Tapped: The Prospect Group Blog

VA Officials Continue to Discuss Proposed Health-Care Changes Out of Public View

In a now familiar pattern, leading veterans organizations are up in arms again over the latest revelations about White House plans for the Veterans Health Administration (VHA)—plans that were concocted behind closed doors.

Last week, the Associated Press reported that Secretary of Veterans Affairs David Shulkin and other Trump officials have been quietly discussing ways to shift veterans, now eligible for VHA care, into Tricare, the private insurance program for active duty military personnel and their families. The administration’s Tricare discussions have been conducted without input from members of Congress or veterans groups.

In recent months, Amvets, Disabled American Veterans, the American Legion, and other veteran service organizations have become increasingly worried about the Trump administration’s moves to out-source more VHA services through expanding a program called “Choice,” which reimburses non-VHA doctors and hospitals that treat veterans.

Veterans’ advocacy groups have reacted with shock and anger about the prospect of a VHA merger with Tricare, which pays for private-sector health-care services. Such a move could ultimately lead to the dismantling of the VHA, which provides integrated, direct care for nine million patients at 1,700 facilities nationwide.   

As Louis Celli, a top staffer for the American Legion, told the Associate Press, a merger would siphon off funds from VHA hospitals and clinics and eventually shift costs directly to veterans, through co-pay and other possible fee increases. (Tricare patients have recently started paying higher co-pays.)

Curt Cashour, a Veterans Affairs Department spokesman, called the concept a possible “game-changer” that would save taxpayers money because it is based on “the type of businesslike, common-sense approach that rarely exists in Washington.”

Recently, congressional Republicans have tried to convince veterans that the troubled Choice program should be renewed with even fewer restrictions on veterans who want to use private-sector providers—even though the program has been rocked by $2 billion in cost over-runs. (The VA Inspector General released a report in September that also revealed that the third-party contractors responsible for the Choice program had overbilled the federal government by almost $90 billion in 2017.)

The author of one such proposal is Representative Phil Roe, the Tennessee Republican who chairs the House Committee on Veterans Affairs. He has insisted that his bill, the VA Care in the Community Act, would actually strengthen veterans’ health services. Some Democrats on the House Veterans Affairs Committee, like Tim Walz of Minnesota, even co-sponsored Roe’s bill, despite the VHA privatization threats. But others, including California Democrat Mark Takano, a staunch supporter of the VHA and ally of veterans group, sought major changes in the legislation that would ensure the VHA maintains a critical role in providing direct care to veterans and coordinating any care veterans receive in the private sector with services provided by the VHA.

But with the revelations about secret meetings, Walz now believes that the real White House goal is “to force unprecedented numbers of veterans into the private sector for their care.” In response to the AP story, Walz demanded that the administration release “unredacted copies of any and all documents, records, memoranda, [and] correspondence” related to the private insurance scheme.

This latest development in the long-running Koch brothers–backed campaign to turn veterans into private-sector health-care customers should not come as a surprise. As The American Prospect has previously reported, when the Choice program was initially created in 2014 to deal with VHA appointment delays, Congress and the Obama administration also formed a VA Commission on Care to make recommendations to improve the health-care system. But health-care industry executives and allies of the Koch brothers who favored VHA privatization influenced the commission’s findings. Darin Selnick, a top official of the Koch brothers–funded Concerned Veterans for America (CVA), served on the commission and later became a senior adviser to Shulkin.

The Prospect also reported that a conservative faction on the commission known as the “Strawman group” short-circuited public deliberations about the future of the VHA by meeting in secret. Their “minority report” called for replacing the VHA with an insurance scheme like Tricare. One Strawman group member, Obama appointee Joyce Johnson, is a top Coast Guard official who helped to move the Coast Guard into Tricare.

Secretary Shulkin’s secretive approach raises new questions about how he intends to run the agency. Last winter, the VHA’s defenders breathed a collective sigh of relief when Trump decided to keep Shulkin (who served as the VHA undersecretary for health under former President Obama) in his cabinet. (The other leading contenders for the job, Pete Hegseth, former CEO of the CVA, and Florida Republican Jeff Miller, the former chairman of the House Committee on Veterans Affairs, had both publicly supported VHA privatization.) His credibility among veterans may take a big hit if he continues to speak out against privatization while working behind the scenes to steer the VHA in that very direction.

