THE ROOSEVELT REVIEW

OF THE ROOSEVELT INSTITUTE AT

COLUMBIA UNIVERSITY
TABLE OF CONTENTS
Democratic Access
8 Prisoner Voting Rights in New York
By Tanisha Aggarwal
10 Increasing Accountability in the House of Representatives by Limiting Fundraising
By Emma Cloyd
12 Local Office, Local Money
By Marion Gibson

Economic Development
16 Targeting Opioid Addiction Where it Begins: The Behavioral Economics of Prescription
By Stephanie Grove
18 Community-Targeted Solutions to Food Deserts in NYC: Strengthening the Healthy Bodegas Initiative
By Ji-Hoon Ko

Education
22 Recess: More Then Just Fun
By Emma Cloyd
24 Federally Funded, Locally Distributed Fully Universal Pre-K
By Carolyn Kelly
26 Providing Better Support for Columbia College & Engineering Students: Guaranteed Housing and Tak-
ing a Leave of Absence
By Shirley Tan

Energy and the Environment
30 Climate Change and the Grid: Addressing Texas’ Utility Grid Vulnerabilities
By Ricardo Jaramillo
32 Decarbonize to Demilitarize Local Law Enforcement Agencies
By Morgan Margulies
34 Give Them Some Space: Banning the Intense Confinement of Animals in American Food Production
By Arianna Menzelos
36 Redirecting RGGI: Increasing Energy Efficiency in the Granite State
By Eric Scheuch

Foreign Policy
40 Reducing Maritime Transportation Pollution: A Template For International Collaboration on Sectoral
Emissions Reduction?
By Connor Haseley

Healthcare
44 Decriminalizing Overdoses: Saving Lives by Protecting the Rights of Parolees
By Francesca Barasch and Augusta Owens
46 Medi-Cal and Work Requirements
By Juliet Emerson-Colvin
 Roosevelt Review
48 Expanding Access to Life-Saving Hepatitis C Treatment: Removing Discriminatory Sobriety Restrictions
By Sinead Hunt
50 Protecting Healthcare Access in the Age of Trump: A Proposal for a State-Based Individual Mandate in
New York
By Sinead Hunt
52 Amending the Federal Controlled Substances Act: Fostering Public Health Innovation at the Local Level
By Sinead Hunt
54 Parity Delayed is Parity Denied
By Alex Siegel

Human Rights
58 Marriage for All: Repealing the Same-Sex Marriage Act in Nigeria
By Dotun Adegbite
60 Homemakers: Creating a Guaranteed Right to Housing Counsel
By Justin Holiman

Technology
64 Electronic IDs: Physical Protection for Metaphysical Data
By Emma Cloyd
66 Governing CRISPR: Effectively Regulating Gene-Editing Technologies
By Meredith Harris
68 Tackling Interoperability of Health Information Technology
By Sarah Lubin
70 China’s Great Firewall as an Economic Threat
By Christopher Philogene
 Letter from the Editor
Dear Reader,

Welcome to the 11th annual edition of the Roosevelt Review published by the Columbia University Chapter of the
Roosevelt Institute! I am excited that you have found our journal. Whether you are a perspective member, Roosevelt alum,
parent, or professor, I am sure that you will find our proposals to take an innovative approach to some of our generations
most pressing issues. This year, our journal includes 25 policy proposals all written by members of the Columbia University
Undergraduate community. Our authors — and by extension all members of the Roosevelt community — come from a
wide range of backgrounds, from political science majors to engineers, but all come together behind the same goal: gener-
ating progressive solutions to the issues that matter most to them.

While Columbia has many political organizations campus, the Roosevelt Institute is unique by focusing on the
tangible solutions, rather than the theoretical conversations. While there are many topics that require extensive discussion
in our community, the Roosevelt Institute is dedicated to discussing the feasible next steps to improve outcomes on the
school, city, state, country, and global level. Since it’s inception, the Roosevelt Institute has had weekly discussions in which
students are able to take a multi stakeholder approach to developing policy changes, exposing them to the perspectives of
others and how said views and biases are developed as a result of personal backgrounds. While the Roosevelt Institute is
a non-partisan organization, our discussions always focus on progressive policies with the aim of developing a society in
which all individuals are treated equally.

In addition to our weekly meetings, the Roosevelt Institute runs eight policy centers, which act as a framework
to address problems within our community. As a result of the ever changing political landscape, this year the Roosevelt
Institute introduced a Technology Center to discuss the intersection between tech and policy. This year, our Human Rights
center ran a successful campaign against Aramark Dining services on Barnard’s campus. Our Energy and Environment
center wrapped up their carbon neutrality campaign with Columbia committing to ad- dressing the issue in their 2020 sus-
tainability plan. Our Economic Development and Education centers presented a proposal to the Barnard Student Govern-
ment Association asking for the creation of an Advisory Committee on Socially Responsible Investing and are preparing
for a meeting with the Board of Trustees.

Serving as the Editor-in-Chief of the Roosevelt Review has been a great privilege, and the perfect way to wrap up
four years on the board of this organization. Seeing the way that our group has evolved in response to the increased attacks
on human dignity in our country and beyond, and the passion with which members address the issues that matter most to
them has made me truly thankful to call this organization my home for the past four years.

To the writers, center directors, and initiative organizers, thank you for your help making this journal a reality. To
the executive board, it has been an honor to serve with you, whether you have been by my side since I joined Roosevelt the
first week of freshman year or entered my life a few months ago. To Connor, my life-saving Deputy Editor, thank you for
your relentless line editing, we are all better writers for it. And to the Future of Roosevelt… may the odds be ever in your
favor.

With gratitude,

Emma Cloyd
Editor-in-Chief of the Roosevelt Review

4
 Roosevelt Review

MASTHEAD
The Executive Board

President - Ricardo Jaramillo

Vice President - Sarah Lubin
Journal Editor - Emma Cloyd
Deputy Journal Editor - Connor Haseley
Outreach Director - Justin Holliman
Treasurer - Lindsay Meyerson
Secretary - Shirley Tan

Center Directors

Democratic Access - Marion Gibson

Economic Development - Cameron Davis
Education - Carolyn Kelly
Energy and the Environment - Arianna Menzelos
Foreign Policy - Meher Malik
Healthcare - Sinead Hunt
Human Rights - Maeve Flaherty
Technology - Christopher Philogene

Initiative Organizers
Economic Development - Stephanie Grove
Energy and the Environment - Meredith Harris
Human Rights - Ji Hoon Ko

5
6
 Roosevelt Review

Democratic Access
This year, the Democratic Access center partnered with several other organizations on
campus to create an iniative called CU Votes, aimed at increasing voter registration
and particpation across Columbia’s campus.

In May of 2019, CU Votes was recognized as it’s own entity, allowing the Democratic
Access center focus it’s efforts beyond the Columbia campus in the upcoming academ-
ic year while continuing a strong working relationship with the iniative.

-- Marion Gibson, Center Director

7
 Prisoner Voting Rights in New York
By Tanisha Aggarwal
Introduction
Ex-felons should be able to vote,
yes. But so should prisoners them-
selves. On April 18, 2018, Governor
Andrew M. Cuomo signed an ex-
ecutive order restoring the right of
prisoners to vote immediately after
release for most New Yorkers who
are on parole following felony incar-
ceration. Moving forward, the Gov-
ernor’s office will individually review
cases of inmates who are released to
community supervision in New York
and will issue a partial executive
pardon that restores each approved
person’s ability to register and vote.
On May 22, 2018, the Governor
issued the first set of 24,086 con-
ditional pardons, restoring voting
rights to more than two-thirds of the
New Yorkers currently on parole.
However voting rights can still be
revoked if a person is re-incarcerat-
ed either due to a violation of parole
or a new conviction, a condition
known as recidivism. [1] Reinstating
voting rights after release simply
isn’t enough.
Background
The government necessarily cannot
expect ex-convicts to once again
use these rights after however many
years of social exile. In fact, many
ex-felons don’t ever realize their
rights have been reinstated upon re-
lease. Felony disenfranchisement has
important implications during key
elections. Florida holds the special
title of the nation’s capital for dis-
enfranchisement. The state stripped
over 1.5 million people of their vot-
ing rights due to a criminal record,
that is, 10% of all adult Floridians.
In comparison, in 2008, Barack
8
Obama took the state with less than
250,000 voters over his rival John
McCain while George Bush won
the state – and hence the presi-
dency – with just 573 votes over Al
Gore in 2000. Florida is one of the
most contested states in presidential
elections and the fact that African
Americans tend to vote democratic
has long presented a political motive
behind felony disenfranchisement
and criminalization of black folks
in southern states. Almost 8% of
adult African Americans are ineligi-
ble to vote because of convictions,
compared to 1.8% of the rest of the
adult population. Florida’s lifetime
ban on voting rights for felons was
finally lifted on November 16th
2018. [2]
New York’s decision in fact, is in line
with a larger recent trend towards
felony enfranchisement. Between
1996 and 2008 twenty-eight states
changed their laws on felon vot-
ing rights, mainly to restore rights
post-incarceration or to simplify the
process of restoration. Additionally,
Maine and Vermont are two states
that already allow prisoners to vote
via absentee ballots.
Prisoner voting rights has strong
legal precedent nationally and
internationally. The main argument
for felony disenfranchisement rests
on the outdated and draconian
notion of “Civic Death.” Civic
Death refers to the loss of all or
most civil rights by a person due to
reasons that include the conviction
of a felony. This is a notion that has
been on the decline. As Justice Earl
Warren wrote in the 1958 case Trop
v. Dulles: “Citizenship is not a right
that expires upon misbehavior.” The
supreme court importantly decided
that prisoners cannot have their citi-
zenship stripped as punishment for a
crime. Subjecting prisoners to a type
of “social death” runs antithetical to
the goals of successful rehabilitation.
As things stand, prisoners already
retain certain civil rights such as the
freedom to worship, organize, pro-
test, and to some extent, free speech
(such as writing for newspapers and
magazines). Thus, voting would
simply be an extension of these
existing freedoms. Furthermore,
contrary to popular belief, Section 2
of the Fourteenth Amendment does
not endorse the disenfranchisement
of convicted criminals, it simply
does not prohibit the practice. It is
currently up to the states themselves
to decide which crimes, if any, could
be grounds for disenfranchisement.
In the global context, in Hirst v
United Kingdom (No 2) the Court
in 2005 ruled that automatic disen-
franchisement resulting from con-
victions to be against human rights.
This ruling applied equally for
prisoners and for ex-convicts. [3].
Moreover, many countries such as
Canada, Croatia, Czech Republic,
Denmark, Finland, France, Germa-
ny, Israel, Kenya, Netherlands, Nor-
way, Peru, Poland, Romania, Serbia,
Sweden, and Zimbabwe already
allow their inmates to vote.
Recommended Action
New York must take advantage of
the momentum set by Governor
Andrew Cuomo and work towards
introducing a bill that restores vot-

ing rights to prisoners while they are
in prison, heeding the model set by
Vermont and Maine. This would re-
store voting rights to the over 51,000
citizens currently behind bars in the
New York state.
Argument 1: The prison popula-
tion in the U.S. has been on an ex-
ponential rise over the past 40 years
and criminal justice reform has been
moving to the forefront of party
platforms. Felony disenfranchise-
ment barred 1.17 million citizens
from voting in 1976 and 6.1 million
in 2016, including 3 million who
have already served their sentences
yet are still denied their constitu-
tional rights. [4] If not reversed,
this trend will only create an ever
increasing constituency of 2nd class
citizens in the United States. It is in
the nation’s best interests to allow
those affected by the criminal justice
system to represent themselves and
take part in national political dis-
course to amend the system. Under
our current justice system, ending
abuses in prisons requires years of
costly litigation as prisoners sue for
maltreatment and prisons adjust to
the rulings accordingly. Allowing
prisoners to vote would benefit pris-
ons by streamlining the process of
creating a political constituency of
prison voters who are well equipped
with the knowledge and expertise
through their personal experiences
to vote on and inform policies that
can improve our criminal justice sys-
tem. Prisoner voting rights ties into
the larger issue of mass incarcera-
tion – a prison population constit-
uency is a prerequisite to voting on
policies and bringing more national
awareness to the issues of over-im-
prisonment.
Argument 2: Even though the
vast majority of states prisoners
cannot vote, they are often counted
in the population for the legislative
district of their prison, influencing
the state’s number of representa-
tives and its presidential electoral
votes. This current practice bears
an uncanny resemblance to the
notorious 3/5ths compromise that
was rendered obsolete by the 13th
amendment.
Argument 3: Allowing prisoners
to vote has a rehabilitative function.
Suffrage in prison allows incarcerat-
ed individuals to maintain valuable
links to their communities, which
can help ease the process of re-entry
into society after imprisonment. [5]
Denying prisoners the right to vote
is likely to undermine their respect
for the law, as citizens who cannot
participate in democratic processes
will be less inclined to recognize
their authority. Allowing them to
vote would strengthen social ties
and instill a sense of civic duty and
legal responsibility in civil society.
[6] Furthermore, felony disenfran-
chisement goes beyond prison walls,
it also has a tendency to depress
political participation among friends,
families, and communities of incar-
cerated individuals. At the Maine
State Prison in Warren and in other
correctional facilities, the NAACP
has been holding voter education
and registration drives for the past
10 years. Inmate political engage-
ment has been on a rise: in 2016
about 400 inmates participated. One
of the voters was Doug Burr, an in-
mate serving a 60-year sentence for
murder. He had been following the
presidential election pretty closely,
“I look at it like, OK, it could affect
my family, could affect people I care
about. So I show interest in it, I get
involved. I read a lot. I watch the
news so I try to stay up, as much as
possible, anyways.” [7]
Roosevelt Review
Argument 4: One common argu-
ment is that those who are convict-
ed of electoral offenses should be
barred from voting to maintain the
integrity of the democratic process,
but since over 99% of incarcerated
persons have not been convicted of
such an offense this would have an
insignificant impact, if any, on the
composition of the electorate. [8]
Argument 5: Finally, allowing
prisoners to vote is not only polit-
ically expedient, but economically
responsible. Citizens who have their
eligibility to vote restored are far less
likely to reoffend and re-enter the
criminal justice system, according
to recent studies by the Office of
Offender Review and the Florida
Parole Commission. [9] As recidi-
vism rates are lowered, New York
taxpayers would pay less for prison
and court costs. According to a 2014
report released by the state Depart-
ment of Corrections and Communi-
ty Supervision: of the 24,605 former
inmates who were tracked over three
years, 42% of parolees were taken
back into custody, 32% for violating
parole terms and 9% for committing
a new felony. [10]
In fact, Andrew Cuomo’s Executive
Order No. 181 already recognizes
many of the arguments put forth
above.
Conclusion
Given the precedent and Governor
Cuomo’s Executive Order, now is
the time to pass legislation ensuring
that prisoners have voting rights.
Expanding voting rights treats
prisoners justly and allows for the
state to have a more representative
democracy.
References
At end.
9
 Increasing Accountability in the House of
Representatives by Limiting Fundraising
By Emma Cloyd
Introduction
Unlike candidates challenging an
incumbent or running for an open
seat, incumbents in the House of
Representatives cannot take time
off for their campaign as they are
elected to do a job for a two year
period, at the end of which voters
can decide how they fared. Despite
this duty, many incumbents fund-
raise extensively throughout their
term, diverting their time from the
legislative process.
Background
In 2016, $1,049,773,181 were
spent on House Campaigns, [1]
the average “cost” of winning a
seat was over $1.5 million, [2]with
the average incumbent raising
$1,590,607, challengers averaging
$231,727, and candidates run-
ning for an open seat averaging
$636,381. [3] From election day
to election day, a representative
must raise $2,054.79 a day, which
equates to nearly one maximum
donation ($2,700) from an individu-
al as defined by the Federal Elec-
tion Commission (FEC). The time
and mental capacity incumbents
must dedicate towards raising such
a large sum of money detracts from
other work they could be doing.
The burden fundraising places on
members of the House interferes
with legislative duties of representa-
tives. In 2017, the Huffington Post
uncovered a PowerPoint presenta-
tion the Democratic Congressional
Campaign Committee (DCCC)
gave to incoming representatives
10
which included a breakdown of
how members were expected to
spend their days. [4] Of the nine
to ten hours they allocated for, only
three to four of hours were recom-
mended for the activities people
often think of as being the primary
responsibilities of representatives:
constituent visits and spending
time on the floor or at committee
meetings. [5] Of the remaining
time, four hours were expected to
go towards fundraising, one for
meet and greets and press events,
and one hour of recharge time. [6]
Both the Democratic and Repub-
lican parties have call centers, lo-
cated a few blocks from the Capitol
that members go to for their call
time. [7] At the National Repub-
lican Congressional Committee
(NRCC), there are rows of small
offices with a phone and computer
where members can use provided
they pay their dues, which is the
money they raise for the party in
addition to themselves. [8]
Recommended Action
Considering the exorbitant amount
of time required to to complete
such fundraising, it is imperative
that measures are taken to ensure
that members of the House of
Representatives do the job they
were elected to do: serve the public.
To effectively devise and implement
a policy to address the issue of
reelection campaign fundraising,
the following two criteria will be
considered when analyzing policy
proposals:
A restriction on the amount of
time incumbents can spend fund-
raising to ensure that it is not their
priority in office
An increase to the amount of time
spent meeting with constituents
and working on legislation
One policy alternative that has
been used in other countries is a
shortened election cycle. In Can-
ada, there is no official length of
the election cycle but it begins
when parliament is dissolved and
must last at least 36 days until the
next general election, [9] France’s
National Assembly has a 20 day
election period, Australia who has
a six week election period, and
Israel who has a 101 day period.
[10] While these are dramatically
shorter than the House’s current
two year long election period,
instituting a one year election cycle
where all candidates whether they
are incumbents, challengers, or
running for an open seat can only
announce their candidacy, adver-
tise their platforms, and solicit and
accept for 365 days before the elec-
tion date would allow legislators to
able to spend more time legislating
and meeting with constituents with
the express purpose of improving
their district and country, rather
than vying for reelection.
Less time would go into fundrais-
ing as a result of it being illegal for
the first year of the two year term.
While the overall impact of forcing
a member of the House to spend
more time doing the job they were

elected to do is unknown, it is
reasonable to assume that it would
give incumbents increased oppor-
tunities to meet with constituents
and create legislation. A potential
consequence of this policy is that
members may try to circumvent
its intentions to minimize the
amount of time spent fundraising
and increase their efforts during
the year it is allowed. Additionally,
this policy would create additional
work for the FEC to ensure that
under the table campaigning is not
happening. Ultimately, this may
be hard to regulate as candidates
could get individuals to commit
to making contributions once
allowed, but the added difficulty
would at least reduce the time
spent fundraising for one year of
the election cycle.
Conclusion
Operating within the institution
of Congress, representatives have
a strong influence which may be
stifled by party leadership who
depend on their fundraising. The
FEC’s influence would be strong
because they are the experts in this
campaign finance, but not strong
enough to counteract represen-
tatives since they amend FECA.
A portion of the representatives
would be in favor of this given the
complaints about the fundraising
expectations. [11] Representatives
who are not strong fundraisers
would strongly support the policy
because it would increase their
chances of receiving a better
committee position. [12] NGOs
would favor this policy because
legislators would spend more time
legislating, rather than soliciting
contributions. The public would
support this policy as 60% find the
constant election coverage to be
exhausting. [13]
The FEC would oppose shortening
the election cycle because it would
increase regulations to ensure that
illegal is not happening. Parties
would strongly oppose this policy
because it would hurt their fund-
raising plan regardless because they
would not be able to fundraise one
year of the election cycle.
Considering the bipartisanism, the
most important part of the passage
would be minimizing the impact of
parties. Introducing legislation early
in a cycle before campaigning is
in full swing but after party assign-
ments have been made to minimize
party impact would be key. In order
to push through legislation with
strong congressional support, they
could also add it to the budget to
overpower other stakeholders.
References
1. “24-Month Financial Activity of
House Candidates (2002-2016),”
Federal Election Commission,
April 7, 2017, , accessed Septem-
ber 23, 2018, https://transition.
fec.gov/press/summaries/2016/
tables/congressional/ConCan-
d3_2016_24m.pdf.
2. “Table 2-1: The Cost of Win-
ning an Election, 1986-2016.”
Campaign Finance Institute.
Accessed September 23, 2018.
http://www.cfinst.org/pdf/feder-
al/2016Report/pdf/CFI_Feder-
al-CF_16_Table2-01.pdf.
3. “Incumbent Advantage.” Open-
Secrets.org. Accessed September
23, 2018. https://www.opensecrets.
org/overview/incumbs.php?cy-
cle=2016.
4. Grim, Ryan, and Sabrina Sid-
diqui. “Call Time For Congress
Shows How Fundraising Dom-
inates Bleak Work Life.” The
Huffington Post. December 07,
2017. Accessed September 23,
2018. https://www.huffingtonpost.
Roosevelt Review
com/2013/01/08/call-time-con-
gressional-fundraising_n_2427291.
html.
5. Ibid.
6. Ibid.
7. “Are Members of Congress
Becoming Telemarketers?” CBS
News. Accessed September 23,
2018. https://www.cbsnews.
com/news/60-minutes-are-mem-
bers-of-congress-becoming-tele-
marketers/.
8. Ibid.
9. Kurtzleben, Danielle. “Cana-
da Reminds Us That American
Elections Are Much Longer.”
NPR, NPR, 21 Oct. 2015, www.
npr.org/sections/itsallpoli-
tics/2015/10/21/450238156/
canadas-11-week-campaign-re-
minds-us-that-american-elections-
are-much-longer.
10. Atwill, Nicole. “Campaign
Finance: Comparative Summary.”
11. Campaign Finance: Compar-
ative Summary | Law Library of
Congress, 1 Apr. 2009, www.loc.
gov/law/help/campaign-finance/
comparative-summary.php#dura-
tion.
12. Hulse, Carl. “Steve Israel of
New York, a Top House Dem-
ocrat, Won’t Seek Re-election.”
The New York Times. December
21, 2017. Accessed September
23, 2018. https://www.nytimes.
com/2016/01/06/us/politics/
steve-israel-house-democrat-new-
york.html.
13. Friedman, Uri. “American Elec-
tions: How Long Is Too Long?”
The Atlantic. October 06, 2016.
Accessed November 07, 2018.
https://www.theatlantic.com/
international/archive/2016/10/us-
election-longest-world/501680/.
11
 Local Office, Local Money
By Marion Gibson
Introduction
For the most part, American politi-
cal campaigns are privately funded.
This forces political candidates
to independently raise funds, and
fundraising often takes up a signif-
icant proportion of their time in
office. Politicians focus their energy
on meeting donors rather than lis-
tening to their constituents. Mean-
while, income inequality is rising
in the United States, which allows
individuals who are already more
economically powerful to have
greater say in the political process.
Background
San Francisco is the most unequal
city in California , largely due to
the growth of the technology in-
dustry. [1] Silicon Valley technolo-
gy giants funnel money into tech-
nology-friendly political candidates,
who may in turn worsen inequality
by failing to adequately regulate the
tech industry. [2] While San Fran-
cisco boasts a robust public-financ-
ing program, this program does not
adequately encourage small-dollar
donations. A mayoral candidate
must raise $50,000 in donations
ranging from $10 to $100 from
San Francisco residents to apply for
public financing. The threshold is
higher for incumbents to account
for incumbent advantage. [3]
Not all of the donations received
for a specific candidate need to be
from San Francisco residents. San
Francisco matches all funds raised
as long as the threshold for San
Francisco residents is reached, not
just those funds raised from San
Francisco residents and not just
those funds raised by small-dollar
12
donations. This means that can- but San Francisco should raise the
didates can still primarily rely on matching ration to 6-1 ratio rather
larger donations from Silicon Val- than a 2-1 ratio. This amplifies the
ley residents while participating in power of small dollar donations
the public financing program. The and encourages candidates to seek
public financing program should out those donations rather than
only be available to candidates who larger ones.
are fully accountable to the resi-
dents of San Francisco. Conclusion
San Francisco must reform its pub-
Recommended Action lic financing program to better in-
San Francisco is not the only city to centivize small dollar donations and
institute city-level campaign finance soften the influence of Silicon Val-
laws. New York City matches the ley in city politics. By implementing
first $175 donated to a candidate a more stringent publicly-funded
by a New York City resident a a six- campaign finance program mirror-
to-one ratio if the candidate agrees ing New York City’s, political can-
to tougher disclosure and spending didates in San Francisco can focus
caps. Candidates must demonstrate on the needs of city residents rather
broad support to be eligible. Under than the desires of billionaires from
this system, it is better for a cam- outside of the city proper. This can
paign to raise $175 from a New be done through simple alterations
York resident than $1000 from in the current program, such as
a Connecticut resident. [4] This only matching donations under $50
policy has worked well in New York rather than a grand total raised
City, which is also home to extreme and by limiting all donations to San
wealth both within the city proper Francisco residents.
and in the surrounding region. Campaign finance reforms are
A New York-style public financing needed throughout United States.
program would be more effective at Cities can take the lead, experi-
encouraging local donations in San menting with innovative public
Francisco because it only matches financing programs that can later
small dollar donations from the city. be implemented on the state and/
Certain aspects of the New York or federal level.
City public financing program can
be applied to San Francisco’s to References
make it more equitable. The San 1. Frederick, Kuo. “San Fran-
Francisco requirements need to cisco Has Become One Huge
be altered to explicitly forbid any Metaphor for Economic In-
contributions from residents outside equality in America.” Quartz,
of the San Francisco city proper in June 21, 2016. https://
order to receive public financing. qz.com/711854/the-inequali-
The program should keep the same ty-happening-now-in-san-francis-
donation value match to donations co-will-impact-america-for-genera-
under $100 as it currently has, tions-to-come/.
 Roosevelt Review
2. Robinson, Melia. “The Tech 1
Millionaire Moguls Most Involved
in San Francisco Politics.” Business
Insider, June 5, 2018.
3. “Public Financing Program –
San Francisco Ethics Commission.”
Accessed April 22, 2019. https://
sfethics.org/compliance/cam-
paigns/candidates/public-financ-
ing-program.
4. “How It Works | New York
City Campaign Finance Board.”
Accessed April 22, 2019. https://
www.nyccfb.info/program/how-it-
works/.
“The San Francisco requirements
need to be altered to explicitly for-
bid any contributions from resi-
dents outside of the San Francisco
city proper in order to receive public
financing.”

13
14
 Roosevelt Review

Economic Development
This year in the Economic Development center partnered with the Education Center to
establish an Advisory Committee on Socially Responsible Investing (ACSRI) at Barnard
College. The primary goal of the campaign was to increase transparency and account-
ability with Barnard’s investments moving forward. The centers successfully presented
before the Barnard Student Government Association (SGA) and will be meeting with
the Board of Trustees in the near future.

Economic Development center at the Roosevelt Institute has always been committed to
discussing the economic issues that are not always at the forefront of economic debates
and the center was proud to continue these endeavours this year.

-- Cameron Davis, Center Director

15
 Targeting Opioid Addiction Where it
Begins: The Behavioral Economics of
Prescription
By Stephanie Grove
Introduction
Behavioral economic theory pro-
vides a good explanation for the
overprescription of opiods through-
out the United States. Currently, in
many states, opiods are the default
option for extreme pain response,
leading to over presctiption, over-
use, and addiction.
Background
Like other places in the country,
Michigan has a huge Opioid prob-
lem, ranked 14th highest state in
the country. A new law went into
effect March 28 that provides the
option for patients to pre-emptively
tell their doctors that they don’t
want to be prescribed opioids, and
would like to be proscribed alter-
native pain medications. It intends
to strike a conversation between
doctors and patients, and to change
the default option for patients that
are unconscious. The lack of a
central database for these advance
directives, prevents a new medical
provider to the patient from access-
ing the patient’s advance directives
filed with previous providers.
While this law provides a poten-
tially-effective way for patients to
preemptively dissent prescription
of opioids, it 1) doesn’t adequately
protect the patient’s freedom to
prevent prescription and potentially
unconscious administration of the
addictive drugs. And 2)
Even if it were successful in accom-
plishing its aim, it would do little to
16
address the issue that 1) people are
not educated on this. And 2) opi-
oids are the default option. Policy
should consider how the default
options and education are import-
ant in the protection of the right to
freedom from addiction.
Recommended Action
In order to adequately address the
opioid crisis, the State of Michigan
should enact a law setting non-opi-
oids as the default option for medi-
cal conditions related to lower-level
pain and pain caused primarily by
swelling, with the option of switch-
ing to opioids.
Roy Soto, M.D., President of
Michigan Society of Anesthesiolo-
gists supports the idea that non-opi-
oid painkillers are, in many cases,
viable alternatives [1]. Some alter-
natives include anti-inflammatory
drugs to reduce swelling as well as
targeted numbing [2].
Economist Richard Thaler (hails
from Columbia) is big on this.
Behavioral economics studies the
way that “nudges,” or policies that
inform the outcome of a decision
without restricting or determining
it, make people more or less free.
Changing the “default option” or
“top choice in a list” have been
shown to drastically influence a
person’s choice of medical services
or medical providers.
This behavioral economic theo-
ry supports the assumption that
changing the default-option will
result in the reduction of pre-
scription of opioids. Reduction of
prescription of opioids is expected
to reduce the frequency of addition
in two major ways, both relating to
the fact that prescribed pain-kill-
ers are the most common gateway
drug to opioid addiction. Firstly,
if fewer patients being treated for
pain are prescribed opioids, their
chance of becoming addicted to
opioids will be reduced. Secondly,
if doctors prescribe fewer opi-
oids, and to the patients that need
them the most, then the chance of
opioids being taken by non pa-
tients living with the treated person
also decreases. Research demon-
strates that this is one of the other
most common pathways to opioid
addiction, the sharing or stealing
of a proscribed-person’s painkill-
ers within a household. If opioids
are prescribed only to those who
suffer from the most severe pain
that cannot be treated by alter-
native medication, those treated
persons will have a larger incentive
to prevent the sharing or stealing
of medication because they rely on
the medication. There will be fewer
doses left over from the patient,
regardless of their efforts to prevent
sharing/stealing. In many cases as
of now, many patients are left with
many more doses than they require,
and do not dispose of them respon-
 Roosevelt Review
sibly.

Conclusion
The enactment of this policy will
require more research to determine
the boundary for what defines
“lower-level pain” versus more
intense pain that requires opioids.
Doctors are still foggy on this. Until
then, a network of civil society,
NGO, policy activists and state leg-
islators will have to work together
to raise attention to this bill.
“This behavioral economic theory supports the assumption
References
1. “Alternatives for Managing Pain that changing the default-option will result in the reduction
that Aren’t Opioids,” Roy Soto, of prescription of opioids. Reduction of prescription of
M.D., President of Michigan Soci-
ety of Anesthesiologists. Beaumont opioids is expected to reduce the frequency of addition in
Hospital Health & Wellness News. two major ways, both relating to the fact that prescribed
2019.
2. “Alternatives for Managing Pain pain-killers are the most common gateway drug to opioid
that Aren’t Opioids,” Roy Soto, addiction. Firstly, if fewer patients being treated for pain
M.D.
are prescribed opioids, their chance of becoming addicted
to opioids will be reduced. Secondly, if doctors prescribe
fewer opioids, and to the patients that need them the most,
then the chance of opioids being taken by non patients
living with the treated person also decreases”

17
 Community-Targeted Solutions to Food
Deserts in NYC: Strengthening the Healthy
Bodegas Initiative
By Ji Hoon Ko
Introduction
“Food deserts” are areas character-
ized by low concentrations of busi-
nesses selling healthy foods and high
concentrations of fast-food restau-
rants. [1] There are many food
deserts in New York City, primarily
located in low-income and predom-
inantly minority neighborhoods. To
address this issue, New York City
has launched various programs to
expand access to healthy foods in
food deserts, such as the FRESH
program, [2] which offers tax in-
centives for developers building new
supermarkets, and the Green Carts
program, [3] which funds street
carts selling fresh produce. While
these programs have fostered eco-
nomic growth, their effectiveness in
improving locals’ dietary practices
has been questioned, as they strug-
gle to motivate residents to regularly
patronize businesses associated with
these programs. [4, 5] Additional
research indicates that expanding
healthy food availability in food
deserts does not necessarily lead to
healthier diets for residents, [6] as
nutritional education appears to be
the primary determinant of food
choices. [7]
Background
A successful program addressing
food deserts must expand access
to healthy foods while providing
nutritional education to residents
and appealing to residents’ unique
shopping habits. The Healthy Bode-
gas Initiative (HBI) addresses all of
these factors. [8] The HBI partners
18
with bodega owners in food deserts,
encouraging them to offer addition-
al fresh produce and other healthy
foods in their stores. Additionally, it
engages with the surrounding com-
munity through outreach events,
advertising campaigns, and part-
nerships with local organizations to
ensure residents patronize healthy
bodegas. [9] Accordingly, the HBI
has demonstrated tangible success.
Of participating stores, 45% report-
ed an increase in sales of 1% milk,
32% reported an increase in fruit
sales, and 26% reported an increase
in vegetable sales. [10] Much of
this program’s effectiveness can
be attributed to two factors: one,
the HBI emphasizes community
involvement and nutritional edu-
cation; two, the HBI utilizes the
bodega, where residents already buy
food. Because bodegas are usually
personalized towards the needs of a
specific neighborhood and maintain
a close bond with the community,
residents may feel most comfortable
shopping there. Thus, increasing the
supply of healthy foods in bodegas
may be more effective in appealing
to residents than inserting a new
and unfamiliar business into a com-
munity. However, the success of this
program has been hampered by a
lack of funding, [11] mostly because
it cannot provide financial incen-
tives to bodega owners.
Recommended Action:
New York City should allow bode-
ga owners participating in the HBI
to claim a tax credit of 50% of all
expenditures incurred from pur-
chasing healthy food inventory and
related products. The credit would
cover fresh produce, transportation
costs, produce displays, and refrig-
eration systems. This would address
the financial concerns voiced by
owners participating in the HBI and
incentivize continued cooperation.
The HBI has been effective because
it addresses both the supply and
demand sides of the food desert
problem. The proposed tax rebate
would ensure this program’s con-
tinued operation, expansion, and
success.
The HBI has significantly improved
the amount of healthy foods pur-
chased in its target areas, with its
success being a result of its com-
munity-based approach. Bodegas
compose more than 80% of food
sources in New York City’s food des-
erts, [12] so this program increases
the accessibility of healthy foods
through sources already familiar to
local consumers. Due to poor fund-
ing, this program cannot currently
offer bodega owners any financial
incentives, limiting the HBI to part-
nering with bodegas that already
stock some healthy foods and own
existing infrastructure to store fresh
produce. [13] Moreover, bodega
owners voiced concerns about “high
prices”, “low demand”, and a lack
of “space (refrigerated or otherwise),
to introduce a new and perishable
product” [14] in regards to the HBI,
indicating that significant financial
aid is needed to make healthy food

products and related storage more
accessible to bodega owners.
The proposed solution would take
the form of a standard small busi-
ness tax rebate. This rebate would
satisfy bodega owners currently
participating in the initiative and
may also attract new bodega owners
in target areas. To date, the HBI
has worked with 520 bodegas, en-
couraging them to stock 15 specific
healthy foods. The relatively small
number of participating bodegas,
even factoring in an expansion of
the program, means that the to-
tal cost of the rebates would not
be prohibitively expensive. [15]
However, very few statistics about
inventories in bodegas presently
exist. [16] A comprehensive study
of bodega inventories is needed to
properly estimate the annual cost of
the proposed program.
Next Steps
In order to improve this policy pro-
posal, local community members
would be interviewed to provide
new insight into the food desert
problem and the potential of the
HBI. Additionally, representatives
of the Department of Health and
Mental Hygiene (DOHMH) and
Small Business Services (SBS) would
be contacted. DOHMH, which
administers the HBI, is a valuable
source of further information and
a potential coalition partner. Sim-
ilarly, as any rebate (if authorized)
would be coordinated in conjunc-
tion with SBS, this department
could provide greater detail on
the institution of a tax rebate for
bodegas.
As Columbia University is located
in Harlem, students have direct
involvement in improving and
advocating for the Harlem com-
Roosevelt Review
munity, which is also an HBI target expansion-to-support-health-fresh-
area. The first step in building a program.
coalition of support would be to 3. “Green Carts,” Official Web-
work with pre-existing community site of the City of New York, NYC
outreach programs and student Health, accessed November 20, 2018,
groups. These groups may have an https://www1.nyc.gov/site/doh/
interest in this policy due to its focus health/health-topics/green-carts.
on the development of the Harlem page.
community. Campus groups focused 4. Cheryl Naa-Lamiokor Lamptey,
on community development, and “Comparing Policy Environments
Columbia Community Impact, the between NYC Green Carts and Phil-
nonprofit organization that coor- adelphia’s ‘Get Healthy Philly’ Ini-
dinates community service activi- tiative: Two Cities Combating Food
ties for the university, would make Deserts and Obesity” (M.P.H., Icahn
excellent coalition partners. With School of Medicine at Mount Sinai,
their support, the coalition could 2014), https://search.proquest.com/
expand to involve church organiza- docview/1625988151/abstract/
tions, youth groups, and commu- F297CFE532194A96PQ/1, 23-25.
nity alliance groups. Together, this 5. Batya Ungar-Sargon, “Have
coalition would launch an advocacy City Subsidies to Supermarkets
campaign focused on lobbying city Made NYC Healthier?,” City
council members, specifically those Limits, April 5, 2016, https://
who represent communities in food citylimits.org/2016/04/05/
deserts, to formally propose this have-city-subsidies-to-supermar-
policy. A petition and a letter-writ- kets-made-nyc-healthier/.
ing campaign would form the 6. Hunt Allcott, Rebecca Diamond,
core of this project, and would be and Jean-Pierre Dubé, “The Geogra-
accompanied by additional grass- phy of Poverty and Nutrition: Food
roots outreach. Finally, influential Deserts and Food Choices Across
representatives and leaders from the United States,” Working Paper
the community could meet with city (National Bureau of Economic Re-
council members to further advo- search, December 2017), https://doi.
cate for this proposal. org/10.3386/w24094, 33-34.
7. Allcott et al., “The Geography of
References Poverty and Nutrition,” 34.
1. Cynthia Gordon et al., “Mea- 8. “Healthy Bodegas Initiative,” 1-3.
suring Food Deserts in New 9. “Healthy Bodegas Initiative,” 11
York City’s Low-Income Neigh- 10. “Healthy Bodegas Initiative,” 13.
borhoods,” Health & Place, 11. “Healthy Bodegas Initiative,” 18.
Geographies of Care, 17, no. 12. “Healthy Bodegas Initiative,” 4.
2 (March 1, 2011): 696–700, 13. “Healthy Bodegas Initiative,” 8.
https://doi.org/10.1016/j.health- 14. “Healthy Bodegas Initiative,” 8.
place.2010.12.012, 699. 15. Rachel Dannefer et al., “Healthy
2. “Food Retail Expansion to Bodegas: Increasing and Promoting
Support Health (FRESH) Program Healthy Foods at Corner Stores in
- NYC Business,” Official Website New York City,” American Journal of
of the City of New York, NYC Public Health; Washington 102, no.
Business, accessed November 20, 10 (October 2012): 27–31, 27, 29.
2018, https://www1.nyc.gov/ny- 16. “Healthy Bodegas Initiative,” 14.
cbusiness/description/food-retail-
19
20
 Roosevelt Review

Education
This year, the Education Center partnered with the Economic Development Center to
undertake a year-long campaign to establish an Advisory Committee on Socially Re-
sponsible Investing (ACSRI) at Barnard College. Propelled by the belief that an ACSRI
would promote transparency and accountability in the management of Barnard’s en-
dowment, members of the Education Center collected hundreds of student signatures,
met with Barnard administrators, and presented before the Representative Council of
the Barnard Student Government Association (SGA). The Center secured a meeting
with the Barnard Board of Trustees and continues to build momentum towards the
establishment of the committee.

While this year’s initiative centered mainly around the financialization of higher educa-
tion, the policies contained in this year’s journal tackle a wide range of education policy
issues. The Education Center Director wrote about universal access to childcare, and
others tackled issues like medical and family leave from higher education.

-- Carolyn Kelly, Center Director

21
 Recess: More Then Just Fun
By Emma Cloyd
Introduction
Despite the fact that recess is
known to bring extensive benefits
to elementary school students, New
York City has not adopted a policy
aligned with the students best inter-
ests. A blind eye has been turned to
the physical and mental health of
children in an effort to drive up test
scores and academic achievement.
While the New York City Wellness
Code acknowledges that students
should be receiving 60 minutes
of physical activity a day, it lacks
a specific plan for children to get
this and only encourages schools to
have 20 minutes of recess on most
days. [1]
Background
There are multiple things that
created a society where children
can no longer play and be creative
and are forced to standardize their
minds for performance based edu-
cation and tests. Since 2001, it has
been found that 62% of elemen-
tary schools increased the amount
of time students learned language
arts and math while 20% of them
cut down on the time children
are given for recess. [2] Currently,
recess is seen as an afterthought
rather than something essential to
children’s development. In 2017,
several states passed laws man-
dating that children be given 20
minutes of recess a day, which is a
meager amount considering many
are in school from around 8:30am
to 3:00pm and at times it was faced
with resistance. [3] The New Jersey
state legislature passed a bill that
would have required all students
to receive at least 20 minutes of
22
recess a day which former Gover- impact on students ability to main-
nor Chris Christie said “That was tain relationships. Furthermore, a
a stupid bill and I vetoed it.” [4] lack of unstructured time in school
Having a system where such behav- further contributes to cliquey and
iors towards finding 20 minutes for exclusionary behaviors because
children to have command of their children will be less likely to try to
own minds and bodies is hindering make new friends because they just
us in our efforts to become a first aren’t given the time.
class education system. Mandating
60 minutes of recess a day for all There is also research that indicates
elementary school students in New having time for recess and play
York City will set a precedent for improves children’s behavior in the
the country, showing that the city classroom. [7] A study found that
cares by putting the students and even a meager 15 minutes of recess
academic research first. a day significantly improved the
way teachers scored eight and nine
Providing children with unstruc- year olds behaviors. [8] Another
tured time during their school day study compared what happened
also provides them with an oppor- to second through fourth graders
tunity to develop their social skills. on days where they had recess and
As a woman who grew up in the days that they did not, and found
Chicago Public School system said, that their behavior was markedly
recess taught her how to get along improved by having recess. [9] Of
with people from different back- the students observed, including
grounds and without it everyone four with ADD, all of them worked
just pairs off into their groups. [5] more and/or were less fidgety on
A Position Paper of the Council on days where they had the ability to
Physical Education for Children play outside. While critics could
And The National Association for argue that adding recess is only
Sport and Physical Education advo- necessary for those who have “too
cated for increased recess time that much energy” or are “a bit more
is distinctly separate from physical rambunctious” the externality
education to allow children to have negative behavior can cause im-
time to hone their interpersonal pacts all students. It doesn’t matter
skills, including conflict resolu- how much time our kids spend in
tion, cooperation, and respecting the classroom if it is not produc-
rules. [6] When children spend tive learning time, so the trade off
their entire day sitting in a class- between additional recess for the
room, rather than conversing and slight shortening of classes seems
interacting with their peers, they like a logical choice to make.
lose their ability to foster connec-
tions. Failing to understand other Above all else, school is for students
people and how to converse and to hone their academic ability and
work through potential conflict at school policies must be designed
a young age could have long term with that in mind. There is a direct

correlation between sitting still for
long reading of times and poorer
reading and math skills, especial-
ly in young boys. [10] This study
looked at the heart rates of chil-
dren and found that a lower level
of physical activity and higher
proportions of time spent sitting
at desks were both associated with
poorer skills, especially when the
two were combined. [11] A 2010
report by the Center for Disease
Control found close ties between
recess and academic performance
and deemed they were closely tied
several policy implications. [12]
The most significant was that they
found an overwhelming correla-
tion between physical activity and
increased academic achievement,
including better grades and higher
test scores and that increasing the
amount of time schools give stu-
dents for recess directly helps their
performance. [13] As the nation’s
primary health protection agency,
the CDC would not publish this
report if they did not genuinely
believe it was important for schools
to be taking such actions. They
explicitly encouraged school lead-
ers to provide greater recess time
for students as it does not have any
negative side effects. [14]
Recommended Action
The New York City DOE should
make their students’ best interests
the priority in setting the curricu-
lum and mandating that all schools
have 60 minutes of recess a day.
An initial concern may be that the
infrastructure to have hundreds of
children playing at once may not
exist, however that can easily be
mitigated by staggering the recess
so different students are outside
or in the gymnasium at different
points in time for half an hour
long shifts; each student would
have two a day. Grades could be
combined, for example first and
second graders, to facilitate in-
creased relationships across class-
es and better develop children’s
essential social skills. By having two
half hour breaks in the day, rather
than one long one, students will
be given multiple times to decom-
press. Being in elementary school is
stressful and having the opportunity
to breathe and unwind is essen-
tial for students mental wellbeing.
Additionally, having two shifts
could allow for play time in both
the morning and the afternoon to
give the effect of making the day go
faster.
Next Steps
As New York City’s schools are un-
der mayoral control, not the State
Legislature’s, the Commissioner of
Education could make the decision
to implement a 60 minute recess
with limited external factors. To
ensure durability of the policy, it
is essential that multiple important
stakeholders, including the may-
or, city government officials, key
NGOs, and teachers unions are on
board with the shift in school day
schedule.
References
1. “New York City Depart-
ment of Education Wellness
Policy.” https://cdn-blob-prd.
azureedge.net/prd-pws/docs/de-
fault-source/default-document-li-
brary/2017-wellness-policy-english.
pdf ?sfvrsn=cbc47378_40.
2. “NCLB Year 5: Choices, Chang-
es, and Challenges: Curriculum
and Instruction in the NCLB Era.”
The Center on Education Policy.
https://www.cep-dc.org//display-
Document.cfm?DocumentID=312.
3. Reilly, Katie. “Is Recess Im-
portant for Kids? Here’s What the
Roosevelt Review
Research Says.” Time. October 23,
2017. http://time.com/4982061/
recess-benefits-research-debate/.
4. Ibid.
5. “Recess Makes Kids Smarter.”
Scholastic. https://www.scholastic.
com/teachers/articles/teach-
ing-content/recess-makes-kids-
smarter/.
6. “RECESS IN ELEMENTARY
SCHOOLS: A Position Paper of
the Council on Physical Education
for Children And The National
Association for Sport and Physical
Education.” Nh.gov. https://www.
nh.gov/gcpah/documents/recess-
inelemschool.pdf.
7. Barros, Romina, Ellen Silver,
and Ruth Stein. “School Recess
and Group Classroom Behavior.”
Pediatrics 23, no. 2 (February
2009): 431-36.
8. Ibid.
9. Jarrett, Olga S., Darlene M.
Maxwell, Carrie Dickerson, Pame-
la Hoge, Gwen Davies, and Amy
Yetley. “Impact of Recess on Class-
room Behavior: Group Effects and
Individual Differences.” The Jour-
nal of Educational Research92, no.
2 (1998): 121-26.
10. Luscombe, Belinda. “Boys
Who Sit Still Have a Harder
Time Learning to Read.” Time.
December 02, 2016. http://
time.com/4588035/sitting-exer-
cise-reading/.
11. Ibid.
12. Ibid.
13. “The Association Between
School-Based Physical Activity,
Including Physical Education, and
Academic Performance.” Center
for Disease Control. 2010
14. Ibid.
23
 Federally Funded, Locally Distributed Fully
Universal Pre-K
By Carolyn Kelly
Introduction
The cost of childcare in the United
States is rapidly rising, particular-
ly for children with special needs
who require home and community
based services (HCBS) like speech
therapy. Caring for any child is
an expensive and lengthy process,
and this is only exacerbated by
lack of access to affordable quality
childcare. Caring for children with
special needs can be a significant
financial strain, often amounting to
30-40% of a single parent income.
Parents of children with special
needs often need to quit their job
or work nights to make ends meet.
Children need to be cared for,
particularly the most vulnerable
children among us. The United
States should pass a universal
childcare program by expanding
public K-12 education to three
and four year olds, including those
with special needs. This should
be accomplished by emphasizing
the educational benefits of early
childhood education and providing
preschool through already existing
public school systems.
Background
Currently, wage growth is not
keeping up with the rising cost
of childcare. In more and more
families, both parents work and
thus require childcare of some sort,
but it is expensive and difficult to
find quality child care that meets
this need. In addition, children
with special needs require access
to HCBS. Right now, families all
over the country are making tough
24
choices about what to do with their
children while they are at work.
Children are deprived of quality
care and time to learn and grow.
Parents are spending $5,000 to
$15,000 -- sometimes up to 40% of
their income -- on care.
Right now, children with special
needs are isolated from other
children and unable to learn in and
adapt to a classroom environment.
This hurts the social and emotional
learning skills of children with spe-
cial needs, and the learning skills of
their peers without special needs.
Exposure on both sides is key to en-
suring children with special needs
live happy and healthy lives.
Recommended Action
The United States should imple-
ment a federally funded, locally dis-
tributed universal pre-K program
which expands access to pre-K
through existing public-school
systems. This will provide a cost ef-
ficient solution for parents, quality
care for children, and an appropri-
ate place for children with special
needs to receive HCBS.
Georgia, Oklahoma and Florida
all offer universal pre-K to four-
year-old children. Georgia provides
vouchers for students to seek care.
Georgia spends $341 million a
year on its preschool program and
55% of four-year olds are enrolled.
Oklahoma spends $167 million a
year on its program and has 71%
of four-year olds enrolled. Unlike
Georgia, which provides 20% of
preschool through public school
systems, Oklahoma provides 90%
of its preschool through public
schools. Oklahoma’s program costs
less and enrolls more students. In
addition, Oklahoma has strict stan-
dards for preschool teachers, pay-
ing them the same as other K-12
teachers and requiring certification
to teach. Schools in Oklahoma can
also partner with existing Head
Start Programs, private centers,
and churhes to provide care, giving
more options to parents. Oklaho-
ma has shown that preschool gives
kids a leg up in school and in life,
teaching essential skills like problem
solving and working with others.
Children with special needs are fed-
erally mandated to receive HCBS
from the age of three, with federal
and state funds matching local ex-
penditures. It has been shown that
receiving these in schools with oth-
er peers helps students. By having
preschool integrated into the fold
of existing school systems, children
with special needs have access to
better trained staff and more re-
sources that would not be provided
in a private care center.
Next Steps
Traditionally, universal pre-K has
been seen as a pet project of Dem-
ocrats, but the states with the most
robust and long-standing programs
are all conservative states. Oklaho-
ma, Florida, Georgia, West Virgin-
ia, Iowa, and Wisconsin all have
largely expanded pre-K programs
enrolling over 50% of four-year
olds. Each state achieved this by fo-
 Roosevelt Review
cusing on on expanding education States-Fund-Pre-K_A-Primer-for-
and the benefits reaped by children Policymakers.pdf.
who attend preschool. By tying
universal pre-K into existing public United States, Department of
schools and their budgets, universal Education. “A Matter of Equity:
pre-K can be passed on a federal Preschool in America.” April, 2015
level. The federal government has
already taken on an expanded role
in education with the passage of
No Child Left Behind and other
programs, and a bipartisan univer-
sal pre-K program even passed the
house and the senate in the 1970s
only to be vetoed by President
Nixon. By advocating for universal
pre-K through education, parents
and children, including those with
special needs, can bring about a
solution to the current crisis of
rising childcare costs. “The United States should implement a
References
federally funded, locally distributed univer-
Bassok, Daphna, and Luke Miller. sal pre-K program which expands access
Florida’s Voluntary Pre-Kindergar-
ten Program: An Overview of the
to pre-K through existing public-school
Largest State Pre-School Program systems. This will provide a cost efficient
in the Nation. ED Policy Works,
2014, Florida’s Voluntary Pre-Kin-
solution for parents, quality care for chil-
dergarten Program: An Overview dren, and an appropriate place for children
of the Largest State Pre-School
Program in the Nation.
with special needs to receive HCBS.”
Bassok, Daphna. “Does State
Preschool Crowd-out Private Pro-
vision? The Impact of Universal
Preschool on the Childcare Sector
in Oklahoma and Georgia.” Jour-
nal of Urban Economics , 2013.
Khimm, Susan. “Is Oklahoma the
Best Model for Universal Pre-K?”
Washington Post. Feburary, 14,
2013.

Parker, Emily, et al. How States

Fund Pre-K A PRIMER FOR
POLICYMAKERS. Education
Commission of States, 2018, How
States Fund Pre-K A PRIMER
FOR POLICYMAKERS, www.
ecs.org/wp-content/uploads/How-
25
 Providing Better Support for Columbia College &
Engineering Students:
Guaranteed Housing and Taking a Leave of
Absence
By Shirley Tan
Introduction
Universities are founded on philos-
ophies of learning and growth. As
such, university administrations
should be expected to continuous-
ly support students in achieving
these goals inside and outside the
classroom. If universities want
successful students, they ought to
support students’ mental health in
addition to their academic pursuits
[1]. Many students are best served
by temporarily taking time off
from school, whether for job op-
portunities, family circumstances,
a desire to travel, or mental health
purposes. Jointly, Columbia College
(CC) and Columbia’s School of
Engineering and Applied Sciences
(SEAS) offer students the option to
take a voluntary leave of absence,
but their return policies, including
the revocation of guaranteed hous-
ing [2], discourage students from
taking necessary leaves of absence
and are discriminatory. Particular-
ly for lower-income students, the
additional financial and emotional
stress of looking for off-campus
housing in New York City upon
their return will be difficult. If CC
and SEAS are dedicated to the
wellness and growth of all students,
they need to ease the leave of
absence return process by stream-
lining procedures and guaranteeing
housing for students who choose to
take time off.
26
Background
Currently, CC and SEAS’s vol-
untary leave of absence policy
does not offer students guaranteed
housing upon their return [3]. The
current policy, last updated in 2015,
places students at the bottom of
the waiting list for housing, making
it necessary to look for off-campus
lodging. The average price of an
one-bedroom apartment in Man-
hattan is $3,100 while a studio
averages at $2,550 a month [4].
Columbia Housing offers lodging
at under $1,000 a month [5]. As
such, students who take a leave of
absence can expect to pay more
than double what they would for
on-campus housing. For many
lower-income students who depend
on financial aid to meet their needs,
this is a serious burden. The diffi-
culty of finding off-campus hous-
ing is worsened by the mounting
housing crisis in New York City, as
landlords exploit a broken system
to diminish affordable housing [6].
NYC’s housing crisis coupled with
Columbia’s non-guaranteed hous-
ing policy effectively limits leaves
of absence to students who have
the financial means. Disincentiv-
izing students of disadvantaged
backgrounds from taking a leave
of absence harms them in three
particular ways, reinforcing a cycle
of inequality.. One, it prevents
students from taking opportunities
that could foster personal growth,
such as a job or travel opportunity.
Limiting their experiences might
disadvantage them compared to
their peers upon graduation Two,
if a student needs to take a leave
of absence for familial circum-
stances, having to worry about
finding housing upon their return
is an unnecessary stressor which
would add to an already taxing
situation. Three, the current policy
discourages students from taking a
leave of absence for mental health
purposes. This is cause for concern
because anxiety and depression
rates amongst college students have
consistently risen over the past two
decades [7]. Columbia is not im-
mune to this phenomenon, in fact
it is renowned for “stress culture.”
Particularly for low-income and/or
first-generation students, adjusting
to an elite college can be a daunt-
ing challenge which may inspire
feelings of anxiety or depression.
Sometimes, a semester off can
relieve these feelings and leave
students better prepared upon their
return. Yet, the financial burden
of non-guaranteed housing would
exclude the very ones who may
need it most from taking a leave of
absence.
Recommended Action
Given the potential benefits of
taking a semester off through a
voluntary leave of absence, it is
crucial that the process of doing so
be made as accessible as possible,
with as much support from the uni-

versity’s administration as possible.
Policies which deter students from
considering the option ought to be
reconsidered and altered.
First and foremost, CC and SEAS
should guarantee students who
take a voluntary leave of absence
housing upon their return. Upon
admission to the colleges, students
are guaranteed housing for eight
semesters, and they typically only
lose housing as punishment—rang-
ing from disciplinary procedures to
a failure to meet deadlines [8]. By
stripping students of guaranteed
housing after a leave of absence,
then, suggests that they are violat-
ing school policy rather than taking
initiative to practice a potentially
beneficial behavior.
Revoking guaranteed housing
after a voluntary leave of absence
certainly impacts student behavior.
Each year at Columbia, around 5
to 20 students take time off across
CC, SEAS, and the School of
General Studies, which has its own
housing policies [9]. Meanwhile,
Harvard, which has guaranteed
housing after a voluntary leave of
absence [10] has over 200 stu-
dents take leaves of absence each
year—their administration strives
to create a wide-open policy in
order to allow students “to use
their eight semesters most effec-
tively” [11]. Many students who
took leaves of absence at Harvard
reported satisfaction with their
decision, stating that it was a good
way to reevaluate, recenter and
gain new experiences [12]. While
some might argue that Columbia’s
location in New York City makes
space far more sparse than at
Harvard, guaranteeing housing to
a student returning after taking a
semester off is not much different to
guaranteeing housing for students
who have studied abroad for a se-
mester. The space for each student
was available upon their admission
to the university, when they were
first guaranteed housing. If Co-
lumbia is committed to the growth
and advancement of its students,
it ought to follow in the footsteps
of Harvard in regards to leaves of
absence by creating easier processes
and guaranteeing housing.
Next Steps
Columbia University is renowned
for its brilliant faculty and students.
Its administration ought to do all
it can to continue nurturing this
talent and ensuring students are
able to perform at their best. This
means relaxing voluntary leave of
absence policies and guaranteeing
housing for students upon their
return. While the policy change
must be officially approved by the
administration officially, students
should also speak up about the
issue by establishing contacts with
Columbia Housing, Residential
Life, and Columbia Psychological
Services to push for the change to
occur. By making these changes,
Columbia can make a statement to
students of their commitment to
bettering educational experiences
on campus and an announcement
to the greater public about the val-
ue of self-care and self-exploration.
As a leading educational institution,
Columbia has a responsibility to its
students and to the public to pro-
mote such positive messages.
References
1. Hazard, Laurie. “Cultivating the
Habits of Mind for Student Success and
Achievement.” Research and Teaching
in Developmental Education 29, no. 2
(2013): 45-48. http://www.jstor.org/sta-
ble/42802413.
2. Columbia College and Engineering.
Voluntary Leave and Readmission Policies
& Procedures. PDF. New York, NY, Sep-
Roosevelt Review
tember 30, 2015.
3. Ibid.
4. Quintana, Mariela. “Average Rent
NYC: Here’s What You’ll Pay in Rent
| Naked Apartments.” Ground Floor.
September 26, 2018. https://www.
nakedapartments.com/blog/average-rent-
al-prices-nyc/.
5. “Rate Structure.” Columbia Housing.
https://housing.columbia.edu/hous-
ing-options/residences/rate-structure.
6. Barker, Kim. “Behind New York’s
Housing Crisis: Weakened Laws and
Fragmented Regulation.” The New York
Times. May 20, 2018. https://www.
nytimes.com/interactive/2018/05/20/
nyregion/affordable-housing-nyc.html.
7. Boncy, Alexis. “Under Pressure.” Co-
lumbia College Today. January 25, 2018.
https://www.college.columbia.edu/cct/
issue/winter17/article/under-pressure.
8. “Assignment Policies.” Columbia
Housing. https://housing.columbia.edu/
room-selection/tips-and-tools/assign-
ment-policies.
9. Abrams, Abby, Sariel Friedman, Jenna
Beers, and Tiffany Lee. “Absent, Alone,
Apart.” The Eye.http://features.colum-
biaspectator.com/eye/2015/03/04/ab-
sent-alone-apart/.
10. “Leaves of Absence.” Harvard College
Handbook for Students. https://hand-
book.fas.harvard.edu/book/leaves-ab-
sence#six.
11. Narayanan, Menaka V. “Number of
Students on Leave of Absence Increases.”
The Harvard Crimson. https://www.
thecrimson.com/article/2016/5/4/
leaves-of-absence-increases/.
12. Schugart, Annie E., and Emma C.
Scornavacchi. “Putting Harvard on
Hold.” The Harvard Crimson. https://
www.thecrimson.com/article/2017/3/2/
putting-harvard-on-hold/.
27
28
 Roosevelt Review

Energy and the

Environment
In the 2018-2019 year, the Energy and Environment center continued to pursue its
carbon neutrality campaign at Columbia through a combination of research, petitions,
letter writing, events, and presentations. On Earth Day 2019, the University announced
its formal commitment to carbon neutrality. Yet the contents of this journal reach be-
yond campus decarbonization into the Texan electric grid, the sustainability and de-
militarization of government vehicles, and the improvement of conditions for animals
in factory farms. All seek to push the envelope on American environmental policy in
aspiring to a cleaner and more just collective future.

-- Arianna Menzelos, Center Director

29
 Climate Change and the Grid: Addressing
Texas’ Utility Grid Vulnerabilities
By Ricardo Jaramillo
Introduction
Climate change is a pressing and
urgent issue worldwide. The reali-
ties of climate change in Texas are
not being adequately addressed
despite its vulnerability: rising
sea levels will exacerbate coastal
flooding, longer droughts will put
a heavier strain on Texas’ water
resources, and higher temperatures
will increase the frequency of wild-
fires and have adverse effects on
cattle ranching and agriculture. [1]
According to the “Billion Dollar
Weather and Climate Disasters”
database run by the federal gov-
ernment, Texas has already expe-
rienced more expensive disaster
events than any other state, with a
total of almost 100 events inflicting
more than $1 billion. [2]
The resiliency of Texas’ electric
grid is under-addressed. Hurricane
Harvey showed a power grid woe-
fully unequipped for the expected
increasing intensity of natural
disasters. In the aftermath of the
hurricane, 280,000 Texans were
left without power due to outages
caused by flooding and high winds,
and utility companies were left
scrambling in an attempt to restore
power. [3] Moreover, storm related
damages to Texas are projected
to increase by $650 million a year
due to climate change, resulting in
a total annual cost of $3.9 billion.
[4] In response, many worried
about climate change have pointed
to grid hardening – the process of
improving the physical readiness of
the electrical grid – as policy which
could mitigate climate vulnerabil-
30
ities resulting from flooding and technologies
high temperatures.
Neither PUC nor ERCOT current-
ly has a mandate to promote cli-
Background mate resiliency in Texas’ electrical
Texas has a Deregulated Electricity grids. Given the expected impacts
Market of climate change on Texas’ grid,
the Texas legislature should man-
Texas has two main regulatory bod- date that that PUC incorporate
ies that oversee its electricity mar- the effects of climate change on
ket: the Public Utility Commission the grid in its regulatory frame-
of Texas (PUC); and the Electric work and promote investment in
Reliability Council of Texas (ER- grid hardening technologies. This
COT). Unlike other states, Texas means understanding the ways in
has a deregulated electricity market which temperature increases will
which means that private retail affect energy consumption and also
electricity companies choose where making the grid more physically
they buy their power from and how resistant to natural weather effects.
to market it to consumers. [5] The The PUC was given a mandate to
main purpose of both the PUC “protect customers, foster compe-
and the ERCOT is to promote tition, and promote high quality
competition within the electricity infrastructure”. [9] And yet, a
market. Their focus on promoting search for “climate change” on the
competition has resulted in con- PUC’s website only pulls up four
tentious debates about the actual results, the most recent of which is
benefits for Texas consumers amid from 2011. The Texas Legislature
talk of dubious regulatory assess- should pass a law clarifying that
ments meant to promote expanded “promoting high quality infra-
power generation. [6, 7] Many structure” includes a mandate to
critics argue that the ‘deregulation’ prepare Texas’ infrastructure for
of the Texas electricity market has the effects of climate change. Other
not resulted in more simple regula- regulatory entities and power utili-
tions but rather an artificial market ties, for example in New York City,
based on esoteric and obtuse rules have already begun to incorpo-
determining the price point of rate climate change predictions in
electricity. [8] planning for the future stability of
the power grid. [10] Requiring the
PUC to consider climate change is
Recommended Action the first step on the road to a broad
Require that the Public Utility scale ‘grid-hardening effort’ that
Commission of Texas consider the would include refitting transmission
effects of climate change and pro- lines to go underground, investing
mote investment in grid hardening in physical flood protection infra-

structure around power generation
plants, and investing in storm pre-
paredness training.
Next Steps
Building Political Support
In the 2018 midterms, Democrats
picked up two seats in the Texas
State Senate and 12 seats in the
Texas House. [11] Although Re-
publicans still have control over all
three branches of the government,
these recent gains might create op-
portunities for compromise. While
the oil lobby is in Texas is strong
and historically opposed to climate
change policies, their energy trans-
mission lines also rely upon a safe
and secure grid. While the phrase
‘climate change’ will be controver-
sial, many groups in Texas, par-
ticularly business advocacy orga-
nizations (such as the Advanced
Power Alliance), support renewable
energy and energy efficiency poli-
cies because they result in cheaper
power. Climate activists and con-
sumer-advocate groups should
build a coalition to make this policy
a part of the conversation during
the next legislative session.
References
1. Environmental Protection Agen-
cy. August 2016. “What Climate
Change Means for Texas”. EPA.
Gov. Accessed November 26, 2018.
https://www.epa.gov/sites/pro-
duction/files/2016-09/documents/
climate-change-tx.pdf
2. “Climate Change To Bring
North Texas Longer Droughts,
Heavy Rains, 120-Degree
Temps Within 25 Years | Cli-
mate Change | Dallas News”.
2018. Dallasnews.Com. Accessed
November 26 2018. https://
www.dallasnews.com/news/cli-
mate-change-1/2018/10/12/
Roosevelt Review
climate-change-may-bring-texas- legal-planet.org/2018/03/26/
longer-droughts-heavy-rains-120- the-paradox-of-electricity-deregu-
temps-august-within-25-years. lation/.
3. DiChristopher, Tom. 2017. 9. “ About The PUCT - Mission
“Texas Utilities Struggle To Re- & History “. 2018. Puc.Texas.
store Power As Harvey Hampers Gov. Accessed November 26 2018.
Progress”. CNBC. Accessed No- http://www.puc.texas.gov/agency/
vember 26 2018. https://www. about/mission.aspx.
cnbc.com/2017/08/28/tex- 10. Columbia Law School Sabin
as-utilities-struggle-to-restore-pow- Center for Climate Change Law.
er-as-harvey-hampers-progress. 2017. “In Florida And Texas,
html. Keeping The Lights On Means
4. Texas Tribune. 2015. “Texas Planning For Climate Change”.
Facing Major Climate Change Im- State Of The Planet. Accessed
pacts, According To New Study”. November 26 2018. https://blogs.
The Texas Tribune. Accessed ei.columbia.edu/2017/09/15/
November 26 2018. https://www. in-florida-and-texas-keeping-the-
texastribune.org/2015/07/28/ lights-on-means-planning-for-cli-
study-climate-change-big-threat- mate-change/.
texas/. 11. “Texas 2018 Mid-Term Elec-
5. Baddour, Dylan. 2016. “Texas’ tion Round-Up: Texas House,
Deregulated Electricity Market, Senate & More - Texas Coalition
Explained”. Houstonchronicle. For Affordable Power”. 2018. Texas
Com. Accessed November 26 Coalition For Affordable Power.
2018. https://www.houstonchron- Accessed November 26 2018.
icle.com/local/explainer/article/ https://tcaptx.com/press-releases/
texas-electric-deregulation-ER- blog-texas-election-round-up.
COT-TCAP-7971360.php.
6. Sixel, L.M. 2018. “Trying To
Hold Electricity Deregulation To
Its Promise”. Houstonchronicle.
Com. Accessed November 26 2018.
https://www.houstonchronicle.
com/business/energy/article/
Trying-to-hold-electricity-deregula-
tion-to-its-13016922.php.
7. Blum, Jordan. 2016. “Power
Company Sues Grid Operator
Over Demand, Supply Projec-
tions”. Houstonchronicle.Com.
Accessed November 26 2018.
https://www.houstonchronicle.
com/business/energy/article/
Power-company-sues-grid-op-
erator-over-demand-7122935.
php?t=17b2015ab8.
8. Dan Farber et al. 2018. “The
Paradox Of Electricity Deregu-
lation”. Legal Planet. Accessed
November 26 2018. http://
31
 Decarbonize to Demilitarize Local Law
Enforcement Agencies
By Morgan Margulies
Introduction
For years, the United States Federal
Government has given inactive mil-
itary-grade vehicles and weapons
reserved for warfare to local law en-
forcement agencies free of charge.
This militarization of local law
enforcement agencies has failed to
reduce crime, increased the use of
force, and damaged local commu-
nities [1]. Additionally, the military
vehicles are unregulated emitters
that release massive amounts of
greenhouse gasses into the atmo-
sphere. While the movement to
demilitarize local police agencies is
mostly based in community safety,
the problem of militarized police
vehicles intersects with the decar-
bonization movement. A multifac-
eted approach is the best way to
challenge this problem.
Background
Since 2006, the federal government
has distributed 865 mine-resistant
ambush protected (MRAP) vehicles
and 335 armored trucks to local
law enforcement agencies[2]. The
militarization of police forces has
proven detrimental to local com-
munities for three reasons: One, a
recent study from the Proceedings
of the National Academies of Sci-
ence reports that police militariza-
tion fails to reduce crime rates and
increases tension amongst the com-
munity [1]. Two, police forces dis-
proportionately militarize in black
communities, and militarization
increases the likelihood that police
will use force, so militarization
contributes to problems with police
32
violence in black communities [1].
Three, the militarization of police
vehicles has increased greenhouse
gas emissions within municipali-
ties. MRAP vehicles average about
3 miles per gallon (MPG) while
armored trucks average 5 mpg [3].
Additionally, MRAP vehicles are
exempt from diesel engine emis-
sion standard requirements meant
to protect local air quality [4]. In
general, police vehicles often emit
a lot of carbon due to high rates of
idling and gasoline demand.
Recommended Action
Policy to address militarization of
local law enforcement agencies
must take environmental justice
into account. Only federal action
is capable of halting militariza-
tion across all municipalities, since
military vehicles are property of
the federal government. Congress
could tackle this through a double
pronged policy. First, a mandatory
buyback initiative where munici-
palities and police departments can
exchange local military vehicles
for federal categorical grants could
remove military vehicles from local
communities. Second, the categor-
ical grant should be used to buy
electric police cars and other low
carbon alternatives.
Removing military grade vehicles
from the control of local police
agencies along with increased
investments in decarbonization
initiatives would dramatically
decrease local police greenhouse
gas emissions. A pilot program in
Fremont, California shows that
buying electric police vehicles can
be environmentally beneficial and
economically feasible.Fremont’s
current fleet produces 980 metric
tons of CO2 a year, and an entirely
electric fleet will reduce emissions
by 10% throughout the entire mu-
nicipality [5]. Additionally, normal
police cars can be retrofitted to run
on fuels like propane and natural
gas which are better for the envi-
ronment. These alternative fuels
still emit CO2 but at much lower
rates than regular gasoline. Burn-
ing these alternative fuels would
also reduce tailpipe emissions by
20-30%, saving up to $1 per gallon
[6]. This approach is a positive first
step towards the demilitarization
of police forces, which has caused
many local problems, and a mas-
sive investment in transportation
decarbonization that is feasible
nationwide.
Conclusion
Only broad uniform action by the
federal government can reverse
the trend towards militarization
and carbonization of local law
enforcement agencies. Right now,
the number of militarized police
departments is only increasing,
demonstrating that certain politi-
cal groups support militarization.
. However the current approach
has proven ineffective, detrimental,
and a threat to local air quality
and global climate change. This
approach can be changed: local de-
militarization and decarbonization
can be enacted by changing the
 Roosevelt Review
way the federal government invests buffalo-grove/community/chi-ugc-
in local law enforcement. article-police-agencies-can-save-fu-
el-reduce-emissio-2015-04-16-story.
References html.
1. Mummolo, Jonathan. “Mili- 7. Garrett, Jerry. “A Green, Mean
tarization Fails to Enhance Police Fighting Machine? Well, It’s Defi-
Safety or Reduce Crime but May nitely Mean...” The New York
Harm Police Reputation.” PNAS, Times, The New York Times, 7
National Academy of Sciences, 11 Nov. 2008, wheels.blogs.nytimes.
Sept. 2018, www.pnas.org/con- com/2008/11/07/a-green-mean-
tent/115/37/9181. fighting-machine-well-its-definitely-
2. Andrzejewski, Adam. “Track- mean/.
ing Military Weaponry and War
Machines Flowing to Ameri-
ca’s Local Police Departments.”
Forbes, Forbes Magazine, 1 Sept. “Removing military
2017, www.forbes.com/sites/ad-
amandrzejewski/2017/08/31/
grade vehicles from the
tracking-military-weapon-
ry-and-war-machines-flow-
control of local police
ing-to-americas-local-police-depart- agencies along with
ments/#3e827fbd2b63.
3. Prospective Technology In- increased investments
corporated. Army Programmatic
Environmental Assessment of the in decarbonization
Mine Resistant Ambush Protected
(MRAP) Vehicle Program. Dec. initiatives would dra-
2010, apps.dtic.mil/dtic/tr/full-
text/u2/a578517.pdf.
matically decrease
4. Gansler, Jaques. ACQUISI-
TION OF MINE ACQUISITION
local police greenhouse
OF MINE -RESISTANT, RESIS- gas emissions”.
TANT, AMBUSH -PROTECTED
(MRAP) VEHICLES: PROTECT-
ED (MRAP) VEHICLES: A CASE
STUDY . University of Maryland,
May 2010, apps.dtic.mil/dtic/tr/
fulltext/u2/a529404.pdf.
5. Plautz, Jason. “Fremont, CA
Pilots Electric Police Vehicle to
Reduce Emissions.” Smart Cities
Dive, 28 Jan. 2019, www.smartci-
tiesdive.com/news/fremont-ca-pi-
lots-electric-police-vehicle-to-re-
duce-emissions/546915/.
6. Koenig, Joe. “Police Agencies
Can Save Fuel, Reduce Emissions,
Save Money by ‘Going Green’.”
Chicagotribune.com, 16 Apr. 2015,
www.chicagotribune.com/suburbs/
33
 Give Them Some Space: Banning the
Intense Confinement of Animals in American
Food Production
By Arianna Menzelos
Introduction
Most Americans are unaware that
no federal regulations protect ani-
mals in agriculture practices. [1] In
the United States, over 95% of ani-
mals raised for the purpose of agri-
culture are reared in factory farms.
[2] Factory farms are also called
concentrated animal feeding oper-
ations (CAFOs), of which there are
20,000 in the United States alone.
[3,4] This is a global problem as
well; worldwide, 42% of eggs, 55%
of pork, and 72% of poultry come
from CAFOs. [5] These institutions
maximize output at the cost of
health, safety, and animal well-be-
ing. They employ rearing practices
that use gestation crates and bat-
tery cages, which damage animal
welfare. [6] In order to carry out
their basic functions, animals must
be able to engage in social behav-
ior and have enough space to turn
around. For example, pigs that do
not have enough space to give birth
sometimes crush their piglets in
their pens. [7] These close confines
also have serious implications on
human health and safety, both for
those who consume the product
and for those who experience the
externality of CAFO pollution.
The basic rights of the animals as
well as legitimate safety concerns
necessitate that farm animals must
be granted more room in which to
be reared.
Background
Common CAFO practices restrict
the movement of animals so se-
34
verely that they cannot turn around
while in confinement.[8] These
practices include mother pigs in
gestation crates, veal calves torn
from mothers, and egg-laying hens
confined in battery cages, which are
unitary crates meant to maximize
egg production on factory farms.
CAFOs have many negative ef-
fects beyond their harm to animal
welfare. The stress of animals in
CAFOs can increase susceptibility
to disease. [9] Collectively, the agri-
culture system in the United States
alone daily administers antibiotics
to farm animals, amounting to 20
million pounds of drugs–or 80%
of all antibiotics sold in the United
States–in 2014. [10] This trend has
led to antibiotic-resistant bacte-
ria contaminating water sources,
causing cancer, foodborne illness,
and leading to infections that cause
about 23,000 deaths per year.[11,
12, 13] Additionally, since CAFOs
do not allow for the natural fer-
tilization of pastures, solid waste
produced in animal-rearing pol-
lutes the air and the water. CAFOs
have other societal repercussions
as well, including the depression
of property values, the threatening
of small businesses and farms, and
a lowered quality of life in rural
areas.[14]
Recommended Action
Following the recommendation of
the Pew Commission on Industrial
Farm Animal Production in 2009,
there should be a federal phase out
and ban by 2030 of intensive con-
finement of farm animals in CA-
FOs.[11] In modeling the successful
policy precedent established by CA
Proposition 12, the most ambitious
farm animal protections legislation
in the United States to date, this
policy proposal would entirely ban
the sale and production of:
• Eggs (shell and liquid) produced
by hens (including turkey, chick-
en, goose, duck, or guinea fowl)
that are not in cage-free laying
facilities ( United Egg Produc-
ers’ 2017 cage-free guidelines).
• Veal meat (whole) taken from a
calf confined to a usable floor
space of less than forty-three
square feet.
• Pork meat (whole) that was
born from a breeding pig
confined to a usable floor space
of less than twenty-four square
feet.
The United States Food and Drug
Administration would be responsi-
ble for implementation and en-
forcement. A violation of this law
would be a federal misdemeanor
(as well as state, in the cases of
existing state animal confinement
laws), warranting an $1,000 fine
per animal violated. The revenue
generated from these fines would
then be directed to subsidies spe-
cifically established for members
of the clean meat and plant-based
meat industries.
Twelve individual states have im-
plemented similar policies.[12] In
2016, Massachusetts passed a ballot

measure that banned gestation
crate, battery cage, and veal crate
use as well as the sale of animal
products produced using these
mechanisms.[13] In 2018, Califor-
nia passed Proposition 12, which
strengthened cage-free require-
ments for laying hens, veal calves,
and mother pigs, and banned the
sale of veal and pork reared in
cages. [14]
Opponents of this policy fall into
two major camps: PETA opposed
Prop 12 in California due to their
belief that such a bill enables an in-
herently flawed animal agriculture
system and does not go far enough
in protecting animal rights. Other
opponents, such as the Association
of California Egg Farmers, argued
that food prices would rise. [15]
As individual states adopt higher
standards, CAFOs that do not
adhere to them will be left out of
major markets within the country.
[16] For example, California is the
fourth-largest beef-producing state
in the United States as well as a
major meat market.
While the transition to less severe
confinement practices will be costly,
amounting to billions of dollars for
the cage-free egg market alone, the
negative externalities of current
farming practices conceal hidden
costs that manifest in costs for
health or safety. [17] Though price
increases will be reflected at the su-
permarket, the costs of antibiotics
given to the animals will likely de-
crease, as will negative externalities
to humans in areas such as public
health. Furthermore, the transition
to more humane farming practices
would improve the price compet-
itiveness of clean and plant-based
meat industries. The comparability
of prices (and of tastes) over time
will incentivize consumers to pur-
chase these vegan substitutes, which
do not contribute to animal rights
violations, which have lower green-
house gas emissions, and which use
less water, energy, and land. [18]
Conclusion
This policy will have the greatest
chance for legislative success if it
is sponsored by a reputable animal
rights organization such as the
Humane Society, which sponsored
California Proposition 12 in 2018.
Through lobbying activities of this
organization and public support
from the League of Conservation
Voters, an organization that en-
dorses environmentally-friendly
candidates and legislation, this
policy could gain the attention of
a national Congressperson, who
would then co-sponsor a bill to pass
nationwide.
No current legislation in Congress
addresses these goals directly. The
2008 CAFO rule addresses dis-
charge from CAFOs specifically.
[19] Considering the recent success
of Proposition 12 in California as
well as the bipartisan nature of
animal protection issues in Con-
gress, this bill would have a high
likelihood of passing.[20] Addition-
ally, both red and blue states have
passed farm animal confinement
legislation, including California,
Massachusetts, Kentucky, and
Ohio. Finally, the general public
has expressed discomfort with the
current animal agriculture system,
with 49% supporting a full ban on
factory farming for animals.[21]
Opposition comes from a small yet
powerful portion of society and is
amplified by the strong agricultural
lobby, which pushes for Ag-Gag
laws, which legally conceal unjust
animal treatment through special
protections granted to factory
Roosevelt Review
farms.[22] Through public aware-
ness campaigns, these sources of
opposition can be overcome by the
popular vote.
References
1. Pew Charitable Trusts, and Johns
Hopkins Bloomberg School of Public
Health. Putting Meat on the Table:
Industrial Farm Animal Production
in America. Accessed April 18, 2019.
http://www.pewtrusts.org/~/media/
assets/2008/pcifap_exec-summary.
pdf.
2. “Farm Animals Need Our Help.”
ASPCA. Accessed April 18, 2019.
https://www.aspca.org/animal-cruel-
ty/farm-animal-welfare.
3. USDA. “Animal Feeding Opera-
tions.” Natural Resources Conserva-
tion Service. Accessed April 18, 2019.
https://www.nrcs.usda.gov/wps/
portal/nrcs/main/national/plantsani-
mals/livestock/afo/.
4. Lehner, Peter, and Nathan A. Ros-
berg. “Legal Pathways to Carbon-Neu-
tral Agriculture.” Env. L. Rep. 47, no.
10845 (2017).
5. Wasley, Andrew, Malden Davies,
David Child, and Fiona Harvey. “Rise
of Mega Farms: How the U.S. Model
of Intensive Farming Is Invading the
World.” The Guardian. Last modi-
fied July 18, 2017. Accessed April 18,
2019. https://www.theguardian.com/
environment/2017/jul/18/rise-of-me-
ga-farms-how-the-us-model-of-inten-
sive-farming-is-invading-the-world.
6. Pew Charitable Trusts, and Johns
Hopkins Bloomberg School of Public
Health. Putting Meat on the Table:
Industrial Farm Animal Production
in America. Accessed April 18, 2019.
http://www.pewtrusts.org/~/media/
assets/2008/pcifap_exec-summary.
pdf.
7. Gonchar, Michael. “Should Farm
Animals Have More Legal Protec-
tions?” The New York Times. Last
modified February 18, 2018. Accessed
April 18, 2019. https://learning.blogs.
nytimes.com/2015/02/18/should-
farm-animals-have-more-legal-protec-
tions/.
35
 Redirecting RGGI: Increasing Energy
Efficiency in the Granite State
By Eric Scheuch
Introduction
Although it has one of the lowest
unemployment rates in the coun-
try, New Hampshire’s economy is
plagued by two serious, long-term
policy challenges related to en-
ergy and the environment: high
energy costs and climate change.
These challenges disproportion-
ately affect the Granite Staters who
can least afford to deal with them,
eating up the paychecks of low
and middle-income residents while
threatening the service and tourism
industries that provide for so many
of those same citizens.
Background
New Hampshire has some of the
highest energy costs in the United
States -- the average resident spent
nearly $4,000 on energy in 2015,
and many low-income Granite
Staters consistently spend more
than a third of their income just
to heat their homes and keep the
lights on. [1] Energy costs vary
across New Hampshire based on
the energy efficiency of homes and
schools, thus energy costs rarely
correlate to individual financial re-
sources. For example, a Pittsburgh
who heats her home with heating
oil spends far more on heating than
a young professional in Manchester
who lives in a modern apartment
with central heating. Likewise, old,
rural high schools which cannot
afford upgrades are far less energy
efficient than newer high schools.
Since 2008, New Hampshire has
participated in the Regional Green-
36
house Gas Initiative (RGGI), a
regional cap and trade program
to reduce carbon emissions from
power plants. The proceeds from
RGGI’s auctions are distributed
among the states, which are then
free to spend the money as they
see fit. Currently, New Hampshire
spends $1 per ton auctioned on en-
ergy efficiency programs, then gives
the rest back to taxpayers through
a rebate. Those energy efficiency
programs are incredibly popular --
10,000 low-income households are
on the waiting list for a program
that serves about 100 per year. [2]
RGGI-funded energy efficiency
programs are beneficial in three
ways: they create jobs in construc-
tion and other industries, cut car-
bon emissions, and reduce energy
costs for low-income ratepayers.
While a dollar spent on a ratepayer
rebate saves that ratepayer a dollar
on their energy bill, a dollar spent
on funding the existing energy
efficiency programs administered
by New Hampshire’s government
provides energy savings of $4.70,
making funding energy efficiency
programs the most efficient way to
reduce energy prices. Those pro-
grams are poised to support 1,200
jobs and reduce emissions by 2.8
million tons over the next three
years. [3] The New Hampshire leg-
islature and governor decide how
to spend RGGI proceeds.
Recommended Action
New Hampshire’s legislature should
repeal the RGGI rebate and redi-
recting the revenue to funding en-
ergy efficiency programs, in order
to should serve New Hampshire’s
economy, environment, and most
vulnerable. The legislature should
increase the amount of money cur-
rently allocated to programs serv-
ing low-income ratepayers from $1
per ton to 35% of RGGI proceeds,
while dedicating any surplus reve-
nue to help finance energy efficien-
cy projects in needy municipalities
and school districts. This change in
the RGGI funding formula would
help reduce the crippling energy
bills faced by low-income ratepay-
ers and cash-strapped localities.
This proposed policy change will
use an existing policy framework,
the RGGI rebate program, to tack-
le high energy costs and climate
change, at the same time. This ap-
proach has a number of advantag-
es. Every year, millions of dollars
leave New Hampshire to buy fossil
fuels from out of state sources. By
cutting energy use, energy efficien-
cy can keep those dollars in the
state. Additionally, those hit hardest
by high energy bills -- the low-in-
come and elderly -- would be first
in line to receive energy efficiency
funds under this policy. Meanwhile,
by increasing energy efficiency,
local governments and school
districts will save taxpayer dollars.
Finally, increased energy efficiency
helps mitigate the effects of climate
change, which poses a grave threat
to our air quality and the health of
our mountains.
Conclusion

Changes to the RGGI funding
formula must originate with the
legislature. A similar policy, HB
559, passed the State House last
year but was defeated by the State
Senate. However, new Democratic
majorities in both houses make this
policy passable during the current
legislative session. A new bill should
originate in the State Senate since
that is the more contentious cham-
ber, and Dan Feltes, who co-spon-
sored HB 559, is now the Senate
Majority Leader.
Ideally, any new bill to change
the formula would consult with
regional groups like the Conser-
vation Law Foundation and the
Acadia Center, which have already
performed extensive research on
the topic. Input from Republican
legislators and the Governor’s Of-
fice of Strategic Initiatives should
be incorporated into the bill, since
right now the bill would need either
the Governor’s support or Republi-
can votes for a veto override. Given
that efficiency is a stated goal of
the Governor’s energy strategy,
Republican cooperation is possible.
Though this might require com-
promises to the proposed funding
formula above, that would be a
small price to pay for immediate
action to deal with pressing energy
and climate crises.
References
1. “NH 10 Year Energy Strategy.”
NH Office of Strategic Initiatives.
April 15, 2018. Accessed No-
vember 27, 2018. https://www.
nh.gov/osi/energy/programs/
documents/2018-10-year-state-en-
ergy-strategy.pdf.
2. Richardson, Herb, and Dan
Feltes. “Our Turn: Bipartisan
Compromise Needed on Energy
Efficiency.” Concord Monitor
Online. January 09, 2018. Accessed
Roosevelt Review
November 28, 2018. https://www.
concordmonitor.com/Biparti-
san-compromise-needed-on-ener-
gy-efficiency-14759209.
3. Ropeik, Annie. “N.H. Senate
Defeats Bill To Funnel RGGI
Funds Into Energy Efficiency.”
New Hampshire Public Radio.
April 26, 2018. Accessed No-
vember 28, 2018. http://www.
nhpr.org/post/nh-senate-de-
feats-bill-funnel-rggi-funds-ener-
gy-efficiency#stream/0.
4. NH General Court: “House
Bill 559-FN”, NH General “New Hampshire has
Court, March 06, 2018. Accessed
April 9, 2019.www.gencourt. some of the highest en-
state.nh.us/bill_status/billText.
aspx?sy=2018&txtFormat=htm-
ergy costs in the United
l&v=HA2&id=476.
5. Sanders, Bob. “NH’s RGGI Deal
States -- the average
Maintains State’s Energy Course.” resident spent near-
New Hampshire Business Review.
August 24, 2018. Accessed No- ly $4,000 on energy
vember 28, 2018. https://www.
nhbr.com/Sept-1-2017/NHs-RG-
in 2015, and many
GI-deal-maintains-states-energy-
course/.
low-income Granite
Staters consistently
spend more than a third
of their income just to
heat their homes and
keep the lights on.”
37
38
 Roosevelt Review

Foreign Policy
While foreign policy and international affairs topics never fail to attract attention and
debate, proposing policy on these issues presents many challenges. More holistically,
the Foreign Policy center focused on developing the ability to look at incredibly com-
plex issues of global proportions and discern tangible, focused policy outcomes that
identify actors in the position to make a difference. The nuance of foreign policy, as
seen in the piece in this section, makes it something incredibly difficult to discuss and
write about. However, the interconnectedness of our society makes it of the utmost
importance that we continue to have these discussions.

-- Meher Malik, Center Director

39
 Reducing Maritime Transportation Pollution:
A Template For International Collaboration on
Sectoral Emissions Reduction?
By Connor Haseley
Introduction
Maritime transportation industries
currently emit some of the dirtiest
transportation fuels on the plan-
et, contributing to pollution and
anthropogenic climate change.
Maritime emissions have steadily
grown faster than land-based emis-
sions. [1] International cooperation
to end the use of the dirtiest fuels
in Arctic maritime transportation
operations is not just a feasible way
of effecting serious change but
also can increase goodwill between
states and set an example for future
international cooperation on other
climate change issues.
Background
Heavy fuel oil, also commonly
called bunker fuel, emits upwards
of 95% more black carbon, sulfur,
nitrogen oxides, and other pol-
lutants compared with other fuel
oils, as well as around 10% more
carbon dioxide than other fuel oils.
Spills of heavy fuel oils are more
damaging to the environment and
several times more expensive to
clean than other oil spills. Maritime
transportation companies generally
use heavy fuel oil instead of green-
er alternatives because heavy fuel
oil is 60% cheaper. [2]
Greenhouse gases from transpor-
tation are a primary contributor
to anthropogenic climate change.
Greenhouse gases must be reduced
in order to avoid the worst effects
of climate change. Black carbon
40
(soot) also contributes to climate
change by decreasing the earth’s
reflectivity.
The International Maritime Or-
ganization (IMO), a United Na-
tions specialized agency in charge
of regulating shipping, recently
called for a 50 percent reduction in
greenhouse gases from the shipping
sector by 2050. [3] This is a big
commitment with the potential for
tangible effects: Emissions from
maritime transportation consti-
tute 2.5% of global greenhouse
gas emissions and are estimated to
increase 50 to 250 percent by 2050
under a business as usual scenario.
[4]
In order to achieve this goal, coun-
tries must work together to regulate
maritime transportation emissions.
This regulation is politically and
practically feasible and thus rep-
resents an invaluable opportunity
for states to collaborate in reduc-
ing greenhouse gas emissions at a
small but still important scale, in
such a way that it might serve as a
template for international cooper-
ation on sector-by-sector emissions
reductions.
Recommended Action
Banning the use of heavy fuel oils
in Arctic maritime transportation
should be the next step toward
reducing emissions and pollution
from the maritime transportation
sector. The Arctic is particularly
vulnerable to the effects of climate
change, black carbon emissions,
and oil spills, yet heavy fuel oil
constituted 75 percent of the mari-
time transportation fuel used in the
Arctic, by weight. [5]
The IMO currently bans the use
of heavy fuel oils in the Antarctic.
The IMO has the opportunity to
issue regulations banning the use
of heavy fuels in the Arctic at the
Pollution Prevention and Response
subcommittee meeting, scheduled
to take place in 2020. The ban
would take effect in 2023. The
subcommittee will do so only if
there is unanimous support from
Arctic member states. Right now,
the ban is supported by the United
States, Finland, Sweden, Norway,
Denmark, and Iceland. Russia and
Canada currently do not support
the ban, though neither has cate-
gorically refused withhold support
in the future. [6]
The political costs of banning
heavy fuel oils from the Arctic
would be low, particularly com-
pared with the political costs of
other climate-related policies such
as closing coal-fired power plants.
The burden would largely be borne
by private companies, and since the
same regulations would bind each
company, it is unlikely that one
state’s shipping industry would ben-
efit at the expense of others. Some
shipping companies have already

begun to phase in lower-emissions
fuels in anticipation of a stricter
regulatory environment. [7]
Conclusion:
United States support for any cli-
mate action during the Trump ad-
ministration is hard to come by, but
the United States supports this ban.
United States diplomats should
pressure Canada and Russia to sup-
port this ban as a way of restarting
United States-supported climate
coordination. Securing their sup-
port will require skilled diplomatic
negotiation but given the rapid
recent shift in consensus towards
prioritizing emissions reduction
within the maritime transportation
industry, achieving this cooperation
is well within reach.
International cooperation on mar-
itime transportation is straightfor-
ward since maritime transportation
is on its face an international issue.
If the ban on heavy fuel oils in the
Arctic is a success, the next step
would be expanding the coalition
of countries within the maritime
transportation sector willing to ban
heavy fuel oils, the goal being a
worldwide ban on the use of heavy
fuel oils. Going further, interna-
tional cooperation on emissions
reduction in the maritime transpor-
tation industry will contribute to
the body of knowledge on how to
reduce emissions within a specific
sector, paving the way for better
cooperation on sectoral emissions
reductions.
Roosevelt Review
ronment. Web. Accessed April 19,
2019.; The Engineering Toolbox.
“Combustion of Fuels - Carbon
Dioxide Emission.” Web. Accessed
April 19, 2019.
3. International Maritime Orga-
nization. “UN body adopts climate
change strategy for shipping.” Web.
Accessed April 19, 2019.
4. European Commission. “Re-
ducing emissions from the shipping
sector.” Web. Accessed April 19,
2019.
5. “7 Reasons.”
6. McKenna, Phil. “Global Ship- “International cooperation
ping Inches Forward on Heavy Fuel
Oil Ban in Arctic.” Inside Climate
on maritime transportation
News. Web. Accessed April 19, is straightforward since
2019.
7. Ibid.
maritime transportation is
on its face an international
issue. If the ban on heavy
fuel oils in the Arctic is a
success, the next step would
be expanding the coalition
of countries within the
maritime transportation
sector willing to ban heavy
fuel oils, the goal being a
worldwide ban on the use
of heavy fuel oils.”

References
1 AirClim. “Air pollution from
ships.” Web. Accessed April 19,
2019.
2. Harun, Kevin, and DJ Tyson.
“7 Reasons to Ban Heavy Fuel Oil
From the Arctic.” Pacific Envi-
41
42
 Roosevelt Review

Healthcare
At the Healthcare Center of the Columbia University Roosevelt Institute, we believe
unequivocally that healthcare is a fundamental human right. In this vein, our Center’s
bi-weekly discussions centered around pragmatic solutions to some of our nation’s
most pressing health policy challenges, including the opioid epidemic, racial disparities
in maternal morbidity and mortality, and the spread of chronic hepatitis C. Beyond
these discussions, we also undertook a letter writing campaign to expand access to
direct-acting antivirals--a novel hepatitis C medication--in New York State. Through
a combination of discourse and activism, our group sought to promote an enhanced
awareness of health policy problems within the Columbia community.

This year’s writers chose to tackle an impressive array of issues, ranging from Medic-
aid work requirements to expanded coverage for mental health disorders. The policies
contained herein are united by one common goal: to expand access to high-quality and
affordable healthcare for all Americans.

-- Sinead Hunt, Center Director

43
 Decriminalizing Overdoses: Saving Lives
by Protecting the Rights of Parolees
By Francesca Barasch and Augusta Owens
Introduction
Drug overdoses are becoming in-
creasingly common throughout the
United States. Decriminalization
policies, however, are not are not
moving at equal rates. Other states
are facing similarly high numbers
of drug related arrests of parolees
and people on probation. However,
18 out of 50 states recognize that
relapse is sometimes a part of re-
covery, and that parolees and peo-
ple on probation who are enrolled
in drug rehabilitation programs
should be protected from drug
related charges under the law. The
majority of these states have passed
laws protecting parolees who
overdose from legal repercussions
since 2011, in response to the spike
in opioid use and related deaths, as
they want to encourage people to
still seek medical attention if they
overdose and not worry about legal
ramifications.
Background
New York State faces an epidemic
of drug overdoses. The numbers
of deaths caused by opiods in New
York has doubled since 2009. Fur-
thermore, 20-25% of high school
students report being offered, giv-
en, or sold illegal drugs. The drug
crisis not only affects the number
of deaths in New York, it relates
to the number of people impris-
oned due to drug related charges.
47% of inmates in federal prisons
are incarcerated due to drug law
violations in the United States. In
New York over 10% of the prison
population is incarcerated due to
44
drug offenses. This population has
high recidivism rates, and people
on probation and parole who over-
dose are criminalized. In 2017 New
York State arrested 1,512 parolees
and 1,432 people on probation due
to drug related offenses.
Recommended Action
The New York State Congress
should amend Controlled Sub-
stance Offenses Laws, section
220.78: Witness or Victim of Drug
or Alcohol Overdose, to protect
parolees who overdose from legal
repercussions if they are seeking
drug treatment. In response to the
opioid crisis, Member of New York
State Congress write and imple-
ment a first-degree amendment to
section 220.78 of the Controlled
Substance Offenses Laws. This
will act to expand New York good
samaritan laws to protect the rights
of parolees and people on proba-
tion in the event of an overdose
if they are seeking drug rehabili-
tation. Of the 18 other states that
have these laws, the majority of
them have passed through first-de-
gree amendments to existing state
laws. Opioid overdoses claim tens
of thousands of American lives ev-
ery year, and many of these deaths
would be preventable through the
life-saving measures of emergency
responders who carry an opioid
antidote, naloxone. Decriminalizing
a parolees overdose if they are seek-
ing drug treatment will save lives
at virtually no monetary cost. In a
Washington state survey of drug
users, 88 percent of those surveyed
said that they would be more likely
to summon emergency personnel
during an overdose if the state
adopted overdose Good Samaritan
laws that would protect them. If
the same policy were adopted in
New York it would likely save lives
and be economically beneficial for
the state. When a parolee overdoses
and consequently are assigned a
court date this wastes overload-
ed judges and public defenders’
time, adding to their caseloads
and detracting from their ability to
devote adequate time and resourc-
es to each case. Ending the opioid
crisis and drug-related deaths is
not possible with one policy. How-
ever, protecting parolees from the
political ramifications of seeking
medical attention during an over-
dose is an important step in destig-
matizing and decriminalizing drug
addiction, and will increase use of
medical attention, allow people to
stay in treatment, and ultimately
save lives.
Conclusion
For previous drug users on parole
or probation, seeking medical
attention during an overdose can
endanger their standing in the
Justice System, making them less
likely to call emergency services in
the event of an overdose. Relapse is
often a stop on the road to recov-
ery and criminalizing addiction is
harmful to the health and lives of
New Yorkers. The New York State
Legislature needs to be the agent of
this important change and pass an
amendment to Section 220.78 of

the Controlled Substance Offens-
es Laws. Various rights advocacy
groups would likely get involved,
as they have in other states that
previously lacked inclusive good
samaritan laws, including the
ACLU and the Osbourne Center.
Additionally, activist organizations
like Rise and Resist, the Urban
Justice Center, and A More Just
NYC would get involved, giving
the cause more lobby power and
putting more pressure on New York
State congress members. We would
organize a group of students invest-
ed in activism by paternering with
interested clubs such as Amnesty
International, CUDemocrats, and
Barnard Criminal Justice Initiative.
We would meet with the heads of
clubs to see if they would promote
our events and join our fight. The
group would then write and ac-
quire signatures on a petition to NY
congressmen by conducting a social
media campaign on Instagram
and Facebook and tabling across
campus. Social media posts would
include information about our pol-
icy, such as statistics on drug over-
doses in New York and the amount
of parolees affected by our policy.
We would feature student voices
on this page, asking them why this
policy is needed. The social media
pages would include the times and
locations of our events including
tabling for petition signatures. Later
in the semester, we would organize,
through facebook event, trips to
the Manhattan district offices of
members of the standing commit-
tee on Drug and Alcohol Abuse to
lobby, creating connections with the
key actors in our policy. Finally, the
semester would culminate in a lob-
bying trip to Albany to meet with
congressmen to advocate for our
policy. We would follow up with the
connections made from this trip
and continue to engage the cam-
pus community to promote direct
contact with representatives.
In December, we will create a
petition for the New York State
Legislature to pass this amendment,
and have people include their zip
code and address on the form, so
we can reach out to them later and
help them directly contact their
state congress members. In Janu-
ary, we will begin a direct contact
campaign, encouraging people to
reach out to their congress mem-
bers via phone and mail. In Febru-
ary, we will lobby at the offices of
New York State Congress Members
that have district offices in Man-
hattan: Dan Court, Linda Rosen-
thal, Nathalia Fernandez, Maritza
Davila, and Carmen E. Arroyo.
The New York State Legislature
has the most session days in March,
making it the best time to lobby. We
would organize a trip and set up a
meeting with the staff of the Chair-
woman of the Standing Committee
on Alcohol and Drug Abuse, Linda
Rosenthal, to discuss implementing
this policy. Following our lobby trip,
we would continue to advocate for
these policies based on what our
congress members say about what
we can do to most effectively sup-
port this policy.
References
1. “LEGAL INTERVENTIONS
TO REDUCE OVERDOSE
MORTALITY: NALOXONE AC-
CESS AND OVERDOSE GOOD
SAMARITAN LAWS.” The
Network of Public Health Law. July
2017. https://www.networkforphl.
org/_asset/qz5pvn/network-nalox-
one-10-4.pdf. P. 12.
2. “New York State - County
Opioid Quarterly Report.” New
York State Department of Health.
Roosevelt Review
October 2018. https://docs.google.
com/document/d/1JmjMjC3k8ze-
wXPjiTgf96pxWwkuBa9VdJE-
E1XSOnEOY/edit. P. 3.
3. “Percentage of high school
students reporting having been
offered, sold, or given an illegal
drug on school property during the
past 12 months by grade level, New
York State.” New York State Opi-
oid Prevention Program. July 2018.
https://www.health.ny.gov/statis-
tics/opioid/data/pdf/p10.pdf. P. 1.
4. “The Drug War, Mass Incar-
ceration, and Race.” Drug Policy
Alliance. January 2018. http://
www.drugpolicy.org/sites/default/
files/drug-war-mass-incarceration-
and-race_01_18_0.pdf. P. 1.
5. Wager, Peter and Wendy Saw-
yer. “Mass Incarceration: The
Whole Pie 2018,” Prison Policy
Initiative, 14 March 2018.
6. “Parolee/ Probationer Arrest
Percent of Total Within County.”
Division of Criminal Justice Ser-
vices Crimestat Report. March
2018. http://www.criminaljus-
tice.ny.gov/crimnet/ojsa/parol-
ee-and-probationer-arrest.pdf. P. 3.
7. “LEGAL INTERVENTIONS
TO REDUCE OVERDOSE
MORTALITY: NALOXONE AC-
CESS AND OVERDOSE GOOD
SAMARITAN LAWS.” The
Network of Public Health Law. July
2017. https://www.networkforphl.
org/_asset/qz5pvn/network-nalox-
one-10-4.pdf. Ibid.
8. Banta-Green, C. Washington’s
911 Good Samaritan Overdose
Law: Initial Evaluation Results
(Nov. 2011), available at http://
adai.uw.edu/pubs/infobriefs/
ADAI-IB-2011-05.pdf
45
 Medi-Cal and Work Requirements
By Juliet Emerson-Colvin
Background
Many agree that Medicaid as a
whole has been a monumental-
ly successful program. It has not
only achieved its fundamental goal
of providing health insurance to
low-income populations but has
also improved health outcomes, re-
ducing the infant mortality rate by
8.5% with expansions in the 1980s.
[1] Assessed on this criterion alone,
Medicaid paid for itself several
times over, as it cost $1 million to
save each of these lives, while each
is statistically worth $3-7 million.
This general satisfaction led to a
widespread Medicaid expansion
through the Affordable Care Act.
California adopted the expansion
in 2014 with 3.8 million more
becoming eligible for the Medi-Cal
program, causing the uninsured
rate to drop from 17.2% to 7.2%
between 2013 and 2017 [2], where-
as the average uninsured rate for
non-expansion states was 18.4% in
2018. [3]
In response to the increased costs
of new expansion enrollees and a
strong belief in motivating work,
some states, including Kentucky,
Arkansas, Ohio, Utah, and Wis-
consin, decided to establish work,
school, or volunteering activities
(later simply referred to as “work”)
as an eligibility requirement for
Medicaid. [4] This policy has been
advertised as a means of advancing
the overarching goals of the pro-
gram while reducing costs. How-
ever, these requirements serve to
fundamentally undermine access to
healthcare for low-income popu-
lations, which is antithetical to the
very purpose of Medicaid. These
46
policymakers seem to interpret
the objective of Medicaid, at least
in part, as pulling individuals out
of poverty, implying that people
should work in order to receive this
coverage and then eventually earn
enough to no longer qualify, thus
saving the government money and
pulling themselves out of poverty.
Recommended Action
In order to promote the well-being
of Californians, it is not recom-
mended that the state of California
follow suit by establishing work
requirements for Medi-Cal.
These new eligibility criteria reveal
a misunderstanding of the popu-
lation of Medicaid recipients. The
vast majority of those not working
are justifiably unemployed: caregiv-
ing for a dependent minor, caregiv-
ing for a disabled person, or having
a disability or serious medical
condition themselves. The majority
of those who can work are working
full-time, full-year. [5] In fact, of
the non-disabled, non-elderly adult
population receiving Medi-Cal,
62% are working and 84% are in
working families. [6] Therefore, the
implementation of a work require-
ment would not motivate signifi-
cant numbers of current Medi-Cal
recipients to work or increase hours
of work.
Even if exemptions to the work
requirements were established, as
they must be, there are significant
barriers for these individuals to
secure exemptions. For instance,
many of those not working who
should qualify for exemptions lack
Internet access, lack access to a
vehicle, and/or have not received
their high school diploma. [7]
Similar barriers prevent even those
who are working to report their
work and comply with eligibility
requirements. Medicaid’s objective
of providing healthcare to low-in-
come individuals implies that the
least well-off individuals are given
assistance by gaining health insur-
ance coverage. The most vulner-
able Medicaid recipients—those
who are unable to work—stand to
lose the most from this program.
The effect of the work requirement
would be to kick people off the
Medicaid rolls who are unable to
qualify for exemptions, including
those who may struggle to formally
verify their disability. The stan-
dard work requirement for states
proposing this change is 80 hours
per month, [8] so people who are
not working enough may lose their
Medicaid coverage as well. Many
working recipients have part-time
and/or part-year jobs and would
face the instability of inconsis-
tent Medicaid coverage. It may
even force those who are working
enough, but have difficulty report-
ing their work, to lose coverage.
16,000 Arkansans, about 3% of
those covered by Medicaid in the
state, have lost coverage after the
establishment of work require-
ments. [9] This effectively means
that about 16,000 Arkansans have
become uninsured, because they
likely cannot afford insurance on
the non-group private insurance
market if they are not working and
may not receive group insurance
through their low-wage, low-bene-

fit, likely part-time job. Thus, while
reducing the number of uninsured
Americans may not be a direct
goal of Medicaid, it is certainly a
consequence of providing generous
insurance to low-income individu-
als who could not afford insurance
otherwise.
A larger uninsured population can
have a variety of negative conse-
quences. This population is more
likely to use expensive, inappropri-
ate emergency care rather than less
expensive, appropriate preventive
and primary care. This can neg-
atively impact these individuals’
health and have a cost-shifting
effect, a process where hospitals’
provision of uncompensated care
to low-income individuals leads
them to increase prices, which are
then passed on the insured pop-
ulation through higher insurance
premiums.
A primary rationale for the estab-
lishment of work eligibility criteria
is that the decreased number of
Medicaid recipients would reduce
costs for state governments. Indeed,
Medi-Cal is expensive, costing Cal-
ifornia $36 billion in 2017. How-
ever, the majority of the Medi-Cal
expansion has been covered by the
federal government, increasing
state spending on Medi-Cal by
only 2.8%. [10] There are much
more effective ways of addressing
the overarching problem of exorbi-
tantly high federal healthcare costs,
including reforming the individual
private insurance market, which
would actually decrease the num-
ber of uninsured individuals. This
may be a more complex policy
issue to solve than simply tactful-
ly reducing Medicaid rolls, but it
would have real positive impacts
on health outcomes and coverage
that the work requirements policy
cannot claim. It is also worth not-
ing that comprehensive reform of
these other segments of the health
insurance market might make cov-
erage more affordable for some of
the current higher-income Medic-
aid recipients. Once those reforms
are fully successful, a conversation
could begin about moving current
Medicaid recipients to the private
insurance market.
Conclusion
Evidence from the contested rollout
of the Arkansas Medicaid work
requirement policy shows that
losing health insurance forced some
individuals to stop working alto-
gether. [11] While we have yet to
see if these effects would be more
far-reaching with the rollout of
other states’ programs, it is logical
that losing coverage for any of the
aforementioned reasons could lead
to worsening health, which could,
in turn, lead to an inability to work
altogether. In this way, the imple-
mentation of work requirements
may act in opposition not only to
the goal of Medicaid by decreasing
the health insurance coverage of
low-income Americans, but also to
its own goal of motivating work.
Fortunately, California’s recent ef-
forts at Medicaid reform, including
the Section 1115(a) Waiver (known
Medi-Cal 2020), have focused on
further decreasing the uninsured
rate and integrating patients into
managed care, [12] in contrast
to the kinds of misguided work
requirements policies enacted by
other states.
References
1. Currie, Janet, and Jonathan Gru-
ber. “Saving Babies: The Efficacy
and Cost of Recent Changes in the
Roosevelt Review
Medicaid Eligibility of Pregnant
Women.” Journal of Political
Economy 104, no. 6 (1996): 1263-
296. http://www.jstor.org/sta-
ble/2138939.
2. Norris, Louise. “California and
the ACA’s Medicaid Expansion: El-
igibility, Enrollment and Benefits.”
Healthinsurance.org. November
29, 2018. Accessed April 16, 2019.
https://www.healthinsurance.org/
california-medicaid/.
3. Keith, Katie. “Two New
Federal Surveys Show Stable
Uninsured Rate.” Two New
Federal Surveys Show Stable
Uninsured Rate | Health Affairs.
September 13, 2018. Accessed
April 20, 2019. https://www.
healthaffairs.org/do/10.1377/
hblog20180913.896261/full/.
4.”Medicaid Waiver Tracker: Ap-
proved and Pending Section 1115
Waivers by State.” The Henry J.
Kaiser Family Foundation. April
18, 2019. Accessed April 19, 2019.
https://www.kff.org/medicaid/
issue-brief/medicaid-waiver-track-
er-approved-and-pending-section-
1115-waivers-by-state/.
5. Garfield, Rachel, Robin Ru-
dowitz, MaryBeth Musumeci, and
Anthony Damico. “Implications of
Work Requirements in Medicaid:
What Does the Data Say?” The
Henry J. Kaiser Family Founda-
tion. July 23, 2018. Accessed April
19, 2019. https://www.kff.org/
medicaid/issue-brief/implications-
of-work-requirements-in-medicaid-
what-does-the-data-say/.
6. Stremikis, Kristoff. “Medi-Cal:
A Program and a Population That
Work.” California Health Care
Foundation. January 17, 2018.
Accessed April 19, 2019. https://
www.chcf.org/blog/medi-cal-pro-
gram-population-work/.
47
 Expanding Access to Life-Saving
Hepatitis C Treatment: Removing Discriminatory
Sobriety Restrictions
By Sinead Hunt
Introduction
Hepatitis C virus infection (HCV)
is the most common chronic
bloodborne infection in the United
States.[1][2] Left untreated, it can
lead to cirrhosis, liver cancer, and
death.[3] HCV disproportionately
impacts historically marginalized
populations, including, people who
are homeless,[4] people who are
incarcerated,[5] and people who
inject drugs.[6] Injection drug use
is the single greatest risk factor
for HCV infection in the United
States.[7] In New York, an estimat-
ed 70% of the over 200,000 HCV
patients are people who inject
drugs.[8][9] Because people who
inject drugs are disproportionately
impacted by hepatitis C, argu-
ably they should be prioritized for
treatment. Paradoxically, the New
York State Medicaid pharmacy
program presently excludes people
who inject drugs from accessing
life-saving treatment through the
use of sobriety restrictions. This
practice is plainly antithetical to the
overarching goal of the New York
State Medicaid program: to pro-
vide healthcare to low-income and
historically marginalized popula-
tions.[10]
Background
Direct-acting antivirals (DAAs) are
promising new drugs that target the
specific proteins of the hepatitis C
virus to disrupt its replication.[11]
Because these medications boast
cure rates of over 90%,[12] they
have been hailed as a cure for hep-
atitis C.[13] Unfortunately, exorbi-
48
tant DAA prices have caused many
state Medicaid programs to limit
their availability through a variety
of bureaucratic restrictions. Cur-
rently, New York State’s Medicaid
program impedes many New York-
ers from accessing these life-saving
medications by employing bureau-
cratic sobriety restrictions.[14] The
NYS Medicaid Fee-For-Service
(FFS) pharmacy program requires
screening for substance and alco-
hol use to determine “treatment
readiness”,[15][16] and five major
Medicaid managed care organi-
zations likewise employ sobriety
restrictions.[17] As a result of these
bureaucratic restrictions, thirty-five
percent of Medicaid recipients with
hepatitis C are routinely denied
coverage for their prescription
treatment.[18]
Proponents of these restrictions
argue that injection drug users
should be excluded from antiviral
therapy because they are unlikely to
adhere to treatment.[19] In reality,
there is mounting evidence that
sobriety is a poor indicator of psy-
chosocial treatment readiness, and
that when people who inject drugs
are provided with adequate social
support, they just as likely to adhere
to DAA treatment regimens as their
abstinent counterparts.[20][21]
[22] According to official guidance
provided by the Centers for Medi-
care and Medicaid Services,[23]
by “imposing conditions for cover-
age that may unreasonably restrict
access to these drugs,” New York’s
use of sobriety restrictions vio-
lates the statutory requirements of
section 1927 of the Social Security
Act.[24] These sobriety restrictions
serve to unreasonably curtail access
to life-saving medication for people
who inject drugs.
Recommended Action
To expand access to direct-acting
antivirals (DAAs), the New York
State Medicaid Drug Utilization
Review Board should eliminate
sobriety restrictions for the Med-
icaid FFS pharmacy program.
Thirteen states have already re-
moved sobriety requirements from
DAA pre-prescribing guidelines,
and several states, including New
Mexico, Michigan and Virginia,
specify that a patient cannot be de-
nied treatment for the sole reason
of substance use.[25] New York
should follow suit and reform its
FFS pre-prescribing guidelines to
expand access to hepatitis C medi-
cation for people who inject drugs.
Some argue that because people
who inject drugs are unlikely to
adhere to treatment, providing
them with direct-acting antivirals is
an inefficient use of public funds.
However, there is a growing body
of evidence that people who inject
drugs are just as likely to adhere to
treatment when they are provided
with appropriate social supports.
[26] Moreover, because people
who inject drugs constitute 70
percent of HCV-infected Medicaid
recipients,[27] the use of bureau-
cratic sobriety restrictions actually
impedes the majority of hepatitis

C patients from seeking out the
treatment they need. Without
access to appropriate treatment,
these individuals may develop
serious health complications that
will require even greater healthcare
expenditure down the line (i.e. liver
transplantation).[28]
Seventy-six percent of NYS Med-
icaid hepatitis C patients receive
treatment through managed care
organizations, not the Medicaid
FFS pharmacy program.[29] As
such, any proposed effort to amend
Medicaid prescribing guidelines
for DAAs must be enforced among
managed care organizations. Prior
attempts by activist groups to
reform restrictive DAA prescrib-
ing guidelines demonstrate that if
standardized DAA authorization
criteria are not enforced across FFS
and managed care organizations,
such reforms are, at best, symbolic.
[30] Transparency and enforce-
ment across managed care organi-
zations will ensure DAA coverage
parity across FFS and managed
care programs.[31]
Expanding access to antiviral
therapy would actually reduce
healthcare expenditure by averting
HCV-driven liver disease. Liver cir-
rhosis accounts for over two-thirds
of the $4.3 billion to $8.3 billion
annually spent caring for people
with hepatitis C.[32] Thus, by
decreasing the incidence of severe
liver disease, direct-acting antivirals
actually reduce the lifetime treat-
ment costs associated with hepatitis
C. Moreover, direct-acting antivi-
rals are cost-saving when compared
to the existing standard-of-care
treatment: interferon therapy. For
instance, when you compare Gra-
zoprevir/Elbasvir, a direct-acting
antiviral, to Pegasys/Ribavirin,
an interferon-based treatment,
the DAA treatment strategy is
significantly cheaper—$58,085
per sustained virologic response
(SVR) versus $101,849.[33] The
societal value of antiviral therapy
($197,574) far exceeds its sticker
price.[34]
Conclusion
As Governor of the State of New
York, Andrew Cuomo has ded-
icated prodigious resources to-
wards eradicating hepatitis C. His
administration’s “first-in-nation
approach” to ending the hepati-
tis C epidemic aims to “improve
the health of…those battling drug
addiction” through upstream inter-
ventions, including expanded fund-
ing for harm reduction programs.
[35] While these efforts are laud-
able, they ignore the needs of the
over 200,000 New Yorkers already
infected with the virus, who require
costly medications that they simply
cannot afford. Although Gover-
nor Cuomo is ostensibly devoted
to improving the health of people
with substance use disorders, whom
he describes as “the most vulnera-
ble among us,” his administration’s
policies systematically exclude peo-
ple who inject drugs from accessing
life-saving treatment.[36] Thus,
in order to improve the health of
people who inject drugs and reduce
long-term Medicaid pharmacy
expenditure, Governor Cuomo
should remove sobriety restrictions
from DAA pre-prescribing guide-
lines.
References
1. Armstrong GL, Wasley A, Si-
mard EP, McQuillan GM, Kuhnert
WL, Alter MJ. The Prevalence
of Hepatitis C Virus Infection in
the United States, 1999 through
2002. Ann Intern Med (2006) May
Roosevelt Review
16;144(10):705‐14.
2. Chen SL, Morgan TR. The Nat-
ural History of Hepatitis C Virus
(HCV) Infection. Int J Med Sci
(2006) 3(2):47‐52.
3. “Hepatitis C.” HHS.gov. April
10, 2018. Accessed November 03,
2018. https://www.hhs.gov/opa/
reproductive-health/fact-sheets/
sexually-transmitted-diseases/hepa-
titis-c/index.html.
4. Nyamathi, Adeline M., Elizabeth
L. Dixon, Wendie Robbins, Cyn-
thia Smith, Dorothy Wiley, Bar-
bara Leake, Douglas Longshore,
and Lillian Gelberg. “Risk Factors
for Hepatitis C Virus Infection
among Homeless Adults.” Journal
of General Internal Medicine17,
no. 2 (2002): 134-43. doi:10.1046/
j.1525-1497.2002.10415.x.
5. Hammett, Theodore M., Mary
Patricia Harmon, and William
Rhodes. “The Burden of Infec-
tious Disease Among Inmates of
and Releasees From US Correc-
tional Facilities, 1997.” American
Journal of Public Health92, no.
11 (2002): 1789-794. doi:10.2105/
ajph.92.11.1789.
6. Hagan H, Pouget ER, Des Jar-
lais DC. A Systematic Review and
Meta‐Analysis of Interventions to
Prevent Hepatitis C Virus Infection
in People who Inject Drugs. J Infect
Dis (2011) Jul 1;204(1):74‐83.
7. “ Who’s at Risk for Hepatitis C”.
New York State Department of
Health. Accessed April 05, 2019.
https://www.health.ny.gov/diseas-
es/communicable/hepatitis/hepa-
titis_c/whos_at_risk.htm.
8. Hart-Malloy, R, Carrascal, A,
DiRienzo, AG, Flanigan, C, et al.
(August 2013). Estimating HCV
Prevalence at the State Level: A
Call to Increase and Strengthen
Current Surveillance Systems.
American Journal of Public
Health, Vol. 103, No. 8.
49
 Protecting Healthcare Access in the Age
of Trump: A Proposal for a State-Based
Individual Mandate in New York
By Sinead Hunt
Introduction
On December 22, 2017, President
Donald Trump signed major legis-
lation that eliminated tax penalties
associated with the Affordable Care
Act’s individual mandate, thereby
repealing the requirement that
Americans maintain health insur-
ance. [1] The individual mandate,
also referred to as the “individual
shared responsibility provision,”
required that Americans maintain
health coverage or face tax penal-
ties of $695 per individual or 2.5
percent of household income. [2]
Among the most philosophical-
ly contentious provisions of the
Affordable Care Act, [3] the man-
date engendered significant de-
bate about the appropriate role of
government in the lives of individ-
uals. Opponents of the Affordable
Care Act argued that it infringed
on personal liberty by requiring
that Americans purchase health
insurance, a commercial good. [4]
Irrespective of its relative unpop-
ularity, [5] many health policy
experts argue that the individual
mandate is an unavoidable desid-
eratum of healthcare reform, an
essential “leg” of the “three-legged
stool” of the ACA. [6] Thus, the
Trump administration’s decision
to repeal the individual mandate
penalty seriously imperils the future
of healthcare affordability in the
United States.
Background
In the absence of an individual
mandate, the two signature protec-
50
tions of the ACA, guaranteed issue
and community rating, [7] threaten
to inflate exchange premiums and
destabilize individual healthcare
markets. [8] Community rating,
which prohibits price discrimina-
tion on the basis of underlying
health status, [9] raises premiums
for young, healthy people, thus dis-
suading these low-risk consumers
from purchasing health insurance.
Guaranteed issue, which requires
that insurers provide coverage to
anyone wishing to purchase it, [10]
further reduces healthy people’s
incentive to proactively maintain
insurance by promising them cover-
age if and when they should fall
ill. Low-risk consumers respond to
these market forces by dropping
coverage and entering the market
only when they fall ill, resulting in
an increasingly risky pool of enroll-
ees. [11] This process of adverse
selection invariably drives up pre-
miums, [12] resulting in a “death
spiral” in which only the very sick
purchase insurance at exorbitant
prices. [13]
The elimination of the individual
mandate penalty is predicted to
trigger a mass exodus of young,
healthy enrollees from the individ-
ual healthcare market. According
to prevailing economic wisdom and
evidence from past policy exper-
iments, the loss of these low-risk
consumers from the actuarial risk
pool will wreak havoc on state-
based marketplaces. The Congres-
sional Budget Office (CBO) esti-
mates that average premiums in the
individual market will increase by
about 10 percent and increase the
number of uninsured individuals
by 13 million by 2027. [14]
In New York, the effects of the
federal individual mandate penalty
repeal are already being felt. On
June 1st, 2018, insurers in New
York submitted their 2019 pro-
posed health insurance premium
rates to the Department of Finan-
cial Services. [15] On average,
insurers requested a 24 percent
premium rate increase in the indi-
vidual market, approximately half
of which is directly attributable to
the Trump Administration’s repeal
of the individual mandate penalty.
[16] These proposed rate increases,
which incited indignation on the
part of consumers,[17] are pre-
dicted to destabilize the New York
individual healthcare market and
increase the number of uninsured
New Yorkers.
Recommended Action
In order to rein in premiums and
maintain widespread access to
affordable healthcare, New York
should enact a state-based individ-
ual mandate. This would remedy
the negative consequences of the
federal mandate repeal by prevent-
ing the departure of young, healthy
enrollees from the actuarial pool,
controlling premium increases. Ac-
cording to an analysis conducted by
the Urban Institute, the implemen-
tation of a state-based individual
 Roosevelt Review
mandate in New York State would ual mandate discouraged the sale New York, consumers are already
reduce the number of uninsured of substandard coverage, including beginning feel the effects of the
residents by 142,000 in 2019 and association health plans (AHPs) and federal individual mandate repeal,
lower marketplace premiums by 9.9 short-term, limited-duration cover- as premiums rise throughout the
percent. [18] A state-based individ- age. [30] In order to protect New state. These increases are likely to
ual mandate would guarantee that Yorkers from exploitative insurer drive out young, healthy enrollees,
over 3 million New Yorkers who practices, it is recommended that and precipitate the dreaded “death
were uninsurable before the ACA New York adopts the same defini- spiral,” in which exchange premi-
have continued access to affordable tion of qualifying coverage em- ums become unaffordable for the
healthcare. [19] ployed in the 2010 ACA individual vast majority of enrollees. New
mandate. York can prevent this by instituting
There is evidence that state-level To ensure that its own individual a state-based individual mandate.
mandates are effective at curbing mandate penalty does not dispro- This would stabilize New York’s
premium increases and maintain- portionately burden already mar- individual healthcare market by
ing health insurance affordability. ginalized individuals and com- retaining low-risk consumers in
On May 30th, 2018, Governor Phil munities, New York should mimic the actuarial risk pool, thus low-
Murphy signed the “New Jersey the ACA federal mandate’s equity ering premiums and maintaining
Health Insurance Market Preserva- provisions. The ACA protected widespread access to health in-
tion Act,” making New Jersey the economically disadvantaged indi- surance. To uphold New Yorkers’
first state in the nation to respond viduals by imposing penalties that unalienable right to healthcare, it is
to federal attacks on the Affordable increased based on ability to pay essential that the state swiftly takes
Care Act with a state-based individ- while providing affordability and action to preserve its state-based
ual mandate. [20] The legislation, hardship exemptions. These ex- marketplace. If not, thousands of
which largely mirrors the now-de- emptions were designed to guaran- New Yorkers will lose access to
funct ACA individual mandate tee that the individual mandate did affordable health insurance.
in terms of tax penalties, [21] is not force poor people to purchase
estimated to have reduced issuers’ health insurance they simply could References
2019 premium requests by about 7 not afford.The affordability ex- 1. “The Tax Bill And The Individual
percent relative to what they would emption allowed individuals whose Mandate: What Happened, And What
have been without the state-based insurance costs were projected to Does It Mean?,” Health Affairs Blog,
mandate. [22] In light of New exceed 8.05 percent of household December 20, 2017. DOI: 10.1377/
hblog20171220.323429
Jersey’s resounding success, many income to claim exempt status. [31]
2. Mangan, Dan. “Trump Touts
states, including Vermont, [23] The hardship exemption allowed Repeal of Individual Mandate in
Connecticut, [24] Maryland, [25] individuals facing particular finan- ‘disastrous Obamacare’.” CNBC.
Washington, [26] and Hawaii, [27] cial, familial, or social exigencies, January 31, 2018. Accessed Decem-
are now considering implementing such as homelessness, foreclosure, ber 31, 2018.https://www.cnbc.
their own state-based individual or the death of a loved one, to com/2018/01/30/trump-touts-re-
mandates. [28] claim exemption. [32] By adopting peal-of-obamacare-individual-man-
these provisions, New York can date.html
In developing New York’s state-lev- further protect its most disadvan- 3. Von Spakosky, Hans. “Individ-
el individual health insurance taged residents from unmanageable ual Mandate Goes Against Basic
mandate, it is recommended that healthcare expenses. Freedom and Liberty.” U.S. News
& World Report. March 25, 2012.
legislators employ the now-defunct
Accessed December 31, 2018. https://
ACA federal mandate as a base- Conclusion www.usnews.com/debate-club/
line. The ACA individual mandate In light of the Trump administra- should-the-supreme-court-overturn-
integrated consumer protections by tion’s myopic repeal of the Afford- obamas-healthcare-law/individu-
clearly defining the benefits which able Care Act’s individual mandate al-mandate-goes-against-basic-free-
plans must provide in order to qual- penalty, it is imperative that state dom-and-liberty
ify as “minimum essential cover- legislatures take action to stabilize
age.” [29] In this way, the individ- individual healthcare markets. In
51
 Amending the Federal Controlled
Substances Act: Fostering Public Health
Innovation at the Local Level
By Sinead Hunt
Introduction
The United States is currently in
the midst of an unprecedented
public health crisis: the opioid ep-
idemic. Opioids, which are a class
of drugs that include prescription
pain relievers, heroin, and fentanyl,
[1] collectively claim the lives of
over 130 Americans every day. [2]
Today, it is widely recognized that
the opioid analgesics common-
ly prescribed by doctors to treat
chronic pain, including oxycodone,
hydrocodone, and codeine, are
highly addictive and dangerous. It
is estimated that 21 to 29 percent
of individuals prescribed opioids
to treat their pain ultimately mis-
use them. [3] Many individuals
who are dependent on prescription
opioid analgesics eventually tran-
sition to illegal drugs like heroin.
Based on data from the Substance
Abuse and Mental Health Services
Administration’s 2017 National
Survey on Drug Use and Health,
over 652,000 Americans are depen-
dent on heroin. As a result of these
alarming statistics, on October 26,
2017, President Trump directed the
Department of Health and Human
Services to declare the opioid crisis
a public health emergency. [4]
Background
In light of the unprecedented chal-
lenges posed by the modern-day
opioid epidemic, leaders of cities
and municipalities across the coun-
try have embraced new, innovative
policies based on the principles
of “harm reduction.” In contrast
52
to the United States’ historically
punitive response to the problem of
substance misuse, [5] harm reduc-
tion does not seek to unilaterally
impose abstinence on people who
inject drugs, but rather, to mitigate
the deleterious consequences of
their drug use. [6] Harm reduction
aims to meet people who inject
drugs “where they’re at” by pro-
viding them with a “spectrum of
strategies” to facilitate the safer use
of drugs. [7]
One such strategy includes the
implementation of “supervised
injection sites,” also known as “su-
pervised consumption services,” or
“overdose prevention centers.” [8]
Supervised injection sites are legally
sanctioned, medically supervised
facilities designed to provide a
hygienic and safe space for people
to inject pre-obtained intravenous
drugs. [9] By providing their clients
with sterile injection supplies,
supervised injection sites reduce
the transmission of bloodborne
illnesses such as HIV/AIDs and
chronic hepatitis C virus infection
(HCV). [10] Supervised injection
sites will often provide their clients
with testing strips to screen their
drugs for the presence of fentanyl,
[11] a dangerously potent synthet-
ic opioid that is often mixed into
heroin supplies. [12] In the case of
accidental overdose, trained health
workers stand by ready to intervene
with naloxone, [13] an overdose
antidote. [14] Through co-location
and referral, supervised injection
sites link their clients to a variety of
health and social services, including
addiction treatment, [15] equip-
ping their clients with the strategies
and support necessary to reduce
the harms of their drug use.
There is a formidable body of
research that corroborates the
efficacy of supervised injection sites
at reducing the harms associated
with injection drug use. Although
no such sites currently exist in the
United States, there are approx-
imately 120 supervised injection
sites operating in 10 countries
worldwide. [16] These existing
sites have been researched thor-
oughly, resulting in over 100 evi-
dence-based, peer-reviewed studies
that support their positive impacts.
[17] Supervised injection sites not
only reduce the incidence of fatal
overdose in the neighborhoods
where they are located, [18] but
they also increase entry into sub-
stance use disorder treatment, [19]
decrease public injection, [20] and
reduce risky behaviors associated
with the transmission of HIV and
HCV. [21]
Given the well-documented success
of supervised injection sites abroad,
leaders of cities across the county,
including Philadelphia, [22] Seattle,
[23] San Francisco, [24] Ithaca,
[25] and New York [26] have all
announced their intention to create
supervised injection sites. Their
efforts have been hitherto thwarted
by Section 856 of the federal Con-
trolled Substances Act, colloquially

referred to as the “Crack House
Statute.” [27] Under this law, any
individual who “knowingly open[s],
lease[s], rent[s], use[s], or main-
tain[s] any place...for the purpose
of...using any controlled substance”
may face up to 20 years in prison
or $500,000 in fines. [28] Thus,
supervised injection site operators
and staff could be at risk of pros-
ecution and imprisonment under
the Controlled Substances Act. [29]
Hypothetically, all that would be
required for supervised injection
sites to proceed is federal inaction.
[30] The attorney general of the
United States could exercise “pros-
ecutorial discretion” by directing
local law enforcement officials to
ignore supervised injection sites.
[31] Unfortunately, this seems
unlikely given the current politi-
cal climate. U.S. Deputy Attorney
General Rod Rosenstein has made
no attempt to conceal his antipathy
towards supervised injection sites,
and has previously characterized
such sites as “taxpayer-sponsored
havens to shoot up.” [32] Beyond
these opprobrious remarks, he has
also asserted that any city wishing
to open a supervised injection site
can expect to encounter “swift
and aggressive action.” [33] The
ongoing threat of federal action
has hitherto stymied public health
officials’ plans to open supervised
injection sites.
Recommended Action
In order to foster public health
innovation at the local level and
encourage creative solutions to
the opioid epidemic, it is recom-
mended that Congress immediately
repeal Section 856 of the federal
Controlled Substances Act. Section
856 was written in response to the
proliferation of “crack houses”
in which people congregated to
collectively consume drugs in the
1980s. [34] The original authors
of the CSA never intended to in-
fringe upon states’ historic author-
ity over matters of public health,
nor interfere in legally sanctioned
public health interventions. [35]
This is evidenced by Section 872
of the law, which encourages the
development of novel public health
practices by authorizing the use of
controlled substances in scientific
research. [36] However, in order to
undertake scientific research involv-
ing controlled substances, Section
872 requires that individuals submit
an application to the Attorney
General’s office, meaning that the
feasibility of such projects too often
depends on the prevailing political
winds. Thus, to foster public health
innovation at the local and state
level, it is recommended that Con-
gress repeal the antiquated “Crack
House Statute” of the Controlled
Substances Act.
Conclusion
In order to combat the devastat-
ing impact of the opioid epidemic
on major American cities, poli-
cymakers, activists, and medical
professionals have teamed up to
implement supervised injection
sites in their local communities.
However, the looming specter of
the “Crack House Statute” has
hitherto hampered their progress.
Luckily, lawmakers have already
introduced legislation to amend the
federal Controlled Substances Act.
On April 1st, 2019, United States
Representative Diana DeGette (D-
CO) introduced H.R. 2012, which
intends to “amend the Controlled
Substances Act to provide that
Federal law shall not preempt State
law.” [37] If successful, this legisla-
tion will allow states and municipal-
ities to enact evidence-based harm
Roosevelt Review
reduction policy solutions to the
opioid epidemic.
References
1. “Opioid Overdose Crisis.”
National Institute on Drug Abuse
(NIDA). January 22, 2019. Ac-
cessed March 17, 2019. https://
www.drugabuse.gov/drugs-abuse/
opioids/opioid-overdose-crisis.
2. ”Opioid Overdose.” Centers for
Disease Control and Prevention.
December 19, 2018. Accessed
March 17, 2019. https://www.cdc.
gov/drugoverdose/epidemic/in-
dex.html.
3. Vowles KE, McEntee ML,
Julnes PS, Frohe T, Ney JP, van der
Goes DN. Rates of opioid misuse,
abuse, and addiction in chronic
pain: a systematic review and data
synthesis. Pain. 2015;156(4):569-
576. doi:10.1097/01.j.pa
in.0000460357.01998.f1.
4. Davis, Julie Hirschfeld. “Trump
Declares Opioid Crisis a ‘Health
Emergency’ but Requests No
Funds.” The New York Times.
October 26, 2017. Accessed March
17, 2019. https://www.nytimes.
com/2017/10/26/us/politics/
trump-opioid-crisis.html.
5. “A Brief History of the Drug
War.” Drug Policy Alliance. Ac-
cessed March 03, 2019. http://
www.drugpolicy.org/issues/brief-
history-drug-war.
6. “Principles of Harm Reduc-
tion.” Harm Reduction Coalition.
Accessed March 18, 2019. https://
harmreduction.org/about-us/prin-
ciples-of-harm-reduction/.
7. Ibid.
8. “Supervised Consumption
Services.” Drug Policy Alliance.
Accessed March 18, 2019. http://
www.drugpolicy.org/issues/super-
vised-consumption-services.
9. Ibid.
53
 Parity Delayed is Parity Denied
By Alex Siegal
Introduction
In March 2019, Chief Magistrate
Judge Joseph Spero of California’s
Northern District ruled that United
Behavioral Health, a subsidiary
of health insurance giant Unit-
edHealthcare, had violated fed-
eral law by discriminating against
customers receiving treatment for
mental health and substance abuse
disorders. [1] The crux of the issue
was, in Judge Spero’s words, “an
excessive emphasis on addressing
acute symptoms and stabilizing
crises while ignoring the effective
treatment of members’ underlying
conditions.” [2] Instead of proac-
tively providing their enrollees with
preventative care, insurance com-
panies required that a patient ex-
hibit an acute mental health crisis
before their coverage could kick in.
Since 2008, mental health parity—
the principle that mental health
and substance abuse disorders
should receive the same treatment
as other physical health issues in
healthcare policy and insurance
plans [3]—has been established in
federal law. However, due to a lack
of clear regulations and insufficient
enforcement, the legislation has
had a muted impact. [4] Private
companies are influenced—Judge
Spero says “infected”— by profit
motives and a desire to keep premi-
ums low, [5] so they have an inter-
est in manipulating parity guide-
lines as best they can, contrary to
the spirit of the legislation.
That insurance companies are
incentivized to evade parity legisla-
tion requires that either (a) existing
54
incentives be restructured,which is
unlikely to happen in the current
healthcare insurance environment,
or (b) that federal agencies more ac-
tively and vigilantly enforce existing
mental health parity laws. The cur-
rent system unfairly places the onus
on patients to appeal their cases to
a confusing and non-standardized
mishmash of federal or state agen-
cies. Unsurprisingly, relatively few
appeals are made, and even fewer
succeed. [6]
Background
When institutionalized patients and
active-duty military service mem-
bers are included, mental disorders
rank as the single largest American
healthcare expenditure, accounting
for $201 billion of a roughly $2.5
trillion total as of 2013. [7] How-
ever, mental disorders are tricky
to visualize and can present no
outward signs, so ensuring mental
health patients have equal access
to healthcare is difficult to legislate
and enforce. The costs of untreated
mental illnesses due to insurance
companies’ crisis-centered ap-
proach are staggering: $38.5 billion
in avoidable emergency room care,
[8] $37 billion in avoidable incar-
ceration, [9] and $193 billion in
lost productivity.
Mental health advocate and
then-Congressman Patrick Kenne-
dy passed the Mental Health Parity
and Addiction Equity Act (“the
MHPAEA”) in 2008, which man-
dated that insurers cover mental
health and substance abuse disor-
ders in the same way that they do
other physical diseases. However,
the federal government found it dif-
ficult to codify that law into regula-
tion—how to categorize outpatient
therapy, which can be far lengthier
than other outpatient services?
[10] How to ensure that carve-
outs, which are administratively
separate units of insurers that only
handle one type of policy (in this
case, mental health), maintain the
same exact standards as the other
branches of their parent company?
Due to these and other difficulties,
the final rules [11] were only estab-
lished in 2014, six years after the
bill’s passage. [12] Still, insurance
companies have exploited the law’s
ambiguity and a lack of oversight
to develop insurance policy stan-
dards that freeze out the quality of
care mental health patients need,
just like the crisis-centered United-
Healthcare policy that Judge Spero
ruled against in March. [13]
Recommended Action
The good news is that, with Spe-
ro’s ruling, the government has
established a clear position on the
issue of mental health insurance
that has lasted across the Bush,
Obama, and Trump Administra-
tions. However, the fact that it took
eight years of patient-initiated
litigation to achieve the preliminary
outcome of the UnitedHealthcare
case indicates that the government
needs to do a better job of enforc-
ing mental health parity. Under
the MPHAEA’s final rules, enforce-
ment has mostly been devolved
to the states, though the Centers
for Medicare and Medicaid also
provide assistance. Federal en-

forcement jurisdiction falls not to a
single agency but to three disjunct
ones: the Departments of Labor,
Treasury, and Health and Human
Services, depending on the type of
insurance plan. [14]
A single, focused authority should
preside over mental health parity in
order to provide effective enforce-
ment. That authority needs to have
the capacity to conduct proactive,
aggressive audits of insurance
companies’ mental health policies.
In this case, and in the interest of
avoiding miscommunication, the
most appropriate choice for that
authority would seem to be a new
joint office between the Depart-
ments of Labor, Treasury, and
Health and Human Services, with
resources drawn from all three and
focused singularly on mental health
parity regulation. [15] Such action
can easily be justified under Con-
gress’s power to regulate interstate
commerce. [16]
Conclusion
Despite Judge Spero’s preliminary
ruling, the class-action case against
UnitedHealthcare is still ongoing,
meaning patients have waited a de-
cade to see the results of legislation
passed under the Bush Administra-
tion. Their case is not unique, and
until the government can adequate-
ly enforce the 2008 MPHAEA,
more cases of postponed parity are
certain to follow.
References
1. Abelson, Reed. “Mental Health
Treatment Denied to Customers
by Giant Insurer’s Policies, Judge
Rules.” New York Times. March
5, 2019. https://www.nytimes.
com/2019/03/05/health/united-
health-mental-health-parity.html.
2. Ibid.
3. “What Is Mental Health Parity?”
National Alliance on Mental Illness.
Accessed April 16, 2019. https://
www.nami.org/Find-Support/Living-
with-a-Mental-Health-Condition/
Understanding-Health-Insurance/
What-is-Mental-Health-Parity.
4. Gold, Jenny. “Advocates Say Men-
tal Health Parity Law Is Not Fulfilling
Its Promise.” Kaiser Health News. Au-
gust 3, 2015. https://khn.org/news/
advocates-say-mental-health-parity-
law-is-not-fulfilling-its-promise/.
5. Ibid.
6. Duong, Yen. “Mental health parity
isn’t panning out for some patients
and parents.” North Carolina Health
News. January 22, 2019. https://
www.northcarolinahealthnews.
org/2019/01/22/mental-health-pari-
ty-isnt-panning-out-for-some-patients-
and-parents/.
7. Roehrig, Charles. “Mental Dis-
orders Top The List Of The Most
Costly Conditions In The United
States: $201 Billion,” Health Affairs,
2016; 35(6):1130-1135. https://www.
healthaffairs.org/doi/pdf/10.1377/
hlthaff.2015.1659.
8. Creswell, Julie. “E.R. Costs for
Mentally Ill Soar, and Hospitals
Seek Better Way.” New York Times.
Dec 25, 2013. https://www.nytimes.
com/2013/12/26/health/er-costs-
for-mentally-ill-soar-and-hospitals-
seek-better-way.html.
9. Swanson, Ana. “A shocking
number of mentally ill Ameri-
cans end up in prison instead of
treatment.” The Washington Post.
April 30, 2015. https://www.
washingtonpost.com/news/wonk/
wp/2015/04/30/a-shocking-number-
of-mentally-ill-americans-end-up-in-
prisons-instead-of-psychiatric-hospi-
tals/?utm_term=.11221ed9aed7.
10. Abelson, Reed. “Lacking Rules,
Insurers Balk at Paying for Intensive
Psychiatric Care.” New York Times.
September 27, 2013. https://www.
nytimes.com/2013/09/29/business/
lacking-rules-insurers-balk-at-pay-
Roosevelt Review
ing-for-intensive-psychiatric-care.html.
12. Abelson, Reed. “Lacking Rules,
Insurers Balk at Paying for Inten-
sive Psychiatric Care.” (Cases of
Melissa Morelli and Jonathan Den-
bo) New York Times. September
27, 2013. https://www.nytimes.
com/2013/09/29/business/lack-
ing-rules-insurers-balk-at-pay-
ing-for-intensive-psychiatric-care.html.
13. Centers for Medicare and Medic-
aid Services, Department of Health
and Human Services. “Mental Health
Parity and Addiction Equity Act
(MPHAEA).” Accessed April 10,
2019. https://www.cms.gov/cciio/
programs-and-initiatives/other-insur-
ance-protections/mhpaea_factsheet.
html.
14. Centers for Medicare and Medic-
aid Services, Department of Health
and Human Services. “Mental Health
Parity and Addiction Equity Act
(MPHAEA).” Accessed April 10,
2019. https://www.cms.gov/cciio/
programs-and-initiatives/other-insur-
ance-protections/mhpaea_factsheet.
html.
15. Per §13002 of the 2016 21st
Century Cures Act, CMS has been
given nominal primary enforcement
jurisdiction over MPHAEA matters,
and has developed a new action plan
accordingly. I advocate that they go
beyond this, as it does not provide
for sufficiently aggressive, singularly
focused enforcement. Centers for
Medicare and Medicaid Services,
Department of Health and Hu-
man Services. “21st Century Cures
Act: Section 13002; Action Plan for
Enhanced Enforcement of Mental
Health and Substance Use Disorder
Coverage.” Accessed April 17, 2019.
https://www.hhs.gov/sites/default/
files/parity-action-plan-b.pdf.
16. Legal Information Institute,
Cornell Law School. “Commerce
Clause.” Accessed April 19, 2019.
https://www.law.cornell.edu/wex/
commerce_clause.
55
56
 Roosevelt Review

Human Rights
The Human Rights center has remained committed to addressing the complex ways in
which individual rights and freedoms are questioned each day by both public and pri-
vate powers. This year, The Human Rights Center organized a boycott of Barnard Din-
ing Services in protest of its use of Aramark, a company that profits from mass incar-
ceration. The Center’s activism led to a change in dining providers to a different dining
provider that is divested from prisons. The Human Rights Center is also working on a
long-term project exploring housing rights and housing access in the Morningside area.

The pieces in this section show the center’s commitment to protect the dignity of all
people, regardless of what systems of oppression may be fighting against them.

-- Maeve Flaherty, Center Director

57
 Marriage for All: Repealing the Same-Sex
Marriage Act in Nigeria
By Dotun Adegbite
Introduction
In 2013, Nigeria passed the Same-
Sex Marriage Act (SSMA), which
officially criminalised homosexual
marriage and introduced a host
of more restrictive laws on homo-
sexual relationships. Over the last
three years, more than 100 men
have been arrested on allegations
of homosexual behaviour, usually
in mass arrests. [1, 2] The true
number of individuals who have
been targeted or arrested due to
allegations of homosexuality is
unknown due to sparse media
coverage. The laws created under
the SSMA infringe on numerous
rights within the Universal Decla-
ration of Human Rights (UDHR).
For example, the punishment of
anyone who “registers, operates or
participates in gay clubs, societies
and organisations” [3] is a clear vi-
olation of UDHR Article 20 (1) in
the UDHR, which states that “ev-
eryone has the right to freedom of
peaceful assembly and association.”
[4] In addition to discriminating
against LGBTQ citizens, these laws
enable the police to make arrests
based on little evidence. Repealing
laws like this is important not just
to uphold minority rights but the
rights of everyone unfairly targeted
by police.
Background
Most former European colonies
retain colonial laws criminalising
homosexuality, and Nigeria is no
exception. Similar to India, [5]
Nigeria has recently furthered
these colonial-era restrictions -- the
58
SSMA prohibits “the registration
of gay clubs, societies and organisa-
tions,” “the public show of same-
sex amorous relationship directly or
indirectly,” and invalidating same-
sex marriages and civil unions.
[6] The SSMA, which was first
introduced in 2006, passed upon
reintroduction in 2013 despite
condemnation from the US State
Department and the UK High
Commission. The UK threatened
to cut aid to African countries that
violate LGBT rights, but ultimately
no action was taken against Nige-
ria’s government.
The criminalisation of homo-
sexuality is detrimental to public
health even beyond explicit threats
from law enforcement.. Surveys of
American homosexual and bisexu-
al individuals during a time when
gay marriage restrictions were
increased showed a 36% increase
in mood disorders, 42% in alcohol
use disorders, and a 248% increase
in generalised anxiety disorder.
[7] Additionally, criminalising gay
marriage and LGBT associations in
Africa prevents Africans persecut-
ed for their sexuality from seeking
asylum while remaining in Africa.
By having to go to Europe or North
America to avoid persecution,
LGBT Africans, particularly those
with a Muslim background, risk
entering highly xenophobic envi-
ronments.
Recommended Action
To solve these issues, the SSMA
should be repealed and replaced
with legislation protecting same-sex
unions and marriages, as well as
the other activities banned in the
act, including protections for any
person “who administers, witnesses,
abets, or aids the solemnisation of
a same-sex marriage … or supports
the registration, operation, and
sustenance of gay clubs, societ-
ies, organisations, processions, or
meetings”. This is a simple pro-
posal, and the only obstacle in its
realisation is the actions of the
Nigerian legislature. While this
action would not have popular
support in Nigeria - 92% of Nige-
rians polled supported the SSMA
in 2013 [8] - Kenya has shown that
governments can take legislative
action on this issue even without
public support. In 2016, a Kenyan
court ordered the reinstatement
of three priests who were accused
of homosexual behaviour. At the
moment, the Kenyan government
is deliberating on the decriminalisa-
tion of gay marriage, which would
make Kenya the first country in
East Africa country and the second
in Africa (after South Africa) to
decriminalise gay marriage. Nigeria
is the most populous country and
largest economy in Africa. If Nige-
ria were to change its laws, it could
influence other countries to follow
suit, potentially paving the way for
a wave of legislative reform across
West Africa and Africa as a whole.
Apart from politicians, Nigerian
religious leaders play a significant
role in influencing public opinion,
and Nigerian religious institutions

are firmly homophobic. Homo-
sexuality is portrayed as sinful and
“unreligious,” and homosexuality is
widely believed to be a Western im-
port and a sign of malign neo-co-
lonial influence, despite the fact
that the criminalisation of hom-
sexuality was first introduced by
colonial powers. Changing attitudes
towards homosexuality in some
European countries have resulted
in the removal of homophobic laws
in much of Europe including the
UK, which colonised Nigeria. As
a result, international pressure to
change homophobic laws such as
the SSMA is seen as neocolonial
meddling rather than an effort to
resolve colonial-era mistakes. In
order to enact the necessary legis-
lative change, the idea that homo-
sexuality is a Western import must
be deconstructed, and the fact that
colonisation brought homophobic
laws not homosexuality must be
recognized.
Conclusion
In order for the SSMA to be re-
pealed, activists, members of the
Nigerian legislative branch, and
religious authorities must present
a united front. Major Nigerian
LGBT activists including Bisi
Alimi, Davis Mac-Iyalla, and Miss
saHHara would have a significant
role to play in mobilising sup-
port and advocating for change.
Alimi’s Independent Project for
Equal Rights could help lobby for
religious and political change. By
conducting a grassroots education
campaign to change public percep-
tion of homosexuality, these activ-
ists could counter the narrative that
homosexuality is a Western import.
They should foster links between
Nigerian religious institutions and
more tolerant religious organisa-
tions in the UK such as Changing
Roosevelt Review
Attitude, a charity advocating for
LGBT inclusion in the Church of
England. Grassroots activism and
mobilisation, in combination with
legislative change, can liberate
Nigeria’s LGBT community and
transform Nigeria into a beacon of
African progress.
References
1. Nigeria: Fifty-Seven Suspected
Homosexuals Arrested. Free Muse.
2018. https://freemuse.org/news/
nigeria-dozens-of-suspected-homo-
sexuals-arrested-freemuse/ “The criminalisation of
2. Mass Nigerian arrests for ‘ho-
mosexual acts’ in Lagos State. BBC homosexuality is detrimental
News. 2017 https://www.bbc.com/ to public health even beyond
news/world-africa-40774930
3. Same-Sex Marriage (Prohibition) explicit threats from law
Act, 2013. §5. enforcement.. Surveys of
4. Universal Declaration of Hu-
man Rights, United Nations, 1948 American homosexual and
5. India top court reinstates gay sex bisexual individuals during
ban. BBC News. 2013. https://
www.bbc.com/news/world-asia-in- a time when gay marriage
dia-25329065 restrictions were increased
6. Same Sex Marriage (Prohibi-
tion) Act, National Assembly of showed a 36% increase in
Nigeria, 2013, §5 mood disorders, 42% in
7. Buffie, William C. Public Health
Implications of Same-Sex Mar- alcohol use disorders, and
riage. American Journal of Public a 248% increase in gener-
Health no.6, 2011. pp 986-990.
8. Nigerians Support Anti Same- alised anxiety disorder. [7]”
Sex Bill - Poll. Vanguard News.
2013. https://www.vanguardngr.
com/2013/06/nigerians-support-
anti-same-sex-bill-poll/
59
 Homemakers: Creating a Guaranteed
Right to Housing Counsel
By Justin Holiman
Introduction
Pulitzer Prize-winning author Mat-
thew Desmond describes the home
as the “wellspring of personhood”
or a fundamental source of human
dignity. [1] The mere existence of
a stable home can dramatically
reduce incarceration rates, improve
physical and mental health, as well
as promote civic engagement. Yet
the status of the American hous-
ing court system ensures that for
renting families, a stable home is
mere fantasy. Without a guaranteed
right to housing counsel, tenants
are at their landlords’ mercy. While
there is a federal right to counsel
in criminal trials, no U.S. state
yet guarantees a right to housing
counsel. Test cities have shown that
providing every tenant in housing
court with access to a free attorney
ensures familial stability and costs
American taxpayers far less than a
national system of eviction.
Background
In the United States, “over 1 in
5 of all renting families in the
country spends half its income on
housing,” and in much of the coun-
try affordable housing waiting lists
are years long. [2, 3] Low-income
tenants face the additional prob-
lem of landlords being willing to
evict them immediately upon a late
payment because demand far ex-
ceeds supply for affordable housing.
Thus, housing court has become a
staple of lower-income America.
Right now, 90% of landlords are
represented by counsel in housing
court while 90% of tenants are not.
60
[4]The result is an eviction factory,
where most eviction hearings are
decided in sixty seconds, normally
in the landlord’s favor. [5] Without
representation, most low-income
tenants are forced to represent
themselves pro se against a sea-
soned attorney; often tenants’ rights
are trampled or they are persuad-
ed to sign unfair stipulations. [6]
Without universal housing court
representation, due process leans
decidedly in landlords’ favor.
The Eviction Lab at Prince-
ton University determined that
there were at least 900,000 evic-
tions judgements issued in 2016
alone. [7] The loss of a home
is life-changing -- being evicted
leads to increased rates of clinical
depression and serves as a major
antecedent to suicide. [8] Once a
tenant’s records shows an eviction,
they are pushed into increasingly
run-down neighborhoods to seek
cheaper rent. This acts as a form
of de facto segregation that dispro-
portionately affects people of color.
[9] This contributes to the fact that
schools are actually more segre-
gated today than forty years ago
because their neighborhoods are
now more segregated. [10] Many
students in these underfunded areas
then commit crime to help parents
pay for rent, [11] contributing to
increases in the incarceration rate
and perpetuating a cycle of pover-
ty. [12] Ultimately, people living in
poverty have a lifespan, on average,
of nearly 10 years less than those
that do not. [13]
Recommended Action
While not a panacea for America’s
housing crisis, guaranteeing free,
legal representation to tenants
facing eviction would ensure that
more people would be able to stay
in their homes. Of course, such
counsel is not free, and efforts to
increase representation in hous-
ing court must be mindful of the
upfront cost. However, New York
City—long on the front lines of
housing rights—commissioned a
study that found providing effective
housing counsel to every city res-
ident within 200% of the poverty
line in a given year would actually
offset the cost of sheltering people
who are evicted from their homes.
[14] In fact, the project would save
the city approximately $320 million
annually. [15] Furthermore, the
report clarified that it could not
fully factor in the advantages of an
increase in child development, and
the savings from criminal justice
costs, among other benefits. [16]
According to another study, con-
ducted in the South Bronx be-
tween 2005 and 2008, providing
housing counsel to 1,300 families
cost $450,000 upfront, [17] but
prevented eviction in 86% of
cases and saved the city more than
$700,000 on welfare costs. [18]
Advocacy groups and legal associa-
tions formed the Right to Counsel
NYC Coalition in 2014 which won
increased funding from the city
council to provide legal assistance
to those facing eviction. [19] Since
the Coalition began providing
 Roosevelt Review
greater legal aid, eviction rates Still to Keep,” 14.
have declined by 24% and the rate References 12. Ibid., 14.
of tenants appearing in court with 1. Desmond, Matthew. Evicted: 13. Burger, Edward B. and Michael
representation has gone from 10% Poverty and Profit in the American Starbird. The Heart of Mathemat-
to 27%. [20] These statistics were City. New York: Penguin ics: An Invitation to
enough for Mayor Bill de Blasio Random House, LLC, 2016, 293. Effective Thinking. Key College
to sign into law a 2017 bill making 2. “After applying, how long will Publishing, 2005, 654.
New York the first city to establish my wait be?” Affordable Housing, 14. “The Financial Cost and
a right to counsel for those facing 2018, Benefits of Establishing a Right to
eviction. [21] While this is only one https://affordablehousingonline. Counsel in Eviction Proceedings
city, it serves as an important case com/housing-help/How-Long- Under Intro 214-A.” Stout Risius
study for future implementation. Will-My-Wait-Be Ross, Inc. 2016, 5.
New York’s example demonstrates 3. Desmond, Evicted, 303. https://www2.nycbar.org/pdf/
that upholding the right to housing 4. Franzese, Paula A. and Steph- report/uploads/SRR_Report_Fi-
counsel can save money and keep anie J. Beach. “Promises Still to nancial_Cost_and_Benefits_
families in their homes. Keep: The Fair Housing Act of_Establishing_a_Right_to_Coun-
Fifty Years Later.” Cardozo Law sel_in_Eviction_Proceedings.pdf
Conclusion Review, 2019, 7. 15. Ibid., 5.
The solution must begin at the city 5. Davis, Martha F.; Kaufman, 16. Ibid., 5.
level. Every city in America experi- Risa; and Wegleitner, Heidi M. 17. Desmond, Evicted, 304-305.
encing rampant housing shortages, “The Interdependence of Rights: 18. Ibid., 304-305.
poverty, and crime can benefit from Protecting the Human Right to 19. Capps, Kriston. “New York
the stability that comes with en- Housing by Promoting the Right to City Guarantees a Lawyer to Every
suring housing security. Early case Counsel.” School of Law Resident Facing Eviction.”
studies have demonstrated clear Faculty Publications, 2014, Paper CityLab, 2017, https://www.cityl-
socio-economic benefits to keeping 58. ab.com/equity/2017/08/nyc-en-
people in their homes. Just like New 6. Desmond, Matthew and Monica sures-
York, each city government should Bell. “Housing, Poverty, and the eviction-lawyer-for-every-
pass legislation providing funding Law.” The Annual Review of tenant/536508/
for housing court attorneys in a Law and Social Science, 2015, pp. 20. Ibid.
similar fashion to criminal public 15-35. 21. Ibid.
defenders, with the particularities 7. Badger, Emily and Quoctrung
varying by city. Bui. “In 83 Million Eviction Re-
cords, a Sweeping and Intimate
Implementing this policy would New Look at Housing in America.”
not be quick or easy. Yet, since The New York Times, 2018 ,
right to counsel legislation would https://www.nytimes.com/inter-
help those in need, cut welfare active/2018/04/07/upshot/mil-
costs, and potentially create jobs, it lions-of-eviction-records-a-
can and should garner bipartisan sweeping-new-look-at-housing-in-
support. For Americans trying to america.html
escape poverty, maintaining a job 8. Desmond, Evicted, 298-299.
and providing children with qual- 9. Rothstein, Richard. The Color
ity education is nearly impossible of Law: A Forgotten History of
without housing stability. Guaran- How Our Government
teed housing counsel is a major step Segregated America. Liveright
toward a more equitable society. Publishing Corporation, 2018, 178-
After all, sixty seconds should never 180.
determine the future of an Ameri- 10. Ibid., 179.
can family. 11. Franzese and Beach, “Promises
61
62
 Roosevelt Review

Technology
The Technology Center at Roosevelt has grown considerably through it’s first year. The
Tech Center is an incredibly interdisciplinary center, uniquely qualifying us to frame
policy debates in a new way. This years conversations included the ramifications of
Amazon’s HQ2 in New York and Huawei operating within the United States, two con-
versations that are based around tech policy but have implications that impact all policy
areas.

In this section, you will find a series of pieces that touch on a wide range of issues from
privacy to the economy, illustrating the role that technology currently plays and will
continue to play in our policymaking systems.

-- Christopher Philogene, Center Director

63
 Electronic IDs: Physical Protection for
Metaphysical Data
By Emma Cloyd
Introduction
Electronic IDs (eIDs) increase cyber
security by allowing individuals to
prove their identity on the Internet.
[1] eIDs are physical cards that can
be used to verify an individual’s
identity that can run on any brows-
er or device. [2] The user inserts
the card into a card reader plugged
into their device in order to verify
their identity. [3] As technology
becomes more stable and secure,
many citizens prefer to complete
their transactions digitally rather
than in person, whether applying
for a loan, shopping in a store, or
any number of other common
activities. [4] Many of these inter-
actions use highly sensitive personal
data, including Social Security
numbers and banking information.
[5] By offering e-IDs in the Unit-
ed States, the federal government
would be able to help protect their
citizens’ interests online by reduc-
ing the chances of identity theft.
Though both the Department of
State and Homeland Security have
operating systems in place that
could be modified to provide citi-
zens with electronic IDs, discussion
of the proposal remains limited. [6]
Background
The lack of a clear way to protect
against identity theft in the digital
sphere harms many Americans.
There are two main implications of
not being able to effectively identify
and verify who someone is: 1) Peo-
ple have to travel to physical banks,
healthcare providers, and other
confidential offices to complete
certain transactions in order not
64
to risk their confidential informa-
tion 2) The government is unable
to provide digital resources that
could help streamline the delivery
of some public services, including
voting, Social Security information,
and pension payments. [7]
Recommended Action
The United States Department of
Homeland Security should design
an eID program to provide its
citizens with effective digital protec-
tion. The creation and implementa-
tion of a federal electronic ID pro-
gram should be nested under the
Department of Homeland Security
(DHS) since it addresses cyberse-
curity, which is one of DHS’s key
areas of expertise. [8] The benefit
of this, over a social security num-
ber which is the current standard
level of proof in the United States,
is that it would be a physical en-
crypted card that would be harder
to steal than a security number
because it would have to physically
be in the users presence and if it is
lost or stolen, they can cancel it the
way they would a credit card.
The United States is lagging be-
hind in the adoption of this digital
policy, along with the United King-
dom, Canada, Australia, Brazil and
a handful of countries throughout
Africa and Asia. [9] Many coun-
tries have already launched eID
programs to protect their citizens’
sensitive information in the digital
sphere. India is currently leading
the charge, with 99% of its popu-
lation over the age of 18 enrolled
in an eID program; Estonia is
close behind at 98%. [10] The
extent to which eIDs can be used
varies by region and country. The
EU, for example, has required all
digital services to accept eIDs and
is implementing programs for eIDs
to be used across different coun-
tries within the EU. [11] Estonia
allows eIDs to be used for banking,
viewing medical records, and even
online voting. [12]
DHS should launch an eID pro-
gram by 2025, giving the agency
six years to develop a system. When
developing the system, DHS must
prioritize the security of citizens’
data, including where it is stored
and how it is encrypted, to mini-
mize privacy risks including threats
from foreign hackers. DHS should
contact governments with strong
eID programs to figure out what
sort of physical characters the card
and card reader need to have to
be unique properly encrypted, and
impossible to forge.
The process for citizens to receive
an eID will mirror that of apply-
ing for a passport: citizens will file
an application, which will include
proof of citizenship, a color photo,
and an application fee of $110.
[13] The first application will have
to be filed in person and locations
will be the same as the as the ones
the Department of State uses for
people to file in person applica-
tions for passports. Once there is a
release date for the eID program,
people will be able to file an appli-
cation up to six months in advance
to avoid bottlenecking. With the

first ID, individuals will also be en-
couraged to purchase an $80 card
reader with the recommendation
of having one per household.
Other departments on the local,
state, and federal level, as well as
private entities, will have to incor-
porate eIDs into their services to
increase security in advance of the
2025 rollout. Governments should
first implement online voting due
to the greater ability to verify one’s
identity. Private entities will have an
easier time incorporating eIDs into
their services -- eID verification can
replace multiple levels of passwords
or security questions. The govern-
ment should partner with these
entities as soon as the intricacies of
the digital infrastructure are iden-
tified.
Conclusion
The digital world is constantly
growing and evolving, and current-
ly the United States has not taken
any steps to protect their citizens
digital footprint. Moving forward,
Congress and DHS must begin to
analyze the costs associated with
implementing an eID program and
various data risks and the best ways
the mitigate them. The United
States should turn to countries like
Estonia who almost all of their
services available on the Internet,
however the United States must
remain cautious and only use this
card as a proof of identification
so the government cannot use it as
a way to acquire information on
citizens.
References
1. “Tech Policy To-Do List.” Tech
Policy To-Do List. Accessed May
10, 2019. https://itif.org/tech-poli-
cy-to-do-list#cybersecurity.
2. “Use of EID and Card Reader:
Instructions.” City of Brussels. Feb-
Roosevelt Review
ruary 07, 2019. Accessed May 10,
2019. https://www.brussels.be/use-
eid-and-card-reader-instructions.
3. Ibid.
4. Castro, Daniel. “Explaining
International IT Application
Leadership: Electronic Identifica-
tion Systems.” Explaining Interna-
tional IT Application Leadership:
Electronic Identification Systems.
Accessed May 10, 2019. https://
itif.org/publications/2011/09/15/
explaining-international-it-applica-
tion-leadership-electronic-identifi-
cation.
5. Ibid.
6. “Tech Policy To-Do List.” Tech
“The digital world is
Policy To-Do List. Accessed May constantly growing and
10, 2019. https://itif.org/tech-poli-
cy-to-do-list#cybersecurity.
evolving, and currently the
7. “Electronic Identities – a Brief United States has not tak-
Introduction.” Europa.eu. Elec-
tronic Identities – a brief introduc-
en any steps to protect their
tion. citizens digital footprint.
8. “CERT | United States Com-
puter Emergency Readiness
Moving forward, Congress
Team.” US. Accessed May 10, and DHS must begin to
2019. https://www.us-cert.gov
/?utm_source=hp_carousel&utm_
analyze the costs associated
medium=web&utm_cam- with implementing an eID
paign=dhsgov.
9. “National IDs Around the World
program and various data
- Interactive Map.” Blog. Accessed risks and the best ways the
May 10, 2019. https://www.
worldprivacyforum.org/2017/07/
mitigate them.”
national-ids-around-the-world/.
10. Gutsol, Oleg, and Oleg Gut-
sol. “Trends in Electronic IDs and
EIDs Integration with Consensus
AI Network.” Medium. February
02, 2018. Accessed May 10, 2019.
https://medium.com/consen-
sus-ai/trends-in-electronic-ids-and-
eids-integration-with-consensus-ai-
network-7899c73002e8.
11. Ibid.
12. Ibid.
13. “Getting or Renewing a U.S.
Passport.” USAGov.
65
 Governing CRISPR: Effectively Regulating
Gene-Editing Technologies
By Meredith Harris
Introduction
CRISPR, short for clustered regu-
larly interspaced short palindromic
repeats, can alter both our genes
and our lives at large--from the
food we consume to our genetic
code. CRISPR is a gene editing
technology that acts similarly to a
word processing program’s cut-
and-paste function, inserting new
genetic codes into cells for disease
treatment. [1] Effective interna-
tional and federal regulation of
CRISPR is critical to ensure its safe
and ethical application. CRISPR
legislation must be enacted as soon
as possible in order to direct the
technology towards productive,
rather than potentially destructive,
goals.
Background
CRISPR technologies must be
closely regulated because of the
both negative and positive effects
the technology could have. The
potentially positive effects CRISPR
can facilitate include editing crops
to be more nutritious, editing the
human genome to destroy genet-
ic diseases such as cystic fibrosis,
editing mutations linked to breast
and ovarian cancer, and eradicating
bacteria, enabling the shift away
from the current overuse of antibi-
otics. [4] CRISPR connects directly
to political, economic, social, and
public health spheres, as the mod-
ifications it can make can alter all
forms of life and financial markets.
If the technology is used incorrect-
ly, and improper edits are made to
DNA, future generations will be
genetically damaged. CRISPR is
66
currently widely accessible, but if
it is improperly regulated, it could
increase socioeconomic gaps if only
certain populations could afford
CRISPR-modified treatments. The
Office of the Director of National
Intelligence included gene editing
in Worldwide Threat Assessments
in 2016 and 2017. Thus, recogni-
tion of the need for a close watch
on CRISPR is critical to ensuring
its protection and success.
Deployment of CRISPR tech-
nologies is already underway--as
of April 2019, the University of
Pennsylvania is running the first
in-human trial of cancer patients
using CRISPR technologies, avoid-
ing the traditional use of viruses for
therapy and instead directly mak-
ing changes to the DNA. However,
there is currently no concrete fed-
eral or international legislation in
place regulating CRISPR technol-
ogies. As of March 14th, CRISPR
research on the germline level has
been halted by the National Insti-
tutes of Health (NIH), and inter-
national organizations such as the
UN’s World Health Organization
(WHO) have only discussed creat-
ing an international registry man-
datory for all CRISPR projects.
International and federal governing
bodies could look towards France’s
current practices. In France, the
creation of the “France Genomic
Medicine 2025” Plan has stim-
ulated CRISPR research and
investments through its creation
of a sharing platform for genome
information and technology. [2]
France has also ratified the Ovie-
do Convention, which states that
“An intervention seeking to modify
the human genome may only be
undertaken for preventive, diag-
nostic, or therapeutic purposes and
only if its aim is not to introduce
any modification in the genome of
any descendants,” which has led
to restrictions on its gene editing
research. [3]
It is critical to begin the process for
regulating CRISPR, as CRISPR
kits are available and sold online
for around $100. This accessibility
could be beneficial, as it would al-
low for increased research towards
curing generational diseases or im-
proving food production. However,
a lack of control over how CRIS-
PR technologies are distributed
and used could ultimately increase
socio-economic divides, as its could
foster the creation of a designer
babies market.
Recommended Action
In order to ensure proper usage,
CRISPR should be regulated
on both the international level,
through a World Health Organiza-
tion (WHO)-led regulation process;
and on the federal level, through
FDA oversight. WHO’s sugges-
tion that all CRISPR experiments
should be registered through an
online database would keep close
watch of labs pursuing CRIS-
PR-related research. However, this
may be inefficient as developments
outpace regulation, and major
companies are increasingly pat-
enting their findings, which might
eliminate the need for this regis-
try. Instead, WHO should release

guidelines as to research that can
and cannot be conducted using
CRISPR, and then hold member
countries of the UN accountable
for their research by establishing a
global treaty similar to the WHO
Framework Convention on Tobac-
co Control (WHO FCTC). [8] Both the FDA and RAC review
On the federal level, there are cur-
rently no guidelines or regulations
for CRISPR research. The Food
and Drug Administration (FDA)
should closely monitor develop-
ments and closely watch the pat-
ents of CRISPR products closely
in order to prevent an exploitative
gene modifying outbreak from
occurring. Establishing an FDA
committee for CRISPR oversight
will ensure CRISPR’s usage for
good and help prevent its moneti-
zation. Senators Lamar Alexander
(R-TN) and Susan Collins (R-ME)
support congressional oversight of
gene editing activity on consumer
safety grounds. [5]
CRISPR is difficult to regulate
because of its many different
forms, and many CRISPR kits
have already been sold to stake-
holders with all levels of expertise
(from high-school biology classes
to major biochemical companies).
However, guidelines are needed for
future experimentation to ensure
proper usage. In mid-March, NIH
declared a moratorium on all
germline gene editing research.
However, this stagnation is not
beneficial -- Jeffrey Kahn, Director
of Johns Hopkins Berman Insti-
tute of Bioethics explained that
banning research simply leads to
researchers conducting their work
in other countries. Congress could
look towards CRISPR regulation
in the UK, where strict oversight is
balanced with clear pathways for
research licensing. [6] [7]
The NIH Office of Science Poli-
cy’s Recombinant DNA Advisory
Committee (RAC), which provides
policy recommendations for the
federal government, has reviewed
American gene therapy protocols.
preclinical and clinical issues, and
have approved 5 products as of
2019. However, while Congress
has prohibited federal funding for
embryonic research projects on the
germline level, most gene-editing
findings has not been monitored in
the US. However, federal legislation
is not enough, as if it were banned
in the US, individuals could travel
abroad for these processes.[9] For
these reasons, legislation monitor-
ing and regulating gene-editing
technologies must be instituted on
the federal and international levels.
Conclusion
Sales of CRIPSR kits should begin
to be regulated to ensure that they
are only being used in monitored
and registered settings. While
CRISPR’s potential to do good is
noteworthy, CRISPR could also be-
come a weapon deadlier than soci-
ety has seen before. This regulation
should be conducted on a federal
level. On the international scale,
countries should meet annually to
discuss their own CRISPR develop-
ments to ensure close watch. There
is not currently any existing legisla-
tion regulating CRISPR. The 21st
Century Cures Act was enacted in
2016 to speed up the review pro-
cess for new medical technologies,
but it does not specifically address
CRISPR. he absence of CRISPR
legislation provides an opportu-
nity for regulation of some sort.
Especially following the creation
of two CRISPR-designed babies
in November 2018, gene editing
Roosevelt Review
has gained national attention. Dr.
Sam Sternberg, biochemist and
colleague of CRISPR co-discoverer
Dr. Jennifer Doudna, emphasizes
the necessity for FDA oversight sim-
ilar to current regulation surround-
ing disease and cancer treatment
as it would effectively augment the
benefits of CRISPR domestical-
ly, and transparent conversation
amongst international actors would
prevent an international CRISPR
arms race.
References
1. Stein, Rob. “First U.S. Patients
Treated With CRISPR As Human
Gene-Editing Trials Get
Underway”. NPR. April 16, 2019.
2. Vogel, Kathleen M., Students
from PLCY 306. “CRISPR goes
global: A snapshot of rules, poli-
cies,
and attitudes.” Bulletin of the
Atomic Scientists. June 5, 2018.
3. Ibid.
4. Plumer, Brad, Eliza Barclay, Julia
Belluz, and Umair Irfan. “A simple
guide to CRISPR, one of the
biggest science stories of the de-
cade.” Vox. December 27, 2018.
the biggest science stories of the
decade.” Vox. December 27, 2018.
5. “Senate Committee Holds Hear-
ing on CRISPR Science, Ethical
Concerns, Regulatory
Approaches.” Genomeweb. No-
vember 15, 2017.
6. Ibid.
7. Ibid.
8. Curran, Kevin. “How on earth
are we currently regulating human
genetic modification?” Rising
Tide Biology. January 3, 2019.
Chen, Angela. “If someone wants
to create gene-edited babies, who
would stop them?” The Verge.
November 26, 2018.
67
 Tackling Interoperability of Health Infor-
mation Technology
By Sarah Lubin
Introduction
The United States ranks highest in
healthcare spending per capita, but
health outcomes do not correlate
with the proportion of spending.
[1] Difficulties with electronic
health records (EHR), including
inadequate codification and poor
usability, exacerbate this problem.
[2] These difficulties are rooted
in the lack of interoperability of
health information technology
(IT) and inadequate data. Interop-
erability of health IT, according
to the 21st Century Cures Act,
“means health information technol-
ogy that— (A) enables the secure
exchange of electronic health
information; (B) allows for com-
plete access, exchange, and use of
all electronically accessible health
information for authorized use; and
(C) does not constitute information
blocking.”[3] In the last decade,
the use of certified health IT has
become widespread among health
care providers, but electronic med-
ical records have not resulted in
increased sharing of health data.
Background
Most patients’ health information
is recorded electronically but this
information is often inaccessible
between different groups including
physicians, payers, and patients. As
of 2015, 96 percent of non-federal
acute care hospitals adopted certi-
fied health IT. [4] For office-based
physicians, 78 percent have ad-
opted certified EHR [5] however,
only about half of these physicians
exchange information with other
health care providers outside of
68
their organization. [6] Although standard maintained is Health
an established right by the HIPAA Level 7 (HL7) which can be used
Privacy Rule, patients often do not for EHR migrations and transi-
have access to their health infor- tions, data export, research, quality
mation. [7] As of 2017, 52 percent measurement as well as patient
of patients were offered online download.
access to their medical record by
clinicians. [8] Of this group, half The Veterans Health Administra-
the individuals viewed their medi- tion (VA) recently updated its EHR
cal records online- this population network to meet the HL7 standard,
represents 28 percent of the United making it one of the largest health
States. [9] Eight in ten people who information exchanges in the US
did view their health records online -- it exchanges the clinical docu-
considered their record useful and ments of nine million veterans with
easy to understand, [10] suggesting over 145 partners. [13] Evaluators
that successful implementation of have found that investments in
accessible EHR programs is possi- health IT have led to meaningful
ble. improvements. A broad analysis of
the VA EHR found decreased error
Three types of barriers must be frequency and other improvements.
targeted to achieve data sharing in- [14] Standardized terminologies for
teroperability: [11] significant tech- codes and data models offer con-
nical obstacles of the current EHR sistency and normalize the clinical
system limit the delivery of success- processes. Unfortunately, EHR
ful healthcare outcomes; consider- data is frequently collected and
able funding is needed to develop, expressed in local organizational
implement, and optimize health codes, leading to inconsistencies in
IT; the need for trust between all data organization and in patient
the players (patients, providers, and classification.
payers) presents a challenge to the
development of health IT. Although the new HL7 standards
offer many benefits such as EHR
Recommended Action sharing, there has been little
The United States Department of adoption to date. HHS should
Health and Human Services (HHS) implement a timeline for pro-
should design a program for health viders to adopt the C‑CDA HL7
care providers to adopt and imple- standard for their EHR systems.
ment congruent and consistent data Hospital networks in mid-sized
communication technology. Cur- cities with populations between
rently, the Consolidated Clinical 200,000 and 500,000 should be
Document Architecture (C-CDA) the initial targets of the program.
is the primary standard for clinical Educational information should
document exchange in the US. [12] be provided to providers, payers,
The latest version of the C-CDA and patients to learn about how to

use the increased access to health
data. Consistent and standardized
training for all parties should be
required. After developing a suc-
cessful foundation for implemen-
tation in midlevel metropolitan
areas, the program should be scaled
up and down. Implementation in
larger hospital networks in expan-
sive metropolitan areas will benefit
from preliminary trials in smaller
urban areas to hopefully minimize
strain in transitioning. Application
development and implementation
should not cause undue burden to
the industry.
Conclusion
Much progress has already been
made to interoperability and
standardization of health IT across
the nation. Many EHR systems
are certified to the HL7 standard,
although adoption and implemen-
tation is the greatest obstacle to
date. Another target, in addition to
the technical and structural modi-
fications of EHRs, should focus on
improving patients’ and providers’
understanding of how to use their
medical data. Access to healthcare
records gives patients autonomy
within this system. Greater accessi-
bility to medical records via smart-
phones is the future of healthcare.
Large technology companies, such
as Apple, are increasingly using the
HL7 format to aggregate patient
data for mobile devices, setting the
groundwork for the actualization
of this goal. [15] Interoperability
and increased access to EHR will
benefit all involved in the health-
care system.
References
1. HHS Office. “Strategic Goal
1.” HHS.gov, US Department of
Health and Human Services, 18
Mar. 2019, www.hhs.gov/about/
strategic-plan/strategic-goal-1/in-
dex.html.
2. “Health Level Seven Interna-
tional.” HL7 Standards Product
Brief - HL7 CDA® R2 Implemen-
tation Guide: Clinical Summary
Relevant and Pertinent Data,
Release 1 | HL7 International,
www.hl7.org/implement/stan-
dards/product_brief.cfm?prod-
uct_id=453.;D’Amore, John et
al. “Interoperability Progress and
Remaining Data Quality Barriers
of Certified Health Information
Technologies.” AMIA ... Annual
Symposium proceedings. AMIA
Symposium vol. 2018 358-367. 5
Dec. 2018
3. Office of the Commissioner.
“21st Century Cures Act.” US
Food and Drug Administration
Home Page, Office of the Com-
missioner, www.fda.gov/regulato-
ryinformation/lawsenforcedbyfda/
significantamendmentstothefd-
cact/21stcenturycuresact/default.
htm.
4. “2016 Report to Congress on
Health Information Technolo-
gy Progress.” 2016 Update to
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69
 China’s Great Firewall as an Economic
Threat
By Christopher Philogene
Introduction
Under the Ming dynasty, the
Chinese built a series of walls and
forts to protect themselves from
the Mongols to the north -- we
now know these monuments as
the Great Wall. Today, the Chi-
nese are once again barricading
themselves against foreigners, this
time through digital suppression
tactics like the ‘Great Firewall’.
’The Great Firewall is a new effort
by the Chinese Communist Party
(CCP) to restrict its citizens’ access
to foreign media, limit freedom
of speech and monitor ‘suspicious
activities’. Some companies, like
Google and Facebook, are fully
banned while others, such as Linke-
dIn, have adapted their platform
to suit the demands of the Chinese
Communist Party (CCP). [1] For
years, American leaders have been
waiting for the internet to liberalize
China; [2] instead, the internet has
only reinforced existing CCP policy.
We must recognize the immense
harm to American interests posed
by the Great Firewall and active-
ly pursue a reformation in CCP
behavior.
Background
Access to critical media is un-
doubtedly a human rights issue
[3] and by limiting such access the
CCP exerts a malign force on its
own people. Experts in the field
have also begun to see this as an
economic issue: many have asked
whether it should be considered a
trade barrier. [4] The 2016 Nation-
al Trade Estimate Report (NTER)
70
claimed China’s “Internet regu-
latory regime” [5] was harming
Sino-American trade by interfering
with Facebook, Google, and Twit-
ter, all large American companies
that spur American innovation and
growth in the American econo-
my. A 2011 study estimated that
Facebook’s Platform feature alone
created at least 180,000 American
jobs; [6] Amazon has advertised its
plan to create 100,000 jobs at its
new American headquarters.
The international expansion of
these companies allows for greater
growth and prosperity in the Unit-
ed States, and a global marketplace
allows American innovators to
bring foreign currency back to the
United States. The Great Firewall
actively restricts companies’ po-
tential for expansion. By limiting
access to American sites, China’s
Great Firewall is actively stymying
the American technological field
for the benefit of Chinese com-
panies, many state-owned. In this
way, it bears resemblance to a more
traditional protectionist policy, as
depriving companies of competi-
tion helps local industries in China.
[7]
Recommended Actions
The US State and Treasury depart-
ment must lay out a clear case for
why China’s Great Firewall brings
about serious economic harm not
justified under the World Trade
Organization’s (WTO) national se-
curity provisions. On the one hand,
the WTO recognizes the rights of
states to regulate economic activity
that is “necessary to protect pub-
lic morals or to maintain public
order”, which is the argument the
Chinese government uses to justify
the Great Firewall. Yet American
government experts have long
dismissed this argument: the 2016
National Trade Estimate Report
(NTER) called this blocking “arbi-
trary”, [8] and decried the CCP’s
behavior as anti-competitive. For
example, the CCP demanded that
the American social network Linke-
dIn not just comply with state
censorship activities but also relin-
quish a significant share of its local
operations to Chinese stakeholders.
Forcing a company to relinquish
shares in order to enter a market is
clearly a form of economic coer-
cion that has no relation to national
security, especially since LinkedIn
had already agreed to follow local
regulations.
Unfortunately, the issue of eco-
nomic regulation of American tech
companies is not at the forefront of
discussions on Chinese trade policy.
The United States is currently
prioritizing trade deficit reduction,
subverting the WTO in the process.
Instead, the United States should
bring its case that China is violat-
ing WTO regulations to the WTO’s
Dispute Settlement System (DSS),
an international framework that al-
lows for states to reach agreements
without resorting to an escalation
of protectionist measures.
Conclusion
 Roosevelt Review
Pursuing a resolution through the References 8. Froman, “2016 National Trade
WTO offers the United States 1. Paul Mozur and Vindu Goel, To Estimate Report” pp. 91
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71
72

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79
 Let us never forget that government is ourselves
and not an alien power over us. The ultimate
rulers of our democracy are not a President and
Senators and Congressmen and government of-
ficials, but the voters of this country.
- Franklin D. Roosevelt

80