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06/07/2020

Mary Paier Powers Discusses What Family Caregivers Should Consider During the Pandemic When a Relative Is Resident in a Long Term Care Facility (June 5th)

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The COVID-19 pandemic has had particularly fatal effect on seniors or the frail elderly residing in Long Term Care (LTC) facilities, e.g., in a Skilled Nursing Facility (SNF_ or in assisted living.  As of last week approximately four in ten COVID-related deaths had occurred in these residences.  For example, in Virginia, as of mid-May approx. 60% of all COVID 19 related deaths have occurred in a SNF, among other states, in Minnesota , 80% of deaths have occurred in SNF and residential care homes.  Beyond LTC residents being immuno compromised, federal regulations concerning SNFs have, again, proven to be inadequate.  The question begged here is what can family caregivers, or those who have Power of Attorney or serve as Medical Proxy, do to protect their family members living in LTC - particularly if the facility is locked down or preventing family visits.

During this 30-minute conversation, Ms. Powers discusses among other related questions: what family members should know about the LTC facility in which their relative resides; beyond LTC facility’s precautions, what added/additional safety steps can the family caregiver take, e.g., if they've not should they pursue obtaining legal Power of Attorney (POA) and health care proxy authority; considering the extent to which the pandemic has adversely affected their family member's LTC facility, should, or how should, family caregivers evaluate proactively relocating their family member; can family members refuse to have their relative tested for COVID-19; if the relative tests positive for COVID 19 is the family caregiver, POA, medial proxy required to tacitly accept their relative being transferred to a hospital; and, if not, what are appropriate, proactive options can they take or what de facto dvanced care plans/planning should family caregivers make? 

Ms. Mary Paier Powers has been practicing law since 1984. Her practice focuses primarily on Estate Planning, Probate matters and Elder Law. She is a native of the Pioneer Valley where 9379 she was born and raised,  Ms. Powers began her career as a trust officer for Bank of New England West.  She next worked at Monarch Life Insurance Company, where she provided legal support and documentation on various life and disability income plans.  In 1993, she opened her own estate planning, probate and elder Law practice.  In 2019, Ms Powers formed Powers Law Group with her husband and son in West Springfield and Springfield, Massachusetts.  Ms. Powers graduated from Trinity College in Vermont and received her Juris Doctorate from Western New England University School of Law. 

Per my mention, the CDC guidance, "COVID-19 Guidance for Shared or Congregate Housing," is at: https://www.cdc.gov/coronavirus/2019-ncov/community/shared-congregate-house/guidance-shared-congregate-housing.html

06/03/2020

Jennifer Kent, Former Director of the California Dept. of Health Care Services, Discusses California's Response to the COVID-19 Pandemic (June 2nd)

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Since the federal government's response to the COVID-19 pandemic remains, as the The New England Journal of Medicine termed last week, laconic, the US response continues to be best understood at the state level.  California immediately comes to mind for obvious reasons.  Among others, it has a population of 40 million or 12% of the nation’s total (and if it was its own nation, would constitute the world’s fifth largest economy).  To date, California has limited COVID-19 related deaths to 4,250 or 4% of total COVID-19 related US deaths - notwithstanding having a substantial homeless population (approximately 20% of the nation's total). 

During this 28 minute podcast Ms. Kent discusses moreover the state's actions in response to the pandemic, especially concerning those most vulnerable including seniors, the poor or the states Medicaid, termed Medi-Cal, population and the homeless.  She also discusses the state's efforts at addressing related mental health and those with substance use disorders as well as whether the COVID-19 infection rate has peaked in the state and the state's predicament in funding its Medi-Cal program going forward. 

Ms. Jennifer Kent is currently CEO of the Sacramento-based Kent Group.  Previously she served as Director of the California Department of Health Care Services.  As Director, she Jkentoversaw the second largest public healthcare system in the nation with an annual budget of over $100 billion and serving approximately 13 million Californians.  She oversaw the administration of twenty-four managed care plans as well as 56 county behavioral health plans.  Ms. Kent has also held leadership roles in the state's Health & Human Services Agency and Governor’s office.  Her previous experience also includes working in the private sector as a lobbyist, consultant and association executive.  Ms. Kent earned her undergrad degree at Saint Mary's College of California and her MPA from the University of Southern California. 

