US Treasury Debt, Default and Work Requirements, New HIV Data
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No Memorial Day barbecues for some on Capitol Hill. Not with debt ceiling negotiations dragging on. One sticking point, work requirements for those on food stamps, Medicaid, and cash assistance. I'm Scott Simon. I'm Aisha Roscoe, and this is Up First from NPR News.

The U.S. may run out of cash to pay its bills by June 5th. But this might actually increase demand for U.S. government bonds. So that just means that there are few options and the options that exist can't handle the size of demand that might come to them, which make U.S. treasuries the natural alternative to come back to, ironically.

And new data shows the U.S. is doing well in controlling HIV. But those numbers reveal racial disparities among groups who see those improvements. Stay with us. We've got the news you need to start your weekend.

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A deal over the debt ceiling is taking shape. But Democrats say they're standing against the proposal to impose new or tougher work requirements for people who get food stamps, Medicaid, or cash assistance. The White House calls that a cruel and senseless tradeoff. NPR's Jennifer Ludden joins us now. Hey there. There are requirements that already exist for some programs, like food stamps, right?

Yes, correct. Let's start with food stamps. 40 million people get them. So right now, if you're 18 to 50, you have no children and no dependents and no disability, you have to show you're working 20 hours a week. House Republicans want to raise that age limit to 55 years old.

Of course, the details on this or any of the new work requirements could change during negotiations. Another program, families that get cash assistance, what used to be called welfare. This is a tiny group, just about a million families. They are extremely poor. And basically, states currently have to show a certain share of them are work.

Under the proposed requirements, the way they calculate that, trust me, it's too complicated to explain, but it would make it even tougher and mean a much higher share needed to work. I spoke with Liz Altman's Ananat. She's an economist at Barnard College, and she says this is a group that faces a lot of barriers to getting or keeping a job. They've recently had a death in the family. They're dealing with a miscarriage.

with a mental health issue. They've had a family breakup. They've been a victim of domestic violence. A lot of folks in crisis. So, Jennifer, both the programs we're talking about, food stamps and cash assistance, have work requirements. What about people on Medicaid? Because right now that does not have a work requirement, does it?

Exactly. This would be new for Medicaid. It would require able-bodied adults without dependents to have some work-related activity for 80 hours a month. Now, where are you going to find that group of people? Analysts say it is going to be those who signed up for the Medicaid expansion under the Affordable Care Act. And this is because the ACA, Obamacare, allowed able-bodied adults without dependents to get Medicaid for the first time.

There have been debates for decades about work requirements. And Republicans often say it's a way to put more people into jobs. And they note that particularly now, it might actually help businesses who say they face a labor shortage. Could these two points come together and work?

Right. You know, it makes sense. People understand this. I'm sure some people would find work. But there's been a lot of research in the decades of this debate. And, you know, it shows it's not necessarily going to be the case on a large scale. There was a real-time experiment. The Trump administration let states impose work requirements for Medicaid and

Arkansas did it for seven months in 2018. Sharon Parrott is president of the Center on Budget and Policy Priorities. And she says in that short time, about a quarter of people subject to those requirements in Arkansas ended up being dropped from Medicaid. There wasn't any increase in employment.

If that was the goal, that didn't happen. And of the people who lost coverage, lots of them actually were working or should have been exempt. But the system is just very challenging for a state to implement and for people to navigate. And she says, you know, when people lose health care coverage or other aid, it can really make it harder to get a job. You know, their health might get worse. They might even lose housing. Final question. Speaker McCarthy says the overall goal of this debt ceiling deal is

is for the U.S. government to spend less. Would stricter work requirements save money for the government? The Congressional Budget Office looked at that question for Medicaid. It found that it would save the federal government a small amount, but some of that cost would then be passed along to states. And here's an interesting thing I learned on cash assistance. States get this money through block grants,

And there's lots of other things they can spend it on, right? They have, you know, workforce training programs. They can promote marriage. They can use the money to reduce teen pregnancy. And so if stricter work requirements are imposed on cash assistance, researchers worry that some states might decide it's just too complicated to give out. They would shut down cash assistance. And states could do that without giving the money back to the federal government. And Pierce, Jennifer Ludden, thanks so much. Thank you.

