FILE PHOTO: Hundreds of people line up outside a Kentucky Career Center hoping to find assistance with their unemployment claim in Frankfort, Kentucky, U.S. June 18, 2020. REUTERS/Bryan Woolston/File Photo
Hundreds of people line up for assistance with their unemployment claim. Because of the pandemic, millions of Americans are out of work and don't have health insurance.

Many Americans lost their jobs and/or their health insurance this year, leading to a surge in applications for medical coverage through Healthcare.gov and other government programs. 
People suffering from COVID-related medical issues during and after the pandemic will need the Affordable Care Act (ACA) more than ever. 
The Trump administration still hasn’t yet unveiled any alternative healthcare plan, meaning the abolishment of the ACA would leave millions of Americans with no recourse.
Bobbi Dempsey is a freelance writer and an economic justice fellow at Community Change. 
This is an opinion column. The thoughts expressed are those of the author.
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Sitting at my desk, I can clearly hear my son hacking and wheezing in his bedroom upstairs. He’s had a persistent cough for a while now, which is more than a little alarming, given the current landscape.

It isn’t just the possibility of my child being infected with COVID-19 — and the serious and terrifying health risks that go along with it — that frighten me. It’s also the realization that we cannot afford to pay for treatment he might need to save his life. Out of my three young adult children, only one currently has medical insurance. Unfortunately for the cough-plagued son in question, he is not so fortunate. 

Trump is trying to dismantle the Affordable Care Act while millions are sick, dying, and out of work. 

When faced with a deadly virus that’s killing in staggering numbers, people shouldn’t have to think about whether they can afford access to treatment that could possibly mean the difference between life and death. But that’s the reality in a country where private healthcare is typically tied to employment, and the most vulnerable and needy people must rely on a patchwork of programs that make up our shredded safety net. 

Right now, the combination of a pandemic and economic disaster means many Americans are experiencing parallel feelings of panic: struggling to survive financially, while also hoping they survive, period. 

Given that harsh reality, it is mind boggling to me that the Trump administration would choose this particular time — during a global pandemic when more than 220,000 Americans have died and many more are sick and struggling — to try and rip healthcare away from vulnerable Americans who desperately need it now more than ever.

The Trump administration is currently urging the Supreme Court to throw out the Affordable Care Act (ACA). Depending on how the Court decides on the specific questions involved, the decision could invalidate the entire law completely and deprive millions of Americans of their only access to health insurance. 

Ironically, the administration’s initial Supreme Court filing came at almost the same time as a news release from the Centers for Medicare & Medicaid Services (CMS) — a division of the Department of Health & Human Services — announcing that nearly 500,000 Americans had applied for new healthcare coverage through Healthcare.gov due in large part due to coronavirus-related job losses. That figure included people who applied through a special enrollment period for those who qualified based on loss of minimum essential coverage, and specifically focused on data for a period which ran from the end of the Open Enrollment Period last fall through May of this year. 

The more recent data about healthcare coverage (or lack thereof) paints an equally grim picture. A news update from the CMS on September 30 showed more than 4 million new Medicaid and Children’s Health Insurance Program (CHIP) enrollments between February and June 2020. This represents an increase of nearly 5.7 percent since March. 

Highlighting the need for universal coverage 

The crisis that would result from the loss of the ACA underscores the problem with having no universal healthcare coverage that’s available to all citizens, and not tied to employment. 

The United States is the only industrialized country that lacks some form of universal healthcare. Some countries, like Australia, have a dual-track system with both public and private options. Other countries like Canada and the United Kingdom have what most people envision when they think of universal healthcare: a government-run system where all citizens have access to coverage. 

The public programs are typically funded through taxes, and insured citizens usually pay minimal premiums or none at all. Critics of universal healthcare programs point out some common complaints, such as long wait times and the challenge of getting pricey treatments approved without a fight. However, many Americans — especially those who have tried to get medical care while uninsured — also frequently encounter similar issues, without the benefits of universal coverage. 

