thefiscaltimes--2020-04-13--National Debt Will Exceed GDP This Fiscal Year, New Projection Says

The Congressional Budget Office projected early last month that the federal debt held by the public would approach the size of the economy in a decade , rising from just over 80 % of gross domestic product this year to 98 % in 2030 .
Then the coronavirus pandemic led to much of the economy being shuttered and Congress passed its $ 2.2 trillion relief package .
The Committee for a Responsible Federal Budget now projects that , as a result of those developments , debt held by the public will now exceed GDP by the end of this fiscal @ @ @ @ @ @ @ will top the record 106 % of GDP set after World War II .
CRFB says the budget deficit will rise from about $ 1 trillion last year to $ 3.8 trillion ( nearly 19 % of GDP ) this year and $ 2.1 trillion ( about 10 % of GDP ) in 2021 — and the group adds that those projections “ almost certainly underestimate ” the deficit totals since they assume Congress doesn ’ t enact additional coronavirus aid or change current tax and spending laws .
If the economy doesn @ @ @ @ @ @ @ bounce back fully within a few years , the budget watchdogs project that debt would climb to 117 % of GDP by 2025 .
Those numbers shouldn ’ t cast the federal response into question , though .
“ Like the record levels of borrowing undertaken during World War II , a large share of today 's massive deficits are both inevitable and necessary in light of the current pandemic crisis , ” the group says .
But it warns that eventually , “ such high and rising deficits and debt levels will @ @ @ @ @ @ @ be needed .
”

The Congressional Budget Office projected early last month that the federal debt held by the public would approach the size of the economy in a decade, rising from just over 80% of gross domestic product this year to 98% in 2030. Then the coronavirus pandemic led to much of the economy being shuttered and Congress passed its $2.2 trillion relief package. The Committee for a Responsible Federal Budget now projects that, as a result of those developments, debt held by the public will now exceed GDP by the end of this fiscal year. By 2023, the debt will top the record 106% of GDP set after World War II.
CRFB says the budget deficit will rise from about $1 trillion last year to $3.8 trillion (nearly 19% of GDP) this year and $2.1 trillion (about 10% of GDP) in 2021 — and the group adds that those projections “almost certainly underestimate” the deficit totals since they assume Congress doesn’t enact additional coronavirus aid or change current tax and spending laws. If the economy doesn’t recover strongly next year or bounce back fully within a few years, the budget watchdogs project that debt would climb to 117% of GDP by 2025.
Those numbers shouldn’t cast the federal response into question, though. “Like the record levels of borrowing undertaken during World War II, a large share of today's massive deficits are both inevitable and necessary in light of the current pandemic crisis,” the group says. But it warns that eventually, “such high and rising deficits and debt levels will prove unsustainable, and corrective action will be needed.”


thefiscaltimes--2020-04-13--Trump Threatened to Block Coronavirus Aid if It Included Postal Service Bailout

President Trump threatened to block the $ 2.2 trillion coronavirus relief package if Congress included emergency aid to the United States Postal Service , The Washington Post reported this weekend .
“ We told them very clearly that the president was not going to sign the bill if [ money for the Postal Service ] was in it , ” an unnamed Trump administration official told the Post .
“ I don ’ t know if we used the v-bomb [ a veto threat ] , but the president was not going to sign it , and we told them @ @ @ @ @ @ @ to provide $ 13 billion to the Postal Service in the form of a direct grant that would not have to be repaid .
But Treasury Secretary Steven Mnuchin blocked that idea , reportedly telling congressional negotiators , “ You can have a loan , or you can have nothing at all.
” In the end , the legislation included a $ 10 billion loan from the Treasury Department to the postal service .
‘ A critical juncture ’ : Plummeting volumes of first-class and marketing mail as a result of the pandemic @ @ @ @ @ @ @ the Postal Service , which employs more than 600,000 people .
“ We are at a critical juncture in the life of the Postal Service , ” Postmaster General Megan Brennan said in a statement Friday .
“ At a time when America needs the Postal Service more than ever , the reason we are so needed is having a devastating effect on our business.
” In a video briefing to members of the House Oversight and Reform Committee last week , Brennan said that the Postal Service would run out of money @ @ @ @ @ @ @ Brennan said that the Postal Service expects to lose $ 13 billion in revenue this year as a result of the pandemic , and an additional $ 54 billion in losses over the next decade .
“ The Postal Service is holding on for dear life , and unless Congress and the White House provide meaningful relief in the next stimulus bill , the Postal Service could cease to exist , '' Oversight and Reform Committee Chairwoman Carolyn Maloney ( D-NY ) said in a statement .
Brennan asked for $ 25 billion @ @ @ @ @ @ @ due to the virus and $ 25 billion for modernization projects , plus a $ 25 billion Treasury loan .
But the Trump administration has reportedly made it clear that a bailout for the Postal Service would scuttle efforts to reach a broader stimulus deal .
“ While the Trump Administration and Mnuchin pushed through private-sector bailouts in the Cares Act — $ 350 billion to the Small Business Administration loan program , $ 29 billion to passenger airlines and air cargo carriers , and economic incentives for the construction , energy and @ @ @ @ @ @ @ Mnuchin has signaled any postal relief funds in a ‘ Phase IV ’ stimulus package under negotiation would amount to a poison pill.
” Read more at The Washington Post .

President Trump threatened to block the $2.2 trillion coronavirus relief package if Congress included emergency aid to the United States Postal Service, The Washington Post reported this weekend.
“We told them very clearly that the president was not going to sign the bill if [money for the Postal Service] was in it,” an unnamed Trump administration official told the Post. “I don’t know if we used the v-bomb [a veto threat], but the president was not going to sign it, and we told them that.”
Lawmakers reportedly had originally agreed to provide $13 billion to the Postal Service in the form of a direct grant that would not have to be repaid. But Treasury Secretary Steven Mnuchin blocked that idea, reportedly telling congressional negotiators, “You can have a loan, or you can have nothing at all.”
In the end, the legislation included a $10 billion loan from the Treasury Department to the postal service.
‘A critical juncture’: Plummeting volumes of first-class and marketing mail as a result of the pandemic have worsened the already shaky finances of the Postal Service, which employs more than 600,000 people. “We are at a critical juncture in the life of the Postal Service,” Postmaster General Megan Brennan said in a statement Friday. “At a time when America needs the Postal Service more than ever, the reason we are so needed is having a devastating effect on our business.”
In a video briefing to members of the House Oversight and Reform Committee last week, Brennan said that the Postal Service would run out of money this fiscal year without federal aid. Brennan said that the Postal Service expects to lose $13 billion in revenue this year as a result of the pandemic, and an additional $54 billion in losses over the next decade.
“The Postal Service is holding on for dear life, and unless Congress and the White House provide meaningful relief in the next stimulus bill, the Postal Service could cease to exist," Oversight and Reform Committee Chairwoman Carolyn Maloney (D-NY) said in a statement.
Brennan asked for $25 billion in emergency funding to offset lost revenue due to the virus and $25 billion for modernization projects, plus a $25 billion Treasury loan. But the Trump administration has reportedly made it clear that a bailout for the Postal Service would scuttle efforts to reach a broader stimulus deal.
The Post’s Jacob Bogage reported:
“While the Trump Administration and Mnuchin pushed through private-sector bailouts in the Cares Act — $350 billion to the Small Business Administration loan program, $29 billion to passenger airlines and air cargo carriers, and economic incentives for the construction, energy and life sciences industries, among others — Mnuchin has signaled any postal relief funds in a ‘Phase IV’ stimulus package under negotiation would amount to a poison pill.”
Read more at The Washington Post.


thefiscaltimes--2020-04-13--Govs. Cuomo and Hogan Say States Need $500 Billion More in Aid

New York Gov .
Andrew Cuomo slammed the federal coronavirus response Sunday , again accusing Congress of failing to address looming budget shortfalls resulting from the pandemic and misallocating aid in a way that shortchanges his state , hit hardest by the pandemic .
Cuomo , a Democrat , and Republican Maryland Gov .
Larry Hogan , the chair of the National Governors Association , on Saturday called on Congress to approve an additional $ 500 billion in direct aid to help states stabilize their budgets and avoid damaging cuts .
“ In the absence of unrestricted fiscal support of @ @ @ @ @ @ @ federal government , states will have to confront the prospect of significant reductions to critically important services all across this country , hampering public health , the economic recovery , and — in turn — our collective effort to get people back to work , ” they said in a joint statement .
At a press briefing on Sunday , Cuomo blasted the federal government ’ s approach to distributing the initial $ 30 billion in emergency grants provided under the Creates Act coronavirus relief legislation , saying the funding “ became a @ @ @ @ @ @ @ of Health and Human Services confirmed last week it would send money to doctors and hospitals based on their historical share of revenue from Medicare , not the number of coronavirus cases they have .
`` You did an injustice to the places that actually had the need , '' Cuomo said .
`` Which , from an American taxpayer point of view , that 's what you were trying to correct .
You were trying to correct the devastation of the virus .
Well then correct the devastation of the virus .
@ @ @ @ @ @ @ for pork barrel . ''
Cuomo cited an analysis by Kaiser Health News that found that states such as Minnesota , Nebraska and Montana are getting more than $ 300,000 per reported Covid-19 case while New York would only get $ 12,000 per case .