Per my mention of California Governor Newsom's response to the pandemic see, for example, https://www.gov.ca.gov/california-takes-action-to-combat-covid-19/.  

05/31/2020

The Sabin Center's Michael Burger Discusses the Administration's Dismantling of Environmental Protections (May 29th)

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It should go without saying that we interact with the environment constantly.   It should also go without saying a degraded environment compromises our health and leaves us less resilient.  This explains why Black Americans, disproportionately suffering from chronic conditions resulting from, e.g., poor air quality, are suffering COVID-19 mortality rates upwards of three time that of White Americans.  According to the National Academies of Science, the environment is responsible for 30% of premature mortality while health care is only responsible for, or prevents, 10%.  Despite formally admitting via, e.g., Environmental Impact Statements, the Trump administration has gutted the nation’s environmental protections.  According to the Sabin Center, the administration has unwound, or intends to unwind, approximately 100 environmental regulations ranging from power plant and car and truck CO2 emissions, mercury and hydroflurocarbons emissions, rules protecting wetlands from oil and gas leasing, rules regarding pesticide use, drilling, fracking and coal leasing rules, off shore oil and gas drilling rules, Arctic exploration rules, rules governing natural gas pipeline construction and logging rules and the US’s commitment to the Paris climate accord.  Concerning the climate crisis, as I've noted previously research published in 2016 concluded that the adverse health affects resulting from health care industry’s greenhouse gas emissions is commensurate with upwards of 98,000 deaths annually in the US alone. 

During this 30 minute discussion, Professor Burger explains the Sabin Center's mission, provides an overview of the administration's efforts to moreover unwind air quality standards, discusses related procedural rules the EPA has/is unwinding, e.g., restrict the use of scientific research, and discusses the Juliana decision in light of related climate crisis-related court decisions world wise.  

Profess or Michael Burger is the Executive Director of the Sabin Center for Climate Change Law.  He frequently collaborates with researchers across Columbia's Earth Institute, and with local and national environmental groups, government representatives, and international organizations.   Previously,  he was an associate professor at Roger Williams University BurgerSchool of Law.  Previously still he taught in the Lawyering Program at New York University School of Law, served as an attorney in the Environmental Law Division of New York City’s Office of the Corporation Counsel.  He has also lead short courses on climate change and human rights in the Hague.  He is also a co-founder and member of the Environmental Law Collaborative, and is the incoming chair of the New York City Bar Association International Environmental Law Committee.  Professor Burger is a widely published scholar, a frequent speaker at conferences and symposiums, and a regular source for media outlets, including The Washington Post, Newsweek, Time, Forbes, The Guardian, Bloomberg, and Vox.com.  Michael is a graduate of Columbia Law School and of Brown University and also holds a Master of Fine Arts degree from the Creative Writing program at NYU.

Though not noted during the interview, listeners are encouraged to read, Climate Change, Public Health and the Law (Cambridge University Press), edited by Michael Burger and Justin Gundlach.  At: https://www.cambridge.org/core/books/climate-change-public-health-and-the-law/D2DED4C703EBD2F8CBD5B302E0B7AA3B.

Concerning the administration's attack on air quality, see, e.g., S. William Becker and Mary D. Becker, "The Devastating Impacts on the Trump Proposal to Roll Back Greenhouse Gas Vehicle Emissions Standards, "The Untold Story," at http://blogs.edf.org/climate411/files/2019/05/FINALGHGREPORT.pdf.   

05/27/2020

Interviewer as Interviewee: David Introcaso Answers Listeners' Questions (May 27th) (Part I)

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Since I've received and answered questions via email concerning podcast interviews and related health care policy questions over the past eight years, I thought it might be it might be useful to attempt answering listeners via a podcast program.  This podcast addresses questions I received via my solicitation a few months ago.  Joe DiLauro, the gentleman whom introduces the podcast and thanks listeners after each interview, and moreover my audio engineer, poses the questions.

During Part I of this discussion, approximately 22 minutes, I address questions concerning the current COVID-19 pandemic and questions concerning health care policy specifics related to Republican and Democratic party approaches to health care reform, Congressional functioning and policy management by Medicare program regulators.    

