Number of Uninsured Jumps Under Trump

Plus, Pelosi’s ‘not messing around’ on drug prices By Yuval Rosenberg and Michael Rainey Nearly 2 Million More Uninsured Under Trump The number of Americans without health insurance rose slightly last year for the first time since 2009, climbing to 27.5 million, the Census Bureau [reported]( Tuesday. Compared with 2017, the number of uninsured grew by 1.9 million and the share of the population without coverage rose from 7.9% to 8.5%. The increases are notable because they came even as the economy continued to grow in 2018 and the poverty rate fell 0.5 percentage points to 11.8%, the lowest level since 2001. A troubling turn: While the uninsured rate is still well below where it was a decade ago, the increase is the first since coverage began expanding under the Affordable Care Act, which introduced government subsidies for private insurance plans for millions of Americans and allowed for the expansion of Medicaid to millions more. The new data “show that insurance gains under the health care law have stalled and are appearing to reverse as the Trump administration focuses on paring back the law's insurance markets and shrink enrollment in safety net programs like Medicaid and the Children's Health Insurance Program,” Politico’s Rachana Pradhan [said](. Driving the numbers: The rise in the number of uninsured was driven primarily by a drop in public insurance for the poor. Despite the stronger economy, the percentage of people with private health insurance didn’t change significantly last year. “There are fewer people in poverty and more people working, but the jobs low-income people are getting often don't come with health benefits. So, job-based health insurance isn't growing, even in an economy with low unemployment,” Larry Levitt of the Kaiser Family Foundation [said](. But the percentage of people covered by government plans dropped 0.4 percentage points, including a 0.7 percentage point decline in Medicaid coverage to 17.9%. The rate of Medicare coverage grew by 0.4 percentage points to 17.8%, due in part to the continued aging of the population. The share of children under the age of 19 without insurance also rose by 0.6 percentage points, to 5.5%, meaning 4.3 million children lacked coverage. Overall, the number of Americans covered by Medicaid and the Children’s Health Insurance Program fell by more than 1.6 million last year, according to data cited by [The New York Times](. Some groups stand out: Many of those who lost coverage last year — about 574,000 — were non-citizens, Kaiser Health News [notes](. And the uninsured rate jumped especially among adults who are Hispanic and foreign-born, both both groups seeing losses of coverage three times as large as the national average, according to The Washington Post. Children who are Hispanic and naturalized citizens also saw outsized declines. “Health policy experts interpreted those patterns as evidence of a chilling effect from the Trump administration’s efforts to restrict several forms of public assistance, including Medicaid, for immigrants seeking to remain in the United States,” The Washington Post’s Amy Goldstein and Heather Long [report](. “In addition, some state[s] have been clamping down on eligibility rules for Medicaid.” More Progress in Tackling Poverty, but Meager Gains for the Middle Class Some 38 million people were living in poverty in the U.S. last year, according to new Census Bureau data. That’s a decrease of 1.4 million people from 2017. The poverty rate fell for the fourth straight year, dropping 0.5 percentage points to 11.8%, the lowest level since 2001. And incomes grew more among poorer households last year. “Employment is the best way out of poverty,” [said]( Tomas Philipson, acting head of Trump’s Council of Economic Advisers. “President Trump’s critics wrongly assert that government programs and handouts are the only way to lift people out of poverty, but today’s data tells a different story.” At the same time, government programs did lift millions of people out of poverty in 2018, the new Census data show. The chart below from the liberal [Center on Budget and Policy Priorities]( breaks down the impact of key safety net programs using the government’s Supplemental Poverty Measure (SPM), an alternative measure of poverty that accounts for taxes and non-cash benefits. Under that measure, the poverty rate was 13.1 percent in 2018, little changed from the year before. The Census report also showed that middle-class incomes reached an all-time high in nominal terms as median household income rose above $63,000 for the first time. The number of full-time year-round workers rose by 2.3 million, and median earnings for full-time year-round workers increased by more than 3% for both men and women, after factoring in inflation. Still, in inflation-adjusted terms, median income was little changed after three years of growth — a surprising and puzzling stall, suggesting that middle-class households saw little in the way of income gains even as the overall economy was strong, Harry Holzer, a public policy professor at Georgetown University, told the [Los Angeles Times](. And median income remains roughly the same as it was 20 years ago. “Median household income today is right where it was in 1999. Two decades with no progress for the middle class,” economist Justin Wolfers [tweeted](. Senate Spending Talks Go Off the Rails Senators racing to move appropriations bills for fiscal year 2020 stumbled out of the gate Tuesday, tripped up by disagreements over abortion-related “poison pills” and funding for President Trump’s border wall. A session to mark up the Labor-Health and Human Services-Education funding bill was reportedly canceled by GOP Senator Richard Shelby, the chair of the Senate Appropriations Committee, after Senator Patty Murray, a Washington Democrat, told colleagues she would propose an amendment to block the Trump administration’s Title X family planning rule, which would prevent federal funds from going to health care providers that offer patients information about abortion. Republicans said that was a “poison pill” and thus violated the terms of the budget deal lawmakers struck in July, which included an agreement to keep controversial policy riders out of the appropriations process. “They might think that’s not a poison pill, and we would deem it would be,” Shelby said, according to [The