Last week, a Trump-appointed Texas District Court judge ordered the U.S. Food and Drug Administration (FDA) to take back its approval of mifepristone, a drug for inducing abortions, used safely in this country for 23 years. Despite abortion access being a winning issue with voters, the Republican Party is continuing to use legislation and right-wing judges to strip away bodily autonomy and the ability for Americans to make their own choices about their health care.
Erin Delaney, PPI’s Director of Health Care Policy, outlines the impact and consequences this decision has on the entire country in her latest post on Medium. She notes that with this latest ruling, 40 million more women could lose access to abortion care by removing a drug that has been proven safer than Tylenol or Viagra.
Erin writes, “Not only does it [the decision] abet the drive by Republican extremists to strip Americans of their reproductive rights, it sets a terrible precedent in which activist right-wing judges overrule the nation’s top health authorities for purely ideological reasons. Judge Kacsmaryk’s atrocious ruling hits a MAGA trifecta — at once undermining personal liberty, medical science, and the Constitution’s separation of powers.”
The Progressive Policy Institute (PPI) is a catalyst for policy innovation and political reform based in Washington, D.C. Its mission is to create radically pragmatic ideas for moving America beyond ideological and partisan deadlock. Learn more about PPI by visiting progressivepolicy.org. Follow the Progressive Policy Institute. Find an expert at PPI.
On Friday, a Trump-appointed Texas District Court judge unsurprisingly ordered the U.S. Food and Drug Administration to take back its approval of mifepristone, a drug for inducing abortions, used safely in this country for 23 years. U.S. District Judge Matthew Kacsmaryk also put a weeklong stay as part of his ruling, making mifepristone still available in all states at this time, unless his ruling stands. Nonetheless, last Friday’s ruling in Amarillo by Judge Kacsmaryk in Amarillo is shockingly dangerous.
Not only does it abet the drive by Republican extremists to strip Americans of their reproductive rights, it sets a terrible precedent in which activist right-wing judges overrule the nation’s top health authorities for purely ideological reasons. Judge Kacsmaryk’s atrocious ruling hits a MAGA trifecta — at once undermining personal liberty, medical science, and the Constitution’s separation of powers.
Prior to his appointment to the federal bench, Judge Kacsmaryk was a fixture of the radical right known for his attacks on contraception, abortion, gay marriage and protections for LGBTQ people. Although he promised in his Senate confirmation to set aside his personal views, there’s little evidence of a judicial temperament in his mifepristone ruling.
At the same time on Friday afternoon as his decision was released, Judge Thomas Rice from the U.S. District Court of Eastern District of Washington came out with a ruling challenging the FDA’s decision to impose restrictions on mifepristone prescribing and dispensing through the Risk Evaluation and Mitigation System (REMS) and that the restrictions imposed by the FDA are unnecessary and limit access. This ruling orders the FDA to maintain access to mifepristone in 17 states and Washington, D.C. Almost immediately after Judge Kacsmaryk’s decision, the Department of Justice filed a notice of appeal to the U.S. Court of Appeals for the 5th Circuit to request a stay while this appeal is considered to maintain access to mifepristone. If this stay is not granted by the 5th Circuit, then the FDA will likely appeal to the Supreme Court to block this ruling throughout the appeals process with the 5th Circuit. Unfortunately, if both courts do not provide a stay during the appeals process, then distribution of mifepristone could be halted across the country.
If President Biden delivers on his promise to bring a new era of jobs and prosperity to blue-collar America, it could be a game changer with working-class voters in the U.S. and beyond.
The Democrats may hold the presidency and, narrowly, the Senate, but their declining vote share among working-class voters and places means they face a much narrower path to victory. Combined with their falling support among Hispanic voters, and an electorate not confident that the country is on the right path, the Democrats face significant challenges ahead of the 2024 presidential election.
Looking across the Atlantic provides some painful lessons in what happens when center-left parties overlook their working-class base. Working-class voters began to pull away from the British Labour Party during the New Labour government years. But it wasn’t until the arrival of Boris Johnson’s brand of Conservatives in 2019 that Labour lost working-class voters and constituencies in historic numbers. That delivered the Conservatives an 80-seat majority in the House of Commons, and for Labour, its worst defeat since 1935.
Treasury Secretary Janet L. Yellen recently tied the failure to raise the debt limit in time to the prospect of more bank failures. The Secretary is absolutely right that if Congress wants to prevent more government bailouts of banks in the short-term, it can ill afford to wait to enact a clean debt limit increase. But in order to help bring down the inflationary pressures that helped undermine Silicon Valley Bank (SVB), President Biden and Democrats must find common ground with Republicans to stabilize the national debt.
While liberal Democrats point to the 2018 banking regulatory relief law and MAGA Republicans to so-called “woke” investments as the culprit of SVB’s collapse, the reality is that neither were to blame. First, SVB’s commitment to investments in renewable energy, community development, and affordable housing was about $16.2 billion, only 8% of its total assets. And these assets were not the ones “underwater.”
