Guest Blog: The FABRIC act will address garment industry workplace concerns

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By Rebecca Ballard

Last year the first ever federal fashion bill, The FABRIC Act, was introduced in Congress, and it will be reintroduced this September. However, the intersection between labor rights, legislation, and the garment industry is far from new. The industry has been tied to labor abuses since before our country’s founding; it was cotton that enabled the United States to reach global economic prominence, and issues with forced labor in fashion continue to this day. And it is not just labor concerns linked to fashion, but key labor achievements as well. Many of the labor laws that govern our lives and workplaces took root in the garment industry.

As a guest blogger for NCL and a longtime partner with the organization, I am excited to briefly share the fascinating history linking the garment industry and labor movements, some of the present-day issues in the industry, and even an opportunity to advocate for change this year.

The Industrial Revolution and the U.S. Fashion Industry

The industrial revolution gave rise to the fashion industry as we know it today, bringing innovation and affordable mass-produced items as well as widespread workplace labor abuses, sweatshop conditions, and pollution. In fact, the beginning of the U.S. industrial revolution is often cited as the opening of a textile mill in Pawtucket, Rhode Island, in 1793. During the Industrial Revolution we saw women, including recent immigrants, and children take jobs in textile mills to supplement family income. Many of these workers were exploited, toiling sometimes for 16 hours a day during high demand periods, for a subsistence income; all too often they were subject to wage theft.

But through this work, many women garment workers also achieved a measure of independence, leaving homes and families, and some used that newfound independence to join social activist movements and advocate for improved labor conditions. Female workers in Lowell, Massachusetts, for example, formed America’s first women’s union in the 1830s, which focused on maximum hours laws, including a 10 hour work day and higher wages, and they conducted one of the first major labor strikes in this nation’s history. Workers in New York’s sweatshops were victims of harassment, wage theft, and terrible conditions, and the International Ladies Garment Workers Union and Amalgamated Clothing Workers of America unions formed to demand labor reforms there in the early 1900s.

The Triangle Shirtwaist Factory Fire and Subsequent Labor Reforms 

Just as unions were gaining strength, the United States saw a devastating example of the incredible harms that can take place in the garment industry. Near closing time on March 25, 1911, the factory fire that broke out at the Triangle Shirtwaist Factory killed 146 workers, many of whom were immigrant women and girls. The building’s only fire escape building had collapsed during the rescue effort. Machinery and tables crushed workers, while locked doors trapped them, and there were only a few buckets of water to douse the flames. Firefighter ladders were too short to reach the 9th floor and safety nets ripped. The survivors from the 500-plus Triangle Shirtwaist Factory recounted the horrors they witnessed, including their fellow workers leaping to their deaths from the 9th floor rather than being burned alive. Some victims were as young as 14 years old.

In New York state, this tragedy prompted the transformation of the state’s labor and fire codes, thirty-six new state laws, and increased labor funding. The New Deal era under President Franklin Roosevelt saw adoption of similar legislation at the federal level nearly 20 years later with the support of some of these same reformers, like Frances Perkins who witnessed the Triangle Shirtwaist Factory fire herself and later became the Secretary of Labor under President Roosevelt. The Occupational Safety and Health Administration, country-wise fire and safety laws, and the Fair Labor Standards Act could be said to have arisen from laws enacted in New York after the Triangle Shirtwaist Factory fire.

Following the lead of women’s suffrage groups, and often in concert with women’s rights leaders, a number of trade unions formed to support the rights of garment workers. Roosevelt’s New Deal offered legal protection to unions, and through union gains and New Deal programs sweatshop conditions lessened and wages increased. However this brief period of reforms for workers in the US garment industry did not continue when the industry expanded and much of the industry moved abroad.

In addition to labor issues, the modern garment industry continues the environmental degradation that started during the industrial revolution. The industry today is playing a role in climate change and not on track to meet key climate goals and operate within planetary boundaries in its current form. Overproduction as well as over-purchasing are both extreme, and there are presently enough clothes on our planet to clothe six generations of people. Waste is often exported to other countries, hurting local economies and climates through waste colonialism. The industry continues to be powered by coal and uses toxic chemicals that are dangerous for workers, wearers, and our planet. Water usage is also highly problematic. For example, it takes over 2,000 liters of water to make just one t-shirt, around as much as one person drinks in three years. The water used in clothing creation, as well as clothing use, is often filled with microfibers that reach even the depths of our oceans and cause great harm to planetary ecosystems.