New York Gov. Andrew Cuomo slammed the federal coronavirus response Sunday, again accusing Congress of failing to address looming budget shortfalls resulting from the pandemic and misallocating aid in a way that shortchanges his state, hit hardest by the pandemic.
Cuomo, a Democrat, and Republican Maryland Gov. Larry Hogan, the chair of the National Governors Association, on Saturday called on Congress to approve an additional $500 billion in direct aid to help states stabilize their budgets and avoid damaging cuts.
“In the absence of unrestricted fiscal support of at least $500 billion from the federal government, states will have to confront the prospect of significant reductions to critically important services all across this country, hampering public health, the economic recovery, and — in turn — our collective effort to get people back to work,” they said in a joint statement.
At a press briefing on Sunday, Cuomo blasted the federal government’s approach to distributing the initial $30 billion in emergency grants provided under the Creates Act coronavirus relief legislation, saying the funding “became a game of political pork.”
The Department of Health and Human Services confirmed last week it would send money to doctors and hospitals based on their historical share of revenue from Medicare, not the number of coronavirus cases they have.
"You did an injustice to the places that actually had the need," Cuomo said. "Which, from an American taxpayer point of view, that's what you were trying to correct. You were trying to correct the devastation of the virus. Well then correct the devastation of the virus. Not everything has to be an opportunity for pork barrel."
Cuomo cited an analysis by Kaiser Health News that found that states such as Minnesota, Nebraska and Montana are getting more than $300,000 per reported Covid-19 case while New York would only get $12,000 per case.


thefiscaltimes--2020-04-13--Small Business Relief Funds Tied Up in Senate Stalemate

With small businesses having applied for more than $ 200 billion worth of loans and grants from the federal government as of Monday morning , some worry that the $ 350 billion Paycheck Protection Program will run dry by the end of the week , leaving smaller firms out in the cold .
Responding to a request from Treasury Secretary Steven Mnuchin , Republicans are seeking to add $ 250 billion to the program , which was established by the $ 2.2 trillion coronavirus relief package that passed in late March .
The program provides loans and grants to small @ @ @ @ @ @ @ on payrolls .
But Democrats last week blocked passage of the additional $ 250 billion for small businesses , saying they want revisions in the program ’ s rules as well as additional relief funds for hospitals and state and local governments .
Democrats insist on negotiating a new bill , resulting in a stalemate .
Following a brief pro forma session Monday , the Senate is not expected to meet again until Thursday .
Huge demand for help : The Paycheck Protection Program has approved 860,000 applications for $ 210 billion of @ @ @ @ @ @ @ , CNBC reported .
Getting the money into the hands of small business and sole proprietors has been more difficult than the approval process , however , and many applicants are still waiting to receive their loans and grants .
One problem is confusion over the terms of the loans , with some bankers saying they are still waiting for clear guidelines from the government about loan guarantees and the conversion of some loans to grants .
“ We have mostly undisbursed loans at this time , ” Tony Wilkinson of the National @ @ @ @ @ @ @ .
“ We still don ’ t have a program guide.
” Voting is tricky : Few lawmakers are in Washington , making it hard to pass legislation except by unanimous consent , a parliamentary maneuver that allows legislation to proceed without recording individual votes .
Staunch libertarian Rep. Thomas Massie ( R-KY ) said Monday that he would not allow the House to vote on any funding legislation via unanimous consent and would call for a recorded vote , forcing lawmakers to return to Washington , just as he did with the @ @ @ @ @ @ @ `` By calling them out on the Constitution and making them come to Washington , D.C. in order to pass a bill , they 're finding it harder to pass this next bill , because they know they 're all going to have to come to work , '' Massie said .
“ They know I will get in my car and drive there and make them vote on it .
And my colleagues , a lot of them , frankly , are cowards.
” Finger-pointing commences : Republicans blamed Democrats for slowing @ @ @ @ @ @ @ not negotiate .
`` Republicans reject Democrats ’ reckless threat to continue blocking job-saving funding unless we renegotiate unrelated programs which are not in similar peril .
... We will continue to seek a clean PPP funding increase .
We hope our Democratic colleagues familiarize themselves with the facts and the data before the program runs dry , '' GOP lawmakers said in a joint statement .
In response , Democrats said a stand-alone bill has no chance of passing the House and demanded that Republicans start negotiations .
“ We have real @ @ @ @ @ @ @ ’ s time for the Republicans to quit the political posturing by proposing bills they know will not pass either chamber and get serious and work with us towards a solution , '' House Speaker Nancy Pelosi and Senate Minority Leader Chuck Schumer said in a joint statement .
How does it end ?
The two sides are currently locked in a high-stakes game of chicken , with no clear outcome in sight .

With small businesses having applied for more than $200 billion worth of loans and grants from the federal government as of Monday morning, some worry that the $350 billion Paycheck Protection Program will run dry by the end of the week, leaving smaller firms out in the cold.
Responding to a request from Treasury Secretary Steven Mnuchin, Republicans are seeking to add $250 billion to the program, which was established by the $2.2 trillion coronavirus relief package that passed in late March. The program provides loans and grants to small businesses to keep firms open and workers on payrolls. But Democrats last week blocked passage of the additional $250 billion for small businesses, saying they want revisions in the program’s rules as well as additional relief funds for hospitals and state and local governments. Democrats insist on negotiating a new bill, resulting in a stalemate.
Following a brief pro forma session Monday, the Senate is not expected to meet again until Thursday.
Huge demand for help: The Paycheck Protection Program has approved 860,000 applications for $210 billion of loans through 4,500 lenders as of Monday, CNBC reported. Getting the money into the hands of small business and sole proprietors has been more difficult than the approval process, however, and many applicants are still waiting to receive their loans and grants.
One problem is confusion over the terms of the loans, with some bankers saying they are still waiting for clear guidelines from the government about loan guarantees and the conversion of some loans to grants. “We have mostly undisbursed loans at this time,” Tony Wilkinson of the National Association of Guaranteed Government Lenders told CNBC. “We still don’t have a program guide.”
Voting is tricky: Few lawmakers are in Washington, making it hard to pass legislation except by unanimous consent, a parliamentary maneuver that allows legislation to proceed without recording individual votes. Staunch libertarian Rep. Thomas Massie (R-KY) said Monday that he would not allow the House to vote on any funding legislation via unanimous consent and would call for a recorded vote, forcing lawmakers to return to Washington, just as he did with the first aid package three weeks ago.
"By calling them out on the Constitution and making them come to Washington, D.C. in order to pass a bill, they're finding it harder to pass this next bill, because they know they're all going to have to come to work," Massie said. “They know I will get in my car and drive there and make them vote on it. And my colleagues, a lot of them, frankly, are cowards.”
Finger-pointing commences: Republicans blamed Democrats for slowing the additional aid and said they would not negotiate. "Republicans reject Democrats’ reckless threat to continue blocking job-saving funding unless we renegotiate unrelated programs which are not in similar peril. ... We will continue to seek a clean PPP funding increase. We hope our Democratic colleagues familiarize themselves with the facts and the data before the program runs dry," GOP lawmakers said in a joint statement.
In response, Democrats said a stand-alone bill has no chance of passing the House and demanded that Republicans start negotiations. “We have real problems facing this country, and it’s time for the Republicans to quit the political posturing by proposing bills they know will not pass either chamber and get serious and work with us towards a solution," House Speaker Nancy Pelosi and Senate Minority Leader Chuck Schumer said in a joint statement.
How does it end? The two sides are currently locked in a high-stakes game of chicken, with no clear outcome in sight.


thefiscaltimes--2020-04-13--How Do We Exit the Shutdown? Hire an Army of Public Health Workers

Last month , facing the prospect of overwhelmed hospitals and unchecked spread of the novel coronavirus , seven Bay Area county and city health departments joined forces to become the first region in the nation to pass sweeping regulations ordering millions of people indoors and shuttering the local economy .
It shocked people , but health experts around the country applauded the bold step , which since has been broadly replicated .
They also say it can ’ t go on forever .
And so Bay Area leaders , along with others around the nation , are trying to figure @ @ @ @ @ @ @ to normal life without triggering a catastrophic wave of illness and death .
The shelter-in-place orders were a sledgehammer response to two colliding realities : a little-understood virus that is proving ferociously deadly in vulnerable populations and a withered public health infrastructure that has made it impossible to track and contain the spread of the virus that causes COVID-19 .
For all the light the new virus has shone on vulnerabilities of the U.S. hospital system — shortfalls in hospital capacity , ventilators and protective gear — what many officials see are the @ @ @ @ @ @ @ .
“ Nothing should come as a surprise , ” said Laura Biesiadecki , senior director for preparedness , recovery and response with the National Association of County and City Health Officials , which represents more than 3,000 local health departments .
“ What you ’ re seeing in COVID-19 is an exacerbation of existing fault lines that everyone in the public health community has recognized over the years.
” Still , there ’ s broad agreement that core public health work — the ability to find people with the virus and prevent @ @ @ @ @ @ @ will be essential to reopening schools and businesses .
That strategy is endorsed by the director of the Centers for Disease Control and Prevention , who recently told NPR the agency was working on a plan to deploy more disease investigators .
We spoke with more than two dozen health experts to get their thoughts on what public health resources will be needed to reopen the economy .
It may be rare that the World Health Organization and experts on the right and left in the U.S. see the same solutions to a @ @ @ @ @ @ @ case when it comes to reopening the economy in the face of COVID-19 .
The principles are simple : Stabilize the number of people who have the virus ( through the strict social distancing already in place ) , and ensure hospitals can handle the cases they have .
Then , put tools in place to stop new infections in their tracks so there isn ’ t a renewed outbreak .
It all starts with testing , and several countries that revamped their public health programs in the wake of the deadly 2003 @ @ @ @ @ @ @ benefits now .
That includes Singapore , which quickly ramped up testing for both active infections of COVID-19 and an antibody test to show previous infection , and South Korea , which tested tens of thousands of people in the weeks after it detected its first cases .
South Korea , like many other Asian countries , is also relying on hundreds of workers armed with phone location data , credit card information and security footage to try to reach everyone who has come into contact with an infected person .
Authorities release @ @ @ @ @ @ @ infected has been in their area .
Though South Korea and Singapore report a recent surge in cases imported from abroad , both countries have seen far more moderate economic and health fallouts than has the U.S .
Politically and culturally , European nations make for an easier comparison with the U.S. Germany not only deployed widespread testing early on , but it also has sent health teams to people ’ s homes to check for symptoms and initiate aggressive interventions if symptoms arise .
Italy , which has had more than double @ @ @ @ @ @ @ than 5 % of its population , has lessons for the U.S. as well — and not all grim .
The scenes from Lombardy , where doctors have rationed care for weeks , making decisions about who lives and who dies , are bleak .
But neighboring Veneto , which found its first case of the virus on the same day as Lombardy , is faring much better , said Dr. Nancy Binkin , a professor at the University of California-San Diego who spent 12 of her 20 years at the CDC embedded @ @ @ @ @ @ @ .
Binkin and colleagues suspect the difference lies in the extensive use of public health tools to contain the initial outbreak in Veneto .
That included testing nearly everyone in the town of Vò where the first cases were found , quarantining that city , and making heavy use of assistenti sanitari , or health assistants , to track down people with the virus and make sure they stay isolated .
There have been far fewer infected health workers in Veneto , and deaths overall , than in Lombardy , which is renowned @ @ @ @ @ @ @ health care .
What the places with fewer cases have in common is not just social distancing , said Binkin , but also aggressive tactics to identify and isolate people with the virus .
2 .
How does the U.S. compare ?
U.S. public health budgets and staff have hemorrhaged over the years , accompanied by a steady stream of warning calls that the U.S. was not ready to face a pandemic .
When COVID-19 arrived , identifying and tracking everyone with the virus was all but impossible for local health departments because @ @ @ @ @ @ @ who should get tested .
Compounding the problem was a beleaguered public health infrastructure .
The stay-at-home orders are largely about slowing the spread of the virus — to keep hospitals from being overwhelmed — not necessarily about preventing cases , said Adia Benton , an anthropologist at Northwestern University who studies inequalities in global health .
Mobilizing a massive workforce to isolate everyone with the virus could prevent infections , Benton said .
“ The interventions we see reflect what we value , ” she said .
Public health is run locally @ @ @ @ @ @ @ and organization .
They are also confronting different degrees of outbreak .
In Tennessee , front-line health workers still are contact tracing everyone who gets the virus .
To do so , many employees are working seven days a week , 12 hours a day , said Dr. Mary-Margaret Fill , a physician and epidemiologist with the state who is helping coordinate its emergency response .
“ They are the internal cog in this response ; without them we fall apart , ” she said .
In California , public health is the @ @ @ @ @ @ @ wildly .
Many , including Sacramento and Orange counties , moved away from contact tracing weeks ago , citing minimal access to testing and a surge in cases .
( A lack of testing is one thing nearly all health departments have in common . )
Even San Francisco , with its abundant wealth and renowned expertise in HIV , was relying on a skeleton staff to track routine communicable diseases like measles , tuberculosis and sexually transmitted diseases , according to the city ’ s health officer , Dr. Tomás Aragón .
@ @ @ @ @ @ @ public health employees , is still doing some contact tracing for every person who tests positive , said Dr. Barbara Ferrer , director of the Los Angeles County Department of Public Health .
Rural Tulare County is trying to do the same , but has pinpointed the need for more people to trace cases as its greatest hurdle .
Those techniques matter everywhere .
“ Social distancing , contact tracing , identification , quarantine and isolation .
We need all of those tools , ” said Ferrer .
3 .
How do we @ @ @ @ @ @ @ necessitates , at least temporarily , adding thousands of people to the ranks of public health .
Three former Obama administration officials called for a “ public health firefighting force ” via a program like AmeriCorps or the Peace Corps .
Others suggest we make use of programs already in place .
The Medical Reserve Corps program , a national network of volunteer medical and public health professionals , has 175,000 volunteers , some of whom have already been deployed to state health departments , said Biesiadecki .
That program could be expanded @ @ @ @ @ @ @ .
We need a New Deal .
We need a WPA for public health , ” said Gregg Gonsalves , a Yale epidemiologist who won a MacArthur Fellowship for his work on global health and justice .
And it doesn ’ t necessarily require M.D.s , Ph.D.s or even public health degrees .
In many countries , governments have trained community health workers in situations like these .
But in the absence of a federal program , some local departments in the U.S. are already taking up the cause .
San Francisco , @ @ @ @ @ @ @ around 160 people to keep tabs on people diagnosed with the virus .
Aragón said he hopes to repurpose staff from within the county where possible , and hire where necessary .
“ We started off with a scarcity mentality , ” Aragón said .
“ We have to have an abundance mentality .
The amount of money that ’ s being lost economically , if we put just a fraction of that into our public health workforce , we could get the economy back up and running.
” Massachusetts asked the global @ @ @ @ @ @ @ it hire 1,000 people to carry out mass contact tracing .
In Connecticut , Yale University faculty said they realized the state had the capacity to contact trace only in Fairfield County , a wealthy bedroom community of New York , leaving few resources for much poorer New Haven , where the university is located .
So they recruited more than 100 public health , nursing and medical students , said Dr. Sten Vermund , dean of Yale School of Medicine .
The volunteers were trained online by the state and , working @ @ @ @ @ @ @ contact tracing for the local hospital .
But he doesn ’ t think these volunteer efforts are the solution .
Vermund called it “ the definition of insanity ” if the U.S. didn ’ t take this moment to reinvest in public health .
“ There is no greater threat to the economic well-being of planet Earth , ” he said , “ than pandemic respiratory viral illness .
”

