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US Treasury’s Unhosted Wallet Proposal Is Unnecessary, Ineffective And Counterproductive

Following the US Treasury notice of proposed rulemaking (NPRM) issued on December 18, 2020 regarding transactions with unhosted wallets and wallets hosted at financial institutions in certain jurisdictions, Elliptic today submitted an open letter to FinCE

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Following the US Treasury notice of proposed rulemaking (NPRM) issued on December 18, 2020 regarding transactions with unhosted wallets and wallets hosted at financial institutions in certain jurisdictions, Elliptic today submitted an open letter to FinCEN in response to the proposed changes.

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Elliptic's Open Letter On US Treasury’s Proposed Rules On Unhosted Wallet Transactions

Policy Division

Financial Crimes Enforcement Network (“FinCEN”)

P.O. Box 39

Vienna, VA 22183

Re: FinCEN Docket No. FINCEN-2020–0020; RIN №1506-AB47; Notice of Proposed Rulemaking: Requirements for Certain Transactions Involving Convertible Virtual Currency or Digital Assets

To whom it may concern:

We are writing in response to FinCEN’s Notice of Proposed Rulemaking (“NPRM”) published in the Federal Register on December 23, 2020, regarding “Requirements for Certain Transactions Involving Convertible Virtual Currency or Digital Assets.” We appreciate the opportunity to comment on this NPRM. The measures it outlines will have far-reaching consequences for regulated entities, could negatively shape the future of financial innovation in the United States, and could adversely impact the effectiveness of US anti-money laundering and countering the financing of terrorism (AML/CFT) efforts for years to come if not addressed in a thoughtful and prudent manner.

It is therefore critical that the public and private sectors have a robust and open consultation about the impact of these proposed measures given their far-reaching consequences.

Though we welcome this opportunity to comment, we are deeply concerned that the comment period has been limited to only 15 days. We urge you to provide additional time for comments so that a truly effective analysis of the NPRM’s impact, and in particular, the resource and cost burdens it will impose on regulated businesses can take place before a final rule is implemented. The short comment period has meant that we are unable to fully analyze the NPRM, provide a comprehensive response, or answer the questions contained within it.

As a provider of blockchain analytics solutions for dozens of US banks and money services businesses (“MSBs”), Elliptic’s mission is to combat financial crime in convertible virtual currencies (“CVCs”). Indeed, we have been providing US businesses with compliance solutions to manage their CVC-related financial crime risk since 2013, when FinCEN first issued guidance related to virtual currencies. We also work closely with US law enforcement agencies, providing them with the ability to trace proceeds of crime through the blockchain and bring those involved to justice. We have a deep understanding of the illicit use of CVCs and have published extensive research on topics such as CVC-specific money laundering and terrorist financing typologies 1 .

It is owing to this ongoing commitment that we are concerned about the measures outlined in the NPRM. We feel the proposed measures will fail to protect against financial crime, and worse, could achieve the opposite outcome and exacerbate illicit activity by imposing requirements that would divert resources away from existing effective practices and incentivizing the use of less transparent CVC trading platforms. We believe the manner in which this NPRM has been rolled out will also undermine its effective implementation.

We have four main objections to the proposed rules and the rulemaking process:

1. The rulemaking process is unjustifiably short and risks introducing ineffective regulation with unintended consequences.

The 15 day comment period for this proposed rulemaking, spanning the Christmas and New Year holidays and during a pandemic, is clearly insufficient and will likely lead to ineffective regulations with unintended consequences, as described elsewhere in this letter.

The curtailed time frame is unnecessary and unjustified. In particular, the NPRM argues that providing the standard comment period is contrary to the public interest because it could tip-off criminals, who could:

“accelerate or cause the movement of assets implicated in illicit finance from hosted wallets at financial institutions to unhosted or otherwise covered wallets, such as by moving CVC to exchanges that do not comply with AML/CFT requirements.”

This argument is not valid for two reasons. First, the proposed rules, if enacted, will not prevent criminals moving their assets to unhosted wallets - they would simply trigger reporting and recordkeeping requirements. The measures themselves do nothing to prevent asset flight, and indeed, their imposition may hasten it by encouraging illicit actors to move funds to less transparent platforms, both in the near-term, and over the long-term. This risk is discussed further below.

Second, even if knowledge of the proposed rules leads criminals to move their funds out of US financial institutions, they have already now had an opportunity to do this owing to the publication of the NPRM in the Federal Register. The small additional risk that a longer comment period would provide these actors with more time to move their funds is far outweighed by the need for the public to assess and provide comment on the proposed rules given their scope and potential impact on regulated entities.