California Legislation

Sweatshops reemerged in the 1960s due to a range of forces in the U.S. and abroad: the changing retail industry, the growing global economy, increased contracting, and a large number of immigrant workers in the U.S. In the 1970s, manufacturers began outsourcing production to other countries to lower labor costs and employ a more compliant, non-union worker base. Despite increased consumption and a growing population, the number of U.S.-based garment workers dropped 37 percent, from 1.2 million in 1970 to 760,000 in 1995.

When sweatshops reemerged on U.S. soil they brought with them many horrific practices.  In California in the 1990s, the El Monte sweatshop, was subject to a raid that uncovered workers held behind fences surrounded by razor wire. These modern-day sweatshops exposed brutal conditions, with many tricked into accepting U.S. employment while living in other countries and once here being subject to debt bondage, threats of harm to them or their families, and violations of wage and hour codes. 

The 2021 California’s Garment Worker Protection Act (SB 62) enacted many statewide reforms for the industry in the state with the greatest number of garment workers. This landmark law aims to end wage theft and the payment of less than a minimum wage to garment workers by ending the piece rate of payment and creating liability for contractors for the full amount of unpaid wages and reimbursement of expenses, no matter how many layers of contracting are used. It also aims to enhance workplace safety by having garment workers no longer need to work at unsafe speeds to complete as many items as possible each day to reach a fair rate of pay.

The FABRIC Act

On the federal level, promising reforms include the first federal fashion industry bill, The Fashioning Accountability and Building Real Institution Change (FABRIC) Act, which was introduced in 2022 and will be reintroduced this September. A federal Lobby Day on September 12th is planned in partnership with national worker rights and sustainable fashion NGOs. The FABRIC Act follows in the footsteps of California’s SB62 by eliminating the piece rate and creating joint and several liability for violations of the law.  The FABRIC Act also creates a national garment manufacturing registry and incentivizes domestic production through a $40 million garment manufacturing grant program and reshoring tax credits. Anyone is welcome to be a part of the Lobby Day, and can sign up to volunteer here.

National Consumers League Live Event Ticketing Principles

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By John Breyault, Vice President, Public Policy, Telecommunications, and Fraud

The ticketing industry is the gatekeeper to much of our nation’s arts, sports and culture. What should be an exciting moment—securing a seat for your favorite event —has become exceedingly frustrating for many consumers as they navigate a confusing ticket-buying process laden with hidden fees.

NCL works on behalf of fans for all live events to ensure that consumers get the best possible experience, the best bargain for their hard earned dollars and don’t feel they’ve been ripped off with gotcha added costs, like mandatory “convenience fees” “processing fees” “venue fees” or the like when purchasing live event tickets.

Consumers are at the mercy of a rigged ticket marketplace. One company – Live Nation Entertainment (LNE) — dominates the marketplace. The company was created after Ticketmaster and Live Nation were given the green light to merge by the Department of Justice in 2009, despite strong consumer and business opposition.  LNE today controls around 80% of primary ticketing services, owns or has exclusive rights to operate many venues, and has major positions in artist management and event promotion. In 2022, LNE reported $4.5 billion in revenue from ticket resale, more than double what it earned in 2019, making it one of the largest players in the secondary ticket market.

Not surprisingly, LNE engages in practices typical of monopolies, working to drive out competitors. NCL and other consumer groups are leading the charge to unwind the ill-advised 2009 merger of Live Nation and Ticketmaster and restore healthy competition to the marketplace.

NCL believes that ticket resale has a legitimate place in the live event marketplace. The availability of ticket resale services provides a hedge for consumers who buy season tickets or non-refundable tickets, and is also a source for ticket buyers to get bargains when supply outpaces demand, allowing them to save money on below-face value tickets.

Below are some general principles on ticketing that NCL supports.