As for my bio . . . , over approximately the past 25 years I have done health care delivery, financing, policy research and evaluation in Washington DC.  My bio includes having served as Health Policy Adviser to the U.S. House of Representatives Majority Leader, Rep. Steny Hoyer.  I also spent eight years working in the US Department of Health and Human Services serving as the Evaluation Officer for the Agency for Healthcare Research and Quality (AHRQ) and as a Public Health Analyst in the Office of Assistant  Secretary for Planning and Evaluation (ASPE).  I have acute care experience having worked at DC General and post-acute experience having worked with the National Hospice and Palliative Care Organization.   My consulting clients have ranged from the American Heart Association and the American Public Health Association to UnitedHealth Group.  Among other awards I received a three-year W. K. Kellogg National Leadership Fellowship.  I have taught as a adjunct at Georgetown and at George Washington universities and over the past eight years, beyond producing over 200 interviews via this podcast, have authored over 50 health policy-related essays.  My BS, MA and Ph.D. degrees were earned at Rutgers and Arizona State.  

05/05/2020

Howard Friedman Discusses His Recently Published Book, "Ultimate Price, The Value We Place on Life" (May 12th)

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Considering how the COVID-19 pandemic has been addressed by federal policy makers, e.g., the US, with 4.25% of the world's population, accounts for approximately 30% of worldwide deaths, the question arises to what extent do we value life - literally.  As Professor Friedman notes in his work, lives undervalued are lives unprotected since they are exposed to greater health and safety risks and enjoy far fewer legal protections. 

During this 33-minute conversation, Prof Friedman discusses his motivation or intent in writing the book, what in theory is intended in calculating a monetary value for a life, how value is calculated or the "Value of a Statistical Life," why valuations vary widely, examples of why and when they're employed, for example, the 9/11 Victims Compensation Fund (VCF), the infamous Ford Pinto example and others including employer insurance policies on employees (commonly termed "dead peasants" insurance") and lives threatened by the climate crisis and relevance today in context of the COVID-19 pandemic.

Professor Howard Friedman teaches at the Columbia University Mailman School of Public Health and Columbia's Data Science Institute. He also provides statistical analysis for the United Nations Populations Fund.  Previously, Dr. Friedman served as a Director at Capital One where he led teams of statisticians, analysts and Howard Friedman photoprogrammers in various areas of operations.  He has authored and co-authored over 70 scientific articles and book chapters in areas of applied statistics, health economics and politics.  His recent publications have appeared in the American Journal of Gastroenterology, Current Medical Research & Opinion, Clinical Therapeutics, Inflammatory Bowel Disease, Journal of Managed Care Pharmacy, Clinical Drug Investigation, American Journal of Cardiovascular Drugs and Value in Health. Professor Friedman is also the author of the 2012 work, Measure of a Nation and the 2013 work, A Modest Proposal for AmericaProfessor Friedman Friedman received his Bachelor’s degree from Binghamton University in Applied Physics, earned a Masters in Statistics and Ph.D. in Biomedical Engineering from Johns Hopkins. 

Information on Ultimate Price is at: https://www.ucpress.edu/book/9780520343221/ultimate-price

  

04/28/2020

Krista Drobac Discusses Sweeping Changes in Federal Telehealth Policy In Response to the COVID-19 Pandemic (April 27th)

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Listeners may be aware that up until recently the Medicare program strictly limited provider use of telehealth services via originating site and other numerous other regulatory rules despite its much wider adoption by other payers and the VA.  (E.g., see my previous interview/discussion with Ms. Drobac.)  Annual Medicare reimbursement for telehealth services equaled approximately 0.003% of annual Medicare spending.  With the onset of the COVID-19 pandemic, the Congress and CMS regulators, recognizing the emergency or dire need to maintain a Medicare beneficiary's ability to access to clinical care in a timely manner, markedly expanded telehealth coverage.  Both the Congress's March 27th CARES Act and CMS' April 6 interim final rule made sweeping reforms to Medicare telehealth policy.   

During this 22 minute conversation Ms. Drobac begins by explaining why the Medicare program significantly restricted use of telehealth.  Moreover, she outlines telehealth policy reforms noted in recent COVID-19-related legislation, moreover the CARES Act, and in CMS' interim final rule.  She discusses take-up or utilization by the provider community subsequent to these reforms, related Stark law issues, the need or persistence of integrity guard rails, and whether telehealth reforms will persist beyond the COVID-19 public health emergency.

