Gilens on Medical Debt and the ‘Centuries-Long Suspicion of the Poor’

UCLA Luskin’s Martin Gilens spoke to KFF Health News and NPR about hesitation among some members of the Black community to use crowdsourcing sites for help covering medical debt. An estimated 100 million people in the United States are burdened by health care debt, with Black Americans at particular risk — yet they are far less likely to seek assistance from sites such as GoFundMe, the news organizations found. Pride and a reluctance to reinforce negative stereotypes are among the reasons. As Gilens, author of “Why Americans Hate Welfare,” explained, “There’s a sort of a centuries-long suspicion of the poor, a cynicism about the degree of true need.” In recent decades, poverty has been cast as a Black problem, even though there are far more white Americans living in poverty, according to census data. This helped drive a backlash against government assistance programs in the 1980s and ’90s, said Gilens, a professor of public policy, social welfare and political science.


 

Gilens on Building Public Support for Black Reparations

An Associated Press story about efforts to win public support for reparations made to Black Americans cited Martin Gilens, professor of public policy, social welfare and political science. The article focused on a new philanthropic initiative that is providing financial support to smaller nonprofits advocating for reparations to atone for the nation’s legacy of slavery and systemic racism. Opponents of reparations argue that current taxpayers should not be responsible for damages for historical wrongs. “It’s kind of a foreign concept to Americans, this idea of collective reparations for collective harms,” said Gilens, whose books include “Affluence & Influence: Economic Inequality and Political Power in America” and “Why Americans Hate Welfare: Race, Media and the Politics of Antipoverty Policy.” Gilens added, however, that support increases when parameters are set that direct potential benefits to specific groups rather than a broad population. 


 

Public Policy Students Take On the Health Care Digital Divide Effort to widen access to telemedicine is one of 15 immersive projects aimed at developing policy solutions for real-world clients

By Mary Braswell

When Sophia Li decided to apply to graduate school to pursue her interest in health policy, she could not have known that the field would soon be upended by a protracted global health emergency.

Along with most of her peers in the UCLA Luskin School of Public Affairs’ master of public policy program, Li began her studies in September 2020, when COVID-19 had already taken more than 1 million lives worldwide and the arrival of vaccines was still months away.

When the time came to embark on the public policy program’s exacting capstone project, Li chose to focus on an inequity brought into sharp focus by the pandemic: As they isolated in their homes, more people turned to telemedicine for their health care needs — but that option was not available to people who lacked computers, smart phones and internet service.

“The pandemic really did shine a light on the possibilities that telemedicine brings,” Li said, “but it also showed that, while the upper half are benefiting from this, what does this mean for the lower half that have these barriers to access?”

Li was part of a team that explored this question on behalf of their client, the nonprofit Community Clinic Association of Los Angeles County. On an evening in May, Li and teammates Stacy Songco, who is earning a master of public policy and a doctorate in medicine, Xinyuan Qi, Ziyi Wei and Yixuan Yu boiled down a year’s worth of policy research and analysis into a 20-minute summary.

They were among nearly 70 second-year students to complete 15 applied policy projects this year, a rite of passage before receiving their UCLA master of public policy degrees. The capstone projects challenge students to find solutions to real-life policy dilemmas on behalf of clients in Los Angeles, across the state and nation, and around the world.

Networking with UCLA Luskin alumni had connected Li with the Community Clinic Association, which supports 65 neighborhood clinics in underserved areas. At the time, the nonprofit was “just dipping their toes into the digital divide issue,” she said.

The team spent months speaking with medical staff, local policymakers, internet service providers and, of course, the patients themselves. The conversations took place via Zoom because of COVID restrictions, but also in person, to make sure those without the means to gather virtually would be heard.

By year’s end, the team had developed more than a dozen recommendations, including the creation of a new role of digital navigator — a clinic staff member trained to guide individuals through the often-confounding world of broadband access, as well as benefits they may be entitled to, which change from ZIP code to ZIP code.

The students proposed a mechanism to receive federal funds for this new position. They stressed that information should be provided in multiple languages, and not just online but in printable formats, for those unable to access the internet. And they quickly determined that unlocking digital doors would open up a world of services and opportunities beyond telemedicine.

One of their focus groups spoke of their experiences with the California Lifeline program, which provides discounted landline and cell phone services to low-income households. While some found it confusing, “we had one unhoused individual who said, ‘Actually, you know what? I can walk you through all the paperwork, I can talk to you about how to use this,’” Li said.