The GOP Tax Plan Places Huge Burden on Graduate Students

Late last week, House Republicans passed the “Tax Cuts and Job Act,” a bill they claim will cut taxes and raise wages for the majority of Americans. One group that would see a huge tax increase are graduate students. Many of them survive on modest stipends, but they could see their taxes quadruple under the GOP plan.    

Most doctoral programs come with a sticker price somewhere between $20,000 and $50,000 per year. Yet many graduate students usually do not pay the going rate. Instead, these students work as teaching assistants who conduct research and teach classes. They receive a small yearly stipend, typically between $15,000 and $35,000. Roughly 145,000 graduate students fall into this category.

The House Republicans' plan would treat waived tuition as income, which means some graduate students would see their tax bills skyrocket despite their meager take-home pay.

In an interview with Wired, Amanda Coston, a Carnegie Mellon PhD student, said she expects her tax bill to increase from roughly $2,000 to more than $10,000. Essentially, Coston would pay taxes on $76,234 (tuition plus stipend), even though her real annual income is only $32,400. (The latest version of the Senate bill does not tax waived tuition.)

Michael Stenovec, a UCLA graduate student working on his doctorate in political science, told The American Prospect that the Republican plan “hurts graduate students who work in high-cost areas like Los Angeles and at public schools without the resources to better compensate grad students.”

The higher tax burden is not the only new penalty: Interest on student loans would no longer be tax deductible. Other workers in the higher-ed sector would also suffer under the Republican tax scheme. University employees from janitors to administrative assistants have long been able to score free tuition for their children. Under the GOP plan, that valuable benefit would be counted as taxable income.

In knowledge sectors like “eds and meds,” graduate students help large research universities—as well as the regions of the country that host them—maintain a competitive edge in the global economy. A plan that forces graduate students to cough up thousands in additional taxes a year to give tax cuts to the super-wealthy is no way to build off that success. It’s actually a move that may put graduate school out of the reach of America’s best and brightest.

Menendez Mistrial Is a Relief to Democrats -- for Now

The bribery trial of New Jersey Senator Bob Menendez ended in a mistrial on Thursday, quelling Democrats’ fears about an open Senate seat being filled by a Republican.

If Menendez, a Democrat who was indicted on 18 counts of corruption, had been convicted and subsequently resigned or been expelled before January 16, New Jersey Governor Chris Christie would have had the authority to appoint a senator to serve in his place until December 2018.

Presumably, Christie would have appointed a Republican to the position (some speculated that he might have even appointed himself), tilting the balance of power to GOP even further: As Vox recently reported, a 53rd Republican senator would have the potential to breathe new life into the Obamacare repeal effort.

If Menendez is retried and found guilty, his resignation or expulsion would be less daunting for Democrats. After Democrat Phil Murphy is sworn in as the state’s new governor this January, the responsibility of appointing a replacement for Menendez would fall into his hands.

Menendez was indicted on bribery and conspiracy charges: He allegedly used his position to protect the business interests of a friend, Salomon Melgen, a wealthy Florida doctor, in exchange for gifts and campaign contributions.

If this trial was any indication, a second trial could be a lengthy one. Menendez was indicted in 2015, but the case did not go to trial until September of this year. Earlier this month, a juror left for a long-scheduled vacation during the deliberations. The judge replaced her and the deliberations restarted this week. Soon afterward, the jurors announced that they were deadlocked.

Menendez is still up for reelection in 2018, but this scandal could weaken his chances of winning. According to a September Quinnipiac University poll, half of New Jersey voters believe that he should not be re-elected. His approval rating had also dropped to 31 percent.

But in October, he told CNN that he was confident he would be acquitted and that his poll numbers would improve as a result.  "I have no intention of being anything but exonerated," Menendez said. "So therefore, I'm not contemplating anything but reelection next year."

If he does decide to run, a handful of the state’s Democratic leaders, including Murphy, have pledged that they would throw their support behind him. 

Medicaid Malpractice

We knew it would happen, but that doesn’t quite reduce the sting.

