The Niskanen Center

We know, and we're sorry about that! Looking into better live recording equipment! :)

RFK Jr., Dr. Oz, and Elizabeth Warren agree on at least one big thing Trump's top health officials are challenging industry groups' stranglehold on how we pay doctors — a move that could help fix our broken primary-care system.

Read @lawsonmansell.bsky.social in The Argument:
www.theargumentmag.com/p/rfk-jr-dr-...

It looks like there's at least one MAHA crusade that every good-government liberal can get behind: Breaking the AMA's stranglehold on how doctors are paid.

From fragmented projects to focused products — A VA case study in capability-based budgeting - Niskanen Center Capability-based budgeting enables a shift to clearer accountability, tighter feedback loops, and stronger digital infrastructure.

The Dept of Veterans’ Affairs piloted capability-based budgeting and proved it works. Agencies don’t need new laws to try this, and the payoff is big:

– More transparent reporting

– Increased flexibility & agility

– Clear accountability

www.niskanencenter.org/fragmented-p...

From fragmented projects to focused products — A VA case study in capability-based budgeting - Niskanen Center Capability-based budgeting enables a shift to clearer accountability, tighter feedback loops, and stronger digital infrastructure.

Most federal budgets are fragmented across so many projects and authorities that everyone loses sight of the outcome.

Solitaire Carroll’s work at the VA shows it doesn’t have to be this way. www.niskanencenter.org/fragmented-p...

Insurance as a potential tool to reduce firearm-related harms - Niskanen Center Through tax credits, direct subsidies, or market stabilization, policymakers could make the insurance industry a critical part of the nation’s ongoing effort to reduce firearm-related harms.

Read the full report from Kerri Raissian & @jennneccidineen.bsky.social here: www.niskanencenter.org/insurance-as...

Congress has several levers available to align insurance with public safety goals.

Because the payouts for gun-related injuries are spread across multiple types of insurers, no single company sees much benefit from investing in prevention.

Gun violence costs the U.S. $557 billion a year.

Insurance companies shoulder much of that cost — but do little to reduce the risks that drive it. Congress can fix this incentive gap.

Opinion: Building a resilient energy grid from Utah to the West A future of energy abundance depends on Western states moving forward together and pushing for federal permitting reform.

Utah is producing a lot of new energy — from solar farms, batteries, and soon nuclear — but much of that power can’t get to the cities and businesses that need it.

There's never been a better time to build a more coordinated electricity grid across Western states!
www.deseret.com/opinion/2025...

Don’t let work requirements become the next expensive government tech meltdown - Niskanen Center State Medicaid administrators face major changes in the year ahead—and without clear CMS guidance, the result could be massive costs and the largest multi-state technology failure since the pandemic.

Medicaid work requirements are coming in 2027.

And without quick action from CMS, they could trigger the next billion-dollar government IT disaster, similar to healthcare.gov, FASFA, etc. 

But a tech meltdown doesn't have to be our story this time.
www.niskanencenter.org/dont-let-wor...

"The U.S. stands to lose more than India with the Trump administration's H1-B fee hike."

🏙️ Niskanen staff represented at YIMBYTOWN!

@aarmlovi.bsky.social, Andrew Justus, Kaj Gumbs, and Rohan Aras presented on a "Federal Policy Roundup" panel (alongside minority staffer Madeleine Marr of Senate Banking and David Garcia of Up For Growth).

Don’t just poke holes in the PRA - Niskanen Center Instead of poking more holes in the Paperwork Reduction Act, Congress should recognize that it is time for an across-the-board fix.

Read the full article here: www.niskanencenter.org/dont-just-po...

The Paperwork Reduction Act doesn’t work, and everybody knows it.

Per Alex Mechanick, it’s time for Congress to make comprehensive changes rather than continuing to pass piecemeal exemptions.

Polling data reveals strong bipartisan support for the Conrad 30 program  - Niskanen Center Most voters reported knowing little or nothing about Conrad 30. Yet, once informed, strong bipartisan support emerged for expanding it.

Read more from Lindsey Warburton here: www.niskanencenter.org/polling-data...

Conrad 30 lets international physicians who train in the U.S. practice in underserved communities.

But last year, 330 of the program’s slots were unused. Congress should fix this.

How states can help curb UI overpayments and improve efficiency - Niskanen Center State unemployment agencies face a persistent processing problem: they struggle to deliver benefits both accurately and on time.

Read more from Will Raderman here: www.niskanencenter.org/how-states-c...

How states can help curb UI overpayments and improve efficiency - Niskanen Center State unemployment agencies face a persistent processing problem: they struggle to deliver benefits both accurately and on time.

Most state agencies wait until after unemployment claims are filed to ask employers why a worker left.

By collecting separation data closer to the time of departure, states could reduce errors and help workers receive their benefits faster.

Our grid isn’t ready for 21st-century demands.

Join us on Wednesday to discuss how unlocking HVDC can drive down energy costs and boost U.S. energy security. www.niskanencenter.org/how-congress...

Markets & innovation can power an abundant, clean energy future.

To get there, reforms should focus on investing in innovation & infrastructure rather than prescribing narrow procedures. nationalinterest.org/blog/energy-...

Shifting the balance: How CMS’s 2026 rules target higher-value care - Niskanen Center The rule begins to rebalance reimbursements by shifting spending away from hospital-owned settings and toward primary care and other freestanding outpatient clinics.

Read more from Lawson Mansell here: www.niskanencenter.org/cms-rules-si...

Medicare reimburses hospitals more than freestanding clinics for the same routine procedures, so they acquire physician practices where patients could otherwise receive the same care at a lower cost.

Newly proposed rules attempt to address this.

Can we reduce the imprisonment rate without endangering public safety? The promise of electronic monitoring - Niskanen Center Electronic monitoring might simply perform better than prison at reducing post-sentence offending.

Electronic monitoring (EM) allows people who have committed crimes to serve their time without burdening an already stressed prison system.

New evidence shows that it can do this while improving public safety. www.niskanencenter.org/can-we-reduc...

A huge thank you to all who made Abundance 2025 happen!

Niskanen partnered with leading organizations to bring together elected officials, academics, and policy experts to explore what abundance can look like across parties and across the U.S.
www.niskanencenter.org/niskanens-ab...

Markets, Innovation, and the March to 100 Percent Clean Energy The march to 100 percent clean energy is attainable, and we are even on the right trajectory, as recent developments look promising.

Read the full article here: nationalinterest.org/blog/energy-...

Per Kenneth Sercy, to reach net-zero, reforms must:

– Invest in transmission and R&D.

– Encourage fair pricing through carbon taxes and border adjustments.

– Promote healthy market competition to spur innovation and drive down prices.

Many thanks to our panelists, including Niskanen's Rachel Levine, Converge Strategies' Jonathon Monken, @acore-org.bsky.social's Jonathon Geldof, and Conservative Energy Network's Connor Marley!

An HVDC macrogrid would:

⚡️ Complement the existing grid

⚡️ Provide access to more power during multi-region weather events

⚡️ Enable low-cost power to reach more consumers

⚡️Relieve transmission congestion

⚡️Be built one line at a time w/ private capital

Today, we went to the Hill to discuss a politically viable fix for our strained and aging electric grid: a high-voltage direct current (HVDC) macrogrid. ⚡️