“If people from the community could tap their experiences to guide others and receive compensation as a digital navigator, imagine the possibilities.”

The project culminated in a full published report for the Community Clinic Association and a formal presentation before Luskin faculty, staff and students, including the team’s advisor, Public Policy chair Martin Gilens.

Other capstone projects completed by the class of 2022 dealt with how to protect the rights of car wash workers, whether to expand the number of seats on the Los Angeles City Council, how to balance public health and humane treatment of asylum seekers at the border, as well as homelessness, mass transit, criminal justice and more.

“It’s an immersive experience. The students value that, and the marketplace also values that,” said Wesley Yin, an associate professor of public policy and economics who has served as coordinator and advisor in the applied policy projects program.

“There’s a professionalism that makes it much more than a class project,” Yin said. “It equips students with the rich experience and knowledge to seamlessly integrate into an organization.”

Li said her team emerged with unexpected areas of expertise. “The digital divide is a really complicated issue that has everything from some little niche funding source that you need to know about, to complex infrastructure issues and these really technical things that you need to understand,” she said.

As she looks toward graduation, Li reflects on the turns in her education that brought her to this point.

She transferred from Chaffey College to UC Merced, where she earned a bachelor’s degree in public health, then managed the rigors of earning her master of public policy at a time of pandemic. Selected as a Presidential Management Fellow, Li will spend the next two years in a program that helps train young scholars to become the next generation of leaders in federal government.

“It’s been a lot of these 90-degree turns that keep putting me on the right path,” Li said. “So let’s go explore new things.”

View photos of this year’s applied policy project presentations on Flickr.

Applied Policy Projects 2022

Gilens on Stalled Attempts to Tax the Rich

A story in The Hill about the forces preventing adoption of new taxes on super-rich Americans quoted Public Policy chair Martin Gilens. Polls show that a majority of voters — both Democrats and Republicans — believe the country’s billionaires should pay more in taxes. Democrats in the White House and Congress have put forth several proposals for progressive taxation on the wealthy, but their chances are “slim to none in the short term and even perhaps the medium term,” said Gilens, co-author of a 2014 study showing the outsize influence of rich people and trade groups on U.S. government policies. Elected representatives spend an enormous amount of time with wealthy constituents or potential donors, and this “creates a sense of distortion about both what the public wants and what seems reasonable,” he said. “Whether taxing wealth seems like a reasonable thing to do might depend on whether you spend a lot of time hanging out with wealthy people.” 


 

Gilens on Efforts to Undercut American Democracy

Public Policy Chair Martin Gilens joined a Scholars’ Circle panel weighing threats to American democracy and prescriptions for reinvigorating democratic norms. Recent efforts to overturn elections and restrict voting rights are rooted in a long-standing lack of government responsiveness to the needs of ordinary citizens, said Gilens, noting that the nation’s elite is responsible for the latest attacks on democratic practices. “It doesn’t take a majority of the public to abandon democracy, for our institutions to be eroded or our electoral processes to be undermined,” he said. “It only takes a willingness of people to look the other way.” Gilens likened the current political atmosphere to the Gilded Age at the turn of the 20th Century, a period of gaping economic inequality and dysfunctional government. Political and economic reforms were enacted, but only after decades of effort at the local, state and national levels. “The change did come, but it didn’t come quickly or easily,” he said.


 

Gilens, Ong on Forces Undermining a Just Economic Recovery

UCLA Luskin’s Martin Gilens and Paul Ong shared insights on economic and political inequality and opportunity as part of a panel organized by the UCLA Anderson Forecast, a quarterly report that frames the economic outlook for California and the nation. Released Sept. 29, the latest report identified a shift from earlier forecasts, which had raised hopes for a blockbuster recovery as COVID-19 vaccines became widely available. Heading into the final quarter of 2021, these hopes have been tempered by the spread of the Delta variant and stagnating vaccination rates, which in turn have led to consumer caution. A panel of experts hosted by the Anderson Forecast brought context to these findings, with a focus on how income is distributed unevenly across the United States. Gilens, chair of UCLA Luskin Public Policy, said political and economic inequality are intertwined, resulting in policies that cater to moneyed interests. “Taming the role of money in American politics won’t be easy, especially with an unsympathetic Supreme Court, and … won’t by itself fix everything that ails our democracy,” Gilens said. “But it’s hard to see how we can fix American democracy without reducing the dominance of money in our politics.” Ong, director of UCLA’s Center for Neighborhood Knowledge, focused on race and ethnicity as factors in the job, food, housing and educational insecurity that persists across generations. “I would encourage my colleagues to think much more explicitly about the fundamentals of why race and racism exist within an economy,” he said. “Simply saying that everybody should have equal opportunity doesn’t make it so.” 

View the Anderson Forecast presentation, including a keynote address by Mary C. Daly, president of the Federal Reserve Bank of San Francisco.


 

Gilens Sounds Alarm for Democracy

The Washington Post was one of several media outlets reporting on a statement of concern about threats facing American democracy, signed by Public Policy Chair Martin Gilens and over 100 other scholars. The statement was a response to efforts by GOP-led state legislatures to restrict voting, which President Joe Biden referred to as an “assault on democracy … aimed at Black and brown Americans.” The statement, published by the public policy think tank New America, highlighted Republican efforts threatening the fundamental principles of democracy and urged Democrats in Congress to reform or end the filibuster to pass sweeping voting rights protections. The authors called for federal protections to ensure the neutral and fair administration of elections and guarantee that all voters can freely exercise their right to vote. “Our entire democracy is now at risk,” they wrote. “History will judge what we do at this moment.” The Hill, Business Insider, Forbes and other news organizations also covered the statement.


Gilens on Debate Over How to Frame Progressive Policies

Professor of Public Policy and Social Welfare Martin Gilens was featured in a New York Times column examining a recent paper published by Yale political scientists Micah English and Joshua Kalla. The scholars contend that, “despite increasing awareness of racial inequities, linking public policies to race is detrimental for support of those policies.” The English-Kalla paper has prompted widespread discussion among Democratic strategists and analysts. “Their findings suggest that, even in this time of heightened public concern with racial inequities, Democrats are not likely to boost public support for progressive policies by framing them as advancing racial equality,” Gilens said. He called the paper “solid work” but also pointed out its limitations. “I would consider the English and Kalla results to be sobering but not, in themselves, a strong argument for Democrats to turn away from appeals to racial justice,” Gilens said.


Policies Reflect Preferences of Affluent Americans, Gilens Finds

Professor of Public Policy and Social Welfare Martin Gilens was featured in an Atlantic article about the influence of wealth on politics. In his research, Gilens has found notable differences in the policy preferences of affluent Americans compared to the middle class. These differences are not limited to economic matters like taxation, but also include funding for public education, racial equity and environmental protections, which the wealthy are less likely to support. These differences in policy preferences are significant because of the influence the rich have over government officials. In one report, Gilens analyzed thousands of public survey responses and found that, on issues where the views of wealthy voters diverged significantly from those of the rest of the populace, the policies ultimately put in place “strongly reflected the desires of the most affluent respondents.” Gilens concluded that the policies on these controversial issues “bore virtually no relationship to the preferences of poorer Americans.”


Gilens Publishes Research on Campaign Finance Regulations

Public Policy Chair Martin Gilens‘ research into the impact of campaign finance regulations was published in American Political Science Review. Many scholars have expressed concern about the dominance of moneyed interests in American politics, and studies have shown that lobbying group interests and federal policies primarily reflect the desires of well-off citizens and well-funded interest groups, not ordinary citizens. While previous reports have faced difficulties drawing causal inferences from observational data, Gilens and his co-authors were able to analyze the effects of an exogenous change in state campaign finance law. The Supreme Court’s 2010 Citizens United decision held that corporations and unions have the same speech rights as individuals, and that corporate spending to influence elections does not give rise to corruption, as long as it is not coordinated with a political campaign. Gilens and his co-authors analyzed the impact of the ruling, which affected 23 states that had bans on independent expenditures by unions or corporations. After the bans were lifted under Citizens United, the states adopted more “corporate-friendly” policies on issues with broad effects on corporations’ welfare, they found. The authors concluded that “even relatively narrow changes in campaign finance regulations can have a substantively meaningful influence on government policy making.” The article, “Campaign Finance Regulations and Public Policy,” was written by Gilens, a professor of public policy, political science and social welfare; Professor Shawn Patterson Jr. of Southern Oregon University; and Professor Pavielle Haines of Rollins College. — Zoe Day