In September, I wrote about a proposed waiver to Kentucky’s Medicaid program, which would foist work requirements on recipients (among other patronizing indignities like premium payments and “health incentives”) and would devastate Kentucky’s large newly insured population. Those work requirements directly conflicted with the federal Section 1115 waiver guidelines, which govern what’s allowable in Medicaid waiver requests.

This week, at a National Association of Medicaid Directors conference, Seema Verma, head of the federal Centers for Medicare and Medicaid Services, indicated that states could request waivers that would permit officials to impose work requirements as a condition of receiving Medicaid. Which means, according to Kentucky’s Medicaid Director Stephen Miller, the state’s waiver request will be approved “soon.”

Verma defended the changes this way: “Believing that community engagement requirements do not support the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration,” she said.

The “soft bigotry of low expectations”? This phrase brings two thoughts to mind.

First, what about the hard bigotry of requiring people to prove their worth to receive health care? That’s what Medicaid “community engagement requirements” (read: work and volunteer requirements) represent. These requirements would force the poor and low-income people who would be subject to these rules (and most of whom are already working) to prove that they are worthy of assistance—in this case, worthy of having good health.

Such requirements often include difficult reporting requirements like documenting each hour of work, and limited flexibility if family or other emergencies arise. They are based on the flawed assumption that people in poverty are lazy—a stereotype that has been disproven again and again.

Second, work requirements just don’t work. So, “low expectations”?

My low expectations have nothing to do with poor people who receive Medicaid, and everything to do with Republicans who make false claims about how “hard work” will improve people’s lives, based on inaccurate ideas of who is poor and why.

I have low expectations that unemployed people who receive Medicaid will be able to find good work—not because they aren’t motivated to find work, but because the abysmal unemployment that plagues many areas in Kentucky and other states will be ignored by Republicans.

The consequences (and causes) of poverty don’t help either, like limited formal education, lack of employable skills, and lack of access to transportation. And since the Trump administration ended rules that would have made it easier for people on welfare to participate in job training, I also have low expectations that Republicans will facilitate participation in such programs.

Plus, even though most people on Medicaid work, many of those jobs are in retail, food service, and construction—sectors that often have variable and inconsistent payroll hours. It’s challenging to meet arduous reporting requirements, like the 20 hours of work per week requirement proposed in Kentucky, if one week you’re scheduled for 25 hours but the next you get 10. And Kentucky nonprofits have already indicated they don’t have the capacity to create new volunteer positions for anyone who wants one.

In short, I have low expectations that any policy that is based on false assumptions about the poor will in any way help them in escaping poverty. Instead, these policies, which reinforce stereotypes of the lazy poor person, are designed simply to push people off of assistance programs in order to limit welfare, decrease the size of government, and save money.

Remember that under past administrations, work requirements were at odds with Medicaid waiver guidelines. So what did the Trump Medicaid officials do? They simply rewrote the rules. “Seemingly, they did that so they could push through Kentucky’s waivers and other waivers after that,” says Dustin Pugel, research and policy associate at the Kentucky Center for Economic Policy.

In her conference remarks, Verma said, “The thought that a program designed for our most vulnerable citizens should be used as a vehicle to serve working-age, able-bodied adults does not make sense.” The problem with this statement is that poor working-age, able-bodied adults are some of our most vulnerable citizens. But in Kentucky, Medicaid expansion allowed this population to finally access health care. New Medicaid recipients began accessing preventative services, and were more likely to seek care for chronic conditions like diabetes. The state got healthier.

The Trump administration is putting those gains into jeopardy—as it will for any Medicaid expansion state that is granted a waiver. In Kentucky, “the changes will result in at least 95,000 fewer people covered, primarily because they can’t keep up with the requirements,” says Pugel. Medicaid provides health care for low-income people. The Trump administration twists this objective into nothing more than shaming the poor.

Robert Rubin Speaks with Forked Tongue

There’s a smart op-ed piece in the Times by Robert Rubin—yes, that Robert Rubin—calling for a massive federal jobs program at decent wages. Rubin correctly points out that most people need good jobs, and that the vogue for a Universal Basic Income doesn’t solve that, and is very expensive.

What prevents us from having a jobs program at a scale that would make a real difference? One factor is the Democratic Party’s obsession with deficit reduction and budget balance as necessary tokens of fiscal virtue. That theme ran through both the Clinton and Obama administrations.

