Marshall for Medium: “Will Conservatives Protect our Children?”

Watching the nation’s political leaders tie themselves in knots over minor changes in gun laws, I can’t help but wonder if America hasn’t become the “pitiful, helpless giant” Richard Nixon warned about decades ago.

Nixon conjured up this arresting image to rally public support for his unpopular plan to invade Cambodia. But it seems more apt today, as Washington fails to stem the growing scourge of mass shootings.

The blunt truth is, the Republican Party is chiefly responsible for this paralysis of national will. Even as our children are slaughtered in classrooms, Republicans shrug and offer nothing more than “thoughts and prayers.” Sorry, they tell us, the U.S. Constitution bars us from taking effective action to protect our children from killers wielding weapons of war.

Read PPI President Will Marshall’s full piece on Medium by clicking here.

PPI Blog: A Simple Way to Help Formerly Incarcerated Americans Reenter Society

Roman Darker, PPI Summer 2019 Intern

We often take for granted the many essential tasks that require government-issued ID, such as a drivers’ license or a state-issued ID card. We need them to open a bank account, apply for a job, rent property, stay in hotels, get a P.O. box, and even for most interstate bus travel.  

People leaving prison often lack ID for various reasons: IDs expire, deteriorate, or are simply lost. Unfortunately for many people formerly incarcerated in the U.S., the need for new government ID is acute, while the process of obtaining it is commonly drawn out. Not having a government ID means not having the ability to get money necessary for food and shelter, nor the requisite documentation for the ladder. Even today, amid promising criminal justice reform, hurdles to getting a new state ID for formerly incarcerated people are extensive.

Most Americans have had government-issued ID, in the form of a drivers’ license, since the age of 16, so we don’t easily recall the process and documents necessary for obtaining our first ID. Depending on the state, applicants must supply one form of primary documentation and/or two secondary forms. Primary forms of documentation are government-issued documents or receipts that indicate a person’s full legal name and date of birth, such as a birth certificate. Secondary forms include both a name and evidence of residency, such as a utility bill or school records.

Prisoners incarcerated in a state other than the one that issued their previous ID will first have to locate their birth certificates, a time consuming process even in the best of circumstances. If born in the state of their release, obtaining a birth certificate can take around two weeks after the responsible agency receives the application, with some variance in the timeline depending on the state (1). However, if the formerly incarcerated person was serving a sentence in a state other than the one in which they were born, then this process can take up to eight weeks (2). 

Of course, this scenario assumes that the individual has a place to receive mail (which is difficult to secure without government identification) and knows the county in which they were born, the hospital they were born in, and their mother’s full maiden name (3). Also, formerly incarcerated people often do not have the luxury of being able to wait eight weeks to find employment. Many need money quickly for food and shelter; moreover, evidence shows recidivism becomes much less likely with stable employment (4).

Fortunately, some states are moving to help people released from prison get IDs. For example, Florida, Maryland, Minnesota, Mississippi, Missouri, Nevada, New Jersey, and Wyoming have passed laws or forged interagency agreements aimed at providing inmates with state ID prior to or upon release (5).

Other states have turned to a simpler, cheaper (albeit less effective) option: allowing prisoners to exchange release documents and/or prison identification for state ID (6). One such state, Ohio, began providing “offender release cards” that contain all the information required by the federal Real ID Act, which lays out the minimum information necessary (7).

The former prisoner can then take that card to any Ohio Bureau of Motor Vehicles and obtain a state ID. The introduction of the offender release cards was one of several reforms that correlated with a drop in the state’s three-year recidivism rate to 27.5 percent back in 2015, which was over 20 percentage points below the national average (8) 

Both federal and state agencies operating prisons should have gathered all of the information provided on the cards through the process of verifying the inmate’s identity. Giving it to prisoners upon release would be a radically pragmatic addition to standard release procedure, and allowing it to suffice for obtaining a state ID is in every state’s interest.

Let’s stop punishing prisoners after they’ve paid their debt to society. Helping newly released prisoners get an I.D. can give them a fresh start and reduce the cost of recidivism in the bargain.

—–

  1. Stephen Lilly, “How Long Does it Take to Receive a Birth Certificate?” PocketSense, November 6, 2018, https://pocketsense.com/how-long-does-it-take-to-receive-a-birth-certificate-12213245.html.
  2. Ibid.
  3. City of Columbus, Columbus Public Health Department, “Birth Certificate Walk-in or Mail Application,” Accessed July 29, 2019, file:///Users/romandarker/Downloads/BirthCert_Application.pdf. 
  4. G. Mesters, V. van der Geest, and C. Bijleveld, “Crime, Employment, and Social Welfare: An Individual-Level Study on Disadvantaged Males,” Journal of Quantitative Criminology, 32, no. 2 (2016), 159-90. doi:10.1007/s10940-015-9258-5.
  5. Juleyka Lantigua-Williams, “The Elusiveness of an Official ID After Prison: A bureaucratic maze within the federal government leaves scores of former inmates without the key to a fresh start,” The Atlantic, August 11, 2016. https://www.theatlantic.com/politics/archive/2016/08/the-elusiveness-of-an-official-id-after-prison/495197/.
  6. Ibid.
  7. U.S. Congress, House, Emergency Supplemental Appropriations Act for Defense, the Global War on Terror, and Tsunami Relief, 2005 (Enrolled as Agreed to or Passed by Both House and Senate): Title II–Improved Security for Drivers’ Licenses and Personal Identification Cards, H.R. 1268, 109th Cong., 1st sess., Introduced in House January 26, 2005, https://www.dhs.gov/xlibrary/assets/real-id-act-text.pdf.
  8. Brian Bull, “As Recidivism Rates Drop In Ohio, Officials Work To Keep Ex-Felons From ‘Revolving Door’ Of Prisons,” ideastream, September 24, 2015, https://www.ideastream.org/news/as-recidivism-rates-drop-in-ohio-officials-work-to-keep-ex-felons-from-revolving-door-of-prisons.

