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Tag: Necessary

  • Understanding Title 42: The Intersection of Public Health and Immigration

    Understanding Title 42: The Intersection of Public Health and Immigration

    What is Title 42?

    Title 42, established under the Public Health Service Act of 1944, grants the U.S. government authority to expel individuals recently present in a country with a communicable disease. Section 362 of the act allows the Surgeon General to halt the “introduction of persons or property” to prevent the spread of disease. While rarely used in modern history, Title 42 became a key immigration enforcement tool during the first Trump administration.

    The first recorded use of Title 42 occurred in 1929 to restrict entry from China and the Philippines during a meningitis outbreak. Decades later, on March 20, 2020, the Centers for Disease Control and Prevention (CDC) invoked the policy to limit the spread of COVID-19 across state and national borders.

    Implementation and Impact

    During the first two years of its enforcement, Title 42 was used around 2.5 million times to deport migrants entering the U.S. It gave border control agents the authority to expel migrants without offering the opportunity for them to seek asylum, although families and children traveling alone were exempt from this provision. Beginning in January 2023, migrants coming from Mexico could request a Title 42 exemption through the CBP One app if they met vulnerability criteria.  

    In April 2022, the CDC announced that Title 42 was no longer necessary and would be terminated in May 2022, citing increased vaccination rates and improved treatments for COVID-19. However, several Republican-led states challenged this decision, and the case went to the Supreme Court. While the Court allowed continued enforcement of Title 42 before it heard arguments, it dismissed the case the following year. Title 42 expired in May 2023.

    Arguments in Favor of Title 42

    Supporters of Title 42, including the Trump administration, argued that the policy was necessary to limit the spread of COVID-19 in detention centers and, by extension, within the United States. In a 2020 briefing, President Trump stated that his actions to secure the northern and southern border under Title 42 would “save countless lives.” The Trump administration’s declaration of a COVID-19 national emergency on March 18th, 2020, framed stricter immigration policy as a matter of public health.

    Some states also supported Title 42 to prevent a surge in migration that could overwhelm their border facilities. Texas, for example, argued that lifting the policy would place an undue burden on the state, leading it to implement Operation Lone Star, which allocated state resources to border security.

    The policy also received occasional bipartisan support, and was willfully enforced by the Biden administration until the CDC attempted to terminate Title 42 in April 2022. In early 2022, at least nine Democrats argued that Title 42 should be extended. President Biden also debated whether or not the policy should end. In January 2023, he expanded the scope of Title 42 to include migrants originating from Cuba, Nicaragua, Haiti, and Venezuela. 

    Arguments Against Title 42

    Critics of Title 42 argue that it violates international norms, particularly Article 14 of the Universal Declaration of Human Rights, which recognizes the right to seek asylum. While the U.S. did not ratify the declaration, it played a key role in its creation and remains a signatory. Additionally, since 1980, U.S. law has recognized the right to seek asylum, rendering Title 42’s restrictions controversial in the context of global and domestic asylum norms.

    Public health experts also questioned the policy’s effectiveness in controlling COVID-19. There is no statistical evidence linking Title 42 expulsions to a reduction in COVID-19 cases. Instead, critics suggest that overcrowding in detention centers may have worsened public health conditions. One migrant described being held in “crowded conditions” for days without COVID-19 testing before being transported in similarly congested vehicles. Additionally, a senior advisor to the Trump administration pushed for the use of Title 42 before COVID-19, raising concerns about whether the policy was implemented for genuine public health reasons. 

    Opponents also contend that Title 42 subjected migrants to precarious conditions. Doctors Without Borders emphasized that mass expulsions left individuals without access to shelter, food, medical care, or legal representation. A fire in a migrant detention center, which killed 39 people, underscored these risks; surveillance footage showed detainees trapped in locked cells while guards failed to intervene. Critics also argue that the policy’s implementation often resulted in asylum seekers being detained in poor conditions and returned to the dangers they had fled.

