Our generation grew up during the 2008 financial crisis and will likely graduate into a COVID-19 recession. Shocks to our already fragile economy will heighten wealth inequality, while climate change will continue to devastate low-income areas. To meet the demands of this new era, we must reinvest in public goods, social safety nets and community infrastructure, including hospitals and education, to protect our most vulnerable. Through bold ideas that reimagine policy solutions, we can all do our part to bring about positive, progressive change. Working with the Roosevelt Institute, our Emerging Fellows have delved deep into addressing inequalities in opioid dependence treatment, risk assessment tools for bail, and kidney transplantation.
Treatment first: Decriminalizing incarcerated individuals with opioid use disorder
As opioid mortality continues to rise by 16% in Georgia — outstripping the national average by 2% — state legislators have passed harsher opioid possession laws, capped the number of methadone rehabilitation facilities and enforced abstinence-only treatment in correctional facilities. Stringent sentencing and an uptick in arrests for non-prescription opioid possession have led to a significant incarcerated population with opioid use disorder, disproportionately affecting Black and Latinx communities of color. Nationally, approximately 15% of the prison population has a heroin use disorder, while an additional 8-12% has a non-heroin opioid use disorder. The criminalization of a public health crisis requires immediate interventions to reverse decades of historical stigmatization.
While the expansion of medication assisted treatment in jails has yielded positive results across the nation, Georgia has yet to implement statewide programs for incarcerated individuals to receive necessary opioid withdrawal medication. Approximately 61% of incarcerated individuals with opioid use disorder nationally will be reincarcerated within a three year time period, but when inmates are offered robust withdrawal treatment for addiction, reincarceration rates decreased by 16%. Studies in Canada, Rhode Island and Vermont found that incarcerated individuals who underwent treatment were seven times more likely to enter a rehabilitation program once they were released when compared to the ‘abstinence-only’ approach of Georgia correctional facilities. Through a public health approach that decriminalizes substance use disorders, policymakers will be better equipped to make decisions that positively impact vulnerable populations.
Implementation of risk assessment tools: What is a fair approach?
The pretrial jail population has exploded from 82,922 in 1970 to 441,790 in 2015, largely due to cash bail. Although intended to compel defendants to return for trial and reduce reincarceration, there is little evidence that cash bail has an effect on either. One strategy to combat this injustice has been to implement own recognizance (OR) bonds, which enable defendants to be released from jail before trial without any payment and only the threat of higher payment if the defendant fails to return for trial or recidivates. The Pretrial Justice Institute reports on this approach’s effectiveness, but courts have struggled to assess which defendants should be eligible.
The rise of artificial intelligence has inspired a potential, though biased, solution: algorithmic risk assessment tools. These tools use individualized data from criminal histories and booking questionnaires to predict the likelihood that a defendant will be reincarcerated if released before trial. Some of this data, however, such as incomes and marital statuses, can punish defendants purely for having a low socioeconomic status. In addition, others are rated as high-risk solely because of their likelihood of committing a low-level offence (e.g. trespassing), which is relatively unlikely and poses little threat to a community. Further still, every stage of the judicial process, from policing to sentencing, is fraught with systemic bias, causing disparities in outcomes that are often detrimental to Black and Latinx populations. Risk assessment tools have no alternative but to employ this biased data to make predictions, and since the inputs are biased so too will be the outputs. Consequently, these tools ought to be pursued very cautiously, and, if implemented, should only be used to aid rather than replace a judge’s final determination and to assess the likelihood a defendant will commit a high level offence when released.
Kidneys for all: Removing financial barriers to living-donor kidney transplant in Georgia
Living-donor kidney transplant offers the best treatment option for patients suffering from End Stage Renal Disease (ESRD), but the financial burden of donating is often prohibitive, especially for low-income communities. The average living kidney donor will accrue an estimated $5,000 in unreimbursed expenses. Such expenses, which include the cost of lost wages and child care, are generally not eligible for reimbursement by private insurers or Medicare, leaving prospective donors without financial recourse. The resulting shortage of living-donor organs is especially critical in Georgia, the state with the lowest adjusted transplant rate in the nation and a high number of ESRD patients.
Georgia currently offers living donors up to $10,000 in tax deductions in order to incentivize transplant. However, according to the Tax Foundation, such tax deductions disproportionately benefit those in higher tax brackets, leaving low-income donors with unmet financial needs. To remove the financial disincentive toward organ transplant, Georgia should introduce a living-donor tax credit, which would cover all expenses up to $5,000, regardless of tax bracket. The creation of an organ donation tax credit presents a proven and cost-effective solution for increasing access to kidney transplant in Georgia, which will translate to a more equitable system and fewer lives lost to End Stage Renal Disease.