Trump’s Immigrant Wealth Test Cleared by Supreme Court

Plus: the administration scrambles on drug prices By Yuval Rosenberg and Michael Rainey Trump’s Immigrant Wealth Test Cleared by Supreme Court The Supreme Court voted 5-4 Monday to allow the Trump administration to start enforcing a new rule designed to screen out immigrants at risk of becoming “public charges.” The rule, which was scheduled to take effect last October before being halted by a federal judge, will make it more difficult for immigrants to obtain citizenship or residency if they have used food stamps, housing assistance, Medicaid or other public benefits — or if, in the judgment of immigration officials, they are likely to do so in the future. Any immigrant who has used one or more benefits for more than 12 months in a 36-month period would be ineligible for residency or entry into the country. Immigrants will have to demonstrate that they have sufficient financial resources to keep them from using such benefits in the future. In evaluating immigrants’ financial status, Department of Homeland Security officials will consider a variety of factors, including wealth, age, health, education, language skills and even credit scores. A more stringent standard: While restrictive rules about “public charges” date to the 19th century, immigrants have typically been denied residency or citizenship only when they have relied on cash benefits from the government as their primary source of income. Critics say the new standard is too severe, and a federal judge in New York [described]( it as “repugnant to the American dream of the opportunity for prosperity and success through hard work and upward mobility.” But the Supreme Court appeared to agree with the administration’s [claim]( that the rule “represents a reasonable and lawful exercise of the substantial discretion Congress has long vested in the executive branch to make public-charge admissibility determinations.” What’s next: The ruling reverses a lower court injunction halting enforcement of the new standard (except in Illinois, which is involved in separate litigation), but challenges to the legality of the rule continue, and the case could again land before the Supreme Court in the coming months. Trump Team Scrambling to Finish Drug Pricing Rule: Report Frustrated by polling data showing that voters trust Democrats more on the issue of health care, President Trump reportedly [lashed out]( earlier this month at Health and Human Services Secretary Alex Azar. That has led Azar to scramble to pull together details of a plan tying U.S. drug prices to a benchmark of prices in other developed countries, Politico’s Sarah Karlin-Smith and Adam Cancryn [reported]( late Friday: “There had been internal disagreement among Azar and other key health officials like White House Domestic Policy Council Director Joe Grogan over whether to release the rule on international benchmarking, as Azar wanted, or keep it for leverage as Congress keeps working on drug pricing, as Grogan has argued. Trump’s insistence on an imminent win helped bring the dueling parties together around issuing the rule. … But the administration has little ability to speed up the pace of federal rulemaking. That means even under the most favorable circumstances, the administration won’t be able to demonstrate any real change to consumers for years.” The pharmaceutical industry strongly opposes the idea of an international price index, as do many Republicans, who object to what they see as government price controls. Republicans have also been wary of backing bipartisan legislation from Sens. Chuck Grassley (R-IA) and Ron Wyden (D-OR), which the White House supports. Working on a plan to cut insulin costs for seniors: On a related note, Axios’s Caitlin Owens and Jonathan Swan report that the Trump administration is working on a plan to lower out-of-pocket costs for seniors who require insulin, though the details thus far “are unclear or undecided.” Seniors spent an average of $588 out-of-pocket for insulin in 2016, or almost double what they paid in 2007, according to Axios. But Owens and Swan add that, “Lowering patients' out-of-pocket spending probably wouldn't lower the actual cost of the drug, meaning that it'd get shifted onto taxpayers.” Number of the Day: 155,798,000 That’s how many individual tax returns were filed last year, according to [the IRS](. The tax agency issued nearly 112 million refunds totaling almost $321 billion, with the average refund coming in at $2,869, down 1.4% from 2018. The 2020 tax filing season starts [today](. How 6 States Achieved Near Universal Health Coverage A half-dozen states and the District of Columbia have health care insurance rates of over 95%, achieving near-universal coverage. Three researchers at the University of Pennsylvania — including Ezekiel Emanuel, a key architect of Obamacare — said Monday that the Affordable Care Act has everything to do with those results. Here’s how the states achieved such high insurance rates, according to the authors: - Expanding Medicaid: States that expanded their Medicaid programs as allowed under the ACA had about half the uninsured rate (6.6%) in 2018 as states that did not do so (12.4%). “Nearly 5 million people would gain health insurance if the remaining 14 states expanded Medicaid,” they write. - Extending enrollment periods: High-coverage states countered the Trump administration’s efforts to shorten enrollment periods and reduce informational assistance. - Lowering premiums: States enacted additional subsidies and reinsurance programs to keep premiums low, a crucial factor in maintaining insurance coverage from year to year. - Simplifying options: Some states limited the number of options available to counteract “choice overload,” which can reduce signups through consumer paralysis. - Maintaining individual mandates: Five states with low uninsured rates maintain some kind of individual and employer mandates, which may help persuade healthy people to sign up. The lesson, the authors say, is that near-universal health coverage can be achieved without national legislation. “While it is easy to dismiss the ACA and focus on the promise of Medicare for All, there is a more straightforward path to universal coverage,” they write, “adopting a handful of relatively simple policies and programs at the state level can ensure health insurance coverage for nearly all Americans.” [Read the full analysis of “Obamacare’s Secret Success” at Politico](. Today is International Holocaust Remembrance Day and the [75th anniversary]( of the [liberation of Auschwitz](. We must never forget. Send your tips and feedback to yrosenberg@thefiscaltimes.com. 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