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COVID-19’s Impact on Communities of Color Sheds Light on Health Care Disparities, Need for Action

Posted on by The Progressive Policy Institute

This week has been a turning point in the United States. I want to make sure you see PPI President and Founder Will Marshall’s statement on the killing of George Floyd, and the commitment PPI is taking to come up with new ideas to fight systemic racism in the United States.

The coronavirus pandemic has had a disproportionate impact on communities of color. Essential workers — in direct care, grocery stores and delivery — are disproportionately Black. Essential workers are more likely to get the virus because their jobs don’t lend themselves to social distancing and working from home. Further compounding the damage the virus has caused, people who have lost their jobs are also more likely to be Black, particularly hurt are Black women of whom almost 19 percent lost their job since February.

The virus has also laid bare disparities in health status by race in the United States. Black Americans are 3.5 times as likely to die from Covid-19 than white Americans. This is partly because the virus is more lethal to people with underlying health conditions and people of color are 1.5 to 2 times more likely than white Americans to have chronic diseases, like type 2 diabetes and obesity because of systemic barriers to housing, income and education which all affect health status.

Solving racial discrimination in medicine is not an easy task. It is built upon years of systemic racism, reasonable distrust, and unconscious biases of medical practitioners.

But there are some policy levers that could help.

Make health insurance more affordable. Cost is the main reason people remain uninsured. Even before the Covid-19 pandemic, Black workers were 60 percent more likely than white workers to be uninsured. By focusing on ways to bring down health care costs — such as introducing a price cap on medical care and increasing subsidies for Affordable Care Act health plans — insurance will be more affordable for all Americans.

Address social determinants of health. Insurance coverage is a first step but it will not by itself address racial disparities in health. Health status is a product of more than medical care — things like safety, housing, education, transportation, and nutrition all impact a person’s health. Federal agencies like the departments of education, health, and housing should collaborate to create new programs to ensure that people get not just health care, but also the housing, education, and other things that health outcomes depend on. To have additional funding for these types of programs, it is paramount to lower overall health care spending. States should also have greater flexibility to spend Medicaid dollars on housing and other social determinants that can reduce health care expenditures.

Address bias in medicine. Health care workers need to better understand the ways in which implicit and explicit bias can affect the care they provide in order to counteract centuries of racism. Sen. Kamala Harris’s Maternal CARE Act, and the accompanying House version, would authorize $150 million to programs that seek to help medical professionals identify high-risk pregnancies and establish implicit-bias training curriculum for medical schools. This type of training should be taught across all disciplines.

Make health care workers more reflective of the population. A more diverse workforce can improve outcomes for Black Americans. Using existing programs like the National Health Service Corps, which provides loan forgiveness and scholarships to workers who practice in underserved areas, the federal government could recruit more medical and nursing students from minority communities. Additionally, boosting funding to medical schools at historically black colleges and universities could increase the number of Black physicians and nurses.

Make scientific research more inclusive. In 2009, the NIH changed its grant review process in an effort to make it more racially equitable yet a new study finds that between 2014–2016, only 10 percent of Black applicants got NIH funding, compared to around 19 percent of white applicants. On the flip side, Black Americans are overrepresented in clinical trials that don’t require informed consent and underrepresented in cancer clinical trials. Undoing these racial disparities in scientific research will help improve the practice of medicine.

Read the full article here

Tackle unemployment, trade, manufacturing and environment: Invest in green infrastructure

Posted on by The Progressive Policy Institute

More than 42 million workers have filed unemployment claims during the coronavirus pandemic, the jobless rate is over 13% and minorities are bearing a disproportionate share of the economic pain, just as people have taken to the streets to protest racial injustice — but there’s a clear path forward for America. We must create millions of new jobs by investing in an infrastructure-led recovery through federal legislation.

Just as we did in the 1930s New Deal and the 1950s Interstate Highway System, in the 1960s through NASA and in the 2009 American Recovery and Reinvestment Act, we can rebuild the foundation of America’s economic future while creating millions of jobs today.

To be most effective at helping workers, such economic recovery and infrastructure legislation should include large investments in clean manufacturing, which will be the fastest growing manufacturing sector in coming years, attracting $10 trillion in investment globally by 2050. A new report from the Progressive Policy Institute finds that means putting Americans to work building tens of millions of new electric vehicles, charging stations, and creating advanced electric grids, as well as upgrading our roads, bridges, high-speed internet, ports, and public transport.

Read the full article here

Guest Column: America’s Top Colleges Are Karens

Posted on by The Progressive Policy Institute

This is a guest column by Ryan Craig.

My stepsister is a lovely person, but she has the great misfortune of being named Karen. When she was born back in 1971, Karen was the 15th most popular name for girls. No one’s exactly sure when the name Karen began to go downhill – my guess is Lorraine Bracco’s portrayal of entitled mob wife Karen in Goodfellas – but in the fast-moving world of social media and memes, Karen has become the insult of choice for entitled people who demand to speak to the manager to sustain their privilege. It’s no longer cool to be a Karen and I’ve taken it upon myself to send examples to my stepsister. Her response is generally one of befuddlement, most recently “what is this baloney?” (an American processed meat popular around the same time as the name Karen).

The Karen-ization of Karen reached its apex two weeks ago when a white woman called the police on an African-American birder in Central Park. Even though the privileged perpetrator’s name is Amy, “Central Park Karen” began trending. Karen has now become shorthand not only for blatant assertions of privilege, but also reinforcing social inequality and racism, as underscored by the tragic death of George Floyd and the resulting national explosion of frustration and anger. In response, a friend tweeted that his bumper sticker for the remainder of 2020 would be: A Little More Carin’, A Little Less Karen. I told him if he produced it, I’d give one to my stepsister.

Last month Washington Monthly reported that elite and wealthy business schools like Northwestern, MIT, Columbia, and Cornell are refusing to grant deferrals to international students concerned about paying full price for what could very well be an online MBA, and also refusing to return deposits to students who withdraw. And just as the University of Southern California was making scandalous national news (again) as Full House’s Aunt Becky and her designer husband admitted committing fraud to get their two daughters in, USC announced it was raising tuition 3.4% for next year and, simultaneously, that it would not provide any discounts if classes are held online. I read this while wearing my favorite new T-shirt (You can’t spell “suck” without USC), and a question crossed my mind: are America’s top universities becoming Karens?

When I wrote A New U: Faster + Cheaper Alternatives to College, I was worked up about the poor employment outcomes of recent graduates and predicted that non-selective colleges and universities that continued to ask students to take on unaffordable levels of debt to pay for tuition, fees, and living expenses were in for a rude enrollment awakening. As Kevin Carey pointed out last week, Covid-19 has thrown gasoline on this dumpster fire and most leaders at mere mortal institutions recognize the world has changed. But even in a faster + cheaper world, F. Scott Fitzgerald informed my view: “Let me tell you about the very rich [universities]. They are different from you and me.” Elite colleges and universities would innovate at the margins, perhaps playing with integrated experiential learning and digital credentials, but remain largely unchanged – a monument to America’s isomorphic college ideal, continuing to attract the most talented and promising students to gothic parklands. But no one anticipated a faster + cheaper + Covid world.

***

Prior to Covid, top universities were already braving unprecedented headwinds. The perception that elite universities were less engines of socioeconomic mobility than brakes gave rise to candidate Bloomberg’s plan to ban legacy admissions (a position also supported by Tony Carnevale in his upcoming book), and to New America’s proposal to mandate lottery-based admissions. Recrimination from left and right coalesced in the first ever endowment tax – a 1.4% annual excise tax on colleges and universities that is costing Stanford $43M and Harvard $38M annually.

Now Covid is shining a blazing spotlight on inequality and racism. The economic and racial gap between haves – who can work remotely and who’ve only experienced inconvenience – and have-nots – who have been risking their lives by showing up at work to keep the country running, and getting sick, and showing up at hospitals, and dying – has never been more stark; it is now clear that social distancing is a luxury much of America cannot afford. Selective schools have made some progress increasing enrollment of low income Pell-eligible students, but no elite college or university has put forth a compelling narrative as to why it – in its current form – should be considered a solution rather than a Karen flaunting exclusivity and perpetuating inequality. It’s a tricky argument for elite institutions to make. But, like Karen, they haven’t really tried. 60% of students at selective colleges come from top quartile income families ($115k+ annually). In recent years, legacies have constituted more than one-third of each class at Ivy League schools; Harvard’s Class of 2022 is over 36% legacy. Carnevale calls it “an inequity machine that raises and perpetuates class and race hierarchies and sinks the lower classes.” As young Americans have always had a knack for spotting and rebelling against insincerity, the more Covid reveals elitism’s dark underbelly (i.e., inequality), the harder it will become for top universities to continue to attract the best talent.