    Future Prospects

    While Title 42 was invoked as a measure to protect public health, its effectiveness in achieving those goals remains debated. Proponents argue it was an effective solution that addressed co-occurring public health and immigration crises, while opponents argue it invited human rights violations and had a counterproductive impact on public health. Internal documents collected from the Trump administration in February 2025 suggest that President Trump aims to reinstate Title 42 policies, labeling unauthorized migrants as “public health risks” that “could spread communicable diseases like tuberculosis.” The Trump administration previously shut down the CBP One app, which assisted migrants in requesting Title 42 exemptions. The policy continues to evoke mixed reactions, and if reintroduced, past experiences may provide insights into its potential impact.

  • Maternal Mortality Review Committees and the PMDR Reauthorization of 2023: Key Perspectives

    Maternal Mortality Review Committees and the PMDR Reauthorization of 2023: Key Perspectives

    Introduction

    The United States faces a maternal mortality crisis, with maternal death rates significantly higher than other high-income nations. According to the CDC, maternal mortality disproportionately affects Black, Indigenous, and rural communities, with Black women experiencing maternal deaths at 2.6 times the rate of White women. The factors contributing to these disparities are complex and include unequal access to quality healthcare, socioeconomic barriers, and more. Despite advancements in healthcare, 80% of maternal deaths are preventable through timely medical intervention and comprehensive data collection. 

    What are MMRCs?

    State-based Maternal Mortality Review Committees (MMRCs) have been shown to play a pivotal role in analyzing maternal deaths to recommend evidence-based interventions. MMRCs are multidisciplinary teams that examine maternal deaths occurring during pregnancy or within one year postpartum. They utilize comprehensive data sources, including medical records, autopsy reports, and social service information. MMRCs assess preventability and contributing factors, allowing them to identify patterns and propose targeted policy solutions. Their review process centers on critical questions related to medical factors, social determinants, delays in care, and provider bias. By systematically addressing these factors, MMRCs generate insights that inform strategies to reduce preventable maternal deaths, which comprise 20% to 50% of all maternal deaths in the U.S.

    However, MMRCs face inconsistent funding and regulatory barriers, limiting their ability to track and analyze maternal deaths across states. Disparities in data collection methods and access to comprehensive patient records further hinder efforts to address maternal health inequities. Some states lack the authority to access certain medical records, while others experience delays in data sharing, reducing the timeliness and effectiveness of recommendations. Without consistent federal funding, many MMRCs struggle to maintain operations, particularly in rural and underserved areas, where maternal health disparities are often most pronounced. 

    Introduction to the Preventing Maternal Deaths Reauthorization Act

    The Preventing Maternal Deaths Reauthorization Act of 2023 (PMDR) was introduced to the House Committee on Energy and Commerce by Congresswoman Robin Kelly (D-IL) on May 18, 2023. The bill passed out of the Senate Health, Education, Labor, and Pensions (HELP) Committee in Fall 2023 and passed the House with bipartisan support in March 2024. However, the bill failed to pass the Senate before the end of the legislative calendar, rendering the bill “dead”. The reauthorization built upon the original Preventing Maternal Deaths Act of 2018, which helped establish and fund state-based Maternal Mortality Review Committees (MMRCs) to investigate maternal deaths and identify preventable causes. It sought to extend funding for MMRCs, enhance data collection, and address racial disparities in maternal health outcomes through the following provisions:

    1. Extending funding for state-level MMRCs to continue investigating maternal deaths
    2. Authorizing $58 million annually for the CDC to support state-level efforts
    3. Enhancing data collection on factors related to maternal health outcomes, particularly for minority populations
    4. Strengthening community-based interventions to reduce racial and ethnic disparities 
    5. Enhancing coordination among agencies to implement evidence-based solutions
    6. Expanding research on social determinants of maternal health 

    Arguments in Support

    Proponents of the PMDR Act of 2023 argue that the bill provides critical support for tried and true interventions to prevent maternal deaths. They emphasize that scientific literature identifies state-based MMRCs as the “gold standard” for preventing maternal deaths due to their multidisciplinary analysis. However, inconsistent funding threatens the effectiveness of MMRCs, particularly in states with high maternal mortality rates. In a letter to Congress, 125 public health and social services associations urged legislators to treat the PMDR as a top-priority bill, stressing the nation’s consistently high maternal mortality rate. Several national associations, including the American Medical Association, argue that continued federal funding is crucial to preventing maternal deaths. They highlight that past funding gaps resulted in reduced MMRC operations, hospital closures, and increased barriers to care. Supporters contend that the only way to ensure MMRCs can continue their vital work without funding disruptions is to pass the PMDR.

