HIV Providers and Advocates Call on Congress to Address Uninsured Rates for Those Under the Federal Poverty Line

Twelve states still refuse to expand Medicaid under the Affordable Care Act; advocates say it is time to create a new health insurance option for the two million most affected.

In a letter to members of Congress on Monday, 34 national and community-based organizations sought federal-level action on dangerous disparities in health care coverage. The letter highlights a widening Medicaid “coverage gap,” a term to describe the lack of accessible health care insurance for low-income populations that are barred from Medicaid, yet are also ineligible for subsidies to afford coverage through the private Health Insurance Marketplace. The coalition of signatories highlight policy opportunities for Congress to prevent needless suffering of diseases and disabilities—sometime life-threatening—and close the Medicaid coverage gap.

An estimated two million people in the U.S. fall into the Medicaid coverage gap because 12 states have opted against expanding Medicaid eligibility under the Affordable Care Act. Today’s letter, signed by a coalition of organizations focused on fighting HIV, underscores the individual and public health risks of denying individuals access to health care coverage. The letter points to the federal government’s goal of Ending the HIV Epidemic by 2030 as an acute example of the need to address the uninsured rate.

“People living with HIV can successfully manage their health condition and eliminate transmission to others with regular access to antiretroviral treatment and care. That is the crux of the federal government’s Ending the HIV Epidemic plan,” said Robert Greenwald, Professor of Law at Harvard Law School and Faculty Director of the Center for Health Law and Policy Innovation. “But we simply cannot carry out that plan when access to treatment remains entirely out of reach for the 20% of people living with HIV who live in non-Medicaid-expansion states and are uninsured. It is time for Congress to look beyond state incentives and implement a national solution.”

A recent issue brief by the Center for Health Law and Policy Innovation of Harvard Law School outlines a menu of policy opportunities for Congress and the Administration to fill the Medicaid coverage gap. Those solutions include:

  • Allowing individuals with incomes under 100% of the Federal Poverty Level to purchase heavily subsidized Marketplace coverage;
  • Enact a public health insurance option that is funded by the federal government, available through the Marketplaces, and administered by the Department of Health and Human Services; and
  • Direct the Centers for Medicare and Medicaid Services to develop a federal Medicaid plan for non-Medicaid-expansion states.

“In more than ten years since the Affordable Care Act passed, we have seen incredible gains made in health care access and outcomes in states that have opted to expand Medicaid eligibility. We have also watched 12 states continuously turn down major incentives to expand Medicaid and deny their constituents access to life-saving care and treatment,” said Phil Waters, Staff Attorney for the Center for Health Law and Policy Innovation. “The federal government has waited long enough for state lawmakers to come around. We need federal-level action to relieve the health care needs of millions of people without health insurance, starting with those in the Medicaid coverage gap.”

Today’s letter to Congress was signed by the following organizations: Advocates for Youth, African American Health Alliance, AIDS Alabama, AIDS Alliance for Women, Infants, Children, Youth & Families, AIDS Foundation Chicago, Aliveness Project, American Academy of HIV Medicine, APLA Health, Black AIDS Institute, CAEAR Coalition, Cascade AIDS Project, Center for Health Law and Policy Innovation of Harvard Law School, Cero VIH Puerto Rico, Friends For Life, Georgia AIDS Coalition, HealthHIV, HIV Dental Alliance, HIV Medicine Association, HIV+Hepatitis Policy Institute, Howard Brown Health, International Association of Providers of AIDS Care, John Snow, Inc. (JSI), Latinos Salud, National Working Positive Coalition, Positive Women’s Network-USA, PrEP4ALL, R2H Action , Ryan White Medical Providers Coalition, SisterLove,  Inc., Southern Black Policy and Advocacy Network, Inc., The AIDS Institute, The Well Project, Treatment Action Group, and Treatment Access Expansion Project.

What’s on the Horizon for Federal Food Waste Reduction and Prevention Policy? Part 2

Originally written by Arlene Karidis and posted on Waste 360 on June 4, 2021.

Advocates for federal policy around food waste reduction and prevention have been working for years to move the needle in this space; meanwhile we get close to 2030, the year that EPA has called for a 50% cut in food waste, which the country is far from reaching. ReFED reports it would require reducing the material by 45 million tons annually to hit the 2030 goal.