Civil society in Ukraine has flourished in the decades after independence – a bright spot in a country that sometimes struggled with other aspects of democratic nation-building,
including electoral politics and the battle against corruption. It is therefore not surprising to see civil society emerge as a critical player in the war effort, sheltering internally displaced persons, providing humanitarian aid in occupied territories, supporting soldiers on the front lines, and more. The Ukrainian civil society isn’t active only inside Ukraine: Diaspora in neighbouring countries has also given rise to a vibrant third sector, and it too has transformed itself in the year since the full-scale Russian invasion.
This research report is the outcome of research looking at 20 civil society organizations active in neighbouring Poland since the invasion of February 2022, including nine in-depth interviews and one focus group. The report offers some modest recommendations for policymakers seeking to leverage grassroots groups to strengthen democracy in post-war Ukraine, including by enhancing ties between Ukraine and the rest of Europe.
The Progressive Policy Institute (PPI) has long been a leader in the fight for equitable access to high-speed internet service, and thanks to President Biden’s Infrastructure Investment and Jobs Act (IIJA), the United States is making historic investments to close the digital divide. For the first time, families across the country will have expanded availability and affordability that will transform the way communities access education, jobs, and health care needs.
Building upon this work, PPI’s Mosaic Project hosted its sixth cohort of experts as part of its Women Changing Policy workshop series to elevate women to the forefront of policy making. Nearly 20 women who are experts in broadband, telecommunications, and digital equity gathered in Washington, D.C., to meet with lawmakers and the media to learn how to engage in meaningful policy conversations.
The latest cohort heard from top journalists and reporters from The Hill, Meet the Press, and NBC News, and also met with key committee staff in the House and Senate to talk about internet access and affordability. They also met with the FCC to discuss telecommunication policies happening at the federal level.
The Women Changing Policy workshop is a two and a half day interactive training opportunity for women experts to hone the skills needed to communicate their work and ideas to policymakers and the media. The workshop is a chance for experts to expand their networks, while getting hands-on experience learning the ins and outs of Washington politics.
The sixth Women Changing Policy Cohort included:
Jenna Alsayegh, Senior Director of Strategic Initiatives & Partnerships at USTelecom
Meagan Bolton, Of Counsel in Ice Miller’s Public Affairs Group
Valarry Bullard, Director of the New Jersey Office of Broadband Connectivity
Naomi Jordan Cook, Co-Founder and CMO of the Virtual Global Consultant Group
Devika Daga, Director of Market Intelligence at Technology Transformation Services in the U.S. General Services Administration
Alexandria Dirl, Project Manager at #BlackTechFutures Research Institute
Sara Nichols, Regional Planner at Land-of-Sky Regional Council
Christine O’Connor, Executive Director for the Alaska Telecom Association
Dr. Christine Parker, GIS and Data Visualization Specialist at the Institute for Local Self-Reliance
Pamela Price, Deputy Director of The Balm In Gilead, Inc.
Holly Rachel, Co-founder of Rachel + Winfree Consulting
Dr. Bibi Reisdorf, Associate Professor in the Department of Communication Studies at the University of North Carolina
Brandy Reitter, Executive Director of the Colorado Broadband Office
Debra Socia, President and CEO of The Enterprise Center
Stacey Wedlake, Research Scientist with the Technology & Social Change Group at the University of Washington Information School
The Mosaic Project is a diverse network of women with expertise in the fields of economics, technology, and more. Mosaic programming aims to bring new voices to the policy arena by connecting cohort members with opportunities to engage with top industry leaders, lawmakers, and the media.
The Progressive Policy Institute (PPI) is a catalyst for policy innovation and political reform based in Washington, D.C. Its mission is to create radically pragmatic ideas for moving America beyond ideological and partisan deadlock. Learn more about PPI by visiting progressivepolicy.org.
The United States’ education system overemphasizes college advising and prep coursework, while work-based opportunities and career preparation programs are overlooked and under-resourced. The reality is that most Americans do not earn college degrees — either forgoing college altogether or enrolling in college but not finishing — often leaving them with crushing student debt.
In an effort to address a lack of career readiness in high school curriculums, the Progressive Policy Institute (PPI) released a new policy brief “Reinventing High Schools: The Importance of Exposing Every Young Person to the World of Work,” detailing innovative approaches to ensuring high-quality career instruction is infused in every young person’s educational experience. Report author Taylor Maag, PPI’s Director of The New Skills for a New Economy Project, offers policy recommendations and calls on leaders to adopt solutions that: ensure every high school student can participate in high-quality work-based learning; boost public investment, and make resources more effective; and build strong cross-sector partnerships which are critical for these efforts to succeed.
“Career learning and experiences are critical for an individual’s success after high school — preparing young people for the world of work and providing strong alternatives for those not interested in or unable to access a four-year degree,” said Tayor Maag. “It is time for our education system to undergo much-needed reform and finally reinvent high schools.”
The Progressive Policy Institute (PPI) is a catalyst for policy innovation and political reform based in Washington, D.C. Its mission is to create radically pragmatic ideas for moving America beyond ideological and partisan deadlock. Learn more about PPI by visiting progressivepolicy.org. Find an expert at PPI and follow us on Twitter.