Giving scared people reason to panic about whether they would be able to get medical treatment if they should get sick at a time when so many are dying or facing life-threatening illness seems intentionally cruel. 

This adds significant and unnecessary anxiety to what is already an emotionally stressful time, particularly for those worried about symptoms they or loved ones may be facing. 

I am extremely grateful that this is one of the rare times in my life when I have decent health insurance. Prior to the Affordable Care Act, my children and I were unable to get insurance due to pre-existing conditions. However, I am still trying to pay off the bills for my out-of-pocket costs from a major surgery I had last fall. And my children have all reached an age where they can no longer be covered under my policy. (Important to note, though, that they would have been dropped from this coverage years earlier were it not for the protections made possible by the ACA.)

This crisis should serve as a wake-up call — a clear illustration of the pitfalls of forcing people to rely on employers or ravaged safety net programs for healthcare coverage. It should be crystal clear that we can no longer wait to initiate a universal healthcare program. During a pandemic, the last thing a sick person should worry about is whether they can scrape together enough cash for cough medicine or if they can afford to pay an ER bill. 

And none of us should have to live in fear that the federal leaders who first failed to protect us from an impending pandemic will then further abandon us by ripping away our ability to get basic medical treatment that could mean the difference between life and death.Bobbi Dempsey is a freelance writer and an economic justice fellow at Community Change. 

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facebook mark zuckerberg
Facebook CEO Mark Zuckerberg leaving The Merrion Hotel in Dublin after a meeting with politicians to discuss regulation of social media and harmful content in April 2019.

We learned this week that the Trump campaign may have tried to dissuade millions of Black voters from voting in 2016 through highly targeted online ads.
The investigation, by Channel 4, highlighted a still little-understood online advertising technique, microtargeting.
This targets ads at people based on the huge amount of data available about them online.
Experts say Big Tech needs to be much more transparent about how microtargeting works, to avoid overblown claims but also counter a potential threat to democracy.
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The Trump campaign in 2016 used online ads to try and dissuade Black voters from voting, according to an investigation this week by UK broadcaster Channel 4.

A cache of documents obtained by Channel 4 included a database of some 200 million Americans’ Facebook accounts, broken down into characteristics like race, gender, and even conclusions about their personalities.

The database was split into different groups and one group, unsubtly labelled “deterrence,” was disproportionately made up of Black users. The idea was to use tailored online ads on platforms like Facebook to dissuade this group from heading to the ballot box. (The Trump campaign has denied this report.)

Trying to sway voters through advertising is not new, but Channel 4’s investigation was a reminder of how the Trump campaign made use of a still little-understood type of advertising called microtargeting.

Microtargeting involves using the huge amounts of data consumers give away online about who they are friends with and what they like to target ads at them.

While microtargeting has long been part of what makes the likes of Facebook and Google so profitable, it really came under mainstream scrutiny in 2018 during the data leak involving political consultancy Cambridge Analytica.

Per investigations by The Observer in 2018, Cambridge Analytica used data to build up “psychographic profiles” of people in order to more accurately target them with political ads.

According to Channel 4’s investigation this week, Cambridge Analytica was behind the 2016 ads targeting Black voters in Georgia.

And yet experts warn that while microtargeting is troubling, imputing the technology with mysterious abilities to persuade vast numbers of voters may be a distraction from real voter suppression. Ultimately, we need to understand the technology better.

Concerns about microtargeting could be overblown

The very broad strokes of how microtargeting works go like this: Your behavior online generates a wealth of data about what you are like.

This data is analysed by companies to try and draw as many conclusions about you as possible and build up a profile, from basic demographic details like your age right down to subjective things like your personality type.

When advertisers place ads on social media platforms they are able to tailor the intended audience for these ads according to these much finer details. The sell is vast scale and speed.