    Proponents of the PMDR Act also highlight its potential to promote health equity. Beyond identifying risk factors, MMRCs are critical in addressing racial, socioeconomic, and geographic disparities in maternal health by filling critical knowledge gaps on the drivers of maternal mortality in underserved populations. The PMDR Act directly supports these efforts by requiring MMRCs to report on disparities in maternal care and propose solutions. Federal support through this bill enables MMRCs to strengthen provider training, expand access to prenatal care, and address structural barriers contributing to maternal deaths. Without reauthorization, proponents argue, efforts to close maternal health gaps would be fragmented, leaving vulnerable populations without necessary protections.

    Arguments in Opposition

    The most prominent critique of the PMDR Act is that it focuses too heavily on MMRCs. Critics voiced concerns about MMRCs’ inconsistency, lack of accountability, and failure to acknowledge all social determinants of health. 

    Opponents highlight that legal and logistical challenges, such as data collection issues and lack of legal protections for participants, can create disparities in MMRC operations. Rural populations, who face higher maternal mortality rates and limited access to care, are often overlooked in MMRCs, further exacerbating disparities. Additionally, bureaucratic barriers and state laws limiting community involvement in MMRCs reduce their effectiveness in addressing maternal health challenges. 

    Others argue that MMRCs lack accountability, particularly regarding inclusivity and equitable decision-making. Advocates contend that MMRCs often exclude community representatives or organizations that challenge the status quo, prioritizing clinical expertise over individuals with lived experience. This exclusion can foster distrust, as community members may feel their knowledge and perspective are undervalued. The lack of compensation for community members to attend all-day MMRC meetings – unlike salaried clinicians – adds another barrier, further entrenching inequalities. Laws that impose burdensome requirements on MMRCs further complicate the process and reduce diversity in ideas. Opponents of the PMDR contend that these factors contribute to a lack of accountability from MMRCs, preventing them from fully creating lasting and inclusive solutions. 

    Finally, critics assert that MMRCs often fail to adequately address the underlying social determinants of health that contribute to maternal mortality. While MMRCs focus on clinical factors, such as healthcare quality and implicit bias, they can lack the frameworks to assess other social determinants like housing instability, food insecurity, or socioeconomic status. Often, these factors are deeply rooted in the broader healthcare system and community environments. Critics argue that the absence of these social factors in MMRC reviews limits the committees’ ability to develop holistic prevention solutions. Reports suggest MMRCs could benefit from incorporating a health equity framework and utilizing socio-spatial measures to address the full spectrum of challenges mothers face. Without this consideration, critics argue that MMRCs fall short of offering effective solutions to reduce maternal deaths and disparities. 

    Due to these critiques of MMRCs, critics of the PMDR argue that the bill should allocate more funding toward alternate interventions 

    Conclusion 

    The Preventing Maternal Deaths Reauthorization Act of 2023 represented an effort to extend investment in evidence-based maternal health interventions. While it received strong bipartisan support in the House, it died before a vote in the Senate, leaving MMRC funding uncertain in the years to come. While the bill was applauded for its potential to expand access to maternal care and fill critical knowledge gaps on maternal mortality factors, critics argued it placed too much emphasis on an intervention that lacked consistency and accountability to marginalized communities. 

    Future Outlook

    The Trump administration has implemented significant changes to the National Institutes of Health (NIH), including halting medical research funding and restructuring the agency, which has led to delays and uncertainties in grant approvals. These actions have raised concerns about the future of critical medical research, including studies on maternal health. Given these developments, the future of the PMDR may depend on an evolving public health funding environment. Advocacy groups and policymakers will need to collaborate to ensure that maternal health research and interventions receive the necessary support, despite the current challenges in the federal funding landscape.

  • Tulsi Gabbard Confirmed as Director of National Intelligence: Can She Keep America Safe?

    Tulsi Gabbard Confirmed as Director of National Intelligence: Can She Keep America Safe?