 

Marshall for NY Daily News: “Why the moderates must prevail”

Thanks to CNN’s penchant for elaborately staged political melodrama, it’s easy to dismiss Round 2 of the Democratic presidential debates last week as a lot of sound and fury signifying nothing. But amid all the sniping and squabbling, a larger theme did emerge: Democrats won’t beat an unpopular president with unpopular ideas.

The pragmatic candidates in the field finally found their voice and pushed back hard against what Montana Gov. Steve Bullock called the left-wing “wish list” that so far has dominated the debates. They took aim at the massively expensive “Medicare-for-All” schemes pushed by Sens. Bernie Sanders, Elizabeth Warren and Kamala Harris; at calls from former HUD Secretary Julian Castro and others to decriminalize illegal immigration; and, at racing to shut down U.S. oil and gas production as part of the “Green New Deal.”

Read PPI President Will Marshall’s full piece here.

Janda for Medium: “Would Single Payer Set Back Progress on Paying for Value?”

While the left and center-left have been debating the wisdom of abolishing private insurance, another critical policy issue has not gotten much attention: The Medicare-for-all bill currently in question would create a single-payer health care system based on fee-for-service, disregarding the financial and outcome-based successes of Accountable Care Organizations, the Center for Medicare and Medicaid Innovation (CMMI), Medicare Advantage, and other payment reforms emphasizing value-based care.

 

Read the full piece on Medium by clicking here. 

Long for Medium: “The Canadian App Economy is Global and Diverse – But Can Improve”

The Canadian App Economy is strong both in terms of app exports and compared to its industrialized peers. The Canadian App Economy has 262,000 App Economy workers as of November 2018, according to a recently released report by the Progressive Policy Institute (PPI). App Economy workers are those that develop, maintain, or support mobile applications. What’s more, Canada is outperforming many of its industrialized peers.

Read the full piece on Medium by clicking here. 

Goldberg for the Washington Examiner: “Forcing More Litigation Isn’t the Answer to Litigation Abuse”

To avoid the expense and stress of going to court, Americans are turning to arbitration to settle workplace, and other, disputes. Free enterprise depends on businesses, employees, and consumers to be able to resolve disputes quickly and fairly. Plaintiffs’ lawyers, who file lawsuits for a living, are trying to convince Congress to take that option away.

The House recently held a hearing to ban pre-dispute arbitration agreements in employment, consumer, and anti-trust matters. Their supporters are attaching anti-arbitration clauses to various bills, including the National Defense Authorization Act this month, and want action on a comprehensive ban (the “FAIR Act”) before recess. They also are trying to leverage the #MeToo movement, which is critical to the success of women in the workplace, to suggest that courts are the only places for protecting people’s rights.

 

Read the full piece by Phil Goldberg by clicking here. 

Media Advisory: Building a #BetterBudget, A Forum on Investing in America’s Future and Tackling Our National Debt

WASHINGTON—The Progressive Policy Institute and House Blue Dog Coalition will host a lunchtime discussion today at the Longworth House Office Building about what leaders in Congress can do to invest in equitable growth while reducing our national debt.

America suffers from a shortsighted fiscal policy that promotes consumption today instead of investing in tomorrow. The federal government now spends more to service our growing national debt than it does on public investments in education, infrastructure, and scientific research combined. Meanwhile, a perfect storm of fiscally irresponsible tax cuts and an unwillingness to tackle escalating health and retirement spending are feeding trillion-dollar deficits as far as the eye can see. This is not a fiscal policy for strengthening America’s future – it’s blueprint for American decline.

At the event, PPI will release a comprehensive budget plan with over 50 policy recommendations for the next administration to make room for public investments in education, and infrastructure, and scientific research; modernize federal health and retirement programs to reflect an aging society; and create a progressive, pro-growth tax code that raises the revenue necessary to pay the nation’s bills.

Lunch will be provided. This event is open to the press.

Who:

  • Rep Stephanie Murphy (D-FL), Co-Chair of the House Blue Dog Coalition
  • Rep. Ed Case (D-HI), Co-Chair of the Blue Dog Task Force on Fiscal Responsibility and Government Reform
  • Rep. Ben McAdams (D-UT), Co-Chair of the Blue Dog Task Force on Fiscal Responsibility and Government Reform
  • Ben Ritz, Director of PPI’s Center for Funding America’s Future
  • Marc Goldwein, Senior Vice President at the Committee for a Responsible Federal Budget
  • Emily Holubowich, Executive Director of the Coalition for Health Funding and Co-Founder of NDD United
  • Will Marshall, President of PPI, Moderator

When: Thursday, July 25, 2019
12:00 PM – 1:30 PM

Where: Longworth House Office Building, Room 1302
15 Independence Ave, SE
Washington, D.C. 20515

For press inquires, please contact Carter Christensen, media@ppionline.org or 202-525-3931.