Now, if debt ceiling negotiations fail, a U.S. government debt default would also send shockwaves through the global financial system. But some forecasters think that would actually increase demand for U.S. government debt. NPR's Scott Horsley joins us now to explain. Hi, Aisha. So, what's the U.S. government debt default?

why would investors want more government bonds if there are questions about the government's willingness to pay back the money it owes? Yeah, that is kind of weird, right? Ordinarily, you would think a deadbeat borrower would have a harder time finding people to lend him money. But whenever there's turmoil in the financial markets, investors look for a safe place to park their money. And some forecasters think that's still going to be U.S. Treasury bonds, even if, in this case, the turmoil is the result of the federal government not paying its bills.

It is strange. It's kind of like climbing into a lifeboat with someone who keeps stirring up the waves. But Josh Lipsky, who's senior director of the Atlantic Council's Geoeconomic Center, says there just aren't a lot of other lifeboats around. Germany is one of the few countries with bonds considered as safe as those in the U.S., and Germany doesn't borrow that much money. Government bonds in China, Japan, the U.K. all have their own problems. So Lipsky thinks that U.S. government bonds will still be in high demand. The financial shorthand for this is zero.

So that just means that there are few options and the options that exist can't handle the size of demand that might come to them, which make U.S. Treasuries the natural alternative to come back to, ironically. Yeah.

Now, that doesn't mean people are going to buy short-term U.S. bonds, the ones coming due right in the middle of this debt ceiling fight. Those are pretty unpopular right now. But if you look just a little further out, once the dust settles, it looks like plenty of people would still be willing to lend the U.S. government money at fairly low interest rates. Well, does that mean that we don't really have to worry about the debt ceiling fight?

I don't think we should be complacent about that. Some people might remember the old Lily Tomlin sketch about the phone company. We don't care. We don't have to. That's a dangerous attitude. That kind of monopoly power doesn't necessarily last forever, especially when you throw your weight around carelessly. Competitors eventually sprang up to challenge the phone company, and Lipsky says the U.S. shouldn't take its position in the global financial system for granted either. I do think there's global fatigue there.

directed toward the U.S. And while there is no alternative in the short term, that doesn't mean that other countries and investors around the world are not looking for alternatives in the long term.

Countries do not want to be so reliant on a system which they see from their perspective right now is dysfunctional. Lipsky says it's a privilege that people all over the world want to buy U.S. treasuries. It lets our government borrow money at very low cost and there are real economic advantages that come from that. He says the U.S. shouldn't squander that, certainly not as casually as some members of Congress seem willing to do.

Both the president and the House speaker have said they're determined to resolve this in a way that doesn't result in a government default. Has there been any fallout, though, from just coming this close?

It certainly hasn't been a good look. You remember earlier this month, the president had to cancel his planned trip to Australia, where he was going to meet with Asia Pacific leaders, and what would have been the first ever presidential visit to Papua New Guinea, just because he had to come home and deal with this manufactured crisis. The White House downplayed the geopolitical cost of that, but

Other countries take note. You know, this worries our friends. It emboldens our rivals. Rohit Kumar, who is a former advisor to Senate Republican leader Mitch McConnell, says an actual default would be an even bigger blow to American leadership. It's hard to imagine a scenario where our standing in the world is improved.

Because we have defaulted on our debt and self-inflicted an economic crisis, not only on ourselves, but perhaps on the rest of the world. It's hard to see how that's a pro-American diplomacy move in the grand scheme of things. Kumar, who's now at PricewaterhouseCoopers, was speaking at an event this past week sponsored by the Concord Coalition, which tries to promote fiscal responsibility.

He added that any actual reduction in government spending that comes out of this fight is likely to be pretty small and certainly not worth the risk of rocking the global economic boat. That's NPR's Scott Horsley. Thank you so much. You're welcome.

The U.S. is making progress in controlling the HIV epidemic. There is a notable reduction in the number of new cases, according to a report released this week by the Centers for Disease Control and Prevention. It's encouraging news, but the numbers also show that not everyone is benefiting from treatments that are slowing overall infection rates.

NPR's Will Stone joins us now to explain. Hi there. Let's start with the good news. How big of an improvement are we talking about here? Well, the CDC found that new cases of HIV were 12% lower in 2021 as compared to 2017. So that's a real and meaningful step in the right direction. And

It's primarily because infections fell substantially in young people. There was actually a 34% decrease in cases among teenagers and those in their early 20s. And here we're primarily talking about gay and bisexual men who account for the majority of new cases in this age group and more broadly in the U.S. And do we have a sense of why that is? There are a number of factors. The biggest, though, is clearly PrEP, and that's the medication you take to prevent HIV infections. The

The percentage of people who would benefit from PrEP and are being prescribed it more than doubled since 2017. I spoke to Patrick Sullivan, who's an epidemiologist at Emory University. We now have a generation of younger gay and bisexual men who've really

grown up and become sexually active at a time when PrEP was available. The one thing that I think we still have to really pay attention to in the data that were just released, it wasn't really realized evenly across the racial and ethnic groups. And that last point is really the other side of the seemingly positive news that some long entrenched disparities actually appear to be growing.

And so what are we seeing along those lines? It's pretty stark in this new data. If you look at white people, it's estimated close to 80% who would benefit from PrEP are being prescribed it. But for those who are Hispanic and Latino, that number drops down to 21%. And it's only 11% among black people. So it's really not a surprise that new HIV infections are disproportionately affecting these groups. You also see disparities play out geographically.

So you're saying that some parts of the U.S. are being more affected by HIV than others? That's right. At this point, actually more than half of new infections are happening in the South. I spoke to Will Ramirez about this. He's with the Southern AIDS Coalition. Raising awareness that PrEP exists does not automatically trigger demand and use. There's still things that they have to contend with, especially here in the South, anti-HIV sentiment, anti-gay stigma.

And then, you know, many people who are eligible for PrEP, they don't access it. Ramirez says one clear barrier is simply not having health coverage. Many states in the South haven't expanded Medicaid. They don't necessarily have programs that cover the cost of labs and visits. And on top of that, you need to find a doctor who's willing to prescribe the drug. So what does this mean looking forward? I mean, didn't the U.S. set a goal of reducing new HIV infections by 90 percent by the end of this decade?

Well, it's not going to achieve that if these big gaps remain, especially when it comes to PrEP. Nina Harawa is a professor of medicine and epidemiology at UCLA, and she points out that prevention efforts can't only focus on gay and bisexual men. About one-fifth of new cases of HIV affect women. There's also more outreach that can be done for people who inject drugs and are at risk.

And Harawa believes that improving access to PrEP, while still very important, can't be the only solution here. Concern people have about taking a medication when they're not sick, I think some of that is cultural, and I'm somewhat concerned that the HIV prevention strategy has been so shaped around PrEP because I think that kind of resistance to taking something when you're not sick is stronger among people of color.

Which is why she thinks there also needs to be attention to other forms of prevention, like condom use, early testing, and ultimately to the root causes that contribute to the racial disparities in HIV. That's Will Stone. Thank you so much for joining us. Thank you.

And that's a first for Saturday, May 27th, 2023. I'm Scott Simon. And I'm Aisha Roscoe. Tomorrow on this podcast, the story of author Stephanie Fu, who struggles with complex PTSD and her efforts to heal from an abusive childhood.

Today's episode of Up First was edited by Catherine Laidlaw, Raphael Nam, Scott Hensley, Adil El-Shulchi, and Dee Parvez. It was produced by Andrew Craig and Fernando Naro and directed by Ryan Bink with engineering support from Hannah Glovna. Evie Stone is our senior supervising editor. Our executive producer is Sarah Lucy Oliver and our deputy managing editor is Jim Kane. And for more information, visit www.upfirst.com.

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