Developing an approach towards consumer privacy and data security

Polly Turner-Ward

By NCL Google Public Policy Fellow Pollyanna Sanderson

This blog post is the first of a series of blogs offering a consumer perspective on developing an approach towards consumer privacy and data security.

For more than 20 years, Congressional inaction on privacy and data security has coincided with increased data breaches impacting millions of consumers. In the absence of Congressional action, states and the executive branch have increasingly stepped in. A key part of the White House’s response is the National Telecommunication and Information Administration (NTIA) September Request for Comment (RFC).

While a “Request for Comment” sounds incredibly wonky, it is a key part of the process that informs the government’s approach to consumer privacy. The NTIA’s process gathers input from interested stakeholders on ways to advance consumer privacy while protecting prosperity and innovation. Stakeholder responses provide a glimpse into where consensus and disagreements lie among consumer and industry players on key issues. We have read through the comments and in this series of blogs are pleased to offer a consumer perspective.

This first blog focuses on a fundamental aspect of any proposed approach to privacy and data security: the scope. Reflecting risks of big data classification and predictive analytics, one suggestion by the Center for Digital Democracy (CDD) was to frame the issues according to data processing outputs. This would cover inferences, decisions, and other data uses that undermine individual control and privacy. However, focusing on data inputs, there was consensus among many interested stakeholders that privacy legislation must cover “personal information.”

The Center for Democracy and Technology noted that personal information is an evolving concept, the scope of which is “unsettled…as a matter of law, policy, and technology.” Various legal definitions exist at the state, federal, and international level. The Federal Trade Commission’s (FTC) 2012 definition defines it as information capable of being associated with or reasonably linked or linkable to a consumer, household, or device. Subject to certain conditions, de-identified information is excluded from this definition. To help to address privacy concerns while enabling collection and use, many stakeholders agree that regulatory relief should be provided for effective de-identification techniques. This would incentivize the development and implementation of privacy-enhancing techniques and de-identification technologies such as differential privacy and encryption. Federal law to avoid classifying covered data in a binary way as personal or non-personal. An all-or-nothing approach requiring irreversible de-identification is a difficult or impossible standard.

In an attempt to recognize that identifiability rests on a spectrum, the EU’s General Data Protection Regulation (GDPR) excludes anonymized information and introduces the concept of pseudonymized data. These concepts demand federal consideration, having been introduced to United States law via the California Consumer Protection Act (CCPA). The law should clarify how it applies to aggregated, de-identified, pseudonymous, identifiable, and identified information. To be considered de-identified data subject to lower standards, data must not be linkable to an individual, risk of re-identification must be minimal, the entity must publicly commit not to attempt to re-identify the data, and effective legal, administrative, technical, and/or contractual controls must be applied to safeguard that commitment.

While de-identified and other anonymized data may be subject to lower privacy standards, they should not be removed from protection altogether. In their NTIA comment, the CDD highlights that third-party personal data, anonymized data, and other forms of non-personal data may be used to make sensitive inferences and to develop profiles. These could be used for purposes ranging from persuading voters to targeting advertisements. However, individual privacy rights may only be exercised after inferences or profiles have been applied at the individual level. Because profiles and inferences can be made without identifiability, this aspect of corporate data practice would therefore largely escape accountability if de-identified and other anonymized data were not subject to standards of some kind.

This loophole must be closed. Personal information should be broadly defined to address risks of re-identification and to capture evolving business practices that undermine privacy. While the GDPR does not include inferred information in its definition of personal information, inspiration could be taken from the definition of personal information given by the CCPA, which includes inferred information drawn from personal information and used to create consumer profiles.

Our next blog  will explore “developing an approach for handling privacy risks and harms.” In its request for comment, the NTIA established a risk and outcome-based approach towards consumer privacy as a high-level goal for federal action. However, within industry and society, there is a lack of consensus about what constitutes a privacy risk. Stay tuned for a deep dive into the key issues that arise.

The author completed her undergraduate degree in law at Queen Mary University of London and her Master of Laws at William & Mary. She has focused her career on privacy and data security.

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.

Calling an end to the health and humanitarian crisis at the border

Nissa ShaffiFlorence Kelley, first general secretary of the National Consumers League (NCL), was a pioneer in progressive social reform during a time in our nation’s history that was defined by mass immigration and egregious health violations. 120 years later, we bear witness once again to the unconscionable transgressions occurring in migrant detention centers across the border with regards to immigrant rights and access to health care. 

At this very moment, people who are exercising their legal right to seek asylum, according to international and U.S. law, are being systemically dehumanized. The atrocities occurring at our border completely tarnish the social protections that NCL has historically fought to solidify.

On July 10, the House Oversight Committee held a hearing to examine the humanitarian crisis at the border. The investigation followed the release of a July 2 report by the Office of Inspector General (OIG) detailing the dangerous and unsanitary conditions migrant detainees are experiencing at Custom and Border Patrol (CBP) and Immigration Customs Enforcement (ICE) facilities.