The privileged insincerity of our top universities is equally clear in their immediate response to Covid. If Harvard were put on trial for continuing to charge full tuition for Zoom U. in March, April, and May, a clever lawyer would force America’s richest university to admit that either: (1) the last three months did not constitute an education worthy of the Harvard name; or (2) Harvard could easily scale enrollment by a factor of 10. Re: #1, the quality of Zoom courses was apparently pretty good. According to an internal Yale survey, 80% of Yale College faculty said their remote courses were good, very good, or excellent after only the first week. And whether correctly, or out of pride or greed, none of the richest colleges and universities that could have afforded to provide discounts offered to do so.

Re: option #2, I argued just ahead of Covid’s arrival that top universities had a moral responsibility to expand geometrically rather than linearly at $625,000 per seat (or in Harvard’s case not at all). Zoom U. demonstrated it’s possible. According to the Yale Alumni Magazine, as Jay Gitlin’s course Quebec and Canada from 1791 to the Present neared the end of a long and winding road, a student’s grandfather popped into the frame to say that, as the course was now available here, there and everywhere in this helter skelter world, he was very grateful to be able to get back several times a week and attend alongside his grandson. The grandfather was none other than Sir Paul McCartney, proving America’s top universities have the capacity to teach many more students, knighted and benighted alike.

***

Elite universities purport to provide students with a bundle of education/skills, college experience, and a branded credential that helps them stand out in the labor market. Not long ago, this bundle commanded unrivaled respect, like Karen at the country club in the 1970s and 80s. But no longer.

One reason is that digitization of the economy, entry-level employment, and the hiring process make it increasingly likely that program of study is a more powerful lever for future employment and income than attending an elite university, particularly ones that fail to prioritize STEM and digital skills; a new AEI study from Joe Fuller and Frederick Hess shows that four years after graduation, median salaries aren’t materially higher for graduates from top schools. A second is that at least for the foreseeable future, the elite college experience will be constrained by social distancing and grab-and-go meals (and a concomitant volume of plastic waste that will be hard for students to swallow). And reductions in campus dining and housing will most significantly impact lower income and underrepresented minority students, further hindering equality on campus. But the biggest challenge may be that thousands of brands are capable of signaling talent and prestige in a less Karen-like manner. A recent survey revealed that to launch a successful career, 60% of Americans would opt for a Google internship over a Harvard degree.

NYU celebrity prof Scott Galloway has gotten a lot of digital ink predicting MIT will partner with Google to launch a category killer STEM degree. While this would go a long way to combatting Karen-ization, no one has ever gone broke betting against the pace of change in higher education. And I’m pretty sure no one has ever lost a single bet betting against change at elite institutions. Outside of the forward-thinking (but not rich) London School of Economics, real online credentials with partners like 2U – distinct from the asynchronous safety and plausible deniability of Coursera and edX courses – remain limited to select graduate and professional degrees (and with limited enrollment). Meanwhile, the Karens of higher education view the current Zoom school experiment as perhaps a decade’s worth of innovation. As a result, with few exceptions (most notably Davidson College President Carol Quillen’s plea to “dramatically expand capacity using every tool we have to reach many more people at dramatically lower cost”), the focus of current leadership is how quickly they can return to their cloistered campuses.

So I fear @profgalloway is wrong about MIT@Google, iStanford, and HarvardxFacebook, just as he’s wrong in believing that the missing link is a multi-year degree program, and wrong in resurrecting that old chestnut that star professors (or in Galloway’s parlance, the 6-12 “ringers” at each university “who are worth it” – presumably he’s one) “will see their compensation rise as much as 10x over the next decade” as a result of online delivery. (He’s probably also wrong to identify himself on LinkedIn as a “Clinical Professor of Marketing.” I’m not sure what clinical marketing is, but if he’s not joking, I’ll dream of a future NYU appointment as Clinical Professor of Private Equity.)

What @profgalloway isn’t wrong about is that Google has a powerful brand, perhaps more powerful than any of higher education’s Karens when it comes to the things today’s students care most about – first and foremost, a clear pathway to a good first job. Ironically, @profgalloway could look closer to home for a working model. NYU has already launched faster + cheaper pathways to careers in the music industry (in partnership with Billboard Magazine, a highly relevant brand) and in the sports industry. These programs guide students through the core elements of the industry – in the case of music, production, performance, business, and technology – and give them a better chance to begin making a living doing what they love than most multi-year degrees, at a tiny fraction of the time and cost. The programs are orchestrated by Yellowbrick, which also offers last-mile training in beauty (FIT, Allure, Bobby Brown, L’Oreal), sneakers (FIT + Complex Media), streetwear (Parsons + Complex Media), and other industries with other brands.

While USC and other top schools may look at what NYU is doing and ask to speak to the manager, NYU is demonstrating that elite doesn’t have to be inconsistent with access and equality. In a post-Covid world, NYU is on the right track. You’re either dramatically expanding capacity using every tool you have to reach many more people – especially black and brown Americans – at dramatically lower cost, or you’re a Karen. And the Karens of higher education should steel themselves for staggering penalties from not-too-distant-future governments, as well as from the market. Because no one wants to enroll at Karen U., even one with a $40 billion endowment.–

Reality bites Trump back

Posted on by The Progressive Policy Institute

Donald Trump is a wretched president but a master illusionist. His greatest skill isn’t solving real-world problems. It is concocting “alternative facts” that allow his supporters to evade unpleasant realities.

Now, however, the president is beset by three intractable realities even he can’t disguise or spin: a deadly virus, an inert economy with mass unemployment, and public outrage over racist cops.

His bungling of the coronavirus pandemic has cost tens of thousands of American lives and prolonged a job-killing economic freeze. These painful realities have penetrated the make-believe world of Trumpistan, in which an infallible Trump valiantly battles the forces of darkness: the media, the “deep state,” immigrants, Democrats, socialists, faithless allies, etc.

Reality has bitten back, and Trump is flailing. His path to reelection this fall has suddenly become much steeper, and he is desperately looking for a political lifeline. Trump imagines he has found it in the vandalism and looting that have accompanied nationwide protests over the killings of George Floyd and other black Americans by police.

Read the full article here

Medicaid Will Be Crucial Safety Net in COVID-19 Crisis

Posted on by The Progressive Policy Institute

Introduction

The coronavirus pandemic has not deterred President Trump and Republicans from trying to kill the Affordable Care Act (ACA), which would strip millions of Americans of health care coverage at the worst possible time. However, Medicaid — significantly strengthened in the ACA — will be a lifeline for the country during this crisis.

The pandemic and the related economic downturn have already led over 40 million people to file jobless claims. Estimates of the number of Americans who may be joining the ranks of the uninsured range from 18 million (1) to 25 million (2) to as high as 45 million. (3)

This is in addition to the 28 million people who were uninsured prior to the COVID-19 pandemic. In a new survey from the Kaiser Family Foundation on the impact of the current crisis, “55 percent of Americans say Medicaid is personally important to them and their families and about one in four adults (23%) who are not currently on Medicaid say it is likely they or a family member will turn to Medicaid for health insurance in the next year.”(4)

However, the safety net provided by Medicaid will differ dramatically depending on where you live. People who live in states that embraced the ACA’s Medicaid expansion will be a lot better off than those who don’t. Since the Supreme Court made Medicaid expansion optional in 2012, 36 states and the District of Columbia have accepted the expansion. (5)

Before the pandemic struck, states that expanded Medicaid covered over 35 percent of unemployed adults compared to just 16 percent in non-expansion states.” (6) Now, the Urban Institute and the Robert Wood Johnson Foundation estimate that about 47 percent of those who have lost their job-based insurance will receive coverage from Medicaid. (7)

The Kaiser Family Foundation estimated a similar 50 percent. (8) Drilling down more specifically, in expansion states, 53 percent of those losing employer insurance are expected to turn to Medicaid, while 23 percent will remain uninsured (the rest will be eligible to purchase insurance on the ACA exchanges). (9) In non-expansion states, just 33 percent will receive Medicaid and 40 percent will likely wind up  uninsured. (10)

In Texas alone, the largest state that declined to expand Medicaid, an estimated 1.6 million individuals have lost their employer-provided health insurance. About half of them will wind up without health care coverage because they will earn too much income to join Texas’ Medicaid program and too little income to be eligible for ACA subsidies for the exchanges. For the country as a whole, over one-quarter of individuals falling into that coverage gap will be in Texas. (11)

The Urban Institute estimated the state by state effects of different unemployment scenarios on insurance coverage. (12) Taking two states from this analysis, New York and Florida, allows us to more clearly understand the fate of people who lose their jobs and employer-provided health care insurance in expansion states vs. those in non-expansion states.