Ms. Krista Drobac is the Executive Director of the Alliance for Connected Care, an organization that advocates for telehealth policy reform.  She is also a Partner at the DC-based Sirona Strategies, a health policy consulting firm.  Previously, Ms. Krista-further-away-picture-1Drobac  was Director of the Health Division at the National Governors Association’s Center for Best Practices.  Prior to NGA, Ms.Drobac spent five years on Capitol Hill as a health advisor.  Prior still, she was a Senior Advisor at the Center for Medicare & Medicaid Services (CMS) working in Medicaid and private insurance regulation and also served as Deputy Director of the Illinois Department of Healthcare and Family Services.    Ms. Drobac holds a BA from the University of Michigan and an MPP from the Harvard University Kennedy School of Government.

The Alliance for Connected Care is at: http://connectwithcare.org/.

Telehealth reform policies detailed in CMS' April 6th interim final rule  are at: https://www.govinfo.gov/content/pkg/FR-2020-04-06/pdf/2020-06990.pdf

The CARES Act is at: https://www.congress.gov/bill/116th-congress/senate-bill/3548/text

04/09/2020

200th Podcast Interview: Dr. Rishi Desai Discusses the COVID-19 Pandemic (April 13th)

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Now, exactly one month after President Trump declared a national emergency, the federal government's response to the COVID-19 pandemic has been largely inept.  As of April 12th, the pandemic has infected over 560,000 Americans constituting slightly more than 30% of the world’s total number of infections. The US accounts for 5% of the world’s population, however, it has suffered 20% of worldwide deaths, more than 22,000 (a number that is substantially underestimated), or more than any other country.   Comparatively, Germany has suffered far fewer infections and deaths per capita due in part to early and widespread testing, a capable health care model (Germany has even been accepting COVID-19 patients from Italy, Spain and elsewhere), a population that has uniformly observed social distancing guidelines (and is advantaged by having a chancellor with a Ph.D. in chemistry).   Among other failures, the federal government has not taken leadership in acquiring necessary Personal Protective Equipment (PPE) and medical supplies forcing states to competitively bid, i.e., pay inflated prices, for the them.  Still fewer than 1% of the US population has been tested, in part because the president failed to deliver on  his March 13th promise to establish drive-through testing sites, causing former CMS Administrator, Dr. Don Berwick, to conclude, “we’re in a lot more trouble than we need to be" because "we are flying blind unless we find a way to find the people who are infected.”  Concerning Congressional efforts, this past Friday HHS Secretary Alex Azar announced he was awarding $30 billion of the $100 billion in grant moneys authorized under the March 27th CARES Act to support provider response to the COVID-19 pandemic.  Despite noting in his press press release theses monies were being distributed in a “fair” manner, Kentucky, the home of Senate Majority Leader Republican Mitch McConnell, received $311,000 per COVID-19 case, while New York, the home state of Senate Minority Leader Democrat Chuck Schumer, received $11,800 per case. 

During this 27 minute conversation Dr. Rishi Desai discusses where we are on the infection curve, mortality projections, success to date in practicing social distancing, uniquenesses associated with COVID-19, the development of a vaccine and antibody tests, supply and demand of PPE, the pandemic's disproportionate effects on minority communities and the poor, mental health effects, what lessons have we or will we learn as a result of the public health emergency and what these lessons suggest for necessary health care policy reforms going forward. 

Dr. Rishi Desai (MD, MPH) is a pediatric infectious disease physician with a public health background who currently serves as the Chief Medical Officer at Osmosis, an online medical _ learning platform developer.  He also recently led Khan Academy Medicine.  Dr. Desai had an accelerated education, completing high school and receiving his BS in Microbiology and Molecular Genetics from UCLA by the age of 18.  He completed his medical training at UCSF and went on to work at medical centers including Boston Children's Hospital, Boston Medical Center, Children's Hospital Los Angeles, and Stanford University.  He earned his MPH in epidemiology at UCLA and then spent two years at the Centers for Disease Control and Prevention as an Epidemic Intelligence Service Officer investigating disease outbreaks before beginning his work in online medical education.  Otherwise, Dr. Rishi spends his time taking his 3-year-old son to the park - when allowed, eating raspberries and learning Mandarin.

For information on Osmosis go to: https://www.osmosis.org/

The CARES Act is at: https://www.congress.gov/bill/116th-congress/senate-bill/3548/text

CDC information on COVID-19 is available via the agency's home page at: https://www.cdc.gov/

Stay well. 

03/26/2020

Daniel Dawes Discusses His Just-Published, "The Political Determinants of Health" (March 25th)

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It is altogether appropriate to discuss the political determinants of health since this past Monday we marked the ten year anniversary of the Affordable Care Act (ACA).   The law was intended, in part, to reduce health inequities.  Research published earlier this month in Health Affairs concluded, “the ACA produced broad gains in insurance coverage,” and “that coverage increased most among groups whose members were mostly likely uninsured before the reforms,” i.e., racial and ethnic minority groups.   We would do well to remember the 19th century German physician Rudolph Virchow whom argued, we should think of medicine as a social science - meaning medical care requires collective action to address social inequality’s contribution to ill health.  (Concerning social inequities, I encourage listeners will to listen to my March 10th conversation with the Center for Budget and Policy Priorities' Mr. Joseph Llobrera regarding the administration's treatment of SNAP.)

During this 33 minute conversation, Daniel Dawes begins by providing historical context, i.e., early efforts in our nation's history to address population health and health inequities, e.g., creation of the (short lived) Freeman's Bureau in 1864.  He identifies and discusses three over-arching political determinants of health, possible reasons why the ACA (and again its health inequity provisions) have been so polarizing and current progress in political determinants addressing inequities, e.g., as related to the climate crisis.      

Mr. Daniel Dawes is the Director of the Morehouse School of Medicine’s Satcher Health Leadership Institute and Associate Lead for Government Relations.   Among previous Danieldawes-685x1024positions he founded and chaired the advocacy group, the National Working Group on Health Disparities and Health Reform and was the co-founder of the Health Equity Leadership and Exchange Network (HELEN).  He has worked to shape federal health equity policies including the Mental Health Parity Act, the Americans with Disabilities Act Amendments Act, the Genetic Information Nondiscrimination Act and the Affordable Care Act.  He is the author of the 2017 work, 150 Years of Obamacare.  He is an elected fellow of the New York Academy of Medicine and has served on several boards, commissions, and councils focused on improving health outcomes and elevating health equity in the United States.  He is an adviser to international, national, regional, state, and municipal policymakers, as well as think tanks, associations, foundations, corporations, and nonprofit organizations.  Mr. Dawes obtained his Juris Doctorate from the University of Nebraska. 

For more information on The Political Determinants of Health go to: https://jhupbooks.press.jhu.edu/title/political-determinants-health

03/25/2020

Dr. Dan Blazer Discusses the National Academy of Sciences Just-Published, "Social Isolation and Loneliness in Adults: Opportunities for the Health Care System" (March 24th)

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Increasing social isolation and loneliness have been recognized for several decades.  The issues was the topic of Harvard’s Robert Putnam’s much publicized research three decades ago, i.e., his 2000 publication "Bowling Alone."   More recently, the Pope has observed “radical loneliness,” caused by a consumer culture is subverting social relationships.  In Japan, loneliness deaths among the elderly have become so common the Japanese have named the phenomenon, kodokushi (lonely death).  In the UK, former Prime Minister Theresa May in 2018 created the new cabinet position, Minister of Loneliness.   In the US, former US Surgeon General Vivek Murthy called loneliness a “growing health epidemic.”  

During this 32-minute conversation, Dr. Blazer begins by defining social isolation and loneliness or collectively social connections.  He then discusses the numerous associated adverse health effects including cardiovascular disease and dementia.  He discusses the current state of play regarding the extent to which the health care sector is addressing, social isolation in context of the ongoing COVID-19 pandemic, he notes several recommendations the report makes, discusses programming, and the scientific evidence for, that attempt to address these issues and potential problems associated with some of these interventions moreover use of technology.        

Dan G. Blazer II, M.D., M.P.H., Ph.D., is the J. P. Gibbons Professor of Psychiatry Emeritus and a professor of community and family medicine at Duke University as well as D014dac2e1-image_0770942adjunct professor in the Department of Epidemiology, School of Public Health, University of North Carolina.  He is the author or co-author of more than 180 books chapters, more than 220 published abstracts, and nearly 500 peer-reviewed articles.  He is also the editor or author of 40 books.  Many of the book chapters and scientific articles are on the topics of late life depression, epidemiology, consultation liaison psychiatry, the interface between religion and psychiatry, and the epidemiology of substance use disorders.  Most of his research projects have focused on the prevalence of physical and mental illness in the elderly.  He has served as the principal investigator (PI) of the Duke University Established Populations for Epidemiologic Studies of the Elderly, the Piedmont Health Survey of the Elderly, and the MacArthur Field Studies of Successful Aging.  He also was the original PI of the Duke Clinical Research Center for the Study of Depression in Late Life.  Dr. Blazer is an elected member of the National Academy of Medicine from which he received the Walsh McDermott Award for Distinguished Lifetime Service to the Academy.

The NAS report is at: https://www.nationalacademies.org/our-work/the-health-and-medical-dimensions-of-social-isolation-and-loneliness-in-older-adults.

03/11/2020

CBPP's Dr. Joseph Llobrera Discusses the Administration's Proposed Cuts to the Supplemental Nutrition Assistance Program (SNAP) (March 10th)

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Despite the fact the US is a net food exporter, the country suffers a significant food security problem (defined as uncertain of having or unable to acquire enough food).  Per the USDA, over 11% of Americans, or over 37 million(including 12 million children), are food insecure or worse.   In addition, the US ranks first among OECD countries in obesity, a primary indicator of a poor or low nutritional diet.  (Many Americans also suffer from "hidden hunger" or micro-nutrient deficiency.)  What explains this includes the fact 42% of American workers are paid $15 an hour or less – causing the US to have one of the highest poverty rates among developed/wealthy countries.   The US, unlike 158 other countries, is not a signatory to the 1966 International Covenant on Economic, Social and Cultural Rights which recognizes “the fundamental right of everyone to be free from hunger.”  In addition, health care ironically contributes to hunger in America.  If health care cost what it does, for example in Switzerland or 30% less per capita, median income growth over the past 30 years would have grown to twice what it is.  Phrased another way, medical expenses push millions of Americans below the poverty line, including 7 million who earn 150% of the poverty level.  (Devoted listeners may vaguely recall I interviewed the CBPP's Dr. Paul Van de Water in January 2013 regarding Medicare and Social Security reform.) 

During this 32-minute conversation Dr. Llobrera begins by providing an overview of the SNAP program and its benefits.  He then explains the Trump administration's proposed FY 2021 SNAP budget that would, like the administration's previously proposed budgets, cut SNAP spending by $182 billion over ten years, or by over 25%, he discusses administration regulatory reforms currently being implemented that will cut SNAP by $50 billion and remove approximately 4 million from the program, how or what rationale the administration uses to explain these budget cuts/program changes, the Congress's response to these policies and what the health care industry/health care providers are doing programmatically to address the reality that food is medicine.     

Dr. Joseph Llobrera is the Director of Research for the Food Assistance team at the Center on Budget and Policy Priorities (CBPP).   Previously, Dr. Llobrera served as Research Associate at Joseph-llobrera-500x500the Center between 2002 and 2007.   Before returning to the Center, he served as an Associate Director of Learning and Improvement at Insight Policy Research, providing technical assistance and training to federal, state, and local human service agencies that administer the Supplemental Nutrition Assistance Program and the Temporary Assistance for Needy Families program.  He also also employed as a researcher at IMPAQ International and the Urban Institute, focusing on food assistance policy, workforce development, and health policy.  Dr. Llobrera received his Ph.D. in Nutrition from the Friedman School of Nutrition Science and Policy at Tufts University, his master’s degree from the University of Washington (Seattle), and a bachelor’s degree in Mathematics and Urban Studies from Brown University.

The CBPP's February 18 memo providing an overview of the president's proposed 2021 SNAP budget is at: https://www.cbpp.org/research/food-assistance/presidents-2021-budget-would-cut-food-assistance-for-millions-and-radically

CBPP's November 2019 SNAP Chartbook is at: https://www.cbpp.org/research/food-assistance/chart-book-snap-helps-struggling-families-put-food-on-the-table