Last month, facing the prospect of overwhelmed hospitals and unchecked spread of the novel coronavirus, seven Bay Area county and city health departments joined forces to become the first region in the nation to pass sweeping regulations ordering millions of people indoors and shuttering the local economy.
It shocked people, but health experts around the country applauded the bold step, which since has been broadly replicated.
They also say it can’t go on forever. And so Bay Area leaders, along with others around the nation, are trying to figure out how we can resume something akin to normal life without triggering a catastrophic wave of illness and death.
The shelter-in-place orders were a sledgehammer response to two colliding realities: a little-understood virus that is proving ferociously deadly in vulnerable populations and a withered public health infrastructure that has made it impossible to track and contain the spread of the virus that causes COVID-19.
For all the light the new virus has shone on vulnerabilities of the U.S. hospital system — shortfalls in hospital capacity, ventilators and protective gear — what many officials see are the cracks in the foundations of public health.
“Nothing should come as a surprise,” said Laura Biesiadecki, senior director for preparedness, recovery and response with the National Association of County and City Health Officials, which represents more than 3,000 local health departments. “What you’re seeing in COVID-19 is an exacerbation of existing fault lines that everyone in the public health community has recognized over the years.”
Still, there’s broad agreement that core public health work — the ability to find people with the virus and prevent them from passing it to others — will be essential to reopening schools and businesses. That strategy is endorsed by the director of the Centers for Disease Control and Prevention, who recently told NPR the agency was working on a plan to deploy more disease investigators.
We spoke with more than two dozen health experts to get their thoughts on what public health resources will be needed to reopen the economy.
1. What works?
It may be rare that the World Health Organization and experts on the right and left in the U.S. see the same solutions to a problem, but that’s the case when it comes to reopening the economy in the face of COVID-19. The principles are simple: Stabilize the number of people who have the virus (through the strict social distancing already in place), and ensure hospitals can handle the cases they have. Then, put tools in place to stop new infections in their tracks so there isn’t a renewed outbreak.
It all starts with testing, and several countries that revamped their public health programs in the wake of the deadly 2003 SARS epidemic seem to be reaping the benefits now. That includes Singapore, which quickly ramped up testing for both active infections of COVID-19 and an antibody test to show previous infection, and South Korea, which tested tens of thousands of people in the weeks after it detected its first cases.
South Korea, like many other Asian countries, is also relying on hundreds of workers armed with phone location data, credit card information and security footage to try to reach everyone who has come into contact with an infected person. Authorities release detailed information to the public whenever someone infected has been in their area. Though South Korea and Singapore report a recent surge in cases imported from abroad, both countries have seen far more moderate economic and health fallouts than has the U.S.
Politically and culturally, European nations make for an easier comparison with the U.S. Germany not only deployed widespread testing early on, but it also has sent health teams to people’s homes to check for symptoms and initiate aggressive interventions if symptoms arise.
Italy, which has had more than double the deaths of China despite having less than 5% of its population, has lessons for the U.S. as well — and not all grim.
The scenes from Lombardy, where doctors have rationed care for weeks, making decisions about who lives and who dies, are bleak. But neighboring Veneto, which found its first case of the virus on the same day as Lombardy, is faring much better, said Dr. Nancy Binkin, a professor at the University of California-San Diego who spent 12 of her 20 years at the CDC embedded in Italy’s public health system.
Binkin and colleagues suspect the difference lies in the extensive use of public health tools to contain the initial outbreak in Veneto. That included testing nearly everyone in the town of Vò where the first cases were found, quarantining that city, and making heavy use of assistenti sanitari, or health assistants, to track down people with the virus and make sure they stay isolated.
There have been far fewer infected health workers in Veneto, and deaths overall, than in Lombardy, which is renowned for the quality of its hospitals and health care.
What the places with fewer cases have in common is not just social distancing, said Binkin, but also aggressive tactics to identify and isolate people with the virus.
2. How does the U.S. compare?
U.S. public health budgets and staff have hemorrhaged over the years, accompanied by a steady stream of warning calls that the U.S. was not ready to face a pandemic.
When COVID-19 arrived, identifying and tracking everyone with the virus was all but impossible for local health departments because of flawed tests and narrow guidelines for who should get tested. Compounding the problem was a beleaguered public health infrastructure.
The stay-at-home orders are largely about slowing the spread of the virus — to keep hospitals from being overwhelmed — not necessarily about preventing cases, said Adia Benton, an anthropologist at Northwestern University who studies inequalities in global health. Mobilizing a massive workforce to isolate everyone with the virus could prevent infections, Benton said. “The interventions we see reflect what we value,” she said.
Public health is run locally, and health departments have different resources and organization. They are also confronting different degrees of outbreak.
In Tennessee, front-line health workers still are contact tracing everyone who gets the virus. To do so, many employees are working seven days a week, 12 hours a day, said Dr. Mary-Margaret Fill, a physician and epidemiologist with the state who is helping coordinate its emergency response. “They are the internal cog in this response; without them we fall apart,” she said.
In California, public health is the responsibility of counties, and resources vary wildly. Many, including Sacramento and Orange counties, moved away from contact tracing weeks ago, citing minimal access to testing and a surge in cases. (A lack of testing is one thing nearly all health departments have in common.)
Even San Francisco, with its abundant wealth and renowned expertise in HIV, was relying on a skeleton staff to track routine communicable diseases like measles, tuberculosis and sexually transmitted diseases, according to the city’s health officer, Dr. Tomás Aragón.
Los Angeles County, with its 4,000 public health employees, is still doing some contact tracing for every person who tests positive, said Dr. Barbara Ferrer, director of the Los Angeles County Department of Public Health. Rural Tulare County is trying to do the same, but has pinpointed the need for more people to trace cases as its greatest hurdle.
Those techniques matter everywhere. “Social distancing, contact tracing, identification, quarantine and isolation. We need all of those tools,” said Ferrer.
3. How do we ramp up?
Experts say the situation necessitates, at least temporarily, adding thousands of people to the ranks of public health. Three former Obama administration officials called for a “public health firefighting force” via a program like AmeriCorps or the Peace Corps.
Others suggest we make use of programs already in place. The Medical Reserve Corps program, a national network of volunteer medical and public health professionals, has 175,000 volunteers, some of whom have already been deployed to state health departments, said Biesiadecki. That program could be expanded.
“We need a Marshall Plan. We need a New Deal. We need a WPA for public health,” said Gregg Gonsalves, a Yale epidemiologist who won a MacArthur Fellowship for his work on global health and justice.
And it doesn’t necessarily require M.D.s, Ph.D.s or even public health degrees. In many countries, governments have trained community health workers in situations like these.
But in the absence of a federal program, some local departments in the U.S. are already taking up the cause. San Francisco, for example, is planning to recruit around 160 people to keep tabs on people diagnosed with the virus. Aragón said he hopes to repurpose staff from within the county where possible, and hire where necessary.
“We started off with a scarcity mentality,” Aragón said. “We have to have an abundance mentality. The amount of money that’s being lost economically, if we put just a fraction of that into our public health workforce, we could get the economy back up and running.”
Massachusetts asked the global health nonprofit Partners in Health to help it hire 1,000 people to carry out mass contact tracing.
In Connecticut, Yale University faculty said they realized the state had the capacity to contact trace only in Fairfield County, a wealthy bedroom community of New York, leaving few resources for much poorer New Haven, where the university is located. So they recruited more than 100 public health, nursing and medical students, said Dr. Sten Vermund, dean of Yale School of Medicine. The volunteers were trained online by the state and, working alongside university staff, have been doing contact tracing for the local hospital.
But he doesn’t think these volunteer efforts are the solution. Vermund called it “the definition of insanity” if the U.S. didn’t take this moment to reinvest in public health. “There is no greater threat to the economic well-being of planet Earth,” he said, “than pandemic respiratory viral illness.”


thefiscaltimes--2020-04-09--Democrats Block Effort to Add $250 Billion to Coronavirus Small Business Funds

A bill that would add $ 250 billion to the emergency loan program for small businesses hurt by the coronavirus pandemic fell short in the Senate Thursday .
In a nearly deserted Capitol , Senate Majority Leader Mitch McConnell ( R-KY ) tried to approve the legislation by voice vote , but Sen. Ben Cardin ( D-MD ) objected to the request , calling it a “ political stunt ” while noting that the program hasn ’ t yet run through its initial $ 350 billion funding .
Sen. Chris Van Hollen ( D-MD ) offered an amendment to the @ @ @ @ @ @ @ , which McConnell promptly blocked .
The Senate then adjourned until next week .
Even if it had passed the Senate , the bill was not expected to pass the House , given Democrats ’ interest in new requirements for the small business program , as well as a broader aid package .
“ The bill that they put forth will not get unanimous support in the House , ” House Speaker Nancy Pelosi said Wednesday .
“ It just won ’ t. ” What ’ s next : The small business relief @ @ @ @ @ @ @ likely receive a substantial increase in funding .
Lawmakers on both sides have reportedly expressed optimism that they ’ ll be able to reach a deal .
When and what the deal might look like remain unclear , though .

A bill that would add $250 billion to the emergency loan program for small businesses hurt by the coronavirus pandemic fell short in the Senate Thursday.
In a nearly deserted Capitol, Senate Majority Leader Mitch McConnell (R-KY) tried to approve the legislation by voice vote, but Sen. Ben Cardin (D-MD) objected to the request, calling it a “political stunt” while noting that the program hasn’t yet run through its initial $350 billion funding. Sen. Chris Van Hollen (D-MD) offered an amendment to the bill with provisions Democrats have been seeking, which McConnell promptly blocked. The Senate then adjourned until next week.
Even if it had passed the Senate, the bill was not expected to pass the House, given Democrats’ interest in new requirements for the small business program, as well as a broader aid package. “The bill that they put forth will not get unanimous support in the House,” House Speaker Nancy Pelosi said Wednesday. “It just won’t.”
What’s next: The small business relief program has seen tremendous demand and will likely receive a substantial increase in funding. Lawmakers on both sides have reportedly expressed optimism that they’ll be able to reach a deal. When and what the deal might look like remain unclear, though.


thefiscaltimes--2020-04-09--Another Staggering Week for Job Losses

Another Staggering Week for Job Losses

Another 6.6 million Americans filed for unemployment benefits last week , bringing the four-week total for initial jobless claims to more than 17 million .
The latest numbers from the Labor Department mean that at least 10 % of the U.S. labor force is now out of work , and some experts think the unemployment rate could be several points higher than that , once all of the people who have been unable to file for benefits at the state level due to overwhelmed reporting systems are taken into account .
“ So far , jobless claims look to me @ @ @ @ @ @ @ of applications has been the states ’ ability to process those claims , ” said Darrell Cronk , chief investment officer of Wells Fargo Wealth and Investment Management .
In a note to clients , economist Chris Rupkey of MUFG Bank said he sees the unemployment rate rapidly heading toward 15 % .
“ This isn ’ t a recession , it ’ s the Great Depression II , ” Rupkey wrote .
A ‘ purposeful sacrifice ’ : Labor Secretary Eugene Scalia emphasized that the eye-popping unemployment numbers are the product of @ @ @ @ @ @ @ of a global pandemic , with about 95 % of the U.S. population currently under stay-at-home orders .
“ Today ’ s report continues to reflect the purposeful sacrifice being made by America ’ s workers and their families to slow the spread of the coronavirus , ” Scalia said in a statement .
Unemployment benefits slow to arrive : The roughly $ 2 trillion relief package signed into law two weeks ago provides an extra $ 600 per week for unemployed workers , but state offices have been overwhelmed with applications , @ @ @ @ @ @ @ to file their claims .
Lawmakers are pushing the Labor Department to move faster .
“ The Department and state workforce agencies have a monumental task ahead in processing these claims , ” a group of Senate Democrats said this week in a letter .
“ But Americans who have lost their jobs don ’ t have time to wait for a check .
People need unemployment compensation now so they can buy groceries , pay rent , and keep up their bills .
Without it , many Americans won ’ t be @ @ @ @ @ @ @ layoffs ahead : As shocking as the unemployment numbers have been so far , economists expect them to move higher in the coming weeks .
Michelle Meyer of Bank of America Merrill Lynch expects to see as many as 20 million job losses by May , pushing the unemployment rate to 15 % .
Oxford Economics has an even grimmer outlook , with 26 million layoffs and a 16 % jobless rate by the end of next month .

