Health Law Could Overwhelm Addiction Services

— Apr. 16 2:15 PM EDT  

In this March 11, 2013 photo, Michelle Adams, left, a case manager at the West Division Family Health Center in Chicago, speaks with Shavonne Bullock, a recovering heroin addict during an appointment. Bullock, who has been drug free since 2006 when she started treatment at the center, pays for her own treatment because she’s uninsured. Millions of Americans will gain insurance coverage for drug addiction and alcoholism treatment when the national health overhaul takes effect next year, and some experts predict the change will help thousands of people get clean and sober. (AP Photo/M. Spencer Green)

 

In this March 11, 2013 photo, Shavonne Bullock, a recovering heroin addict, holds a demonstration dose of the medication Suboxone during an appointment at the West Division Family Health Center in Chicago. Each dose is incorporated on a dissolvable film, which is placed below the tongue where is dissolves and is absorbed into the bloodstream. Suboxone helps suppress withdrawal symptoms and reduce cravings for people recovering from addiction to opioid drugs. (AP Photo/M. Spencer Green)

 

In this March 11, 2013 photo, Michelle Adams, left, a case manager at the West Division Family Health Center in Chicago, speaks with Shavonne Bullock, a recovering heroin addict during an appointment. Bullock, who has been drug free since 2006 when she started treatment at the center, pays for her own treatment because she’s uninsured. Millions of Americans will gain insurance coverage for drug addiction and alcoholism treatment when the national health overhaul takes effect next year, and some experts predict the change will help thousands of people get clean and sober. (AP Photo/M. Spencer Green)

 

In this March 11, 2013 photo, Shavonne Bullock, a recovering heroin addict, smiles during an appointment at the West Division Family Health Center in Chicago. Bullock, who has been drug free since 2006 when she started treatment at the center, pays for her own treatment because she’s uninsured. Millions of Americans will gain insurance coverage for drug addiction and alcoholism treatment when the national health overhaul takes effect next year, and some experts predict the change will help thousands of people get clean and sober. (AP Photo/M. Spencer Green)

 

This April 2, 3013 photo shows the detox waiting room at Haymarket Center in Chicago. These men are waiting for a bed in the addiction treatment facility. (AP Photo/M. Spencer Green)

CHICAGO (AP) — It has been six decades since doctors concluded that addiction was a disease that could be treated, but today the condition still dwells on the fringes of the medical community. Only 1 cent of every health care dollar in the United States goes toward addiction, and few alcoholics and drug addicts receive treatment. One huge barrier, according to many experts, has been a lack of health insurance.

But that barrier crumbles in less than a year. In a major break with the past, 3 million to 5 million people with drug and alcohol problems — from homeless drug addicts to working moms who drink too much — suddenly will become eligible for insurance coverage under the new health care overhaul.

The number of people seeking treatment could double over current levels, depending on how many states decide to expand their Medicaid programs and how many addicts choose to take advantage of the new opportunity, according to an Associated Press analysis of government data. The analysis compared federal data on the addiction rates in the 50 states, the capacity of treatment programs and the provisions of the new health law.

The surge in patients is expected to push a marginal part of the health care system out of church basements and into the mainstream of medical care. Already, the prospect of more paying patients has prompted private equity firms to increase their investments in addiction treatment companies, according to a market research firm. And families fighting the affliction are beginning to consider a new avenue for help.

"There is no illness currently being treated that will be more affected by the Affordable Care Act than addiction," said Tom McLellan, CEO of the nonprofit Treatment Research Institute and President Barack Obama's former deputy drug czar. "That's because we have a system of treatment that was built for a time when they didn't understand that addiction was an illness."

But those eager for a new chance at sobriety may be surprised by the reality behind the promise. The system for treating substance abuse — now largely publicly funded and run by counselors with limited medical training — is small and already full to overflowing in many places. In more than two-thirds of the states, treatment clinics are already at or approaching 100 percent capacity.

The new demand could swamp the system before even half of the newly insured show up at the door, causing waiting lists of months or longer, treatment agencies say. In recent years, many rehab centers have been shrinking rather than growing because of government budget cuts for patients who receive public support.

"Advocates just get so excited, but at some point, reality is going to hit and they'll find it's not all it was cracked up to be," said Josh Archambault of the Pioneer Institute, a nonpartisan public policy research center in Boston.

In the coming years, treatment programs and medical colleges will face pressure to ramp up to create a larger system.

But until then, addiction treatment may represent an extreme example of one of the Affordable Care Act's challenges: actually delivering the care that people are supposed to receive.

Many with substance problems are waiting eagerly for January, when the new insurance will become available.

"It's the chance to clean up and not use anymore, so I could live a stable life," said 30-year-old Ashley Lore of Portsmouth, Ohio, who was jailed and lost custody of her 4-year-old daughter as a result of her heroin addiction. "If I get into treatment, I get visitation to my daughter back. And I get her back after I complete treatment."

Only about 10 percent of the 23 million Americans with alcohol or drug problems now receive treatment, according to the National Survey on Drug Use and Health. Shame and stigma are part of the reason but about a quarter of them don't have insurance coverage. That compares with the overall uninsured rate of 16 percent.

With money for treatment limited, slots in rehabilitation centers and hospitals are scarce. In Minnesota, which has one of the higher substance abuse rates in the nation — 11.6 percent of the population — there are slightly more than 3,900 inpatient beds for the 491,000 people who need treatment, according to federal data. Occupancy is over 100 percent.

Insurance can mean the difference between getting a spot or waiting indefinitely for publicly subsidized help.

Michelle Hines, an Illinois mother, had both experiences when her 19-year-old son became part of a disturbing new trend: suburban teenagers hooked on heroin.

Because he was uninsured, the wait would stretch to a month or six weeks for a public bed. His parents, who own a small business, couldn't afford the $2,000-per-month injections to block the heroin high. Overall, outpatient programs cost about $10,000, and a residential treatment stay about $28,000.

Everything changed after her son was able to get coverage under the family's insurance plan because of an early benefit of the Affordable Care Act.

They now pay only $40 a month for the shot that helps him stay clean. "He's working hard at getting his life back together," Hines said. "He's in school full time; he's got a job." (Michelle Hines asked that her son's name be withheld to avoid hurting his future employment prospects.)

Nine alumni of Hines' son's high school have died from drug overdoses. "A waiting list for a heroin addict could mean death," Hines said. "So many have died waiting, it's awful."

Today, those without insurance include many lower- and middle-income people who don't get the benefit from an employer — businesses provide coverage for about 50 percent of Americans — don't qualify for Medicaid or Medicare and can't afford their own policies.

The new law would provide subsidies to help many buy private coverage. The government is also pressing states to expand their Medicaid programs to include more working poor people. If 20 states expand their Medicaid programs — roughly the number now planning to do so — an additional 3.8 million prospective patients with addiction problems would get insurance, according to the AP analysis. If virtually all of the states eventually decide to expand, as federal officials predict, the ranks of the newly insured with addiction problems could reach 5.5 million.

Perhaps as important as the expansion, the new law designates addiction treatment as an "essential health benefit" for most commercial plans.

"This is probably the most profound change we've had in drug policy ever," said Michael Botticelli, deputy director of the Office of National Drug Control Policy. "We know one of the most significant reasons for the treatment gap is folks who don't have insurance or who have an inadequate coverage package for substance use disorders."

But will those who suddenly get coverage for treatment have a place to get it?

Haymarket Center in Chicago illustrates what may await many addicts. One Friday morning, seven men slumped in chairs in a small, bare room with only an untouched rack of health brochures to break the monotony of waiting for the chance of a detox bed that night. The six-story brick building is a beehive of programs for 300-plus patients: short term detox, long-term residential treatment, recovery units where people can live sober while looking for work. Everything is overbooked. On this day, the waiting list totaled 91 people who want help.

"Last year the state cut our dollars so we had to cut back our beds," said Dan Lustig, vice president of Haymarket, which gets most of its funding from the government. "We had clients literally pleading for services. Some were sleeping on our front steps."

In Illinois, where 92,000 people get treatment now, nearly 235,000 addicts and alcoholics without insurance will be able to get coverage next year. Not only beds are lacking. The pool of physicians who are addiction specialists must grow by 3,000 nationwide, almost double what it is now, to handle the demand, according to health industry experts.

"The big question for providers is how do we bridge the gap between now and then?" said Bruce Angleman of Heritage Behavioral Health Center, which provides treatment in Decatur, in central Illinois.

There are also questions about how comprehensive and affordable the new coverage will be. Consumers or their employers who choose cheaper policies with high out-of-pocket costs may find themselves unable to afford their share of an expensive program.

The future ideal may end up looking something like the care Shavonne Bullock receives in a neighborhood clinic in Chicago, the metro area with the highest rate of heroin-related emergency room visits. Seven years into her recovery, Bullock, a 54-year-old former heroin addict, still gets counseling and takes medication— "my blessing" she calls it — at the Access Community Health Network clinic to suppress withdrawal symptoms and reduce craving.

Her doctors and counselors work together. They recognize that addiction is a chronic condition, like diabetes, that needs maintenance.

"I haven't thought about drugs in seven years," she said. Treatment, she said, "works if you work it. It's all up to the individual. And it really works."

___

AP Medical Writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson

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Health and Human Services Secretary Doesn't Understand What Insurance Is

Health and Human Services Secretary Doesn't Understand What Insurance Is - The Daily Beast var _sf_startpt = (new Date()).getTime(); Follow @thedailybeast TUMBLR Home Politics Business Video Entertainment Fashion Books Art Women in the World Newsweek Featured: WITW Summit Travel The Royalist Howard Kurtz David Frum Newsweek Subscriber Help Content Section Health and Human Services Secretary Doesn't Understand What Insurance Is by Megan McArdle Mar 27, 2013 10:13 AM EDT Kathleen Sebelius thinks insurance isn't really insurance unless it covers routine expenses. This is exactly backwards.

How can insurance make everyone better off?  

After all, the insurance company has to make money.  That has to mean that the expected value of the claims they pay out is lower than the expected value of the premiums their customers pay in.  In some sense, then, the expected value of your insurance premium is negative.  

But insurance does make everyone better off, because it covers very large costs that most people would have trouble paying.  Even most really good savers would have a hard time replacing the value of their house, or paying off a $250,000 judgement for an auto accident.  The expected value of those incidencts is very, very negative--more than just the value of the cash, you have to factor in the horror of being homeless or bankrupt.  When you factor in the homelessness, the bankruptcy, and so forth, the slighly negative expected financial value is more than outweighed by the positive value of being protected against personal catastrophe.  Not to mention the peace of mind one gets from not having to worry about homelessness, etc.  

This is the magic of risk pooling.  But notice that it's the catastrophe which makes insurance a good deal.  You wouldn't get much value from buying "grocery insurance".  At best, you'd be paying an extra administrative fee to route your routine expenses through an insurer, rather than paying them directly.  At worst, you'll end up with bills skyrocketing as all sorts of perverse incentives appear.  After all, if the insurer is paying all your grocery claims, why not load up on filet mignon instead of ground turkey?

But insurers try very hard never to sell insurance for less than the cost of your expected claims.  If you expect to buy $10,000 worth of groceries next year, it will not charge you less than that for a "grocery policy".  And if we all drive up the costs of grocery insurance by consuming more, the insurer can do one of two things: raise everyone's "insurance premiums" to cover a filet mignon budget, or create a list of "approved groceries" that it will cover, and start hassling anyone who tries to file an excessively expensive claim.

Sound familiar?

This is why you should always have liability insurance, but should think twice about collision damage coverage.  It's why high deductibles are a good idea--for small expenses, it's better to self insure.  And it's why "catastrophic" health plans, which only cover the sort of extremely expensive events that most people would have difficulty financing, are a much better deal than the soup-to-nuts plans that most people get through their employers.  Those plans are expensive, both because they're paying for a higher percentage of your expenses, and because they drive up utilization--which means that they drive up next year's premiums even more.  Imagine what your car insurance would cost if it covered gasoline, routine maintenance, and those little air freshener trees you hang from the rearview mirror.  Then stop asking why health insurance costs so much.

But Kathleen Sebelius, the Secretary of HHS, thinks that catastrophic insurance isn't really insurance at all.  

At a White House briefing Tuesday, Health and Human Services Secretary Kathleen Sebelius said some of what passes for health insurance today is so skimpy it can't be compared to the comprehensive coverage available under the law. "Some of these folks have very high catastrophic plans that don't pay for anything unless you get hit by a bus," she said. "They're really mortgage protection, not health insurance."

She said this in response to a report from the American Society of Actuaries arguing that premiums are going to rise by 32% when Obamacare kicks in, as coverage gets more generous and more sick people join the insurance market.  Sebelius' response is apparently that catastrophic insurance isn't really insurance at all--which is exactly backwards. Catastrophic coverage is "true insurance".  Coverage of routine, predictable services is not insurance at all; it's a spectacularly inefficient prepayment plan.

Now, it occurred to me that Sebelius might be thinking about the scam insurance that is all too often sold to naive, mostly lower-middle-class folks who labor in the service industry.  That stuff isn't insurance at all; it's a fraud, and the people who sell it will richly deserve any justice that is meted out to them in either this life or the next.  But that stuff doesn't protect your mortgage, either; they're almost-worthless discount plans or very-limited-coverage insurance sold by fly-by-night operations who tend to evaporate as soon as claims have to be paid.  So I don't think that's what she's talking about; I think she's talking about catastrophic plans.

Nor do I think that Sebelius is responding awkwardly to a report that the administration would like to wish away.  I think she's sincerely confused about the difference between insurance, and prepayment.  Which explains a lot about the new health law.  

Last week, I was at a health care conference where the subject of catastrophic plans came up.  Obamacare has, unfortunately, sharply curtailed the ability to offer these plans; very high deductible plans are now effectively illegal.  Which is a great shame, because these plans, combined with a dedicated health savings accounts, were showing real promise at controlling costs.  

A liberal policy professor at the event explained this as a result of the toxic political environment surrounding policy these days; since Republicans wouldn't cooperate on Obamacare, Democrats stuck the knife in one of their favorite programs.  

But Sebelius' answer suggests another explanation: the Democratic opposition to castrophic plans was not strategic, or vengeful, but entirely heartfelt.  The Secretary of Health and Human Services genuinely believes that health insurance should do more than just, well, protect your ability to keep paying the mortgage.  Unfortunately, "more" is very expensive and inefficient.

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Megan McArdle is a special correspondent for Newsweek and The Daily Beast covering business, economics, and public policy. A former senior editor at The Atlantic and writer for The Economist, Megan has a diverse work history including three small startups and a disaster recovery firm at Ground Zero.

For inquiries, please contact The Daily Beast at editorial@thedailybeast.com.

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ObamaCare's Free Preventive Services Aren't Free

Credit: National Institutes of Health Library / Foter.com / CC BY-NC-SA

As public support for ObamaCare slumps into a post-election decline, the Department of Health and Human Services is trying to convince people that they ought to like the law by noting that it’s already given free stuff to a whole bunch of people. An HHS news release this week brags that the “Affordable Care Act extended free preventive care to 71 million Americans with private health insurance” as well as 34 million Medicare Advantage beneficiaries—free benefits the agency says are giving Americans “more value” for their health dollars.

The problem is that the benefits in question are neither “free” nor likely to produce valuable savings. ObamaCare’s rules eliminated individual cost-sharing for a number of preventive services, but, as the administration admitted a few months after the law passed, at the cost of higher insurance premiums on average. It’s like a gym that suddenly makes all the drinks and snacks at its café “free”—but raises the price of membership. It’s not free. You’re just paying in a different way.

It’s not cost-saving as public policy either, despite initial Democratic hopes that it would be. In fact, most evidence shows that it increases health spending. That’s because eliminating cost-sharing increases utilization of preventive services; when there’s no immediate price to pay for using a service, people tend to use more of it. And as the Congressional Budget Office reported back in 2009, “the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall." In general, the CBO noted, researchers have found that “the added costs of widespread use of preventive services tend to exceed the savings from averted illness.”

For preventive services to have the largest benefits relative to costs, the CBO explained, the prevention efforts need to be narrowly targeted at only a few people who are likely to develop a particular ailment. The HHS claim that 105 million people took advantage of ObamaCare’s “free” services suggests that there was not much targeting involved. Instead, the law took a broad-brush approach that likely raised insurance premiums for many and perhaps most of the individuals affected. But I suppose “Affordable Care Act shifts costs and raises premiums for 71 million Americans with private health insurance” doesn’t make quite as good a press release.

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Military Leaders: Sequester Cuts Will Prevent Veterans From Accessing Mental Health Services

During a hearing before the House Military Personnel Subcommittee Wednesday, American civilian and military leaders issued lawmakers a stark warning: federal budget cutbacks under the so-called “sequester” will leave veterans with Post-Traumatic Stress Disorder (PTSD) and other mental illnesses without access to the health care that they desperately need.

The sequester cuts will force multiple governmental departments to cut back on programs or eliminate them entirely. Charged with taking care of the staggering percentage of Iraq and Afghanistan war veterans with PTSD, the Defense Department has had to increasingly rely on civilian mental health specialists to address the backlog. In fact, out of the 2,118 psychologists, 809 psychiatrists, and 2,533 social workers now employed by the military — a substantial increase over past years — over half are civilians. But under sequestration, the Department has been bracing for massive cuts to this civilian workforce, and is preparing to send notices to “more than 800,000 Defense Department civilian workers telling them that once-a-week unpaid furloughs will begin in April and continue for 22 weeks.”

As Military.com reports, that is particularly problematic for the military when it comes to these civilian mental health specialists because “they have options to seek employment elsewhere” and might be tempted to do so seeing as they are not exempt from the furloughs:

Lt. Gen. Patricia Horoho, the Army’s surgeon general, has lobbied to exempt the mental health specialists from furloughs to retain them for treating PTSD. The Pentagon has said that 20 percent of the civilian workforce will be exempt from furloughs. However, it did not look like the mental health specialists would receive that exemption, said Col. Rebecca Porter, the chief of Behavioral Health in Horoho’s office.

“We value these individuals greatly,” Porter said of the mental health workers. “If they start to go out the door, it’s going to take a lot longer for us to rebuild that” mental health workforce, Porter told a defense writers breakfast Tuesday.

“We have in the past offered retention bonuses, but that’s not specifically on the table now,” said Porter, a former military police officer and now a clinical psychologist whose main task is treating PTSD in the Army.

Her comments echoed those of Gen. Ray Odierno, the Army’s chief of staff, who told a Senate hearing last month that “before sequestration, we allocated the dollars and positions to increase military and civilian mental health providers.”

“The problem is there are not enough out there,” Odierno said. “Now what’s going to happen is we’re going to have to reduce the number we already have.”

The officials’ testimony is a clear-cut demonstration of the real world consequences brought on by budget cuts that lawmakers and the media tend to discuss in rather shallow terms. Budget cuts to military health care programs are also particularly cruel considering the already-massive backlog of over 900,000 veterans’ benefit claims — a problem that will be exacerbated as more military personnel return home from the waning Afghan war. Those veterans will already be plagued by poverty and a bleak economic outlook when they return home — and under sequestration, their mental health care outlook is even worse.

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Rep. Gutierrez moves from Financial Services Committee to Judiciary for immigration reform

Rep. Luis Gutierrez (D-Ill.) is taking a leave of absence from the House Financial Services Committee to serve on the House Judiciary Committee to help pass new immigration reform legislation.

Gutierrez, the chairman of the Congressional Hispanic Caucus Immigration Task Force, recently met with a number of Republican lawmakers who are likely to play a prominent role in upcoming immigration reform negotiations. He discussed immigration reform with both Sen. Marco Rubio (R-Fla.) and Rep. Paul Ryan (R-Wis.) in December.

Gutierrez, who was the third-ranking Democrat on the Financial Service Committee, will likely be the 13th ranking Democrat on the Judiciary committee. The move was announced Friday.

President Obama has vowed to make immigration reform a top priority of his second term and already a number of legislators have begun initial talks on immigration reform legislation.

"All of the road signs are pointed in the right direction, and I felt I must be on the Judiciary Committee during this Congress to help the others on the Committee get immigration reform to the finish line," Gutierrez said in a statement. "We are poised for serious action to fix our broken immigration system, a top priority for Democrats, for the Democratic leadership, and for the president, and I have spoken to numerous Republicans in the House and Senate who want to get it done."

Gutierrez thanked the Democratic leadership for approving the move.

"I look forward to working with the chairman and the subcommittee chairmen and the Ranking Member, Rep. John Conyers (D-Mich.), and the Immigration Subcommittee Ranking Leader, Rep. Zoe Lofgren (D-Calif.), in crafting bipartisan immigration reform that fixes our broken immigration system," Gutierrez also said in the statement.

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Ensuring that LGBT Victims of Domestic Violence Can Access Critically Needed Services and Protections

Posted by Lynn Rosenthal, Tonya Robinson on May 15, 2012 at 11:06 AM EDT

Last week, the U.S. House of Representatives Judiciary Committee approved legislation to reauthorize the Violence Against Women Act (VAWA) of 1994, but failed to include critical provisions that would ensure that all victims of domestic violence can access vital services and protections.  Victims are victims, and, if you have been battered, stalked or otherwise threatened with violence, you should not be turned away by a shelter or denied the assistance you need merely because the aggressor is the same sex as you or because you are transgender.  Yet, the legislation approved by the House Judiciary Committee and being considered this week on the House floor would allow just that.

The guiding principle behind VAWA and each of its subsequent reauthorizations has been an unyielding commitment to the notion that no sexual assault or domestic violence victim should be beaten, hurt or killed because they could not access the support, assistance and protection that they need.  In enacting VAWA in 1994, Congress acknowledged that the criminal justice system chronically failed to respond to the crimes of domestic violence, sexual assault and stalking, too often blaming victims and refusing to hold offenders accountable as violent criminals.  In reauthorizing VAWA in 2000, Congress included new VAWA programs and provisions to help particularly vulnerable populations, including younger victims, immigrant victims, the elderly, and persons with disabilities.  In the 2005 reauthorization, Congress once again strengthened the Act to improve the health care response to domestic violence, to include a new focus on prevention, and to expand protections for children exposed to violence. 

This year, the VAWA reauthorization bill passed by the Senate in April would remove barriers faced by lesbian, gay, bisexual and transgender (LGBT) victims, whose needs often are overlooked by law enforcement, prosecutors, courts, and victim service providers. LGBT victims experience domestic violence at roughly the same rate as the general population.  Nonetheless, recent surveys show that LGBT victims frequently are turned away when attempting to access services. For example, according to a 2010 survey by the National Coalition of Anti-Violence Programs, 45% of LGBT victims were denied services when they sought help from a domestic violence shelter, and nearly 55% were denied protection orders. 

Without LGBT-specific training, criminal justice personnel often underestimate the physical danger involved in same-sex relationships or fail to identify a primary aggressor and instead arrest both victim and perpetrator.  Even well-intentioned service providers may generate outreach materials that do not accurately or fully reflect the experience of LGBT victims, and thus inadvertently discourage individuals who have suffered abuse from seeking needed care.  In all these cases, bias or a lack of understanding contributes to an environment where the needs of LGBT victims are underserved.

The Senate bill would improve VAWA further, authorizing States and service providers to ensure that VAWA protections extend to all victims - including LGBT victims - of domestic violence, dating violence, sexual assault, and stalking.  The Senate bill includes three provisions that would help LGBT victims access VAWA-funded services. 

First, the Senate bill would add a LGBT-focused purpose area to the STOP Violence Against Women Formula Grant program, the largest VAWA program and the one that supports law enforcement, prosecution, court and victim service activities in every State.  This new purpose area would authorize States, at their discretion, to fund projects that focus specifically on improving responses to male and female victims of domestic and sexual violence whose ability to access traditional services is affected by their sexual orientation or gender identity. 

Second, the Senate bill would amend the Act’s definition of “underserved population” to recognize that LGBT victims face barriers to service.  Not only does this improvement send an important message to those who administer and receive VAWA funding, but it will ensure that organizations serving this community can obtain funding from a new grant program that focuses on underserved populations. 

Third, the Senate bill would protect LGBT victims from discrimination by prohibiting VAWA grantees from denying LGBT victims access to programs on the basis of their sexual orientation or gender identity. Plainly put, this provision would ensure that all victims of domestic violence are able to access life-saving services.  In contrast, the VAWA reauthorization bill reported out of the House Judiciary Committee, which is being advanced by House Republican leadership, excludes these critical protections for LGBT victims.

Opponents claim that the Senate bill’s LGBT provisions are a solution looking for a problem.  That is just not true.  Domestic and sexual violence against LGBT individuals is an unfortunate reality, as is violence against non-LGBT individuals – and we shouldn’t allow any victim of such abuse to go unprotected.

Lynn Rosenthal is the White House Advisor on Violence Against Women.  Tonya Robinson is the Special Assistant to the President for Justice and Regulatory Policy.

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