Treasury also justifies the abbreviated 15 day comment period, because:

“FinCEN has engaged with the cryptocurrency industry on multiple occasions on the AML risks presented in the cryptocurrency space and carefully considered information and feedback received from industry participants. These engagements have included a FinCEN Exchange event in May 2019, visits to cryptocurrency businesses in California in February 2020, an industry roundtable with the Secretary of the Treasury in March 2020, and a FinCEN Exchange event on cryptocurrency and ransomware in November 2020.”

Elliptic was present at both of the FinCEN Exchange events and the industry roundtable with the Secretary of the Treasury. These meetings were highly productive in enabling public-private sector collaboration on topics impacting CVCs. We welcome and are appreciative of this engagement. However, none of these events included discussion of the specific measures outlined in the NPRM, and the industry was not invited to comment on them at that time.

As the NPRM highlights in referencing these events, the industry has demonstrated its willingness to engage as a constructive partner with the public sector. The industry should be afforded more time to comment on the NPRM given that it was not invited to do so at the events noted above. If offered ample time to comment, the industry can provide more detailed views about how these measures can be improved, or can propose alternative measures that might be more effective than those outlined in the NPRM.

By not affording the industry more time to comment, or allowing more time for implementation, there is also a risk that the industry may struggle to implement the proposed measures effectively owing to a lack of clarity about their provisions, thereby undermining the intended outcomes of the proposed rule. We have outlined specific implementation issues that require further clarification in an Annex to this letter, but feel that additional time is essential to fully assess and clarify these issues and other challenges that the NPRM raises.

To ensure effective outcomes, it is therefore in both the public and private sectors’ interest to undertake a lengthier comment period. We recommend a 90 day comment period to ensure sufficient time, as has been requested in a petition by the Chamber of Digital Commerce 2 .

2. Data shows that the risks posed by unhosted wallets have been overstated and that the proposed rules are largely unnecessary for combating financial crime in CVCs.

The risk associated with unhosted wallets is overstated for at least two reasons:

(i) Unlike with physical cash, peer-to-peer CVC transactions through unhosted wallets are visible on the blockchain, and can be traced using blockchain analytics solutions. Using these techniques, law enforcement can already achieve the outcomes that the NPRM claims can only be achieved by imposing new measures.

The use of unhosted wallets does not prevent blockchain analytics techniques from being used to identify and trace proceeds of crime in CVCs. This has been readily demonstrated by numerous successful law enforcement investigations, including cases involving ransomware, fraud, sanctions evasion and terrorist fundraising. Regulated financial institutions engaged in CVC transactions also use blockchain analytics tools to successfully identify customer transactions to or from illicit actors, including those that have passed through unhosted wallets. Regulated businesses also rely on blockchain analytics to pre-screen transactions to identify and prevent dealings with sanctioned persons, as well as other illicit actors who use unhosted wallets - ensuring financial resources are denied to these threat actors.

By combining the data from blockchain analytics with other sources of intelligence, law enforcement agencies are frequently already able to identify users of unhosted wallets, apprehend them, and confiscate their assets - the same objectives the NPRM purports to achieve. The US has successfully accomplished this through recent law enforcement action. This includes recent action in September 2020 against cyber-enabled terrorist financing campaigns that utilized CVCs to raise funds. 3 US law enforcement relied on a combination of blockchain analytics and traditional techniques to dismantle those terrorist fundraising efforts. The new proposed measures would be redundant and merely impose a cost on the private sector to document information that law enforcement agencies have demonstrated they are able to access and act upon through existing means. The new measures would also threaten to jeopardize these techniques if they encourage users to move away from regulated platforms, a risk we describe further below.

The NPRM correctly points out that blockchain tracing is more challenging for anonymity-enhanced cryptocurrencies. However, the risks posed by these technologies can and should be addressed most effectively through risk-based application of existing Bank Secrecy Act (“BSA”) requirements, rather than through additional rules.

(ii) Illicit actors are almost completely dependent on being able to “cash-out” to fiat currency, and they use financial institutions subject to BSA requirements to do so. Information about this activity is already shared with FinCEN through the suspicious activity reporting (“SAR”) filing process.

Elliptic’s analysis of several billion dollars of criminal proceeds in bitcoin moved between 2011 and 2020 demonstrates that more than 90% of illicit funds were sent to exchanges and other MSBs that are already subject to identity verification, recordkeeping and SAR requirements. Fewer than 10% of the illicit-origin funds we analyzed remained in unhosted wallets. Of the minority of criminal funds currently in unhosted wallets, the vast majority are simply dormant, rather than being circulated in an “unregulated” part of the CVC ecosystem.