Another 6.6 million Americans filed for unemployment benefits last week, bringing the four-week total for initial jobless claims to more than 17 million.
The latest numbers from the Labor Department mean that at least 10% of the U.S. labor force is now out of work, and some experts think the unemployment rate could be several points higher than that, once all of the people who have been unable to file for benefits at the state level due to overwhelmed reporting systems are taken into account.
“So far, jobless claims look to me like the only limitation on the number of applications has been the states’ ability to process those claims,” said Darrell Cronk, chief investment officer of Wells Fargo Wealth and Investment Management.
In a note to clients, economist Chris Rupkey of MUFG Bank said he sees the unemployment rate rapidly heading toward 15%. “This isn’t a recession, it’s the Great Depression II,” Rupkey wrote.
A ‘purposeful sacrifice’: Labor Secretary Eugene Scalia emphasized that the eye-popping unemployment numbers are the product of an intentional effort to slow the pace of a global pandemic, with about 95% of the U.S. population currently under stay-at-home orders. “Today’s report continues to reflect the purposeful sacrifice being made by America’s workers and their families to slow the spread of the coronavirus,” Scalia said in a statement.
Unemployment benefits slow to arrive: The roughly $2 trillion relief package signed into law two weeks ago provides an extra $600 per week for unemployed workers, but state offices have been overwhelmed with applications, making it difficult for millions of workers to file their claims.
Lawmakers are pushing the Labor Department to move faster. “The Department and state workforce agencies have a monumental task ahead in processing these claims,” a group of Senate Democrats said this week in a letter. “But Americans who have lost their jobs don’t have time to wait for a check. People need unemployment compensation now so they can buy groceries, pay rent, and keep up their bills. Without it, many Americans won’t be able to make ends meet.”
More layoffs ahead: As shocking as the unemployment numbers have been so far, economists expect them to move higher in the coming weeks. Michelle Meyer of Bank of America Merrill Lynch expects to see as many as 20 million job losses by May, pushing the unemployment rate to 15%. Oxford Economics has an even grimmer outlook, with 26 million layoffs and a 16% jobless rate by the end of next month.


thefiscaltimes--2020-04-09--Fed Unleashes Another $2.3 Trillion to Rescue the Economy

The Federal Reserve announced Thursday it would take unprecedented emergency steps to pump as much as $ 2.3 trillion into an economy and job market that Fed Chair Jerome Powell described as deteriorating “ with alarming speed.
” The sweeping new loan programs unveiled by the Fed will draw on the money provided by Congress in its coronavirus relief package to provide additional support for small and medium-size businesses as well as to states and cities facing budget crunches as a result of the pandemic and economic shutdown .
The Fed , backed by Treasury Department funds authorized by Congress @ @ @ @ @ @ @ into riskier new areas it has previously avoided , including municipal debt and some lower-rated corporate debt .
The change will allow firms that until recently had been rated as investment grade to access the central bank ’ s loan facilities .
Under the new programs , the Fed will offer through banks up to $ 600 billion in four-year loans to businesses with up to 10,000 employees or revenues of less than $ 2.5 billion .
These loans can be larger than those offered by the Small Business Administration .
The Fed @ @ @ @ @ @ @ billion in short-term bonds from all 50 states as well as counties with at least 2 million residents and cities with more than a million people .
“ The Fed ’ s actions are intended to rejuvenate the $ 3.8 trillion market for municipal bonds and lower the rates state and local governments pay .
That should help government agencies avoid more layoffs , ” Martin Crutsinger of the Associated Press writes .
Help for ‘ fallen angels ’ : “ The reason the Fed had to expand the pool of credit that @ @ @ @ @ @ @ so many borrowers are slipping into these lower-rated categories , ” Mark Vitner , senior economist at Wells Fargo Securities , told Bloomberg News .
“ This is aimed more at fallen angels rather [ than ] dastardly devils.
” Nevertheless , Bloomberg notes that the latest Fed action “ thrusts the institution into the sort of speculative lending activities it had shunned in the past -- underscoring the risks that Chairman Jerome Powell is willing to take to shore up the economy.
” Powell reportedly indicated Thursday he “ won ’ t @ @ @ @ @ @ @ or adjust the loan programs as needed .
“ We are deploying these lending powers to an unprecedented extent , enabled in large part by the financial backing from Congress and the Treasury , ” he said in a speech following the Fed ’ s announcement .
“ We will continue to use these powers forcefully , proactively , and aggressively until we are confident that we are solidly on the road to recovery.
” Powell added that the Fed is using “ lending powers , not spending powers ” and that “ @ @ @ @ @ @ @ kinds that need direct fiscal support rather than a loan they would struggle to repay.
” The Fed , for example , is offering up to $ 500 billion in loans to states and municipalities , but its new program will not close state budget gaps , according to analysts at Goldman Sachs , who continue to expect that Congress will provide another $ 100 billion to $ 200 billion in direct fiscal aid to those governments .
The Fed had already dropped interest rates to zero and launched massive bond-buying programs to @ @ @ @ @ @ @ credit keeps flowing during the coronavirus crisis .
The new and expanded programs were unveiled just as the Labor Department announced that 6.6 million Americans filed for first-time jobless claims last week , lifting the total number of job losses to 16.8 million over the past three weeks ( see more on this below ) .
The bottom line : The Fed is going far beyond what it did during the financial crisis and Great Recession , buying a wider range of debt and doing so more aggressively .
“ The Fed had @ @ @ @ @ @ @ worth of emergency lending programs , so this could more than quadruple the size of those programs , ” Jeanna Smialek of The New York Times writes .
And Michael Gapen , chief U.S. economist at Barclays Capital in New York , told Bloomberg : “ The Fed has now done virtually everything we think it should be doing and we think it can do .
”

The Federal Reserve announced Thursday it would take unprecedented emergency steps to pump as much as $2.3 trillion into an economy and job market that Fed Chair Jerome Powell described as deteriorating “with alarming speed.”
The sweeping new loan programs unveiled by the Fed will draw on the money provided by Congress in its coronavirus relief package to provide additional support for small and medium-size businesses as well as to states and cities facing budget crunches as a result of the pandemic and economic shutdown.
The Fed, backed by Treasury Department funds authorized by Congress, is also expanding its emergency response into riskier new areas it has previously avoided, including municipal debt and some lower-rated corporate debt. The change will allow firms that until recently had been rated as investment grade to access the central bank’s loan facilities.
Under the new programs, the Fed will offer through banks up to $600 billion in four-year loans to businesses with up to 10,000 employees or revenues of less than $2.5 billion. These loans can be larger than those offered by the Small Business Administration.
The Fed will also buy up to $500 billion in short-term bonds from all 50 states as well as counties with at least 2 million residents and cities with more than a million people. “The Fed’s actions are intended to rejuvenate the $3.8 trillion market for municipal bonds and lower the rates state and local governments pay. That should help government agencies avoid more layoffs,” Martin Crutsinger of the Associated Press writes.
Help for ‘fallen angels’: “The reason the Fed had to expand the pool of credit that they are willing to buy is that so many borrowers are slipping into these lower-rated categories,” Mark Vitner, senior economist at Wells Fargo Securities, told Bloomberg News. “This is aimed more at fallen angels rather [than] dastardly devils.”
Nevertheless, Bloomberg notes that the latest Fed action “thrusts the institution into the sort of speculative lending activities it had shunned in the past -- underscoring the risks that Chairman Jerome Powell is willing to take to shore up the economy.”
Powell reportedly indicated Thursday he “won’t hesitate” to move into other areas or adjust the loan programs as needed. “We are deploying these lending powers to an unprecedented extent, enabled in large part by the financial backing from Congress and the Treasury,” he said in a speech following the Fed’s announcement. “We will continue to use these powers forcefully, proactively, and aggressively until we are confident that we are solidly on the road to recovery.”
Powell added that the Fed is using “lending powers, not spending powers” and that “there will also be entities of various kinds that need direct fiscal support rather than a loan they would struggle to repay.” The Fed, for example, is offering up to $500 billion in loans to states and municipalities, but its new program will not close state budget gaps, according to analysts at Goldman Sachs, who continue to expect that Congress will provide another $100 billion to $200 billion in direct fiscal aid to those governments.
The Fed had already dropped interest rates to zero and launched massive bond-buying programs to keep borrowing costs low and ensure that credit keeps flowing during the coronavirus crisis. The new and expanded programs were unveiled just as the Labor Department announced that 6.6 million Americans filed for first-time jobless claims last week, lifting the total number of job losses to 16.8 million over the past three weeks (see more on this below).
The bottom line: The Fed is going far beyond what it did during the financial crisis and Great Recession, buying a wider range of debt and doing so more aggressively. “The Fed had previously rolled out about $500 billion worth of emergency lending programs, so this could more than quadruple the size of those programs,” Jeanna Smialek of The New York Times writes. And Michael Gapen, chief U.S. economist at Barclays Capital in New York, told Bloomberg: “The Fed has now done virtually everything we think it should be doing and we think it can do.”