And the leading Democratic proponent of that view, along with his Republican Wall Street cronies like Pete Peterson, was the same Robert Rubin.

Now that the good jobs desert has brought us Trump, it’s nice that Rubin is having new thoughts. And tactically, it’s useful that Rubin now supports a massive federal outlay on jobs. But hypocrite and opportunist are among the kinder words to describe this man.

Immigration Advocates Warn Undocumented Are ‘Fair Game’ After Detention of Texas Child

The arrest of Rosa Maria Hernandez, an undocumented ten-year-old with cerebral palsy, by Customs and Border Protections, after she received emergency gallbladder surgery in a Texas hospital is a heinous example of the dark turn immigration enforcement has taken under Donald Trump.

Marissa Montes, an immigration attorney with the Loyola Immigrant Justice Clinic at the Loyola Law School in Los Angeles says that Rosa Maria’s arrest sends the message to undocumented people that “anyone is fair game: Regardless of whether you have a criminal record, under the Trump administration, you are considered an enforcement priority.”

The child is not the first undocumented person arrested at a hospital, or even at Driscoll’s Children Hospital. Earlier this summer, Oscar and Irma Sanchez, the undocumented parents of an American-born infant were arrested at the same hospital as their child underwent surgery. Other undocumented people have been arrested at public facilities as ICE has stepped up its enforcement efforts, including a father who was dropping his daughter off at school and a woman who was detained after seeking a protective order from domestic abuse at a courthouse.

During the first three months of the Trump presidency, ICE arrested 20,000 undocumented people, a 30 percent increase over the same period in 2016. Revisions to Department of Homeland Security guidelines, made during Trump’s first month in office, have produced the spike in arrests by expanding the categories of people considered a “priority for removal.”

In the waning years of the Obama administration, undocumented people with criminal backgrounds who posed a threat to public safety were the focus of deportation efforts. The Trump DHS has moved to deport any undocumented person with any kind of record, including minor infractions.

These rule changes essentially make every undocumented person in the U.S. a deportation target, because they have all technically broken the law by crossing the border illegally. Rosa Maria’s arrest was not a mistake: Under DHS rules, she is a priority for deportation.

Montes tells The American Prospect that under previous administrations—and even during Obama’s first term, when total deportations peaked—ICE agents didn’t make arrests in schools, hospitals, courts, or places of worship. This changed under Trump, despite pleas by local officials who say detaining undocumented people at courthouses created a chilling effect that has caused a drop in reports of sexual assault and domestic violence.

Ali Noorani, the executive director of the National Immigration Forum, argues that if DHS “is really interested in keeping the homeland secure, they should be spending every dollar available on public security threats.”

During the early Obama years, more undocumented people were deported per year than under any other president in history. But in 2014, President Obama directed DHS to prioritize threats to public safety and deportations declined thereafter. The Trump administration has reversed that trend. Instead, ICE and CPB now spend their time prowling around courthouses and checking the documents of people in ambulances en route to hospitals. While Trump officials growl about the threat that undocumented people pose to public safety, they seem less interested in responding to real public safety issues, like the circumstances that allowed a gunman commit mayhem in Las Vegas, than they are in making all undocumented people fear for their own safety, and proving that no one—not even a ten-year-old girl with cerebral palsy needing emergency surgery—is out of the reach of immigration agents.

Facts Again Go Missing as Trump Declares Opioid Addiction a National Health Emergency

During a speech last week declaring opioid addiction a national public health emergency, President Trump made the extraordinary claim that 64,000 American lives were lost last year due to drug overdoses. “More people are dying from drug overdoses today than from gun homicides and motor vehicles combined,” he said.

Trump continued to embellish his case, adding that the “shocking death toll,” of addiction has resulted in “families ripped apart and, for many communities, a generation of lost potential and opportunity,” he said. “This epidemic is a national health emergency, unlike many of us [have] seen and what we've seen in our lifetimes. Nobody has seen anything like what's going on now,” Trump added. “As Americans, we cannot allow this to continue.” 

The opioid crisis is indeed a public health menace. But Trump’s narrative, one that claims that drug-related deaths are a greater scourge than gun homicides and motor vehicle deaths put together is at variance with the facts. Every raised decibel on overdoses only serves to amplify the silences on the deaths that he downplays.  