The data therefore shows that the primary risk lies not in criminals’ ongoing use of unhosted wallets. Rather, the largest risk would derive from imposing unnecessary requirements on regulated businesses, which might only encourage criminals to go further underground. The solution to this is to more tightly enforce existing requirements and encourage expansion of efforts that have already proved successful in preventing financial crime, rather than to impose costly and likely ineffective requirements on transactions involving unhosted wallets.

3. The proposed rules would be ineffective and possibly counterproductive, leading to increased criminal use of CVCs by forcing banks and MSBs to divert attention and resources from measures that are already working.

The proposed rules will provide law enforcement investigators with little additional insight into transactions facilitated by MSBs or banks that they cannot glean already. It will also not succeed in its aim of ascertaining the identities of high risk and illicit actors using unhosted wallets beyond what is already possible.

Even under the proposed rules, CVC users with accounts at MSBs/banks would still be able to transact with unhosted wallets controlled by third parties without those institutions being fully aware of those third parties’ identities. For outgoing transactions 4 this would be achieved by simply withdrawing CVC to an unhosted wallet controlled by the customer of the MSB/bank before then quickly sending the CVC to the third-party beneficiary’s unhosted wallet. Despite the proposed rule, the bank/MSB would have undertaken activity on behalf of the ultimate beneficiary of the transaction but without having this person’s identity recorded or reported by the MSB/bank. To glean further information about the flow of funds beyond the transfer to the customer’s own unhosted wallet, the regulated entity and law enforcement can already leverage blockchain analytics solutions, as noted above. It is therefore unclear what additional meaningful information the recordkeeping requirement is expected to produce beyond what is discernible from existing sources and through pre-existing AML compliance practices the cryptocurrency industry already employs.

As described above, illicit actors are still highly dependent on CVC service providers such as exchanges to cash-out or exchange their CVC holdings. Over 90% of criminal proceeds in bitcoin go either directly or via unhosted wallets to businesses that are subject to AML requirements such as SAR filing. Law enforcement greatly benefits from these transactions between regulated service providers and third party wallets, because valuable insights can be gained when publicly available information from the blockchain is combined with private information held by those regulated businesses. This information can already be readily accessed and utilized without imposing additional requirements.

Furthermore, the NPRM risks producing an unintended outcome: by imposing additional information collection requirements at the point where both industry and the public sector are already able to glean substantial amounts of information, the proposed rules would greatly incentivize both legitimate and illicit actors to move away from using centralized, regulated service providers towards decentralized, unregulated alternatives. This would make it considerably more challenging for illicit CVC use to be monitored and investigated than is the case today.

The proposed rules are also an inefficient use of the scarce compliance resources available to regulated entities. It is not the case that all recordkeeping and reporting requirements provide a net benefit in terms of the underlying AML/CFT goals. The opportunity cost must also be taken into account. The resources required to comply with the proposed rules would be far better invested in improved controls to detect and report suspicious activity that leverages existing techniques, rather than new blanket recordkeeping and reporting. The time and effort required to implement these new measures would force private sector entities to divert resources and effort away from processes and procedures that are already working.

As the NPRM itself highlights, FinCEN already receives valuable information from the private sector in the form of substantial volumes of SARs about CVC activity. This effectiveness could be lost if the industry is required to undertake these new measures, which provide little additional benefit, and particularly if implemented on a hasty timeline necessitated by the short comment period offered on this NPRM. Owing to the rushed comment period, MSBs, may, for example, be forced to divert staff urgently away from engaging in blockchain monitoring and SAR filing activities merely to fulfill the recordkeeping obligations set out in the NPRM - undermining the outcomes the NPRM purports to achieve and potentially making regulated entities more, and not less, vulnerable to illicit activity.

These concerns about the proposed rules are echoed by many within the law enforcement community who the NPRM cites as benefiting from its proposals. According to Jarek Jakubcek, an experienced investigator at Europol and one of the world’s foremost experts on the criminal use of CVCs, Treasury’s proposed rules are 5 :

“Probably the worst value-for-money compliance proposal that has a dangerous potential for diverting legitimate clients from the most to the least compliant services.”

Public sector resources can also be better used by reinforcing and doubling-down on existing initiatives that have proven effective to date in mitigating against certain risks associated with unhosted wallets, rather than diverting resources to a new set of requirements whose value is unproven.

For example, the November 2020 FinCEN Exchange event that Elliptic and our peers in the industry attended provided an excellent forum for the public and private sectors to discuss information on threat actors, specifically ransomware perpetrators, who rely on unhosted wallets. Public and private sector resources would be better directed at undertaking a greater number of public-private initiatives that allow relevant parties to share information in a collaborative fashion, including information on self-hosted wallets known to be used by illicit actors, rather than directing those same resources at fulfilling the rote recordkeeping requirements set out in the NPRM.