Under a projection of 20 percent unemployment, New York (an expansion state) and Florida (a non-expansion state) are both estimated to see around 1.5 million people lose their job-based coverage. In New York, 923,000 are projected to gain Medicaid coverage (61 percent) with 282,000 left uninsured (19 percent). In Florida, only 475,000 would gain coverage (31 percent) with 581,000 (38 percent) left uninsured. (13) (See Figure 1)

 

MEDICAID EXPANSION UNDER THE ACA

Medicaid has always been a crucial backstop for low-income families with children. In addition, Medicaid spending goes up when the economy turns down, making it an important part of the government’s suite of countercyclical tools for mitigating recessions. Before the coronavirus pandemic appeared, Medicaid provided insurance for one in five Americans and about 40 percent of children.

Prior to expansion in 2013, Medicaid targeted coverage to children in low-income families and some low-income parents. The expansion in the ACA included childless adults, making Medicaid a true safety net program for low-income Americans. The program now largely covers anyone with annual income below 138 percent of the federal poverty line (in 2020 that is $17,236 for an individual). About 13 million people have received Medicaid coverage in the expansion states. Since 2013, 21 of these states saw increases in Medicaid enrollment of at least 25 percent. (14) In non- expansion states, says the Kaiser Family Foundation, “eligibility levels for parents remain very low, often below half of poverty, and, with the exception of Wisconsin, other adults are not eligible regardless of their incomes.” (15)

The best way to mitigate a Covid-19 induced explosion of uninsured Americans would be for the 14 outlier states to expand their Medicare programs under the ACA. Unfortunately, this is unlikely to happen since the reasons for not expanding up until this point have been partisan and ideological, not related to the underlying levels of uninsured in the states or state budget problems.

In fact, Medicaid expansion is a good deal for the states, since the federal government picks up 90 percent of the costs. And it’s worth recalling how shortsighted the 14 states were in rejecting expansion initially given the desperate need now — especially considering the federal government promised to pay for 100 percent of costs for the first three years.

It is true that the remaining 10 percent contribution would now be a difficult lift given the pandemic-induced fiscal crises in most states. Congressional Democrats should thus propose returning to the 100 percent inducement for expansion in upcoming negotiations over further federal aid. (16)

STATE BUDGETS NEED HELP

The amount of economic suffering in general, and availability of Medicaid as a comprehensive safety net specifically, will also depend on whether national leaders enact further economic relief legislation. The Congressional Budget Office (CBO) projects that if Congress fails to pass additional economic support, even by the end of 2021 there would still be 10 million more unemployed than before the crisis.

The nation’s leaders must take further action and their top priority should be aid to state and local governments. With most businesses closed, state sales tax revenues are falling off a cliff even as costs for unemployment insurance and health care are exploding. PPI estimates that state and local governments will need between $445 and $835 billion in additional federal support between now and the end of 2021. (17)

Without that support they will be forced, by state balanced budget requirements, to cut employees and services, and to raise taxes — both of which would prolong the economic downturn. That, in turn, would mean many more people will lose their jobs and the ranks of the uninsured will swell.

And, it means pressure on Medicaid — often the largest and fastest growing expense in a state’s budget (in 2019, estimated at 30 percent of total state spending across all states). (18) States have reported the near certainty of Medicaid budget shortfalls and some have already begun cutting by hundreds of millions of dollars. (19)

Given the centrality of Medicaid as a comprehensive health care safety net for those with low incomes and those who have lost their employer-provided health insurance, states’ abilities to administer and maintain robust programs will be incredibly important for people for as long as the Covid-19 crisis lasts.

House Democrats have passed a $3 trillion relief bill, the HEROES Act, that whatever its flaws, (20) includes around $900 billion for state and local governments. The Trump administration and Senate Republicans, however, are balking at providing further aid.

It is worth noting that in the “Families First Coronavirus Response Act,” the second piece of emergency legislation passed so far, there was a small and restricted increase in aid-to-states funneled through the federal government’s Medicaid funding system. Importantly, this funding included Medicaid  maintenance of effort” requirements. In exchange for taking the funding, states had to agree to not cut people already from the state’s Medicaid rolls or impose new restrictions on who is eligible to receive benefits. States are then bound by these requirements for as long as the health emergency lasts. (21)

Making sure those requirements are not watered down or eliminated in future relief bills will be essential. Nonetheless, given the enormous funding challenges states face, and the amount of jobless people now requiring health care insurance, Medicaid beneficiaries will still be at risk over the longer term. Studying the effects of the Great Recession, Rice University researchers found that, despite maintenance of effort requirements,

“On average, states suffered a $222 per capita negative revenue swing in 2009, which in the long term led to a $64 cut in Medicaid spending per child beneficiary, a 1 percent reduction in the number of elderly people enrolled in Medicaid and an $82 per capita cut in long-run state education spending. Such cuts are sobering, given that other economists have found that Medicaid coverage is effective in reducing infant and child mortality.” (22)

What’s more, the Trump administration and Republican state leaders in recent years have been probing the edges of legality to cut their Medicaid rolls, impose new restrictions on eligibility, and to cut Medicaid benefits. (23) So there is always a threat to this crucial safety net program – especially in the Republican-led states who have yet to expand their programs.

CONCLUSION

The Covid-19 crisis is far from over. Thanks to the ACA’s expansion of Medicaid, the program is poised to provide a crucial backstop for millions of Americans who have lost their jobs and their health coverage. For those who happen to live in the 14 Republican-dominated states that did not expand Medicaid, however, the picture looks bleak.

Medicaid expansion started out as the less-flashy, sometimes forgotten achievement of the ACA. It was originally projected to insure substantially less people than the ACA’s insurance exchanges and it built on an existing program, so it didn’t suffer from a website meltdown or a new, broadly unpopular “mandate” — which were certainly attention grabbing. But, there was also the fact that it focused support on low-income, childless individuals – a class of Americans often overlooked by national policymakers.

More attention was paid to the expansion’s success when Republican bills to “repeal and replace” the ACA were debated and failed — in part, because even Republicans had a hard time swallowing the huge numbers of people who would lose Medicaid coverage in their states. (24)

Ultimately, during the decade since passage of the ACA, those with insurance from the Medicaid expansion have outnumbered those getting insurance through the private market insurance exchanges. (25) As both ramped up during the 2013-2016 period, they insured roughly the same amount annually (reaching 13 million each by 2016). Since 2017, Medicaid expansion has maintained enrollment, while enrollment in the exchanges has shrunk by about 3 million people (largely due to Trump Administration
sabotage). (26)

The ACA’s Medicaid expansion is a sterling example of a federal government program accomplishing what it set out to accomplish. Now, progressive supporters of the ACA should focus on two critical goals. The first is passing federal aid to state and local governments, which will relieve pressure for cutting back on Medicaid during the pandemic. This step is supported by bipartisan majorities, who are also specifically averse to cutting Medicaid as a means of addressing upcoming budget shortfalls. (27) The second goal should be to build public pressure on the 14 recalcitrant states to put the needs of their citizens for health coverage over partisan enmity.

Authored by Josh Gordon, Ph.D., Senior Health Care Policy Fellow

PPI_Medicaid-Will-Be-Crucial-Safety-Net-in-Covid-Crisis

References

1 University of Minnesota, “As many as 18.4 million Americans face disruption, loss of health insurance in pandemic,” MedicalXpress, April 28, 2020. https://medicalxpress.com/news/2020-04-million-americans-disruption-loss-health.html

2 Garrett, Bowen and Anuj Gangopadhyaya, “How the COVID-19 Recession Could Affect Health Insurance Coverage,” Urban Institute and Robert Wood Johnson Foundation, May 4, 2020.
https://www.urban.org/research/publication/how-covid-19-recession-could-affect-health-insurance-coverage

3 Urban/RWJF projected the amount of uninsured at different levels of the unemployment rate and developed a baseline and high scenario for each. In this paper, I used their 20 percent unemployment rate analysis and their baseline (25 million) scenario not their high (45 million) scenario.

