival the G7 (U.S., Canada, France, U.K., Germany, Japan, and Italy) economically. Today, the alliance is sometimes referred to as BRICS+. The overarching goal of BRICS is to create a system of transnational governance wherein countries of the Global South share equal representation in economic and political institutions historically controlled by Western nations. This involves establishing an international financial network that rivals the current dollar-based system, and promoting development in the Global South. 

    Structure

    Presently, BRICS is not a formal institution such as the UN or OPEC. The group meets annually, with the chairmanship rotating between member states, and all policy decisions made by consensus. It is currently chaired by Russia, where the annual summit will be held in October 2024. According to the summit’s official website, the group plans to discuss the potential inclusion of 30 new countries in some capacity, as well as strategies for the development of a more coordinated foreign policy platform.

    Successes and Potential

    • Creation of Banks and Funds: The most ambitious programs enacted by the BRICS alliance thus far have been the creation of the New Development Bank and the Contingency Reserve Agreement. Founded in 2015 with an initial capital base of $50 billion, the New Development Bank (NDB) will fund infrastructure and development projects in BRICS countries and other nations in the Global South. The Contingency Reserve Agreement (CRA) is a $100 billion fund established to provide liquidity for BRICS during economic crises. Both of these institutions were created to combat the influence of US-led economic institutions such as the International Monetary Fund and the World Bank. 
    • Addressing Development in the Global South: BRICS has successfully implemented policies pertaining to one of their slated goals: development in the Global South. Examples include: Improving access to clean water in Guwahati, India, river restoration and ecological protection projects in China, and establishing the BRICS Agriculture and Rural Development Forum, which aims to address poverty and food insecurity. 
    • Attracting New Member States: Membership in BRICS has proven attractive to developing nations worldwide, including several Asian countries. Thailand, Malaysia, and Vietnam have all taken the necessary steps to apply for membership, while other Asian nations such as Myanmar and Sri Lanka are openly considering applying. 
    • Potential for Peacebuilding: The inclusion of rival countries in the Middle East such as Iran and potentially Saudi Arabia indicates that BRICS membership may be used to facilitate peace and development in a region historically preoccupied with US sanctions and military involvement. The expansion of BRICS would challenge the heavy U.S. influence in developing countries, which BRICS member states see as a successful step towards equalizing power on an international scale. 

    Failures and Critiques 

    • Intra-group Disagreements: Differing cultural values, contrasting political ideologies, and competing economies all pose obstacles for BRICS to strengthen cohesion and thus influence. The group’s two largest members in terms of population and GDP, India and China, disagree about whether or not the group should expand, and have also engaged in armed border disputes in recent years. 
    • Lack of Global Economic Influence: Despite efforts to “de-dollarize” by promoting trade between member states in local currencies, the USD still dominates international trade. The dollar was present on at least one side of nearly 90% of all international trade transactions in 2022. The dollar was on one side of 97% of all trades involving the Indian rupee, and 94% of all trades involving the Chinese renminbi. Furthermore, much of the world’s international commodity trading is priced by the dollar, and the dollar frequently comprises the foreign currency reserves of many countries’ central banks. Globally, 58% of foreign exchange reserves were held in dollars, including an estimated 50% in China and India. 
    • Risk of Unilateralism: While the growth of all BRICS members has slowed since its conception, China’s economy is larger than any other economy within the agreement, and trade within the alliance mostly flows through China. This runs the risk of BRICS becoming an exclusively China-led group as opposed to a mutual power-sharing alignment of non-Western nations. With China now being the United States’ major rival globally, China’s de-facto leadership within the agreement will necessitate a strong U.S. response. Whether U.S. foreign policy will take a continued adversarial approach, or a new, collaborative effort remains to be seen. 
  • What is the Department of Government Efficiency? 

    What is the Department of Government Efficiency? 

    President-Elect Donald Trump recently began announcing his presidential cabinet nominations, tapping Congresspeople, former Republican presidential nominees, and close allies. As the leader of the executive branch, the President must appoint about 4,000 officials, including the members of his cabinet, who serve as heads of executive departments. Some cabinet positions, including UN Ambassador, require confirmation by the Senate and typically involve confirmation hearings. In the midst of his cabinet nominations, Trump introduced an idea for a new executive department that has caused debates about executive power. 

