Category: Uncategorized

Press Release: Will the Senate Defend Our Constitution?

Posted on by The Progressive Policy Institute

WASHINGTON—Will Marshall, President of the Progressive Policy Institute, today released the followed statement after President Trump declared a national emergency to fund the border wall:

“By declaring a national emergency to build a border wall, President Trump has crossed the Rubicon. He has turned a cheap partisan stunt into a bona fide Constitutional crisis.

“Congress this week declined to give Trump all the money he demanded to wall off Mexico from the United States. The president has declared an emergency explicitly to defy the will of Congress and usurp its Constitutional power to raise and spend public money. In his contempt for democratic norms, Trump makes no effort to conceal the fact that the alleged ’emergency’ on the border is a political contrivance to assert his will. Having failed to extort wall funding from Congress through the longest government shutdown in U.S. history, he is willing to violate the Constitution to get a political ‘win.’

“This is a clear and cynical abuse of presidential power. Trump seems not to understand or care that U.S. presidents aren’t medieval monarchs, who can demand money from parliaments. Now he’s willing to politicize and trivialize presidential authority to declare national emergencies to fulfill a demagogic campaign promise. The White House will now seek to shift funds Congress has appropriated for national defense and other legitimate purposes to finance a stupid ‘solution’ to a non-existent problem.

“All friends of American democracy, regardless of outlook or party, must rally to the defense of the U.S. Constitution’s separation of powers. Shamefully, Senate Republicans have yet to stand up for the Constitution they’ve sworn to defend. Their supine unwillingness to put patriotism above partisanship means that Americans must trust to the courts to stop a rogue president.

“Trump’s power grab will no doubt give fresh impetus to efforts to impeach him. That’s understandable, but for now the wiser course for progressives is to keep the pressure on the Senate to defend its Constitutional powers and institutional prerogatives, and to use all legal means to prevent Trump from spending public money without Congressional authority. We need to keep the public focused clearly on how deeply Trump is damaging not just our political system, but now also the Constitutional framework that has enabled American democracy to endure through genuine national emergencies.”

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New Ideas for a Do-Something Congress No. 4: “Expand Access to Telehealth Services in Medicare”

Posted on by The Progressive Policy Institute

America’s massive health care industry faces three major challenges: how to cover everyone, reduce costs, and increase productivity. Telehealth – the use of technology to help treat patients remotely – may help address all three. Telehealth reduces the need for expensive real estate and enables providers to better leverage their current medical personnel to provide improved care to more people.

Despite its enormous potential, however, telehealth has hit legal snags over basic questions: who can practice it, what services can be delivered, and how it should be reimbursed. As is the case with any innovation, policymakers are looking to find the right balance between encouraging new technologies and protecting consumers – or, in this case, the health of patients.

Telehealth policy has come a long way in recent years, with major advances in the kinds of services that are delivered. Yet a simple change in Medicare policy could take the next step to increase access and encourage adoption of telehealth services. Currently, there are strict rules around where the patient and provider must be located at the time of service – these are known as “originating site” requirements – and patients are not allowed to be treated in their homes except in very special circumstances. To expand access to telehealth, Congress could add the patient’s home as an originating site and allow Medicare beneficiaries in both urban and rural settings to access telehealth services in their homes.

 

THE CHALLENGE: LEGAL BARRIERS LIMIT THE POTENTIAL FOR TELEHEALTH TO INCREASE ACCESS TO PATIENT CARE.

Under Medicare, telehealth is defined as “the use of electronic information and telecommunications technologies to support long-distance clinical health care” (1). Each program in Medicare – traditional Medicare, Medicare Advantage, and Medicare demonstration projects – has unique rules limiting when and how telehealth can be used. Because Medicare Advantage has different rules governing telehealth, this brief is specifically focused on the roughly 39 million seniors enrolled in traditional fee-for-service Medicare (2).

In traditional, fee-for-service Medicare, the Social Security Act defines how telehealth services may be covered. As amended in 1997, the law limits telehealth to services that are furnished to beneficiaries in certain types of geographic areas: either a rural health professional shortage area (HPSA) or a county outside of a Metropolitan Statistical Area (MSA). Besides being in a qualifying rural area, the originating site – or where the patient is located – is required to be at a physician office, hospital, rural health center, skilled nursing facility, federally qualified health center, community mental health center, or a hospital-based dialysis facility. In those facilities, patients can receive care remotely from 10 types of distant site clinicians qualified to deliver telehealth services. In other words, traditional Medicare beneficiaries, except in special circumstances, cannot receive telehealth services in their homes.

Though the Centers for Medicare and Medicaid Services (CMS) cannot authorize new originating sites without Congress, it does have the authority to decide which telehealth services are payable under the Medicare Physician Fee Schedule. In 2019, that schedule includes roughly 100 billing codes covering consultations, psychiatric care, smoking cessation, end-stage renal disease management, nutrition counseling, new and existing patient evaluation and management services, and post-nursing facility care. It’s clear that many of these services – particularly psychiatric care and smoking cessation – should not require the patient to drive into a qualifying medical facility and could be effectively delivered in the home.

More beneficiaries could benefit from increased access to telehealth.