It is the end of February in Indianapolis. I arrive at a newly developed building complex that houses Ascend Indiana — a nonprofit intermediary organization that connects Hoosiers to in-demand careers and regional employers to skilled talent, fostering cross-sector partnerships, building capacity, and developing insights that enable system-level change to transform the career trajectory of youth and adults in the community.
As part of their efforts, Ascend partners with EmployIndy, the local workforce board, to offer the Modern Apprenticeship Program (MAP). MAP is a three-year program designed to prepare Central Indiana high school students for the workforce with paid, hands-on experiences that complement their traditional academic coursework. Apprentices start in their junior year and pursue jobs in growing fields such as business, advanced manufacturing, and IT. Afterward, they can continue to college or jump right into their career.
While visiting Ascend, I had the pleasure of meeting three of these youth apprentices. They all are extremely impressive, going to school full-time while also advancing in their apprenticeship program — with positions working in human resources, talent acquisition, and business management. High school students earning college credits, a wage, and critical job skills; this type of opportunity was not available to me and my peers in high school.
In fact, most young people in our country still don’t have access to high-quality career learning experiences like MAP apprentices. This is a result of our nation’s education system over-emphasizing college prep coursework and advising, while career preparation programs are overlooked, under-resourced, and even discouraged by federal and state policy. While we know that college — specifically a bachelor’s degree — often leads to higher long-term earnings, most Americans still do not earn degrees, with many forgoing college altogether, and many — 39 million to be exact — enrolling in college but not completing a degree. They are left with student debt and without a credential of value.
This trend is expected to worsen as young people increasingly question the career and financial benefits of traditional higher education. As a result, students aren’t attending, or are postponing their college plans altogether, which is apparent in the sharp declines in college enrollment among recent high school graduates. Rather than just focusing on college prep in their academic curriculum, students seem to be looking for ways to infuse career relevance into their education.
Career education does exist in schools today, for example, through our nation’s Career and Technical Education (CTE) system. CTE funds most of career learning in K-12 and these programs seek to provide students with academic and technical skills and the guidance needed to make informed career choices. Data shows that CTE concentrators, or students that have completed at least two CTE courses in a pathway, have a 94% high school graduation rate, which is 8% points higher than the national average. Additionally, CTE concentrators are employed full-time at higher rates and earn more than non-concentrators throughout their career. Yet even with promising outcomes, one in four high schools don’t offer CTE at all and out of roughly 15 million public high school students across the country, only 3 million are CTE concentrators.
It is clear the CTE system has its limitations. Funding is a big one. The federal government spends over $57 billion annually on our nation’s secondary schools. This investment does not include the majority of public funds for K-12 which come from the state and local level or the $122 billion in relief from the American Rescue Plan Act. Of all that, the CTE system receives roughly $1.3 billion annually for both youth and adult career education. As a result, only $600 million of total CTE funds goes toward K-12 to support career learning and experiences.
Compared to other public resources for secondary education, that truly is a drop in the bucket. School districts trying to provide career learning opportunities cite insufficient funding as the biggest barrier to offering these options in high school. However, funding constraints are not the only challenge. Inconsistent state support and the stigma that often attaches to career-oriented coursework and its students result in programs of widely varying quality and accessibility. Additionally, logistical hurdles, like recruiting and retaining qualified instructors, inflexible scheduling of programming, and finding willing employers make it especially hard to offer a critical element of CTE: work-based learning.
Work-based learning programs, like MAP in Indianapolis, can include apprenticeships, pre-apprenticeships, internships, and on-the-job training, among other options. These opportunities help young people gain the knowledge, skills, and credentials needed to achieve strong career outcomes. Work-based learning is beneficial for all young people but can be especially useful for individuals from low-income backgrounds and others who may otherwise not have access to career exposure, educational opportunities, professional networks, and social capital that play a critical role in career success.
The popularity of work-based learning has surged in recent years, with new energy and activity from the public and private sectors. States and locals can now leverage federal CTE dollars for these activities while also including work-based learning as a program quality indicator. While roughly half of states selected work-based learning as a quality indicator for their CTE programs, early data from these efforts demonstrated mixed success, with fewer students than expected accessing high-quality opportunities. The pandemic was a factor in these outcomes, especially for young people in rural and underserved communities that lack an extensive employer base or access to the necessary digital tools to access virtual options.
Faced with these obstacles, it is no wonder schools have continued the outdated approach of focusing on college prep coursework and have generally ignored career education in high schools. However, it can’t be ignored any longer. These opportunities are critical for an individual’s success after high school — preparing young people for the world of work and providing strong alternatives for those not interested in or unable to access a four-year degree. It is time for our education system to undergo much-needed reform and finally reinvent high schools.
This brief calls on policymakers to do just that — elevating innovative approaches across the country, like MAP in Indianapolis, that can be replicated and scaled. It also offers policy recommendations, calling on leaders to adopt solutions that: ensure every high school student can participate in high-quality work-based learning, boost public investment, and make these resources more effective and build strong cross-sector partnerships, which are critical for these efforts to succeed. This work is more important now than ever to ensure our nation’s education system creates paths to greater economic opportunity and avoids leaving millions of young people behind, especially those who don’t go to college.
FACT: Multinationals employ three out of every 10 American workers.
THE NUMBERS: Employees of multinational firms (U.S.- and foreign-based) as a share of total U.S. private-sector employment –
2020 31%
2019 29%
2012 26%
2002 26%
1992 25%
WHAT THEY MEAN:
Here is J.M. Keynes, looking back from 1919 at the “globalized” world of the 1910s, from the perspective of a wealthy (male) Londoner:
“[For] the middle and upper classes, life offered, at a low cost and with the least trouble, conveniences, comforts, and amenities beyond the compass of the richest and most powerful monarchs of other ages. The inhabitant of London could order by telephone, sipping his morning tea in bed, the various products of the whole earth, in such quantity as he might see fit, and reasonably expect their early delivery upon his doorstep; he could at the same moment and by the same means adventure his wealth in the natural resources and new enterprises of any quarter of the world, and share, without exertion or even trouble, in their prospective fruits and advantages; or he could decide to couple the security of his fortunes with the good faith of the townspeople of any substantial municipality in any continent that fancy or information might recommend.”
Taking up his themes of easy and uninterrupted flows of investment and trade a century later, with some employment focus as against Keynes’ investor-and-consumer viewpoint–
The U.N. Conference on Trade and Development’s annual “World Investment Report”, reports that annual cross-border “foreign direct investment” flows have varied between $1 trillion and $2 trillion over the last decade, with the U.S. in most years both the largest source and recipient. Last year was a typical example, with the U.S. receiving $367 billion of the worldwide $1.6 trillion in total inbound FDI flows, and sending out $404 billion.
Reporting each year on these flows’ real-world manifestations, the Commerce Department’s Bureau of Economic Analysis publishes figures on international businesses’ employment, investment stocks, employment, R&D, payrolls, and so forth in the United States and abroad. Their most recent editions cover the year 2020 and find U.S. “affiliates” of foreign-based firms employing 8.6 million workers, and U.S.-based firms with overseas operations employing 28.4 million people in the U.S. (along with 14 million overseas). Together, then, internationally operating businesses employed 37 million private-sector workers, or 31% of the COVID-depressed 120 million total. Two bits of perspective on this:
(1) Economic role: The “multinational’ firms — both U.S. “parents” and foreign “affiliates” — are particularly employers in manufacturing (10 million of 12.2 million), retail (10 million of 17 million, and information industry (2.0 million of 2.7 million). They are also very prominent in private-sector science, together accounting for $430 billion of 2020’s $717 billion in U.S. R&D spending. (U.S.-based firms did most of this at $361 billion, not counting $59 billion in overseas R&D; U.S.-based affiliates of foreign firms contributed $73 billion in U.S.-based R&D. And they account for about two-thirds of U.S. goods trade, including $1.08 trillion of 2020’s $1.66 trillion in exports, and $1.43 trillion of the $2.35 trillion in imports.
(2) Over time: At least with respect to employment, multinationals’ role in U.S. economic life has been pretty stable over the last generation. The 31% share of employment in 2020 is at the high end of BEA’s records, but this is mainly because, before COVID vaccines, employment was especially depressed in industries with fewer multinationals, such as restaurants, hotels, beauty shops, and other small services businesses. Over the last 30 years, the “multinational” share of U.S. employment has varied between 25% and 29% of private-sector workers – or, to cite a few specific years, 26% of the 121 million private-sector workers in 2012, 26% of the 108 million in 2002, and 25% of the 90 million in 1992. Over this time, U.S.-based multinationals have added about 11 million employees in the U.S. (17.5 million then, 28.4 million in 2020), while simultaneously adding 10 million overseas. International firm employment in the U.S. has grown at a slightly faster pace in percentage terms but less sharply in total numbers, rising by about 80% from 4.8 million in 1992 to 8.6 million in 2020.
Lots of money and research, the various products of the world freely available, employment rising at typically modest but positive gradations each year. All this may feel a bit reassuring, as “geopolitics” grows steadily more menacing, and international institutions fray at the edges — but it also makes Keynes’s close, as he reflects on how fragile the apparent calm and stability of his own recent past were, especially unsettling:
“[H]e [the hypothetical upper-middle class Londoner, probably referring to himself] regarded this state of affairs as normal, certain, and permanent, except in the direction of further improvement, and any deviation from it as aberrant, scandalous, and avoidable. The projects and politics of militarism and imperialism, of racial and cultural rivalries, of monopolies, restrictions, and exclusion, which were to play the serpent to this paradise, were little more than the amusements of his daily newspaper, and appeared to exercise almost no influence at all on the ordinary course of social and economic life.”
BEA’s figures look at U.S. private-sector investment abroad as well as multinationals operating here, with some detail on destinations for U.S. investment and the ownership of investment here. As both a destination and a source, Europe is the main partner and Canada is disproportionately large. By value (“investment stock”), Europe is home to $4 trillion of $6.5 trillion in U.S. FDI abroad (2020), with the U.K. at $1.0 trillion, EU members $2.7 trillion, and Switzerland, Norway, Iceland, and Turkey together $0.25 trillion. Latin American countries are at $0.25 trillion, led by Mexico at $110 billion; Asia and the Pacific are at $960 billion, topped by Singapore at $294 billion, Australia at $167 billion, and Japan and China both around $118 billion. Measured by jobs, though, U.S. firms employ about as many people in Asia as in Europe. A table of U.S. overseas employment by region:
Looking the other way, European firms are likewise the main international employers in the United States, at 5 million jobs or about 60% of the 8.6 million total. By country, U.K. firms led at 1.2 million, followed by Japanese at just above 1 million, Canadians just below, Germans at 885,000, French at 740,000, and Dutch at 569,000. Japanese firms employed a bit more than 1 million Americans, second only to the Brits; Canadians just a bit less at 940,000. Chinese firms, though receiving much attention and publicity, were modest employers of Americans at 153,000; Mexicans were at 89,000, and Indians 73,000.
Ed Gresser is Vice President and Director for Trade and Global Markets at PPI.
Ed returns to PPI after working for the think tank from 2001-2011. He most recently served as the Assistant U.S. Trade Representative for Trade Policy and Economics at the Office of the United States Trade Representative (USTR). In this position, he led USTR’s economic research unit from 2015-2021, and chaired the 21-agency Trade Policy Staff Committee.
Ed began his career on Capitol Hill before serving USTR as Policy Advisor to USTR Charlene Barshefsky from 1998 to 2001. He then led PPI’s Trade and Global Markets Project from 2001 to 2011. After PPI, he co-founded and directed the independent think tank Progressive Economy until rejoining USTR in 2015. In 2013, the Washington International Trade Association presented him with its Lighthouse Award, awarded annually to an individual or group for significant contributions to trade policy.
Ed is the author of Freedom from Want: American Liberalism and the Global Economy (2007). He has published in a variety of journals and newspapers, and his research has been cited by leading academics and international organizations including the WTO, World Bank, and International Monetary Fund. He is a graduate of Stanford University and holds a Master’s Degree in International Affairs from Columbia Universities and a certificate from the Averell Harriman Institute for Advanced Study of the Soviet Union.
George Floyd’s reprehensible murder put in motion a long overdue reckoning over police violence in communities of color. More can and should be done to rectify eons of systemic abuse. However, not every measure taken thus far has been wise, including removing School Resource Officers who are charged with keeping the peace in and around school buildings.
Last week, a 17-year-old student shot two deans at Denver’s East High School. The student fired multiple rounds as the deans physically patted him down — precisely to discover whether or not he was armed. This raises several questions.
First, why was the student patted down in the first place? Denver Public Schools (DPS) Superintendent Alex Marrero revealed — likely in violation of the minor gunman’s Family Educational Rights and Privacy Act (FERPA) rights — that he was subject to a “safety agreement” that required him to be searched at the beginning of each school day. An investigation by a local ABC News station revealed that the search protocol is part of DPS’ “Discipline Matrix,” which measures student misconduct at different levels of severity. The document begins, “You make a difference in breaking historical patterns of inequity! Disrupt bias, fight disproportionality, and apply the Discipline Matrix in anti-racist and trauma-informed manner.”
North Carolina has officially become the 40th state to expand Medicaid under the Affordable Care Act (ACA), which is expected to be implemented in 2024 after the state budget is approved, likely this summer. Once implemented, an estimated 600,000 people will be eligible for coverage under the expansion. PPI applauds Governor Roy Cooper for his persistent leadership to garner bipartisan support to ensure North Carolinians have the health care access they deserve through Medicaid expansion. The North Carolina House passed expansion in an 87-24 vote last week, with nearly two-thirds of House Republicans voting in favor.
The path to expansion in North Carolina was no simple feat, as North Carolina Republicans have been staunchly opposed to expansion for over a decade since it’s a policy that was implemented by the Obama administration through the ACA 13 years ago. In fact, GOP members of the North Carolina legislature were so opposed to expansion that they passed a law in 2013 to prevent the governor from even seeking expansion without approval from the General Assembly. The GOP attitude on preventing expansion in North Carolina began to change once they realized Congressional Republicans were not going to succeed in repealing or replacing the ACA in 2017, or raising the state match that coverage requires. Additionally, in May 2022, longtime expansion opponent, State Senate Leader Phil Berger, publicly expressed his support for expansion and framed it as a sensical budget move and one that would help those who fall in the coverage gap whose income is too high to qualify for Medicaid, but too low to benefit from highly subsidized private insurance.
Both chambers of the North Carolina legislature initially passed Medicaid expansion in 2022 but were unable to reach an agreement on the specifics of the state’s Certificate of Need (CON) regulations. An agreement was reached to loosen the CON regulations this year, which also helped pave the way for the expansion’s passage. Notably, the American Rescue Plan (ARP), the $1.9 trillion stimulus package that was passed by Congress and signed into law by President Biden in 2021, allows newly expanded Medicaid states to receive additional federal Medicaid funding for their non-expansion population. North Carolina will now receive this additional funding from the ARP for the first two years of the expansion.
Under the ACA, Medicaid coverage was expanded for adults with incomes up to 138% of the federal poverty level (FPL). This provision was initially a requirement, but became optional after the June 2012 Supreme Court ruling in National Federation of Independent Businesses v. Sebelius, permitting states to choose to opt into expansion or not. With North Carolina now expanding Medicaid, 40 states, including the District of Columbia, have expanded the program. Ten states remain as hold-outs: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. Before North Carolina expanded, South Dakota recently expanded Medicaid in 2022 in a referendum, and will start implementation in July 2023.
600,000 North Carolinians will be eligible for coverage;
North Carolina hospitals provide roughly $1 billion in uncompensated care each year. This amount will sharply decline once Medicaid expansion is implemented and the uninsured patients that can opt into Medicaid are covered;
North Carolina Medicaid expansion will create 40,000 new jobs in North Carolina and will help keep rural hospitals open;
North Carolina will receive $8 billion in annual federal funding with no additional cost to the state along with an additional $1.8 billion to support behavioral health, public safety support, rural health care and other needs. The state left $5.9 billion in federal funding by not expanding Medicaid in 2022.
This data clearly demonstrates what non-expansion states are missing out on. Medicaid expansion is a state revenue generator, a job creator, lowers health care system costs, and most importantly, provides access to health care for low-income and marginalized communities, decreasing health disparities. An estimated 3.7 million people, including non-Hispanic Black people, young adults, and women of reproductive age would gain coverage in 2023 if these remaining hold-out states expanded Medicaid eligibility. It’s high time for Republican lawmakers in non-expansion states to come to the consensus that Medicaid expansion is more than worth setting aside futile partisanship over the ACA. They should look to North Carolina as an example of what is possible when Republicans put aside their opposition to the ACA and reconsider the state budgetary and health benefits of expansion. Americans are still facing financial hardship, incalculable loss, and long-COVID illnesses and disabilities due to the COVID-19 pandemic, which also wreaked havoc on our health care system. Medicaid expansion can provide access to affordable health care and greater financial stability that many Americans desperately need now.
The development and production of leading-edge semiconductors is a difficult, expensive, and risky endeavor. Case in point: Intel, once the world’s top chipmaker, has fallen behind Taiwan-based TSMC and Korea-based Samsung in mass-producing the latest, most powerful generation of chips, used in applications such as artificial intelligence, autonomous vehicles, and high-end weapons systems.
Moreover, each new generation of chips requires comparable advances in related technologies like software for designing chips (primarily made by U.S.-based companies such as Cadence or Synopsys) and ultra-precise photolithography equipment from companies like Netherlands-based ASML and Japan-based Nikon that are essential to the chip-making process.
So far, there are no Chinese companies on the very short list of global businesses contributing key technologies to leading-edge advanced chips, which aren’t easy even for companies like Intel. However, Chinese manufacturing facilities have become key producers of “mainstream” or “legacy” chips, which are powerful but “not-the-latest-model” chips that run everything from appliances to tire sensors on cars.
Against the background of this complex global chip ecosystem, the United States is pursuing a clear policy: To “maintain as large of a lead as possible” over competitors in “key technologies,” in the words of President Biden’s National Security Advisor, Jake Sullivan. In particular, this goal reflects mounting concern in Washington about China’s long-term strategic threat, both military and economic. Notably, the ruling Chinese Communist Party is doubling down on a “military-civil fusion” research and development strategy that links civilian and military modernization and technology development. The immediacy of the threat can be argued, but not its nature.
The new policy has two parts and a difficult choice. The first part is to slow down the transfer of Western knowledge and capabilities to the Chinese semiconductor industry. This goes under the name “export controls,” but it really means a series of actions, described below, aiming at slowing down or stopping the conveyor belt that for the past two decades has swiftly and efficiently carried technology from the Western countries to the broad swathe of thriving Chinese factories, including those supplying the Chinese military.
The second part of the new policy must be aimed at maintaining and even accelerating advanced Western chip progress. The CHIPS Act is a start, but as noted earlier, the cutting-edge of semiconductor technology is a dangerous and expensive place to be. The U.S. is still the leader, but it can’t expect to go it alone. Other countries have unique knowledge and capabilities that must be appreciated and respected. For example, ASML is the only company in the world making extreme ultraviolet (EUV) lithography equipment, without which the most powerful chips would not be possible.
The difficult choice is how far to extend the new controls in practice. There is a general consensus (though in some cases grudging) that China should be denied the latest and greatest chip technologies. To that end, the Commerce Department’s Bureau of Industry and Security (BIS) is prohibiting the transfer of advanced semiconductor technologies to any Chinese company or fab that manufactures chips for supercomputers and other military applications is included. Moreover, American workers and companies that operate or service advanced chipmaking equipment in China henceforth will require a special waiver to continue their work. The new controls also require non-U.S. companies to comply with the new restrictions or risk being cut off from using American semiconductor technology. Indeed, the U.S. was able to convince the governments of the Netherlands and Japan, home to key suppliers, to ban the export of leading-edge technologies.
This policy, directed toward advanced chips, could well be successful in slowing China’s semiconductor progress. No matter how much China spends on semiconductor R&D, it may not be able to easily match the combined intellectual and scientific heft of the U.S., Europe, Japan, Taiwan, and Korea working together.
But the consensus begins to fray once the policy conversation turns to putting similar controls on mainstream or legacy chips. On the one hand, mainstream semiconductors are still very powerful in historical terms, and the technologies used to make them can be potentially adapted to produce more advanced chips. An argument can be made that to be truly effective, controls have to be both broad and tight. One example of potentially tight controls: The Commerce Department just proposed a set of “guardrails” that would prohibit recipients of CHIPS Act funds from expanding the capacity of their existing legacy manufacturing plants in China by more than 10% from today’s level. That would effectively put a permanent cap on U.S. production of legacy chips in China for export-oriented products.
On the other hand, these chips, used by the bucketful in all sorts of modern applications, are low-margin, and therefore a low-cost country like China logically has a comparative advantage. Moreover, automakers, aerospace companies, and other U.S. businesses benefit from the ability to import these chips at a low price, which then in turn benefits U.S. consumers.
How to escape this conundrum? The key is to look ahead toward the future. The technical bar for each new chip generation gets higher and higher, so the more hands the better when it comes to pushing the frontier forward. The Semiconductor Industry Association estimates that meeting future semiconductor needs will require $3 trillion in investments over the next decade for R&D, supply chain resiliency, and new fabs, both for advanced and mainstream chips. To put this in perspective, Intel’s total capital investment and R&D budget in 2022 came to $42 billion, suggesting what is needed is about 10 Intels.
On a global basis, that’s doable. What’s needed is a “coalition of growth” with no single country monopolizing the funding, expertise, blueprint, or supply chain for manufacturing semiconductors. This diffusion of technical know-how necessitates a balanced approach to address national security needs, safeguard semiconductor supply, and advance semiconductor technology and equipment, as the Department of Commerce and BIS are doing by soliciting public comment on the new restrictions.
The importance of semiconductors will only continue to rise in a digitized society. No one disputes the importance of semiconductors for national security. The United States cannot compromise on ensuring a secure global environment. However, the essential nature of chips will require a roadmap that integrates national security needs with chip advancement and innovation.
For various factors, a single federal drug program that accounts for tens of billions in annual spending has hit a tipping point in its evolution. The combination of legal disputes, a growing data repository and investigative reports have necessarily put the 340B Drug Pricing Program under the microscope. Combined with the fact that the policy lacks any necessary guardrails to ensure transparency and integrity for patients, 340B has spiraled out of control to the point that no policymaker can ignore the need to look closer.
Recently, a federal appeals court in Philadelphia admonished the Department of Health and Human Services for requiring drugmakers to provide discounted drugs to an unlimited number of pharmacies that contract with hospitals or clinics eligible for such federally required drug discounts. Under the so-called 340B Drug Pricing Program, drugmakers must give deep discounts to certain nonprofit hospitals and clinics.
When the program began in the early 1990s, those hospitals and clinics that did not have an in-house pharmacy could sign a contract with one outside pharmacy to distribute their discounted drugs. In 2010, despite no statutory provision concerning contract pharmacies, HHS permitted hospitals and clinics to contract with an unlimited number of outside pharmacies, and the 340B program exploded.
France has one of the most generous — and fiercely guarded — welfare states in the Western world. No one knows that better than President Emmanuel Macron, who recently won a six-year battle to raise France’s retirement age from 62 to 64.
That may not sound draconian to Americans since the normal retirement age for Social Security is 67. But in France, Macron’s move has ignited a furious wave of violent protests and paralyzing strikes that have shut down railways and airports and left mountains of uncollected garbage festering in the streets of Paris.
There’s a warning here for U.S. policymakers, who also confront ballooning costs of a public retirement and health system designed when there were many more young workers per retiree. Last Friday, Social Security’s and Medicare’s trustees warned that major parts of both programs will run out of money within a decade.
PPI’s Reinventing America’s Schools (RAS) Project has a new podcast series on titled “WHAT NEXT: The Future is Now!” recorded at the SXSW Education conference in Austin, Texas.
In the first episode of our five-part series, RAS co-director Curtis Valentine sits down with Emory Edwards of EdChoice. Emory Edwards is the Vice President of Outreach for EdChoice, which is a nonprofit that works to ensure families have the ability to choose the best education for them. In this episode, Curtis and Emory discuss the different ways choices can benefit the education system from solving the teacher shortage to reducing class size and increasing representation for everyone in the system. Curtis and Emory speak about what they hope to hear in this year’s panel, including the discussion of how culture influences education. To wrap it up, Curtis and Emory look to the future and what they would like schools and classrooms to look like.
The venerable International Telecommunications Union (ITU), the world’s oldest “international organization,” has been printing, telegraphing, broadcasting, and posting telecom data since its launch in 1865.* Its most recent look at the digital world, out last September, finds 5.3 billion people, or two-thirds of the world’s 8 billion population, now have internet access. Two observations on this:
(1) This year’s 5.3 billion internet users are nearly three times the 2.0 billion ITU counted in 2010; over ten times the 0.4 billion it found in 2000; and about 1,000 times the roughly 3 million comp sci students, telecom enthusiasts, and government officials using the pre-WWW, copper-cable-based networks of 1990. In high-income countries, more than 90% of people are now online, with the exceptions (if the U.S. is a good sample) mostly infants and elderly people who don’t want service. Many of the newer users — 600 million have logged on since the COVID pandemic — are now in lower-income regions: Least-developed country use has jumped from 89 million to 407 million since 2015, and 40% of sub-Saharan African households are now online, as against 11% in 2015.
(2) Information exchange is rising faster than user count. ITU estimated 1,230 terabits of bandwidth in use every second (Tbps) in 2022, up from 979 Tbps in 2021, and four times the 292 Tbps it found in 2017. About 40% of data exchange goes on in Asia, which accounted for 542 of the 1,230 TBps last year. Europe added 242 TBps, the Western Hemisphere (including the U.S., Canada, the Caribbean, and Latin America) 224, and the rest of the world 220.
Intellectual and cultural assessments of the rising user counts and accelerating data exchanges are always pretty subjective. Economic measurements are also often murky, but there are some useful gauges, especially with respect to the U.S.. The OECD, for example, estimates that the $25 trillion U.S. economy now includes $112 billion in annual sales of data and data-related advertising, and that data stocks are worth about $421 billion in national “wealth.” With respect to trade, the Commerce Department’s Bureau of Economic Analysis reports $89 billion in U.S. exports of information and communications services and $594 billion in digitally deliverable services in 2021 — together, more than a quarter of the $2.26 trillion in total U.S. exports.
In purely physical terms, the growth in user counts will have to slow down by the late 2020s. But the scale of information exchange can easily keep rising, since the physical capacity to carry data continues to grow both under the oceans and above the atmosphere. The glass-watchers at TeleGeography, for example, see 552 submarine cables operating in 2023, with 33 new ones scheduled to go live this year and 19 more so far in 2024. Meanwhile, satellites are handling larger shares of data flow, and 1,000 to 1,500 new ones go into orbit each year.
In ‘governance’ terms, however, questions about fraying policies and thickening cyber-borders seem to be intensifying even as the Internet accommodates more users and carries more information. Examples: steady interest among lots of governments in digital service taxation; last year’s efforts, especially from India, to end the WTO’s 24-year-old “moratorium” on tariffs for digital transmissions; and the quiet but intense ideological tug-of-war between the “internet sovereignty” concepts proposed by authoritarian governments and the “multi-stakeholder”/free flow of data views held traditionally by the U.S. and most liberal democracies, and elaborated in last year’s 61-country Declaration for the Future of the (“open, free, global, interoperable, reliable, and secure”) Internet.
* Created to deal with the questions raised by the deployment of the first telegraph cables; converted into a League of Nations organization in 1919, and a U.N.-specialized agency more recently.
FURTHER READING:
ITU’s 2023 “Facts and Figures” report on internet populations, data exchange, smartphone use, and more worldwide and by region.
… and the 61-country Declaration for the Future of the Internet, including 39 in Europe, five in the Pacific, three in Africa, one in the Middle East, and 9 in the Western Hemisphere (of which two are Caribbean, two North American, one Central American, and four South American).
Ed Gresser is Vice President and Director for Trade and Global Markets at PPI.
Ed returns to PPI after working for the think tank from 2001-2011. He most recently served as the Assistant U.S. Trade Representative for Trade Policy and Economics at the Office of the United States Trade Representative (USTR). In this position, he led USTR’s economic research unit from 2015-2021, and chaired the 21-agency Trade Policy Staff Committee.
Ed began his career on Capitol Hill before serving USTR as Policy Advisor to USTR Charlene Barshefsky from 1998 to 2001. He then led PPI’s Trade and Global Markets Project from 2001 to 2011. After PPI, he co-founded and directed the independent think tank Progressive Economy until rejoining USTR in 2015. In 2013, the Washington International Trade Association presented him with its Lighthouse Award, awarded annually to an individual or group for significant contributions to trade policy.
Ed is the author of Freedom from Want: American Liberalism and the Global Economy (2007). He has published in a variety of journals and newspapers, and his research has been cited by leading academics and international organizations including the WTO, World Bank, and International Monetary Fund. He is a graduate of Stanford University and holds a Master’s Degree in International Affairs from Columbia Universities and a certificate from the Averell Harriman Institute for Advanced Study of the Soviet Union.