Images of children sprawled across cold concrete floors in overcrowded holding cells, wrapped in nothing but flimsy mylar blankets, prompted members of Congress, immigration lawyers, and physicians to visit various migrant detention centers throughout Texas to witness the matter firsthand.

Visitors noted a stench that could be detected immediately upon entry into the facilities, which was attributed to detainees being sardined into holding cells, in conditions that have been classified as inhumane and in violation of international law. A majority of detainees have been denied access to basic toiletries like soap and toothbrushes to help them maintain their hygiene. Additionally, individuals have not been able to shower in weeks, are sleep deprived, and are housed in frigid temperatures in rooms that have been given the apt moniker of the “ICE Box.” Many migrants have claimed that they were wearing the same soiled clothes that they wore during their long passage into the country.

These facilities were not designed to house migrants for prolonged detainment. Regulations prohibit the detention of detainees for longer than 72 hours, yet OIG reported that migrants had been held indefinitely, some even as long as several weeks. The unsanitary conditions prevalent in the detention centers have resulted in outbreaks of the flu, lice, shingles, scabies, and chickenpox. The processing centers in the facilities are housed beyond infrastructural capacity, leading border officials to take desperate measures to hold detainees in cages and under overpasses. These dangerous conditions will inevitably advance the spread of disease, endangering the lives of detainees as well as the general public who will come into contact with CBP and ICE agents.

These facilities are privatized, for-profit migrant detention centers that function outside the purview of federal oversight and accountability. Shareholder interests call for incentivized cuts to medical staffing, which as a result, has led to cruel and negligent practices that have encouraged the spread of disease, the proliferation of trauma, and the violation of human rights.

NCL calls on Congress to address the harrowing health and human rights violations taking place at our borders. NCL strongly advocates for a principled, comprehensive immigration reform that treats all immigrants with respect and dignity, no matter their legal status in the United States. NCL’s immigration policy advocates to:

  • keep families together;
  • ensure a humane pathway to citizenship and builds upon the success of Deferred Action for Childhood Arrivals (DACA) to incorporate young immigrants into mainstream society; and
  • ensure effective enforcement that protects our borders, fosters commerce, and promotes the safe and legitimate movement of people and goods at our ports of entry.

To learn about NCL’s immigration policy, click here.

The National Consumers League calls on lawmakers to work together to enact humane immigration policy reform that genuinely encompasses the promise of American values. Congress must act swiftly and in the best interest of migrants detained to collectively bring an end to this humanitarian crisis.

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.

Raise the Wage Act 2019: House majority looking to lift millions out of poverty

headshot of NCL Health Policy intern Alexa

By NCL Health Policy intern Alexa Beeson

June 16 marked the longest period the United States has gone without an increase in the federal minimum wage. The federal wage floor was last raised a decade ago, in 2009. The current minimum wage is just $7.25 an hour, which is a poverty wage by federal standards, but tipped workers and people with disabilities often make even less. Worse yet, the value of this wage has decreased by 13 percent since its enactment due to inflation.

Many states have increased their minimum wages, including some red states like Arkansas and Missouri. These states have done so through the popular-vote referendum process. There is widespread support from all Americans–Democrats and Republicans alike–on this issue. In fact, 70 percent of Republican voters want a raised federal wage floor. There are still 21 states, however, whose workers receive only the bare minimum federal wage or, even worse, a tipped wage.

The U.S. House of Representatives, now led by a Democratic majority for the first time in many years, will be taking up the Raise the Wage Act (H.R. 582), and there is a companion bill by the same name in the Senate (S. 150).

The Raise the Wage Act will incrementally lift the federal wage floor to $15 an hour over the next five years. If enacted, the legislation would reduce levels of poverty across the nation without driving vulnerable populations into unemployment. It will also help decrease the wage gap between minimum and median wage workers. The House is expected to have a roll call vote on H.R. 582 before the August recess. If it does pass in the House, the act will have a hard time making it through the Republican-controlled Senate. However, this is still a progressive step in the right direction.

This act will also end subminimum wages for tipped employees. If employees make less than the $7.25 federal minimum wage, including tips, employers are supposed to add the rest to their paycheck. However, some employers fail to do so. The affected employees can make as little as $5 less than the minimum wage. The way the system works now, customer gratuities act as wage subsidies that we believe should be covered by the employer. For those concerned with whether raising the minimum wage will stop customers from tipping, studies show that eliminating the tiered wage system will not stop patrons from leaving tips.

Raise the Wage will end the subminimum wage for people with disabilities, some of whom make mere pennies an hour. Subminimum wages act as a form of legalized discrimination, and this bill will make it impossible for employers to get new special exemptions to pay their employee’s subminimum wages. It will also end current exemptions because all wages will be increased to $15 an hour in the next seven years.

Some fiscally conservative groups have claimed that raising the wage to $15 an hour would lead to high unemployment or business closures, with small businesses burdened by the extra costs. However, studies contradict those claims. Many show that raising the minimum wage would have little or no impact on employment. A study conducted by the University of California at Berkeley Institute for Research on Labor and Employment found that when the town of Berkeley raised the minimum wage, it actually saw a decrease in unemployment and a reduction in poverty. Further research showed that wage increases in 51 counties over 45 states had no adverse effect on employment hours or weeks worked.

NCL has been a long-standing advocate for fair minimum wages. In the early 1900s, the League’s General Secretary Florence Kelley ran a minimum wage campaign, which passed laws in 14 states. We are encouraged to see the House of Representatives taking affirmative steps to raise the federal minimum wage.

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.

Oral argument for ACA case will determine the fate of millions

Nissa ShaffiOn Tuesday, July 9, the U.S. Court of Appeals for the 5th Circuit will hear oral arguments that will determine whether or not the Affordable Care Act (ACA) may be overturned. Throughout the course of its life, the ACA has been under the specter of possible repeal. While there have been piecemeal attempts to strike down the legislation over time, none have been as concerning as the most recent Texas v. United States case, which argues that since the individual mandate is no longer enforced, ACA  would be unconstitutional.

The individual mandate requires that most people maintain a minimum level of health insurance or be subject a financial penalty. In 2017 however, the Tax Cuts and Jobs Act (TCJA), set the individual mandate to $0 as of 2019. As a result of this ruling, the Texas v. United States case was filed by 20 Republican state attorneys general and governors. The plaintiffs argue that the ruling rendered the individual mandate futile, as it no longer produces revenue for the federal government, and since Congress declared the individual mandate to be “essential” when enacting the ACA, this would now make the entire law invalid.

In an ideal situation, the court would maintain the ACA as it exists today, absent the individual mandate. If the ACA is repealed along with the protections that come with it, close to 20 million people would lose their health coverage. Those affected will include mostly low-income adults and children with chronic or pre-existing conditions, dependent adult children ages 26 and younger, Medicare and Medicaid enrollees, employer and employee groups, and more.

Repealing the ACA would jeopardize Medicaid expansion, further burdening uncompensated care and provider reimbursement. In addition, repealing the ACA would increase health care costs among the uninsured by $50.2 billion, result in more than 9 million people losing federal subsidies to purchase health insurance via the marketplace, and would endanger consumers’ ability to obtain essential health benefits.

California’s Attorney General, Xavier Beccerra, is leading a coalition of 21 Democratic attorneys general who have intervened to defend the ACA. Advocates interested in joining these efforts can contact izzy@xavierbecerra.com – please do so and sign the petition by July 14. In addition, organizations can participate in the TXvUS Tweetstorm to express their concerns regarding this case, using the hashtags #TXvUS and #WhatsAtStake, on July 9th at 2 pm EST/ 11 am PST.

NCL is a zealous supporter of the ACA and notes that it is still the law of the land. We are following the developments of this case closely and will continue to fight for access to affordable healthcare for all Americans. For more information on developments of this case, please click here.

FDA acts to protect women’s health

Nissa Shaffi

Last April, the U.S. Food and Drug Administration (FDA) issued a ban on all sales of pelvic surgical mesh products after determining that the manufacturers, Boston Scientific and Coloplast, failed to “demonstrate [a] reasonable assurance of safety and effectiveness.”

The ban comes on the heels of a 2016 reclassification of the product by the FDA, resulting in a class III (high-risk) designation. As a result, the manufacturers were required to undergo meticulous review and obtain premarket approval by the FDA in order to continue sales of their products in the United States.

A surgical mesh is a medical device used to treat urogynecological or pelvic organ issues. Most commonly, surgical mesh has been used to treat pelvic organ prolapse (POP). POP is a type of pelvic floor disorder that occurs when the muscles and tissues supporting pelvic organs become weakened–often resulting in urinary incontinence typically seen as a result of childbirth or advanced age.

A transvaginal surgical mesh is intended to provide additional support to the pelvic floor muscles to reinforce a weakened vaginal wall for treatment of POP. A urethral sling surgical mesh is supposed to provide support to the urethra or bladder to address urinary incontinence. Surgical mesh comes in two forms: synthetic and animal derived. Synthetic surgical mesh remains in the body indefinitely and acts as a permanent implant. Animal derived mesh, made from the intestine or skin of pig or cow, are absorbable and lose durability over time.

The most frequent complications from these devices include vaginal scarring, mesh erosion, increased risk of infection, and painful urination. Nearly 10 million women worldwide have received mesh implants, with about 10 to 15 percent of these women suffering from complications. Following the ban, there are currently no FDA-approved pelvic surgical mesh products available for sale in the United States.

The FDA advises that women who have already received a transvaginal mesh for the surgical repair of POP should continue their routine follow-up care with their provider and need not take any additional action if they are satisfied with their procedure. Patients should notify their provider if they experience any adverse reactions, such as bleeding or pain, following the procedure.

Given the grave injury these devices have caused in women patients, the National Consumers League questions how they ever received FDA approval in the first place. Nevertheless, banning the devices now is better than keeping them on the market. We must expect better from our healthcare regulators. Thankfully, we now have stronger safety standards that have brought an immediate halt to the sale of these unsafe medical devices.

To read the FDA’s full report on transvaginal mesh, click here.

NCL Health Policy Intern Alexa Beeson contributed to this blog.