This article is the second in a two-part series on policy around food waste loss and prevention. Part 1 includes comments from multiple stakeholders—mainly their projections on if and how Congress and the Biden Administration will work together on policy around food waste loss and prevention.

In Part 2, Waste360 looks at an ambitious policy action plan created by partners who have some large asks of Congress and President Biden.

COVID-related costs along with the Biden Administration’s plans to invest heavily in slowing Climate Change and in building infrastructure leave little money for other mega-budget initiatives. But four long-time partners who are fighting for food waste and loss prevention policy believe this is actually an opportune time to call on the federal government to support their agenda.

The partners are the World Wildlife Fund (WWF), Harvard Law School Food Law and Policy Clinic, ReFED, and the National Resource Defense Council. They recently finished their U.S. Food Loss & Waste Policy Action Plan that asks Congress and President Biden to take action to halve food waste by 2030, in line with the target set by the U.S. Environmental Protection Agency (U.S. EPA) and the U.S. Department of Agriculture (USDA).

“We knew that infrastructure, job creation, and climate change would be early priorities for the Administration, and they all align with addressing food waste,” says Alex Nichols-Vinueza, manager on the World Wildlife Fund Food Waste team.

“Reducing the country’s food waste in half would lower U.S. greenhouse gas emissions by an estimated 75 million metric tons of CO2 equivalent annually. We would be able to rescue four billion meals for people in need each year (at a time when one in four adults face hunger). And it would create 51,000 jobs over the coming decade,” he says.

Building food waste management infrastructure alone could generate 18,000 jobs annually through 2030 and help cut greenhouse gas emissions by 5.8 million metric tons of CO2 equivalent a year, according to Nichols-Vinueza and a ReFED report.

“So, the timing felt right to come together and quickly harmonize our asks to policymakers,” he says.

The Food Loss & Waste Policy Action Plan focuses on five areas and makes specific recommendations under each. Those areas are:

  • Invest in infrastructure to measure, rescue, recycle, and prevent organic waste from entering landfills and incinerators.
  • Expand incentives to institutionalize surplus food donation and strengthen regional supply chains.
  • Assert the U.S. government’s leadership on food loss and waste globally and  domestically (with an emphasis on adopting a food waste reduction goal in the U.S. 2030 Nationally Determined Contribution towards the Paris Climate Agreement).
  • Educate and activate consumers via private and public food waste behavior change campaigns.
  • Require a national date labeling standard.

The partners had been collaborating for some time and decided to come together to create a single playbook. WWF took a lead role, coordinating the development and editing of the Action Plan. The four organizations held calls to discuss content, much of which Harvard’s Food Law and Policy Clinic had already developed with ReFED for ReFED’s Roadmap to 2030: Reducing U.S. Food Waste.

NRDC had some key additions, and both NRDC and WWF brought in their government affairs experts to help.

They had plenty to work on.

Among challenges says Nichols-Vinueza is that food waste occurs incrementally across the entire food supply chain from farm to fork.

“Our focus was to develop pragmatic policy measures that would be comprehensive enough to equip a diverse set of actors [producers, manufacturers, retailers, schools, governments, consumers, etc.] to take action,” he says.

At the same time that they prioritized identifying what could work seamlessly for multiple stakeholders, they looked to lessen complexity by calling on the federal government to devise standard rules and give clear guidance.

Emily Broad Leib, director of the Harvard Law School Food Law and Policy Clinic, illustrates by expounding on two Action Plan areas: food donation and date labeling. Her office has tried to advance policy around both for years.

With food donation, a problem she says is that states base food laws on federal guidance, which is lacking in this space.

“The Emerson Act was created by Congress to lay out rules on food donation, and the last Farm Bill asked the USDA to provide guidance and raise awareness about this Act.  But it’s very thin,” Leib says.

“Businesses and nonprofits need more guidance and answers to questions on the liability protection that is available. USDA should create more detailed guidance that explains how businesses should interpret the Emerson Act.”

Leib also touches on the rationale for the Action Plan’s standard date label recommendations. States have varied label rules, and consumers and food retailers are throwing out good food, confused by a mixed bag of information.   

