issue: Health Care

A Radically Pragmatic Vision for Universal Health Care

Posted on by The Progressive Policy Institute

When it comes to health care, Americans could not face a clearer choice. Progressives believe all Americans should have access to affordable, high-quality health coverage. Republicans want to kill the Affordable Care Act – thereby depriving an additional 17 million Americans of insurance – and have no credible plan to replace it. Too often, however, the health care debate focuses on how to pay for health insurance rather than how to deliver better health care.

PPI believes producing better outcomes at lower prices must be the first principle of health care reform, and share a vision for health care reform in Des Moines, Iowa on Friday, April 12th. 

 

 

Kane for Medium: “Trump’s trail of broken promises on health care”

Posted on by The Progressive Policy Institute

On the campaign trail, Donald Trump promised no cuts to Medicaid, that he would protect those with preexisting conditions, and that everyone would have insurance under his new health care plan.

He has broken every one of those promises over the last two years. What’s more, the White House campaign to sabotage the Affordable Care Act (ACA) sparked a voter backlash that cost Republicans dearly in last year’s midterm election.

The president apparently has learned nothing from that rebuff. Having failed to pass legislation to kill the ACA, the administration is now turning to judicial activism and the courts. The Department of Justice (DOJ) announced yesterday that it is endorsing a Texas court ruling striking down the entire ACA.

 

Read the full piece on Medium by clicking here.

Price gouging bills miss the mark

Posted on by The Progressive Policy Institute

A bill working its way through the Minnesota state legislature would prohibit drugmakers from “price gouging” for essential prescription drugs. The law seeks to end some pretty egregious behavior by bad actors in the biopharmaceutical industry.

Like any industry, the drug industry has its share of bad actors. The loathsome “pharma bro” Martin Shkreli is now serving time in prison after his company, Turing Pharmaceuticals, increased the cost of a lifesaving AIDS drug by 5,000 percent. And one pharma executive has defended prices increases as a “moral requirement to sell the product at the highest price.” These examples of price-gouging, and more, are inexcusable.

In response, states have been looking for ways to curb this type of behavior. Maryland passed a first-of-its-kind anti-price gauging law. The law sought to stop drugmakers from hiking generic drug prices in an “unconscionable” way as determined by the state. It allowed the state attorney general to sue the makers of off-patent and generic drugs for particularly egregious price increases that could not be justified by new production or distributing costs.

However, the law has since been challenged in court and a federal appeals court ruled that it violated the commerce clause of the constitution because it forced manufacturers and wholesalers to act in accordance with Maryland law outside of the state. The Supreme Court decided not to take up the appeal, so the lower ruling stands.

Now a similar law is under consideration in Minnesota. SF 1518 would authorize the state to publish a list of “essential” generic or off patent drugs, defined as drugs which treat “a life-threatening health condition or a  chronic health condition that substantially impairs an individual’s ability to engage in  activities of daily living.” In other words, almost every drug. If a manufacturer increased the drug price more than 50 percent within a year without legitimate market considerations to substantiate the price increase, it would allow the Board of Pharmacy to take disciplinary action against the manufacturers or wholesale distributors. This law may end up having the same legal trouble as the Maryland one.

While intended to protect consumers, this law would add another level of bureaucracy to the already challenging and low-margin generic drug market. The passage of various state-level drug pricing laws may be counterproductive – with lawsuits challenging the legality of each one, conflicting rules, and a patchwork system across states, smaller companies or generic producers with small margins may find it too expensive to participate in the market.

As a result, as Michael Mandel and Elliott Long argued in a paper published last year by PPI,  state price gouging and drug transparency laws may end up raising health care costs, which is not what the sponsors want at all. Indeed, state legislators are focusing too much on pharmaceutical prices and not enough on other drivers of health care costs: hospitals and providers.

Ritz for Forbes, “Donald Trump’s Budget For A Declining America”

Posted on by The Progressive Policy Institute

After the president’s budget was released on Monday, House Budget Committee Chairman John Yarmuth (D-KY) called it “A Budget for a Declining America.” Unfortunately, that might be an understatement.

The Trump administration’s Fiscal Year 2020 budget proposal is a compilation of the worst ideas to come out of the Republican Party over the last decade. It would dismantle public investments that lay the foundation for economic growth, resulting in less innovation. It would shred the social safety net, resulting in more poverty. It would rip away access to affordable health care, resulting in more disease. It would cut taxes for the rich, resulting in more income inequality. It would bloat the defense budget, resulting in more wasteful spending. And all this would add up to a higher national debt than the policies in President Obama’s final budget proposal.

The most harmful aspect of Trump’s fiscal blueprint is its scheme for gutting investments in public goods that are core responsibilities of government. The administration proposes to reduce the share of gross domestic product devoted to non-defense (domestic) discretionary spending – the category of the budget that is annually appropriated by Congress and includes most federal spending on infrastructure, education, and scientific research – by more than half over the next decade. The result is deep cuts to all three of these important investments that provide the foundation for long-term economic growth.

Continue reading at Forbes.

 

 

Trump Gets It Half Right on PBMs

Posted on by The Progressive Policy Institute

In searching for ways to satisfy public demand for lower drug prices, President Trump has found rare common ground with Democrats. The White House recently released a plan to reform the way pharmacy benefit managers (PBMs) negotiate prices with drugmakers on behalf of health insurance companies. Specifically, the proposal takes aim at special discounts or rebates negotiated by PBMs that create a perverse incentive for drugmakers to push up the list price of their products.

The idea is to get rid of these incentives in order to bring down drug prices, which would mean lower out-of-pocket expenses for patients. Democrats like Senator Ron Wyden have long pushed for changes to the rebate structure. However, Trump’s plan has drawn fire from critics who say it could become a boon for big drug companies by shifting more costs to the federal government. The truth is, the rebate proposal is a good first step to help Medicare beneficiaries at the drug counter; but, without further action to increase transparency around drug pricing and encourage competition, costs could be shifted from drug companies to taxpayers.

 

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

Posted on by The Progressive Policy Institute

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

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

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

 

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

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

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

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

More beneficiaries could benefit from increased access to telehealth.

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

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

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

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

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

Telehealth could reduce costs.

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

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

 

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

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

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

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

 

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

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

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

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

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

 

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

 

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

 

ENDNOTES

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

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

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

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

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

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

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

8) Ibid.

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

Telehealth and vision tests in Washington State

Posted on by The Progressive Policy Institute

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

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

 



			


	

			




			
				


	

		
Republican sabotage is working: Uninsured rate ticks upward

				

			Posted on  by The Progressive Policy Institute		

			


	

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


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


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


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


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


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


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


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


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


    

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

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

  • Helping small businesses afford comprehensive health care coverage
    • 

  • Increasing price transparency throughout the health care system
    • 



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


			


	

			




			
				


	

		
PPI Launches Series of New Ideas for a ‘Do-Something’ Congress

				

			Posted on  by The Progressive Policy Institute		

			


	

		
Dear Democratic Class of 2018,


Congratulations on your election to the U.S. House of Representatives! In addition to winning your own race, you are part of something larger – the first wave of a progressive resurgence in U.S. politics.


The midterm elections gave U.S. voters their first opportunity to react to the way Donald Trump has conducted himself in America’s highest office. Their verdict was an emphatic thumbs down. That’s an encouraging sign that our democracy’s antibodies are working to suppress the populist virus of demagoguery and extremism.


Now that Democrats have reclaimed the people’s House, what should they do with it? Some are tempted to use it mainly as a platform for resisting Trump and airing “unapologetically progressive” ideas that have no chance of advancing before the 2020 elections. We here at the Progressive Policy Institute think that would be huge missed opportunity. 


If the voters increasingly are disgusted with their dissembling and divisive president, they seem even more fed up with Washington’s tribalism and broken politics. For pragmatic progressives, the urgent matter at hand is not to impeach Trump or to embroil the House in multiple and endless investigations. It’s to show Democrats are determined to put the federal government back in the business of helping Americans solve their problems.


We think the House Democratic Class of 2018 should adopt this simple mantra: “Get things done.” Tackle the backlog of big national problems that Washington has ignored: exploding deficits and debt; run-down, second-rate infrastructure; soaring health and retirement costs; climate change and more. And yes, getting things done should include slamming the brakes on Trump’s reckless trade wars, blocking GOP efforts to strip Americans of health care, as well as repealing tax cuts for the wealthiest Americans.


PPI, a leading center for policy analysis and innovation, stands ready to help. We’re developing an extensive “Do Something” Agenda. Today, we are releasing the first in a series of concrete, actionable ideas designed expressly for Democrats who come to Washington to solve problems, not just to raise money and smite political enemies.


As you get settled into your new office, we’ll look for opportunities to acquaint you and your staff with these pragmatic, common-sense initiatives, and to discuss other ways we might be of service to you. That’s what we’re here for.


Regards,




 


 


Will Marshall

President

Progressive Policy Institute




New Ideas for a Do-Something Congress No. 1: “A Check on Trump’s Reckless Tariffs”


First and foremost, it’s time for Congress to start doing its job on trade. A key step is enacting the Trade Authority Protection (TAP) Act. This balanced legislation would rein in Trump’s abuse of delegated trade powers, require greater presidential accountability, and enable Congress to nullify irresponsible tariffs and trade restrictions.




A Radically Pragmatic Idea for the 116th Congress: Take “Yes” for an Answer on Net Neutrality




For the last two decades, different versions of net neutrality have bounced between Congress, the Federal Communications Commission, the courts – and most recently the states – but the issue remains unresolved.


It is time for Congress to solve this problem for good by enacting a strong, pro-consumer net neutrality law – an outcome that is politically possible even in this era of maximalist gridlock and deeply divided government, given the broad consensus that has formed around the vital issue of ensuring an open internet.




New Ideas for a Do-Something Congress No. 2: “Jumpstart a New Generation of Manufacturing Entrepreneurs”


The number of large U.S. manufacturing facilities has dropped by more than a third since 2000, devastating many communities where factories were the lifeblood of the local economy.


One promising way to revive America’s manufacturing might is not by going big but by going small – and going local. Digitally-assisted manufacturing technologies, such as 3D printing, have the potential to launch a new generation of manufacturing startups producing customized, locally-designed goods in a way overseas mega-factories can’t match. To jumpstart this revolution, we need to provide local manufacturing entrepreneurs with access to the latest technologies to test out their ideas. The Grassroots Manufacturing Act would create federally-supported centers offering budding entrepreneurs and small and medium-sized firms access to the latest 3D printing and robotics equipment.




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


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


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




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


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


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


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




New Ideas for a Do-Something Congress No. 5: Make Rural America’s “Higher Education Deserts” Bloom


As many as 41 million Americans live in “higher education deserts” – at least half an hour’s drive from the nearest college or university and with limited access to community college. Many of these deserts are in rural America, which is one reason so much of rural America is less prosperous than it deserves to be.


The lack of higher education access means fewer opportunities for going back to school or improving skills. A less educated workforce in turn means communities have a tougher time attracting businesses and creating new jobs. Congress should work to eradicate higher education deserts. In particular, it can encourage new models of higher education – such as “higher education centers” and virtual colleges – that can fill this gap and bring more opportunity to workers and their communities. Rural higher education innovation grants are one potential way to help states pilot new approaches.




New Ideas for a Do-Something Congress No. 6: Break America’s Regulatory Log-jam


Regulation plays a critical role in refereeing competition in a free market economy. But there’s a problem: Each year, Congress piles new rules upon old, creating a thick sludge of regulations – some obsolete, repetitive, and even contradictory – that weighs down citizens and businesses. In 2017, the Code of Federal Regulations swelled to a record 186,374 pages, up 19 percent from just a decade before. PPI proposes a Regulatory Improvement Commission (RIC), modeled on the highly successful Defense Base Realignment and Closure (BRAC) process for closing obsolete military installations. Like the BRAC process, the proposed RIC would examine old rules and present Congress with a package of recommendations for an up-or-down vote to eliminate or modify outdated rules.




New Ideas for a Do-Something Congress No. 7: Winning the Global Race on Electric Cars


Jumpstarting U.S. production and purchase of Electric Vehicles (EVs) would produce an unprecedented set of benefits, including cleaner air and a reduction in greenhouse gas emissions; a resurgence of the U.S. auto industry and American manufacturing; the creation of millions of new, good, middle class manufacturing jobs; lower consumer costs for owning and operating vehicles; and the elimination of U.S. dependence on foreign oil. U.S. automakers are already moving toward EVs, but the pace of this transition is lagging behind our foreign competitors. A dramatic expansion of tax credits for EV purchases could go a long way toward boosting the U.S. EV industry as part of a broader agenda to promote the evolution of the transportation industry away from carbon-intensive fuels.




New Ideas for a Do-Something Congress No. 8: Enable More Workers to Become Owners through Employee Stock Ownership


More American workers would benefit directly from economic growth if they had an ownership in the companies where they work. To help achieve this goal, Congress should encourage more companies to adopt employee stock ownership plans (ESOPs), which provide opportunities for workers to participate in a company’s profits and share in its growth. Firms with ESOPs enjoy higher productivity growth and stronger resilience during downturns, and employees enjoy a direct stake in that growth. ESOP firms also generate higher levels of retirement savings for workers, thereby addressing another crucial priority for American workers.


 




New Ideas for a Do-Something Congress No. 9: Reserve corporate tax cuts for the companies that deserve it


Americans are fed up seeing corporate profits soaring even as their paychecks inch upward by comparison. Companies need stronger incentives to share their prosperity with workers – something the 2017 GOP tax package should have included.


Though President Donald Trump promised higher wages as one result of his corporate tax cuts, the biggest winners were executives and shareholders, not workers. Nevertheless, a growing number of firms are doing right by their workers, taking the high road as “triple-bottom line” concerns committed to worker welfare, environmental stewardship and responsible corporate governance. Many of these are so-called “benefit corporations,” legally chartered to pursue goals beyond maximizing profits and often “certified” as living up to their multiple missions. Congress should encourage more companies to follow this example. One way is to offer tax breaks only for high-road companies with a proven track record of good corporate citizenship, including better wages and benefits for their workers.


			


	

			




			
				


	

		
Kane for NY Daily News, “When Republicans decide to love an activist judge: The Affordable Care Act ruling exposes GOP hypocrisy”

				

			Posted on  by The Progressive Policy Institute		

			


	

		
Republicans love to complain about “activist judges,” that is, until they find one willing to do their political bidding.


On Friday, members of the GOP hailed a ruling by U.S. District Judge Reed O’Connor striking down the Affordable Care Act (ACA) as unconstitutional. They didn’t seem to care that O’Connor had to use some highly questionable reasoning to arrive at that conclusion, which the Supreme Court rejected in 2012.


For his part, President Trump was delighted that a federal judge was able to do what he and the GOP-controlled Congress failed to do in 2017: kill Obamacare. “As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster! Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions,” he tweeted.


Others in the GOP also celebrated the decision over the weekend. In a tweet, Missouri Sen.-elect Josh Hawley, who signed onto the lawsuit as attorney general and spent his campaign telling voters he would protect preexisting conditions, called upon both parties to work together to protect those with preexisting conditions. Hawley did so despite knowing his lawsuit seeks to fully overturn those protections.


Continue reading at the New York Daily News.


			


	

			




			
				


	

		
Marshall for USA Today, “Pig-headed Republicans are pushing America toward government-run national health care”

				

			Posted on  by The Progressive Policy Institute		

			


	

		
New Texas ruling is the latest example of Republican efforts to kill Obamacare. But while the GOP is winning on tactics, it’s losing hearts and minds.


What is the strongest political force driving America toward national health care? No, it’s not Sen. Bernie Sanders and his “Democratic Socialist” minions. It’s the Republican Party.


Hang on, don’t Republicans stand foursquare against a government takeover of the entire U.S. health care system? So they say. But the GOP’s pig-headed opposition to less drastic ways to make sure everyone has coverage is stimulating Americans’ appetite for a bigger government role in health care — and it will only be fueled by a federal judge’s ruling Friday night that the Affordable Care Act is unconstitutional.


In a recent poll commissioned by the Progressive Policy Institute, for example, voters by a margin of 54 to 46 percent, including nearly half of Republicans, favored changing “the current health system so everyone gets health care through Medicare instead of through people’s place of work or instead of buying it directly.” A more general “new government health care program” drew even more support, including 52 percent of Republicans.


Such findings should be taken seriously, but not literally. When you present voters with facts about the astronomical cost of nationalizing health care — $32 trillion over 10 years — and tell them they’d have to give up their job-based health plans, their enthusiasm for a Medicare-for-all “single payer” scheme starts to melt away.


Still, the public’s receptivity to more government intervention in health care markets shows that U.S. conservatives are losing ground on health care. And Republicans, the drivers behind the lawsuit in Texas, have only themselves to blame.


Read more at USA Today.


			


	

			




			
				


	

		
Poll shows Americans want greater government involvement in health care

				

			Posted on  by The Progressive Policy Institute		

			


	

		
Health care costs continue to be top of mind for a plurality of voters, according to a recent poll by PPI and Expedition Strategies. Our poll surveyed 1,090 likely voters on to gather data to apply context and to for what kind of agenda progressives should craft as the 2020 election cycle dawns. Health care handily outweighed other issues overall and was the one issue where there was agreement across party lines in its importance.


In the midterms, this was most clear in states like Arizona where Senator-elect Kyrsten Sinema essentially ran a one issue campaign – protecting those with preexisting conditions – and beat out Republican Martha McSally. Her messaging resonated with voters who were afraid of losing affordable coverage because of preexisting conditions.


Among respondents of our poll, 45 percent ranked health care as one of their top three concerns, including 55 percent of Democrats, 42 percent of Independents and 38 percent of Republicans. The results showed that there is anxiety around health care costs. When asked about the best way to reduce the gap between the wealthy and poor in the United States, 19 percent of respondents cited reducing health care costs as a possible policy lever.




The Affordable Care Act (ACA) was a market-based solution that focused on getting more Americans covered. And in that regard, it did succeed. The uninsured rate among the non-elderly population has dropped from 18.2 percent in 2010, to 10.3 percent in 2018.


That being said, costs are still a driving factor for why so many remain uninsured or why even those with coverage struggle to afford their co-pays and co-insurance. In 2016, of those who said they were uninsured, 45 percent cited cost as the driving reason. Additionally, one in four Americans taking prescription drugs reports difficulty affording their medications. Though overall drug spending only accounts for roughly 10-13 percent of total health care spending, it is the fastest growing sector. This may explain why drug companies find themselves out of favor with voters. When asked how they would rate industries, drug companies came in lower than oil companies.




It’s clear that the uncertainty stemming from GOP sabotage of the ACA contributes to voter anxiety over pre-existing conditions, drug costs, and out of pocket costs. The concern over cost could explain why there is significant public interest in nationalized health care and Medicare-for-all. By a margin of 54 percent to 46 percent, voters said they favor a system in which “everyone gets health care through Medicare instead of through people’s place of work or instead of buying it directly,” with even 47 percent of Republicans favoring such a universal program, according to the poll.


Health care is a top concern among women in particular. Women reported being very worried that drug companies are charging too much and were twice as worried as men about their ability to pay health care bills.


The big question for Dems is, having won the 2018 midterm in significant part on defending ACA, what should Dems do next on health care? Our poll suggests voters want action to stabilize markets, protect people with preexisting conditions and keep premiums down. Though many reported supporting Medicare-for-all, our poll also shows that people don’t want big tax increases. Additionally, Kaiser Family Foundation polling has found that when informed about the tradeoffs of greater government involvement (i.e. higher taxes) some of the support for Medicare-for-all wanes.


As PPI has documented, there are many roads to universal and affordable health care. As the 2020 presidential cycle gets underway, there should be a robust debate about the best way for Dems to build on the ACA’s successes.


Overall, the poll suggested that a progressive, yet pragmatic, agenda could help Democrats sustain a governing majority. Voters clearly favor individual initiative and self-determination even if they favor a larger government role in health care specifically. Democrats need to maintain and expand this near-majority advantage going into 2020. And to do that, they must craft a broadly appealing agenda that brings in and keeps independents and less committed partisans—the majority of whom call themselves ‘moderate’—under the tent.


			


	

			




			
				


	

		
America’s Resilient Center and the Road to 2020 – Results from a New National Survey

				

			Posted on  by The Progressive Policy Institute		

			


	

		
The Progressive Policy Institute (PPI) today released a national opinion survey that highlights the surprising resilience of America’s pragmatic political center two years into Donald Trump’s deeply polarizing presidency. The poll reinforces a key takeaway from the 2018 midterm elections: Suburban voters – especially women – are repelled by the president’s racial and cultural demagoguery and are moving away from a Trump-dominated GOP.


“Our poll suggests that Donald Trump’s election in 2016 is more likely to be an aberration than any permanent shift in America’s political course,” said Anne Kim, PPI Director of Social and Domestic Policy and PPI President Will Marshall. “The defection of suburban voters creates a political landscape that favors Democrats in 2020 – if they stick to the ‘big tent’ approach that proved so effective in the midterm.”


The poll conducted by Pete Brodnitz at Expedition Strategies contains findings about what’s top of mind for voters, their ideological outlook and leanings, and their views on health care, trade, growth and inequality, the role of government, monopoly and competition, and other contentious issues.


“The agenda that could help Democrats sustain a governing majority, our poll suggests, is one that is progressive yet pragmatic—one that’s optimistic, aspirational and respects Americans’ beliefs in individual initiative and self-determination; one that broadens Americans’ opportunities for success in the private sector and strengthens the nation’s global economic role; one that demands more from business but doesn’t cross the line into stifling growth; and one that adopts a practical approach to big challenges such as immigration reform and climate change,” write Kim and Marshall.


“For Democrats to maintain and expand this near-majority advantage, they must craft a broadly appealing agenda that brings or keeps independents and less committed partisans—the majority of whom call themselves ‘moderate’—under the tent.”


PPI-Expedition-Strategies-2018-Poll-PPT


PPI_Americans-and-The-Economy2018


			


	

			




			
				


	

		
Ritz for Forbes, “Victorious Democrats Should Thank Young Voters By Funding America’s Future”

				

			Posted on  by The Progressive Policy Institute		

			


	

		
On Tuesday, Democrats won control of the U.S. House of Representatives and state legislatures across the country thanks to record-breaking turnout among young voters. Now it is time for newly elected Democrats to stand up for the interests of their constituents by supporting an economic agenda that funds America’s future.


The reckless policies of the current administration, and many of its predecessors, have slashed critical public investments that most benefit young Americans while simultaneously burying them and future generations under a mountain of debt. In a recent report, the Progressive Policy Institute documents these trends and explores how these reckless policies could drain America’s economic strength and seriously harm young Americans for decades if no action is taken to change course.


Continue reading at Forbes.


			


	

			




			
				


			
				


	

		
Ben Ritz Discusses New PPI Report on Two Radio Interviews

				

			Posted on  by The Progressive Policy Institute		

			


	

		
Director of PPI’s Center for Funding America’s Future, Ben Ritz, participated in two radio interviews this week to discuss his new report, Defunding America’s Future: The Squeeze on Public Investment in the United States. The report explains how short-sighted fiscal policy is undermining critical investments in education, infrastructure and scientific research that are integral to the long-term health of our economy. Read the full report here.


The first interview was on Facing the Future with host Chase Hagaman, which airs on New Hampshire’s WKXL radio station. Listen to the WKXL interview here.


The second interview was on Reality Check with host Charles Ellison, which airs on Philadelphia’s WURD radio station. Listen to the WURD interview here.