  1. We want the DOJ and Congress to unwind the Ticketmaster-Live Nation merger.
  2. Hidden ticket fees, deceptive dark patterns, and other anticompetitive ticketing practices should be prohibited. “All in” ticket pricing should be required so that consumers can compare prices from one site to another.
  3. Ticket holdbacks (also known as allocations) should be disclosed to ticket buyers prior to purchase.
  4. Secondary ticket exchanges should be required to disclose the face value of tickets offered for sale on their platforms.
  5. Ticket resellers should be prohibited from engaging in deceptive practices that are deliberately intended to confuse consumers into believing they are buying tickets from the primary seller. Deceptive design practices such as using URLs or other indicia of affiliation with a venue, team, or artist and by paying for search engine optimization that results in resale websites appearing higher in search results than the official box offices should be prohibited.
  6. Secondary ticket exchanges should be required to closely monitor their ticket inventory to ensure that they are not listing tickets obtained in violation of federal or state laws.
  7. All stakeholders in the live event industry should be required to assist enforcement agency’s efforts to stop illegal automated ticket buying and resale.
  8. Federal or state law enforcement agencies should investigate how tickets appear on the secondary ticket market at prices far above face value before offered for sale by primary ticket sellers and whether such sales violate applicable laws.

To these ends, NCL has endorsed legislative reforms to protect ticket buyers and promote competition in the live event industry, such as the BOSS and SWIFT Act and the TICKET Act.

What’s going on with student debt cancellation?

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By Eden Iscil, Public Policy Manager

A few weeks ago, the US Supreme Court ignored the facts of the case in front of them and wrongfully ruled that President Biden’s first attempt at cancelling student debt was illegal. While the Court was misguided and seemingly hellbent on making life worse for millions of Americans, debt cancellation is not dead. Earning much less media coverage than the Court’s ruling, President Biden announced on that same day that his Department of Education had initiated a plan B for debt cancellation. Additionally, he revealed a 12-month “on-ramp” to repayment. Here’s what we know so far about these two programs. 

Plan B for cancelling student debt 

Over the past 60 years, Congress passed two laws giving the secretary of education the authority to cancel student debts—the Supreme Court’s ruling last month only applied to one of them. While there is still one more legal avenue available for the Education Department to broadly cancel student debt, the law requires a lengthy regulatory process to get there. Specifically, the department must initiate a negotiated rulemaking, seeking input from various stakeholders involved in student debt. From nominating and appointing negotiators to reaching a final recommendation for the Department, this stage will likely finish around the end of the year. 

Next, the Department will have to publish a proposed rule outlining the parameters of the debt cancellation plan. Currently, the administration has not spoken to how much debt will be cancelled under plan B and who will be eligible beyond an intention to deliver “debt relief for as many borrowers as possible.” This means that we shouldn’t expect to see the details of plan B until early 2024. And once the Department publishes its proposal, there will be a 60-90 day comment period for the public to submit their thoughts on the plan. Only after this comment period is finished (and the Department has read the public’s thoughts) can the program go into effect. Once all of these steps are completed, it will likely be around springtime next year at the very earliest. 

A 12-month “on ramp” to repayment 

Congress set September 30 as the last day of the federal loan payment pause. Without some form of debt cancellation, it is estimated that repayment will put over 9 million borrowers into default. Recognizing this reality and its legal inability to extend the current payment pause thanks to Congress, the Department will waive certain repayment related penalties from October 1, 2023 through September 30, 2024. 

Specifically, during this year-long period, missing a monthly federal loan payment: 

  • Will not result in default or delinquency 
  • Will not be reported to credit bureaus 
  • And will not be referred to debt collection agencies 

While both plan B and the 12-month on ramp are imperfect, the Department is taking steps to minimize harm and is still working to deliver debt relief. It’s important that we continue to show our support for debt cancellation, especially during the public comment period. We should not tolerate an educational system that results in lifelong debt and average monthly payments of $500. 

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

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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

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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.

Financing the healthcare of tomorrow playlist: Tracks for consumers and policymakers

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By Robin Strongin, Health Policy Director

July 12, 2023

My husband has advanced Lewy Body Dementia and one of the few things we can still enjoy together is listening to music. We used to curate playlists for all kinds of music. We even put together playlists to mark special occasions (like our daughter’s wedding). Really, any topic became fair game for a playlist.

I was invited to speak at the Patients Rising Disrupting Healthcare Summit summer conference in Washington DC. My panel topic was Financing the Healthcare of Tomorrow. As I was preparing my presentation, I spoke with Michael Capaldi, Executive Director, the Institute for Gene Therapies. Mike is an expert on gene and cell therapies, and these therapies are definitely the healthcare of tomorrow, although thankfully, we are beginning to see the promise of these therapies today. When we talked about my presentation, he said, “you know, Robin, patients are really at a crossroads:  on the one hand, they are much more educated and empowered about their care, but some of the new therapies on the horizon are so complex, the cost and time commitments to innovate in these areas are so high, that groups like the National Consumers League [i]are in position to help patients and caregivers understand these complexities.”