4 KFF Health Tracking Poll – May 2020. Published May 27, 2020. https://www.kff.org/report-section/kff-health-tracking-poll-may-2020-health-and-economic-impacts/

5 Nebraska, one of the 36 states, has adopted the expansion but isn’t scheduled to implement until October 1, 2020. See also the AdvisoryBoard, “Where the states stand on Medicaid expansion,” January 13, 2020, https://www.advisory.com/daily-briefing/resources/primers/medicaidmap

6 Center on Budget and Policy Priorities, “Larger, Longer-Lasting Increases in Federal Medicaid Funding Needed to Protect Coverage,” May 5, 2020. https://www.cbpp.org/research/health/larger-longer-lasting-increases-in-federal-medicaid-funding-needed-to-protect. And Anuj Gangopadhyaya and Bowen Garrett, “Unemployment, Health Insurance, and the COVID-19 Recession,” Urban Institute, April 2020.

7 Garrett, Bowen and Anuj Gangopadhyaya, “How the COVID-19 Recession Could Affect Health Insurance Coverage,” Urban Institute and Robert Wood Johnson Foundation, May 4, 2020. https://www.urban.org/research/publication/how-covid-19-recession-could-affect-health-insurance-coverage

8 Garfield, Rachel, et. al. “Eligibility for ACA Health Coverage Following Job Loss,” Kaiser Family Foundation, May 13, 2020. https://www.kff.org/coronavirus-covid-19/issue-brief/eligibility-for-aca-health-coverage-following-job-loss/

9 Park, Edwin, “New Urban Institute State-Level Health Coverage Estimates as Unemployment Rises,” Georgetown University Health Policy Institute Center for Children & Families (CCF), May 5, 2020. https://ccf.georgetown.edu/2020/05/05/new-urban-institute-state-level-health-coverage-estimates-as-unemployment-rises/

10 ibid.

11 Johnson, Kim and Dallas Williams, “1.6M Texans Lost Employer-Sponsored Health Insurance Because Of The Pandemic,” Texas Public Radio, May 26, 2020. https://www.tpr.org/post/16m-texans-lost-employer-sponsored-health-insurance-because-pandemic

12 Garrett, Bowen and Anuj Gangopadhyaya, “How the COVID-19 Recession Could Affect Health Insurance Coverage,” Urban Institute and Robert Wood Johnson Foundation, May 4, 2020.

13 ibid. Author calculations based on study.

14 The Medicaid and CHIP Payment and Access Commission, “Medicaid enrollment changes following the ACA,” Accessed on February 24, 2020, https://www.macpac.gov/subtopic/medicaid-enrollment-changes-following-the-aca/

15 Artiga, Samantha, Robin Rudowitz and MaryBeth Musumeci, “How Can Medicaid Enhance State Capacity to Respond to COVID-19?,” Kaiser Family Foundation, March 17, 2020. https://www.kff.org/medicaid/issue-brief/how-can-medicaid-enhance-state-capacity-to-respond-to-covid-19/

16 The SAME Act from Democratic Senators Doug Jones (AL), Mark Warner and Tim Kaine (VA) is one ready-to-go option. https://www.modernhealthcare.com/government/senate-bill-wants-sweeten-deal-states-expand-medicaid

17 McDermott, Brendan, Interactive Calculator: How Much Federal Support Do State and Local Governments Need?,” Progressive Policy Institute, May 7, 2020. https://www.progressivepolicy.org/publications/interactive-calculator-how-much-federal-support-do-state-and-local-governments-need/

18 National Association of State Budget Officers, “State Expenditure Report,” https://www.nasbo.org/reports-data/state-expenditure-report

19 Zeballos-Roig, Joseph, “3 cash-strapped states are making deep cuts to Medicaid as coronavirus devastates their budgets — and millions of jobless people lack health insurance,” Business Insider, May 6, 2020. https://www.businessinsider.com/states-medicaid-cuts-coronavirus-devastates-economy-budgets-ohio-dewine-2020-5

20 Ritz, Ben. “House HEROES Act Gets The Trade-Offs Wrong,” Progressive Policy Institute, May 15, 2020. https://www.progressivepolicy.org/projects/center-for-funding-americas-future/house-heroes-act-gets-the-trade-offs-wrong/

21 Aron-Dine, Aviva, “Medicaid ‘Maintenance of Effort’ Protections Crucial to Preserving Coverage,” Center on Budget and Policy Priorities, May 13, 2020. https://www.cbpp.org/blog/medicaid-maintenance-of-effort-protections-crucial-to-preserving-coverage

22 Rice University, “State revenue declines lead to cuts in children’s Medicaid benefits, education spending, Rice experts say,” May 11, 2020. https://news.rice.edu/2020/05/11/state-revenue-declines-lead-to-cuts-in-childrens-medicaid-benefits-education-spending-rice-experts-say/

23 See Gordon, Joshua, “Getting Back to Basics on Health Care,” Progressive Policy Institute, March 2020. https://www.progressivepolicy.org/publications/getting-back-to-basics-on-health-care/

24 ibid.

25 Author’s calculations based on the regularly updated Congressional Budget Office report “Federal Subsidies for Health Insurance.”

26 ibid.

27 KFF Health Tracking Poll – May 2020. Published May 27, 2020. https://www.kff.org/report-section/kff-health-tracking-poll-may-2020-health-and-economic-impacts/

Statement by PPI President Will Marshall

Posted on by The Progressive Policy Institute

As someone who grew up in the Jim Crow South, I know that progress toward racial justice and concord is possible in America. I’ve seen it happen. I also know that social progress is neither linear nor inevitable. Progress stalls, people backslide, old prejudices find new ways to express themselves. Even well-intentioned Americans lose focus, become complacent and stop grappling with the legacy and persistence of racism in our country.

The depraved killings of George Floyd, Ahmaud Arbery, Breonna Taylor and too many more black Americans remind us that we can never stop struggling for racial justice. The PPI community is aggrieved and sickened by these deaths, and by the despicable conduct of a president who stokes racial fear and animosity for political gain. Our hearts go out to the families of the victims, and to all African-American citizens who worry with reason about their safety and that of their families.

In coming weeks, PPI will work to develop new ideas for tackling the systemic racism that seems so stubbornly embedded in the nation’s institutions. 

We also encourage you to read these heartfelt words by former President Bill Clinton, who has never lost faith in America’s ability to keep moving forward towards racial justice and reconciliation.

Statement from President Bill Clinton on the death of George Floyd

Posted on by The Progressive Policy Institute

We couldn’t have said it better. A statement we’d like to re-share from President Bill Clinton on the death of George Floyd:

“In the days since George Floyd’s death, it is impossible not to feel grief for his family—and anger, revulsion, and frustration that his death is the latest in a long line of tragedy and injustice, and a painful reminder that a person’s race still determines how they will be treated in nearly every aspect of American life.

No one deserves to die the way George Floyd did.  And the truth is, if you’re white in America, the chances are you won’t.  That truth is what underlies the pain and the anger that so many are feeling and expressing—that the path of an entire life can be measured and devalued by the color of one’s skin.  Fifty-seven years ago, Dr. King dreamed of a day when his “four little children would be judged not by the color of their skin, but by the content of their character.”  Today, that dream seems even more out of reach, and we’ll never reach it if we keep treating people of color with the unspoken assumption that they’re less human.

We need to see each other as equally deserving of life, liberty, respect, dignity, and the presumption of innocence.  We need to ask ourselves and each other hard questions, and listen carefully to the answers.

Here’s where I’d start.

If George Floyd had been white, handcuffed, and lying on the ground, would he be alive today?

Why does this keep happening?

What can we do to ensure that every community has the police department it needs and deserves?

What can I do?

We can’t honestly answer these questions in the divide and conquer, us vs. them, shift the blame and shirk the responsibility world we’re living in.  People with power should go first—answer the questions, expand who’s “us” and shrink who’s “them,” accept some blame, and assume more responsibility. But the rest of us have to answer these questions too.