thefiscaltimes--2020-04-08--Pelosi and Schumer Want Billions More for Hospitals, States, Food Aid

With the Trump administration seeking another $ 250 billion for small businesses struggling during the coronavirus crisis , House Speaker Nancy Pelosi and Senate Minority Leader Charles Schumer said Wednesday that they would like to include hundreds of billions more in a relief package that could pass as early as this week .
In a joint statement , the Democratic leaders called for more than $ 250 billion in additional funds , above and beyond the new money for small businesses , in the next round of relief : • $ 150 billion for state and local governments struggling with @ @ @ @ @ @ @ plummet ; • a 15 % increase in the maximum benefit in the Supplemental Nutrition Assistance Program .
Pelosi and Schumer also said they would seek new rules for the small business assistance program , including a requirement that half of the new small business funds , or $ 125 billion , be distributed “ through community-based financial institutions that serve farmers , family , women , minority and veteran-owned small businesses and nonprofits in rural , tribal , suburban and urban communities across our country.
” The political calculus : The Democrats @ @ @ @ @ @ @ gamble , says The Washington Post ’ s Erica Werner , as they look to make a deal with Senate Majority Leader Mitch McConnell : “ It was unclear whether McConnell intended to accept any of the Democrats ’ demands or would push forward with trying to pass the $ 250 billion increase for small businesses by unanimous consent on Thursday , daring Democrats to object.
” Schumer has not indicated whether he would hold up the boost for small businesses , which comes on top of the $ 350 billion already allocated @ @ @ @ @ @ @ relief package , if McConnell fails to include the additional funds Democrats are seeking .
House Majority Leader Steny Hoyer told Politico Wednesday that he thought the two sides could make a deal .
`` I don ’ t think we ’ re that far apart in some respects , ” Hoyer said .
“ McConnell is apparently only doing what the administration asked him to do and I think he is also , to some degree , playing chicken . ''
More relief to come , at some point : However the @ @ @ @ @ @ @ and Schumer made it clear that are pursuing another large aid package : “ After we pass this interim emergency legislation , Congress will move to pass a CARES 2 Act that will extend and expand the bipartisan CARES Act to meet the needs of the American people . ''
Republicans warned Tuesday , however , that the next round of comprehensive relief could take weeks to negotiate .
“ There ’ s not as much urgency to doing a 4.0 right now , ” a Republican aide told The Hill , referring @ @ @ @ @ @ @ [ I ] t ’ s not like the market is saying , ‘ Oh my God , when is 4.0 coming ?
’ ”

With the Trump administration seeking another $250 billion for small businesses struggling during the coronavirus crisis, House Speaker Nancy Pelosi and Senate Minority Leader Charles Schumer said Wednesday that they would like to include hundreds of billions more in a relief package that could pass as early as this week.
In a joint statement, the Democratic leaders called for more than $250 billion in additional funds, above and beyond the new money for small businesses, in the next round of relief:
$100 billion for hospitals, community health centers and health systems;
$150 billion for state and local governments struggling with increased demand for services even as revenues plummet;
a 15% increase in the maximum benefit in the Supplemental Nutrition Assistance Program.
Pelosi and Schumer also said they would seek new rules for the small business assistance program, including a requirement that half of the new small business funds, or $125 billion, be distributed “through community-based financial institutions that serve farmers, family, women, minority and veteran-owned small businesses and nonprofits in rural, tribal, suburban and urban communities across our country.”
The political calculus: The Democrats’ demands are something of a political gamble, says The Washington Post’s Erica Werner, as they look to make a deal with Senate Majority Leader Mitch McConnell: “It was unclear whether McConnell intended to accept any of the Democrats’ demands or would push forward with trying to pass the $250 billion increase for small businesses by unanimous consent on Thursday, daring Democrats to object.” Schumer has not indicated whether he would hold up the boost for small businesses, which comes on top of the $350 billion already allocated to them in the $2 trillion relief package, if McConnell fails to include the additional funds Democrats are seeking.
House Majority Leader Steny Hoyer told Politico Wednesday that he thought the two sides could make a deal. "I don’t think we’re that far apart in some respects,” Hoyer said. “McConnell is apparently only doing what the administration asked him to do and I think he is also, to some degree, playing chicken."
More relief to come, at some point: However the small business package plays out, Pelosi and Schumer made it clear that are pursuing another large aid package: “After we pass this interim emergency legislation, Congress will move to pass a CARES 2 Act that will extend and expand the bipartisan CARES Act to meet the needs of the American people."
Republicans warned Tuesday, however, that the next round of comprehensive relief could take weeks to negotiate. “There’s not as much urgency to doing a 4.0 right now,” a Republican aide told The Hill, referring to a fourth relief bill. “[I]t’s not like the market is saying, ‘Oh my God, when is 4.0 coming?’”


thefiscaltimes--2020-04-07--Eli Lilly Introduces Program to Lower Insulin Costs

Drug giant Eli Lilly said Tuesday that it is capping the out-of-pocket cost of its insulin at $ 35 a month to help patients who may face financial struggles as a result of the coronavirus pandemic .
The new program is available for people with commercial insurance or without insurance .
Patients with government insurance , including Medicaid , Medicare , Tricare or any State Patient or Pharmaceutical Assistance Program , are not eligible .
`` Too many people in the U.S. have lost their jobs because of the COVID-19 crisis , and we want to make sure no one @ @ @ @ @ @ @ Mike Mason , president of Lilly ’ s diabetes division , said in a statement .
The context : Insulin makers , including Lilly , have faced intense criticism as the price of the drug has soared in recent years and Reuters notes that the three top producers , Lilly , Sanofi SA and Novo Nordisk , have lowered the costs of their diabetes drugs to blunt such criticism .
The Trump administration , meanwhile , announced a plan last month to create a flat monthly copay of $ 35 for Medicare enrollees @ @ @ @ @ @ @ the program planned for next year .
The administration said that Medicare beneficiaries pay an average of about $ 675 a year for insulin and projected that the new program could lower than to $ 229 a year , saving the government $ 250 million over five years .

Drug giant Eli Lilly said Tuesday that it is capping the out-of-pocket cost of its insulin at $35 a month to help patients who may face financial struggles as a result of the coronavirus pandemic. The new program is available for people with commercial insurance or without insurance. Patients with government insurance, including Medicaid, Medicare, Tricare or any State Patient or Pharmaceutical Assistance Program, are not eligible.
"Too many people in the U.S. have lost their jobs because of the COVID-19 crisis, and we want to make sure no one goes without their Lilly insulin," Mike Mason, president of Lilly’s diabetes division, said in a statement.
The context: Insulin makers, including Lilly, have faced intense criticism as the price of the drug has soared in recent years and Reuters notes that the three top producers, Lilly, Sanofi SA and Novo Nordisk, have lowered the costs of their diabetes drugs to blunt such criticism.
The Trump administration, meanwhile, announced a plan last month to create a flat monthly copay of $35 for Medicare enrollees with diabetes, with a test of the program planned for next year. The administration said that Medicare beneficiaries pay an average of about $675 a year for insulin and projected that the new program could lower than to $229 a year, saving the government $250 million over five years.


thefiscaltimes--2020-01-03--Chart of the Day: The Long Decline in Interest Rates

That ’ s how much the private debt collection program at the IRS collected in the 2019 fiscal year .
@ @ @ @ @ second year in a row , the program cleared nearly $ 148 million after commissions @ @ @ @ @ controversial program , which empowers private firms to go after delinquent taxpayers , began in @ @ @ @ @ years before the IRS ended it following a review .
It was restarted in 2015 @ @ @ @ @ for the next two years .
Senate Finance Chairman Chuck Grassley ( R-IA ) , @ @ @ @ @ in establishing the program , said Monday that the net proceeds are currently being used @ @ @ @ @ personnel at the IRS .

Are interest rates destined to move higher, increasing the cost of private and public debt? While many experts believe that higher rates are all but inevitable, historian Paul Schmelzing argues that today’s low-interest environment is consistent with a long-term trend stretching back 600 years.
The chart “shows a clear historical downtrend, with rates falling about 1% every 60 years to near zero today,” says Bloomberg’s Aaron Brown. “Rates do tend to revert to a mean, but that mean seems to be declining.”


thefiscaltimes--2020-01-03--Former Fed Official Calls for US to Issue More Long-Term Debt

In a column for Bloomberg Opinion , former Minneapolis Fed president Narayana Kocherlakota poses five big macroeconomic questions he sees for 2020 and beyond .
Among them is how governments can take advantage of low interest rates : “ The 30-year yield on U.S. Treasuries is just over 2 % — about half what it was a decade ago and about a third of what it was two decades ago .
It would seem like a lot of public investments would be profitable if financed at this remarkably low interest rate .
Shouldn ’ t the U.S. government issue ( @ @ @ @ @ @ @ maturity of 30 years or possibly even longer ) bonds to finance increased subsidies to higher education ?
Increased subsidies to research by universities and corporations ?
Spending on infrastructure like roads or hospitals ?
” Others have made similar calls for the U.S. to issue more long-term debt and extend durations beyond 30 years , the longest it now sells , to take advantage of low interest rates .
Treasury Secretary Steven Mnuchin told CNBC last September that the U.S. could issue 50-year bonds as soon as this year , depending on @ @ @ @ @ @ @ “ derisking ” the national debt , which now totals more than $ 23 trillion .
He said that 100-year bonds could follow .
The Treasury Department confirmed in October that it is exploring selling 50-year bonds .
Read Kocherlakota ’ s four other big questions at Bloomberg .

In a column for Bloomberg Opinion, former Minneapolis Fed president Narayana Kocherlakota poses five big macroeconomic questions he sees for 2020 and beyond. Among them is how governments can take advantage of low interest rates:
“The 30-year yield on U.S. Treasuries is just over 2% — about half what it was a decade ago and about a third of what it was two decades ago. It would seem like a lot of public investments would be profitable if financed at this remarkably low interest rate. Shouldn’t the U.S. government issue (a lot) more long-term (with maturity of 30 years or possibly even longer) bonds to finance increased subsidies to higher education? Increased subsidies to research by universities and corporations? Spending on infrastructure like roads or hospitals?”
Others have made similar calls for the U.S. to issue more long-term debt and extend durations beyond 30 years, the longest it now sells, to take advantage of low interest rates. Treasury Secretary Steven Mnuchin told CNBC last September that the U.S. could issue 50-year bonds as soon as this year, depending on market demand, with the aim of “derisking” the national debt, which now totals more than $23 trillion. He said that 100-year bonds could follow. The Treasury Department confirmed in October that it is exploring selling 50-year bonds.
Read Kocherlakota’s four other big questions at Bloomberg.


thefiscaltimes--2020-01-02--How Corporations Squeezed Billions More From Trump’s Tax Cuts

Big American corporations liked what they saw in the 2017 Tax Cuts and Jobs Act , but they wanted more – and the Trump administration was happy to give it to them as it wrote rules and regulations around the new tax law , The New York Times ’ Jesse Drucker and Jim Tankersley reported earlier this week .
“ [ N ] ot long after the bill became law in December 2017 , the Trump administration began transforming the tax package into a greater windfall for the world ’ s largest corporations and their shareholders , ” they wrote @ @ @ @ @ @ @ big companies have ended up even smaller than what was anticipated when the president signed the bill.
” Some highlights from the Times piece : • Lobbyists swarmed the Treasury Department starting in early 2018 , looking for favorable interpretations of the new rules .
“ The crush of meetings was so intense that some top Treasury officials had little time to do their jobs , according to two people familiar with the process , ” Drucker and Tankersley said .
• The lobbying effort was led by representatives from some of the @ @ @ @ @ @ @ General Electric , United Technologies , Coca-Cola , Bank of America , IBM , Kraft Heinz , News Corporation and ConocoPhillips .
• Companies sought favorable interpretations and exemptions of the new tax rules – and largely got what they wanted .
As a result , the “ Internal Revenue Service is collecting tens of billions of dollars less in corporate taxes than Congress projected , inflating the tax law ’ s 13-figure price tag.
” • The winners from the process will surprise no one : “ It is largely the top @ @ @ @ @ @ @ the wealthiest people in the world , ” said Bret Wells , a tax law professor at the University of Houston .
And the rule-writing process isn ’ t over .
“ In the coming days , the Treasury is likely to complete its last round of rules carrying out the tax cuts , ” Drucker and Tankersley said .
“ Big companies have spent this fall trying to win more .
”

Big American corporations liked what they saw in the 2017 Tax Cuts and Jobs Act, but they wanted more – and the Trump administration was happy to give it to them as it wrote rules and regulations around the new tax law, The New York Times’ Jesse Drucker and Jim Tankersley reported earlier this week.
“[N]ot long after the bill became law in December 2017, the Trump administration began transforming the tax package into a greater windfall for the world’s largest corporations and their shareholders,” they wrote. “The tax bills of many big companies have ended up even smaller than what was anticipated when the president signed the bill.”
Some highlights from the Times piece:
Lobbyists swarmed the Treasury Department starting in early 2018, looking for favorable interpretations of the new rules. “The crush of meetings was so intense that some top Treasury officials had little time to do their jobs, according to two people familiar with the process,” Drucker and Tankersley said.
The lobbying effort was led by representatives from some of the largest U.S. corporations, including Anheuser-Busch, General Electric, United Technologies, Coca-Cola, Bank of America, IBM, Kraft Heinz, News Corporation and ConocoPhillips.
Companies sought favorable interpretations and exemptions of the new tax rules – and largely got what they wanted. As a result, the “Internal Revenue Service is collecting tens of billions of dollars less in corporate taxes than Congress projected, inflating the tax law’s 13-figure price tag.”
The winners from the process will surprise no one: “It is largely the top 1 percent that will disproportionately benefit — the wealthiest people in the world,” said Bret Wells, a tax law professor at the University of Houston.
And the rule-writing process isn’t over. “In the coming days, the Treasury is likely to complete its last round of rules carrying out the tax cuts,” Drucker and Tankersley said. “Big companies have spent this fall trying to win more.”
Read the full story here.


thefiscaltimes--2020-01-02--When Hospitals Merged, Patient Care Didn’t Improve: Study

A recent spate of hospital mergers hasn ’ t led to improved quality of care , according to a new @ @ @ @ @ Journal of Medicine highlighted by The Wall Street Journal .
“ Hospital merger-and-acquisition activity has @ @ @ @ @ with executives involved in transactions making the case that greater size will boost quality with @ @ @ @ @ improvements as deal makers benefit from each others ’ strengths , ” the Journal ’ @ @ @ @ @ The study , one of the first major efforts to examine the effects of hospital @ @ @ @ @ found otherwise .
It concludes that patient experiences got “ modestly worse ” while readmission @ @ @ @ @ significantly changed .
Past studies have found that hospital mergers result in higher prices for @ @ @ @ @

A recent spate of hospital mergers hasn’t led to improved quality of care, according to a new study in the New England Journal of Medicine highlighted by The Wall Street Journal.
“Hospital merger-and-acquisition activity has surged in recent years, with executives involved in transactions making the case that greater size will boost quality with new investments and yield other improvements as deal makers benefit from each others’ strengths,” the Journal’s Melanie Evans writes.
The study, one of the first major efforts to examine the effects of hospital consolidation on patient care, found otherwise. It concludes that patient experiences got “modestly worse” while readmission and mortality rates were not significantly changed. Past studies have found that hospital mergers result in higher prices for patients with private insurance.


thefiscaltimes--2020-01-02--Bill Gates Calls for Higher Taxes on the Rich

Microsoft co-founder Bill Gates , the second richest person in the world , says people like him should be paying higher taxes .
In a year-end blog post , Gates applauds the ongoing debate over America ’ s tax system , calling it one of the most important happening in our country right now .
“ It isn ’ t always popular to stand up for higher taxes , so it ’ s great that many Americans are having this conversation , ” he writes .
Gates says that he ’ s “ been pushing for a fairer tax system @ @ @ @ @ @ @ ’ s a persistent imbalance between the government ’ s spending and its revenue collection : “ the U.S. government simply does not bring in enough money to meet its obligations .
This isn ’ t a value judgment ; it ’ s just a fact .
The government collects about 20 percent of GDP in taxes while spending about 24 percent .
And the cost of commitments is going up.
” To address that gap , Gates calls for raising the capital-gains tax “ probably to the same level as taxes on @ @ @ @ @ @ @ reason to “ favor wealth over work the way we do today.
” He also supports raising the estate tax ; eliminating the cap on income subject to Medicare taxes ; closing the carried-interest loophole that benefits investment-fund managers ; and instituting a form of wealth tax that would apply to fortunes held for extended periods , which he suggests might be 10 years or more .
He adds that state and local taxes also need to be reformed to make them fairer .
Gates also addresses some common arguments made in response @ @ @ @ @ @ @ the suggestion that he should voluntarily pay more instead of calling for systemic changes and the criticism that higher tax rates would hurt growth and innovation : “ When I say the government needs to raise more money , some people ask why Melinda and I don ’ t voluntarily pay more in taxes than the law requires .
The answer is that simply leaving it up to people to give more than the government asks for is not a scalable solution .
People pay taxes as an obligation of law and citizenship @ @ @ @ @ @ @ voluntary giving will never raise enough money for everything the government needs to do .
If Melinda and I signed over our foundation ’ s entire endowment to the state of California , it wouldn ’ t be enough to fund their public schools for even one year .
A vibrant economic system depends on setting expectations for who pays how much .
… “ Americans in the top 1 percent can afford to pay a lot more before they stop going to work or creating jobs .
In the 1970s , when @ @ @ @ @ @ @ , marginal tax rates were almost twice the top rate today .
It didn ’ t hurt our incentive to build a great company .
”