To modernize telehealth delivery, Congress directed CMS under the 21st Century Cures Act and the Bipartisan Budget Act of 2018 to start relaxing some telehealth rules in 2019. Thanks to this legislation, beneficiaries under traditional Medicare now have access to a range of telehealth services that fall outside the parameters listed above, including at home. These include:

  • Allowing Accountable Care Organizations (ACOs) to furnish telehealth services in the beneficiary’s home regardless of geographic location
  • Permitting ACOs to use teledermatology and teleophthalmology services provided through asynchronous store-and-forward telehealth* technologies
  • Expanding coverage of telestroke services – a service where emergency department clinicians can consult with stroke specialists in distant locations – to all geographic areas
  • Providing individuals with end-stage renal (ESRD) disease monthly ESRD-related clinical assessments via telehealth at home after first receiving a face-to-face appointment

Despite these advances, there are still many instances where Medicare beneficiaries
could benefit from telehealth from home but are not permitted to do so under current rules.

It is no surprise that telehealth utilization in traditional Medicare remains low. Though utilization increased between 2014 and 2016, only 90,000 traditional Medicare beneficiaries used 275,199 telehealth services in 2016. This represents roughly a quarter of 1 percent (0.25 percent) of the more than 35 million fee-for-service Medicare beneficiaries included in CMS’s telehealth analysis. Interestingly, growth was highest among the oldest group – those beneficiaries over 85. The data show that 85.4 percent of the traditional Medicare beneficiaries using telehealth services had at least one mental health diagnosis – and that psychotherapy was one of the most used telehealth services. The data also show that telehealth use is higher in states with large rural areas or HPSA. This, no doubt, reflects the legal requirement that patients must be in such areas to receive telehealth services (3).

By adding the patient’s home as an originating site in traditional Medicare, patients in urban or other underserved areas could also benefit from using telehealth services in their homes. Roughly 80 percent of seniors have one chronic disease and 68 percent have two or more (4). Telehealth can help patients better manage their conditions in the convenience of their own home. According to a 2017 GAO report, a Veterans Health Administration’s (VHA’s) program – that provided home-based telehealth services to veterans with chronic conditions – resulted in a 40 percent reduction in hospitalizations (5).

Telehealth could reduce costs.

In addition to expanding access to high-quality medical services to people in underserved areas, telehealth may also save money. This is crucial because, as Medicare’s Trustees warn year after year, the nation’s health-care program for seniors faces serious financial challenges that threaten its ability to meet its obligations to future beneficiaries. Though it used to have budget surpluses, now, each year, the hospital insurance (HI) fund, which covers Medicare Part A, runs a chronic deficit (6).

Virtual visits are cheaper than in-person care, on average, in the commercial insurance market. In the commercial market, telehealth visits cost roughly $100 less per visit than in-person visits. Generally, virtual consultations are priced at $40–50, while office visits check in at $136–$176 (7). In Medicare, however, online visits are priced the same as in-person visits and usually involve a facility fee to cover the patient’s visit to a medical facility. Savings could be realized from serving patients in home and eliminating redundant facility fees (8).

 

THE GOAL: EXPAND ACCESS TO TELEHEALTH SERVICES AS A WAY TO IMPROVE ACCESS AND POTENTIALLY REDUCE MEDICARE COSTS

Commercial plans generally permit telehealth originating sites in both rural and urban areas, though they vary with coverage of services provided while the patient is at home. While expanding the coverage of telehealth services in Medicare may increase costs initially, those extra costs could be justified by both the expanded access and the better outcomes telehealth services could deliver. Moreover, in the long run, helping patients manage chronic conditions, avoid hospitalizations, and reduced facility fees will save money.

For example, one program focused on providing acute care at home for older, vulnerable patients with one of nine conditions – exacerbations of congestive heart failure, chronic obstructive pulmonary disease, community-acquired pneumonia, cellulitis, deep venous thrombosis, pulmonary embolism, complicated urinary tract infection or urosepsis, nausea and vomiting, and dehydration – found a 38 percent reduction in mortality for patients treated at home. Appropriately titled “Hospital at Home” outpatients had comparable or better clinical outcomes and saved an average of 19 percent relative to similar hospital inpatients. Among the important components of this program were “telehealth nurses,” who monitored patients’ vital signs remotely via telehealth units installed in patients’ homes (9).

There is an ongoing debate between advocates of telehealth who argue that expanding services increases access to care and other policymakers who caution that telehealth may not act as a substitution for in-person services and instead increase unnecessary utilization without improving outcomes. Because telehealth has been limited to-date, the data are mixed. However, there is clear potential to improve access and convenience, and, over time, that could improve outcomes.

 

THE PLAN: EXPAND ACCESS TO TELEHEALTH BY ALLOWING REIMBURSEMENT UNDER TRADITIONAL MEDICARE FOR APPROVED TELEHEALTH SERVICES DELIVERED TO PATIENTS’ HOME

Rather than slowly increasing the sites and services allowed under telehealth, Congress should allow CMS to authorize a patient’s home as an originating site so clinicians can deliver medically necessary services via telehealth to patients’ homes.

There’s a precedent for abolishing originating site rules. In 2016, the Department of Defense (DoD) announced that a patient’s home would qualify as an originating site as long as the provider worked at a military treatment facility. Additionally, California has recently proposed abolishing originating site rules in its Medicaid program, saying telehealth originating sites can include, but are not limited to, “a hospital, medical office, community clinic, or the patient’s home.” By expanding the definition of “originating site,” California is moving to allow clinicians to provide more telehealth services. These changes are too recent to have garnered data, but it is clear that other agencies are looking to expand access to telehealth.

Congress should follow suit. Lawmakers could significantly expand access to services by amending the Social Security Act clause that governs originating site rules and expanding the definition to include the patient’s home as a qualifying originating site.

Telehealth has come a long way since it was first authorized under Medicare in 1997. But the laws governing telehealth from 20 years ago are outdated. It’s time to allow Medicare recipients to get telehealth services in their home.

 

* When health-care providers review patient medical information like lab reports, imaging studies, videos, and other records at another location and at a time that is convenient for them. The service is not delivered in real time.

 

[gview file=”[gview file=”https://www.progressivepolicy.org/wp-content/uploads/2019/02/PPI_NewIdeas_Telehealth_FINAL.pdf”]

 

ENDNOTES

1) Health Resources and Services Administration Federal Office of Rural Health Policy. Available from: https://www.hrsa.gov/ruralhealth/telehealth/

2) Medicare Enrollment Dashboard, “Hospital/Medical Enrollment,” Centers for Medicare and Medicaid Services, October 2018. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Dashboard/Medicare-Enrollment/Enrollment%20Dashboard.html.

3) “Information on Medicare Telehealth,” Centers for Medicare & Medicaid Services, 2018.
https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Information-on-Medicare-Telehealth-Report.pdf.

4) “By the Numbers: The Impact of Chronic Disease on Aging Americans,” CVS Health, January 2017.
https://cvshealth.com/thought-leadership/by-the-numbers-the-impact-of-chronic-disease-on-aging-americans.

5) “Information on Medicare Telehealth,” Centers for Medicare & Medicaid Services, 2018.
https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Information-on-Medicare-Telehealth-Report.pdf.

6) “OASDI and HI Annual Income Rates, Cost Rates, and Balances,” Social Security Administration, 2018. https://www.ssa.gov/oact/tr/2018/lr6g2.html.

7) Daniel H. Yamamoto, “Assessment of the Feasibility and Cost of Replacing In-Person Care with Acute Care Telehealth Services,” Red Quill Consulting, December 2014.
https://www.connectwithcare.org/wp-content/uploads/2014/12/Medicare-Acute-Care-Telehealth-Feasibility.pdf.

8) Ibid.

9) Lesley Cryer, Scott B. Shannon, Melanie Van Amsterdam, and Bruce Leff, “Costs For ‘Hospital At Home’ Patients Were 19 Percent Lower, With Equal Or Better Outcomes Compared To Similar Inpatients,” Health Affairs 31, no. 6 (2012): 1237-1243, https://content.healthaffairs.org/content/31/6/1237.full.

Bledsoe for Forbes, “Green New Deal Must Grow Up Fast To Influence Bills Congress is Already Writing”

Posted on by The Progressive Policy Institute

Little noticed in the media circus surrounding the mere introduction of a non-binding Congressional resolution on the Green New Deal was the deletion of much-criticized and plainly unachievable mandates contained in previous GND versions.

Gone was the impossible diktat requiring 100% renewable energy for the entire economy by 2030. Missing was the politically suicidal and practically infeasible flat-out prohibition on fossil fuels in little more than a decade. Even extraneous language on guaranteed jobs in the resolution had been watered down from earlier texts, and would of course never be a legal requirement in actual climate legislation that passes Congress in any event.

In fact, the more extreme provisions in the GND have served largely to provide Trump and other Republican anti-climate action forces with irresistible political fodder. Republicans hope to scare the American people into opposing sensible climate actions by invoking GND extremism, and have already produced ads with these themes.

Continue reading at Forbes.

Escaping the Startup Trap: Can Policymakers Help Small Companies Grow to Major Employers?

Posted on by The Progressive Policy Institute

Starting a new business is hard. Scaling it up to a significant size is harder. Europeans have long fretted about their lack of ‘unicorns’— privately held startups with a valuation of more than $1 billion. More generally, there is a sense that European startups either fail to grow or are bought out by larger companies before they go public or create a significant number of new jobs.

A January 2019 analysis by CB Insights showed only 33 European unicorn companies, compared to 83 in China and 150 in the United States. For example, SoundCloud, an online audio platform, was founded in 2007 in Stockholm and later moved to Berlin. By 2016, it was valued around $700 million, and at one point sought a $1 billion valuation to be sold. However, by 2017, the company was on the verge of bankruptcy, abruptly fired 40 percent of its staff, and closed two offices. By August 2017, the company was valued at just $150 million. Or consider restaurant delivery firm Take Eat Easy, founded in Brussels in 2012. After a year, the company expanded to Paris and raised two rounds of venture capital funding in 2015. Take Eat Easy scaled from 10 to 160 employees and from 2 to 20 cities. But in 2016 Take Eat Easy shut down, citing revenue not yet covering fixed costs and an inability to raise a third round of funding.

Even in the relatively successful United States, it seems that new companies are scaling up less frequently than they used to. The Progressive Policy Institute analyzed Census Bureau data on business dynamics over time, focusing on “young” businesses—aged 6-10 years after being founded. We found that in 2014, 0.05% of young businesses were major employers, defined as having 1,000 or more workers. That’s half the 1994 rate when 0.1% of young businesses were major employers.

 

Telehealth and vision tests in Washington State

Posted on by The Progressive Policy Institute

Washington has long been a leader in both innovation and health care. Telehealth, which lays at the intersection of the two, is an innovative, cost-effective way to deliver health care to underserved populations. Seeing the value of telehealth, Washington State requires health insurance companies, Medicaid managed care plans, and health plans offered to Washington State employees to reimburse health care providers who provide health care services via telehealth technology.

