issue: Health Care

A Better Way to Fix the Pandemic Premium Tax Credit Than Income Caps

Posted on by Alyssa Brown

One of the biggest obstacles to ending the government shutdown is partisan disagreement about how to address the looming expiration of a pandemic-era expansion of the Affordable Care Act’s (ACA) premium tax credit (PTC). Established in 2014, the PTC gave subsidized health insurance to Americans who didn’t receive it through their employer or the government. The American Rescue Plan (ARP) made this program substantially more generous, including to higher-income households that were never supposed to receive assistance under the original ACA. Democrats want to continue the pandemic PTC expansion in its entirety, while most Republicans want it to expire.

A bipartisan consensus appears to be emerging that the way to better target assistance moving forward and end the shutdown is to impose an income cap on eligibility for the PTC. Unfortunately, this compromise would restore the biggest flaw in the original ACA design that ARP solved: the benefit cliff. Before ARP expanded the PTC, households with income greater than 400% of FPL were not eligible for the ACA subsidy. That meant a single extra dollar of income could trigger thousands of dollars in higher premiums — an abrupt cutoff that discouraged work. Bringing back an income cap today would leave households vulnerable to sudden increases in health-care costs as a penalty for working. 

Instead of repeating past mistakes, a better approach would be to establish a gradual phase-out of benefits for households as their income increases. This would smooth out the benefit cliff established under the ACA and avoid giving windfalls to high-income households.

Under PPI’s preferred approach, households with incomes under 300% of FPL would be eligible for the same expanded subsidies next year that they are today. But rather than capping health-care premiums at a certain percentage of recipients’ income, premiums would steadily increase as household income increases. As a result, high-income households’ subsidies would taper off as their earnings increase, thus reducing unnecessary benefits for high earners without recreating the benefit cliff. Subsidies would also fully phase out at lower income levels than they do today.

If lawmakers are concerned about high-income households still qualifying for subsidized health insurance, the best solution is to adjust the phase-out such that a household’s premiums are set to increase starting at a lower level of income. Accordingly, PPI proposes that the phase-in threshold gradually decreases for each of the next two years — similar in concept to a recent proposal from Sen. Mike Rounds (R-S.D.) to gradually phase down the credits back to pre-pandemic levels. But PPI’s proposal preserves free health insurance for families in poverty while still requiring reasonable contributions from middle-income households that can afford it, and lowering benefits for high-income households that don’t need the support.

Along with providing generous support to those who don’t need it, the other problem with simply extending the pandemic PTC expansion is that it is expensive, costing at least $23 billion per year. Rather than cutting health-care costs, it merely shifted the burden onto taxpayers. Fortunately, there are solutions that will both pay for the proposed expansion — letting taxpayers off the hook — and cut health-care costs in the long run. 

Medicare Advantage, which allows seniors to receive their Medicare benefits from private insurers, costs taxpayers tens of billions of dollars per year because certain loopholes allow insurance companies to make patients appear sicker than they actually are, which artificially increases their government reimbursements. The No UPCODE ACT would end this practice and save at least $125 billion over 10 years, according to the Committee for a Responsible Federal Budget. Medicare also currently pays far more for services provided in hospital outpatient departments than in independent physician offices, a disparity that encourages hospitals to buy up clinics and drive consolidation — raising costs for patients and taxpayers alike. Adopting site-neutral payments could save $175 billion over the next decade.

Together, these two reforms would fully offset the cost of PPI’s proposed PTC expansion extension on a permanent basis. By eliminating the benefit cliff under the original ACA and establishing gradual phase-outs, PPI’s plan would prevent middle-class families from experiencing a sudden loss in benefits, ensure the poorest families remain protected, and avoid unnecessary tax subsidies for high-income households. These values reflect the goals of the ACA: affordable coverage and strong work incentives. Now is an opportunity for Democrats to push Republicans to adopt thoughtful reforms to the PTC. Millions of Americans are depending on them to get it right.

PPI Proposes Pragmatic Plan to Reform ACA Premium Tax Credits and Curb Skyrocketing Health-Care Costs

Posted on by Alex Terr

WASHINGTON — As partisan disagreements over extending pandemic-era premium tax credits (PTC) threaten a government shutdown next week, the Progressive Policy Institute (PPI) today released a pragmatic plan to protect families from steep premium hikes while reining in unsustainable federal spending on health care.

“A Pragmatic Path Forward on Premium Tax Credits,” authored by Tim Sprunt, Policy Analyst at PPI’s Center for Funding America’s Future, and Ben Ritz, PPI’s Vice President of Policy Development and Director of the Center for Funding America’s Future, charts a fiscally responsible middle path between Democrats who want to make pandemic-era subsidy expansions permanent and Republicans who want to let them expire abruptly.

PPI’s analysis finds the 2021 expansion of the Affordable Care Act (ACA) premium tax credits provided critical benefits during the COVID-19 pandemic and corrected structural problems with the original design, such as a “benefit cliff” that discouraged work among upper-middle-income households. However, the expansion also made the ACA significantly more regressive and would cost $380 billion if continued for the next decade, showering unnecessary benefits to high-income households while doing nothing to address the underlying drivers of rising health-care costs. 

“Democrats must stop reflexively seeking to extend every Biden-era fiscal policy, no matter how poorly designed, and Republicans must stop seeking to cut support for American health care at every available opportunity,” said Sprunt. “PPI’s proposal offers a pragmatic path between the two extremes.” 

Specifically, PPI proposes to gradually move from the pandemic PTC structure to one that splits the difference between it and the structure originally established by the ACA. Free coverage would be permanently preserved for families at or below 100% of the federal poverty level, while higher-income households would eventually be required to pay premiums roughly halfway between the pandemic-era expansion and the original ACA. This structure would also permanently smooth the benefit cliff that significantly increased premiums for anyone just outside the original PTC’s eligibility range. 

PPI’s proposed PTC would cost roughly half as much as a permanent expansion of the pandemic PTC. But crucially, PPI’s proposal would fully pay for these targeted subsidies by pairing them with real reforms to attack the drivers of rising health-care prices. These reforms include:

  • Cracking down on Medicare Advantage upcoding: Adopting key provisions of the bipartisan No UPCODE Act would save at least $125 billion over 10 years by preventing insurers from inflating risk-adjustment payments.
  • Expanding site-neutral payments: Curtailing the practice of paying hospitals more than independent clinics for identical services could save Medicare $175 billion over the next decade and discourage the consolidation of providers that leaves all Americans with fewer health-care choices.

“PPI’s proposal shows pragmatic Democrats are serious about cutting medical costs rather than simply increasing government spending,” said Ritz.

Read and download the new proposal here.

Launched in 2018, the Progressive Policy Institute’s Center for Funding America’s Future works to promote a fiscally responsible public investment agenda that fosters robust and inclusive economic growth. To that end, the Center develops fiscally responsible policy proposals to strengthen public investments in the foundation of our economy, modernize health and retirement programs to reflect an aging society, transform our tax code to reward work over wealth, and put the national debt on a downward trajectory.

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.

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Media Contact: Ian O’Keefe – iokeefe@ppionline.org

A Pragmatic Path Forward on Premium Tax Credits

Posted on by Alyssa Brown

INTRODUCTION

Democrats have made extending a pandemic-era expansion of the Affordable Care Act’s (ACA) premium tax credit (PTC) their central demand in this year’s government funding negotiations, going so far as to threaten a government shutdown next week if Republicans do not attach it to a short-term funding bill. The pandemic PTC served an important purpose in the midst of the COVID-19 pandemic, helping reduce the cost of health insurance for households that did not have coverage through their employer or another government program at a time when workers were at heightened risk of losing their jobs or experiencing a medical emergency. It also corrected some long-standing problems with the PTC’s original structure, such as a “benefit cliff” that discouraged earnings by cutting benefits off altogether for households that made even one dollar more than the income eligibility limit.

Allowing the expansion to expire immediately in its entirety, as most Republicans propose to do, would be deeply damaging: the Congressional Budget Office (CBO) estimates that more than 4 million Americans could lose their health insurance when the pandemic PTC expires, while the Kaiser Family Foundation (KFF) estimates that out-of-pocket premium payments for enrollees on the individual insurance exchange marketplaces would rise by more than 75%.

But reflexively continuing the policy in its current form, whether through repeated temporary extensions or outright making it permanent, would also be unwise. The pandemic PTC provides substantial subsidies for households higher up the income ladder that go far beyond the program’s original intent. The extension is expensive, costing more than $20 billion per year — a cost Democrats never proposed to sustainably pay for, despite the national debt already being at historic heights. The tax subsidies it provides for a small slice of the population are significantly more costly than the tax subsidies from which most Americans benefit through employer-sponsored insurance. And perhaps worst of all, the pandemic PTC pumps more money into a broken and costly health-care system while doing nothing to tackle the true drivers of high prices.

PPI proposes a pragmatic path forward between these two extreme positions. Our proposed framework would gradually transition into a new PTC structure somewhere between the original PTC and the pandemic PTC — one that eliminates the benefit cliff without showering unnecessary tax subsidies on high-income households. Moreover, we propose to pair this policy with other changes that more than offset its cost to the federal budget while reducing the price of health care for taxpayers and patients alike.

THE PANDEMIC PTC MAKES THE ACA MORE REGRESSIVE AND EXPENSIVE 

The original PTC was created by the ACA in 2014 to ensure that Americans who did not receive health insurance from the government or their employer could still afford quality health insurance. The ACA established thresholds for affordable health insurance based on income: for an American at the Federal Poverty Level (FPL), that affordability threshold could be just 2% of their income, while a middle-income American could be asked to pay up to 10%. If the cost of a benchmark plan exceeded this affordability threshold, enrollees with household incomes below 400% of FPL would receive a premium tax credit to make up the difference, which they could use to purchase any insurance plan on the ACA’s individual marketplace exchanges.

Even before the pandemic, the PTC had been unintentionally expanded through the practice of “silver-loading.” Insurers raised the cost of their middle-tier “silver” plans, which serve as the benchmark plans for PTC calculations, even though costs for both cheaper “bronze” and premium-tier “gold” plans on the exchanges remained unchanged. This practice increased PTC payments across the board, meaning households shopping on the exchanges could purchase a higher-quality plan using a smaller share of their income than the affordability threshold dictated.

The American Rescue Plan Act (ARP) passed during the COVID-19 pandemic then made the PTC significantly more costly — and less progressive — by lowering the affordability threshold across the board and making all households eligible for the PTC regardless of income for 2021 and 2022. The Inflation Reduction Act (IRA) extended this pandemic PTC expansion for an additional three years, but the policy is set to expire at the end of this year.

On the positive side, the pandemic PTC expansion fixed one of the greatest problems with the original PTC, whereby recipients could lose several hundred dollars of tax credits if they earned just one dollar over the 400% of FPL eligibility limit. It also made health insurance significantly more affordable during a once-in-a-century pandemic in which many people faced the sudden loss of income and insurance, along with higher medical risk.

But the pandemic PTC was never designed as a thoughtful long-term policy. Median-earning households are now expected to pay only two-thirds what the original ACA intended them to pay for a benchmark plan, and households with income below 150% of FPL are expected to pay no premium whatsoever. Even worse, the combination of a low benchmark premium cap with no eligibility limitation results in very high-income households receiving subsidies that were never intended for them when the ACA became law. In New York City, for example, couples with no children earning 1,000% of FPL — more than double the original PTC’s eligibility limit — are currently eligible for a PTC of more than $3,000 per year.

Those costs all add up: today, the average annual subsidy for the 7% of Americans who are covered by ACA exchange plans is $6,600 per person. That’s more than three times the tax subsidy that benefits people with employer-sponsored insurance, who make up more than half the population. These costs were worth the benefits during a global public health emergency, but they make little sense to continue as permanent policy — especially since supporters never determined a way to pay for them at a time when the government is running $2 trillion annual budget deficits.

Yet Democrats have rallied around legislation to extend the pandemic PTC permanently, which would cost approximately $380 billion over the next 10 years. At a minimum, they — and even a few Republicans — have argued in favor of extending the expiring subsidies for one year at a cost of $23 billion. But nobody has offered a coherent rationale for why it would make more sense to phase down subsidies next year than this year, especially considering that it is a midterm election year. A one-year extension with no adjustments or strings attached now simply sets the stage for more extensions in the future as a backdoor attempt to make the policy permanent.

Democrats must move beyond the desire they’ve shown in recent years to reflexively extend expiring pandemic-era policies that were never designed as long-term solutions. There is a better approach that prevents sharp premium hikes for families and eases into a more sustainable long-term policy while permanently fixing the benefit cliff and leaving health care more affordable for families than it was before the ARP.

PPI proposes to gradually move towards a reworked PTC structure that is more progressive and fiscally sustainable than the pandemic PTC, yet more fair than the original ACA. In 2026, households with incomes under 300% of FPL should be eligible for the same enhanced subsidies created by ARP. But the affordability threshold should continue to rise for higher earners rather than being capped at 8.5%. This will result in higher-income households gradually receiving lower subsidies as their income rises, and will fully phase out subsidies at lower income levels than they do today.

Then, over the next two years, the beginning of the phase-in for higher affordability thresholds would gradually move from 150% of FPL in 2026 to 100% of FPL in 2028. This compromise offers free health insurance for families in poverty while requiring modest contributions from middle-income households that can afford it and tapers off support for high-income households that don’t need it. Policymakers can choose at this point whether they would make the new subsidy structure permanent or let voters decide its future in the 2028 elections. Based on modeling from the Committee for a Responsible Federal Budget, we estimate this proposal will cost roughly $200 billion over 10 years if made permanent, relative to allowing the pandemic PTC to expire at the end of this year.

CONGRESS MUST TACKLE THE REAL DRIVERS OF HEALTH COSTS

The other flaw with simply extending the pandemic PTC is that it doesn’t address the real problem of rising health-care costs, which have dramatically increased over time relative to the size of the economy. In 1963, health-care costs represented 5% of Gross Domestic Product (GDP). In 2025, they are projected to reach 18.5% of GDP. Today, the average cost of health care in the United States is estimated to be more than $16,500 per person, which historically has been nearly twice as much as the average cost of health care per person in other wealthy countries.

Expanding subsidies for a small slice of the population without tackling the drivers of high health-care costs will only fuel further price increases. When government assistance covers a larger share of premiums, insurers and providers face less pressure to control spending, allowing them to charge more knowing that taxpayers will pick up the bill. Prices climb in response, and costs to families and the federal budget escalate. It would therefore be both good policy and good politics to ensure that Americans who benefit from the PTC keep their health insurance while also confronting the structural reasons behind rising health-care costs.

Fortunately, there are smart reforms that policymakers can and should pair with any PTC expansion to both offset their cost to taxpayers and tackle the root causes of rising health-care costs. One place lawmakers should start is Medicare Advantage, which allows seniors to receive their Medicare benefits from private insurers rather than the federal government. While this program was originally intended to save money, it now costs taxpayers tens of billions of dollars per year because of loopholes that allow insurance companies to inflate their government reimbursements without increasing the quality of their care.

Through Medicare Advantage, insurance companies are paid based on the number of seniors they cover, plus an adjustment for enrollees’ “risk scores,” based on their health history. This mechanism was designed to compensate insurers for covering sicker, more expensive seniors. But insurers have manipulated the system through a practice called upcoding, which entails inflating patients’ risk scores with questionable diagnoses in order to make them appear sicker than they really are. Insurers use a variety of tactics to increase risk scores, including pushing patients to complete health risk assessments with company-employed providers and combing through patients’ medical records in chart reviews to look for diagnoses that doctors never reported.

In order to curb these overpayments, Congress should adopt key provisions from the bipartisan No UPCODE Act, introduced by Senators Cassidy (R-La.) and Merkley (D-Ore.). The first provision would block insurers from inflating risk scores with diagnoses from chart reviews and health risk assessments, unless they are confirmed in a medical setting, and the second would modify the risk adjustment formula to increase parity with traditional Medicare. Combined, these two changes would save $125 billion over 10 years, enough to offset more than half the cost of our PTC proposal. And if lawmakers went further to tackle all the causes of Medicare Advantage upcoding, they could increase their savings to $600 billion, enough to fully pay for our PTC and also begin to address our ballooning federal deficit. Forcing Medicare Advantage plans to boost profits through innovation rather than upcoding could unlock efficiencies from which non-Medicare patients could also benefit.

Expanding the use of site-neutral payments would tackle another perverse incentive currently built into Medicare. Every year, Medicare pays billions more for services performed in a clinic connected to a hospital than it does for similar services performed in a freestanding clinic. One report estimates that payments for preventative exams provided in a hospital outpatient department were 51% higher than payments provided in a freestanding physician’s office.

Since hospital systems still receive higher Medicare reimbursements when providing services in their lower-cost clinic settings, hospital systems are incentivized to buy up freestanding physicians’ offices so they can charge higher reimbursement rates. This swift trend toward consolidation and anti-competitive monopoly structure significantly increases costs to both taxpayers and patients, who are left with fewer cost-effective options for seeking care.

To address this problem, policymakers should work towards equalizing reimbursement rates between outside physician offices and hospital outpatient departments. CMS has some statutory authority to implement site-neutral payment policies and recently proposed ambitious reforms to advance site neutrality as well as other cost-saving measures for beneficiaries. But enacting legislation similar to a bipartisan bill introduced in 2023 would further expand site-neutral payments and could save taxpayers $175 billion over 10 years.

CONCLUSION

Instead of threatening to shut down the government over an outdated pandemic-era program, Democrats should be pressuring Republicans to meet them at a pragmatic middle-ground — one that permanently corrects the structural flaws of the original ACA in a fiscally responsible way. Doing so would signal to the American people that Democrats are serious about cutting medical costs rather than simply increasing government spending. PPI’s fix offers a balanced path forward: scale back the costly and regressive pandemic PTC expansion, smooth the benefit cliff, and pair any new spending with meaningful savings from reducing health-care costs. This combination of targeted assistance and real cost control would deliver more lasting affordability than another costly extension of overpriced subsidies.

This Week in RFK Jr.’s Vaccine Conspiracy Theories

Posted on by Alex Terr

Two high-profile meetings in Washington this week will shed light on Robert Kennedy Jr.’s controversial stewardship of the U.S. Department of Health and Human Services (HHS). Today, Sept. 17, Dr. Susan Monarez is appearing before the Senate HELP Committee to discuss her abrupt firing by Kennedy from her role as CDC Director last month. The hearing will be led by Senator Bill Cassidy (R-La.), a medical doctor and proponent of vaccines, who has begun to push back on Kennedy’s anti-vaccine actions at HHS. Then on Thursday and Friday, the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) will meet to discuss vaccine policy. This is the second meeting of ACIP since RFK Jr. fired all 17 members in June and replaced them with his handpicked appointees.

The thread connecting these two events is Secretary Kennedy’s crusade against vaccines, which is fueled more by conspiracy theories than science. His preference for quack medicine has gone far to discredit Kennedy’s Make America Healthy Again (MAHA) agenda in the eyes of public health professionals, if not President Trump.

That’s too bad, because MAHA contains some good ideas, such as working with companies to encourage healthier food and a comprehensive all-of-government approach to address the chronic disease epidemic, which has bipartisan support from Americans. Kennedy is aware of the popularity of these initiatives, which is why he is using MAHA as a Trojan horse to infiltrate his anti-vaccine, anti-science views into every federal health agency within HHS.

Despite his efforts, polls show that nearly 80% of Americans support requiring childhood vaccines. Moreover, Kennedy’s anti-vaccine theories clash with what is arguably the greatest achievement of Trump’s first term — Operation Warp Speed (i.e., the public-private partnership to accelerate the development of COVID-19 vaccines). A tightrope Kennedy has struggled to walk as Secretary of HHS.  

Kennedy initially praised Dr. Monarez, who was appointed by Trump and confirmed by the Republican Senate. However, she is expected to testify that Kennedy demanded she rubber-stamp any recommendations put through by his obliging new allies at ACIP. In an op-ed, Monarez predicted Kennedy would “discredit research, weaken advisory committees, and use manipulated outcomes to unravel protections” and generally seek to undermine the federal health review process.

Her testimony could put ACIP on the spot the next day. Historically, ACIP follows an evidence-to-recommendation framework, a targeted and transparent process of reviewing evidence to direct recommendations. However, observers expect the committee to abandon this framework when they review and update recommendations on previously well-vetted vaccines without receiving new evidence. If ACIP updates its guidance to better align with Kennedy’s inaccurate vaccine beliefs, as Dr. Monarez has predicted, it will make vaccines less accessible across the U.S., resulting in everyone being less healthy and safe.

The two events will illuminate Kennedy’s pernicious attempts to substitute crackpot theories for scientific rigor in determining the efficacy of vaccines. If Kennedy — and President Trump — get their way, it will likely prove injurious to the health of millions of Americans.

RFK Jr. Wants Us to Trust Health Tracking Devices and Apps. Should We?

Posted on by Alex Terr

As people are turning to health tracking devices and apps for understanding, tracking, and treating their health more than ever, current U.S. law has not evolved to protect this sensitive data. Despite this, Health and Human Services Secretary Robert F. Kennedy Jr. wants all Americans wearing health tracking devices by 2033, claiming it will improve health monitoring and detect disease earlier.

Wearables are any device worn by individuals to track health and activities. To function, these devices (e.g., smartwatches, fitness trackers) are connected to apps to allow a user to review their data. In addition, users can manually input data into apps. While wearable devices and their connected apps are already common in the U.S. and other countries, the scale of Kennedy’s plan raises serious data privacy and security concerns around how health data from these devices is collected, stored, and shared on their connected apps.

Many U.S. users are under the mistaken impression that health information collected through health tracking apps is protected by U.S. privacy laws. However, the main federal health privacy law, the Health Insurance Portability and Accountability Act (HIPAA), covers only health care providers, insurers, and their business partners. Commercial health apps fall outside HIPAA’s protection, which means they can legally collect and share user data ranging from daily steps to blood pressure to mental health diagnoses.

Without a national privacy law in place, it is unclear who controls and can use sensitive consumer data entered into these apps either manually or through a wearable device. For example, BetterHelp, a mental health and therapy app, was fined $7.8 million by the Federal Trade Commission (FTC) after it was found to have shared users’ sensitive mental health data with third-party advertising platforms, including Facebook and Snapchat. The FTC alleged BetterHelp violated §5 of the FTC Act for deceptive practices because the company assured customers their data would not be shared with third parties and conversations would be kept private.

In the European Union, the same platforms are held to stricter standards under the General Data Protection Regulation (GDPR). The GDPR, which many regard as unduly rigid, nonetheless holds organizations responsible for handling data, including requiring them to meet a lawful basis for processing data and being held accountable when not meeting these standards. For example, Fitbit, a widely used health tracking app connected to Google wearable devices, but is usable without a device, must receive explicit consent from users before processing health data.

U.S. law and regulatory policy have not been meaningfully updated to account for the rise of artificial intelligence and digital health technology. In 2021, Senator Jacky Rosen (D-Nev.) and Senator Bill Cassidy (R-La.) introduced the SMARTWATCH Data Act. The aim was to ensure health data collected by wearables through their connected apps would be protected under similar standards that apply to traditional health data. But the bill did not advance past committee.

Congress needs to create a federal framework to enforce data privacy before RFK Jr. moves forward with a national wearable initiative. Although the FTC has taken action against individual companies, fines on large companies are typically viewed as a slap on the wrist. Consumers need a new federal law to stop companies from collecting and selling data once wearable apps are downloaded. Wearables and their connected apps offer real benefits, such as early detection and long-term tracking of chronic conditions; however, privacy, consent, and data transparency must come first.

Without updated data laws, Americans will continue to be vulnerable to the misuse of their health data. Data such as fertility, heart rate, and sleep patterns will become a valuable, sellable commercial product to companies. This kind of mass data collection risks creating a system that prioritizes profit over user safety. The Trump administration should not pile more risk on consumers by failing to protect the privacy and security of health tracking devices and apps.

Ware for The Hill: Republicans are Making Boogeymen of Their Own Voters on Medicaid

Posted on by Max Sherrill

Republicans love their boogeymen; the grotesquely exaggerated villains they use to justify their worst policy ideas. President Trump loves to parade his favorite boogeymen: the “criminal aliens,” the dishonest media, the Democrats, and so on. These dehumanizing caricatures help him rile up his base and lead them to back his cruelest initiatives.

As the GOP-controlled Congress argues the merits of the cuts included in Trump’s “big, beautiful bill” act — which is deeply unpopular with voters — they’re discovering new boogeymen to deflect criticism.

Republicans are very defensive about their $1 trillion cut in Medicaid, which will deprive almost 12 million, mostly low-income and working-class Americans, of their health care coverage.

Keep reading in The Hill.

New PPI Report Finds GOP’s Medicaid Cuts Reckless and Wasteful

Posted on by Alex Terr

WASHINGTON — As President Trump’s “Big Beautiful Bill” moves through Congress, one section included in the legislation will not only skyrocket the cost of living for many working-class Americans, but will also impact how they receive critical care. As part of the One Big Beautiful Bill Act, Congressional Republicans are presenting an $880 billion cut to Medicaid that will kick more than 8.6 million Americans off the program and slash critical health care funding in the communities that need it most.

In a new report for the Progressive Policy Institute (PPI), Alix Ware, Director of Health Care Policy, argues that the proposed Medicaid cuts harm working Americans trying to make ends meet, force rural and underresourced hospitals to close, and push more people to rely on emergency rooms for routine care. Titled “The High Cost of Republican Medicaid ‘Savings,’” Ware’s research dives into how the GOP cuts don’t actually save Americans money or make the program more efficient, instead excluding people from getting the necessary health care they need to survive.

“These cuts aren’t about efficiency — they’re about shifting costs onto working families while giving the wealthiest Americans a tax break,” said Ware. “The bill adds bureaucracy, guts coverage, and penalizes states for innovation, all under the false promise of ‘savings.’”

Key takeaways from the report include how, in its current form, the One Big Beautiful Bill Act:

  • Removes 8.6 million Americans from Medicaid;
  • Threatens the stability of hospitals in rural or underserved communities, many which will have to close or reduce hours;
  • Creates harmful work requirements for many recipients who already meet the requirements to be eligible for the program;
  • Forces Americans to go to emergency rooms for routine visits that cost more money and make hospitals more inefficient, or forgo medical treatment altogether;
  • Eliminates state Medicaid expansion programs that have saved millions; and
  • Reduces access to preventative care as red tape makes it difficult to schedule the necessary appointments to get the help they need before it’s too late

Ware argues that instead of pursuing reckless cuts that restrict Medicaid coverage for those who need it most, Congress should focus on improving the program’s efficiency by eliminating unnecessary red tape — such as work requirements that most recipients already meet — and streamlining paperwork to save both time and money.  States, Ware says, have been at the forefront of Medicaid innovation, like Oregon and Maryland, where pragmatic legislators have controlled care costs and made it easier for people to access affordable care — reducing the need for costly emergency room visits for routine health issues.

“The U.S. health system is a complicated mess,” said Ware. “Instead of restricting health care for people who cannot afford it, lawmakers from both parties should seek bipartisan consensus on provisions that reduce inefficiencies while increasing access to coordinated and comprehensive care like Coordinated Care Organizations that reduce emergency room visits,  and the Total Cost of Care Model that lowered costs and improved the quality of care.”

Read and download the report here.

Founded in 1989, 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. Find an expert and learn more about PPI by visiting progressivepolicy.org. Follow us @PPI.

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Media Contact: Ian O’Keefe – iokeefe@ppionline.org

The High Cost of Republican Medicaid “Savings”

Posted on by Alex Terr

Congressional Republicans are disingenuously presenting their $880 billion Medicaid cut in the budget reconciliation bill as an enormous savings to Americans. But this cut in federal health care spending will have very different repercussions for all Americans, regardless of whether they have Medicaid, Medicare, or private insurance.

The GOP’s “one, big, beautiful bill” will kick 8.6 million Americans off Medicaid, leaving them no recourse but to forgo medical treatment or go to hospital emergency rooms — absolutely the most expensive way to deliver care in America. We know from experience that most will choose the emergency room if they have no insurance.

The Republican plan will also reduce access to health care when hospitals close, and worse health outcomes when people delay care. The National Rural Health Association warns that “drastic cuts…will force many rural facilities to reduce or cut service lines or close their doors entirely, impacting access to care for everyone who lives in the community.” If fewer people seek medical help in the early stages of an illness or injury for even a short period, diminished patient flows will put safety net hospitals at risk for closing. If these facilities close, many Americans, particularly in rural parts of the country that voted heavily for President Trump, will be harmed.

Some House Republicans were so concerned with the threat to “the viability of hospitals, nursing homes, and safety-net providers nationwide,” they sent a letter to House Republican leadership. The letter acknowledged, “Many hospitals — particularly in rural and underserved areas — rely heavily on Medicaid funding, with some receiving over half their revenue from the program alone. Providers in these areas are especially at risk of closure, with many unable to recover.” Despite these dire concerns, Trump demanded their compliance, and eventually they capitulated.

The U.S. is already an outlier compared to similarly wealthy countries, spending nearly double per capita on health expenditures than the average of other similar countries. Switzerland is the closest in per capita spending at $9,688 compared to the $13,432 the U.S. spends. The U.S. spends a larger percentage of its GDP on health expenditures as well. Despite spending so much more, the U.S. has lower life expectancy, higher age-adjusted mortality rate, and a higher premature death rate. In the U.S., 26.8 patients out of every 100 patients skip a medical appointment due to cost, compared to an average of 7.0 in comparable countries. It is unacceptable for the U.S. to be falling this far behind. Congress needs to address this gap, but kicking millions off of Medicaid is not the way to do it.

Instead of reforming the system to reduce inefficiencies and drive down costs, Republicans are imposing changes that will force the middle and working classes to pay more. Health care, a necessity that already eats up too much of the average working family’s income, is therefore slated to become even more expensive — all so the rich can enjoy a tax cut.

Read the full report.

Republicans Surrender the War on Cancer

Posted on by Alex Terr

As we near President Donald Trump’s July 4 goal to have his big, beautiful bill, there has been plenty of debate and pushback within the republican party regarding how to handle Medicaid and state and local tax (SALT) deductions. In stark contrast, Republicans — outside of Senator Susan Collins calling them “very troubling” — have been nearly silent regarding the president’s proposed cuts to the National Institutes of Health (NIH) and cancer research. It appears Republicans will acquiesce to the president on these cuts and, a half-century after President Richard Nixon declared a war on cancer, Republicans will surrender that war.

In 1937, the U.S. formally declared its intent to be a leader in cancer research when President Franklin D. Roosevelt signed the National Cancer Act, which created the National Cancer Institute (NCI). In the succeeding nearly 90 years, presidents and Congresses led by both Democrats and Republicans have recommitted to the promise of finding a cure for cancer. This consistent bipartisan support has created better diagnostic tools to find cancer sooner, a better understanding of how cancer metastasizes, and how to target different cancers. Since the early 1990s, the U.S. has made major strides in survival rates of cancer. In addition, the U.S. has increased access to palliative care to treat the whole person, not just the disease, and introduced concurrent care for children to ensure patients, families, and communities are supported through a cancer diagnosis. Much of these improvements in care were from U.S. innovation through partnerships between academic centers, life sciences companies, private foundations, and the federal government. The majority of the support is through funding from the NIH and NCI which has made the U.S. the international leader in funding cancer research.

Regardless of improved prognosis and better support, we are still in search of a cure for cancer so a diagnosis remains scary. The U.S. needs to continue to push forward with innovative treatments and research. However, President Trump has repeatedly committed to cutting science and innovation funding at the NIH, NCI, the Department of Health and Human Services, and the Centers for Disease Control and Prevention. This is in addition to the devastating and haphazard cuts to NIH grants by Elon Musk and DOGE. These federal cuts to cancer research have already stopped current research and will cause the U.S. to lose its place as the leader in cancer research. Where are the Congressional Republicans to push back on the cuts to NIH and NCI? Do they not realize this research helps all Americans, including them, their staff, and their constituents? Cancer does not discriminate based on political party, being a leader in cancer research is good for all Americans.

Representative Sean Casten (D-Ill.) recently spoke on the House floor about the federal cuts to research after hearing from a constituent whose son is fighting cancer. Casten was appropriately indignant when he stated: “Republicans fear Trump more than they fear cancer.” At first, this statement seems incredulous since cancer’s impact touches so many, it is hard to find an American who has not been impacted — whether experiencing it themselves, by their family, or in their community. Approximately 40% of people will be diagnosed with cancer in their lifetimes and, in 2024 alone, almost 15,000 children were diagnosed with cancer. Surely, Republicans do not fear losing their job more than cancer, right?

Although private foundations and the life science industries may increase their funding of cancer research, it will not be enough to make up for the nearly $8 billion the federal government provides. Nor will this replace the unique and necessary perspective of the federal government. So who picks up the mantle and leads in this space? On May 5, the European Union and France announced an over half-billion-dollar initiative to do just that. French President Emmanuel Macron and European Commission President Ursula von der Leyen announced the initiative would fund research and bring foreign scientists to Europe. American scientists have already signaled they are likely to take advantage of an opportunity like this. This investment as the U.S. divests from research is going to have devastating impacts on generations of Americans. Americans will no longer be the first to access groundbreaking treatment or better diagnostics and once scientists leave the U.S. for other opportunities it is going to take a herculean effort to convince them to return.

Waiting until 2026 or 2028 for a Congress or administration who believes in science again is not enough as every day nearly 5,500 Americans are diagnosed and 1,600 die from cancer. They need the trials and research to continue now and in their communities. For individuals enrolled in the trials stopped or delayed by Trump and DOGE, I imagine they would not say they “didn’t get anything out of it,” as Trump indicated. If Congressional Republicans acquiesce to Trump and further cut research, Representative Casten will be completely right about them fearing Trump and losing their job more than they fear cancer. They will have surrendered the war on cancer and that will be devastating for all Americans.

The Media’s Misguided Coverage of Smoke-Free Nicotine Products

Posted on by Alex Terr

Recent coverage regarding smoke-free nicotine products is more than just unfair – it’s irresponsible and damaging to public health. A recent story in the New York Post should be cheered by tobacco companies: its distortion of the facts will keep adult smokers using the most harmful nicotine delivery method – combustible cigarettes.

Unfortunately, this is par for the course when it comes to how the media covers cigarette alternatives such as nicotine pouches and heated tobacco products, which offer adults better options than continuing to smoke.

Critics of nicotine pouches often contend that they are not authorized by the U.S. Food and Drug Administration (FDA). This is false. The most popular nicotine pouch in the U.S., ZYN, recently received marketing authorization for all 20 of its products, including flavored varieties. In its January decision, the FDA noted that “these products offer greater benefits to population health” and “meet that bar by benefiting adults who use cigarettes and/or smokeless tobacco products and completely switch to these products.”

Another common misperception is that nicotine pouches are increasingly used by young people. But according to the U.S. Centers for Disease Control and Prevention’s latest National Youth Tobacco Survey, “youth nicotine pouch use did not show a statistically significant change from 2023” and remains low, at just 1.8 percent.

Heated tobacco products are another promising innovation that offer adults a better alternative to cigarettes. To be clear, IQOS is the only FDA-authorized heated tobacco product on the market in the U.S., and the agency acknowledges it significantly reduces the production of harmful chemicals compared to cigarette smoke.

Personally, I was a smoker with the lung capacity of someone 165 years old. I switched to heat-not-burn and now have the lung capacity of someone 50. Many other adult smokers have similar success stories – stories the media should cheer instead of sneer at.

The media has a responsibility to report the facts so the American public is fully informed about the realities of FDA-authorized smoke-free products, including their health benefits compared to smoking.

When the media fails to get the facts right, adult smokers pay the price. We can – and must – do better.

Why the U.S. Senate Should Reject RFK Jr.

Posted on by Max Sherrill

The nomination of Robert F. Kennedy Jr. to lead the Department of Health and Human Services comes at a pivotal moment for public health policy. Americans’ trust in public health institutions is at an all-time low, while the promise of rapidly advancing biotechnology is at an all-time high. 

It is unfortunate that Kennedy seems a poor steward of both. His vaccine skepticism seems designed to relitigate public health battles of the past, while his distrust of the medical profession and pharmaceutical companies could imperil new drug discovery and approval. While the right has long questioned federal health initiatives, Kennedy’s nomination — alongside a slate of other science skeptics in key health roles — augurs a more consequential change than a reshuffling of political appointees: the Republican Party has rejected modern science. The Senate should reject this nomination due to the clear harm Kennedy would do to the nation’s health.

Rapid advancements in biotechnology promise exciting innovation in pharmaceuticals, alongside enormous potential risks. This is especially true with the development of artificial intelligence tools for drug discovery.  This will be a pivotal time for the Food and Drug Administration, as the number of new drugs and novel therapeutics they have to approve dramatically increases. For example, the FDA made history in 2023 by approving the first CRISPR-based gene-edited drugs to treat sickle cell anemia. The agency will have to innovate and modernize to keep up with scientific developments.

It’s also an important moment for public health. In the wake of the COVID pandemic, trust in government health agencies has eroded. Partisanship has infected discussions of public health as climate change and dual-use technologies exacerbate the risk of future pandemics. Other than some modest internal reform at the Centers for Disease Control, the Biden administration did not give priority to fixing the structural issues that led to a shaky initial federal government response to COVID.  Rebuilding public trust while balancing future pandemic risk would be a challenge for any incoming administration. 

Unfortunately, Robert F. Kennedy Jr. is ill-suited to fulfill his department’s critical dual mandate to advance biomedical innovation while protecting Americans from disease. Kennedy’s unfounded skepticism of vaccines leaves America in danger of missing out on breakthrough drugs and treatments while leaving us vulnerable to diseases of the past. His strong opposition to the weight loss drug Ozempic also betrays a reflexive anti-progress attitude poorly suited to the coming acceleration of drug development.  Kennedy also seems uninterested in future pandemic prevention, reportedly saying,  “We’re going to give infectious disease a break for about eight years.”  

Kennedy’s anti-vaccine activism warrants particular attention, given its grave real-world consequences. During a 2019 measles outbreak in Samoa that left 83 people dead, Kennedy’s organization, Children’s Health Defense, helped spread misinformation that contributed to vaccination rates dropping from 60% to 31%. Though Kennedy later claimed he “had nothing to do with people not vaccinating in Samoa,” he had visited the country months before the outbreak, supporting local anti-vaccine activists and suggesting the vaccine itself might be responsible for the deaths.  Children’s Health Defense also funded the viral conspiracy film “Plandemic,” which falsely claims that influenza vaccines can cause COVID, and that the virus was somehow “manipulated.” That’s in line with his musings that COVID may have been deliberately engineered to target “Caucasians and Black people” while sparing “Ashkenazi Jews and Chinese.”

Kennedy may have a public health crisis waiting for him if he is confirmed.  The United States currently faces its largest-ever outbreak of H5N1 bird flu:57 people and 689 herds of cows have tested positive for the virus. The most troubling news from the ongoing outbreak is the two patients, a man in Missouri and a child in California,  who tested positive without any known ties to infected animals. A bird flu pandemic could cause catastrophic harm, and the speed and transparency of the current response do not induce confidence.  Kennedy is poorly suited to lead this response given his promotion of raw milk consumption, which is currently being recalled for contamination with extremely high levels of bird flu virus.  

Some of Trump’s other health nominations have similar involvements with pseudoscience.  Like Kennedy, Dr. David Weldon, Trump’s nominee for CDC director, believes the measles vaccine causes autism.  Dr. Mehmet Oz, the president-elect’s nominee for the Centers for Medicare & Medicaid Services, has a well-documented history of promoting questionable medical treatments and products on his television show. A 2014 study in the British Medical Journal found that nearly half of his medical recommendations either lacked evidence or contradicted medical research.

Anti-vaccine paranoia on the right predates Trump. State legislatures, particularly in Republican-governed states, have already expanded vaccine exemptions and limited public health powers over the past decade, while Project 2025 proposed paying damages to all medical professionals who were dismissed due to the CMS vaccine mandate, effectively undermining established public health protocols and potentially setting a dangerous precedent for future health crises. It also calls for expanding federal religious exemptions for both taking and administering vaccines.

 Trump has proved reluctant to tout the main health policy success of his first term: Operation Warp Speed. A Progressive Policy Institute report found that the COVID vaccines saved 2.9 million lives, avoided 12.5 million hospitalizations, and saved $500 billion in hospitalization costs. This was an enormous success of government collaboration with the private sector, and it is very telling that the former president is shying away from claiming this victory. 

The nomination of Robert F. Kennedy Jr. isn’t just a concerning personnel decision — it represents a dangerous turning point in American politics. While vaccine skepticism and distrust of medical institutions have long simmered on the fringes, their embrace by a major political party marks a stark departure from evidence-based public health policy. This rejection of scientific consensus comes at a particularly perilous moment: as we face evolving threats from bird flu, climate change, and emerging pathogens, while simultaneously standing on the cusp of revolutionary biotechnology breakthroughs. The Senate must reject this nomination to protect our public health institutions at this critical moment for America’s scientific future.

New PPI Report Proposes Solutions to Reduce Health Care Costs for Working Americans

Posted on by Alex Terr

WASHINGTON — As the 2024 U.S. presidential election draws near, high health care costs remain a top concern for voters without a four-year degree. A new report from the Progressive Policy Institute (PPI), “A Comprehensive Plan to Lower Health Costs Without Reducing Coverage,” outlines a set of innovative reforms to reduce health care costs for working Americans.

This new publication is a key output of PPI’s Campaign for Working America, launched earlier this year in partnership with former U.S. Representative Tim Ryan of Ohio. The Campaign aims to develop and test new themes, ideas, and policy proposals that help Democrats and other center-left leaders make a compelling economic offer to working Americans, bridge divides on cultural issues like health care, immigration, and education, and rally public support for the defense of democracy and freedom globally.

As part of PPI’s Campaign for Working America, this report, authored by Erin Delaney, PPI’s Director of Health Care Policy, addresses the growing affordability crisis in health care and offers a range of policy solutions to lower costs for working families. According to a recent YouGov poll commissioned by PPI, rising medical bills are a critical financial worry for voters without college degrees, with health insurance, hospital costs, and prescription drugs cited as the most significant burdens. Delaney highlights that high prices, exacerbated by an inefficient fee-for-service model, have made health care inaccessible for many working-class Americans.

“Health care costs are outpacing inflation, putting significant strain on household budgets,” said Delaney. “Our recommendations focus on targeted reforms that will make health care more affordable while ensuring families have access to the care they need.”

Capping prices for out-of-network care based on Medicare rates to curb excessive charges and lower premiums, ensuring site-neutral payments to eliminate discrepancies in costs between different care settings, banning anti-competitive practices like “pay-for-delay” and “evergreen patents” to improve access to affordable generic drugs, and expanding telehealth services under Medicare to provide more convenient, cost-effective care for working families.

Delaney emphasized that addressing the structural drivers of medical inflation is essential to keeping health care costs in check: “Without bold reforms, health care costs will continue to rise, further squeezing working families.”

The report also explores solutions to improve maternal health, expand the nursing workforce, and support reproductive health services, ensuring comprehensive care for all Americans.

Read and download the report here.

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.

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Media Contact: Ian O’Keefe – iokeefe@ppionline.org

A Comprehensive Plan to Lower Health Costs Without Reducing Coverage

Posted on by Alex Terr

Campaign for Working America PPI

Introduction

The U.S. economy is growing at a healthy clip, but working Americans continue to identify high prices and living costs as their chief economic worry in this crucial election year. According to a recent YouGov poll commissioned by PPI, soaring medical bills are a top financial concern for voters without college degrees. Asked specifically which health care costs hit them hardest, they say health insurance, hospitals and drugs.

According to a 2023 report from the Centers for Medicare & Medicaid Services (CMS), health care spending increased by 4.8% in 2022, outpacing the 3.2% rise in the Consumer Price Index (CPI), which measures inflation. This disparity underscores the worsening affordability crisis in health care, where the cost of medical services, including hospital visits, prescription drugs, and insurance premiums, is escalating more rapidly than general living costs. Consequently, households are feeling the pinch as a larger portion of their budgets is consumed by health care expenses, leaving less room for other essential needs.

Every dollar that is spent on out-of-pocket medical costs is a dollar less to pay for food, gas, and other household necessities. Three out of every four families report they are worried about being able to afford unexpected medical bills, which have left millions of households collectively shouldering more than $200 billion in medical debt. Anxiety about household expenses is especially acute in households making less than $40,000 annually, leading families to prioritize pressing financial needs over preventive or routine medical care.

Voters generally have greater trust in the Democratic Party than the Republican Party when it comes to managing high health care costs and ensuring access to abortion services. Surveys consistently indicate that a majority of voters trust Democrats more when it comes to reproductive health and reducing health care expenses.

During her debate with former President Donald Trump, Vice President Kamala Harris committed to capping insulin prices, limiting patient cost-sharing for generic drugs, and expanding Medicare’s authority to negotiate drug prices. She also vowed to protect and enhance the Affordable Care Act (ACA), promising to make permanent the Biden-Harris administration’s enhanced tax credits, which have lowered premiums by an average of $800 annually for millions of Americans.

Despite his repeated failures to convince Congress to repeal the ACA during his presidency, Trump in the debate vowed again to replace it with “something better.” When pressed for specifics, however, he could only reference a vague “concept of a plan,” nearly a decade after his initial promise to provide a viable alternative. Over that period, public support for the ACA has risen dramatically, from 38% to 62%, according to polling by KFF.6 Nonetheless, Congressional Republicans are still trying to weaken the law by pushing for the elimination of enhanced tax credits passed during the COVID-19 pandemic. This would mean higher premiums for working Americans with modest incomes.

Trump also is trying to distance himself from the public backlash against the Supreme Court’s decision striking down abortion rights. Since the Court overturned Roe v. Wade in June 2022, Republican-controlled states enacted laws that either ban abortion outright or impose strict restrictions on access to reproductive health care, affecting 25 million women. This shift has resulted in a patchwork of laws, with many states erecting significant barriers to abortion access. Consequently, millions of American women are at risk of not receiving timely reproductive health care.

Beyond restricting abortion access, the impact of the Roe decision has complicated life for women seeking maternal care services. Many hospitals in states with stringent abortion laws have closed their maternity wards or significantly reduced maternal health services in response to legal challenges from right-wing politicians and pressure groups. Tragically, this led to the death of Amber Thurman, a 28-year-old nursing assistant and mother of a six-year-old son who succumbed to an infection after medical providers delayed care for the effects of a medication abortion in a state with such a ban, according to an investigation by ProPublica.

Maternal mortality review committees, like the one in Georgia that examined this case, typically operate with a two-year delay in reviewing the cases they investigate. As a result, experts are only now beginning to assess deaths that occurred after the Supreme Court’s ruling. As this data is reviewed and released, more such stories are likely to emerge.

Having stacked the Supreme Court with antiabortion ideologues, Trump now offers the ludicrous defense that Americans — who strongly supported the national right to abortion established by Roe — were clamoring for states to decide whether abortion should be legal. He now claims to support exceptions to abortion bans for rape and incest, drawing fire from outraged Christian conservatives who’ve accused him of political opportunism. Trying to avoid another minefield, the former president has also declared himself a “leader in fertilization” and proposed mandating free access to in vitro fertilization (IVF). Congressional Republicans, however, have blocked the Right to IVF Act.

Harris has vowed to push for national legislation restoring Americans’ reproductive rights; assuring access to contraception; and safeguarding families’ rights to access IVF if they can’t have children on their own. She also promised to continue to advocate for access to FDA-approved abortion drugs and select judges who uphold reproductive freedom.

In addition, Harris’ proposals provide a promising foundation for lowering medical bills for working families. But Democrats should be thinking about a bolder, more comprehensive attack on the structural drivers of medical inflation, which makes the U.S. health care system by far the most expensive in the world. In this report, PPI offers a radically pragmatic slate of new ideas for assuring access to providers, driving down medical prices, and improving health care outcomes for working Americans.

Read the full report.

Harris’ Pledge: Affordable Health Care and Reproductive Rights

Posted on by Max Sherrill

Health care costs and reproductive health were key topics in Tuesday night’s debate. Vice President Harris presented concrete solutions for managing costs — such as addressing insulin and prescription drug prices and strengthening the ACA — while criticizing Trump for failing to deliver an alternative to the ACA despite promises since 2016. Additionally, Harris delivered impactful critiques by emphasizing Trump’s central role in undermining American women’s reproductive rights. This focus is particularly relevant, given the ongoing strain of high health care costs on American households and Trump’s continued efforts, alongside Republicans, to undermine reproductive health.

A recent Progressive Policy Institute poll reveals that working-class Americans are deeply concerned about soaring health care costs, which they largely blame on drug manufacturers, insurance companies, and hospitals. Key issues include opaque hospital pricing and high drug prices. In response, Harris has pledged to address these concerns as part of her health care platform, which was highlighted in the debate. Her proposals include capping insulin prices, limiting cost-sharing for generic drugs, and expanding Medicare’s ability to negotiate drug prices.

Harris’s evolution from support for Medicare for All to these more prosaic concerns is welcome.  This pragmatic approach is likely due to the political decision to tamper the announcement of any major policy reform that would be targeted by the Trump campaign. Harris intends to instead protect and bolster the Affordable Care Act (ACA), along with making the Biden-Harris tax credit enhancements permanent, which are reducing health care premiums by an average of around $800 annually for millions of Americans.

Meanwhile, Trump’s inconsistent stance on repealing and replacing the ACA underscores his lack of seriousness and leadership on the issue, as evidenced by his vague statement during the debate: “I have a concept of a plan” to address or alter the law. Thanks to the ACA, a record percentage of Americans (92%) have access to health insurance. The Biden-Harris admin made an important contribution to this achievement by including enhanced subsidies for the ACA marketplace in its landmark Inflation Reduction Act. A record 21 million people enrolled through the ACA this year alone, reducing the uninsured rate from 16% in 2010 to under 8% today. But health care costs remain exorbitantly expensive, forcing working families to reprioritize their immediate financial needs over preventive or ongoing medical care.

Meanwhile, reproductive health care access remained a critical focus for Harris throughout the debate, as she vowed to reinstate Americans’ reproductive rights that were undermined when Trump’s Supreme Court justices overturned Roe v. Wade. Harris promised to seek national legislation to restore the legal right to abortion; enhance access to contraception; safeguard a woman’s right to access IVF, and repeal the Hyde Amendment. She also promised to continue to advocate for access to FDA-approved abortion drugs and select judges who uphold reproductive freedom.

Trump proved once again that he and the Republican Party are completely out of touch with working-class Americans who are increasingly distressed about the state of abortion access since the end of Roe. Refuting his record and providing faltering answers on reproductive access, Harris swung back, reiterating that Trump should “not be telling a woman what to do with her body.”

In PPI’s Winning Back Working America poll, 56% of participants said they are concerned about abortion access. Trump’s relentless effort to curtail access to reproductive health care is directly opposed to the majority of Americans’ wishes, eroding the foundation of democracy and their personal liberty. Harris and Democrats are aptly appealing to working-class voters, including Independents and Republicans, who are anxious about the fragile state of access to reproductive care in the 2024 election and beyond.

Harris’ focus on reducing health care costs and enhancing reproductive health access in the debate and in her campaign represents a refreshing shift that addresses the concerns of working-class voters. Even those with coverage often encounter substantial out-of-pocket expenses. Similarly, despite some states protecting reproductive freedom, individuals still face barriers and threats from Trump and Republicans seeking to undermine these protections. Harris and Democratic lawmakers present a promising vision for working Americans seeking relief from harmful Republican policies that threaten to increase costs and reduce access to care.

Listen up Democrats: Don’t Forget Health Care

Posted on by Max Sherrill

In 1992, James Carville coined his famous phrase, “It’s the economy, stupid.” Inside the Clinton campaign, a laser-like focus on economic issues resonated deeply with voters grappling with a recession they attributed to the policies of George H.W. Bush. Carville’s focus ultimately propelled Clinton to victory. But that famous slogan was only one of three key messages on which the Clinton campaign focused. The lesser-known others were “Change vs. more of the same” and “Don’t forget health care.”

As Democrats gear up for the upcoming elections, it’s clear that voters have a lot on their minds. Recent swing state polling data, commissioned by the Progressive Policy Institute, sheds light on what’s really driving voter concerns. The full poll results and an accompanying memo present a golden opportunity for Democrats to solidify their standing as the party of pragmatic solutions for Americans’ concerns on the economy and where voters believe healthcare costs have run amok.

Let’s face it: The economy is top of mind for most voters. Inflation and the skyrocketing costs of food and housing are causing serious anxiety across the board. This trend cuts across all demographics, signaling a pressing need for an effective economic strategy accompanied with a simple message that voters can understand. Democrats have long struggled in the past to win over voters on economic issues, but there’s a real chance to change that narrative by tackling these concerns head-on.

When it comes to health care policy in general, voters generally trust Democrats to handle the policy. Half of the voters trust Democrats more on setting policy related to the price of prescription medications, compared to 40% who trust Republicans. Democrats are also seen as more reliable when it comes to ensuring U.S. drug makers continue to innovate and develop new treatments. And with abortion rights under threat, Democrats will again mobilize voters as they vow to protect access to abortion, contraception, and women’s health care priorities.

Looking specifically at health care costs, while important, they rank third on the list of costs that are most concerning to voters — well below food and housing. A total of 13% of respondents named health care costs as their most pressing concern, compared to 22% who said food and another 19% who pointed to housing costs This suggests that while health care costs remain critical, Democrats need to balance their focus with broader economic policies to truly resonate with the electorate.

The poll then delves into health care costs more specifically. The cost of health insurance is by far the biggest worry, with 28% of voters citing it as their top issue. Out-of-pocket costs and the expense of doctors and hospitals are also major concerns, particularly among Republicans and non-college white voters. While capping the cost of key prescription drugs like insulin is a popular move and common talking point by Democrats on the campaign trail, only 8% of voters think Congress should prioritize expanding Medicare negotiations for more medicines. Voters are much more concerned about the overall cost of health insurance and are looking for more from their leaders on this challenge.

Additionally, the poll highlights several other policy areas that voters prioritize. When asked about the most important policy priorities for the party that controls Congress next year, a significant 30% of voters want to see more investment in manufacturing, energy production, and other industries. Another 24% support increased IRS action to ensure billionaires and millionaires pay their fair share of taxes. These priorities show that voters are looking for comprehensive economic strategies that extend beyond health care.

The poll’s findings underscore the need for strategic messaging that balances health care costs and more pressing economic priorities. When crafting their pitch, Democrats should consider:

• First and foremost, emphasizing broader economic policies that address inflation, housing, and food costs, which align with voters’ top concerns.

• Advocating for investment in manufacturing and fair taxation policies, which resonate strongly with key voter demographics and are more top of mind than health care costs.

• Refocusing the primary message on health care costs to address the cost of health insurance message, rather than solely the cost of prescription drugs, in order to better match voter priorities.

By adopting a balanced approach that addresses both healthcare and broader economic issues, Democrats can effectively connect with voters and reinforce their position as practical leaders committed to addressing the most pressing concerns of the American people.

Paying for Progress: A Blueprint to Cut Costs, Boost Growth, and Expand American Opportunity

Posted on by The Progressive Policy Institute

The next administration must confront the consequences that the American people are finally facing from more than two decades of fiscal mismanagement in Washington. Annual deficits in excess of $2 trillion during a time when the unemployment rate hovers near a historically low 4% have put upward pressure on prices and strained family budgets. Annual interest payments on the national debt, now the highest they’ve ever been in history, are crowding out public investments into our collective future, which have fallen near historic lows. Working families face a future with lower incomes and diminished opportunities if we continue on our current path.

The Progressive Policy Institute (PPI) believes that the best way to promote opportunity for all Americans and tackle the nation’s many problems is to reorient our public budgets away from subsidizing short-term consumption and towards investments that lay the foundation for long-term economic abundance. Rather than eviscerating government in the name of fiscal probity, as many on the right seek to do, our “Paying for Progress” Blueprint offers a visionary framework for a fairer and more prosperous society.

Our blueprint would raise enough revenue to fund our government through a tax code that is simpler, more progressive, and more pro-growth than current policy. We offer innovative ideas to modernize our nation’s health-care and retirement programs so they better reflect the needs of our aging population. We would invest in the engines of American innovation and expand access to affordable housing, education, and child care to cut the cost of living for working families. And we propose changes to rationalize federal programs and institutions so that our government spends smarter rather than merely spending more.

Many of these transformative policies are politically popular — the kind of bold, aspirational ideas a presidential candidate could build a campaign around — while others are more controversial because they would require some sacrifice from politically influential constituencies. But the reality is that both kinds of policies must be on the table, because public programs can only work if the vast majority of Americans that benefit from them are willing to contribute to them. Unlike many on the left, we recognize that progressive policies must be fiscally sound and grounded in economic pragmatism to make government work for working Americans now and in the future.

If fully enacted during the first year of the next president’s administration, the recommendations in this report would put the federal budget on a path to balance within 20 years. But we do not see actually balancing the budget as a necessary end. Rather, PPI seeks to put the budget on a healthy trajectory so that future policymakers have the fiscal freedom to address emergencies and other unforeseen needs. Moreover, because PPI’s blueprint meets such an ambitious fiscal target, we ensure that adopting even half of our recommended savings would be enough to stabilize the debt as a percent of GDP. Thus, our proposals to cut costs, boost growth, and expand American opportunity will remain a strong menu of options for policymakers to draw upon for years to come, even if they are unlikely to be enacted in their entirety any time soon.

The roughly six dozen federal policy recommendations in this report are organized into 12 overarching priorities:

I. Replace Taxes on Work with Taxes on Consumption and Unearned Income
II. Make the Individual Income Tax Code Simpler and More Progressive
III. Reform the Business Tax Code to Promote Growth and International Competitiveness
IV. Secure America’s Global Leadership
V. Strengthen Social Security’s Intergenerational Compact
VI. Modernize Medicare
VII. Cut Health-Care Costs and Improve Outcomes
VIII. Support Working Families and Economic Opportunity
IX. Make Housing Affordable for All
X. Rationalize Safety-Net Programs
XI. Improve Public Administration
XII. Manage Public Debt Responsibly

Read the full Blueprint. 

Read the Summary of Recommendations.

Read the PPI press release.

See how PPI’s Blueprint compares to six alternatives. 

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