    In another significant development in Washington, Tulsi Gabbard—once a Democratic congresswoman, later an outspoken critic of her party, and now a key ally of President Donald Trump—has been confirmed as the Director of National Intelligence (DNI).

    Gabbard’s political journey has been anything but conventional. Born in American Samoa and raised in Hawaii, she became the youngest person elected to the Hawaii state legislature at 21. After serving in the Hawaii National Guard and deploying to Iraq, she was elected to the U.S. House of Representatives in 2012, becoming the first American Samoan and Hindu member of Congress.

    Her tenure in Congress was marked by independent positions on foreign policy, including a 2017 meeting with Syrian President Bashar al-Assad, which drew bipartisan criticism. In 2022, she announced her departure from the Democratic Party, claiming it was under the control of an “elitist cabal of warmongers.” 

    A Contentious Confirmation Process

    During her confirmation hearings, Gabbard faced intense scrutiny over her past statements and actions. Senators questioned her previous defense of Edward Snowden, whom she had once called a “brave whistleblower.” When pressed to label Snowden a traitor, she responded: “Edward Snowden broke the law.” 

    Snowden, a former NSA contractor, leaked classified information in 2013 about the U.S. government’s mass surveillance programs, including the bulk collection of American phone records under the Patriot Act. His revelations exposed the extent of the NSA’s global surveillance operations and sparked a worldwide debate on privacy, national security, and government overreach. While some view Snowden as a whistleblower who revealed unconstitutional surveillance, others, including U.S. officials, see him as a criminal who endangered national security.

    Gabbard had previously argued that Snowden deserved a fair trial rather than immediate prosecution under the Espionage Act, which does not allow whistleblowers to defend their actions in court. However, her confirmation hearing remarks signaled a shift, suggesting she would take a harder stance on intelligence leaks now that she leads the nation’s intelligence apparatus.

    Reversal on Surveillance Policies

    During her confirmation hearings, Tulsi Gabbard faced intense scrutiny over her past statements and actions. Senators questioned her previous defense of Edward Snowden, whom she had once praised for exposing illegal government activities. When pressed to label Snowden a traitor, she acknowledged that he broke the law but refrained from using the term “traitor.” 

    Regarding government surveillance, Gabbard had been a vocal critic of Section 702 of the Foreign Intelligence Surveillance Act (FISA), expressing concerns that citizens’ communications could be incidentally collected when targeting foreign nationals. 

    However, during the hearings, she indicated a shift in her stance, suggesting that with appropriate reforms, Section 702 could be a valuable tool for national security. This change led some Democrats to accuse her of political opportunism, while Republicans viewed it as a necessary evolution given her prospective role.

    Despite strong Democratic opposition, Gabbard’s nomination was confirmed by the Senate with a vote largely along party lines. 

    As Director of National Intelligence, Gabbard now oversees all 18 U.S. intelligence agencies, including the CIA, NSA, and FBI. Her appointment raises pressing questions about the future of U.S. intelligence policy. Will she uphold her past calls for transparency and civil liberties protections, or will she adopt a more traditional intelligence posture now that she’s at the helm?

    With rising global threats, cybersecurity challenges, and intense domestic political divisions, Tulsi Gabbard faces an uphill battle. The question is no longer whether she could get here. It’s whether she can succeed.

  • Protecting Our Democracy Act: Weighing the Pros and Cons

    Protecting Our Democracy Act: Weighing the Pros and Cons

    Background

    The Protecting Our Democracy Act (PODA) is a bill under consideration in Congress that aims to protect the integrity of the democratic process. The bill was originally passed in the House in 2021. It was received in the Senate in late 2021, where it failed to pass due to the use of a filibuster. It was reintroduced to the House in 2023, where it remains.

    PODA’s provisions center around three main goals:

    • Shifting power from the executive to the legislative branch: PODA would limit presidential powers, reassert Congress’s constitutional authority over federal spending decisions, and require congressional approval of presidential emergency declarations. PODA would also codify Congress’s subpoena and investigatory power, giving the legislative branch greater oversight of the executive branch.
    • Preventing corruption: PODA would require greater presidential transparency, enact new protections for both inspectors general and whistleblowers, and codify the Constitution’s Emoluments Clauses, which prevent government officials from receiving profits from foreign officials or states. It would also reinforce the Hatch Act of 1939, which limits the political activities of federal employees and other government officials involved with federally-funded programs.
    • Strengthening election integrity laws: PODA also prohibits foreign election assistance in the form of donations and would require greater transparency in digital political advertisements.

    Arguments in Favor of the Protecting Our Democracy Act

    One of the main arguments in support of PODA is that gradual institutional decay has undermined congressional authority. PODA’s proponents point to resistance to congressional oversight by former Presidents Donald Trump and Barack Obama as evidence of this phenomenon. They argue that the recent growth of the executive branch at the expense of the legislative branch can be mitigated through PODA’s provisions, which give Congress clear authority to enforce subpoenas, reassert congressional power over federal spending, and restrict a president’s use of emergency declarations. Proponents believe that this would effectively reform the balance of power between the two branches and restore the democratic process to the federal government.

    PODA’s supporters also emphasize a need for greater defenses against corruption and abuses of power. They point to the Trump administration’s refusal to disclose tax returns, dismissals of inspectors general, and issuance of pardons for corruption charges against close associates as evidence of the need for greater oversight of the executive branch. They believe that reinforcing the Hatch Act would keep federal programs fair and non-partisan, reduce corruption, and prevent political patronage. Supporters also believe that government whistleblowers need greater protections. A poll conducted by Marist in 2020 found that 86% of American voters agree that there should be more legal protections for federal employees who report fraud. Whistleblower protections are also popular across party lines. Supporters of PODA believe that the bill would provide these popular protections by granting whistleblowers increased anonymity and a private right of action if outed by other government officials.

    Finally, proponents of PODA argue that the bill will prevent foreign interference in elections. The federal ban against foreign interference in national elections has not been updated since the Supreme Court’s 2010 Citizens United v. FEC decision, which allowed corporations and other organizations to spend unlimited amounts of money on campaigns and elections. PODA’s supporters believe that this outdated policy has allowed foreign interests to fund campaigns, pay for digital advertising, and conduct social media campaigns freely, potentially spending almost $1 billion total on U.S. elections in the past decade. If passed, the bill intends to decrease foreign influence by explicitly banning foreign assistance in elections and requiring political groups to report all attempts by foreign actors to influence campaigns or elections.

    Arguments Against the Protecting Our Democracy Act

    The main argument against PODA is that the bill interferes with the separation of power between the three branches of government. Opponents of PODA argue that its provisions diminish the executive branch by requiring congressional oversight of the presidential pardon, a constitutionally-granted presidential power. Critics also believe that PODA would diminish the judicial branch by attaching new definitions to constitutional language that courts have already ruled upon, overriding court decisions and further upsetting the balance of power. Specifically, they point to PODA’s new definition of emoluments, which expands the definition to include payments arising from commercial transactions at fair market value. In light of this, opponents believe that PODA’s passage would upset the American political system of checks and balances by tipping the scales too far in the direction of the legislative branch.

    Opponents of PODA also point to the bill’s protections for whistleblowers and inspectors general as a key reason to oppose the proposal. They believe that the increased protections and anonymity for whistleblowers make it difficult for the federal government to vet claims, shielding poorly-performing employees from scrutiny. They also believe that requiring congressional oversight for firing Inspectors General decreases government efficiency and intrudes on internal operations.

    Critics also believe that PODA is politically-motivated. They argue that the bill specifically targets former President Trump and his administration’s actions. As such, they believe that PODA’s proponents only support it with the intent of politically damaging Trump and that the bill’s provisions are unnecessary.

    Conclusion

    In summary, PODA supporters argue that the bill would restore congressional authority, defend against government corruption and abuses of power, and prevent foreign interference in elections. Critics argue that PODA is a politically-motivated bill that would interfere with the constitutional separation of powers, make it difficult to vet whistleblower claims, and decrease the efficiency of the federal government. 
    After its introduction to the Senate in December 2021, PODA entered committee, where it has remained for the last three years. Even with its recent reintroduction to the House, it is unlikely to pass the Senate in its entirety unless the filibuster is abolished.