    The Department of Government Efficiency (DOGE)

    On Tuesday, November 12th, 2024, Trump announced that he would be creating a new executive department, the Department of Government Efficiency, led by billionaire businessmen Elon Musk and former Republican presidential candidate Vivek Ramaswamy. In a post on Truth Social, Trump said he is creating the new department to “dismantle Government Bureaucracy, slash excess regulations, cut wasteful expenditures, and restructure Federal Agencies.” Also known as DOGE, the department aims to provide “outside guidance” to the government and foster “an entrepreneurial approach” to government spending. The department is slated to last until July 4th, 2026, giving it a deadline to accomplish its objective of cutting government spending. It is still unclear as to how the department will officially be created or funded, as creating new federal departments requires congressional approval. If Congress does not move forward with establishing DOGE, Musk and Ramaswamy may act as advisors to the President rather than as leaders of an official executive department.  

    Who are the proposed heads of the Department of Government Efficiency?

    • Elon Musk: Musk is a businessman worth over 303 billion dollars and the co-founder of over seven companies, some of the most notable being Tesla and SpaceX. Throughout Trump’s 2024 presidential campaign, Musk has been a staunch supporter, attending rallies, giving at least $130 million in campaign donations, and hosting a $1 million raffle in the swing state of Pennsylvania for those who registered to vote. At Trump’s Madison Square Garden rally in October, Musk stated that he wanted to reduce the federal budget by “at least $2 trillion,” about 30% of the federal government’s total fiscal spending in 2024. 
    • Vivek Ramaswamy: Ramaswamy made political news in early 2023 when he ran for the Republican presidential nomination. His policy positions included militarizing the southern border, ending the funding of sanctuary cities, diversifying healthcare insurance options, abolishing the Department of Education, and increasing the voting age to 25. Ramaswamy founded Roivant Sciences, a biotech company focused on applying technology to drug development. He previously signaled support for cutting government spending when he announced his plans to cut the number of federal workers through “reduction of force” regulations when he was campaigning for president in 2023.

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  • The “Let Pregnancy Centers Serve Act” of 2024: Key Insights and Implications

    The “Let Pregnancy Centers Serve Act” of 2024: Key Insights and Implications

    What are Crisis Pregnancy Centers?

    Crisis pregnancy centers (CPCs) are nonprofit, community-based organizations that aim to ensure pregnant people carry their pregnancy to term. CPCs provide services, including pregnancy tests, ultrasounds, baby formula, and diapers to achieve their mission. While they have operated in the U.S. for decades, CPCs have become more prominent in the public eye in light of the Supreme Court’s Dobbs v. Jackson decision that overturned the national right to abortion. Contention has emerged concerning whether CPCs should continue to receive federal funding and qualify as eligible healthcare centers for patients using federal healthcare assistance programs. 

    Introduction to the Let Pregnancy Centers Serve Act of 2024

    The Let Pregnancy Centers Serve Act of 2024 was introduced to the Senate Committee on Finance by Senator Cindy Hyde-Smith [R-MS] on January 18, 2024, and is currently in the introduction stage. The Act contains two central provisions:

    1. Maintaining TANF Eligibility: Temporary Assistance for Needy Families, or TANF, is a government program that provides financial assistance to pregnant people and families for the purpose of accessing food, housing, healthcare, and other necessities. States have autonomy in implementing TANF, including determining the type and amount of assistance payments, and the services that can be obtained with TANF funds. The Act would ensure that people who receive TANF can use their benefits to pay for CPC services, and that CPCs can continue to receive TANF-delegated funding from the federal government.
    2. Renewing federal funding: The Act would prevent the federal government from denying CPCs funding via grants, on the basis that doing so merits federal discrimination against grantees. 

    Arguments in Support of the Let Pregnancy Centers Serve Act of 2024

    Enhanced Access to Pregnancy Services

    Proponents of the Act argue that PCPs should be praised for the broad range of goods and services they provide at little to no cost, such as baby clothes and formula. Early pregnancy confirmation is cheaper and more accessible at a CPC than at an abortion clinic, which supporters argue increases accessibility. They cite a study that showed that patients without health insurance were significantly more likely to visit a CPC than not to visit a CPC during their pregnancy. Additionally, proponents believe that the educational programs provided by some centers, such as parenting classes and prenatal care, help equip new and expecting parents with necessary knowledge and skills. In addition, some CPCs offer different types of emotional and psychological support. Advocates of the Act believe that the counseling services provided by some centers can help individuals and families navigate the pregnancy experience and its complexities. 

    Protection from Federal Discrimination

    One of the primary objectives of the Act is to ensure that CPCs continue to receive TANF funding. The bill aims to prevent the Biden administration’s proposed rule that would reduce or cut TANF funding to CPCs. Proponents argue that these centers play a crucial role in providing support to pregnant women, and that losing TANF funding eligibility could significantly impact their ability to offer essential services. Advocates of the bill argue that protection against federal discrimination is crucial for maintaining the viability of CPCs and ensuring they can continue to provide their service without undue interference. Advocates emphasize that CPCs have been allowed to receive federal funding since 1996, and that reversing this practice signals federal discrimination on a national scale. Proponents also argue that states should have the flexibility and power to direct funds to organizations that align with their values and priorities, and that the federal government would infringe upon state’s rights by prohibiting funding to CPCs nationally. 

    Arguments Against the Let Pregnancy Centers Serve Act of 2024

    Misleading Patients 

    Opponents of the Act argue that CPCs provide misleading or incomplete information about reproduction with the goal of preventing patients from seeking abortion, which can impact patients’ ability to make informed decisions about their health. Most crisis pregnancy centers have a religious affiliation and are not medically licensed, and thus fall outside the scope of consumer protection regulations that are designed to protect patients. Opponents argue that CPCs purposefully and unethically market themselves as health clinics, which has led to the development of websites like ExposeFakeClinics.com and The Anti-Abortion Pregnancy Center Database to warn patients about CPCs in their area. 

    Critics also claim that many ethical concerns that arise when the government provides TANF funding to organizations that are unqualified to provide medical advice. In particular, critics argue that CPCs’ main goal is to discourage or delay women from seeking abortion services, and that providing them with TANF funding could lead patients to perceive them as legitimate and objective healthcare providers. Delays in medical care, whether it be prenatal checkups or appointments about different options, can lead to more complex and costly procedures later on, and potentially put pregnant people’s lives at risk. Critics believe that by prioritizing funding for un-licensed pregnancy centers, the government risks misleading pregnant people into seeking services at centers with no medical credentials and thus neglecting their healthcare needs.

    Misuse of Federal Funds

    Additionally, opponents of the Act are concerned that CPCs lack the oversight and accountability required of other TANF-eligible medical facilities, which could increase the risk of mismanaged or ineffectively-used federal funds. While states must spend TANF funding on programs that achieve one of four TANF purposes, some argue that CPCs are deceptive and lack patient-centered care. Critics of the Act believe that TANF dollars could be used in more efficient ways than funding CPCs, such as promoting job preparation and work. They believe that funding CPCs risks diminishing government funds that could be used to fund prenatal care, contraceptive counseling, and more comprehensive maternal health services. Many believe that allowing TANF funds to support CPCs could weaken the overall monetary support network for reproductive health in the nation. 

    Conclusion

    The Let Pregnancy Centers Serve Act of 2024 aims to protect crisis pregnancy centers by allowing states to allocate TANF and other federal grant funds to these centers without federal interference. Supporters argue that CPCs offer vital services that deserve protection and uphold states’ rights to manage their grant distributions. Conversely, opponents express ethical concerns about funding centers that lack medical qualifications, licensure, and oversight. Critics warn that the Act could misallocate federal funds, diverting resources from licensed maternal and contraceptive care programs to less regulated centers. The legislation’s outcome will significantly impact pregnant individuals nationwide.

  • Pros and Cons of the National Suicide Hotline Improvement Act

    Pros and Cons of the National Suicide Hotline Improvement Act

    What is the National Suicide Hotline Improvement Act?

    The National Suicide Hotline Improvement Act of 2018 mandated the Federal Communications Commission (FCC) to coordinate with relevant agencies to study and implement a three-digit dialing code, later designated as 988, for the national mental health crisis hotline. Introduced by Senators Cory Gardner, Tammy Baldwin, Jack Reed, and Jerry Moran, the Act aims to simplify the process of reaching out for help during a crisis, given the rising suicide rates among youth and high-risk groups such as veterans, LGBTQIA+ people, and individuals in rural areas.