And that’s when it hit me. A playlist. My colleague had me at Crossroads. If you’re a fan of delta blues, like my husband and me, then you know Robert Johnson and his classic, Crossroads.  The rest of my remarks rounded out my Financing the Healthcare of Tomorrow Playlist: Tracks for Consumers and Policymakers, which include:

Crossroads (Robert Johnson)—Robert Johnson’s haunting work reminds me of the difficult choices health policymakers have to make when it comes to healthcare financing—of course research and innovation are expensive—the diseases for which there are no cures, the conditions crying out for prevention, are complex and require decades of research, a deep understanding of basic science, and navigating an unpredictable regulatory path. Too many diseases and too few resources lead to heartbreaking trade-offs. Patients also have difficult choices to make when it comes to paying for their care. We shouldn’t have to be making deals with the devil—as Robert Johnson sings about in Crossroads. Instead, we need to reframe the questions we ask, review how we prioritize funding streams, and think creatively about financing mechanisms. Rather than question if society spends too much on healthcare, we should be asking how can we spend it more efficiently? How do we adequately incentivize all involved in funding transformational innovation? How do we make sure patients can afford and access the treatment they need?

I Am Woman (Helen Redding)—it gets really old but here we are, still talking about, and working on, closing the gender gap—in raising capital for venture funding for women-lead innovation teams; and in awarding grants to women lead research teams. Did you know, that according to the NIH Database monitoring NIH grants, grants awarded to women lead teams in 2022 numbered 19,028 and in the same year men won 31, 560 NIH grants? Progress yes, but not good enough. Not even close. Why is this important?  Because the teams with funding ask the research questions. The more diverse the research teams, the broader the array of diseases that are studied. More cures for more people.

Your Cheatin’ Heart (Hank Williams, Jr.)—I want to be careful and not paint all hospitals with the same brush but I would be remiss not to point out that too many hospitals are behaving badly: taking huge advantage of their nonprofit status, aggressively placing liens on patients who can’t afford their care, engaging in abusive debt collection activities, and worse, denying care; manipulating the 340B program designed 30 years ago to enable true safety-net providers to help low-income and other vulnerable patients access more affordable medicines and healthcare services. Some entities participating in the 340B program have taken advantage of the program’s current lack of clarity at the expense of the patients that the program is meant to serve.

Bad to the Bone (George Thorogood) – When it comes to taking advantage of our healthcare system, one major player in the drug pricing process might be considered “bad to the bone” – pharmacy benefit managers, or PBMs. PBMs continue to find ways to increase their profits while consumers are forced to pay high out-of-pocket costs for the prescription medicines they need. Although they were intended to help negotiate savings on medicines (which would be good), they are not passing along discounts to patients and are actually incentivized to steer patients to higher cost medicines – b-b-b-b-bad to the bone if you ask me!

Party Like It’s 1999 (Prince)—Shakespeare asked, What’s in a name? Fair question. Reminds me to also ask, what’s in a definition and when is it time to update it? How we defined value, quality (as in value of care, quality of care) and other terms in 1999, needs to be reevaluated on an ongoing basis. New innovations, insights, and understandings necessitate we revisit how we define, measure, and update the terms and metrics used to make decisions that affect healthcare financing. A great example comes from another colleague[ii]  who has co-authored and published compelling work on a “paradigm shift in managing high blood pressure.” He and his colleagues make the case that “Abandoning the view that hypertension is a disease in favor of regarding it as a cause of a disease and hence, adopting a population-based preventive approach would encourage the development of simpler guidelines.” Refreshed decades old thinking that could yield the elusive results the status quo has not achieved seems worthy of a party, like its 2023.

I Will Survive (Gloria Gaynor) and Stayin’ Alive (The Bee Gees)—Really, isn’t this what we are all trying to do?

A Change Is Gonna Come (Sam Cooke)—for patients like my husband, for our family, and for all the other patients and caregivers, change cannot come soon enough.  I pledge to do everything possible to advocate for meaningful change and help Patients Rising.

[i] I direct health policy for National Consumers League

[ii] Wald, Nicholas J., Wald, David S., Kellermann, Arthur L., “When Guidelines Cause Hypertension,” Commentary, The American Journal of Medicine, 2018, pp. 1402-4.