The rules apply to both real-time transmitted appointments and to “store-and-forward” services which involve information, including images, data and labs, reviewed at a later time – though reimbursement for those services must be explicitly outlined in provider agreements. Telehealth shows particular promise at reducing the costs and hassle associated with renewing contact lens prescriptions.

 



			


	

			




			
				


	

		
Langhorne for The 74, “At D.C.’s Ingenuity Prep, Personalized Learning Hasn’t Replaced Teacher Time; It’s Put the Focus Back on Small Groups”

				

			Posted on  by The Progressive Policy Institute		

			


	

		
When Aaron Cuny and Will Stoetzer were thinking about how they wanted to structure their own D.C. charter school back in 2012, they kept returning to the same question: “When were we doing the best work for kids?”


“For both of us, it came down to teaching in a small group setting, where you could think about how to reach kids individually rather than spending the majority of time and mental energy thinking about classroom management,” says Stoetzer.


Stoetzer was a special education teacher and Cuny a resident principal-in-training at D.C. Bilingual Public Charter School, a top-ranked elementary school in one of Washington’s middle-income neighborhoods. Both felt the city lacked quality educational options for kids in the neighborhoods that needed them most.


“In pockets across D.C., some schools had shown that when adults got it right, there was success at educating low-income kids,” says Stoetzer. “Schools like KIPP and D.C. Prep have been very purposeful about producing academic results for low-income kids. Their success inspired us, but we had differences in perspective about how that success might be accomplished.”


When they opened Ingenuity Prep a year later with Cuny as CEO and Stoetzer as COO, they located it in Ward 8, Washington’s poorest neighborhood, and built two essential components into the school’s design so that small group learning could be its main focus: co-teaching and computer-based learning.


Continue reading at The 74.


			


	

			




			
				


	

		
Investment Heroes 2018: Encouraging and Diffusing Innovation Throughout the Economy

				

			Posted on  by The Progressive Policy Institute		

			


	

		
Despite the low unemployment rate, productivity growth is still stuck in slow gear. Non-farm business output per hour increased by 1.3 percent from the third quarter of 2017 to the third quarter of 2018 – well below the post- war average of 2.2 percent.1 Other countries around the world are also grappling with this slowdown in productivity growth.2 Productivity growth is the primary factor in boosting wages and living standards.


The continued lack of productivity growth arises from several causes. One important issue is a growth shortfall in the amount of capital relative to the amount of labor, where capital represents investment in equipment, structures, software, and other intellectual property.


The Bureau of Labor Statistics (BLS) calculates a measure it calls “capital intensity,” which measures the services produced by capital assets relative to the number of labor hours worked in the non-farm business sector. As shown in Figure 1, capital intensity has grown much more slowly over the past 10 years than in previous 10-year periods.


There has been much debate over the reasons for this shortfall. Some have suggested that corporate managers and stock market investors have become myopic and too focused on short-run returns. Others blame excessive regulation.


But, no matter the reason for the investment shortfall, we think it’s important to identify those companies that are bucking the trend. Starting with our 2012 “Investment Heroes” report, and continuing through this report, we have focused on identifying those companies making the largest capital investments in the United States. By expanding the capital stock, these companies are helping boost productivity and wages, and creating new jobs.


The Progressive Policy Institute’s (PPI) Investment Heroes report provides an exclusive estimate of domestic capital spending for major U.S. companies. Currently, accounting rules do not require companies to report their U.S. capital spending separately. To fill this gap in the data, we created a methodology using publicly-available financial statements from non-financial Fortune 150 companies to identify the top companies that were investing in the United States. That methodology, with small modifications, has been used in each year’s report since the first in 2012.


 


			


	

			




			
				


	

		
The Google GDPR Fine: Some Thoughts

				

			Posted on  by The Progressive Policy Institute		

			


	

		
The GDPR will mean big changes in the way that European and U.S. companies do business in Europe. As we noted at a recent privacy panel, rather than being a matter of speculation, its economic impact has become an empirical question. Will the tighter privacy protections of the GDP slow growth and innovation, as skeptics claim, or will these provisions increase consumer trust and usher in a new era of European digital gains, as supporters say? We await the answers to these questions with great interest.


However, the enforcement stage of the GDPR has not gotten off on the right foot. CNIL, the French National Data Protection Commission, just fined Google 50 million euros for what they called “lack of transparency, inadequate information and lack of valid consent regarding the ads personalization.” The fines were based in part on complaints filed by privacy groups on May 25, 2018, the very day that the GDPR went into effect. Moreover, the complaints were filed in France, despite that fact that Google’s European headquarters are in Ireland.


The location of the complaints is relevant because the most straightforward reading of the GDPR’s “one-stop-shop” principle suggests that the location of a company’s European headquarters is the main factor determining the company’s lead regulator for GDPR purposes. That’s not the only criterion, for sure, but it was only natural for the Irish Data Protection Commission to take the lead role in regulating Google.


The fact that the privacy organizations filed their complaints with France, not Ireland, suggests that they were forum-shopping–looking for a country which would look favorably on the issues they raised.  Moreover, France’s willingness to jump to the front of the regulator queue suggests that they were interested in setting a precedent, rather than letting the GDPR process unfold.


Finally, an important part of the rationale behind the GDPR was to further move towards a digital single market, by allowing companies to only deal with a single privacy regulator.  If other countries follow France’s lead and find reasons to levy data protection-related fines on multinationals that have their European headquarters elsewhere, then the GDPR will end up fragmenting markets, rather than making them more consistent. That’s a losing proposition for everyone.


			


	

			




			
				


	

		
Langhorne for The 74, “Creating the Next Generation of Digital Innovators at Washington, D.C.’s First Computer Science-Focused Middle School”

				

			Posted on  by The Progressive Policy Institute		

			


	

		
When I finish writing the statement, that cat will move,” promises Deshaunte’ Goldsmith, a sixth-grader at Digital Pioneers Academy Public Charter School. She presses enter on the keyboard and, sure enough, the animated cat on her screen begins to pace back and forth.


Goldsmith is a member of the founding class at the school knows as DPA, Washington, D.C.’s first computer science-focused middle school. Opened in August, the school is small, serving about 120 sixth-grade students across four classes but has plans to build out to 12th grade. Every day, students take computer science as a part of their core curriculum.


Today, in computers science, Goldsmith is learning how to write conditional statements — such as if the space bar is pressed, the cat will jump — using MIT’s animation-based platform Scratch. First, the students have to identify conditional statements, and then they have to write their own. At the end of class, they have to find and correct the error intentionally planted in the teacher’s code.


“The error’s in the third line of code,” Goldsmith says. “It’s missing part of the conditional statement.”


DPA occupies the second floor of Washington Heights Baptist Church in the Hillcrest neighborhood of the city’s seventh ward. Ninety-eight percent of the students come from wards seven and eight, D.C.’s poorest neighborhoods, and, because DPA’s leadership recruited heavily in the local area, two-thirds of the students went to the neighborhood elementary schools.


 


Continue reading at The 74.


			


	

			




			
				


	

		
Press Release: PPI Urges Support for Bipartisan Legislation to Ensure Congressional Review of National Security Tariffs

				

			Posted on  by The Progressive Policy Institute		

			


	

		


WASHINGTON— Ed Gerwin, Senior Fellow for Trade and Global Opportunity at the Progressive Policy Institute (PPI), today released the following statement in response to the introduction of the bipartisan, bicameral Congressional Trade Authority Act:






PPI welcomes the introduction of the Congressional Trade Authority Act by Representatives Ron Kind (D-WI) and Michael Gallagher (R-WI) and Senators Pat Toomey (R-PA) and Mark Warner (D-VA). We urge Congress to enact this responsible and balanced legislation.






The bill would amend the Trade Expansion Act of 1962 to provide Congress with new tools to oversee and either approve or reject the use of tariffs or other trade restrictions for national security purposes. Under the bill, national security trade restrictions proposed by the president would require congressional approval under an expedited, 60-day procedure. National security tariffs imposed within the past four years would also, retroactively, be subject to congressional review. Other reforms in the bill would include tightening the definition of “national security” to prevent the abuse of congressionally delegated powers to restrict trade for security reasons.






As PPI has explained in a recent policy brief, legislation like the Congressional Trade Authority Act is needed to restore an appropriate balance between Congress and the president in the exercise of trade and tariff powers. 






Article I, Section 8 of the U.S. Constitution empowers Congress to “lay and collect . . . duties” and “regulate commerce with foreign nations.” For almost a century, in exercising these powers, Congress has delegated significant authority to the president, including the power to restrict import trade for national security reasons. 






Past presidents have generally used these delegated security powers prudently. The Trump Administration has not. Instead, it’s imposed “national security” tariffs and quotas on imports of aluminum and steel from longstanding U.S. allies with scant security justification. And the President has threatened to impose “national security” tariffs—to be paid ultimately by American drivers—on imported autos, as well. As PPI has detailed, the Administration’s unfocused tariffs and trade restrictions have cost jobs for American workers, raised prices for American families, increased costs for businesses and state and local governments, and led to crushing retaliation against American exports.






When he signed the Trade Expansion Act of 1962, President Kennedy advocated building stronger trade alliances and warned against “stagnating behind tariff walls.” At the same time, as PPI has  explained in the context of China’s technology theft, smart and targeted trade restrictions are sometimes required to address critical national security threats. Congress has crucial roles to play in both promoting open trade and protecting national security. The balanced reforms contained in the Congressional Trade Authority Act would help Congress better exercise these important responsibilities.




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New Ideas for a Do-Something Congress No. 3: “End The Federal Bias Against Career Education”

				

			Posted on  by The Progressive Policy Institute		

			


	

		
As many as 4.4 million U.S. jobs are going unfilled due to shortages of workers with the right skills. Many of these opportunities are in so-called “middle-skill” occupations, such as IT or advanced manufacturing, where workers need some sort of post-secondary credential but not a four-year degree.


Expanding access to high-quality career education and training is one way to help close this “skills gap.” Under current law, however, many students pursuing short-term career programs are ineligible for federal financial aid that could help them afford their education. Pell grants, for instance, are geared primarily toward traditional college, which means older and displaced workers – for whom college is neither practicable nor desirable – lose out. Broadening the scope of the Pell grant program to shorter-term, high-quality career education would help more Americans afford the chance to upgrade their skills and grow the number of highly trained workers U.S. businesses need.


 


THE CHALLENGE: THE AMERICAN ECONOMY DESPERATELY NEEDS MORE SKILLED TALENT.


For years, U.S. businesses have complained of a “skills gap” – the inability to find the right talent for the positions they are seeking to fill. Though some have questioned the existence of these shortages, new research finds that, while some lower-skilled sectors have a surfeit of workers, other industries do indeed face a real – and dire – need for skilled employees.


Healthcare, finance, and information technology are among the fields with the

greatest shortages of skilled workers.

A study by the U.S. Chamber of Commerce Foundation and Burning Glass Technologies finds that as many as 4.4 million American jobs are going vacant because companies can’t find the right employees. More than 1.1 million of these openings are in healthcare, followed by business and financial operations, office and administrative support, sales, and computers and math.


Many openings are in so-called “middle-skilled” jobs that require specialized training or education but not a four-year degree.

The vast majority of in-demand positions require some sort of post-secondary education beyond high school. In fact, the economy is shedding low-skill jobs even as demand for higher-skill occupations is rising. The Georgetown Center on Education and the Workforce, for instance, estimates that as many as 6.3 million jobs for workers without a high school diploma have permanently disappeared since the recession (2).


While some of the fastest-growing occupations require advanced schooling and extensive training – such as occupational therapy, physician’s assistant, and nurse practitioner – many well-paying jobs don’t require a four-year degree (3). These so-called “middle-skill” jobs currently account for more than half of all U.S. jobs (4) and include such fields as cybersecurity, welding and machining, truck driving, and home health (5). These jobs might demand an associates’ degree, but, in many cases, instead require a certificate, certification, license, or other industry-recognized credential attainable without attending a traditional college.


Federal financial aid for higher education is largely unavailable for career education and training.

Despite the need for middle-skill workers, current federal policy is tilted heavily in favor of traditional college over career and occupational education. In 2016, for instance, the federal government spent more than $139 billion on post-secondary education, including loans, grants and other financial aid for students. Yet, of this amount, just $19 billion went toward career education and training (6).


THE GOAL: EXPAND AFFORDABLE ACCESS TO HIGH-QUALITY CAREER EDUCATION – ESPECIALLY FOR OLDER AND NONTRADITIONAL STUDENTS

Restrictions in federal financial aid programs – that shut out many career-focused programs – are a major source of the disparity in federal support for traditional college versus career education and training. Federal Pell grants for low-income students, for example, can be used only for credit-bearing programs offered by accredited schools that last over 600 clock hours and run at least 15 weeks (7). Many high-quality coding “boot camps,” for instance, often don’t meet this standard; nor do many other occupational courses, such as programs aimed at helping students earn a welding certification or a commercial drivers’ license.


For example, Delaware’s Zip Code Wilmington, a non-profit coding school, offers an intensive computer skills program that has helped students’ salaries jump from an average of $30,173 to $63,071. Yet, because Zip Code Wilmington is not a college or university and the coursework is only 12 weeks long, the $3,000 course is ineligible for Pell funding – which could it make it unaffordable for many students (8).


 


THE PLAN: BROADEN THE AVAILABILITY OF PELL GRANTS TO INCLUDE HIGH-QUALITY SHORTER-TERM CAREER EDUCATION

Congress should expand the federal Pell grant program to include high-quality career education and training programs in fields with demonstrated demand for workers. Making career education more affordable through so-called “workforce Pell” would increase the pipeline for skilled talent, thereby diminishing the “skills gap” among U.S. companies. It would also open new opportunities for older and displaced workers for whom going to college or returning to school is neither practicable nor desirable. And, given the growing recognition that higher education is a lifelong endeavor (rather than one limited to the young adult years), this shift would help modernize federal higher education policy to better suit the needs of students, workers and businesses.


One promising approach is the Jumpstart Our Businesses by Supporting Students (JOBS) Act, proposed in the 115th Congress by Senators Rob Portman (R-OH) and Tim Kaine (D-VA), which would shorten the number of course hours required for Pell eligibility to 150 clock hours over eight weeks but also require that programs lead to an industry-recognized credential and meet other requirements for quality (9). Quality safeguards would help ensure that fly-by-night credential providers cannot exploit students – helping steer students toward top-flight programs.


Growing the Pell grant program need not come at the expense of higher education funding more broadly; potential sources for funding a Pell expansion include earmarking revenues from the excise tax on large university endowments (included in the 2017 tax bill), or limiting tax-preferred 529 college savings accounts, whose benefits overwhelmingly accrue to the upper middle class (10).


Although expanding Pell grants to more career education could ultimately make the program more costly, occupational credentials are typically much cheaper to acquire than college degrees, and the ultimate return – more workers in better jobs with better wages – makes the investment worthwhile.


 


[gview file=”[gview file=”https://www.progressivepolicy.org/wp-content/uploads/2019/01/PPI_NewIdeas_FederalStudentAid_V4.pdf”]


 


ENDNOTES


1) Restuccia, Dan, Bledi Taska, and Scott Bittle, Different Skills, Different Gaps, Burning Glass Technologies, 2018, available at https://www.burning-glass.com/wp-content/uploads/Skills_Gap_Different_Skills_Different_Gaps_FINAL.pdf.


2) Anthony P. Carnevale, Tamara Jayasundera and Artem Gulish, Six Million Missing Jobs: The Lingering Pain of the Great Recession, Georgetown Center on Education and the Workforce, December 2015, https://1gyhoq479ufd3yna29x7ubjn-wpengine.netdna-ssl.com/wp-content/uploads/Six-Million-Missing-Jobs.pdf.


3) Chamber of Commerce Foundation and Burning Glass Technologies.


4) National Skills Coalition, United States’ Forgotten Middle, available at https://www.nationalskillscoalition.org/resources/publications/2017-middle-skills-fact-sheets/file/United-States-MiddleSkills.pdf.


5) Burning Glass Technologies, “Which Middle Skill Jobs Will Last a Lifetime?” June 20, 2018, available at https://www.burning-glass.com/blog/which-middle-skill-jobs-will-last-lifetime/. See also Anthony P. Carnevale, Jeff Strohl, Neil Ridley, and Artem Gulish, Three

Educational Pathways to Good Jobs: High School, Middle Skills and Bachelor’s Degree, Georgetown Center on Education and the Workforce, 2018, available at https://1gyhoq479ufd3yna29x7ubjn-wpengine.netdna-ssl.com/wp-content/uploads/3ways-FR.pdf.


6) Opportunity America/AEI/Brookings Working Class Study Group, Work, Skills, Community: Restoring Opportunity for the Working Class, Opportunity America, 2018, available at https://1gyhoq479ufd3yna29x7ubjn-wpengine.netdna-ssl.com/wp-content/uploads/3ways-FR.pdf.


7) 20 U.S. Code § 1088, accessed at https://www.law.cornell.edu/uscode/text/20/1088.


8) Anne Kim, Forget free college. How about free credentials? Progressive Policy Institute, October 2017, https://www.progressivepolicy.org/wp-content/uploads/2017/10/PPI_FreeCredentials_2017.pdf.


9) Office of Sen. Tim Kaine, “Kaine, Portman Introduce Bipartisan JOBS Act to Help Workers Access Training for In-Demand Career Fields,” Jan. 25, 2017, https://www.kaine.senate.gov/press-releases/kaine-portman-introduce-bipartisan-jobs-act-to-help-workers-access-training-for-in-demand-career-fields.


10) Kim.


			


	

			




			
				


	

		
Marshall for The Hill, “Donald Trump has zero faith in the power of American ideas”

				

			Posted on  by The Progressive Policy Institute		

			


	

		
Let’s hope special counsel Robert Mueller gets to the bottom soon of Donald Trump’s strange dalliance with Russian President Vladimir Putin.


The plot thickened last week as the GOP-led Senate narrowly rejected a Democratic bid to prevent the administration from lifting sanctions on Russian oligarch and Putin crony Oleg Deripaska, who also did business with Paul Manafort, Trump’s disgraced former campaign manager.


Once again, President Trump appears to be bending over backward to curry favor with Putin. His infinite tolerance of Russia’s interference in U.S. politics and its well-documented online “malign influence” campaign stands in weird contrast to his churlish behavior toward America’s actual friends.


Trump routinely denigrates America’s oldest and strongest allies in Europe as trade cheaters and security freeloaders. A small but telling example has recently come to light: The State Department last year quietly downgraded the diplomatic status of the Delegation of the European Union to the United States.


Continue reading at The Hill.


			


	

			




			
				


	

		
Osborne for The Los Angeles Times, “Striking Teachers Scapegoated Charter Schools, But They’re Not The Problem”

				

			Posted on  by The Progressive Policy Institute		

			


	

		




Listening to the rhetoric of the teachers unions, one might have thought the teachers’ strike in Los Angeles was about charter schools. “When someone says there’s no money, why isn’t there money?” National Education Assn. President Lily Eskelsen García asked on MSNBC the first day of the strike.










“A big reason is because they’ve given it away to for-profit charters. If you’re in the charter industry, what do you want to do? You want to create horrible public schools…. The billionaires who are behind this, the venture capitalists, the Wall Street guys, are out to make money on public schools.”










This was nonsense: California never had many for-profit charters, and last year the legislature banned them entirely. Most of the people “behind” L.A.’s 277 charter schools are dedicated educators who work 60 hours a week to help low-income children. They’re more like Peace Corps volunteers than “Wall Street guys.”










But Garcia’s comments were illuminating. Clearly the unions saw the strike as an opportunity to discredit charters.






















Continue reading at The Los Angeles Times.




			


	

			




			
				


	

		
Yarrow for Washington Post Magazine, “The Rise of the Grandfamily”

				

			Posted on  by The Progressive Policy Institute		

			


	

		
A D.C. housing development serves as a refuge for grandparents raising young children. Is it a model for the rest of the country?


It’s a few days after Christmas, and Akirah Carter is sitting in her living room, still wearing her Santa-and-reindeer-patterned pajamas and pointed elf slippers as she tinkers with her gifts: a PlayStation 4, a magic set, Harry Potter books. On the kitchen counter sits a plate of snickerdoodles the 10-year-old baked with her grandmother. She spent Christmas Eve at her great-uncle’s house in Bowie, Md., playing games with her family and singing “Santa Claus Is Coming to Town” on a karaoke machine. That night, after returning home, she left out a few cookies and a glass of milk for Santa.


“She knows there’s no Santa,” says Akirah’s grandmother Tonya Carter, 58. “But she still puts out cookies for me.”


For the past eight years, Carter has served as Akirah’s Santa. Akirah can’t remember a Christmas with her parents. Her mother has drifted in and out of homeless shelters and is now in South Carolina, and her father — who sees her every other weekend — lives miles away and can’t care for her on his own. So Akirah lives full time with her grandmother in Plaza West, a brand-new apartment building in Washington’s Mount Vernon Triangle neighborhood built especially with families like hers in mind.


Plaza West reserved 50 of its 223 units for “grandfamilies”: families made up of grandparents raising their grandchildren full time. It’s one of a handful of buildings across the country created for low-income grandfamilies to live in affordable apartments with neighbors in similar circumstances.


Grandparents taking in their grandchildren isn’t a new phenomenon, but their numbers have been growing in recent years. As of 2017, 2.8 million young people — about 4 percent of American children — were being raised by 2.6 million grandparents (including 7,250 kids in Washington, D.C.), according to the U.S. Census Bureau. Nationally, the number of children raised by their grandparents increased by nearly 15 percent between 2007 and 2017.


Continue reading at Washington Post Magazine.


			


	

			




			
				


	

		
Republican sabotage is working: Uninsured rate ticks upward

				

			Posted on  by The Progressive Policy Institute		

			


	

		
Despite a strong economy and low unemployment, the number of Americans who lack health insurance is rising. The uninsured rate among adults in the fourth quarter of 2018 climbed to 13.7 percent, well above the low point of 10.9 percent in 2016, according to Gallup’s National Health and Well-Being Index.


That means 7 million Americans fell out of coverage over the last two years. What happened? For one thing, premiums rose sharply in 2018. For example, the benchmark silver plans sold on healthcare.gov, which covers roughly 70 percent of health care costs, rose an average 32 percent. Additionally, cutbacks in spending on outreach, advertising and enrollment assistance may account for the decline in coverage among low-income households. The expiration of the Accountable Care Act’s (ACA) individual mandate is another likely suspect.


In any event, it’s clear that the campaign of sabotage against the ACA waged by the Trump administration and Congressional Republicans is taking a toll.


Undaunted by their failure in 2017 to “repeal and replace” the ACA, President Trump and Republicans have pursued their obsession with killing “Obamacare” by other means. First, the Trump administration ended Cost Sharing Reduction (CSR) payments to insurers for discounts they are required to give to low-income enrollees. Getting rid of CSR payments led to a 10 percent increase in 2018 silver plan premiums, according to the Congressional Budget Office.


The White House also shortened and reduced advertising for the 2018 open enrollment period. They slashed funding for navigators, who assist consumers in signing up for insurance, from $63 million in 2016 to $10 million. Finally, Congress passed a tax reform package at the end of 2017 with only Republican votes and eliminated the individual mandate that required everyone to get coverage or face a penalty.


Republicans paid dearly in last year’s midterm elections for their relentless assault on the ACA. Voters identified the fear of losing or being unable to afford health coverage as their top concern. Seizing on these worries, Democrats threw GOP incumbents on the defensive for their anti-ACA obsession, winning 40 seats and flipping the House of Representatives.


Unfortunately, the Republican efforts to sabotage the law are working and the uninsured rate rose across income groups compared with the fourth quarter of 2016. Though there may be different reasons why low-income and higher-income people aren’t enrolling, the fact is, the uninsured rate is climbing.


[gview file="https://www.progressivepolicy.org/wp-content/uploads/2019/01/Uninsured-rate.pdf" title="Uninsured rate"]


Democrats should work to undo some of the damage done by the Trump administration and Congressional Republicans by reinstating CSR payments to insurers. They could also build on the ACA and pass legislation that would help those above 400 percent of the federal poverty level afford coverage ($48,560 for a single person household and $100,400 for a four-person household). However, because they only control one chamber of Congress, they could work on other policies as well, ideas that have been traditionally bipartisan, to help put downward pressure on prices. Things like:


    

  • Instating a broad-based reinsurance program which helps insurers cover the cost of particularly high claims
    • 

  • Prohibiting or limiting balanced billing (out-of-network bills) to consumers
    • 

  • Helping small businesses afford comprehensive health care coverage
    • 

  • Increasing price transparency throughout the health care system
    • 



Democrats are in a better position to defend the ACA now that they have taken over the House. While an ideological battle over Medicare-for-all is likely to play out during the 2020 primary, they should not get so lost in the clouds and neglect promises they made to voters to stabilize and tweak the ACA on the ground.


			


	

			




			
				


	

		
Langhorne for The 74, “A, B, C, F: Why This High School Never Gives Ds and Teaches Its Students to Think Like Lawyers”

				

			Posted on  by The Progressive Policy Institute		

			


	

		
“Coats off, scarves off, hats off! Belts on; shirts tucked,” Stacey Stewart, Thurgood Marshall Academy’s director of student affairs, yells at the two lines of students waiting to check-in and begin the school day.


“Ms. Stewart, I’m early today,” a student says as he approaches check-in.


“It’s 8:29. You are not early; you are on time,” she says, exasperated and amused. Check-in runs from 8 to 8:30 a.m. After students check in, they head downstairs for breakfast.


Nothing about morning check-in at Thurgood Marshall Academy (TMA) hints that there’s anything exceptional about the school, but a glass case near Stewart, filled with academic awards, reveals the truth: this is an extraordinary school.


Consistently ranked as a top-tier public charter school in Washington, D.C., Thurgood Marshall Academy is a law-themed school that serves about 400 students in 9th through 12th grade. Over 90 percent of students live in Wards 7 and 8, the city’s two poorest neighborhoods. Nearly 100 percent are African American, and 61 percent are designated “at-risk” by the Office of the State Superintendent, meaning they are at greater risk of dropping out based on their receipt of public assistance, food stamps, involvement with the D.C. Child and Family Services Agency, homeless status, or being older than expected for their grade.


Continue reading at The 74.