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Entrepreneur-Led Economic Development: A New Strategy for Generating Local Growth and Productivity

May 19, 2021

The best way for local governments to foster economic development is to support entrepreneurship. Policymakers should focus on the small group of growth-oriented companies—often, but not always, in the technology sector—that can successfully expand. This report outlines a comprehensive approach, which we call "entrepreneur-led economic development," for working with these important companies. The goal is to create feedback loops between entrepreneurial leaders and other local decision makers and to cultivate networks that connect successful entrepreneurial leaders with future growth-oriented founders who can use their guidance to grow. 

Can U.S. Health Care Escape MACRA's Bureaucratic Briar Patch?

March 28, 2018

Congress has struggled for decades to reform Medicare's fee-for-service payment system, which has driven up the cost of American health care by reimbursing medical providers for services, regardless of their value or quality. The most recent attempt at reform, the 2015 Medicare and CHIP Reauthorization Act (MACRA), seeks to quantify the value of care delivered and to get medical practices to bear some responsibility for the aggregate costs associated with a course of treatment.To do so, the law provides higher payments to clinicians who participate in Alternative Payment Models (APMs), in which practices are penalized for excessive aggregate costs associated with the delivery of a full course of treatment. Most medical practices have balked at APMs, which require them to bear substantial financial risks. These practices, however, will become subject to a complex grading mechanism, the Merit-based Incentive Payment System (MIPS), which will adjust Medicare payments to clinicians in line with their performance relative to peers on a vast array of performance metrics. Yet the federal agency tasked with overseeing this scoring system has publicly declared MIPS to be unworkable and called for its repeal.The fact that Medicare has inadvertently encouraged the proliferation of low-value services does not mean that it is capable of transforming health care for good by identifying and rewarding high-value care. It would be enough to avoid doing harm. That goal can be accomplished if APMs were to give clinicians full credit for treating patients enrolled in Medicare Advantage—which would eliminate the risk to taxpayers of inflated volumes of low-value services, while freeing medical practitioners from arbitrary and counterproductive regulations.

How to Increase Health-Insurance Coverage by Reducing ACA Crowd-Out

January 23, 2018

Public health-care entitlements in the U.S. have traditionally been designed to supplement rather than to supplant privately purchased health insurance. About 40% of the entitlement funds disbursed under the Affordable Care Act (ACA), however, have gone to individuals who already had private coverage. This displacement of private-sector spending by public-sector activity is called "crowd-out." While the ACA has reduced the share of the American population without health insurance, its spending has been poorly-targeted to fill gaps in care, and 28 million remain uninsured.This paper reviews estimates of ACA crowd-out and examines the potential for block grants to allow states to target assistance at individuals otherwise lacking coverage. Under such a reform, the same level of federal funding could do more to expand access to care and to provide protection from catastrophic medical costs for those who need help the most.

The Individual Mandate Is Unnecessary and Unfair

October 25, 2017

The importance of the individual mandate to the Affordable Care Act's exchanges has been greatly exaggerated. It has done little to increase enrollment, to reduce insurance premiums, or to alleviate the burden of uncompensated care. Rather, the main effect of the provision has been to concentrate more of the expense of covering the chronically ill on the relatively small cohort of working Americans who lack employer-sponsored coverage. By doing so, the mandate has served to obscure the total cost of the entitlement.This issue brief examines the intent of the individual mandate, investigates why it was implemented in its present form, and demonstrates that its poorly distributed penalties have done little to enhance the affordability of health insurance or the stability of the individual market.

Narrowing The Charter Enrollment Gap: Denver's Common-Enrollment System

December 8, 2015

As charter schools continue their rapid expansion in America's cities, questions related to equitable access to these schools of choice have jumped to the forefront of the policy conversation. Indeed, the proportion of students in charters with classifications that suggest that they are difficult to educate -- such as students with disabilities, those who are not proficient in English, and those who are eligible for free or reduced-price lunch -- is often substantially below their respective proportions in traditional ("district") public schools. This paper uses longitudinal data from Denver to measure whether adoption of common enrollment increased the proportion of disadvantaged students enrolled in that city's charter elementary schools. It finds that Denver's adoption of common enrollment substantially increased the proportion of students enrolling in charter kindergartens who are minority, eligible for free/reduced-priced lunch, or speak English as a second language. Importantly, this paper considers only one specific effect of common enrollment on the charter-school sector. While policymakers should take a more expansive measure of the merits of common enrollment before adopting it, this paper suggests that an effective way to boost disadvantaged students' enrollment in charters is to make applying to them easier.

What Works: English-Language Learning in America

December 3, 2015

Abundant research demonstrates the benefits of learning English—for educational attainment, employment, earnings, homeownership, civic participation, and naturalization. Much more could be done to help immigrants to the United States acquire the skills they need, survival English as well as the higher levels of proficiency that allow a new American to excel.

Policy Options For Improving Economic Opportunity and Mobility

May 22, 2015

America's economic recovery is finally taking hold and current deficits are down from the record highs during the recession. At the same time, far too many American families are being left out of the recovery, and our nation still faces an unsustainable long-term fiscal outlook. Lower unemployment and improvements in growth are fueling renewed optimism, yet the nature of the recovery is uneven and the longer term trends of income stagnation are of great concern. On everyone's minds is the questionable state of opportunity in America.In the interest of enriching the discussion on the state of economic opportunity in America today, the Peter G. Peterson Foundation asked two experts, representing different viewpoints, to recommend policy options to foster greater economic opportunity and mobility.

Does Immigration Increase Economic Growth?

December 1, 2014

The question of how many legal immigrants should be admitted to the United States -- and what level of skills these immigrants should have --is among the most divisive issues in the current U.S. domestic policy landscape. Much of the controversy that it sparks can be traced to a single question: Do immigrants help or harm the economy?This paper reviews scholarly literature and examines government data on immigration's contribution to economic growth and finds that both high- and low-skill immigration, on net, boosts economic growth. The paper concludes with a series of pro-growth, long-term policy reforms that Congress would do well to include in immigration reform legislation.  (This is not to imply an endorsement of the granting of legal status to nonlegal immigrants by executive action, as pledged by the White House at the time of the release of this report.)

Rhetoric and Reality The Obamacare Evaluation Report: Access to Care and the Physician Shortage

July 9, 2013

President Barack Obama's first term was defined by the battle over, and the passage of, the Patient Protection and Affordable Care Act, the landmark health-reform legislation known popularly as Obamacare. Along the way, Obama, the law's supporters, and independent analysts such as the Congressional Budget Office (CBO) made specific claims or projections about how the law would affect consumers, patients, and businesses.Now, three years after Obamacare's passage, many key provisions of the legislation are beginning to be implemented. Whether implementation succeeds or fails will be strongly influenced by the reactions of states, providers, insurers, businesses, and consumers to the law's provisions and to the thousands of pages of new health-care regulations.Rhetoric and Reality is a project of the Manhattan Institute's Center for Medical Progress that is designed to offer an ongoing, objective, and accessible perspective on the law's performance in light of key claims or projections made about it. Our project will examine the law's effect on Americans in five overarching areas: health-care costs, insurance coverage, employment, access to care, and consumer-driven health plans. Additional topics may be added.Each evaluation will be based on the best available data and will be revised as new or more authoritative data become available.

Ensuring Structural Success: Building Effective TJ Budgets and Program Structures

April 1, 2008

Presentation about building effective transitional jobs budgets and program structures. Presented at the 2008 NTJN Conference.

Public High School Graduation and College Readiness Rates in the United States

September 1, 2003

Uses data from the U.S. Department of Education to estimate the percentage of students -- by race/ethnicity, region, and state -- who graduate high school, as well as the percentage that finish high school ready to attend a four-year college.