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Safety in question: The alarming disparities between cannabis product health claims and research, and the magnified risks for women

By Health Policy Intern Grace Lassila

July 27, 2023

When I started my National Consumers League (NCL) internship in May 2023, I quickly dove into NCL’s health policy work. NCL is leading on several efforts to protect consumers –one area of focus that stood out to me is their work in the cannabis policy space. NCL is a founding member of Cannabis Consumer Watch (CCW), which educates consumers on cannabinoids, their effects, the risks related to the unregulated marketplace, and the ways policymakers and regulators can help protect consumers. NCL is also a part of the Collaborative for Cannabinoid Science and Safety (CCSS), which also works to educate people about cannabinoids and policy in the interest of public health.

CCW’s “test your cannabis knowledge” quiz was shocking for me. Going into the quiz, I was fairly confident about my knowledge, but as I started getting wrong answer after wrong answer, I realized I had no idea that not only are these products under-researched, but they may pose serious public health risks for consumers. Products can be sold, without having gained FDA approval, making false claims about their medicinal abilities.  And side effects are not adequately researched or revealed to consumers.

One particularly concerning aspect of the cannabis marketplace is that while CBD or Delta-8 or other cannabis products are often marketed to women, there is a concerning lack of research into the safety of these products for women. Historically, misogyny and sex discrimination have made women’s health severely under-researched and underfunded. More research on diseases, disorders, and medication is conducted on men, not women. Women are misdiagnosed far greater than men are, and experience dangerous health outcomes because of it (Greenhalgh). And without sufficient research and data on women’s health, it is incredibly difficult for legislators to write policy (Adams). Overall, for women’s health to improve, more resources need to be devoted to this issue.

Despite cannabis companies’ marketing efforts that claim their products can help with anything from menstrual cycle-related pain to morning sickness, there is little insight into the effects of cannabis or cannabis derivatives on women, pregnant people, nursing parents, and newborns. What we do know is that the risks are very real – a recent study found that THC use during pregnancy was linked to changes in fetal development and several studies have shown that CBD can be transferred to a baby via breast milk. The FDA strongly advises against THC or CBD usage while pregnant or breastfeeding. And, given the evidence currently available, I would caution any women from using these products for medical benefit.

The lack of regulation, as well as research, is very concerning. Because the FDA currently does not regulate these products, consumers have no way of knowing whether the dosage, ingredients, or claims on the label are accurate and no way of knowing whether or not they are contaminated. Though some products may acknowledge they are ‘Not Approved by FDA,’ many consumers may not see this fine print – and assume that anything they can buy at their local grocery store must be safe for consumption. While the risks of an unregulated cannabis marketplace affects all consumers, women who need medical health and relief and turn to cannabis products may be more at risk.

The good news is that in January of this year, the FDA recognized this grey area for regulation – particularly for CBD – and stated that CBD would not be regulated as a food and dietary supplement anymore, because of the unknown safety risks, and requesting that Congress act quickly to protect public health and the consumers involved.

While cannabis products are often marketed as a miracle drug, they are not. While there may be some health benefits, without comprehensive research and regulation of these products, the risks outweigh the potential good. Consumers remain responsible for making their health decisions, and women in particular should be vigilant. The FDA is heading in the right direction but more must be done to protect consumers – and women in particular. I encourage you to learn more about a safe path forward here and help NCL raise awareness of this important issue.

Sources:

Adams, Katie. “Women’s Health Is Suffering Due to Lack of Research and Funding, Experts Say.” MedCity News, 9 Dec. 2022, medcitynews.com/2022/12/womens-health-is-suffering-due-to-lack-of-research-and-funding-experts-say/#:~:text=Women’s%20health%20has%20been%20historically,healthcare%20conference%20in%20Washington%2C%20D.C.

Eversheds Sutherland. “FDA Says ‘No’ to CBD: Now What?” FDA Says “No” to CBD: Now What? – Eversheds Sutherland, us.eversheds-sutherland.com/mobile/NewsCommentary/Legal-Alerts/256713/FDA-says-no-to-CBD-Now-what#:~:text=Since%202018%2C%20the%20FDA%20has,%2Dapproved%20drug%20(Epidiolex). Accessed 6 July 2023.

Greenhalgh, Ally. “Medicine and Misogyny: The Misdiagnosis of Women.” Confluence, 5 Dec. 2022, confluence.gallatin.nyu.edu/sections/research/medicine-and-misogyny-the-misdiagnosis-of-women.

Grinspoon, Peter. “Cannabidiol (CBD): What We Know and What We Don’t.” Harvard Health, 24 Sept. 2021, www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476.

“What You Should Know about Using CBD When Pregnant or Breastfeeding.” U.S. Food and Drug Administration, www.fda.gov/consumers/consumer-updates/what-you-should-know-about-using-cannabis-including-cbd-when-pregnant-or-breastfeeding#:~:text=FDA%20strongly%20advises%20against%20the,during%20pregnancy%20or%20while%20breastfeeding.&text=Cannabis%20and%20Cannabis-derived%20products,products%20appearing%20all%20the%20time. Accessed 6 July 2023.

Growing up in fields

By Child Labor Coalition Intern Jacqueline Aguilar

July 20, 2023

I grew up in a small rural area named Center, Colorado which has a population of about 2,000 people. Growing up my parents were always working in the fields, I remember my father coming home from work, and I would feel how raspy his hands were on my face. I would always ask myself, “Why are his hands so rough?” Eventually, I realized it was because of the hard work he did every day.

In middle school, buying school clothes was difficult for my parents. I started working in the lettuce fields at the age of eleven with many of my friends. We would go in at 5:00 am and get out around 2:00 pm, my parents couldn’t take me to work because they had their own job to get to, so I would have to catch a ride with my supervisor at 4:30am and get home around 3:00 pm.

Walking down those lettuce fields was draining physically, and mentally. It consisted of tired feet walking down the field with my blistered hands holding a bulky hoe and keeping an eye out on the lettuce heads making sure they grew the right way. Most days would start with the fields cold and wet with dew. I was often drenched in mud. By the time the sun rose, it was boiling outside. I would still wear layers of clothes to avoid getting sunburnt and wrap bandanas around my head and neck.

There was no cold water available for us during working hours, or even on our lunch break. We normally worked a 12-hour shift with a 30-minute lunch—typically just cold food or snacks since we didn’t have enough time to go home and make something.

I found the work exhausting, so I started working a food service job. But soon found myself back in the fields when my father got diagnosed with lung cancer. My father had migrated to the U.S. when he was 19 and had been working in the fields ever since. The cancer could have been caused from the fertilizer, dust, and pesticides that he breathed in the fields.

My mother is now disabled with torn ligaments in her shoulder, which can also be from her field work and the movements of sorting the potatoes for so many years.

My parents were unable to provide for me financially and had to move three hours from home for my dad’s cancer treatment, so I worked the potato harvest while attending high school. I juggled a lot of responsibilities during this time, and it was difficult to still be a child with so much on my plate.

I recall one morning it began to snow, we didn’t know any better, so we kept working in the heavy weather. My fingers and feet grew ice-cold as I sorted potatoes, and I wished they would tell us to go home for the day. At that moment, I knew I wanted more for myself.

I am trying to give back to my community. I dedicate two days of my week tutoring ESL students at Center Middle School, where I previously attended. I want to help Spanish-speaking students continue school without the language barrier.

I have also been connected to the Migrant and Seasonal Head Start Program since youth. For the past three years, I have been the Otero Migrant and Seasonal Head Start Recruiter in the San Luis Valley in Colorado which allows me to promote a good program that benefits farmworker children and parents. I am an active member of the College Assistance Migrant Program at Adams State University where I’ve learned the value of an educational community and the power of coming together to work toward a common goal.

I am now a rising junior at Adams State University working toward a major in sociology with an emphasis in social work and a minor in Spanish. I hope to receive my Master’s degree at Colorado State University-Pueblo to become a medical social worker. I want to stay close to my community to help families that face barriers to medical services—just as mine did when my father had cancer.

Not so sweet: Child labor in banana production

By Child Labor Coalition intern Ellie Murphy

Americans eat a lot of bananas. The U.S. is the world’s biggest importer of bananas, eating between 28 and 30 bananas per person per year. Worldwide, bananas are the most popular fruit with 100 billion consumed annually. The fruit is nutritious and cheap. Prices generally fluctuate between 30 cents and $1.00 per banana. It’s a great deal for the consumer, but someone is paying a heavy price to produce bananas: exploited farmworkers, including many children.
Stagnating banana prices have put the squeeze on farmers, leading some planters to hire the cheapest workers—children. The work is hard, often dangerous, and not fit for children. Yet they toil in the fields to help their impoverished families.

Countries that use child labor to produce bananas include Ecuador, Belize, Brazil, Nicaragua, and the Philippines, according to the U.S. Department of Labor’s (USDOL) List of Goods Produced by Child Labor or Forced Labor.