From class action to mass arbitration: Exposing corporate evasion in modern commerce

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Sally Greenberg

By Sally Greenberg, Chief Executive Officer

July 6, 2023: Several decades ago, clever lawyers for large corporations came up with a scheme to prevent their clients from being held accountable for wrongdoing. They did so by putting “forced arbitration clauses” in consumer and business contracts. The effect was to block consumers and others from getting access to the courts, and instead force them into arbitration, which is a private system for deciding legal cases that is controlled largely by the corporation itself.

It was a sad day for consumers when the Supreme Court gave its blessings to this underhanded scheme; today forced arbitration clauses are put into virtually every contract that we as consumers are forced to sign in exchange for services like cable, cell phone, credit cards, mobile homes, and car sales.

Class action lawsuits have served as a critical safeguard for consumers against powerful corporate interests; they remain an essential pillar of corporate accountability. These collective legal battles help to restore consumer rights and maintain marketplace ethics. Landmark cases such as the Enron scandal, which highlighted fraudulent accounting practices, class actions against the makers of addictive opioids and against those responsible for the Deepwater Horizon oil spill illustrate again the power of collective legal action.

But now, as consumers are fighting back and cleverly using forced arbitration in their favor, corporate America is crying foul. The very companies that championed forced arbitration and blocked class actions don’t much like it when they have a taste of their own medicine.

According to Consumer Reports, for example, a new strategy, mass arbitration, has already had a significant impact. It has pressured several corporate defendants—including Uber, DoorDash, Samsung, Chipotle, and DraftKings—to grapple with accusations they otherwise could have swatted away. And it reportedly led at least one corporate giant, Amazon, to remove mandatory arbitration provisions altogether from its retail website’s terms of use.

According to the magazine, a group of enterprising lawyers representing about 40,000 TurboTax customers employed a kind of legal jiujitsu: They simultaneously filed thousands of arbitration claims, swamping Intuit with fees, prompting the company into a hasty retreat. But it was too late for the company: Several judges have refused to let Intuit out of the arbitrations, with one commenting that the company has been “hoisted by [its] own petard.”

Sadly, the companies are nevertheless employing delaying tactics, exploiting loopholes, and resisting the system they once endorsed and in fact created, all of which points to the need for an overhaul of the system.

Recent arbitration reforms in California offer a glimmer of hope. They champion a justice system built on fairness, transparency, and accountability. Reforms must tackle forced arbitration clauses and corporations from exploiting system vulnerabilities and face strict penalties for stalling or refusing to engage with the system they created.

As consumers, employees, and members of society, we must insist on corporate transparency and accountability; giving consumers a fair shake is more important than ever. Only then can we end corporate evasion, restore balance in our dispute resolution processes, and protect individual consumer rights against corporate wrongdoing.

We must never forget the importance of vaccines

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Sally Greenberg

By Sally Greenberg, Chief Executive Officer

I have written before about being born into a family that experienced the agony of the polio epidemic. My uncle Roger Joseph’s battle with the disease—including his diagnosis in 1951 by my father, a practicing internist—devastated our entire family. My uncle, a golden boy, popular, handsome, brilliant, and kind, graduated from the University of Minnesota and Harvard Law School; he also won a silver star for his military service in WW2. Married with three daughters, he had a thriving law practice when he fell ill.

His case was severe and rendered him paralyzed. Confined to an Iron Lung for two years, the device was designed to stimulate breathing in patients whose lungs no longer functioned. With a great deal of therapy, my Uncle Roger, by then quadriplegic, moved to a motorized wheelchair that he ended up using for the rest of his life. He doted on his children, moved in with my grandmother, slept in a rocking bed to facilitate his breathing, and had an attendant on duty 24 hours a day. When we visited my grandmother, we visited our uncle too. He also came to our home for Sunday dinners, and I recall him taking breaths carefully before speaking, and when he did, he was wry and funny. He also had to learn to write again with his non-dominant hand. My mother, who had always idolized him, marveled at how his handwriting never changed.

My uncle lived 16 years with polio, thanks to a loving family, modern medicine, financial wherewithal, his wheelchair, and his attendant. Paralyzed from the neck down, he nonetheless spent these years productively, doting on his daughters, going to work every day, and attending baseball games, and even traveling abroad.