Ritz for Medium: “Budget Deal Perpetuates Broken Status Quo”

The budget deal scheduled for a vote tomorrow gets two things right and nearly everything else wrong. The main thing it gets right is the need to unshackle domestic public investment that would be subject to an across-the-board cut known as “sequestration” in the absence of legislative action. It also suspends the federal debt limit for two years, which will allow the Treasury Department to continue paying the bills America has already incurred without risking the prospect of a catastrophic default on our debts. What it gets wrong is charging $320 billion in new spending to our national credit card, which will further grow those debts and so perpetuate Washington’s governing dysfunction.

 

Read the full piece on Medium by clicking here. 

Health Care 2020: What’s Missing from the Debate?

The Progressive Policy Institute’s Health Care 2020 panel relayed the overwhelming opinion that the American health care system is broken and in desperate need of reform. 

Americans need health care reform to achieve timely access to effective, affordable, and quality medical care. The Progressive Policy Institute (PPI) hosted a panel discussion on Wednesday, July 24th featuring the Honorable John Kitzhaber, MD, Tara O’Neill Hayes, Anand Parekh, MD, and Arielle Kane on the often forgotten elements of comprehensive health care reform.

The panelists discussed how to get to universal coverage, how to transition to an accountable delivery system, the need for a global budget, and, most importantly, how to reinvest savings to address social determinants of health. Governor Kitzhaber said that “at 18 percent of GDP, we know that health care has huge opportunity costs. When you look at the things that have long term impacts on health, it’s housing, safe communities, maternal care, and other social determinants of health.”

This conversation, with over 80 people in attendance, focused on crucial elements of holistic health reform rather than the more frequent discussions around “repeal-and-replace” or “Medicare-for-all.” Anand Parekh, MD, MPH, the chief medical advisor of the Bipartisan Policy Center noted that: “A lot of the oxygen in the debate surrounds increasing access to affordable health insurance and access to affordable prescription drugs. Those are critical — but it’s also important to focus on what happens beyond the four walls of a health center.” This focus on health beyond the hospital included a discussion of preventative care and improving health in a financially sustainable way.

Tara O’Neill Hayes, the deputy director of Health Care Policy at the American Action Forum, said “Medicare and Medicaid already account for 26.5 percent of the federal budget, with a percentage that’s grown each year. By 2027, these two programs alone will cost the federal government over $2 trillion.”

The overwhelming sentiment was that the American health care system is broken and in desperate need of reform in a manner that is both financially sustainable and prioritizes patient outcomes.

 

Reframing the 2020 Health Care Debate

“Health care and poverty are inseparable issues and no program to improve the nation’s health will be effective unless we understand the conditions of injustice which underlie disease. It is illusory to think that we can cure a sickly child and ignore his need for enough food to eat.” Robert Kennedy, 1968

Reframing the 2020 Health Care Debate by the Honorable John A Kitzhaber, M.D.

Last month’s Democratic debates demonstrate how central health care will be in the 2020 election. Indeed, health care, more than any other issue, propelled the Democrats to regain control of the House of Representatives in 2018. Whether the upcoming election leads to meaningful relief for the millions of families struggling under the escalating financial burden of medical care, however, depends largely on how the issue is framed and on the clarity with which we see our policy goal and the steps necessary to achieve it.

Today the vast majority of dollars in our health care system are spent on the after-the-fact treatment of acute and chronic medical conditions rather than on investments that could prevent these conditions in the first place.

If we could reduce our health care spending from the current 18 percent of the GDP to the 12 percent average of most other industrialized nations, it would free up well over a trillion dollars a year for the social investments that actually improve health (1).

What concerns voters most about health care and, by a wide margin, is the cost — but, and this is important — not the cost of the overall U.S. health care system, but the cost to them as individuals (2). Most voters believe, to some extent in the abstract, that everyone should have access to affordable health care, but they are far more concerned that they as individuals have access to affordable health care. This is understandable because, at the end of the day, health care is intensely personal.

And yet, it is fair to say that nobody wants to need medical care or to be a “patient.” When you are sick or injured it is important that you have timely access to care at a cost you can afford, but we also know that among the factors contributing most to lifetime health status, our medical system is a relatively minor contributor. Far more important are things like healthy pregnancies, affordable housing, nutrition, stable families, good jobs, safe communities and the other “social determinants of health” (3),(4).

Therefore, our policy goal should be to improve the health of our people through a system that is financially stable, ensures that all Americans have timely access to effective, affordable, quality medical care; and also makes, strategic long-term investments in the social determinants of health. A system that can achieve this goal must include five core elements: 1. Universal coverage; 2. an affordable defined benefit; 3. a delivery system that assumes risk and accountability for quality and outcomes; 4. a global budget indexed to a sustainable rate of growth; and 5. savings reinvested upstream in the community to address the social determinants of health.

A system that incorporates these elements can take many forms, but without all five we cannot achieve our goal of improving health care in a financially sustainable way.

The most significant obstacle to achieving this goal is the total cost of care and the structure of the delivery system that is driving it. Health care is the only economic sector that produces goods and services none of its consumers can afford. Such a system only works because the care for individuals is heavily subsidized—increasingly with public resources—either directly through public insurance programs like Medicare and Medicaid; or indirectly through the tax exclusion for employer sponsored health insurance; and the public subsidies for those purchasing insurance through the Affordable Care Act (ACA) exchanges.

For decades, the national health care debate has been focused on these subsidies—on who pays them and how much they pay—rather than on why health care costs are so much in the first place. The political paralysis around this issue is due largely to the fact that neither Republicans nor Democrats assume any change in the health care delivery model: we either pay for it or we don’t, creating a false choice between cost and access. Republicans want to spend less on health care (e.g. “repeal and replace” the ACA) while Democrats want to spend more (e.g. Medicare for All). Neither approach directly addresses the total cost of care.