Poverty is the main driver of child labor, but children in the developing world face barriers to accessing education that can push them to farm work. Besides the cost of school, uniforms, and books, there are also some countries that don’t have enough schools, classrooms, or teachers. And transportation problems can impact children’s ability to attend school.

Child labor in the banana sector poses significant challenges to children’s health and overall well-being. Child workers employed at these plantations are often forced to handle sharp tools like machetes, carry heavy loads, and face exposure to agrochemicals like pesticides and fungicides without protective clothing or gear. Dizziness, nausea, and negative long-term health conditions can result in child workers, and because child workers often live on banana plantations, escaping these health hazards is nearly impossible.

Let’s take a closer look at Ecuador, the world’s top exporter of bananas.

A Human Rights Watch (HRW) report released in April 2002 found widespread labor and human rights abuses on Ecuadorian banana plantations. Children as young as eight were found performing hazardous work. “The use of harmful child labor is widespread in Ecuador’s banana sector,” concluded HRW. Report authors interviewed 45 child banana workers and found that 41 began working between eight and 13 with most starting at age 10 or 11. “Their average workday lasted twelve hours, and fewer than 40 percent of the children were still in school by the time they turned fourteen,” noted HRW. According to USDOL, almost half of indigenous children in rural areas do not attend school, “which can make them more vulnerable to child labor.

“In the course of their work, [child banana workers] were exposed to toxic pesticides, used sharp knives and machetes, hauled heavy loads of bananas, drank unsanitary water, and some were sexually harassed,” noted HRW.

Roughly 90 percent of the children HRW interviewed reported that they “continued working while toxic fungicides were sprayed from airplanes flying overhead. In an attempt to avoid harmful chemicals, children interviewed about their experience stated that they used various methods to avoid toxic chemicals: “hiding under banana leaves, bowing their heads, covering their faces with their shirts, covering their noses and mouths with their hands, and placing banana cartons on their heads.”

About one in 20 Ecuadorian children in the 5-14 age group work—and four in five of these child workers toil on farms, according to data from USDOL released in its 2019 Findings on the Worst Forms of Child Labor (2019) report.

Clearly, child labor laws in Ecuador are not being adequately enforced. Alarmingly, according to the USDOL, funding for Ecuador’s labor inspectorate fell dramatically from $1.5 million in 2017 to $265,398 in 2018. During that time the number of inspectors increased from 150 to 249. There is no explanation provided for these conflicting numbers but USDOL did note there were fiscal pressures on the Ecuadorian government.

The 2002 HRW report cited many causes of child labor, including discrimination against unionized adult workers who earn higher wages. As a result, many workers who unionize are fired and replaced with children who earn around $3.50 per day, 60 percent of the minimum wage for banana farmers. “Ecuadorian law fails to protect effectively the right to freedom of association, and employers take advantage of the weak law and even weaker enforcement to impede worker organizing,” noted HRW.

Since the 2002 HRW report, Ecuador has raised the minimum age of employment to 15, banned children from hazardous work, and raised fines for employers hiring children.

In its 2019 child labor Findings report, USDOL noted that “in 2018, Ecuador made a significant advancement in efforts to eliminate the worst forms of child labor.” One change involved better protecting unionized employees against discrimination so that children are not targeted for cheap labor. Ecuador has also created more social programs for children susceptible to child labor, including the “Lifetime Plan” that provides conditional cash transfers to vulnerable children from birth.

Despite the positive ranking for Ecuador, child labor in the banana sector continues to be prevalent in Ecuador.  Poverty and limited law enforcement make child labor an unfortunate reality for families.

Banana exporting companies often fail to address adequately child labor and hazardous working conditions in their supply chains. The big players –Dole, Del Monte, and Chiquita Fyffes—need to do more if we are to end child labor in banana production. Dole claims to prohibit child labor stating that “[it prohibits] any people younger than 18 from being hired or employed in any form.” Yet, child labor in the sector flourishes in at least five of the major exporting countries, according to USDOL.

In its Findings report, USDOL makes a number of recommendations to help reduce child labor in Ecuador, including a call for a new national child labor survey, added funding to hire more labor inspectors, and social programs in rural farm areas and informal sectors. USDOL also suggests “removing school-related fees, increasing classroom space, and providing adequate transportation.” These modifications will specifically help children living in rural areas such as migrant children and indigenous children stay in school.

Concerted efforts by the Ecuadorian government and multinational banana exporters are needed if child labor is to be reduced.