In 1954, U.S. physician Jonas Salk developed a vaccine to prevent the disease. The polio vaccine was first tested on 1.6 million children in Canada, Finland, and the United States before it was used more broadly. By 1957, annual cases had dropped from 58,000 to 5,600, and by 1961, only 161 cases remained. Had my uncle had access to the vaccine, he never would have gotten sick.

The powerful lessons about vaccines weren’t lost on anyone in my family. This explains why I feel obligated to confront head-on the dishonesty and lies of the anti-vaxxers. I have traveled to the CDC and the FDA numerous times to testify in support of childhood and adult vaccinations, and each time have been confronted by vaccine deniers.

Here’s the problem: Those of us with memories of family members with devastating diseases like polio are aging out. We are victims of our own success in wiping out childhood diseases. Younger generations have now been vaccinated for polio, measles, rubella, mumps, influenza, diphtheria, tetanus, and whooping cough so they do not know the trauma these illnesses caused to millions of families. Come to think of it, I’m in that category myself.

Florence Kelley, who in 1899 launched the National Consumers League, wrote in the 1880s about the dark days of “diphtheria”; she lost three young siblings to the disease, which sent her mother into lifelong depression. But I have never known anyone with diphtheria, thanks to vaccines.

My 27-year-old son never had measles—nor any of his friends. But my siblings and I all did, along with rubella, chicken pox, and the mumps. Measles alone is far more serious than often understood. In 2021 alone it killed nearly 128,000 unvaccinated children under age 5 around the world.

All of which leads me to the reason I have written this blog. Each year, Uncle Roger’s daughters proudly award the Roger E. Joseph Prize, (created by my Uncle Burton Joseph, in honor of his brother and their dad) and for this year’s prize, my cousin Linda produced a video; it tells a compelling story of her experience with her father’s illness. Hebrew Union College, which graduates reform rabbis, hosts the awards. Honorees have included Rosa Parks, Henry Louis Gates, Morris Dees, Sara Bloomfield, and the Center for Reproductive Rights. A complete list is at the link below.

Indeed, the Roger E. Joseph Prize is a point of immense pride for our family, but it also gives us the opportunity to talk about diseases like polio and, now Covid, and the critical importance of the vaccines developed to prevent them.

How truly fortunate we are to have a medical establishment that has helped to prevent families from suffering, the way ours did, when a loved one falls ill from an infectious disease.

As the anti-vaccine movement grows each year—a = movement that traffics in conspiracy theories and junk medicine—note Robert Kennedy Jr.’s anti-vaccine crusade, which his own family has denounced in this article published by Politico.

Now more than ever we need to have conversations about the critical importance of vaccines.

http://www.rogerejosephprize.org/about-the-prize

Nancy Glick

A message for National Minority Health Month: Take obesity seriously

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Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

As National Minority Health Month in April comes to a close, It is a good time to take stock of the health status of the more than 125 million Americans of color or 38.4 percent of the population now living in this country.

The good news is that improvements in disease prevention are saving lives. For example, more minority women are getting mammogram screenings for breast cancer, getting treatment with antibiotics earlier, and seeking counseling for smoking cessation.  As a consequence, Hispanic, American Indian, and Asian women all have lower death rates from heart disease when compared with white women and breast and lung cancer deaths have been declining steadily among African American women.

But while we can celebrate these advancements, now is the time to be even more mindful of the minority health problems that are often discounted and go untreated. And here, no problem needs our attention more than the disease of obesity, where people of color face an unequal burden of weight-related chronic conditions and premature death due to significant disparities in medical care.

In sheer numbers and its toll on death and disability, obesity has reached crisis proportions in the US. According to the Centers for Disease Control and Prevention, the adult obesity rate now exceeds 40 percent – the highest level ever recorded. And the costs are staggering.  Not only is obesity a serious disease by itself, but it worsens the outcomes of over 230 chronic conditions including type 2 diabetes, heart disease, and certain cancers. Thus, obesity is responsible for 300,000 premature deaths each year and costs the U.S. economy over $1.72 trillion annually in health costs.

But these statistics only begin to document the problem. Obesity disproportionately affects Black and Brown communities and is now one of the most serious health equity issues facing the nation. Due to higher rates of obesity among communities of color, Black adults are 1.5 times as likely to experience stroke, 40 percent are more likely to have high blood pressure and 60 percent are more likely to be diagnosed with diabetes than White adults. Additionally, Hispanics are 1.7 times more likely to have diabetes than Whites, Asian Americans are 40 percent more likely to be diagnosed with diabetes, and Native Hawaiians/Pacific Islanders are 2.5 times more likely to have diabetes and 3.9 times as likely to experience a stroke.