The burden of rising health care costs on individuals manifests itself in a variety of ways: rising insurance premiums and deductibles, short-term insurance policies that actually cover very little, the denial of coverage based on preexisting medical conditions, surprise billing, and the high cost of prescription drugs. It is not surprising, then, that most Democratic voters blame insurance companies and drug companies for the high cost of care. Generally, consumers do not blame health care providers, the delivery system itself, or the many new health care related startups and huge private equity firms that are making a profit off the $3.5 trillion health care budget (5).

And while Democrats are right to go after short-term junk health insurance policies, huge drug price increases, and surprise health care bills, these fixes only address shortcomings with health insurance rather than the total cost of medical care. The total cost of care is the primary driver of increases in insurance premiums as well as the increase in copayments and deductibles.

Since none of the current proposals address the systemic cost of care, they cannot prevent cost shifting onto individuals. All of these short-term fixes are worth making, but they are treating symptoms of the problem, not the problem itself.

The problem is illustrated by viewing our health care system through the lens of five questions or “variables”: 1. who is covered (eligibility); 2. what is covered (benefit); 3. how much is covered (cost-sharing—e.g. premiums, copayments, deductibles); 4. how much are we paying (reimbursement); and 5. how much is borrowed (debt financing).

When the total cost of care exceeds the ability/ willingness of the major third-party payers (government and private sector employers) to pay for it, instead of seeking to reduce the cost of care, payers use one of five strategies to shift the cost to individuals who cannot afford it; or to future generations. These strategies include: reducing eligibility, reducing benefits and/or raising premiums, copayments and deductibles— all of which shift cost to individuals; reducing provider reimbursement which often results in efforts by providers to avoid caring for those who cannot pay; and pushing the cost of care into the national debt, shifting cost to future generations.

Cost shifting is the way we avoid directly confronting both the reality of fiscal limits and the fact that health care in the United States has simply become unaffordable for individuals, employers and the government. Cost shifting does not reduce the total cost of medical care. Furthermore, at 18 percent of our GDP, the cost of medical care, more than anything else, is undermining our ability to invest in children and families, housing, economic opportunity and the many other things that contribute to health. This is the primary reason why the U.S. has such embarrassingly poor population health statistics when compared to other industrialized nations that spend far less on medical care and far more on the social determinants (6).

The one indispensable step in moving toward a realistic and effective solution is to cap the total cost of care through a global budget indexed to a sustainable annual growth rate, while requiring providers to assume financial risk and accountability for quality and outcomes within that budget. Taking this step will fundamentally shift the debate from the subsidies to the delivery system. As long as we allow an ever-increasing share of our public resources to be spent paying whatever prices are demanded—whether for prescription drugs, hospital care or to grow profits of private equity funds—American families will continue to struggle under the burden of medical costs and this crisis will deepen.

Capping the total cost of care will allow us to expand coverage for a basic benefit package to all Americans (universal coverage); and to begin to invest upstream in the social determinants of health. The only way to expand access and to make room in the federal budget for serious investment in the social determinants of health is to reduce the total cost of care.

We already have two very successful examples of how global budgets work to bring down the total cost of care: Oregon’s Coordinated Care Organizations, which manage the state’s Medicaid program, and Medicare Advantage, that today serves more than 20 million seniors. Under these care models, providers receive a fixed amount of money for a defined population, without sacrificing quality (7). If the global budget is exceeded in any given year, the providers are at financial risk for the difference. In short, these care models begin to change the system incentives from rewarding sickness to rewarding wellness.

Extending these models more broadly across the U.S. health care system will reduce the total cost of care and free up resources to invest in the social determinants of health. It’s not necessary at this point in the 2020 election cycle to be prescriptive about how providers, insurers and other stakeholders in the current system will operate under a global budget cap indexed to a sustainable growth rate, but setting a target effective date for such a cap would fundamentally change the nature and the focus of the health care debate from where we want to go to how we are going to get there.

That is exactly what President John F. Kennedy did in 1962, when he challenged the nation to put a man on the moon. He did not give us a roadmap, he gave us a destination and, in so doing, unleashed American ingenuity and technological innovation to serve a common cause. Fifty years ago, this month, we achieved that goal. We succeeded in going to the moon because we were clear on our destination and because we imagined it; because the story preceded the accomplishment.

Surely, we can imagine linking the total cost of medical care to a sustainable growth rate within the next few years, then work backwards to create a health system that meets the objectives of both Democrats and Republicans: expanding coverage and improving health and quality; while reducing the rate of medical inflation through fiscal discipline and responsibility.

That’s the challenge. It’s not a challenge of technology—it is a challenge of political will and human compassion. And it’s not nearly as difficult as going to the moon.

[gview file=”https://www.progressivepolicy.org/wp-content/uploads/2019/07/GK_AK_HealthcareFinal.pdf”]