“Standardizing date labeling is important and likely to go through Congress. We are focused on getting legislation passed through Congress mainly because we want the label to be standard across the Food and Drug Administration and the USDA,” Leib says, explaining the significance of involving both agencies: the USDA regulates safety and labeling for meat, poultry, and some egg products, and the FDA regulates the rest of the food supply.

“Congress can enact standard labels that distinguish between food safety and freshness, and ensure that all products bear those labels, whether they are regulated by FDA or USDA,” she says.

A coalition of leading U.S. companies, NGOs, and city and state governments has signed on to the Action Plan, publicly stating that they support its policy recommendations. The plan’s creators are confident their collective voices will motivate Congress to take a serious look at their ideas.

While they do not expect the proposed plan to be adopted in its entirety, they are hopeful it will be picked up in pieces and added to other bills.

“As specific bills come up, we plan to help lawmakers identify which aspects of the Action Plan could be a good fit for each of those bills. For instance, we’ll be releasing recommendations specific to the Child Nutrition Reauthorization soon [Congress’s process of changing statutes that authorize the child nutrition programs; the Special Supplemental Nutrition program for Women, Infants, and Children (WIC); and similar initiatives].

We’ve already had the chance to discuss the entire plan with some Congressional staff and expect that indeed pieces of it will make it into bills that are being introduced this year,” says Dana Gunders executive director, ReFED.

Says Nichols-Vinueza, “We are growing food and throwing it in the trash, and nearly everyone can get behind wanting to change that, especially in the wake of COVID. We’re seeing positive initial interest from policymakers and are hopeful we can find a path forward to enact some of our proposed policy measures. But there’s still a long way to go.”  

What’s on the Horizon for Federal Food Waste Reduction and Prevention Policy? Part 1

Originally written by Arlene Karidis and posted on Waste 360 on June 3, 2021.

Advocates for federal policy around food waste reduction and prevention have been working for years to move the needle in this space; meanwhile we get close to 2030, the year that EPA has called for a 50% cut in food waste, which the country is far from reaching. ReFED reports it would require reducing the material by 45 million tons annually to hit the 2030 goal.

Advocates’ efforts to near that mark range from a push for standardized date labeling to other provisions introduced and reintroduced in the Farm Bill, to the latest: a new proposed Food Loss & Waste Policy Action Plan, and the formation of a national Coalition advocating for greater investment in composting infrastructure.

With a reborn commitment to addressing Climate Change, will we also see change in how food waste prevention and policy is viewed and addressed? Waste360 asked that and related questions to food system attorneys, an NGO, and a national research and advocacy organization focused on food waste prevention.

In this article, the first of a two-part series, these stakeholders make projections on if and how Congress and the Biden Administration will work together. They reflect on how very strained financial resources  could impact advancement of their proposed policies, and explore other anticipated and hoped for change.

Stay tuned for Part 2, which looks at an ambitious policy action plan created by partners who have some large asks of Congress and President Biden.

Waste360: What are your thoughts on how the Biden Administration and Congress may impact policy around food waste reduction/prevention?

Nicole Civitavice president for Strategic Initiatives

Food Systems Transformation agent, Ethicist & Educator, Sterling College, VT: Given that the USDA is again under the leadership of Secretary Vilsack, as it was when food waste returned to the federal policy consciousness (after its initial appearance in the late 1990s), it is reasonable to expect a similar approach to the Obama-era, which is to say there would be increased attention to policy possibilities and possibly work with Congress to secure more funding for food waste-reducing programs.

Many anticipate a more muscular approach than the inadequate Trump-era posture of merely championing voluntary efforts by private sector actors.

And with the Biden administration’s attention to both climate change and green infrastructure, it is possible that we could see more public investment in composting and aerobic digestion facilities.

However, I’ve yet to hear of the really exciting possibilities gaining traction. By this, I mean concepts like building and funding the municipal and county food resource management infrastructure that helps capture, process, and redistribute excess food and can also serve as critical food distribution infrastructure in times of emergency or high local need.  

Emily Broad Leib, director of the Harvard Law School Food Law and Policy Clinic: I do foresee the Biden administration taking action on this issue, and more importantly, I see Congress taking action. There are several bills introduced or about to be introduced that look at this issue, including the Food Donation Improvement Act, Food Date labeling Act, Agriculture Resilience Act, and others.

On the administrative side, re-entering the Paris agreement means that we will need to recommit to climate change action, and food waste reduction was a part of that for many countries and led to the initial U.S. food waste goal. Despite many competing interests, I am optimistic that this issue will remain at the forefront and will be included in Congressional and Administrative actions.

Laurie J. Beyranevand, professor of Law

director, Center for Agriculture and Food Systems

Vermont Law School: Given the Biden Administration’s whole of government commitment to tackling the climate crisis, which includes a focus on the food system, I anticipate we’ll begin to see some real momentum in policies that address food waste from production to consumption.

While other climate-focused policy interventions may be contentious, addressing food waste presents a tremendous opportunity for the Administration to curb significant emissions generated by food waste in landfills while addressing other prioritized societal goals including food security, farm viability, energy efficiency, conservation, and environmental protection.  

Waste360: How do you think monies required for other crises (COVID-19 relief, disaster relief necessitated by a blitz of natural disasters, etc.) will impact prioritizing food waste under President Biden?

Broad Leib: Funding efforts to reduce food waste are well aligned with many COVID-19 relief efforts and, likewise, with efforts to prevent future climate-related disasters and provide relief to people affected by disasters. Adopting better food donation policies, for example, is one way to support families most affected by crises such as COVID-19 or  natural disasters, that impact access to food and the economy.

Additionally, we know that food waste is a big contributor toward climate change, and that climate change is drastically increasing the risk and frequency of natural disasters and crises.

Also, focus now is on job creation, and food waste reduction creates jobs. Massachusetts created 500 new jobs and supported 900 jobs from its waste ban. There is big opportunity to build food waste-related infrastructure into any infrastructure legislation to help reduce waste and create jobs.  

Waste360: What have been impacts of COVID-19 on food waste, and how do you see the federal government responding to that?

Broad Leib: COVID-19 caused major market and supply chain disruptions that led to food surpluses and, as a result, food waste. These supply chain disruptions remain an issue, especially for small and mid-sized and minority- and women-owned farmers. Even as things reopen, we have heard that food waste remains a challenge because restaurants or food service operations can’t predict demand.

The federal government has taken steps to address these gaps, for example, through USDA’s Farmers to Families Food Box Program. However, this program had some weaknesses. We did an analysis of the F2FFB program, and found that while many people were very pleased with the program, it contributed to inequity in terms of the suppliers supported. It also did not address food waste specifically. We put in our report some things that could help to reduce waste (i.e., a tax benefit more tailored to farmers; tax benefit for transport; allowing food to be sold at low cost and get tax/liability benefits; requiring F2FFB distributors to have a food waste plan).

The F2FFB will end after May, and there is even bigger opportunity to take learnings of that program, and the new awareness of food waste, and develop programming and incentives to improve our food stewardship.

Waste360: Do you see the Senate, House, and President Biden working together on a solution? Do you anticipate roadblocks and, if so, how would you propose getting around them?

Alex Nichols-Vinueza, manager on the World Wildlife Fund Food Waste team: We developed a Food Waste Action Plan with other NGO’s. Since the plan was released, we’ve seen real interest and collaboration from all three [House, Senate, and White House Administration] to explore food waste policy solutions. It’s too early in the process to predict how it will all play out, but there certainly is momentum and a growing understanding that addressing food waste can have clear climate, job, and food security benefits, which support many of the administration’s current priorities. 

Broad Leib: We have seen bipartisan support for preventing food loss and waste in the past (for example, the Food Date Labeling Act had bipartisan support in the House, and the Food Donation Modernization Act had bipartisan support in the Senate).

Also, the Trump Administration launched the Winning on Reducing Food Waste Interagency Initiative.

Given prior bipartisan support, plus the current administration’s focus on climate change, this opens up great potential for renewed attention.

The biggest challenge will be maintaining and directing interest to get priorities enacted. This was a big reason we decided to launch the U.S. Food Loss and Waste Action Plan with ReFED, NRDC, and WWF when we did. The next steps are to really think about the ways that food waste reduction can fold into coming legislative vehicles: infrastructure legislation, Child Nutrition Reauthorization, and the 2023 Farm Bill.

Waste360: Has there been appeal made to federal government, and specifically to previous White House Administrations, for policy around food waste before? Has it made a difference?

Broad Leib: Yes and yes! Prior advocacy had impacts. It resulted in developing a national food waste reduction goal (2015) and the Winning at Reducing Food Waste Interagency Strategy (2019). Another success was the 2018 Farm Bill. Prior to that, there was not a dollar spent on food waste reduction or a single mention of the issue. After much advocacy, the last farm bill included nine separate programmatic, staffing, and funding priorities for food waste. Now we can build on that.

Waste360: Can you discuss needed policy when food cannot be saved for consumption? How do you believe compost should fit in?

Brenda Platt, director Composting for Community Initiative Institute for Local Self-Reliance: The U.S. EPA’s Food Waste Hierarchy rightly prioritizes the importance of not producing waste in the first place, followed by rescuing edible food. But it then lists industrial uses including energy recovery via digestion above composting. That’s a mistake.  Composting can be small scale and large scale and everything in between, but too often home composting, onsite composting, community-scale composting, and on-farm composting are overlooked.

Policies are sorely needed to encourage a distributed and diverse healthy infrastructure for composting and to encourage locally based composting solutions as a first priority over large-scale regional solutions.

Waste360 What is the ask of ILSR and the U.S. Composting Infrastructure Coalition of the Biden Administration? And what is your hopeful response?

Platt: Our ask of the Biden Administration, as well as Congress, is to include funding for composting infrastructure in the infrastructure bill. Recycling is infrastructure too! But do not privilege large-scale sites in the disbursing of those funds. Ensure a mix of sizes and program types are funded.

I’m an optimist so I believe we will see funding for composting infrastructure.

Action on the Hill looks promising for support of composting and compost use. On April 12, Senator Booker (NJ) introduced S. 1072, a bill that would in part provide $100 million per year in grants over a 10-year period for equipment for agricultural producers to carry out climate stewardship practices. On-farm composting is listed as one of two priorities for funding. 

In addition, the U.S. Composting Infrastructure Coalition has been having conversations with the Biden Administration about composting infrastructure, and they have been promising too.

Waste360: How long do you anticipate real change could take? And what happens if another Administration from another party comes in in four years? 

Nichols-Vinueza: The risk here isn’t an Administration change—the federal government’s interagency effort to halve food loss and waste is a rarity in that it started under the Obama Administration and continued under the Trump Administration. As our plan’s list of signatories shows, there’s broad support from citizens and businesses across the country to act on food waste, and real change is already happening at the city, state, and regional levels. It’s just not happening at the pace or scale needed to meet our national commitment to reduce food loss and waste by 50 percent by 2030. To get back on track, we need the federal support our Food Loss & Waste Action Plan outlines now, so that municipalities and states further behind in this process can develop the necessary planning and infrastructure to keep food out of the trash.  

Waste360: What are your hopes for the future around food waste policy?

Civita: My hope is that we can foster a nuanced policy dialogue around food waste that goes beyond mechanistic interventions — e.g., tax incentives that reward food donation but may encourage over-production and dumping; composting mandates that do not require wholesome food to be valorized or rescued, etc.  

I’d also like to see an approach to food waste policy grounded in principles of circular economy that address nutrient flows between rural largely-producing agricultural areas and urban/suburban largely- consuming areas. Similarly, we may find really valuable synergies if we think about crafting policies that simultaneously try to foster urban/peri-urban farming and better organic waste management, creating close nutrient loops and cycles.  

Finally, I’d advocate for really examining our approaches to all parts of food policy (especially examining food waste and conservation policy) through ecological and socio-cultural lenses, rather than just thinking about finance, supply management, and operational efficiencies, or even just mechanistically quantifying tonnage of waste or CO2e emissions avoided.  

We need to bring a more holistic view to create solutions that dislodge us from the take-make-waste paradigm. We should set new cultural expectations about how we value and cherish — rather than just utilize our waste — we need to prioritize [food] as nourishment.