It’s the least we can do for George Floyd’s family, and the families of all other Americans who have been judged by the color of their skin rather than by the content of their character.  The future of the country depends on it.”

This statement originally appeared on the Clinton Foundation website, which can be found here. 

Gary Pearce: Protests and Politics Echo 1968

Posted on by The Progressive Policy Institute

Gary Pearce on Politics and Public Policy in North Carolina

2020 feels like 1968.

Peaceful protests erupt into looting and burning. Police battle demonstrators in the streets. Black Americans vent their rage and frustration.

In 1968, Dr. Martin Luther King’s assassination in Memphis lit the fires. This year, it was the death of George Floyd at the hands of policemen in Minneapolis.

In 1968, the nation was already divided by the Vietnam war – and protests against the war. This year, our nerves were already rubbed raw by the Covid pandemic, the economic meltdown, stay-home orders – and protests against the orders.

Then, as now, there was the sickening sense that the floor under American society was collapsing.

1968, like 2020, was a big election year. 1968 ended 36 years of Democratic dominance in Washington, since FDR’s election in 1932. It ushered in an era – more than half a century now – dominated by a Republican Party dependent on white Southerners and dedicated to the proposition that government is the problem, not the solution.

In 1968, an anguished President was trapped inside the White House by protesters chanting, “Hey, hey, LBJ, how many kids did you kill today?” Four years after winning a historic landslide, he withdrew as a candidate for reelection. His dream of a Great Society slipped away.

Today inside a White House again surrounded by protesters, an angry President lashes out at critics, the media and political opponents. Four years after winning a historic upset, he fears his dream of a smashing reelection victory fueled by a rising economy is slipping away.

In 1968, Democrats’ election hopes were shattered when their national convention in Chicago exploded in violence. This year, the Republican convention will be in Charlotte, assuming the city and state can come to terms with the Republican Party and President Trump over Covid precautions.

They also must consider the risk that Charlotte could attract a volatile mix of protesters against racism, “tyranny”-protesting Reopeners and camo-clad white nationalists waving Confederate flags and wielding assault weapons.

We don’t want Charlotte to be to 2020 what Chicago was to 1968.

Then, the violence in Chicago and the riots nationwide set off a white backlash that helped elect Richard Nixon President. George Wallace, running as a third-party candidate, fanned the flames.

Nixon benefitted from Democratic disarray, Roger Ailes’ TV genius and Strom Thurmond’s Southern Strategy. Republicans began their rise in North Carolina and the South. In 1972, North Carolina elected a Republican governor and a Republican Senator named Jesse Helms.

It almost didn’t happen. Vice President Hubert Humphrey, the seemingly hapless Democratic candidate, nearly caught Nixon in the final days.

Former North Carolina Governor Terry Sanford and his chief political adviser, Bert Bennett, helped lead Humphrey’s national campaign. Bennett said years later that Humphrey would have won with another week.

But he didn’t. Nixon won and promised to “bring us together.” But he didn’t. The Vietnam War dragged on, and our racial divide persists today.

Politics, like life, rarely moves in a straight line. We don’t control events; they control us.

Even people with power – Governor, President, police chief, protest organizer – are no more in control than a ship in a storm is in control of the winds and waves.

A few months ago, we thought this election would be about impeachment and a roaring, soaring economy.

Then a virus kills 101,000 Americans and puts millions out of work.

A white policeman keeps his knee on a black man’s neck for almost nine minutes even after the victim pleads “I can’t breathe.”

An angry protester throws a firebomb.

History pays no attention to human intention.

Gary Pearce writes on policy and politics in North Carolina, and is a guest writer for the Progressive Policy Institute. You can learn more about Gary by visiting www.NewDayforNC.com.

The HEROES Act fixes what the CARES Act broke

Posted on by The Progressive Policy Institute

Conservatives call the House Democrats’ Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act a “gigantic political scam.” Senate Republicans say HEROES, passed by the House on May 15th, is “dead on arrival when it reconvenes. As they negotiate with Democrats, Republicans should think carefully about certain student loan relief provisions in the bill.

Even in good times, a substantial portion of 45 million Americans’ paychecks go to student loan payments rather than to goods and services that keep our economy churning. There’s little doubt that this debt contributes to suppressed consumer consumption, which stifles economic growth. In this bad time, Americans collectively owe $1.6 trillion in student debt. This debt burden is now dramatically heavier with the economic shutdown and coming diminished post-pandemic employment opportunities.

Some say no additional student loan relief is needed because the Coronavirus Aid, Relief and Economic Security (CARES) Act that Congress passed in March temporarily suspended student loan payments. That would be a decent argument if CARES applied to everyone, but it doesn’t.

Read the full article here

The HEROES Act fixes what the CARES Act broke

Posted on by The Progressive Policy Institute

Conservatives call the House Democrats’ Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act a “gigantic political scam.” Senate Republicans say HEROES, passed by the House on May 15th, is “dead on arrival when it reconvenes. As they negotiate with Democrats, Republicans should think carefully about certain student loan relief provisions in the bill.

Even in good times, a substantial portion of 45 million Americans’ paychecks go to student loan payments rather than to goods and services that keep our economy churning. There’s little doubt that this debt contributes to suppressed consumer consumption, which stifles economic growth. In this bad time, Americans collectively owe $1.6 trillion in student debt. This debt burden is now dramatically heavier with the economic shutdown and coming diminished post-pandemic employment opportunities.

Some say no additional student loan relief is needed because the Coronavirus Aid, Relief and Economic Security (CARES) Act that Congress passed in March temporarily suspended student loan payments. That would be a decent argument if CARES applied to everyone, but it doesn’t.

Read more here.

How a New Wave of Digital Platforms can Lift Growth

Posted on by The Progressive Policy Institute

Getting the economy back on its feet again isn’t going to be easy. New types of digital platforms can help.

A well-functioning business is like a table with four legs: Customers, capital, workers, and suppliers. The pandemic knocked out all four legs simultaneously, with terrible consequences.

When and if the health impacts of the pandemic are mitigated, the big question is: How fast can we stand all four legs back up again?

Read the full article here

Is Work-from-Home Really the Wave of the Future?

Posted on by The Progressive Policy Institute

Zillow CEO Rich Barton recently tweeted that he was giving all employees the option to work from home for the rest of 2020. “My personal opinions about WFH (work from home) have been turned upside down over the past 2 months. I expect this will have a lasting influence on the future of work … and home.”

Barton’s epiphany about working from home – echoed by other U.S. business leaders – may mark a decisive shift toward pervasive telework in the post-pandemic economy. Before COVID-19 appeared, just five percent of the U.S. workforce worked remotely full-time. Now, thanks to America’s extensive digital infrastructure, two-thirds of employees are working from home.

Some companies say they have witnessed an immediate bump in productivity as workers save time on commuting and have fewer in-office distractions. The temporary switch to remote work has gone so well at Twitter that the company has decided to make it the permanent default for most employees. Other tech companies may soon follow suit.

But before too many companies go all in on work from home, there is an important reason for caution: the current increase in productivity may be an illusion.

DRAWING DOWN ON ORGANIZATIONAL CAPITAL — NETWORKS, CULTURE, AND PROCESS

Even as they work from home, employees are leveraging the relationships, routines, and habits they developed from interacting with coworkers in person on a daily basis. Over time, however, as workers begin drawing down on this social and organizational capital — culture, structure, and processes — we may find that they become less productive as collegial networks and opportunities to acquire new skills erode. Ironically, the demographic that most identifies with telework — millennials — would likely be most harmed over the long run, since more senior employees typically have a deeper reservoir of institutional and professional knowledge.

As employees switch jobs, problems linked to the withering of collegial relationships may start to seem more obvious. Eventually, companies will have trouble hiring the right people and integrating them into a cohesive team.

The Federal Reserve Bank of St. Louis took a closer look at this phenomenon and found that professional networks are, indeed, central to the career advancement. In a 2016 paper titled “Network Search: Climbing the Job Ladder Faster“, the authors found that “…jobs found through a worker’s network have (i) higher wages and (ii) longer employment duration and (iii) workers experience shorter unemployment spells.”

EVERYONE’S DOING IT RIGHT NOW. BUT FOR HOW LONG?