Microsoft co-founder Bill Gates, the second richest person in the world, says people like him should be paying higher taxes.
In a year-end blog post, Gates applauds the ongoing debate over America’s tax system, calling it one of the most important happening in our country right now. “It isn’t always popular to stand up for higher taxes, so it’s great that many Americans are having this conversation,” he writes.
Gates says that he’s “been pushing for a fairer tax system for years.” He notes that there’s a persistent imbalance between the government’s spending and its revenue collection: “the U.S. government simply does not bring in enough money to meet its obligations. This isn’t a value judgment; it’s just a fact. The government collects about 20 percent of GDP in taxes while spending about 24 percent. And the cost of commitments is going up.”
To address that gap, Gates calls for raising the capital-gains tax “probably to the same level as taxes on labor,” saying he sees no reason to “favor wealth over work the way we do today.” He also supports raising the estate tax; eliminating the cap on income subject to Medicare taxes; closing the carried-interest loophole that benefits investment-fund managers; and instituting a form of wealth tax that would apply to fortunes held for extended periods, which he suggests might be 10 years or more. He adds that state and local taxes also need to be reformed to make them fairer.
Gates also addresses some common arguments made in response to calls for higher taxes, including the suggestion that he should voluntarily pay more instead of calling for systemic changes and the criticism that higher tax rates would hurt growth and innovation:
“When I say the government needs to raise more money, some people ask why Melinda and I don’t voluntarily pay more in taxes than the law requires. The answer is that simply leaving it up to people to give more than the government asks for is not a scalable solution. People pay taxes as an obligation of law and citizenship, not out of charity. Additional voluntary giving will never raise enough money for everything the government needs to do. If Melinda and I signed over our foundation’s entire endowment to the state of California, it wouldn’t be enough to fund their public schools for even one year. A vibrant economic system depends on setting expectations for who pays how much. …
“Americans in the top 1 percent can afford to pay a lot more before they stop going to work or creating jobs. In the 1970s, when Paul Allen and I were starting Microsoft, marginal tax rates were almost twice the top rate today. It didn’t hurt our incentive to build a great company.”
Read Gates's full blog post.


thefiscaltimes--2020-01-02--Drug Companies Ring in the New Year With Higher Prices

Drugmakers rang in the new year with an old tradition , reportedly raising the U.S. list prices of hundreds of their products .
Pharmaceutical companies including industry giants Biogen , Bristol-Myers Squibb , Gilead Sciences , GlaxoSmithKline , Pfizer and Sanofi hiked prices on more than 250 drugs , according to an analysis by research firm 3 Axis Advisors .
Price hikes averaged 5.3 % , and most increases were less than 10 % .
Under pressure from Congress and the White House , some drugmakers have pledged to keep price increases in the single digits .
“ Double-digit increases @ @ @ @ @ @ @ the past , ” Bloomberg analyst Brian Rye said .
Even so , the average increase was still well above the rate of inflation — and that won ’ t do much to persuade lawmakers to cease their efforts to reduce to cost of prescription drugs .
“ Prices go up but demand remains the same , ” said Michael Rea of Rx Savings Solutions , which found in a separate analysis that the 2020 prices increases have averaged 5.8 % so far .
“ Without the appropriate checks and balances in place @ @ @ @ @ @ @ ” Rea told The Wall Street Journal .
“ Consumers , employers and health plans ultimately pay the very steep price.
” The bottom line : High drug prices are expected to be an important issue in the 2020 election , and President Trump and Congress may take steps to reduce prices before voters head to the polls .
“ In terms of potential legislation , nothing is imminent , but investors should circle May 22 on their calendars , ” Bloomberg ’ s Rye said .
“ That ’ s the health-extender @ @ @ @ @ @ @ ago in the government-spending bill .
Policy makers could use drug-pricing and/or surprise billing reforms to offset the cost of long-term extensions for those non-controversial programs .
”

Drugmakers rang in the new year with an old tradition, reportedly raising the U.S. list prices of hundreds of their products.
Pharmaceutical companies including industry giants Biogen, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Pfizer and Sanofi hiked prices on more than 250 drugs, according to an analysis by research firm 3 Axis Advisors.
Price hikes averaged 5.3%, and most increases were less than 10%. Under pressure from Congress and the White House, some drugmakers have pledged to keep price increases in the single digits. “Double-digit increases largely appear to be a thing of the past,” Bloomberg analyst Brian Rye said.
Even so, the average increase was still well above the rate of inflation — and that won’t do much to persuade lawmakers to cease their efforts to reduce to cost of prescription drugs.
“Prices go up but demand remains the same,” said Michael Rea of Rx Savings Solutions, which found in a separate analysis that the 2020 prices increases have averaged 5.8% so far. “Without the appropriate checks and balances in place, this is a runaway train,” Rea told The Wall Street Journal. “Consumers, employers and health plans ultimately pay the very steep price.”
The bottom line: High drug prices are expected to be an important issue in the 2020 election, and President Trump and Congress may take steps to reduce prices before voters head to the polls. “In terms of potential legislation, nothing is imminent, but investors should circle May 22 on their calendars,” Bloomberg’s Rye said. “That’s the health-extender deadline Congress established a couple of weeks ago in the government-spending bill. Policy makers could use drug-pricing and/or surprise billing reforms to offset the cost of long-term extensions for those non-controversial programs.”


thefiscaltimes--2020-01-07--Chart of the Day: How Hospital Charges Soared Over 20 Years

Hospital care accounts for a third of total U.S. health care spending , and the costs of that care have @ @ @ @ @ decades , according to a new study in Health Affairs .
The study found that @ @ @ @ @ , payments for inpatient hospital stays , emergency department visits and outpatient hospital care grew @ @ @ @ @ patients that for those on Medicare and Medicaid .
The gap between what private insurers @ @ @ @ @ then stabilized or narrowed between 2012 and 2016 .
Overall , though , the growth @ @ @ @ @ room care in particular stands out , as the Axios chart below highlights .

Hospital care accounts for a third of total U.S. health care spending, and the costs of that care have soared over the last two decades, according to a new study in Health Affairs.
The study found that, from 2000 to 2012, payments for inpatient hospital stays, emergency department visits and outpatient hospital care grew much faster for privately insured patients that for those on Medicare and Medicaid. The gap between what private insurers and government programs paid hospitals then stabilized or narrowed between 2012 and 2016.
Overall, though, the growth in payment rates for emergency room care in particular stands out, as the Axios chart below highlights.


thefiscaltimes--2020-01-06--IRS Looks Back at 2019, Gets Set for 2020

“ The IRS touches more Americans than any other entity , public or private , ” Internal Revenue Service Commissioner Chuck Rettig said in the agency ’ s annual report released Monday .
The document provides a summary of IRS operations in the previous fiscal year and an update on the status of the agency ’ s long-term strategic plan .
Ahead of this year 's tax-filing season , which the agency just said will start January 27 , here are some highlights from the new 41-page report : • The IRS processed 255 million tax returns and forms in @ @ @ @ @ @ @ receipts came to roughly $ 3.6 trillion , about 96 % of the country ’ s revenues .
• Employment at the IRS grew by 1,593 full-time positions , for a total of 78,004 in 2019 ( that number includes 12,600 temporary and seasonal workers ) .
• Over the last 10 years , however , the IRS has lost nearly 30,000 full-time positions — and those losses `` directly correlate with a steady decline in the number of individual audits during the past nine years , '' the report says .
The @ @ @ @ @ @ @ five years as nearly 20,000 employees — 31 % of the workforce — retire , “ creating a significant risk of a large knowledge and experience gap for the nation ’ s tax agency .
”

“The IRS touches more Americans than any other entity, public or private,” Internal Revenue Service Commissioner Chuck Rettig said in the agency’s annual report released Monday.
The document provides a summary of IRS operations in the previous fiscal year and an update on the status of the agency’s long-term strategic plan.
Ahead of this year's tax-filing season, which the agency just said will start January 27, here are some highlights from the new 41-page report: