Are We At Full Employment Yet?

Jared Bernstein on why we’re not at full employment yet, federal courts block Trump’s public charge rule from taking effect, and “Catching the Flu Got Me Kicked Out of My Addiction Treatment Program.” Subscribe to Off-Kilter on iTunes.

As econ nerds know all too well… on the first Friday of every month, the Bureau of Labor Statistics releases its monthly update on the nation’s unemployment rate and how many jobs the economy added — or lost — in the prior month. With the unemployment rate at or nearing a 50-year low, some are saying we’ve reached full employment — which is sort of like the holy grail when it comes to what we want to see in the economy, because it’s the point at which pretty much everyone who wants a job can find one. But a growing number of economists — including Jared Bernstein, former chief economist to Vice President Biden and a senior fellow over at the Center on Budget and Policy Priorities — are instead ringing the alarm bells, pointing to another key indicator that they say means we aren’t there yet — and that there’s something seriously wrong with the current economy. And that’s the anemic pace of wage growth. Rebecca sat down with Jared to understand what’s going on — and to get a sneak peek at Emmanuel Saez & Gabriel Zucman’s widely acclaimed new book “The Triumph of Injustice.”

Later in the show… Some good news for a change! Late last week, multiple federal judges blocked the Trump administration’s public charge rule, via a set of preliminary injunctions that halted the rule from taking effect, as it was scheduled to do this week. Rebecca talks with Madison Allen of the Center for Law and Social Policy, and one of the lead organizers of the Protecting Immigrant Families campaign, for the latest on where things stand.

And finally: with the continued national spotlight on opioid misuse, on this show, we’ve sought to have conversations about the parts of the debate that too often get left out — such as the unintended consequences that blanket restrictions on opioid access can have for people struggling to manage chronic pain. Another important piece of the puzzle that doesn’t get nearly enough attention is the unintended consequences of so-called “abstinence policies,” which punish patients who fail to jump through their treatment program’s many hoops. Rebecca spoke with Elizabeth Brico, a TalkPoverty Fellow and a freelance writer who is herself a former opioid treatment patient. She recently authored a highly personal essay for TalkPoverty detailing her own experience with these kinds of harmful policies.

This week’s guests:

• Jared Bernstein, senior fellow, Center on Budget and Policy Priorities
• Madison Allen, senior policy attorney, Center for Law and Social Policy
• Elizabeth Brico, TalkPoverty Fellow and author, “Catching the Flu Got Me Kicked Out of My Addiction Treatment Program.”

For more on this week’s topics:

• For more on why the unemployment rate isn’t enough to tell us whether we’re at full employment, here’s an Axios explainer — and for a sneak peek at Saez & Zucman’s new book, “The Triumph of Injustice,” check out their New York Times op-ed
• Learn more about the implications of courts blocking the public charge rule from taking effect in this Vox explainer — and stay up to date on the fight with the Protecting Immigrant Families campaign
• Read Elizabeth Brico’s essay for TalkPoverty, “Catching the Flu Got Me Kicked Out of My Addiction Treatment Program”

This week’s transcript:

♪ I work and get paid like minimum wage

sights to hit the class by the end of the day

hot from downtown into the hood where I stay

the only place I can afford ’cause my block ain’t saved

I spend most of my time working, trying to bring in…. ♪

REBECCA VALLAS (HOST): Welcome to Off-Kilter, powered by the Center for American Progress Action Fund. I’m Rebecca Vallas. This week on Off-Kilter, some good news for a change, finally. Late last week, multiple federal judges blocked the Trump administration’s public charge rule via a set of preliminary injunctions that halted the rule from taking effect as it was scheduled to do this week. I talk with Madison Allen of the Center for Law and Social Policy, better known as CLASP. She’s one of the lead organizers of the Protecting Immigrant Families campaign and shares the latest on where things stand with the rule. Later in the show, Catching the Flu Got Me Kicked Out of My Addiction Treatment Program. I talk with writer Elizabeth Brico about her recent essay by that title for TalkPoverty and what’s wrong with abstinence-only treatment program approaches.

But first, as econ nerds know all too well, on the first Friday of every month, the Bureau of Labor Statistics releases its monthly update on the nation’s unemployment rate and how many jobs the economy added or lost in the prior month. With the unemployment rate at or nearing a 50-year low, some are saying we’ve reached full employment. It’s sort of like the Holy Grail when it comes to what we want to see in the economy because it’s the point at which pretty much everyone who wants a job can find one. But a growing number of economists, including Jared Bernstein, former chief economist to V.P. Biden and a senior fellow over at the Center on Budget and Policy Priorities, are instead ringing the alarm bells, pointing to another key indicator that they say means we aren’t there yet and that there’s something seriously wrong with the current economy. And that is the anemic pace of wage growth. I sat down with Jared to understand what’s going on. Let’s take a listen.

Jared, thanks so much for taking the time to come back on the show.

JARED BERNSTEIN: I always like to talk with you about whatever you’re thinking about.

VALLAS: Well, you’re one of my favorite people to break down this kind of stuff because it gets wonky, and people’s eyes might start to glaze over. But it’s really, really important to understand. So, before we get into wage growth, which I sort of teased is a big part of what we’re about to talk about, help us understand what is full employment, and why does it matter?

BERNSTEIN: Well, full employment is the condition where everybody who wants a job can find a job. Now, that probably sounds like an unemployment rate of zero, which we never have. Because remember, the unemployment measures people who want a job but can’t find one. But you’re always going to have people who are between jobs or can’t quite find a job that meets their particular criteria. But broadly speaking, full employment is a condition where people who want work are handily finding it. And not just finding jobs, but finding the number of hours they want to work so they’re not underemployed. And as you alluded to earlier, finding work at a decent wage.

VALLAS: So, Jared, why is full employment so significant as a goal? I mean, I sort of said it’s kind of like the Holy Grail. But is that overstating things, given that it is something that people focus a lot on and that we actually hear a lot about from the Fed, the Federal Reserve?

BERNSTEIN: No, I think it is kind of a Holy Grail, in no small part because those conditions have eluded us in the American economy more often than not. Since the 1980s, we’ve only been at full employment as it’s measured — and I think the measures are pretty far off — about a third of the time. So, this is an elusive condition. But the other reason I think it’s such a Holy Grail is because of bargaining power. Every time we’ve talked, you and I, these words come up because moderate- and low-wage workers in this labor market, in our labor, for years have just lacked the kind of bargaining clout they need to claim their fair share of growth that they themselves are helping to produce. You can talk about this under the rubric of inequality, and that’s germane as well. But when the job market is really tight, when a worker who doesn’t like the quality of their job or the way they’re being treated or the hours that’re being offered, has the option to say, “Take this job and shove it” and go work someplace else because the economy is hot enough that those opportunities exist. That’s a real force multiplier for bargaining power. So, that’s another reason it’s a Holy Grail.

VALLAS: So, just looking at the record low unemployment rate — which we hear plenty about from President Trump and from his advisers, touting it as the best economy ever and all the different phrases that they like to trumpet — but just looking at the unemployment rate, one might think that we’re at that Holy Grail point, that we’re at full employment. But some economists, yourself included, have started to point out that there are real limitations in headline statistics like the unemployment rate. I want to borrow some words from the president of the Minneapolis Fed, Neel Kashkari, who is widely quoted saying that the unemployment rate is, “Almost useless in assessing whether we’re at full employment.” You’ve been noting that we need to be looking at wages, and that tells a very different story.

BERNSTEIN: Yeah, and President Kashkari, who’s the president of the Minneapolis Federal Reserve, has really been a great advocate for these issues. I actually think there’s important information in the unemployment rate, so I wouldn’t be that dismissive of it. But he’s definitely right that you can’t look at a 50-year low in unemployment, which we’re currently enjoying this 3.5 percent unemployment rate that prevailed last month, and declare full employment. You have to look at measures of prices and measures of wages. And in fact, Chair Jay Powell, who is the chairperson of the Federal Reserve, has said, yeah, this job market doesn’t look all that hot to me, even at 3.5 percent unemployment, because wage growth hasn’t been all that strong.

So, if we were really at full employment, employers would have to bid up wages, and probably prices too eventually, to get and keep the workers they need. And we’ve seen some of that. I don’t want to create the misimpression that wage growth has been flat or hasn’t responded to low unemployment. It has. It just hasn’t gone up as much as you might expect if we were truly at full employment.

VALLAS: And give folks maybe a little bit of a refresher, because I feel like again, back to the things you hear from the Trump administration, they have been making a lot of claims about rising wages. Folks may remember that some of those claims go hand in hand with certain promises that they made around their tax law. Trump famously promised that average workers would see a $4,000 increase in their wages once the tax law took effect, something that we have not seen happen. But what have we seen in terms of trends of wage growth? And why are you and some others describing the pace as anemic?

BERNSTEIN: No, it’s a good question. So, basically, if you look at average wages, they fell, their growth rate fell a lot in the recession, as you’d expect. So, just like full employment tends to create pressure pushing wage growth upwards, recessions and rising unemployment push the other way. And so, wage growth fell to maybe around 1 percent or so. We’re taking inflation out of the picture. We’re talking about what’s called “nominal wage growth.” So, putting deflation aside because that’s a different thing. A lot of times that has to do with global oil markets and stuff like that. So, we’re talking about nominal wage growth. And then as the job market improved, wage growth went from 1 to 2 percent. It’s out there at 2 percent for about a year, even as the unemployment rate was coming down. So, that started us scratching our heads. And then it went up to 3 percent. And some months, it sort of bumps up above that. You can get growth rates of 3.2, 3.4 in certain months. So, we have seen nominal wage growth respond to lower unemployment, but it’s been stuck there at around a bit north of 3 percent on average for about six months now, even as the job market has further tightened. So, again, that leads you to conclude that a, we’re not at full employment and b, there’s room for faster wage increases. And interestingly, the Federal Reserve agrees. It’s one of the reasons why they’ve been actually in a campaign to lower interest rates recently to give the economy a little bit more juice.

VALLAS: So, putting some of these economic semantics aside, whether we are or are not at full employment, you argue and have long argued that there’s more to full employment than just whether everyone who wants a job can find a job. And part of that is that it’s not just the quantity of jobs out there that matters. It’s also the quality that matters. But you also, you’ve made some really important points over the years about the people who might actually still be left behind even when we are at full employment. So, talk a little bit about how even if we get to that Holy Grail it isn’t maybe the end of the conversation.

BERNSTEIN: Yeah. That’s really important because this, “Holy Grail” doesn’t get us all the way where we need to be, especially for some of the most economically-vulnerable people. There are people who face such steep barriers to getting and staying in the labor market that regardless of the unemployment rate, they’re going to have difficulties. Some of this has to do with deep skill deficits. Some of it has to do with discrimination. Some of it has to do with having a criminal record. Some of it may have to do with living in a place where just the overall economy isn’t reaching. So there are people in places left behind, even at full employment, meaning labor demand in those places is weak, even while it’s strong in other places. You can imagine parts of rural America that look like that.

And so, the kind of work that I do, which is trying to get the overall macro economy working as best as it can for working people is not, [chuckles] it’s a big job, but it’s not the only job. You also have to consider what I think is kind of micro-level policy. So, macro is one thing, but micro is more about crafting more granular policies to help people who face those skill deficits or labor market discrimination or criminal records. And these are policies that might involve subsidizing employment. And it might, certainly would involve some apprenticeship programs. It certainly involves laws that really hit back hard when employers are found to discriminate. And that’s absolutely a critical part of the package too.

VALLAS: How do gig workers fit into all of this?

BERNSTEIN: Well, a lot of times with gig workers, what you’re really looking at there is involuntary underemployment. You know, a lot of times we can get all excited about entrepreneurialism and how the gig economy gives people all these options to be entrepreneurs. And that’s definitely some of that there: Set your own hours and things like that. That’s real. But a lot of it is involuntary entrepreneurs, and that is people just can’t find a good, stable, quality job with a steady paycheck. And so, they get into the gig economy. And that’s problematic because oftentimes, the gig economy exists at a pretty long arm’s length from the regular labor market in terms of coverage of labor standards. So, minimum wages over time, mischaracterization by employers whether somebody’s actually a worker or a self-employed person, misclassification they call that. So, I don’t want to get too celebratory about the gig economy when it involves involuntary labor.

VALLAS: And also, just as you described, a lot less in the way of job security, even if people are in jobs and being counted that way. So Jared, you’re also one of the people who over, especially the past few months, has really taken pains to point out that while we’re busy celebrating unemployment being at record lows as sort of one headline statistic that, yes, is significant, but for all the reasons you’ve been describing, is not the whole picture. Meanwhile, income and also wealth inequality are also at record highs. And that tells us a lot about how strong this economy is and who it’s working for and who it’s not working for. Would you talk a little bit about how we should be thinking about inequality as it fits in with this overall picture and conversation about full employment and what it tells us and doesn’t tell us?

BERNSTEIN: Sure. A lot of connections there. So, first of all, I mentioned something in passing earlier: that full employment has been the exception to the rule in our economy since about 1980. Something like two thirds of the time, the unemployment rate has been “too high” from this perspective of full employment. Well, if you think about the inequality problem, when did it take off? It started taking off in the 1980s and has continued to grow since then to the kind of heights you just described. That’s not a coincidence. I don’t want to say that these macro conditions are the only thing. Obviously, trade has been in the picture as well. Globalization, many other forces, concentration we’ve been talking about lately. So, there’s a lot of things going on. But a weak labor market does erode the bargaining power of middle- and low-wage workers, and that’s contributed to inequality.

Now, the thing about wealth inequality, though, is really important and is finally getting the kind of attention it deserves, both through candidates like Elizabeth Warren and Bernie Sanders and also through scholars like Gabriel Zucman and Saez, who I know we may get to speak about later regarding their new book. They’ve documented the extent of wealth concentration, how it’s doubled since the late 1970s. It used to be the top 1 percent held something like 20 percent of all wealth. Now it’s closer to 40 percent. And this is a completely, almost a completely different discussion than the labor market discussion. Basically, when you’re getting up to the top half of the top 1 percent, you know, all the people Bernie Sanders talked about, the richest 400, they have almost no labor income. Virtually all of their income is asset-based. And these are folks who just can make literally millions of dollars a month by doing nothing but investing their assets in capital markets and just sitting there and gleaning these returns. So, that type of concentration is really a very different beast than when we’re talking about people earning 14, 15 bucks an hour.

VALLAS: Well, and since you brought up Zucman and Saez’s new book, it’s called The Triumph of Injustice, a lot of us are reading it and had been eagerly awaiting it for, for some time. I actually would love to get into that a little bit, because it is so timely to so many of the conversations that are being had on the 2020 trail. The central argument of their book is basically that we need to stop acting like there’s nothing we can do to change tax policy in this country and to change the fact that we have a massively unfair and regressive tax system. And the book also really tells the story of how the U.S. basically invented progressive taxation and had the most progressive tax system in the world before it sort of took a pretty sharp U-turn in the opposite direction, which may actually be a history lesson worth telling a little bit of. For folks who are familiar with the way things are now, that all may seem somewhat foreign.

BERNSTEIN: Yes, I think what you mention there is the most important kernel of wisdom from their book. I mean, these are two really deep scholars of the dynamics of inequality, whether we’re talking about income or wages or wealth, any dimension of the tax policy. And they’ve put all their knowledge and insight together. They also have a great handle on the international situation, which is very helpful in this regard, because when you say, we can’t do that, you can look at other countries and ask yourselves, well, why can they do it? And I think the conclusion of their book — there’s a lot of wonky details that we can and should get into — the conclusion of their book is essentially you collect the revenue that you decide to collect in terms of the policies that you set and the tax system that you set up. You get the tax avoidance and evasion that you allow for. And the idea that we have to accept levels of tax avoidance and tax evasion that currently bedevil our code is completely belied, completely shown to be false by their critically important work.

It is the case, by the way, that our tax system even, certainly at the federal level, but even if you include state and local, it’s still a progressive system. It’s just less progressive than it used to be. And it’s also the case that the tax rate paid by those at the very top of the scale, those asset accumulators I was talking about a few minutes ago, have gone down significantly. And yes, the Trump tax cut was part of the problem because it was very much weighted toward benefiting the very top of the scale. But that’s been going on for a long time. And I think what Zucman and Saez are saying is that is, you know, cut it out. We don’t have to have such a system that’s lost so much progressivity and collects so little revenue relative to what we need to do, the kind of things that we’re always talking about on this podcast

VALLAS: And they argue, and you sort of alluded to this a little bit in in summarizing some of the points that they make, but they argue chiefly for not just reforms to make our income tax policies more progressive, but they also make a powerful case for a wealth tax. And that’s something that, as you noted, has been getting lots and lots of attention on the campaign trail — on the Democratic side of the campaign trail, I should say — including in this week’s Democratic debate. And while we can’t get into talking about individual candidates, it was definitely front and center in the conversation earlier this week on that stage with 12 candidates. There were a couple of weird moments. I think you and I were actually both tweeting some of the same observations. Like I was not a huge fan of the moment where the CNN moderators were seeming to pit policies like a wealth tax against policies like tax credits for low- and moderate-income families, because those are policies that should be complements. They’re not either/or. But there was a lot of discussion about the idea of a wealth tax and frankly, whether we should even have billionaires in this country, something I talked about last week a little bit, or two weeks ago, a little bit with Michael Linden over at the Groundwork Collaborative. But that is one of the central proposals and arguments really in this new book by Zucman and Saez and an idea that’s really gaining increasing traction among the quote-unquote very serious people, with Capital VS and P.

BERNSTEIN: [chuckles] Well, Gabriel’s Zucman has, throughout his career — and he’s still a young guy. So, he’s done a lot of work so far — has focused on the extent to which wealth eludes taxation. It becomes what the tax expert Ed Klineberg calls “stateless wealth.” It has no kind of known locality. And I think, again, at the core of Gabe’s work, is this idea that that kind of leakage is a policy decision. It doesn’t come from above or maybe more likely below. If you allow, and by you, I should definitely be more specific. If countries — I don’t just mean one country because this capital is internationally mobile, so countries have to hold hands together and go after this — if countries allow wealth to become stateless, of course, it’s going to evade taxation. And why this is so important is that rich people say what you want about them, smart or dumb, they have a lot of tax lawyers. [chuckles] And they recognize that whatever income is hard to tax, that’s the kind of income they want a lot of. And so, the more loopholes you have in your system protecting wealth, the more you’re going to see this kind of evasion, avoidance, and concentration.

Now, I think we should be clear that there are lots of different ways to get at taxing wealth, and the Warren plan, for example, is but one of them. What I like about where I think Democrats are going these days, is that they’re really thinking about doing more taxation or wealth, whether it’s building on what we have, closing some of the loopholes like the step-up basis loophole, or making an estate tax that actually really taxes inheritances, some people are thinking about something called a “mark to market tax,” which tax the appreciation of your assets if you’re a wealthy person. So, there’s lots of really good ideas that are starting to bounce around the echo chamber based on this realization that if we don’t tax wealth concentration, it’s going to just continue to be exacerbated.

VALLAS: So, Jared, we only have a few minutes left. This always goes by so quickly. When I have you on the show, I wish I had you for hours and hours. And I guess that’s something we’ll have to do at some point so that I can stop saying it’s what I wish, and instead, manifest it and make it happen. But another topic that has really come up in the context of the 2020 debate, and again, without getting into individual candidates and just sort of staying with the issues, is the conversation about a universal basic income. And many, including debate moderators on these stages often like to frame the question as, should we have a universal basic income or should we have a job guarantee in some form? And that, again, came up in in this week’s debate. And I know you have a lot of views on this subject.

BERNSTEIN: Yeah, I have been somewhat of a critic of universal income, but largely because of the universal part. I mean, I still think we live in a world with budget constraints. It may not seem that way given our fiscal accounts. And so, I’m not prone to fight too hard for a policy that’s going to write checks to people at the top of the income scale who really don’t need them. So, while I’ve been a huge advocate, along with my colleagues here at the Center on Budget of expanding refundable tax credits that are targeted at low-income households, I’ve been critical of UBI. I do think a job, some sort of job subsidization or guarantee makes a lot of sense. I’ve written somewhat critically about a massive job guarantee idea nationwide because I just think that calls for a level of administration that even a functional federal government would have difficulty with. But I’ve been a big advocate of subsidizing jobs.

And I’ll get back to a comment I made earlier when I said that even at the fullest of full employment, you’re going to have some people in places who are left behind. Maybe those folks really want to work. They just can’t find their way over the steep labor market barriers they face. And for those folks, subsidized employment is actually a tried and true thing we’ve done in this country, and I think we should do more of it.

VALLAS: So, in the last minute that I have with you, Jared, are there any other policies that you want to tag as we’re kind of having this conversation about full employment and what would get us there but what needs to go along with the policies that you’ve been referencing? What’s the agenda that you would want to see here?

BERNSTEIN: Well, I think it’s been really notable that the Federal Reserve has stressed more so than I can remember in recent years the benefits of full employment to folks who really depend on tight labor markets. And then I think we are starting to recognize that monetary policy plays a role here, certainly fiscal policy, the idea of investing in things like job subsidies for places that have been left behind. And then if you square that kind of macro side with more micro policies of the type I talked about earlier, everything from apprenticeship and training programs to job quality things like higher minimum wages and a better overtime threshold, then you really get the micro and macro working together. And I think if we can get those two sides working together, we can not only tap the benefits of full employment, but we can help people who are left behind even in tight labor markets.

VALLAS: I’ve been speaking with Jared Bernstein. He’s a senior fellow at the Center on Budget and Policy Priorities. He’s also formerly chief economist to Vice President Joe Biden. Jared, thanks so much as always, for taking the time and helping us to unpack some of these wonky but really important things. And I already am looking forward to having you back soon.

BERNSTEIN: Well, it’s always a pleasure to talk to you, and thank you for what you’re doing.

VALLAS: Don’t go away. More Off-Kilter after the break. I’m Rebecca Vallas.

[hip-hop music break]

You’re listening to Off-Kilter. I’m Rebecca Vallas. Some good news for a change as promised. Late last week, multiple federal judges blocked the Trump administration’s controversial public charge rule, issuing a set of preliminary injunctions to halt the rule from taking effect as it was scheduled to do this week. While the injunctions represent only a temporary victory, hundreds of thousands of families will now be spared, at least for now, the harmful family separating consequences of the rule pending the outcome of multiple lawsuits challenging its legality. For an update on where things stand and a look inside how we got here, I talked with Madison Allen. She’s a senior policy attorney at the Center for Law and Social Policy, better known as CLASP, and one of the lead organizers of the Protecting Immigrant Families campaign that organized against the rule. Let’s take a listen.

Madison, thanks so much for taking the time to come on the show.

MADISON ALLEN: Hi, Rebecca. Thanks so much for having me.

VALLAS: So, Madison, before we get into this injunction and what it means, take us back and remind us, what would this public charge rule do if it takes effect?

ALLEN: Sure. It’s a great question. First, I’ll just say that public charge is not a new concept. It’s been around for over 100 years, and there’s been federal policy guidance on public charge in place since 1999. But with the Trump administration wants to do here is to radically expand the concept of public charge and really turn it into a wealth tax. So, there’s three main pieces of the public charge proposal that we’re seeing from the Trump administration.

First is they want to change the definition of who is a public charge. They want to change it from someone who relies on the government as their main source of support to someone who is just likely to participate in a health, nutrition, or housing program. The second big change is that the government wants to add a lot of additional factors that make it harder for low- and moderate-income families to pass the public charge test. In the notice of proposed rulemaking that we saw, they say that immigrants could fail the public charge test simply for having a low income, if they don’t speak English well, or even if they have a medical condition. And then the third big change, and the one that’s probably been the most talked about, is that in this radical attempt to change public charge, the government wants to consider additional public benefits in the test. So, instead of just looking at receipt of cash assistance and long-term care, the government wanted to consider the use of Medicaid, of SNAP, and of housing assistance programs that we know help so many immigrant families thrive.

VALLAS: And so, in effect, and this is a big part of what you have been so helpful at helping our listeners understand at different points in the process, but it’s not just a sort of a mean-spirited rule that can restrict access to benefits for immigrant families. It, in effect, also if it takes effect, could cause families to be separated, could actually result in pushing parents to have to make impossible choices, like do I make sure my kids have health insurance and food and a roof over their head, or do I need to be thinking about how I can protect myself and my ability to stay in this country and with my family? Am I getting that right?

ALLEN: Yeah. I think that’s absolutely right. I mean this public charge rule is just another brick in the Trump administration’s invisible wall. Like so many of the other policies we’re seeing from this administration, this attempt, it’s really rooted in discrimination and racial animus. And this rule is targeting families that are lawfully present here in the United States and sending a message to them that they’re only welcome here if they’re white and if they’re wealthy.

VALLAS: So, with all of that as the backdrop here, to remind people about what’s at stake if this rule takes effect, the rule which the Trump administration did finalize after having a notice and comment period that ran a few months and a huge influx of comments — and we’ll talk a little bit about that in a second, all in, in mostly in opposition to this nefarious rule — they did take the step of finalizing the rule, the last step in the administrative rulemaking process. And so, the rule was set to take effect this week, actually Tuesday of this week. But, and this is where the good news comes in, last week, we got word that a federal judge had issued an injunction blocking the rule from taking effect. And while I noted up in my intro that that doesn’t mean the rule is gone forever, this is a temporary victory, talk a little bit about that injunction, what it means for the rule and for the future of the rule. And would love to hear you give a little bit of an overview of some of the litigation that’s under way that actually played a big part in why the judge issued that ruling.

ALLEN: Sure. Happy to talk about that. And first, I’ll just say that we breathed a sigh of relief last Friday when we saw the first preliminary injunction issued in these cases. It’s been incredible to see our partners come together. There’s actually been a total of nine challenges to this public charge rule. And since last Friday, five federal courts have issued preliminary injunctions against the rule, which is really incredible. And this is just a huge victory for immigrant families. What I’ll see about the injunctions is that three of the five injunctions are nationwide. And what that does is it prohibits the Department of Homeland Security from implementing this revised public charge rule anywhere in the United States. We do think it’s likely that the government will appeal these decisions pretty quickly. But for now, those changes are on hold. And as long as any one of these nationwide injunctions are in place, nothing will change for immigrants who are seeking to adjust their status here in the United States.

VALLAS: And while these injunctions, and you mentioned that there are multiple of them, while these injunctions are not the final rulings in these cases — and that’s important to note. The litigation is still under way in a total of nine different cases — it is significant and perhaps gives us a little bit of a sense of where these cases might go, given that at least one of the judges who issued these injunctions said that a big part of why they felt the need to issue the injunction was because one or more of the cases appeared likely to succeed on the merits. So, does that give you and the litigation team hope that we’re likely to see a win at the end of the litigation battle?

ALLEN: It does. It definitely gives us hope. I think it’s important to point out that the litigators in these cases had a high bar to meet. They persuaded the judges that they were likely to win on the merits and that there would be immediate harm if this rule went into effect. And if folks have a chance to go through and read the opinions, I’d encourage you to do so. I think seeing what the judges had to say in these cases were just incredibly powerful. For example, Judge Daniels in the New York case, he called this rule a policy of exclusion in search of a justification. And he said that the rule is repugnant to the American dream. Those types of sentiments, I think, were echoed by judges across the country. And we are going to be standing by to see what happens next, and we’ll continue to update all of our partners as this litigation moves forward.

VALLAS: So, Madison, rarely do we get to celebrate victories like this, particularly when the tool being deployed is a regulatory attack that, by definition, sidesteps Congress and means that effectively, the Trump administration in this case is using its administrative authority — authority that it claims it has and that the litigation actually is claiming it does not have — to ram this policy through without the opportunity for Congress to actually weigh in and to say anything. So, with the ongoing and seemingly relentless swirl of administrative rulemakings targeting low-income and marginalized communities, this is just one of many that we’ve talked about on this show and that have come out of this administration since Trump took office, part of what I wanted to do in this conversation with you is to actually take a look inside the Protecting Immigrant Families campaign to get a glimpse inside the winning strategy for beating back these types of rulemaking. So, would you tell us a little bit about kind of the campaign, its anatomy? If memory serves, it wasn’t long after Trump took office that advocates like you and others started to get wind that the public charge attack might be coming.

ALLEN: Sure. I’d be glad to talk about the work of the campaign. So, the Protecting Immigrant Families campaign is co-chaired by the Center for Law and Social Policy, where I work, as well as the National Immigration Law Center. And you’re absolutely right that our two organizations came together in the early days of the Trump administration to focus on the intersection of attacks on immigrant families, as well as on the relentless attacks on access to basic needs programs. So, for more than a year now, the focus of the PIF campaign has really been on this public charge threat.

In the spring of 2018, when we saw drafts of the public charge rule that were being leaked, we knew we had to fight back against this. And so, when the public charge notice of proposed rulemaking came out, we set a goal as a campaign of generating over 100,000 comments in opposition to the rule. And at that time, that was actually more comments than had ever been submitted on any rule from the Department of Homeland Security. And we definitely heard from people who thought that that was not an achievable goal. But by the end of the comment period, over a quarter million people had commented on the proposed rule, and the vast majority of those comments were in opposition to the rule. And I think what’s so incredible is the variety of people that spoke out. We had people speaking out from all different sectors. And the comments that they submitted established an administrative record that ultimately formed the basis of the litigation that’s taking place today. I’m happy to talk through, if it’s helpful, a little bit more about what went into the campaign.

VALLAS: Yeah, it’s exactly what I’d love for you to do, because there seem to be so many lessons that advocates may be able to take away from what you guys were able to build. And in particular, as you were just describing, how you were able to motivate the engagement of so many, not just the sheer numbers of people, which itself is a tremendous feat, but engagement from so many different corners of the advocacy community in a fight that was against an attack on immigrant families, on low-income families. These are often seen as sort of other people’s fights or not — Just to be super blunt, the health care fight in the 2017–2018 all hands on deck moment, trying to preserve the Affordable Care Act and also Medicaid, that was something that everyone clearly saw as sort of everyone’s fight. And it wasn’t much of a heavy lift for the health care community to get folks from pretty much every walk of the progressive community to oppose repeal of the ACA because people got that it was sort of about us, that it was everyone’s fight. And unfortunately, attacks on immigrant communities and attacks on low-income families generally are often ones where we only really see engagement from anti-poverty groups, from immigrant groups, from groups who are squarely clear that those attacks are kind of within the bread and butter mission of their organizations. So, how were you successful and effective at engaging such a broad base of momentum against this rule?

ALLEN: So, Rebecca, I think you’re absolutely right that partners played a huge role in generating over a quarter million comments. We at the PIF campaign, we have over 400 partners from across the country and almost 40 states. We’re really proud to have national partners, state partners, and local partners from the immigrant rights world, civil rights, health, nutrition, anti-poverty, early childhood education, and other worlds. And as we were working on our current campaign, we actively recruited many of these diverse partners to serve as sector leads, and that dramatically expanded our reach. Sector lead organizations were able to tailor their comments and their messaging to their audience and then to activate their network.

Some other things that I’ll mention as far as the campaign and how I think we were able to be successful in this fight against public charge: our planning and our structure. So, for planning, ultimately time was on our side, and that was partly luck. But we did get started really early. From the time when we first heard about these leaked public charge rules to when the notice of proposed rulemaking was issued, there was a delay of about eight months there. And during that eight-month period, we were able to put a lot of media pressure out there to talk about the impact that this rule would have. And we had dozens of meetings with the Office of Management and Budget. It also gave us time to develop a rapid response plan so we knew what we would be doing the moment that the proposed rule was issued. We were also able to have a digital communications plan, which was really crucial in this fight. We worked with a national digital communications firm. They helped us develop a website with a comment portal, talking points, and a lot of digital content that we pushed out onto social media. And we were also able to get our model comments out within just two weeks of the rule being posted.

And then the last thing I wanted to talk about was the structure of the campaign. As you mentioned, we know that every member of the campaign has their own fight. And at this point in the Trump administration, we’re all exhausted. So, our goal with the Protecting Immigrant Families campaign was to make it easy for groups to join the campaign with a low barrier to entry. And we wanted to have active participation by groups across the country. And the way we did that is through a working group structure. So, we had a policy legal working group, a field working group, research working group, federal advocacy, and communications. And those groups were instrumental in this fight. You know, so, for example, the research working group: during the open comment period, the research working group was able to come together, and more than a dozen studies were published talking about the harm and the impact of the public charge rule. And then the communications working group: they were able to help us have consistent messaging that still allowed for flexibility from our partners. So, some of the core messages that they were putting out there were things like, our lives should be defined by how we contribute to our communities, not by how much money we have. And we found that repeating those messages were really resonating with allies across the country.

VALLAS: So, Madison, in the last few minutes that I have with you, and so much of this — I’m sure advocates are listening and, I hope, taking notes because there are so many different features of what you’re describing there that are eminently replicable no matter what the subject matter of a particular administrative attack might be — so much of what you guys pulled together and often building the plane while you were flying it, I can say as one of the people kind of putting on my advocate hat witnessing you guys building this strategy out at multiple different stages because of changes and unforeseen happenings and shifts in need and crowding of the space that was sucking all the air out of the room because of so many other attacks on, in many cases, adjacent and even the same populations. But at the core of your strategy was really driving as many comments as possible. And you guys saw this early on as necessary to the litigation strategy. Would you talk a little bit about the value of public comments? And I ask that question largely in light of all of the other ongoing administrative attacks coming out of the Trump administration that, as I mentioned, are impacting the Supplemental Nutrition Assistance Program. We talk a lot about those attacks on this show. It seems like there’s a new one every day that ends in Y, but that have taken many, many different flavors and which have caused people, I would suspect, to start to wonder, man, do I really have to comment again? I’m so sick of having to submit public comments! All these organizations are telling me that I have to submit comments. So, for anyone who’s out there and wondering, does it really make a difference if you submit public comments in response to these kinds of rule makings, what is your takeaway now that you’ve started to see the trajectory that this campaign has taken?

ALLEN: That’s a great question. And I would say that absolutely, comments are essential. In the public charge rule, commenters provided research and evidence about the harm that this rule would cause. They shared their own powerful stories on their community’s experience. They showed that this rule contradicts the will of Congress. And they documented the harm that this rule would cause to their state, to their city, and to their providers in their community. The comments established the administrative record that formed the basis of the litigation, and we see in all of the cases APA claims about how this rule was arbitrary and capricious. By law, in the notice and comment period, the government is required to read and respond to every unique comment. So, in these comment periods, it’s essential that you not only have a really high quantity of comments, but that you also have a high quality of comments and raise issues and concerns that will really slow this process down that the government will have to respond to your concerns before they issue a final rule. And if they issue a final rule without responding to those concerns, then we have a basis to challenge it in court.

VALLAS: So, where do things head from here? You mentioned that there are I believe you said nine active cases underway. We saw these preliminary injunctions filed in several of them. What is the timeline that the litigation is moving forward on and what should folks be watching in the weeks and months ahead?

ALLEN: So, that’s a great question. From here, we’re going to be continuing to monitor the litigation and see what happens next. It could take months or longer before we see a final decision in the public charge cases. Hopefully, we can delay until we have a new administration in place. But one thing I want to just keep in mind: as we’re celebrating these legal victories and the delay in implementation, I want to remind people that the harm is still being felt in communities across the country. We know that this policy and related policies, they’re intentionally complex and confusing, and they’re designed to make immigrant families feel afraid and unwelcome. So, we really are asking all of our allies and partners, while we think it’s important to celebrate and to monitor the status of litigation, we want to make sure that people are continuing their outreach and education efforts and encouraging families to fight back. And the best way that families can be fighting back right now is by continuing to meet their children’s needs. So, I think that’s something important to keep in mind. We can get into the policy detail of the rule and of the litigation here, but none of this matters unless families are aware that these changes are not happening now and that they can still access the programs they’re eligible for.

VALLAS: So, a really, really important note to end on and a lot of what you guys are up to at the Center for Law and Social Policy, CLASP, and also your colleagues at the National Immigration Law Center and others involved with this Protecting Immigrant Families campaign is really trying to get the word out that the rule is not in effect. And in fact, you guys had been doing a lot of work in the weeks leading up to the rule being expected to take effect, trying to help educate the community about what it would mean. Really important for people to know that this has happened. The rule is not in effect. So, spread that word. And where can folks go to learn more about the campaign, how they can plug in in its current stages and get updates if they want to keep abreast of happenings in these cases?

ALLEN: Thanks for asking. We would love to have people visit our website, which is www.ProtectingImmigrantFamilies.org. On that website, there’s link at the bottom that says, “get involved.” If folks click on that link, you can sign up for our listserv and get our weekly updates. You can find out how to join the Protecting Immigrant Families campaign as an active member. And then also on our website, you’ll see a lot of different resources, both for advocates as well as a lot of community education materials that are available in English and Spanish and other languages. So, in light of these injunctions, we’re going to be updating those materials over the next few days and weeks and really encourage folks to use our website and NILC and CLASP as resources in this site.

VALLAS: And we’ll make sure to have links to all of that on our nerdy syllabus page so that folks can plug in and learn more and get involved. Madison Allen is a senior policy attorney at the Center for Law and Social Policy, better known as CLASP. She’s also been one of the lead organizers of the Protecting Immigrant Families campaign. Madison, thank you so much for all of your work, for your and your colleagues leadership over this multi-year fight. And congratulations on this temporary but incredibly important victory, considering especially the long odds that many people told you you would be tilting against in taking on this fight.

ALLEN: Of course. Thank you so much for having me today. It was fun to talk.

VALLAS: Don’t go away. More. Off-Kilter after the break. I’m Rebecca Vallas.

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You’re listening to Off-Kilter. I’m Rebecca Vallas with the continued national spotlight on opioid misuse, off and on this show, we’ve sought to have conversations about the parts of the debate that too often get left out, such as the unintended consequences that blanket restrictions on opioid access can have for people struggling to manage chronic pain. Well, another important piece of the puzzle that doesn’t get nearly enough attention is the unintended consequences of so-called abstinence policies, which punish patients who fail to jump through their treatment programs’ many hoops. I spoke with Elizabeth Brico, a TalkPoverty fellow this year and a freelance writer who is herself a former opioid treatment patient. She recently authored a highly personal essay for TalkPoverty, detailing her own experience with these kinds of harmful policies. It’s called Catching the Flu Got Me Kicked Out of My Addiction Treatment Program. I spoke with her by phone. Let’s take a listen.

Elizabeth, thank you so much for taking the time to join the show.

ELIZABETH BRICO: Thank you for having me.

VALLAS: So, to kick off, your essay is incredibly powerful, and I would love for our listeners to get to hear a little bit of your writing. Would you mind reading the opening paragraphs of the piece that tell a little bit about your story?

BRICO: Thank you. Yeah, sure. Yeah. Let me get it. Should I just go ahead and start?

VALLAS: Mmhmm.

BRICO: OK, great. Thank you. “In early September 2019, I was dropped from care by my medication assisted treatment program — a highly effective treatment for opioid addiction that uses medication to rebalance brain chemistry and mitigate withdrawals and cravings — because I had the flu.

I was biking to treatment three to five days a week in the Florida heat, and had no other transportation, so I wasn’t able to come in for dosing after I came down with a fever and a deep, phlegmatic cough. But I called in, emailed, and texted each day that I missed a scheduled day of treatment. At no point was I warned of an impending discharge; my counselor simply wished me well, and suggested I go to urgent care if I felt I needed it.

When I returned to treatment next week, though, I learned that my provider, Memorial Outpatient Behavioral Health, had assumed I was skipping to use drugs. They dumped me without even a few days’ supply of my prescribed buprenorphine, upon which my body was physically dependent; a referral elsewhere; or a solid reason.

This was in spite of my having an active prescription from my doctor and a future appointment with her. I could also no longer access the psychiatric medication I was prescribed through the same provider.

All of a sudden, without warning, I lost all of my addiction and mental health care. As shocking as these events have been, they are not uncommon. In fact, they represent a dangerous status quo among opioid addiction treatment providers across the nation, one that defies all modern research on addiction treatment and leaves patients stranded.”

VALLAS: Elizabeth, thank you so much for sharing that and for reading from this piece. You go on to write in this essay that your story is far from the exception. In many cases, it’s actually the rule. And it’s not just you who’s encountered this type of experience with an opioid treatment program because there’s an approach, as your piece describes that comes out of the theory of abstinence as sort of the goal that can have really serious, unintended consequences for people who are going through these types of programs. Talk a little bit about the idea of abstinence policies and how that played out in your case.

BRICO: Right. So, that’s exactly right. A lot of, I would say, even the majority of programs have an abstinence-only policy, which means that patients are expected to not engage in any kind of substance use besides whatever they’re prescribed by their provider. And that can have really dangerous consequences for patients if they, for example, relapse on their substance of choice, which is, of course, a symptom of the disease for which they’re seeking treatment, or if some patients don’t necessarily — [clears throat] excuse me — some patients don’t necessarily want to be abstinent. For example, some patients, may have a desire to stop using an opioid but continue to use marijuana or alcohol. And in abstinence-only practices, that can mean they’re noncompliant and can be dropped from care, even if they’re actually doing really well and meeting all of their own goals.

In the case of one of the people who I interviewed for this story who I write about, she was tapering from methadone. By her own choice, she had decided at the time that she did not want to be on methadone, which is interesting because that person is actually currently in a long-term methadone maintenance program and doing really, really well. But at the time, a few years ago, she wanted to come off of it, and the taper was really hard on her. She told them about that, and they didn’t really offer her much help. So, she ended up going to the street and buying diazepam, which’s commonly known as valium and was just totally dropped from care when that came up in her drug screen. And as a result, she went through horrible withdrawals, ended up in the hospital with psychosis, and ultimately ended up relapsing, which is why she ended up going back on methadone through a different program.

So, this can be really problematic for people who end up being dropped care and just end up doing so much worse. Especially if someone does relapse on the drug that they’re trying not to use, that really means that they need more treatment, not to be just dropped from care. It makes sense that they would go back to using it quite a lot in most cases, instead of, I’m not really sure what the program intends for them to do when they’re dropped from care. But it can be really harmful, and people can end up overdosing.

VALLAS: And you write, and I feel like this one particular quote really kind of sums up the point that you’re making, “No part of best practice includes suddenly dropping patients from care for any reason, but especially not for showing symptoms of the disorder for which they are seeking care.” In your own experience, you also write in this essay that you thought that maybe if you gave them what they were expecting, a positive toxicology screen, maybe that would actually result in care, the care that you needed, the care that you were seeking. But instead, it had the opposite effect and actually just pushed you straight out of the program.

BRICO: Right. And of course, it was a terrible choice. And I recognize that to go out and use, which is what I did after I came into treatment and couldn’t get medication. But I remember sitting in there in the room with my counselor and another counselor from the program, and they were very suspicious of me for having missed a few days because of being sick. Which was interesting because I was actually still sick and still coughing and still very clearly showing symptoms of having had a virus. So, I’m not sure why they didn’t believe me when they could clearly see that. But they really thought that I was still using or that I had been using, and they were accusing me of that. And they were telling me, “You know, if you used, we’re not going to kick you out.” They specifically said that. And I hadn’t used, and I didn’t really know what to say.

But I thought that if I could come back and tell them, “Oh, you know, I did use, and I need care. And here’s the urine screen that you’re looking for,” that maybe they would give me my medication, which is terrible logic. But I felt really trapped when they wouldn’t give me my medication. And of course, I was starting to go into withdrawal, not receiving it. So, it was just a really bad situation. And it didn’t, nothing, nothing worked. I couldn’t get them to give me treatment.

VALLAS: And part of what you write in this piece is that it’s not just whether you are using or believed to be using that can cause people to be shut out of these programs at the times when they need the most. But also that sort of administrative and bureaucratic hurdles that people may be aren’t able to meet. You described a missing appointments because of having the flu, a really good reason to miss appointments, but that people can actually be shut out of their programs because they’ve been incarcerated or actually because they’re unable to pay.

BRICO: Mmhmm. Yeah, that’s really common. People being unable to come up with payments is a reason that a lot of people lose access to methadone, especially. It’s something that’s called an “administrative taper” where they’re put on a very, very quick taper because they’re not able to pay. And I mean, I understand that providers do need to have money in order to provide treatment. But the problem is that these patients are physically dependent on this medication, and if they suddenly have a financial setback or are not able to pay for whatever reason, then they get stranded. And they are in a position where they’re just put through a really, really harrowing taper that puts them through physical withdrawal and leaves them in a really dangerous situation, which could be lethal if they end up relapsing and overdosing.

VALLAS: And notably, you mentioned as part of your own experience, and you also write in this piece, that this is incredibly common. You didn’t just lose access to your opioid treatment and to the important medications that came along with that, that stopped you from having those kinds of withdrawal symptoms that can, as you said, be so incredibly dangerous and health-threatening. But you also lost access to your mental health treatment, which was an important go-with along with the physical pieces of the opioid treatment and the medication piece of that. Talk a little bit about the interplay there and the consequences of abruptly losing access to mental health services like that.

BRICO: Yeah, that was also really hard. This provider, one of the things that they kind of both did was that they were a comprehensive provider. So, they provided addiction treatment care, they provided mental health care, and they also provided primary care for some patients, which met certain criteria like being in a certain area, which I met those criteria. So, I was starting to receive primary care services through them as well, which I also lost access to. And so, I lost access to, I was taking an antidepressant, Zoloft. I lost my prescription for that access to it. I was no longer able to receive counseling that I was receiving — [clears throat] excuse me — through that provider. Sorry. I was receiving individual counseling and then also going to group therapy, and so I lost all of that. I lost pretty much all of my peer support that I had been receiving through that group therapy program. It was really, really difficult to suddenly go from having this sort of robust support system to having absolutely nothing and totally unexpectedly.

VALLAS: So, in the last few minutes that I have with you, you don’t just describe in this essay your own experience and other people’s experiences with these kinds of horrific practices that are counter to the research, counter to what we know about what works, you also write about what those best practices are. And you actually talk with an interview for this piece, a treatment expert at a program that does not use an abstinence model like this because they recognize the problems inherent in it. And that program is called REACH.

BRICO: Yes. REACH is in New York. I talked with Justine Waldman, who is the medical director there. They’re based on a harm reduction model instead of abstinence only, which is kind of what research is showing is really the most effective practice And there are these places around the country that are starting to move towards that model, and they are the providers who all providers should be looking at for kind of the model of how they should be treating patients. Basically, what it says is just meet people where they are. Talk to patients. Don’t have these punitive policies so that patients feel that they need to lie. There’s one issue with places that have an abstinence-only policy is that patients might feel that they need to declare that they want to be abstinent even if that’s not true in order to receive the treatments they do want in order to be safer and healthier. And then they are deemed non-compliant, and providers feel that they’ve been lied to because the patient isn’t doing what they said they wanted to do. And if you allow people to be honest and you have this harm reduction approach, then patients can tell you what they really want, which in some cases, may be to reduce drug use, to have safer drug use, to stop using certain substances, but continue to occasionally engage in marijuana use or something like that. Or in some cases, it may be that they want to be abstinent, but they’re having a really tough time of it, and they’re able to be honest about that and honest about why they’re having this difficulty and what they need in order to achieve their goal.

VALLAS: So, a much better approach that really, as you said, meets people where they are, and evidence is starting to suggest has much better results when it comes to the people who go through those programs and their well-being on the other side. I’ve been speaking with Elizabeth Brico. She’s the author of Catching the Flu Got Me Kicked Out of My Addiction Treatment Program, a powerful personal essay over at TalkPoverty, which you can, of course, find on our nerdy syllabus page. Elizabeth, thank you so much for taking the time to join the show, and I’m already looking forward to having you back. You write frequently for TalkPoverty because you’re one of this year’s TalkPoverty writing fellows, so there’s lots more to come that I know folks will look forward to reading from you.

BRICO: Thank you so much for having me. I really, really appreciate you taking the time.

VALLAS: And that does it for this week’s episode of Off-Kilter, powered by the Center for American Progress Action Fund. I’m your host Rebecca Vallas. The show is produced by Will Urquhart and David Ballard. Find us on Facebook and Twitter @offkiltershow, and you can find us on the airwaves on the Progressive Voices Network and the We Act Radio Network or anytime as a podcast on iTunes. See you next week.

♪ I want freedom (freedom)

Freedom (freedom)

Now, I don’t know where it’s at

But it’s calling me back

I feel my spirit is revealing,

And now we just trynta get freedom (freedom)

What we talkin’ bout…. ♪