Hill](. Lawmakers also clashed over funding for Trump’s wall, with Democrats pushing back against the administration’s plans to divert money previously appropriated to the Penatgon to pay for barrier construction. Democrats charged that Republicans were shifting money away from other domestic spending and reportedly were pushing for greater funding in the Labor-HHS-Education bill and a reduction in the proposed allocation for the Department of Homeland Security. “Senate Republicans have decided to begin the appropriations process with a partisan plan to raid taxpayer dollars from health care programs, education, job training and our military to pay for an ineffective border wall that will do nothing to address the humanitarian crisis on our southern border,” a Senate Democratic aide said in a statement reported by [Politico](. Why it matters: These fights will continue, this week and beyond. “The squabbling reinforces the likelihood that a stopgap spending bill will be needed through mid-November or early December, which House and Senate leaders are mulling as they face another government shutdown at the Sept. 30 end of the fiscal year,” Politico said. Pelosi’s ‘Not Messing Around’ on Drug Prices House Speaker Nancy Pelosi’s proposal to lower the cost of drugs would empower the federal government to negotiate prices directly with pharmaceutical companies, according to a draft of the plan circulating Tuesday. A Pelosi spokesperson said that the speaker was still seeking input to the plan, and a senior Democratic aide said the draft was out of date, but it nevertheless sent shockwaves through Washington (and [dinged pharmaceutical shares]( on Wall Street), and is being seen as a sign that Pelosi’s “not messing around” when it comes to drug prices, as Bloomberg’s Max Nisen [put it](. Here are some key details of what the draft plan would do: • Allow the Health and Human Services secretary to negotiate the prices every year of the 250 drugs that cost Americans the most and lack competition. • Apply the negotiated prices not just to Medicare, but to the private market as well. • Set maximum prices equal to 120% of an international index price. • Penalize companies that refuse to negotiate with a fee equal to 75% of gross sales for specific drugs. • Penalize companies that overcharge consumers with a fee equal to 10 times the difference between the negotiated price and the actual price. Does the proposal have a chance? Pelosi’s proposal is more aggressive than expected, raising questions about whether it could possibly win bipartisan support. “The plan is sure to please House progressives who have agitated for bold policy on drug prices but, at least as drafted, has almost no chance of winning conservative support,” STAT’s Nicholas Florko and Lev Facher [wrote]( Tuesday. Evercore ISI’s Michael Newshel [said]( that the “more aggressive provisions make the bill’s fate even less realistic for the near-term window for legislative action likely closing by year-end, with any kind of government negotiating provisions highly unlikely to pass the current Senate.” President Trump is, as always, a wild card. He has expressed interest in using an international benchmark of some sort to set prices in the U.S., and The New York Times’ Abby Goodnough [said]( that might be one reason Pelosi included such an approach in her proposal. But even if Trump embraces Pelosi’s proposal, it seems unlikely that Republicans in the Senate would be willing to go along in the face of intense resistance from the pharmaceutical industry. Those conservative lawmakers might, however, take renewed interest in the [more moderate plan]( introduced by Senators Chuck Grassley and Ron Wyden in July. “I’m trying to tell Senate Republicans that they ought to consider [my bill] a moderate position,” Grassley told the Times Monday. Ramping up the political pressure: In any event, Pelosi’s proposal appears to be an effort to pressure Republicans to act on drug pricing, while giving her members “a potent line of attack on an issue that resonates with voters” should the GOP fail to do so, Bloomberg’s Nisen said. “It might just succeed on both fronts,” Nisen added, since “drug pricing is an area where Republicans are vulnerable.” Deficit Tops $1 Trillion After 11 Months The annual federal budget deficit rose above $1 trillion in August, the Congressional Budget Office said Monday. The deficit reached $1,067 billion in the first 11 months of the 2019 fiscal year, according to CBO’s [monthly budget review]( $168 billion higher than the same period last year. The 12-month number is expected to fall below $1 trillion, however, since the U.S. typically posts a surplus in September, the final month of the fiscal year. CBO is projecting an annual deficit of $960 billion for the full 2019 fiscal year, $181 billion higher than the total in 2018. Number of the Day: $15 Trillion A staggering amount of foreign direct investment is really just “phantom” capital passing through corporate shells, typically to avoid taxes, according to a [new study]( published by economists at the International Monetary Fund. Countries often compete for foreign direct investment — defined by the researchers as “cross-border financial investments between firms belonging to the same multinational group” — in the hopes of improving their populations’ skills and technology use. But in 2017, about $15 trillion of the nearly $40 trillion in foreign direct investment recorded worldwide, or about 40%, was just passing through, the researchers found, leaving little behind in terms of concrete and productive investment. The bottom line: While policymakers have long known that tax issues drive a substantial amount of investment by multinational corporations, the data suggests that countries have more work to do if they want to cut down on the shell games of international tax avoidance. News - [Trump Ousts John Bolton as National Security Adviser]( – New York Times - [Senate Democrats to Force One More Vote Against Trump’s Border Emergency Declaration]( – Washington Post - [Bernie Sanders Went to Canada, and a Dream of ‘Medicare for All’ Flourished]( – New York Times - [Elizabeth Warren's Wealth Tax Could Cost the Rich Hundreds of Billions]( – Fox Business - [Real US Debt Levels Could Be 2,000% of Economy, a Wall Street Report Suggests]( – CNBC - [Why Is Healthcare So Expensive? 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