The threat is real, but hand ringing is not the answer. Obesity is a treatable disease, just like type 2 diabetes and hypertension. Yet obesity remains largely undertreated by healthcare providers.  As documented in a National Consumers League report issued in July 2022, 108 million adult Americans have obesity, but only 30 million adults have been diagnosed with the disease (source:  PharMetrics-Ambulatory EMR database, 2018. Novo Nordisk Inc.).

Compounding the problem, only 2 percent of those eligible for treatment with FDA-approved anti-obesity medicines (AOMs) have been prescribed these drugs. This means that very few Americans with obesity are benefiting from a new class of safe and effective medicines that control appetite and cravings to achieve significant weight loss. According to a study published in the New England Journal of Medicine, use of one of these drugs resulted in more than a 20 percent reduction in obesity when added to lifestyle modification.

While there are many reasons why obesity is going undiagnosed and untreated, the most pernicious are insurance barriers that keep people from getting the care they need. This includes government policy that allows states to define what are the essential health benefits that must be covered under any Affordable Care Act (ACA) marketplace plan sold on state health insurance exchanges. Yet, despite the ACA’s guarantees of providing all essential health benefits to consumers, a 2016 analysis by the Obesity Care Advocacy Network (OCAN) found that 24 states excluded coverage for weight/obesity management services in their benchmark marketplace plans, resulting in blatant discrimination against people with obesity.

An equally troubling situation involves the Medicare program, which prohibits coverage for FDA-approved anti-obesity medicines based on a policy dating back to 2003 when these drugs did not exist. This resistance to change leaves millions of seniors, particularly members of Black and Latino communities, vulnerable to disability, disease and premature death due to lack of treatment. Moreover, the extent of the disparities in obesity care will only get worse in the coming years if the status quo remains. As documented in a March 2023 report from AmerisourceBergen, the total number of Black, Native American, Asian, and Hispanics eligible for Medicare is predicted to more than double by 2038, many of whom will have obesity and a different set of chronic conditions than what Medicare is currently prepared to address.

Then, there is the Medicaid program operated by the states, which covers about three in ten Black, American Indian and Native Hawaiians/Pacific Islanders under age 65 and more than two in ten Hispanic adults. While Medicaid has helped narrow longstanding disparities in health coverage and access to care for people of color, this is not true for those Medicaid beneficiaries living with obesity. Today, only 15 Medicaid programs cover anti-obesity medications in fee-for-service Medicaid, and only four additional programs cover anti-obesity medications under at least one Medicaid managed-care plan. Moreover, only two states cover anti-obesity medications in benchmark Marketplace plans.

Adding to these coverage disparities, 15 million people on Medicaid – 30 percent of whom are Hispanics and 15 percent are African Americans  – could lose access to their health coverage in the coming months. This is due to the end of a federal program that paid states to add more low-income and disabled residents to the Medicaid rolls during the COVID-19 pandemic.

Already, five states – Arizona, Arkansas, Idaho, New Hampshire, and South Dakota – have begun to disenroll people and by the end of June, 34 states and the District of Columbia will cut their Medicaid rolls, either due to their income status or for procedural reasons, such as not completing renewal forms. For this reason, advocates are using all available levers to help enrollees keep their Medicaid coverage and to assist those dropped from the program to find coverage through the Affordable Care Act’s marketplace or other options.

While this is a short-term solution, it is part of the national commitment by the public health community, minority health leaders, clinicians, patient advocates, and consumer organizations to change outdated and discriminatory policies that restrict coverage and access to obesity treatments. Our message is clear: the health of all Americans depends on taking obesity seriously and ensuring that those with the disease receive timely, comprehensive obesity care.

Judge Kacsmaryk is poised to redefine the withdrawal method: FDA interuptus should alarm everyone

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By Robin Strongin, Health Policy Director

Bill Tompkins

Here we go, again.

Up until the Dobbs decision in 2022, Roe v Wade had been the law of the land since 1973.

Up until today, women didn’t have to worry that mifepristone, approved by FDA in 2000, would be available as a safe and effective and legal way to end an early pregnancy.

But, Texas Federal Judge Matthew Kacsmaryk, who has been vehemently anti-choice his entire life, is the judge who will decide whether to issue a preliminary injunction ordering FDA to withdraw its longstanding approval of mifepristone, the first pill in the two-drug medication abortion regimen.

Women, and their health providers, stand at a crossroads.  All women, not just those in Texas.

For some, it’s not enough that Roe was overturned in 2022.  Back in November 2022 the Alliance Defending Freedom, a conservative legal group, filed a lawsuit on behalf of antiabortion medical organizations and doctors.  At issue is the FDA’s approval of mifepristone, otherwise known as the medication abortion pill.  The plaintiffs, led by the Alliance for Hippocratic Medicine, have asked the judge to issue a preliminary injunction ordering the FDA to withdraw mifepristone.

Photo: Robyn Beck / AFP via Getty Images

This is unchartered territory.  The court is being asked, for the first time, to basically overturn the approval of a drug.  A drug that has been safely used for decades by over 5.6 million[i] women.  The drug regimen terminates pregnancies successfully 99.6% of the time, with a 0.4% risk of major complications, and an associated mortality rate of less than 0.001 percent (0.00064%).[ii]

This case, and several others that have been brought forward on medication abortion, raise questions about the role of the courts in reviewing the FDA’s findings about a particular drug.  This is chilling. Not only for the women who rely on this medication, but this case has the potential to set up an extremely alarming precedent for other FDA approved drugs.

And it’s dangerous territory for women and their health providers.  According to a court filing, FDA stated that overturning its approval of mifepristone would “cause significant harm, depriving patients of a safe and effective drug that has been on the market for more than two decades.”

Should Judge Kacsmaryk rule in favor of the plaintiffs, over half the abortions in the US could come to a halt—this includes abortions in states where abortion rights are (still) protected.  This case is expected to find its way to the Supreme Court—to the same justices who overturned Roe v Wade.

Through a coordinated strategy to take away women’s reproductive rights, advancing abortion bans—at the federal level, at the state level, and through the courts, results in confusion, fear, and poor health outcomes.

Fortunately, experts seem to agree that if the worst were to happen, and the preliminary injunction is granted (and remain in place following the inevitable appeals), there are several options that could allow for the continuing supply of the drug and for providers to continue prescribing.

For example, some abortion providers are planning to provide only the second abortion medication, misoprostol, which is used safely on its own in many countries, though it does have more side effects than mifepristone.

Earlier this week, Governor Gavin Newsom (D-Calif) announced that California state government would no long do business with Walgreens because of their decision that it won’t sell mifepristone in states where Republicans have threatened legal action, even in those states where abortion remians legal.

All of this is happening during Women’s History Month.  But, knowledge is power. According to the Guttmacher Institute, a leading research and policy organization committed to advancing sexual and reproductive health and rights worldwide,  “Since its approval, medication abortion has been used over four million times and has become so widely accepted by patients and providers that it now accounts for more than half of all US abortions—492,210 of the 930,160 abortions (53%) provided in 2020 were done with abortion pills.”

According to the Guttmacher researchers, the impact of eliminating access to medication abortion would differ greatly state to state, but could be especially promounced in rural counties and regions of any state….These 10 states could experience the most severe impact:

Colorado, Georgia, Indiana, Iowa, Maine, Montana, New Mexico, Pennsylvania,Vermontand Washington.

Guttmacher created an interactive map, capturing abortion-related policies and data, categorizing states from the most restrictive to the most protective.

On the map, viewers can also see demographic information and key abortion statistics. The data for women of reproductive age* in each state include:

  • Age-groups and race/ethnicity
  • Proportion living below 200% of the federal poverty level
  • Types of health insurance used
  • Proportion born outside the United State

Abortion-related statistics for each state include:

  • Number and rate of abortions provided
  • Number of clinics that provide abortions
  • Average driving distance to the nearest abortion clinic

The new interactive map is available here.

*The use of “women” to refer to the population of people potentially impacted by abortion policies reflects the terminology in the US census, from which many of our data points are drawn. We recognize that gender identities are diverse and not everyone who needs an abortion may identify as a woman. We reflect that reality in our language where we can, while also accurately describing the underlying data.

[i] Mifepristone US Post-Marketing Adverse Events Summary through 6/30/2022; TTT #2022-2468.  NDA 020687.  ANDA 091178. www.fda.gov

[ii] Mifepristone US Post-Marketing Adverse Events Summary through 12/31/2018; RCM #2007-525.  NDA 20-687.  www.fda.gov