Consumers have a part to play in the solution as well. The Food Empowerment Project advises consumers to buy bananas produced with less exploitation. They recommend buying from Equal Exchange. Bananas from small farmer-owned cooperatives are available in some parts of the United States. Look for bananas from Coliman, Earth University, and Organics Unlimited/Grow. “If your grocery stores do not carry these brands of bananas, we encourage you to ask them to,” says the Food Empowerment Project.

Consumers should make their voices heard: the sweetest banana is a child-labor-free banana.

Ellie Murphy is a rising junior at Tufts University, majoring in International Relations and Sociology.

‘Should I stay or should I go?’ How the pandemic has affected higher education

By NCL Health Policy intern Talia Zitner

Every morning, I wake up with a new decision to make. Am I going back to campus? Or am I spending the Fall semester taking online classes from the comfort of my childhood bedroom? I’m a rising sophomore at Wesleyan University, and to add insult to injury, I’m also an incoming transfer student. My internal debate about going back to school is near-constant, and despite weighing the pros and cons of each, I still can’t seem to come to a comfortable conclusion.

Around the country, colleges and students are faced with this same, nearly impossible challenge. If schools can’t or won’t open in the fall, they risk closing forever without tuition money. If they do allow students to come back to campus, and an outbreak occurs, they put students, professors, faculty, staff, their families, and the greater community at risk. Students rely on colleges to be their home away from home, a place where they can work and learn in a structured, safe, and healthy environment, not to mention the social benefits.

Consequently, coming back to campus poses a serious financial and ethical question. Like anything else, college and higher education is a business. Consumers want to get the most for their money, and the colleges and universities need consumers to engage to have a sustainable business model. The pandemic has shifted the conversation in many areas of life, higher education included.

This issue is especially complicated because it can be broken down from multiple perspectives. For example, an economic point of view argues that colleges are only re-opening because they need the money. Like many other businesses, they stay open because they have no other choice. Without the money generated through tuition and other forms of revenue like donation and state funding, it would take years for schools to recover from the impact of COVID. But college is a substantial investment for families. Why should consumers be expected to pay full (or reduced) tuition for an experience that is more like a monastery than college? Will the investment really be worth it if schools are simply shut down again because of an outbreak at a campus party?

On the other hand, if students aren’t in school come fall semester, what else would they be doing? Most students are hard-pressed to find a job or internship that’s worth taking a semester off for in this environment. And time off may push back a student’s graduation time, putting them behind the rest of their peers. For very legitimate reasons, students want to come to campus and keep their college experience intact.

This seems to be where my own expectations fall. I have no idea if the situation will improve between now and the spring semester. To me, the only course of action is to enjoy the experience that I will have, even if it means wearing a mask.

Talia is a Washington, DC native and a rising sophomore at Wesleyan University, where she is studying English. Beyond health policy, Talia’s interests are in journalism, law, and social justice.

Reopening the economy prematurely has dire consequences for states

By NCL Health Policy intern Talia Zitner

The past month has seen a serious surge in reported coronavirus cases in the United States. It seems the virus is going to be with us for a while. Of states where COVID is spiking, the majority are in the South, many of which had ambitious reopening plans that are now being reconsidered.

Three of these states—Texas, Florida, and Arizona—have current surges. All three pushed to reopen their economies early in an attempt to “return to normal.” The current deluge in cases that resulted was due to a lack of continuing stay-at-home order and a failure to require masks.

Texas officially started Phase 1 of its reopening plan on May 1, but—as of June 26—had to retract much of the opening that it had started. In total, Texas was only able to reopen the state for 55 days. As of July 27, Texas has seen an average of 8,089 new cases of the coronavirus over a seven-day period. Compared to cases in April, when there were 814, this is astounding. Texas Governor Greg Abbott (R) has since ordered everyone to start wearing face masks and has limited the size of public gatherings.

It does not appear that Texas will shut down again, however. As the governor said, “we need to refocus on slowing the spread, but this time we want to do it without closing down Texas again.” Although it is an issue of public health, the issuance of a statewide masking policy and the staggered re-opening of the economy has become a matter of contention across party lines. Some residents find the Governor’s actions to be inadequate, and others feel as if the newly implemented precautions impede their personal liberties.

Florida and Arizona are not faring much better. As of April, Florida had 1,027 cases reported. In July, it was 6,563. Florida started its reopening plan on May 4 and entered into Phase 2 on June 5. Clearly, cases have surged.

Earlier this week, Florida reported 8,892 new COVID-19 cases. Like Texas, there seems to be a mixed reaction among Florida representatives to slow the spread of the virus. Senator Rick Scott (R) has been vocal about his intentions for Florida, and it appears the state will not roll back any of its reopening course. As Senator Scott put it a couple of months ago, “wearing a mask is a choice you get to make.”