Felix Simon, a communications expert at the Oxford Internet Institute, told Business Insider that too often media reports on political campaigns using microtargeting take it as read their tactics have been successful in changing people’s minds.

Although the Channel 4 documentary rightly pointed out that voter turnout among Black people fell in the districts where the Trump campaign  deployed its “deterrence” campaign, Simon said this could be down to correlation rather than causation.

“I think what we see here is first and foremost a form of negative advertising which has a long and dirty history and can have voter suppression as one of its aims,” he said. “But that it actually works (and on such a scale as suggested here) is highly doubtful and — based on everything we know about targeted advertising and attempts at persuasion — most likely pales in comparison to very real voter suppression efforts, which include removing polling stations, gerrymandering, or restrictive voting laws.”

Simon is broadly skeptical of the so-called “psychographic” microtargeting employed by Cambridge Analytica — i.e. trying to use people’s data to make conclusions about their personality and target them accordingly. He believes the media has, in some ways, fallen for these firms’ own hype.

“It’s [presented as] this almost magical technology which promises so much and which is heavily pushed by the industry in this, which is all these digital campaigning companies and the political data analytics industry. And they make all these big promises,” he said.

Dr. Tom Dobber, an expert in political communication at the University of Amsterdam, agreed that the Channel 4 report did not prove the Trump campaign’s attempt to influence Black voters had been a success. More generally he does believe microtargeting can be effective — but its efficacy can be blown out of proportion.

“While the effects are reasonably strong, they should not be overestimated. It’s not like you can get a staunch Conservative to vote for Labour if you microtarget him long enough. Rather, citizens who are not already set on a party are susceptible and it seems that microtargeting ads is more effective than using untargeted ads,” he told Business Insider.

Microtargeting might not be inherently bad

Dobber said the granular nature microtargeting has the potential to be both advantageous and dangerous for democracy.

“There are clear downsides as well as upsides, e.g. sending relevant information to inactive citizens might activate them,” he said. “Microtargeting can increase turnout. These are generally good things. But there is clear potential for manipulation and also potential for the amplification of disinformation.”

He added: “I suppose it can be used for good when actors operate in good faith, but microtargeting can just as easily be detrimental for society when used in bad faith.”

Jamal Watkins, vice president for the NAACP, told Channel 4 that the use of microtargeting to systematically disenfranchise voters was a disturbing part of the documentary’s findings.

“We use similar voter file data, but it’s to motivate, persuade, encourage folks to participate. We don’t actually use the data to say ‘who can we deter and keep at home.’ That seems fundamentally it’s a shift from the notion of democracy,” said Watkins. 

Part of the problem here is that microtargeting is a new and largely unregulated market, so platforms like Facebook are not beholden to an industry standard for how they decide which ads are are allowed to appear on their platform. Facebook has broadly said it will not fact-check or constrain political speech in ads even if it is demonstrably untrue, although there have been some exceptions.

Tech platforms have also only provided restricted amounts of data to researchers like Simon and Dobber.

“It would be helpful if the large social platforms would give more information about which article is targeted to which groups, on the basis of what data, tailored to which characteristics. Now, social platforms only provide rough estimations on only a few large categories,” Dobber said.

Even if it’s useless, it’s dangerous

To Felix Simon, even if microtargeting is ineffective it poses a potential threat to individuals’ privacy because for it to be an economically viable product it requires massive amounts of data, which can in turn be sold for other purposes.

“I think the problem is it’s not just used for that [microtargeting],” he said. “Think of a scenario where the personal information they have about you, which could be everything in the US down from the way you vote to where you live, how much you earn, how much you spend on what things, and then that is being used in a context you definitely don’t want it to be used, for instance to set the rate of your health insurance,” he said.

“That for me is more important, because from what we know there is a lot of shady stuff going on with data being sold without [people’s] knowledge, potentially to people we don’t want to have our personal data,” added Simon.

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