ENDNOTES

  1. Stuart M. Butler, Dayna Bowen Matthew, and Marcela Cabello, “Re-balancing Medical and Social Spending to Promote Health: Increasing State Flexibility to Improve Health Through Housing,” February 2017. https://www.brookings.edu/blog/usc-brookings-schaeffer-on-health-policy/2017/02/15/re-balancing-medical-and-social-spending-to-promote-health-increasing-state-flexibility-to-improve-health-through-housing/
  2. Ashley Kirzinger, Cailey Muñana, Bryan Wu, and Mollyann Brodie, “Data Note: Americans’ Challenges with Health Care Costs,” The Henry J Kaiser Family Foundation, June 11, 2019, https://www.kff.org/health-costs/issue-brief/data-note-americans-challenges-health-care-costs/
  3. Len M. Nichols and Lauren A. Taylor, “Social Determinants as Public Goods: A New Approach to Financing Key Investments in Health Communities,” Health Affaits, August 2018,https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.0039
  4. Ara Ohanian, “The ROI of Addressing Social Determinants of Health,” American Journal of Managed Care, January 11, 2018, https://www.ajmc.com/contributor/ara-ohanian/2018/01/the-roi-of-addressing-social-determinants-of-health
  5. Rabah Kamal and Cynthia Cox, “Total health expenditures have increased substantially over the past several decades,” Peterson-Kaiser Health System Tracker, December 10, 2018, https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changedtime/#item-total-health-expenditures-have-increased-substantially-over-the-past-several-decades_2017
  6. Carlyn M. Hood, Keith P. Gennuso, Geoffrey R. Swain, Bridget B. Catlin, “County Health Rankings: Relationships Between Determinant Factors and Health Outcomes,” American Journal of Preventive Medicine, 2015. https://www.countyhealthrankings.org/sites/default/files/Hood_AmJPrevMed_2015.pdf
  7. The Institute of Medicine defines quality as “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

Regulatory Reform Could Revitalize Sluggish Business Creation

The U.S. economy recently marked 10 years of economic expansion – its longest in history – but there’s an important exception: new business creation. In recent decades, the American entrepreneurial engine has decelerated. Regulatory reform could help revive American entrepreneurship, reducing the burden on new businesses and realizing gains in economic growth. That doesn’t necessarily mean deregulation, but rather streamlining and updating old or obsolete rules to provide entrepreneurs with flexibility in today’s fast-changing world.

New and young businesses are the foundation of the United States’ economy, creating jobs and spreading wealth across our society. “Together, startups and high-growth firms (which are disproportionately young) account for about 70 percent of firm-level gross job creation in a typical year,” write entrepreneurship researchers Decker et al. Many of these young companies go on to become the next generation of small businesses, which employ 48 percent of private sector employees.

Unfortunately, the rate at which new businesses are being created has fallen off in the wake of the Great Recession. While firm deaths have returned to their pre-recession levels, firm births are down 22 percent compared to 2006 levels. And, for the first time since the Census Bureau began collecting data, firm deaths exceeded firm births from 2009 to 2011.

Smart policy can help increase the number of new businesses that are created and the number that scale up, though. Regulation is one area where policy can be made more efficient. A 2017 National Small Business Association survey estimated that the average small business owner spends at least $12,000 every year on compliance, with nearly one in three spending more than 80 hours every year dealing with federal regulation.

We know from research by Victor Bennett and Ronnie Chatterji that many people have entrepreneurial aspirations, but fail at many steps along their path to move to actual business formation. While many fail at early stages, such as basic market research, others undoubtedly run up against these mountainous regulatory costs and say, “not worth it.”

One way to reduce these costs is to focus on the steady buildup of regulation, or regulatory accumulation. The Code of Federal Regulations, where rules promulgated by the federal government are published annually, swelled by 17 percent from 2008 to 2018 alone. While Washington has dozens of agencies that issue new rules, not one institution is dedicated to streamlining the accumulated body of regulations. That’s why PPI proposed the Regulatory Improvement Commission (RIC). The RIC would fill an institutional vacuum in regulation policy by creating a mechanism for the periodic clearing out of obsolete rules.

Modeled on the Base Realignment and Closure Commission (BRAC) and comprised of a bipartisan group of highly qualified stakeholder appointees, the RIC would be an independent commission of eight members, appointed by the President and Congress, with regulatory expertise across industry and government. It would meet as authorized by Congress to review and, following a public comment period of 60 days, draw up a list of 15 to 20 rules for elimination or modification. The package would be sent to Congress for an up-or-down vote, and the RIC would be disbanded. If the proposed changes pass Congress, they would go to the president’s desk for signature or veto.

In 2015, bipartisan groups of lawmakers introduced bills in the House and Senate to establish the RIC based on the BRAC model. House cosponsors included Mick Mulvaney (R-SC), now acting White House Chief of Staff, and Kyrsten Sinema (D-AZ), now a Democratic Senator from Arizona.

Startup-friendly policies such as the RIC can help reduce compliance and opportunity costs, catalyzing a rebound in America’s startup rate and spurring economic growth. Streamlining regulation would help inventors and entrepreneurs spend less time and resources on regulatory compliance and focus instead on delivering goods and services and scaling their enterprises.

Research assistance was provided by Roman Darker, economics intern at the Progressive Policy Institute.

Marshall for Medium: “First Debate Spotlights Democrats’ Vulnerabilities”

Bombarded by all-over-the-map questions by no less than five NBC interlocuters, the 10 candidates didn’t have time to go deep on anything.

Nonetheless, the low-key encounter was revealing. On the plus side, all those on the stage showed they are better qualified by intellect and temperament to be president than Donald Trump. On the minus side, the conversation highlighted four large political vulnerabilities Democrats must confront if they are serious about evicting Trump from the White House.

 

Read the full piece on Medium by clicking here. 

Kim for Governing: “Anti-Fluoride Activism is Bad, and Not Just for Public Health”

In 1901, a Colorado Springs dentist named Frederick McKay noticed many of his patients had peculiarly mottled brown teeth — but far fewer cavities than the norm. The cause, Dr. McKay determined after years of investigation, was high levels of natural fluoride in the town’s water. His discovery eventually led to the widespread fluoridation of public water systems across America and a dramatic decline in tooth decay over the past 70 years.

Numerous studies have shown the protective effects of adding fluoride to water, especially for kids, and the Centers for Disease Control and Prevention hails community water fluoridation as one of the 20th century’s top 10 public health achievements. State and local budgets have benefited too, thanks to lower public expenditures for dental care.

 

Read the full piece on Governing by clicking here. 

Kim for Medium: “The Next Step in Criminal Justice Reform”

For many Americans, one traffic ticket could be all it takes to derail their financial security — and perhaps even their livelihood.

Loathe to raise taxes, many states and cities are increasingly relying on fines and fees — whether for traffic offenses, court costs or misdemeanors such as littering — to fill their coffers. The amounts demanded are often exorbitant, and fall disproportionately on low-and moderate-income Americans who can least afford to pay. In California, for instance, the Lawyers’ Committee for Civil Rights found that a $100 traffic ticket can ultimately cost a motorist as much as $815 after various surcharges, “administrative” fees and late penalties are factored in — a cripplingly large figure even for someone who is relatively wealthy.

 

Read the full piece on Medium by clicking here. 

The Economic Implications of State-Based Chemical Regulation: Two Approaches

We are seeing two important, and in some ways, potentially contradictory trends in manufacturing these days. On the one hand, there are signs of a transformation and rebirth in domestic manufacturing. Technological innovations such as 3D printing and robotics are lowering the cost of manufacturing at home, while global trade tensions are leading companies to shorten their supply chains (1). This raises the possibility of a new round of job creation in local domestic manufacturing.

At the same time, states are increasingly moving to tighten their oversight and regulation of chemicals, especially those in consumer products. For example, the state of Washington just adopted “The Pollution Prevention for Our Future Act,” billed as the strongest such measure in the country. The New York State legislature has recently passed legislation regulating chemicals in children’s products. In the same vein, Vermont’s legislature just passed a bill strengthening and broadening existing rules for disclosure of chemicals in children’s products.

Increased attention to safety is not a bad thing. We can have innovation and safety in manufacturing, while still encouraging growth and jobs.

But let’s be honest: state governments do not have the budgetary resources to assess the risk of hundreds of chemicals. As a result, state regulators and legislatures are reaching out globally and relying on lists of chemicals assembled by highly trusted authorities around the world, in addition to any information from the U.S. federal government. For example, in the U.S., states such as Maine, Minnesota, and California, among others, have relied on the E.U.’s conclusions about certain chemicals when crafting their Chemicals of Concern lists, which prioritize chemicals for further reporting, study, and/or possible regulation. Canada and Australia also have agencies that are well respected in assessing potential risks from chemicals.

In drawing on other parts of the world, states must be aware that these authorities can analyze the same data and come to different –and even conflicting – conclusions depending on the principles their regulatory regime is founded on. The E.U., for example, tends to take a “hazard-based” approach founded on the precautionary principle, which holds that “when an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically” (2). The precautionary principle generally leads to more skepticism about innovative materials and technologies. As a result, the E.U. identifies chemicals as “Substances of Very High Concern” (SVHC) purely on the basis of their hazardous properties, such as being very persistent and very bioaccumulative (vPvB).

By contrast, Canada, Australia, and the U.S. have tended more towards a risk-based approach to regulation. A risk-based approach focuses not only on the theoretical potential for harm, but actual harm. If no actual harms can be measured, the action or product is allowed, and no regulatory action is taken.

Thus, a state’s choice of reference for regulating chemicals is not purely a technical matter. It is important for states to realize the different approaches to chemicals regulation at hand, and the economic consequences the approach they opt for could have. Chemicals are a sizeable industry in the U.S. economy, with total sales of $493.4 billion in 2017, according to a 2018 industry report (3).

More importantly, the approaches states take to chemicals regulation has powerful implications for jobs and economic growth in the future. The next wave of tech-based innovation will come in such physical industries as manufacturing and will be driven in part by new materials and new processes. Excessively stringent regulatory regimes or blacklisting certain chemicals will unnecessarily squelch innovations that could establish a new digital manufacturing sector that creates local jobs.

This paper will first describe how states use their limited resources to focus their chemical regulation. We will then contrast the precautionary principle with the risk-based approach, using siloxanes as an example. Specifically, as the Progressive Policy Institute wrote in a previous paper, siloxanes octamethylcyclotetrasiloxane (also known as “D4”), decamethylcyclopentasiloxane (also known as “D5”), and dodecamethylcyclohexasiloxane (also known as “D6”) have been assessed by the E.U., Canada, and Australia for their impact on human health and the environment (4). In the U.S., states such as Maine, Minnesota, and California, among others, have relied on the E.U.’s conclusions when crafting their own Chemicals of Concern lists. Contrastingly, Canada has chosen not to restrict the use of siloxanes, and other states, including Washington State and Oregon, have removed siloxanes from their lists due to the lack of evidence of real-world harm.

Finally, we will examine the economic implications of the differing regulatory approaches.

 

The Limited Resources of States

State governments simply do not have the budgetary resources to test chemicals themselves. As a result, they rely on federal or international governments to conduct the scientific research that forms the rationale for much of their health and environmental legislation and regulation. After all, why would states duplicate research that those governments have already done?

One example of this is in state Chemicals of Concern lists, where some U.S. states have imported lists of chemicals from trusted sources such as the U.S. federal government, the E.U., and Canada. For instance, Maine includes chemicals on its Chemicals of Concern list that have been listed by another authoritative governmental entity as being harmful to human health or the environment (5). These entities include the U.S. Department of Health and Human Services (HHS), Food and Drug Administration, Centers for Disease Control and Prevention, EPA, and the European Chemicals Agency, among others.