Work from home also faces a systemic collective action problem — when every company does it, then it’s easier for each company to do it. That dynamic is a tailwind right now because  so many workers are telecommuting. But as some companies start to revert to their previous policies, it will quickly become a headwind.

These things are extremely difficult to quantify but they must be important. Otherwise, companies wouldn’t invest heavily in offices and travel aimed at building personal and professional relationships and trust. For any kind of creative work, the serendipity of sharing ideas in informal and unscheduled collaboration is crucial.

It seems unlikely that all this sunken investment in office culture and relationships is irrelevant, as the newfound enthusiasm for telework often implies. What’s more, we’ve seen spurts of interest in telework come and go.

It wasn’t so long ago that the trends in corporate America were moving away from work from home. In 2013, newly installed Yahoo! CEO Marissa Mayer ended the company’s work-from-home option, forcing several hundred employees to either move to the nearest office or quit. In the next few years, IBM, Bank of America, Best Buy, and Aetna followed suit.

COVID-19 WON’T BE THE LAST DISASTER TO FORCE WFH

But Mayer’s all-or-nothing approach doesn’t seem quite right either. It’s time to think about making work more resilient against unforeseen catastrophes like COVID-19. Central to that thinking is finding the optimal balance between office work and work from home for white-collar employees.

For instance, periodic telework commits individuals to exercise their “remote work environment”. This forces employees to spot-check necessities such as network compatibility and hardware and software updates, which can be essential to business continuity and resiliency planning in the event of emergencies suddenly dictating work from home.

Additionally, organizations need to address the increased cybersecurity risks associated with a remote work force, which provides new opportunities for sophisticated attackers to insinuate themselves within a network. As Verizon Business Group CEO Tami Erwin told Reuters, “A lot of people ended up sending workers to work from home without really thinking through what were some of the security elements in the future. I think employees working from home are probably more vulnerable to attacks.”

Overall, as workers spread out, risk increases and corporate decision-making needs to respond appropriately. A challenging economic environment only compounds the difficulty in managing new risks due to work from home policies. According to a recent Moody’s investor research note, “As profits fall, strong governance will be required to ensure that any reduction in cyber security budgets does not expose issuers to increased cyber risk.”

Insurance alone cannot be the answer – legal liability precedents are still in their infancy and the entire cyber insurance offering is under defined and risky. And even if insurance does mitigate some risk, it can’t prevent negative reputational impact, harm to employees (trust, retainment, etc.), and damage to client and customer relationships.

According to one executive of a Chicago based firm that specializes in cyber security risks and responses for large corporations, “Those who started mitigating increased telework risks before Covid-19 are doing well, and those trying to play catch up are making mistakes that will be amplified due to the distributed workforce and economic pressures.” They noted that time is not the only thing lost: “It’ll cost more too.”

CONCLUSION

Remote work can include financial advantages in lower fixed costs like office space, and lower benefit outlays for commuter and daycare. Employers are even seeing a decline for lower overall worker salaries as qualified employees are willing to take less pay in exchange for telework benefits.

And the technology supporting remote work has clearly improved, especially in the last five years. The “consumerization” of enterprise software means there are finally products for telework that employees want to use, from videoconferencing, to instant messaging to new tools for managing relationships with customers. But because of heavy investments in organizational capital, companies are beginning to realize that having the right tools wasn’t the only thing holding them back from transitioning to full-time work from home earlier.

The future will likely feature a robust and variable mix of telework and office work. Companies that leap prematurely to the conclusion that their ability to prosper during the shutdown proves that the “office” is obsolete risk burning through their organizational capital, just as their rivals start to build it back up.

PPI_IsWorkFromHomeWaveOfFuture (1)

Bryan Morton Leads Fight for Better Schools in Camden, N.J.

Posted on by The Progressive Policy Institute

For Bryan Morton and Parents for Great Camden Schools, the fight for a great school in every neighborhood is the best way to ensure that no child in Camden, New Jersey, falls into the pre-K-to-prison pipeline.

Parents for Great Camden Schools (PGCS) is, in many ways, built in the image of its founder. A native of Camden, Morton grew up seeing police officers, firefighters and schoolteachers who looked like him.

Educated in the Camden City Public Schools (CCPS), Morton attended the only public schools available to him. He excelled early and tested into gifted and talented programs.

By the time Morton entered high school, Camden looked very different. The municipal unions had negotiated away city workers’ residency requirements, creating an exodus of the African-American workers Morton grew up emulating.

Read the full piece here.

Dealing with Zoom Fatigue: Using Project-Based Learning to End the School Year on a High Note

Posted on by The Progressive Policy Institute

As schools wind down from a, hopefully, once-in-a-lifetime shutdown, many students and teachers find their motivation also winding down. Educators are calling this “zoom fatigue,” referring to the commonly used teleconference platform. To end the year on a high note, teachers could turn to project-based learning (PBL), by asking students to complete a project they are interested in.

Motivation is the key to learning. “If the kids want to learn, you can’t stop ‘em,” former Ohio State professor of education Jack Frymier once said. “If they don’t, you can’t make ‘em.”

So urge students to work on something they care about. Education researchers have identified four main strategies to motivate students: focusing on learning students find relevant; giving them autonomy, or ownership of their learning; using positive feedback; and creating strong student-teacher relationships. So let students pick something they find relevant and give them some autonomy.

Jodi Chamberlin, a Tacoma, Washington, elementary school teacher, provides a good example. She selected projects “based on my students’ individual interests,” she wrote on DonorsChoose.org, a website where teachers can ask for donations for school projects. “I selected car building kits for my students who are interested in physics and mechanics of cars. I selected origami kits for a few of my kiddos who are always folding paper into various games during class time. I selected comic book templates for kids who are interested in being illustrators one day.”

Projects do not have to be physical. Some could be built online, through video games such as Minecraft, in which users enter a blocky, 3-D, computer-generated world in which the user has free reign to create any structure he or she can imagine using the tools built into the game. The first graphic shows a Minecraft world, while the second shows a suggested school project using Minecraft, from Fusion Yearbooks.

Source: Planet Minecraft

Irene Weinstein, a library media specialist at New Beginnings Family Academy in Bridgeport, CT, has used BreakoutEdu, an immersive learning games platform, to get her students excited about learning from home. “I have given students completely digital breakouts that I was able to access for free and the excitement and focus that I saw has been unmatched by any other activity,” she wrote on DonorsChoose.org. “However, there are only a handful of free lessons. With the access that this kit gives us, students can continue their thinking adventures throughout the year.”

Another teacher raised money to give students the material needed to build a terrarium at home, so they can grow plants and record their life cycles in a closed environment. Another raised funds for aquaponics sets, so students could grow their own vegetables.

Larry Berger, CEO of the curriculum and assessment firm Amplify, described a science project for older students from Amplify’s curriculum, in a recent interview. “Every kid participates in what we call an engineering internship for each unit,” he said. “They are on a fictional team at a science and engineering company. In the unit where we’re learning about changing climate, we’ve been tasked with designing rooftops for a city, and we are trying to use the science we’ve learned, but in an applied way, working with our team, designing rooftops, and we’ve set it up so most of the time, the really good idea that your team has fails for an interesting scientific reason and you’ve got to go back to the drawing board, like real engineers.”
Teachers could ask students who are passionate about sports to design the reopening of their favorite professional league. They could give students a series of questions they have to answer, such as how they would keep players and referees from exposure to the COVID-19 virus, whether any spectators would be allowed, how much television revenue each game would generate, whether the teams could make any profit this way, and if not, how the league would keep teams from going bankrupt. As they developed answers, teachers could continue to challenge them, poking holes in their reasoning and asking them to think more deeply.

Some teenage boys, who are disengaged in most classes, might love working on a project like this.

Through PBL, teachers serve as coaches and guides, giving inspiration and constructive feedback to help their students succeed. By posing increasingly demanding challenges and questions, they help students learn many different skills, from math and writing to critical thinking and digital publishing.

Students without computers or internet access could be put on teams with students who do have those resources. For individual assignments, teachers could either have the family photograph or record the student’s project and send it to the teacher or drop it off at a designated pick-up location.

At the end of the year, students and/or teams could showcase their work through an online show-and-tell. Every student or team would talk about their project, why they care about it, and what they were able to learn from it. This would help students develop the confidence to present in front of the class. For the students without internet, the teacher could present the project visually as the students discuss their work through a phone connection.