Like Texas and Florida, Arizona is hurting badly, with only 115 in April surging to 4,753 cases in July. Arizona’s stay-at-home order lasted until May 15, and was replaced by the new Stay Healthy, Return Smarter, Return Stronger Executive Order, on May 16. When Arizona first reopened, Governor Doug Ducey did not require residents to wear face masks, but as the case numbers increased, he allowed local governments to set their own masking policies. As of July 1, officials said that Arizona saw the highest rate of new cases in the entire country.

Many public officials are starting to realize opening too soon was foolhardy and has spread the virus. New revelations by scientists show the virus can actually be airborne, urging those to take indoor transmission more seriously. The virus is also proving to be more of a blood vessel disease than solely a respiratory one, which may lead to long-term impacts that doctors are still learning about.

There’s one takeaway here: following the example of states like Texas, Florida, and Arizona is not recommended. The more seriously states take this crisis the better, and the sooner the entire country will be able to move towards a newer, safer “normal”.

Talia is a Washington, DC native and a rising sophomore at Wesleyan University, where she is studying English. Beyond health policy, Talia’s interests are in journalism, law, and social justice.

Trump’s fuel economy rollbacks: a loss for workers, consumers, the environment

headshot of NCL LifeSmarts intern Alexa

By NCL LifeSmarts intern Elaina Pevide

Cars are baked into American life – around 83 percent of households own one – so any change in the cost or availability of gasoline affects an enormous group of Americans.

Although most of us have grumbled about the cost of gas at some point—and memories of the Great Recession and its dramatic spikes in gas prices are enough to send shivers down the spine of many Americans—some Americans are affected more than others by increases. Did you know that low-income households spend twice as much of their income on gasoline as other Americans? For this group, fuel economy is an especially close-to-home issue.

The Obama Administration made significant headway in improving fuel economy standards and fostering American innovation when it announced the One National Program in 2010. That program unified the Environmental Protection Agency’s (EPA) greenhouse gas emission standards with the fuel economy standards set by the National Highway Traffic Safety Administration (NHTSA). This initiative set long-term goals for fuel efficiency aiming at Model Year 2025, when vehicular CO2 emissions were slated to be reduced by half. The One National Program was a win-win for consumers and the environment. Obama’s initiative would have made the American automotive industry a world leader in environmentally-friendly innovation while also giving the U.S. a huge advantage in a turbulent global economy adapting to the threat of climate change.

Perhaps the greatest benefactor of Obama’s One National Program was the average consumer. Doubling fuel economy means that consumers get twice the bang for their buck at the pump. These benefits would eventually help the less affluent the most, many of whom own used vehicles. Low-income secondhand car owners would pay little of the front-end cost of innovation, but would still save hundreds of dollars on gas on later model used cars.

During the last 7 months of the Obama Administration, EPA Administrator Gina McCarthy determined that, given the success of the program thus far, the program would maintain its initial goal of a 54.5 mpg fuel economy standard by 2025. Unfortunately, the Trump administration did not take long to backpedal on this dramatic win for consumers, workers, and the environment.

On March 15, 2017, then-EPA Administrator Scott Pruitt and Department of Transportation Secretary Elaine Chao reopened the evaluations. Two weeks later, they provided their disappointing and controversial results: the Trump EPA did not believe in the efficacy of the One National Program. By August, NHTSA and the EPA announced a new rule, called the Safer Affordable Fuel-Efficient (SAFE) Vehicles Rule, the euphemistically-named rollback that handed the automotive industry a big win. The federal actions revoked the ability of California and 13 other states to enforce their own higher standards for environmentally-friendly vehicles.

The SAFE Vehicles Rule is misnamed. The Trump Administration is, in our view, mistaken in its assertions that the freeze and rollback of fuel economy standards will benefit anyone. An analysis by the Consumer Federation of America found that the program has already saved consumers $500 billion, with an extra $400 billion to be found in health, macroeconomic and environmental benefits. Trump’s plan will end these savings and cost the average American household $4,500. We know that fuel efficiency creates a healthy economy, environment, and, thus, a healthier society. Sadly, the current Administration has thrown that out the window.

Global warning and climate change are urgent problems. According to an article from Union of Concerned Scientists, cars and trucks account for nearly one-fifth of all U.S. emissions, emitting around 24 pounds of carbon dioxide and other global-warming gases for every gallon of gas. About five pounds comes from the extraction, production, and delivery of the fuel, while the great bulk of heat-trapping emissions–more than 19 pounds per gallon–comes right out of a car’s tailpipe.

Improving vehicular fuel efficiency is crucial to the future of the United States. High fuel economy standards reduce our need for foreign oil and encourage American companies to keep up with the green innovation around the world. As Europe, China, and other regions address global warming and reducing auto emissions, America is rolling back the clock. As a nation heavily reliant on cars for daily life, we call upon President Trump, his federal appointees, and the auto industry, to reverse these foolhardy decisions and demand improved fuel economy–to set us back on track towards the goals we were on course to meet just a few years ago.

Elaina Pevide is a student at Brandeis University where she majors in Public Policy and Psychology with a minor in Economics. She expects to graduate in May of 2020.

No more surprises: Congress and patients alike sick of surprise billing

headshot of NCL Health Policy intern Alexa

By NCL Health Policy intern Alexa Beeson

This July, the House Energy and Commerce’s Health Subcommittee passed the No Surprises Act (H.R. 3630) to protect patients from surprise billing. The Senate Health, Education, Labor and Pensions Committee also passed its companion to address surprise billing, the Lower Health Care Costs Act (S.1895). These bills were being considered after a press conference at which President Trump called for reform in surprise billing.

Stakeholder witnesses at the House hearing this June on H.R. 3630 included patient, provider, and insurance payer groups. Reimbursement models were discussed at length, but the unifying theme was that patients should be held harmless in surprise billing situations.

Surprise billing happens mostly in a small subsect of out-of-network providers; the patient has no idea about who’s in or out of network. Some professionals are out-of-network technicians subcontracted by an in-network facility, such as a last-minute anesthesiologist switch for a surgery, or any other non-disclosed provider. To get reimbursed for their services, providers send a bill to the patient for whatever wasn’t covered by the insurance company.

Surprise billing also occurred among patients who should receive reduced prices for care. Johns Hopkins Hospital filed suit on more than 2,400 patients in the last decade, collecting the equivalent of 0.03 percent of its operating revenue. Some of these patients were never told about their right to charity care, and many who qualify never received a discounted rate. These bill collections are inconsequential for Johns Hopkins but could bankrupt a patient.

Legislation to address balance or surprise bills will protect patients, ensuring they will only have to pay in-network rates for out-of-network emergency care. This will help patients avoid bills that can set them back, sometimes, hundreds of thousands of dollars. Although surprise bills only come from a small portion of providers, 1 in 7 insured adults will receive a surprise medical bill from an in-network hospital. The Kaiser Family Foundation found that 70 percent of such patients were not aware that the provider was out-of-network when they received the care.

Panelist Sonji Wilkes, a patient advocate, presented testimony about her struggle with a surprise bill sent after the birth of her son, who was diagnosed with hemophilia. That child was treated by a charitable out-of-network hematologist who did not charge them for her services. However, the NICU that observed the boy was subcontracted to a third-party provider. This meant that the NICU was out-of-network. The Wilkes were sent a $50,000 bill by the hospital that still haunts them 15 years later.

Thomas Nickels, the executive vice president of the American Hospitals Association, claimed that fixed reimbursement rates, such as a median benchmark or percentage of the Medicaid reimbursement value, would disincentivize insurers from maintaining adequate provider networks. Nickels supported the Alternative Dispute Resolutions method, which involves baseball-style arbitration where providers and payers settle on reimbursement value on a case-by-case basis.

Jeanette Thornton, a senior vice president at America’s Health Insurance Plans, argued that the New York model of baseball-style arbitration would create immense clerical burden, resulting in lost time and greater administrative costs. She argued the arbitration reimbursement model would raise costs for patients in the end. Instead, she advocated for the government-dictated fixed reimbursement rates.

Both versions of the bill call for a benchmark to resolve payments between insurance plans and out-of-network providers. This benchmark says health plans would reimburse providers with the median in-network rate already contracted within specific geographic areas. The House bill contains binding arbitration as a fallback in case either the provider or payer decide the payment was an unfair price.

The National Consumers League supports Congress’ tackling of this issue of surprise or balance billing. NCL has taken no position on how these bills are settled between the payer and provider, as long as patients are protected from outrageously expensive bills they can never hope to pay and were never anticipating. In addition, medical debt is the greatest contributor to consumers declaring bankruptcy, and balance billing is a contributor to that troubling consumer issue. The bottom line is that a bill for medical services should never cause bankruptcy, and a patient should never have to choose between medical treatment and food or housing. We are hopeful this issue will be resolved during this Congressional session.

Alexa is a student at Washington University in St. Louis where she studies Classics and Anthropology and concentrates in global health and the environment. She expects to graduate in May of 2020

Finally, regulation where it’s needed: seven new bills with a focus on consumer safety

headshot of NCL Health Policy intern Alexa

By NCL Health Policy intern Alexa Beeson

This June, the House Energy and Commerce’s Consumer Protection and Commerce Subcommittee held a hearing in which they considered seven different bills concerning product safety. The hearing was motivated by a commitment to removing life-threatening products from the market, which–somehow–remain in circulation for purchase. Most notably, the bills address furniture tip-over (H.R. 2211), crib bumpers (H.R. 3170), inclined infant sleepers (H.R. 3172), and fire safety (H.R. 806).

The witnesses included Will Wallace, a manager at Consumer Reports; Crystal Ellis, a devastated mother and founder of Parents Against Tip-Overs; Chris Parsons, the president of Minnesota Professional Fire Fighters; and Charles A. Samuels, a member of Mintz, a law firm that represents manufacturers of some of the products implicated in various accidents.

Ellis was especially moving. She lost her son, Camden, five years ago on Father’s Day in a tip-over accident involving an unstable dresser. The day she testified would have been her son’s 7th birthday. Camden’s death and the deaths of many others in tip-over accidents catalyzed the founding of Parents Against Tip-Overs, which advocates for children who were victims of unsafe consumer products. Ellis recounted the devastating loss of her son and pleaded that the committee act to protect other children from suffering the same fate. Ellis urged the committee to evaluate the standards set forth by the Consumer Product Safety Commission (CPSC), which are not regulated enough to prevent tip-overs.

Furniture tip-over is a more widespread problem than you might realize. According to the CPSC, an estimated annual average (2014-2016) of 9,300 children ages 0-19 were treated in the emergency department for furniture tip-over injuries, not including televisions or appliances. If you include television and other appliances, which were not covered in the bills at the hearing, the number jumps to more than 15,000. From 2000-2016, furniture tip-overs killed 431 children.

These deaths could have been prevented by enforcing stricter safety regulations. The current CPSC regulations do not demand mandatory safety standards for tip-over prevention. The product manufacturing industries are only held to a voluntary standard. Additionally, products under 30 inches tall are exempt from any such safety regulations. However, as found by a Consumer Reports investigation, shorter furniture still causes major tip-over accidents.

The Stop Tip-overs of Unstable, Risky Dressers on Youth (STURDY) Act would seek to change these standards. The bill would require the CPSC to mandate manufacturers to produce more rigorous testing of their products; to perform more “real-world” testing and to revise consumer warning requirements, ensuring higher standards of product safety and transparency.

The National Consumers League thanks the Consumer Protection and Commerce Subcommittee for taking measures to hold industry accountable with regards to product safety standards. One positive message that everyone can take away from this hearing is that times are changing. Industry will be held accountable, and consumers will be protected. It looks like the time for the CPSC to take charge in handling consumer safety and protection–instead of letting industry set its own rules–is just around the corner, to paraphrase Rep. Frank Pallone (D-NJ).

Alexa is a student at Washington University in St. Louis where she studies Classics and Anthropology and concentrates in global health and the environment. She expects to graduate in May of 2020

NCL continues to advocate for breastfeeding mothers

headshot of NCL Health Policy intern Alexa

By NCL Health Policy intern Alexa Beeson

This July, Dutch airline KLM found itself in the middle of a breastfeeding snafu: “public decency” vs. “natural practice.” A mother wrote about the airline with a Facebook post describing how a KLM flight attendant asked her to cover up if she wanted to continue nursing her baby. The new mom said that, while contacting KLM to file a complaint, she was told that she should “be respectful of people of other cultures.”

Other moms went on Twitter to ask KLM about its official breastfeeding policy. KLM responded with: “Breastfeeding is permitted at KLM flights. However, to ensure that all our passengers of all backgrounds feel comfortable on board, we may request a mother to cover herself while breastfeeding, should other passengers be offended by this.” The National Consumers League is disappointed.

New moms should be encouraged, supported, and protected to breastfeed. It has so many health benefits for mom and baby including the prevention of allergies in babies and the reduced risk of developing certain forms of cancer in moms.

A few years back, NCL posted a Breastfeeding Mothers’ Bill of Rights, that included the following:

  • A mother should have the right to breastfeed her child in any public or private establishment where they both are legally present, without harassment or discrimination of any kind,
  • No establishment should enact a rule that prevents breastfeeding a child, and
  • Breastfeeding mothers should not be told to only do so in a discreet manner.

Breastfeeding is a safe, healthy, and natural act, through which mothers provide nourishment to their children. NCL stands with mothers wishing to express milk whenever needed, regardless of the presence of their child. In no way should breastfeeding ever be considered lewd, immoral, or indecent–you are feeding your baby! That has nothing to do with sex.

Memo to KLM: check with your lawyers. Both the United States and the Netherlands protect public breastfeeding. All 50 states have laws that allow breastfeeding in public or exempt breastfeeding from public decency laws. In the Netherlands, there are no specific laws regarding public breastfeeding, but it is widely socially accepted. Why then, on a flight from San Francisco to Amsterdam, should KLM be able to prevent a woman from breastfeeding?

Reading replies to this tweet is a happy reminder that people do, in fact, support a woman’s right to breastfeed in public. Many people were upset that KLM considered breastfeeding an offensive act. Others satirically asked whether KLM would force an adult to cover his head if his eating “offended” another passenger. A few people questioned why a woman needs permission from an airline to feed her child. KLM themselves called breastfeeding “the most natural thing in the world,” yet still uphold their policy of having the right to discourage mothers from breastfeeding.

No mother should never feel uncomfortable or judged by another while feeding her child or expressing milk. KLM’s policy shows they would rather cater to someone who is “offended” by the most basic act of feeding one’s child; that is wrong. KLM–you must do better! And all airlines should publish affirmative policies supporting breastfeeding. Women and their babies need our support.

Alexa is a student at Washington University in St. Louis where she studies Classics and Anthropology and concentrates in global health and the environment. She expects to graduate in May of 2020

The ‘tampon tax’: an unconstitutional loss to American consumers

headshot of NCL LifeSmarts intern Alexa

By NCL LifeSmarts intern Elaina Pevide

Bingo supplies in Missouri, tattoos in Georgia, cotton candy in Iowa, gun club membership in Wisconsin; what do these products and services have in common? They are all treated as tax-exempt by states that still put a tax on tampons.

Sales taxes on menstrual products, often referred to as “tampon taxes”, are still present in 35 states. Tampon taxes are cited as a major contributor to the “pink tax”, the heightened cost of products and services marketed toward women. For example, a purple can of sweet-smelling shaving cream for women will almost always cost more than its male counterpart across the aisle. This trend translates across industries. A 2015 study from the Joint Economic Committee found that women pay more 42 percent of the time for products from pink pens to dry cleaning. These pricier goods and services serve no benefit to the consumer and have no apparent improvement in function or quality. The pink tax cuts into women’s spending power and takes advantage of consumers simply on the basis of gender.

Tampon taxes and the pink tax have both been making waves recently as pressing feminist issues. While markups on products for women are unjust, activists are targeting the tampon tax as priority number one. Menstrual products, they argue, are necessities and states have the power to cut sales taxes on them by labeling them as such. States give tax exemptions to other items– like bingo supplies, tattoos, and cotton candy–that are far less vital to the health and success of consumers. Today, five states do not have sales taxes on any products, five states have always given hygiene products tax-exemption status, and five states have successfully fought to eliminate the tampon tax. Currently, 35 states remain with 32 having tried–and failed–to pass legislation on the matter.

States resistance to eliminate the tampon tax, typically for fiscal reasons, is at odds with the interests and demands of consumers. A survey of 2,000 women, conducted on behalf of menstrual cup company Intimina, found that three out of four women believe the tampon tax should be eradicated. Nearly 70 percent of those surveyed interpreted taxes on feminine products as a form of sexism.

Countless advocacy organizations have been established out of the need to provide consumers with affordable menstrual products and eliminate the tampon tax. One such group, Period Equity, recently launched a campaign with reproductive care company LOLA called “Tax Free. Period.”. Their campaign calls for the remaining 35 states with a tampon tax to eliminate it by Tax Day 2020. In the meantime, they’re gearing up for a legal battle to challenge the states that refuse to comply. Their argument? Taxes on a product that affect only women and other individuals who menstruate is a form of discrimination and thereby unconstitutional.

As reproductive rights groups await the response of state legislatures and federal courts on this issue, the half of Americans that use menstrual products in their lifetime are suffering. Women make less in wages than men but are forced to spend more. The tampon taxes expound gender inequality and costs American consumers millions of dollars each year–dollars that could benefit their families and stimulate the economy elsewhere. Period Equity’s tagline says it best: “Periods are not luxuries. Period.” It’s about time for American tax policy to reflect that reality.

Elaina Pevide is a student at Brandeis University where she majors in Public Policy and Psychology with a minor in Economics. She expects to graduate in May of 2020.