Similarly, Minnesota’s Chemicals of High Concern list was sourced by “reviewing the hazard characteristics of chemicals studied by other state, national and international agencies” (6). These agencies include Maine’s Chemicals of Concern List, the U.S. HHS, the U.S. EPA, and the European Parliament’s Authorization List under the REACH regulation (7).

California imports chemicals for its Candidate Chemicals List based on their inclusion on other authoritative lists, such as the E.U.’s substance of very high concern (SVHC) list, Canada’s Domestic Substances List, and the U.S. EPA’s Integrated Risk Information System, among others (8).

Vermont’s existing Chemicals of High Concern to Children list requires the Vermont Health Commissioner to review the list every two years to determine if additional chemicals should be added, considering “designations made by other states, the federal government, other countries, or other governmental agencies,” including the E.U.’s SVHC list (9). The state’s new legislation would make it even easier to add chemicals to the list.

Washington State uses “authoritative sources that identify chemical toxicity…and evidence of potential for exposure” to craft its Chemicals of Very High Concern to Children list.10 The authoritative sources include the U.S. EPA’s Integrated Risk Information System, the E.U.’s SVHC list, and the International Agency for Research on Cancer, among others.

And Oregon’s Health Authority uses “guidance developed by the State of Washington and other federal, state and nongovernmental organizations” to create its Chemicals of Concern for Children’s Health list (11).

 

The Risk-Based Approach vs. The Precautionary Principle

However, the importation of chemicals lists from different authoritative sources can lead to different outcomes for states, depending on the principles the regulatory regime of the authoritative source is founded on. Regulation in the E.U. tends to be rooted in a hazard-based approach that is founded on the precautionary principle, or the belief that “when an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically” (12). This hazard-based approach is consistent with the E.U.’s skeptical approach to innovation in general.

Conversely, Canada and Australia tend to opt for a risk-based approach where all available scientific evidence is evaluated. A risk-based approach requires harms to be identified and measured. Harms can include impact to human health, the environment, or to the economy. If no harms can be identified, the product or action is permitted to continue, and no regulatory action is taken.

Take for example siloxanes, which the E.U. added to its SVHC list based on characterizing them as “persistent, bioaccumulative and toxic” (PBT) or “very persistent and very bioaccumulative:” (vPvB). Some states have drawn on the E.U.’s assessment when creating their own chemicals of concern lists (13). California includes siloxanes D4, D5, and D6 on its Candidate Chemicals List, based on the siloxanes’ presence on the E.U.’s SVHC list (14,15,16,17).

Maine uses the presence of a chemical on its Chemicals of Concern (COC) list that meets additional toxicity and exposure criteria for inclusion on its Chemicals of High Concern (CHC) list (18). As a result, D4 has been included on the state’s most recent 2015 CHC list based on the E.U.’s toxicity assessment (19). Similarly, D5 has remained on Maine’s Chemicals of Concern list based on E.U. findings. Contrastingly, D6 was removed from Maine’s COC list because of the lack of assessments by authoritative institutions (20).

In Minnesota, D4 was included on its most recent 2016 Chemicals of High Concern list based on appearing on Maine’s 2015 Chemicals of High Concern list.21 And D4 is listed on Vermont’s list of Chemicals of High Concern to Children. Like Maine, the inclusion is based on its assessment by the E.U (22).

Contrastingly, Canadian regulators initially found D4 and D5 to be harmful to the environment and, as such, both substances could possibly have been subject to regulatory measures to lessen the substances’ impact on the environment (23, 24). However, an independent review board of experts analyzed a wealth of available data, including studies that showed the real-world behavior of D5, and concluded “there is no evidence to demonstrate that Siloxane D5 is toxic to any organism tested up to the limit of solubility in any environmental matrix” (25).

In terms of D4, a government-funded environmental monitoring study, which measured real-world concentrations of D4, D5, and D6 in the environment, found very low levels of D4 in Canadian surface waters (26). Rather than restricting or banning the substance’s use in consumer or industrial products, the Canadian government required certain facilities that use D4 to implement pollution prevention plans (27).

Australian regulators came to similar conclusions when they determined that product restrictions or bans on D4, D5, and D6 were not necessary because evidence demonstrated that “[t]he direct risks to aquatic life from exposure to these chemicals at expected surface water concentrations are not likely to be significant” (28).

Similarly, some states have revised their Chemicals of Concerns lists, based on additional study by other authoritative bodies. Washington State initially included D4 on its Chemicals of High Concern to Children (CHCC) list based on its inclusion on the E.U.’s priority list for Category 1 Endocrine Disruptors. But following a detailed review of the available evidence, including a study funded by the U.S. National Institutes of Health, the Washington State Department of
Ecology concluded (30):

“D4 is present on the European Commission (EC) Category 1 list, based on a single study, showing an increase in uterine weight (McKim et al, 2007). However, a more recent study shows no effect on uterine weight by D4 (Lee et al, 2015). These mixed results, along with biomarker and in vitro data for D4 (He et al, 2003; Quinn et al, 2007; Lee et al, 2015) are not sufficient for CHCC listing…D4 is not listed by any of the other CSPA authoritative sources. D4 does not meet the CHCC listing criteria” (31).

And, because Oregon’s list is primarily sourced from Washington State’s list, Oregon also removed D4 from its High Priority Chemicals of Concern for Children’s Health list (32).

The authoritative sources that states use when crafting their own chemicals of concern lists has resulted in binary outcomes. A regulatory approach founded on precaution (such as California, Maine, and Minnesota have imported) inherently prohibits innovation. States like California, Maine, Minnesota, and Vermont, who have crafted their lists from inclusion based on the E.U.’s Category 1 Endocrine Disruptor program or SVHC lists, have taken a step toward identifying the chemicals as priority chemicals, putting siloxanes or products containing them on the road to regulation and potential ban.

Moreover, manufacturers do not want to be associated with any listed chemicals, so they stay away from them even if chemicals have not been officially banned.

For example, in Vermont, manufacturers of children’s products using chemicals of high concern to children are required to report to the state when the chemicals are used in a significant amount, and the law allows the Health Commissioner to consider banning the sale of products including the chemical (33).

In California, inclusion on the Candidate Chemicals List is an action toward listing products as a “priority product,” which would require businesses manufacturing the siloxanes to notify the California Department of Toxic Substances Control (DTSC) if their product is listed. The designation would also allow the DTSC to take other regulatory actions such as limiting the siloxanes’ use or requiring companies to replace it with an alternative (34).

Meanwhile, Washington State removed siloxanes from its list after taking a “weight of evidence” approach and analyzing all available evidence for real-world harm to human health or the environment. This approach permits advancements in innovation and growth to be realized unless evidence of real-world harm can be found.

 

Economic Implications of Chemical Regulation

The regulatory approach states take to silicones regulation has implications for jobs and economic growth not just today, but also in the future. Indeed, silicones are an input in many industries including construction, electronics, health care, household products, renewable energy technologies and personal care products, to name a few. A 2016 industry report estimated total sales of silicones products in the Americas to be $3.1 billion in 2013, with the highest consuming industries being industrial processes, construction, and personal care and consumer products (35). Restricting these materials will raise prices for both manufacturers and the industries that utilize silicones.

What’s more, the rebirth of manufacturing jobs in the U.S. will rely on new technologies such as 3D printing, which themselves rest on the creation of new and reformulated materials. As the Progressive Policy Institute (PPI) pointed out in a 2018 paper, “the range of materials that can be 3D printed is constantly expanding. Desktop Metal is expected to come out with a metal 3D printing system for mass production in 2019. HP plans to launch a line of 3D printers that produce metal objects, an expansion from the company’s existing 3D printers that produce plastic-based products” (36).

Take German chemical company Wacker Chemie for example, who in 2016 discovered how to 3D print silicones, a process that requires heating and binding a material that is naturally heat-resistant to manufacture goods (37). This innovation will open up new markets for manufacturers in critical areas of application such as medicine, where silicone is considered to be bio-compatible and durable. Silicone 3D printing also enables manufacturers to cut production costs, become more efficient, and enable new business models upon which new U.S. manufacturing jobs would be based.

New and reformulated materials will also be needed to revitalize the construction sector, where productivity growth has lagged and the cost of construction has doubled since 2000, as PPI wrote in a 2017 report (38). One of the contributors to rising prices in the sector was the cost of materials, as certain asphalt products, paving mixtures, and steel products are nearly twice as expensive today as they were in 2000. Innovation in materials would help revitalize productivity and economic growth in the sector.

If states move to blacklist or even prohibit silicones based on the E.U.’s lists rooted in the precautionary principle rather than on real-world scientific evidence, that is not a good sign for the regulatory attitude toward new materials with less of a track record.

Indeed, the broader danger is that a strict precautionary approach to chemical listing
and regulation, as would be implied by tighter regulation of silicones, would have negative implications for the rebirth of manufacturing jobs in the U.S. After all, under states importing lists from the E.U., the companies that manufacture and use new materials would have to be able to conclusively prove their lack of impact on human health and the environment in order to continue using them.

 

Conclusion

State governments do not have the budgetary resources to test or evaluate chemicals themselves. As a result, they rely on national and international governments to conduct the research and assessments that form the basis of health and environmental regulation. But, depending on the underlying principles of the authoritative source’s regulatory regime, states could end up with different conclusions.

Siloxanes provide a prime example of these differences in approach. The E.U. has designated them as substances of very high concern and have moved to restrict the use of silicones in certain products, based on being “very persistent and very bioaccumulative.” By contrast, Canada and Australia have taken a weight of evidence approach, analyzing all the available evidence and requiring real-world harm to the environment or human health before taking regulatory action.

The result has led to different outcomes. While states relying on the E.U.’s SVHC list and related criteria have put D4, D5, and D6 on a path to regulation, states that have taken a weight-of-evidence approach similar to Canada and Australia have removed silicones from their Chemicals of Concern list and allowed the silicones unrestricted in the marketplace. If states are to develop Chemicals of Concern lists at all, state policymakers should consider basing those lists only on authorities that evaluate chemicals utilizing a risk-based approach. This would decrease instances where substances that pose little or no risk, like siloxanes, are blacklisted unnecessarily.

These divergent outcomes have implications for jobs and economic growth today and in the future. Silicones are a multi-billion-dollar industry in the Americas and an input in many goods and services, including industrial processes, construction, healthcare, and personal care and consumer products.

What’s more, the rebirth of manufacturing jobs in the U.S. will rely on new technologies such as 3D printing, which themselves require the creation of new and reformulated materials. Silicones will play a critical role in realizing new materials that will revitalize other industries such as manufacturing and construction, where productivity and job growth has lagged for years.

Indeed, precautionary regulation of silicones by states, rather than risk-based, does not indicate regulators are prioritizing innovation. Rather, it signals negative implications for the revitalization of historically important industries to the U.S. economy.

 

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