Whether it is origami animals, a Minecraft world, a terrarium, or an NBA restart, every student has something unique and noteworthy to contribute. Through these projects, students would be able to fuel their passions without ever leaving home.

And who knows, perhaps teachers would learn something they could use to motivate and engage their students in future years.

Bruce Arao, a spring 2020 intern at the Progressive Policy Institute, is a student at the University of California, Santa Barbara, double-majoring in economics and sociology.

State and Local Budget Cuts Jeopardize U.S. Recovery 

Posted on by The Progressive Policy Institute

As the coronavirus crisis grinds on, state and local leaders are warning of a looming fiscal meltdown. Unlike the federal government, most state and local governments are required to balance their budgets, so they may need to implement painful budget cuts as unemployment soars and as tax collections dry up. Cuts are not inevitable, but they can only be avoided if the Democrat-controlled House and Republican-controlled Senate pass flexible aid for state and local governments. But rather than coming to the rescue, Congress is in gridlock over the next package of economic relief, in part because of misplaced Republican concerns about giving aid to state, county, and city governments. 

Based on the most recent economic projections from the non-partisan Congressional Budget Office, the Progressive Policy Institute estimates that state and local governments will need an additional $445-$835 billion in federal support through the end of 2021 just to maintain their normal operations without cutting spending or raising taxes. If Congress does not pass more aid, the budget cuts made after the Great Recession suggests that schools and universities, Medicaid recipients, and state and local government employees will bear the brunt of the coming cutbacks. Steep budgets cuts would also lead to a more severe recession and a slower economic recovery. 

The Center on Budget and Policy Priorities found that in the years after the 2008 financial crisis and subsequent recession, 44 states laid off or cut pay for state employees, 43 states cut higher-education spending, 31 cut health-care spending, 34 cut K-12 education spending, and 29 cut services or cash benefits for the elderly and disabled. Eight states also cut the maximum amount of time for which workers can draw unemployment benefits. Some of those cuts were never reversed: Pew Charitable Trusts estimates that a decade after the recession, states employed 132,300 fewer noneducational workers and spent $1,175 less per student on higher education than they did prior to the recession. As of 2016, states also spent 1.75 percent less on K-12 education in inflation-adjusted dollars than they had spent in 2008.

The cuts state and local leaders are considering now look a lot like those made during the Great Recession. Ohio leaders have proposed cutting $775 million from the state’s budget, primarily to K-12 education, Medicaid, and higher education. Colorado expects it will have to cut about a quarter of its discretionary spending, and is deliberating over cuts to K-12 education, health care programs, and infrastructure. In Oregon, leaders are considering cuts to policing, prisons, financial aid for college students, and social programs that benefit children, people battling addiction, and the elderly. Local governments of all sizes, from New York City to small cities in Mississippi, claim that they will have to furlough workers or cut back on city services such as transit and garbage pick-up. 

Prior to the pandemic, roughly 20 million people worked for state and local governments. As those governments reduce their workforces, the already record-high unemployment rate could rise even further. Meanwhile, cutting aid to low-income people – those who are most likely to spend whatever money they receive – would hurt our most vulnerable citizens while also depressing consumption, which would hurt businesses and undermine the recovery.

These short-term cuts can also have longer-lasting consequences. For example, students who were affected by cuts to K-12 education in the wake of the Great Recession earned lower test scores years later, and even became less likely to attend college. The effects were particularly pronounced for black children, Latino children, and children in low-income families. 

In a normal recession, sales taxes (states’ largest tax revenue source) fall less than other revenue sources like income taxes, lessening the blow the recession has on state and local budgets. But experts fear social distancing will cut into sales tax revenues more than it has in the past, as even people who didn’t experience a loss in income have fewer opportunities to spend what they earned. And oil-producing states, which tend to have large “rainy day” funds that could insulate them from fiscal crises, will have to reroute some of those reserves to offset revenue losses caused by historically low oil prices in addition to making up for pandemic-related losses. 

The stakes are enormous, but the Trump administration is trying to tie aid for state and local governments to unhelpful tax cuts, while Congressional Republicans complain that aid would bail out poorly-managed states. But those claims are misguided, because the scale of state and local losses will dwarf what even the most fiscally-disciplined governments could have foreseen. Federal support for state budgets now will prevent government workers from joining the ranks of the unemployed and prevent budget cuts that would hurt vulnerable Americans, both of which would slow economic recovery. If Washington Republicans really are serious about restarting the economy as quickly as possible, they should stop stalling and start working with House Democrats to deliver the aid our states urgently need. 

This piece was also published on Medium.com.

How Workplace Testing Can Get Us Back to Work

Posted on by The Progressive Policy Institute

We’re used to thinking of COVID-19 testing as an activity that is led by government public health agencies, supported by private testing laboratories such as Quest Diagnostics and LabCorp.

But American businesses have a broader role to play. Workplace-based testing for COVID-19 infections is shaping up to be a crucial component of managing the virus and getting the economy restarted again.

In mid-April Scott Gottlieb, former head of the FDA, wrote a op-ed (1) for the Wall Street Journal where he argued that:

As employees return to work, perhaps as early as May, employers can offer screening at their place of business. Rapid diagnosis and containment will be a critical part of limiting spread.

Government policy can encourage employer-based testing in two ways. First, without cutting corners, federal and state regulatory agencies should be open to approving employer-based testing laboratories that will add significantly more national testing capacity. Second, the U.S. should consider subsidizing sick leave for workers that test positive, in order to encourage more companies to do testing.

Oddly enough, the CDC is still treating testing as a scarce resource, as it has since the beginning of the pandemic, and actively discouraging employer use of tests. The current CDC guidelines (2) for employers suggest checking workers for virus symptoms or elevated temperatures, but goes on say: “[e]mployers should not require a COVID-19 test result ….to return to work.”

But to be polite, that attitude from the CDC misses the point. President Donald Trump has explicitly made testing the responsibility (3) of state governments, in conjunction with the leading private labs, and they simply don’t have the resources to carry the whole load. It’s time to harness the financial heft of the business sector to pick up some of the testing burden.

Even in the face of CDC discouragement, companies such as Amazon, U.S. Steel (4), Whirlpool (5), Microsoft, Intel and Las-Vegas based Wynn Resorts are either considering or already exploring (6) workplace-based testing. Amazon (7), in particular, is taking steps towards (8) setting up its own laboratory facilities in order to regularly test all staff, including those without symptoms, according to CEO Jeff Bezos in his letter to shareholders. According to its latest earnings report, the company expects to spend “hundreds of millions” of dollars in the second quarter to develop its own COVID-19 testing capabilities.

What are the pluses and minuses of workplace-based testing? Done right, it benefits workers, businesses, and the broader society. Individuals get a safer work environment and sick leave if they test positive. Businesses get to stay open in a sustainable way. And public health is improved, especially if the information gained from the test can be used to inform contact tracing. It becomes a bridge to broader testing. Workplace testing gets us a lot closer to the 500,000(9) to 1,000,000 (10) tests per day that many experts think are necessary.

Done wrong, workplace-based testing can be used as a hammer against workers, violating privacy without gains. The key is to understand what workplace-based testing can do and what it can’t.

It’s important to realize that we’re talking about tests for current COVID-19 infection, not tests for antibodies or immunity. Some people have suggested favoring workers who have coronavirus antibodies, but it’s going to be some time before we know how long immunity (11) lasts. As long as that’s unknown, companies have to test for infections, not antibodies.

A company that wants to do workplace-based testing has two key decisions. First, will the tests be voluntary or mandatory? The safest thing for workers is to test everyone at regular intervals, but that’s more expensive.

Companies also need to choose whether to contract for third-party testing services, to buy tests for use in in-house clinics, or to actually set up their testing laboratories. Most businesses will choose one of the first two options. Currently, each cartridge for Abbott Laboratories’ rapid coronavirus tests costs (12) $40. The Cepheid point-of-care test requires a cartridge (13) that sells for $35. In addition, companies have to figure in the cost of the equipment and trained personnel to administer and run the tests. Medicare is reimbursing as much as $100 per test. (14)

But these numbers will likely come down quickly as more tests come on the market. Big companies can buy in bulk, which can help bring down the costs.

Moreover, the largest companies have the financial strength and incentive to set up their own lab facilities, if they choose. That would add new testing capacity to the United States and take the pressure off both the supply of tests from manufacturers and off the leading private labs. LabCorp and Quest Diagnostics are both in the Fortune 500, but they are dwarfed by companies such as Amazon, Walmart, Target and even Tyson Foods, which has been hit by outbreaks (15) at some of its meat-processing plants.

One reason for large companies to choose the third option– setting up their own lab facilities— is economies of scale. COVID-19 is not going away, and the nasal swabs or saliva (16) analysis will have to be repeated regularly, both because of the possibility of false negatives and because workers can obviously pick up the coronavirus at home or in the community. At the volumes needed, it wouldn’t be surprising to see the marginal cost per test drop to $10-$20 per test. (that’s the added cost of running an additional test, not including capital costs).

Setting up a testing lab is not a one-day process, by any means. Companies that go this route have to hire a lab director and other professionals, buy lab equipment, and get CLIA (Clinical Laboratory Improvement Amendments) certification from the federal and appropriate state governments. The new labs also have to develop their own testing protocols for COVID-19, and get them approved, though that will be easier as more companies go this route.

None of these steps are true blockers for a motivated company that want to do this. But they do require the company to invest some money, and involves going through a regulatory approval process for each state where testing is done. State governments can help by encouraging companies to invest in testing laboratories that add more capacity.

However, as an economic and social decision, workplace testing is a positive for both employees and employers. Everyone wants to earn a living, and no one wants to die. So workplaces that pay more attention to safety will be more attractive to workers, especially if a positive test comes with paid sick leave and payments for care.

Similarly, as the cost of testing goes down, it looks increasingly appealing from a business perspective as well. A large body of economic literature (17) on the risk-pay tradeoff implies that businesses that don’t test will have to pay significantly higher wages in order to attract workers, even in these hard times. Workers have a good sense of their risk level, and vote with their feet accordingly. By contrast, businesses that implement an effective testing strategy will find themselves able to run their operations more efficiently and profitably, while protecting their workers.

The largest businesses are likely to be the ones that lead the way towards testing. Let’s do an illustrative calculation. Pre-pandemic, there were roughly 1400 firms with employment over 10,000 workers in the United States. Together these firms employ roughly 30 million workers. Not every big company will test, of course, but if 20% of these big-company workers are tested every two weeks, on average, that comes to an average 400,000 tests per day. Assuming a marginal cost of $10-$20 per test, that comes to $4-$8 million per day. That’s on top of the sizable capital cost of setting up the testing laboratories. (Amazon’s large outlays partly reflect the costs of being the pioneer in this area).

In addition, workers that test positive should be eligible for paid sick leave, probably averaging two weeks. That’s likely to raise payroll costs more than the testing itself. If we assume that 5% of the tests come back positive, that’s 300,000 additional workers on sick leave at any time. Assuming average compensation costs of $25-$35 per hour that raises annual compensation costs to large companies by $6-9 million per day. That’s a significant cost, but it can be absorbed or passed onto consumers as an essential part of doing business.

To be a good proposition for workers and businesses, testing doesn’t have to be perfect but it does have to be systematic. Businesses can’t stop and start — they have to pick a strategy and stick to it. And the strategy has to include a commitment to take immediate steps when positives occur, as they inevitably will.

It should be noted that there’s one part of the labor market where the risk-pay tradeoff doesn’t hold, and that’s immigrant workers, especially from Mexico. According to a 2010 economic study (18), Mexican immigrant workers “on average receive zero or very low levels of wage premiums for fatal injury risks.” The key factor appears to be whether the immigrant worker is fluent in English. So industries that employ a larger number of Mexican immigrants who are not fluent in English — notably agriculture and food production — may not be under the same pressure to test. That suggests a need for special scrutiny by state and local governments.

Legally, testing by employers (19) is on firm ground during a pandemic, as part of providing a safe workplace. The EEOC has noted that:

Employers may take steps to determine if employees entering the workplace have COVID-19 because an individual with the virus will pose a direct threat to the health of others. Therefore an employer may choose to administer COVID-19 testing to employees before they enter the workplace to determine if they have the virus.

In addition, the EEOC has noted that while employers must keep health records in a confidential file, they may disclose the name of employees that have COVID-19 to public health authorities.

That’s important. The information from the tests has to be available to the public health authorities for contact tracing and potential isolation of infected people.

While much of testing can be decentralized to workplaces, contract tracing and followup is something only the public sector can take the lead on, aided perhaps by the sort of technological capabilities that companies such as Apple and Google are building.

The public health system needs to be ready to act on the information garnered from employer testing with sustained contact tracing, to understand how the worker got infected and to potentially isolate their families and contacts who may be asymptomatic and not realize that that they are infectious. So business testing makes sense as a complement to investment in public health contact tracing as well.

The government can give businesses an incentive to do the right thing by subsidizing sick leave that is the result of a positive test. That would encourage more companies to test their workers.

The government could also help by finding a way to streamline the approval process for corporate testing labs in multiple states, in response to the pandemic. Simply having the CDC come out in favor of workplace testing would make things easier. And while the EEOC statement is reassuring, it may also be helpful for Congress to address potential liability issues connected with employer testing, which is the right thing for workers.

What about the downsides of workplace-based testing? It clearly raises issues of privacy, especially if the names of people who test positive are passed onto public health authorities. It’s essential that workers not be penalized for testing positive. Nor should they be penalized for being in a vulnerable category, like being over 60 or immune-compromised. Indeed, comprehensive testing makes it easier to employ such people.

Another issue is whether small businesses can afford workplace-based testing that allows them to compete with big businesses. Some provision should be made for allowing small businesses to take advantage of the testing supply chains that large companies develop, perhaps by giving them access to low-cost testing.

In the end, testing in the workplace is an affordable proposition. It will raise costs and likely prices, and lower profits, but that’s a small price to pay for a safer workplace. President Trump is eager to reopen the U.S. economy. But he doesn’t seem to understand that will require much more testing that we are doing today. Sustained business testing will take a significant burden off the public health system. If a significant number of large employers start workplace testing, it has the potential for reaching a large number of Americans quickly. It’s the right thing for businesses to do.

PPI_How-Workplace-Testing-Can-Get-Us-Back-to-Work

References:

  1. https://www.wsj.com/articles/the-employer-will-test-you-now-11586714684
  2. https://www.cdc.gov/coronavirus/2019-ncov/community/guidance-business-response.html
  3. https://edition.cnn.com/2020/04/27/politics/white-house-testing-blueprint/index.html
  4. https://time.com/5833633/employer-coronavirus-testing/
  5. https://www.washingtonpost.com/gdpr-consent/?next_url=https%3a%2f%2fwww.washingtonpost.com%2fnation%2f2020%2f04%2f13 %2fbusinesses-workforce-coronavirus%2f
  6. https://blog.aboutamazon.com/company-news/scalable-testing-for-coronavirus
  7. https://www.bloomberg.com/news/articles/2020-04-16/amazon-s-jeff-bezos-wants-to-test-all-employees-for-covid-19
  8. https://s2.q4cdn.com/299287126/files/doc_financials/2020/ar/2019-Shareholder-Letter.pdf
  9. https://www.vox.com/2020/4/15/21222029/coronavirus-trump-plan-reopen-economy-end-social-distancing
  10. https://www.theatlantic.com/science/archive/2020/05/theres-only-one-way-out-of-this-mess/611431/
  11. https://www.nytimes.com/2020/04/13/opinion/coronavirus-immunity.html
  12. https://www.wsj.com/articles/slow-start-for-rapid-coronavirus-tests-frustrates-states-11586597401
  13. https://www.wired.com/story/coronavirus-testing-is-moving-closer-to-your-doctors-office/
  14. https://www.cms.gov/newsroom/press-releases/cms-increases-medicare-payment-high-production-coronavirus-lab-tests-0
  15. https://www.foxbusiness.com/markets/coronavirus-tyson-foods-wilkesboro-nc-outbreak
  16. https://abc7ny.com/health/new-rutgers-saliva-test-for-covid-19-gets-fda-approval/6100286/
  17. https://oxfordre.com/economics/view/10.1093/acrefore/9780190625979.001.0001/acrefore-9780190625979-e-138
  18. https://law.vanderbilt.edu/files/archive/296_Immigrant-Status-and-the-Value-of-Statistical-Life.pdf
  19. https://www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws