Dear Mr. President

Winter 2017
Illustrations by Andrew J. Nilsen

As they’ve done for previous administrations, fellows and scholars from Rice’s Baker Institute for Public Policy prepared policy briefs in their fields of expertise to present to the new administration. This cycle’s 27 election briefs covered a wide range of foreign and domestic policy issues, including health care reform, energy markets, immigration, trade, relations in the Middle East, entrepreneurship, children’s health, terrorism and space exploration. They were delivered to President Trump’s transition team in December.

“The mission of the Baker Institute as a nonpartisan, data-driven resource for high quality public policy research has never been more important,” said Ambassador Edward P. Djerejian, director of the Baker Institute. “The issue briefs provide policy guidance on the many challenges ahead.” Like think tanks across the country, the Baker Institute seeks to engage policymakers and provide expert analysis for the media. In 2016, the institute was ranked the fourth-best university-affiliated think tank in the world by the University of Pennsylvania’s “Global Go To Think Tank Index.” We’ve broken down some of the policy briefs here.

See the full briefs and many more here.

Reform U.S. Drug Policy

WILLIAM MARTIN
Director, Drug Policy Program at the Baker Institute and Harry and Hazel Chavanne Emeritus Professor of Religion and Public Policy and Sociology
KATHARINE A. NEILL
Alfred C. Glassell III Postdoctoral Fellow in Drug Policy at the Baker Institute

THE CHALLENGE: Along with many in the medical and scientific community, Martin and Neill advocate treating substance abuse as a medical and public health issue and not a crime. This necessitates policy changes at all levels of government, including “an early emphasis on prevention over incarceration,” they said.

THE AUTHORS: Martin’s research covers two distinct areas: the political implications of religion and ways to reduce the harms associated with drug abuse. He wrote the authoritative biography of Billy Graham. Katharine Neill’s research focuses on state sentencing policies for drug offenders and the legalization of medical and recreational marijuana, as well as criminal justice policy.

BRIEF SUMMARY: “Just 10 percent of American adults believe the war on drugs is a success, an all-time low,” Martin and Neill wrote, and attitudes about drug use and treatment for abuse are changing. Marijuana is allowed for medical or recreational use in a growing number of states. Opioid abuse is of growing concern. Policymakers are already calling for greater access to treatment and recovery options as an alternative to incarceration — all positive steps, the researchers said. However, they believe that “the very foundation of U.S. drug policy — prohibition — is seriously flawed, can never succeed and produces more harm than the drugs it seeks to control.” Their policy recommendations include:

• Remove cannabis from Schedule 1 of the Controlled Substances Act.
• Expand federal funding for treating opioid abuse.
• Encourage research into drug policy and draw from other nations’ approaches.

Make Health Care Affordable Again

VIVIAN HO
Director, Center for Health and Biosciences and James A. Baker III Institute Chair in Health Economics

THE CHALLENGE: To provide affordable health insurance coverage to the millions of Americans who do not have access to health insurance policies via a new policy that replaces the Affordable Care Act (ACA). Ho recommends maintaining the concept of state-based insurance marketplaces with some key changes and promotes a compassionate, affordable, market-based health coverage plan.

THE AUTHOR: Economist Vivian Ho’s research examines the effects of economic incentives and regulations on the quality and costs of health care. Often cited by journalists, Ho is a widely published researcher and a founding board member of the American Society for Health Economists.

BRIEF SUMMARY: According to the Kaiser Foundation, before the ACA went into effect, more than 40 million nonelderly Americans were uninsured, a number that decreased to 28.5 million after the bill passed. (In Texas alone, the data show that about 1 million previously uninsured people gained coverage.)

“While some of the ACA’s provisions were based on sound economic principles,” Ho said, “it’s also true that the law specified overly generous coverage provisions, which raised costs for taxpayers and middle-income purchasers.” Ho’s recommendations:

• Lower the premiums for younger people to entice them to enroll.
• Eliminate some preventive care coverage and reform risk adjustment formulas.
• Lift the employer mandate to firms with 100 or more (instead of 50) workers.
• Limit the scope of Medicaid expansion.

Define a Strategy to Defeat ISIS

AMBASSADOR EDWARD P. DJEREJIAN
Director, Baker Institute for Public Policy

THE CHALLENGE: “The Islamic State is a threat to every country in the Middle East and to the international community at large,” said Djerejian. A coherent strategy to combat ISIS, he said, must be based on a better understanding of radical jihadist groups and “a balanced strategy that applies post-9/11 lessons to counter them.”

THE AUTHOR: Djerejian, a career diplomat with deep knowledge of the Middle East, served as U.S. Ambassador to Syria (1988–1991) and Israel (1993–1994) among numerous other appointments.

BRIEF EXCERPT: “The key elements of a coherent strategy for defeating ISIS would involve both a nearer-term coordinated counterterrorism policy with a military component and a longer-term geopolitical approach to address the underlying causes of radical jihadism in the broader Middle East.

“In this latter respect, U.S. strategy should consider the geopolitical effects of the struggle against ISIS, including the role of Iran and Russia and the situation of failing states in the region. We must understand that this is a struggle between the forces of moderation and extremism primarily within the Muslim world of some 1.6 billion people. It is a struggle of ideas on what constitutes the true face of Islam and Muslim society. ISIS and other radical groups seek to establish themselves as credible participants in this debate. …

“The deficits in the region are well known: the lack of real political participation, faulty educational systems, deficient economies, systemic corruption, high rates of youth unemployment and human rights abuses. It is the primary responsibility of the region’s countries and societies to address such issues by ending civil and sectarian conflicts and establishing credible and efficient governance. Accordingly, our approach should be based on a true understanding of the forces at play in the region and a clear definition of what we support and oppose. The United States should take the lead in this international effort.”

Improve the Future of America’s Children

QUIANTA MOORE
Baker Institute Scholar in Health Policy

THE CHALLENGE: About a fifth of America’s 74 million children live in families with incomes below the federal poverty threshold, and poverty puts children at risk for poorer health and reduced educational achievement. “Investments in early childhood to support healthy brain development can improve children’s health and learning, thus reducing societal costs in remediation, health care, mental health services and incarceration,” Moore said.

THE AUTHOR: Moore aims to advance children’s health by developing data-driven policy recommendations. She focuses on access to care in vulnerable populations through school-based clinics, telehealth and health education and recently has worked on improving access to HIV prevention for high-risk adolescents.

BRIEF SUMMARY: The critical window for healthy brain development is birth to age 4 — that’s when neuronal connections are rapidly being formed, strengthened and maintained, said Moore. At this stage, the caregiver-child relationship is key. “The caregiver’s response to the child’s verbal or nonverbal communication, often called ‘serve and return,’ shapes which neuronal connections remain and which are eliminated, making the caregiver-child relationship the most significant influence on brain development,” Moore said. She recommends focusing on the child-caregiver relationship in federal policies around poverty with the following policy changes:

• Adjust federal poverty levels to a realistic level, which would give more family access to federal programs.
• Include younger children in the Early Head-Start Program.
• Increase licensing requirements for child care workers.
• Fund and make mandatory parenting classes for those enrolled in Women, Infants, Children or Supplemental Nutrition Assistance Program.

Stop the Spread of Poverty-Related Diseases

PETER J. HOTEZ
Baker Institute Fellow in Disease and Poverty and U.S. Science Envoy

THE CHALLENGE: What were once thought of as diseases ofthe developing world are growing more common in the developed world.

THE AUTHOR: Hotez is dean of the National School of Tropical Medicine and professor of pediatrics and molecular virology and microbiology at Baylor College of Medicine.

BRIEF SUMMARY: “Today, a new and defining feature of the world’s poverty-related neglected diseases is that they are no longer mostly the purview of the poorest and most devastated African nations,” said Hotez. A major tenet of this new reality, which Hotez calls “blue marble health,” is that G20 countries “now account for most of the world’s poverty-related diseases.” (For example, “the U.S. Gulf Coast states — including Texas, Louisiana and Florida — where the largest numbers of impoverished Americans live, are at risk for Zika and Chagas disease.”) After poverty, the next most important factors driving new neglected diseases may be conflict and climate change. In areas of conflict, health system infrastructures collapse, allowing viruses like Ebola to thrive. Hotez suggests the following policy changes:

• Use the Office of Global Health Diplomacy in theU.S. State Department to drive engagement withG20 leaders.
• Create a center for excellence for neglected diseases in the U.S. that would boost research and development, prevention and monitoring of these diseases (12 million Americans already live with a neglected tropical disease).
• Encourage research and development ofvaccines and embrace vaccine science diplomacy.

Support Small Business Growth

EDWARD J. EGAN
Baker Institute Fellow and Director, McNair Center for Entrepreneurship and Innovation

THE CHALLENGE: Small business growth has slowed since the turn of the millennium, said Egan, and policymakers need to take steps to stoke this economic engine. Perhaps most urgently, small businesses need greater access to loans and to increase their capacity to finance debt.

THE AUTHOR: Egan is an applied microeconomist, specializing in entrepreneurial finance, intellectual property policy and startup strategy. He founded his first high-tech startup at the age of 19 and has judged many academic and industry-sponsored business plan competitions. He also taught at the Imperial College Business School in London.

BRIEF SUMMARY: Small business owners say that a lack of debt financing hinders growth. Community banks, which are best able to assess the risks and returns of their local clients, have suffered disadvantages under regulation and were disproportionately hit by the 2008 financial crisis, Egan wrote. He recommends changing community banking regulation and reforming the Small Business Administration to enable greater access to capital. The benefit could be new levels of GDP growth from small business entrepreneurs.

Illustrations by Andrew J. Nilsen