About 35,000 people died in car crashes in 2015, according to the Insurance Institute for Highway Safety’s most recent data, and the United States has the highest rate of crash deaths in the developed world, according to the Centers for Disease Control and Prevention. The U.S. also ranks near the bottom of 20 nations for front-seat seatbelt use and has the second-highest level of accidents involving drunk drivers.

Families are no less ripped apart by deaths involving a drunk driver. In 2013, nearly a third of traffic deaths involved a driver operating a vehicle under the influence of alcohol, yet a president has never declared a public health emergency to force the auto industry to make cars safer; encourage drivers and passengers to be more conscientious; entice drivers off the road with better public transportation; or to make drunk-driving punishments harsher.

Trump played fast and loose with the number of Americans who have died because of gun violence. Homicides actually account for only a third of the 34,000 annual deaths involving guns. The other two-thirds, more than 21,000 a year, are from suicide.

Why Trump chose to ignore gun suicides is unknown. Is it because he wanted to blow out the embers from a gun control debate that got reignited after Las Vegas? Was he afraid that spotlighting the high U.S. gun death rates would anger the National Rifle Association? Did the president want to downplay a racial issue? It’s well known that the opioid crisis has ripped through rural and low-income white communities. Less commonly known, because the NRA and their puppets in Congress make sure there is little or no funding for federal gun studies, is that white men account for seven out of every ten suicides, according to the American Foundation for Suicide Prevention. Or did some White House officials simply realize that Trump’s fudging of the numbers on gun and motor vehicle deaths and comparing those figures to the numbers of opioid deaths was flat out wrong?  

The opioid crisis demands attention. But despite the declaration, Trump has said little about long-term solutions or funding to address this national emergency. It is also extremely unclear and highly doubtful that an administration that is rolling back regulations with a vengeance will spend any time looking into the role of the pharmaceutical industry that pushes the sale of prescription opioids that many patients have abused.

If Trump really cares about public health emergencies, the efforts to fight opioid addiction should include concurrent actions against gun violence. When Congress cannot even act on the bump stocks that enabled the Las Vegas gunman to turn his weapons into virtual machine guns, that failure to act speaks volumes about the willful disregard about public health crisis. Put another way, about half a million Americans have died in domestic gun incidents since the terrorist attacks of September 11, 2001. Families have been ripped apart and in many communities, a generation of promising young people have died. When does the president plan to declare a national emergency for that?

The Wieseltier Moment -- a Tipping Point

With the ouster of Leon Wieseltier for a long, sordid history of hitting on young women who worked in junior positions at The New Republic where he was literary editor for three decades, the women’s movement has achieved a goal that has eluded it for centuries. Powerful men, famous or not, are no longer exempt from being held accountable. Masses of women are willing to tell their stories. Boards of directors are compelled to act.

It was one thing for celebrity offenders to fall from grace—Cosby, Weinstein, et al. Leon Wieseltier is not a major celebrity, except perhaps in his own eyes. He’s a literary intellectual, who was about to launch a new quarterly magazine called Idea, underwritten by Laurene Powell Jobs, the widow of Steve Jobs.

Wieseltier, with the appropriate literary flourish, issued an abject mea culpa:

For my offenses against some of my colleagues in the past I offer a shaken apology and ask for their forgiveness. The women with whom I worked are smart and good people. I am ashamed to know that I made any of them feel demeaned and disrespected. I assure them that I will not waste this reckoning.

Presumably he was aware of these serial offenses and shames before they went public? Maybe not.

It wasn’t enough to save his neck. When the litany of complaints surfaced, his benefactor Powell Jobs not only fired Wieseltier but killed the magazine.

When most regular people outside literary circles read the stories, their reaction was …. Leon who? But if Wieseltier can be held accountable, so will many thousands of others.

All over America today, men who held positions of power that they abused sexually two or ten or 20 years ago, are feeling just sick. You never know which former underling will decide to speak up, and whose heads will roll.

That includes college professors, executives of middling enterprises, managers of fast-food joints, directors of nonprofits—anyone and everyone. It’s about time.

This is an epochal tipping point. There will be a long overdue reckoning, and then maybe—maybe—men in positions of power will stop doing this, or at least think very hard about the risks. And women—all women—will feel, and be, newly empowered.

Virtue is said to be its own reward. In this case, virtue is also conducive to sound sleep for men who did not abuse their positions of power for sexual favors or coercions.

In social revolutions, change comes very slowly, and then abruptly. But the deeper change will be behavioral. Consensual hanky-panky will not end, but when there is an imbalance of power there is no such thing as consensual.

Wieseltier’s public shaming will be the first of many such falls from grace of non-celebrity offenders. And more men will behave more decently, or at least more prudently.

California Wildfires Stoke Need to Concentrate on Climate Change, Public Health

Northern California has been battling wildfires since early October, which have burned  almost 250,000 acres, killed 42 people, displaced 100,000 residents, and destroyed thousands of homes. The hardest-hit areas have been Napa and Sonoma counties, the epicenter of the U.S. wine industry, and Santa Rosa, a town of 175,000 50 miles north of San Francisco. As many as 11,000 firefighters worked to combat the flames, including 6,000 volunteer inmate firefighters. With wildfire threats shifting to southern California as temperatures climb and the dry Santa Ana winds pick up, Californians are taking a hard look at what happened and how to better protect local communities.

The wildfires in the northern areas of the state disrupted residents’ food and water supplies and health-care systems. Fire and smoke taint water sources—which led California to issue a “boil water” notice—and can affect bottled or canned food. Several health-care facilities burned down or had to be evacuated. Those developments also meant loss of vital medications, “and pharmacies in the [affected] areas are struggling to fill prescriptions, especially for respiratory illnesses,” said Dr. Linda Rudolph during a recent press briefing for state policymakers organized by Climate Nexus, a nonprofit science literacy organization. Rudolph directs the Center for Climate Change and Health at the Public Health Institute in Oakland. Skilled nursing facilities were also adversely affected since senior citizens are often too infirm to mobilize on such short notice.

Meanwhile, the intensity of the infernos did not surprise LeRoy Westerling, a University of California Merced management professor who co-directs the Center for Climate Communication, and has studied factors that make California so susceptible to wildfires. According to Westerling, the wet winter of 2016 following years of drought and dry coastal climates created perfect conditions for a fire of this magnitude. Plants grew rapidly after the heavy rainfall. The summer of 2017 was also one of the hottest on record, which further dried up all the vegetation and brush that had grown during the winter, creating the perfect  conditions for wildfires. “It’s usually pretty dry this time of year, and given the proximity to lots of population centers, there’s lots of human fire ignitions,” said Westerling during the briefing. “When you combine all of those together, it’s kind of a peak opportunity time in October for some of these big fires to occur,” he added. Other factors, such as dead plant debris from years of drought, provided “standing dead fuel” for the fires to surge. The summer of 2017 was also one of the hottest on record, which further dried up all the vegetation and brush that had grown during the winter.

To respond to the increased fire risks, Bill Stewart, a UC Berkeley Cooperative Extension Specialist, noted that California is developing a “vegetation treatment plan” that will require studying fire risk reduction techniques, weighing public health concerns, and monitoring wildlife and ecosystems, including endangered species habitats. Stewart also believes that California environmental officials should reconsider the kind of vegetation planted near population centers. Certain plants are more susceptible to fire than others, such as grassland, which easily dry out in summer.

Decades of other incremental changes in the climate helped create an environment that makes fires more intense, Westerling said. Because of warmer temperatures in recent years, soil and trees have retained much less moisture. These conditions, spurred by “diablo winds” and fluctuating temperatures between coastal and inland climates, also helped the fires spread even farther. (Diablo winds refer to hot, dry winds in the San Francisco Bay area that blow from the interior of the state to the coastline.)

California state legislators and energy officials are also working on statewide climate assessments. These studies explore the long- and short-term effects of climate events, performing simulations of both average and extreme events, such as the current fires. The state is also focusing on fuel management, population growth scenarios, and ecological development footprint scenarios, all of which influence climate patterns. In addition, the University of California is funding a multi-year project to compare climate change and public health concerns, and create projections that would help inform the state’s decision-making in the next decade.

Big Banks Blame Automation as They Offshore American Jobs

When Capital One announced in August that they were laying off 400 call-center workers from a Rolling Meadows, Illinois, location, the company officials claimed that they were moving toward automation. “Call volumes continue to decrease as customers increasingly self-service through a mix of our digital tools and contact center calls,” Sie Soheili, a Capital One spokesperson, told the Chicago Tribune. The Rolling Meadows layoffs follow the loss of 1,500 Capital One call-center jobs in Oregon and South Dakota in 2015. Yet last year, Capital One opened a new customer-service and technical-support office in the Philippines, creating 2,000 call-center jobs. Today, Capital One employs 4,800 call-center workers in a country that had no call centers at all just four years ago.

With 2.5 million people employed at call centers in the United States, employees in the sector face an existential crisis as companies close down one center after the other. While the corporate officials may say they are bowing to pressures from consumers, many of these companies decide to lay off American workers and hire less-expensive foreign workers in countries like the Philippines.

Wells Fargo, who earlier this week laid off hundreds of employees at a call center in Allentown, Pennsylvania, also has shifted jobs to the Philippines. The company has laid off hundreds of American call-center employees over the last decade, even as the company expands their call-center hiring in the Philippines (which assists U.S. customers).

Tim Sloan, the CEO of Wells Fargo, effectively admitted to offshoring jobs during a Senate Banking Committee hearing in early October. Senator Joe Donnelly, an Indiana Democrat, asked Sloan whether Wells Fargo “let people go in the states and then added people in the Philippines?” Sloan responded, “Senator, we did,” before attempting to brush off the offshoring issue by claiming the call centers in the Philippines allowed Wells Fargo to provide 24/7 customer service. A smirking Donnelly replied that he knew many Americans who would be willing to work night shifts.

Call centers are at the front of a company, providing general customer service or technical support. They also serve as telemarketing hubs. Most sectors with large numbers of customers who require those services, from telecommunications and media to banking and financial services, use call centers. But the nature of the work means that it can be done from anywhere in the world, and companies pay Filipino and Indian employees much less than comparable American workers.

Offshoring call centers isn’t just a threat to workers. This trend also presents a problem for American consumers. Poorly paid center employees in the Philippines and India have few opportunities for advancement. In that climate, it is easy to see why cybersecurity analysts say there is a risk of call-center workers committing identity theft. Despite this, almost all of the major banks in the United States, from Bank of America and Chase, to Capital One and Wells Fargo, operate call centers overseas.

Organized labor has been fighting corporate offshoring of call-center jobs for years. But with labor unions’ power waning and corporations eager to reduce labor costs any way possible, that skirmish proved to be a tough one. Even so, the Communications Workers of America, which represents most unionized call-center workers, has had some success. In 2016, striking Verizon workers represented by the CWA stayed on the picket line until Verizon made wage concessions and promised that 1,300 new call-center jobs would be created in the United States. Shane Larson, a CWA spokesman, described the Verizon strike as a “huge win.”

“We kept good jobs in the U.S. and brought back previously offshored jobs,” he said. US Airways, also under pressure from CWA, closed the last of their Filipino call centers in 2011, a process that began in 2004 after a labor dispute.

Prodded by union activism, seven Senate Democrats, led by Senators Sherrod Brown of Ohio and Robert Casey of Pennsylvania, introduced the U.S. Call Center Worker and Consumer Protection Act earlier this year, which would require overseas call-center employees to inform American callers and give those callers an option to speak with a U.S. call center if they’d prefer. It would make corporations that offshore call-center jobs ineligible for some federal grants and loans. Representatives Gene Greene, a Democrat from Texas, and David McKinley, a Republican from West Virginia, introduced a similar bill in the House. He said in a press release, “our number one priority in Congress is protecting and creating American jobs. Plain and simple, we should not be rewarding companies for moving jobs offshore.”

Similar bills have been introduced in eight state legislatures, including Georgia and Alabama, where Republicans introduced the bills that echo President Trump’s “America First” message: In the Peach State, the bill is called “The Georgia Jobs First Act of 2017.”

Offshoring call centers is an easy way for corporations to cut labor costs. But with wage stagnation and growing income inequality, state and federal lawmakers need to decide whether corporations should be allowed to lay off American employees and then hire workers abroad for less money while enjoying lucrative government contracts and tax subsidies.

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