    Arguments in Favor of the National Suicide Hotline Improvement Act

    Improved Accessibility and Crisis Service Coordination

    One of the primary arguments in favor of the National Suicide Hotline Improvement Act is that it offers better access to mental health support. By designating 9-8-8 as the national suicide prevention hotline number, proponents say the Act simplifies the process of seeking help during a crisis. According to a national report, a three-digit number is easier to remember than the previous ten-digit number, which helps ensure that individuals in distress can quickly access the support they need. Proponents highlight that such an ease of access significantly increases the likelihood of timely assistance, which is crucial in emergency situations where every second counts. Furthermore, using the 988 number for mental health crises directs individuals in distress to appropriate and specialized professional support which they may not otherwise receive from the more general 911 line. Some praise this aspect of the Act for relieving the burden on other emergency medical services, which are often overburdened and under-equipped to respond to mental health crises on top of other emergencies. 

    Follow-Up and Continuous Care

    Supporters also praise the National Suicide Hotline Improvement Act’s emphasis on follow-up and continuous care for individuals who contact the 9-8-8 Lifeline. The Act recognizes that immediate crisis intervention is just the first step in preventing suicide and addressing mental health crises. By ensuring systematic follow-up programs, the Lifeline can provide ongoing support to individuals after their initial contact. Follow-up care can include regular check-ins, referrals to local mental health services, and support in navigating the healthcare system, all of which contribute to a comprehensive approach to crisis management and suicide prevention. Proponents hold that this continuous engagement helps to maintain the well-being of individuals, citing a study that suggests follow-up care reduces the risk of future crises and improves overall mental health outcomes. 

    Enhanced Funding and Resource Allocation

    Supporters claim the Act also has the capacity to drive a cultural shift in how mental health crises are perceived and addressed. By equating the importance of mental health emergencies with medical emergencies, proponents argue that the legislation encourages greater recognition and prioritization of mental health issues. This shift has the potential to lead to increased funding and resources for mental health services, ultimately improving the quality and availability of care. Indeed, the Biden-Harris Administration’s investment of nearly $1 billion in the 988 Lifeline, including a sub-network for Spanish speakers, highlights the commitment to expanding and enhancing these critical services.

    Arguments Against the National Suicide Hotline Improvement Act

    Uneven State Response

    One significant concern regarding the National Suicide Hotline Improvement Act is the uneven state response to the 9-8-8 implementation. Critics highlight that in-state answer rates currently range from 55% to 98%, indicating significant disparities in service quality across the country. States like Alaska, which have the lowest in-state answer rates, often lack local call centers. As a result, residents are redirected to national backup centers that may lack access to or knowledge of local resources for treatment referrals. This variability leads to different levels of accessibility and dependability, which critics claim compromises the overall effectiveness of the 988 hotline and leaves individuals in certain areas without the crucial help they need during crises. Critics warn that the discrepancies in care between states might lead to a general distrust of the hotline.

    Resource and Capacity Constraints

    Critics also argue that the National Suicide Hotline Improvement Act was enacted without proper attention to resource allocation and capacity building. They claim that building the infrastructure for a new nationwide crisis hotline is a long-term endeavor, complicated by a national shortage of mental health professionals. Critics point to the development of the 911 system, which took decades to achieve full operational capacity, as a predictor of the difficulties that may be faced with such a quick 9-8-8 rollout. They argue that workforce shortages and infrastructure limitations could delay the system’s full functionality, potentially causing a snowball effect in which crisis centers drop out of the network, rendering care less accessible, reducing the effectiveness and legitimacy of the hotline, and ultimately dissuading people in crisis from calling.

    Low Public Awareness

    Another crucial issue is the low public awareness of the 988 Lifeline and its purpose. Without widespread knowledge and understanding of the service, the number’s reach and impact are significantly reduced. Critics highlight that many Americans, particularly racial minorities and those without a college education, are unaware of the 988 hotline or do not understand how to use it. They argue that the Act should have included more specific programs to increase consumer awareness of the hotline, especially in communities where mental health is a taboo topic. Similar to the rollout of 911, building public awareness will take significant time and effort to ensure that the 988 lifeline is effectively utilized by all segments of the population. Critics of the bill claim this awareness curve could have been mitigated by a more robust public outreach strategy. 

    Conclusion

    The National Suicide Hotline Improvement Act aims to improve access to mental health crisis support by simplifying the process of reaching out for help. Some believe the Act was an urgently needed intervention that provided an adequate basis for the national hotline, while others argue its passage could have been delayed to include more specifics on public awareness and capacity building. While the Act has the capacity to greatly enhance mental health crisis intervention and reduce suicide rates, challenges such as uneven state responses, resource constraints, and low public awareness must be addressed to fully realize its benefits.