Furthermore, public-private partnership initiatives such as FinCEN Exchanges can be augmented through related information sharing initiatives that leverage existing frameworks and do not require the imposition of any new measures. For example, FinCEN recently provided valuable clarification about the types of counterparty information that private sector entities can share under section 314(b) of the USA PATRIOT Act. 6

FinCEN should work with the cryptocurrency industry to ensure that banks and MSBs can maximize the value offered by 314(b). Leveraging 314(b) alongside the open data available from blockchain analytics offers the promise of law enforcement receiving greater intelligence insights about illicit activity passing through unhosted wallets than the proposed measures in the NPRM can achieve. Resources and time would be better devoted to enriching and enhancing these information sharing efforts that draw on pre-existing mechanisms. Imposing new requirements that merely focus resources and attention in the wrong places will lead to increased opportunities for criminals to exploit the CVC ecosystem.

4. The proposed rules are disproportionate because they impose far more onerous requirements on CVC transactions than for physical cash transactions, despite cash presenting a substantially higher risk.

The proposed rule requires that MSBs and banks should report CVC transactions to or from an unhosted or “otherwise covered” wallet, with an aggregate value greater than $10,000 in one day. The information reported should include the name and physical address of the counterparty, and should be filed in the form of a Currency Transaction Report (“CTR”). The rule would also require MSBs and banks to record the name and physical address of counterparties using unhosted or otherwise covered wallets for any transactions over $3,000.

These requirements do have an analogy in legacy finance. However, the proposed rule goes far beyond the existing reporting requirements for physical cash by requiring that an individual counterparty’s name and physical address to be collected, reported and in some cases verified, including during the course of CTR reporting. Again, the proposed rulemaking provides no justification for this discrepancy with existing reporting requirements for physical cash transactions.

We believe that there is no reasonable justification for these additional recordkeeping and reporting requirements. They go far beyond the existing requirements for physical cash transactions, despite the level of illicit use of cash being far higher than for CVCs. Elliptic’s own research has shown that fewer than 1% of bitcoin transactions can be linked to criminal activity 7 , and this aligns with other independent industry analyses. The NPRM calls into question the accuracy of such figures based on blockchain analytics; however, this type of analysis represents the most accurate available measure of the illicit use of CVCs. The NPRM cites the volume of CVC-related suspicious activity reports (SARs) in the US as representing 11.9% of CVC transactions. However, SARs are filed where there is only a suspicion of illicit activity. Financial institutions are known to file SARs “defensively”, leading to significant over-reporting. Indeed, according to a survey of past and present FIU heads, 80-90% of SAR filings are of “no operational value” 8 . When this over-filing is taken into account, all available data infer that 1% represents the order of magnitude of illicit CVC use.

The lack of transparency that makes cash a far more powerful criminal tool than CVCs also makes it more challenging to measure its illicit use. However, Harvard economist Kenneth S. Rogoff has estimated that more than a third of all U.S. currency in circulation is used by criminals and tax cheats - a figure that far exceeds the proportion of illicit activity in CVCs 9 .

By imposing a significantly higher recordkeeping and reporting burden for CVC transactions than for fiat cash transactions, the proposed rules would impose an unjustified tax on financial innovation, and could discourage US banks and MSBs from offering new innovative services - ultimately hindering US competitiveness. Before undertaking such a significant measure, FinCEN should provide further explanation for the justification behind these measures, and the private sector should be afforded more time to comment on their potential impact.

Our Recommendations

1. The NPRM consultation period should be increased to 90 days in order to allow a comprehensive analysis and response by stakeholders.

2. The proposed counterparty recordkeeping requirement should be removed.

3. If the new CTR reporting requirement is retained, the obligation to collect and report counterparty information should be removed. This would bring the requirements in line with those for cash and other monetary instruments.

4. FinCEN should work with the cryptocurrency industry to expand public-private partnership initiatives that can be used to generate intelligence on illicit users of unhosted wallets, and that would yield more valuable information than the measures outlined in the NPRM.

Finally, we attach an appendix listing areas of the NPRM that require further clarification. We are concerned that the lack of clarity in the NPRM around these issues could prevent banks and MSBs from successfully complying with the measures if adopted as written - a problem that would be compounded if banks and MSBs are forced to do so at extremely short notice.

Sincerely,

Simone Maini

Chief Executive Officer

Elliptic

Appendix - Key Issues Requiring Further Clarification

In addition to those points raised above, there are other more specific points regarding technical compliance with the proposed measures that we feel require additional clarification.

These issues have been raised to us by US banks and MSBs that we engage with, and who have indicated to us that failure to obtain clarification on these issues could prevent them from implementing the measures effectively.

We therefore request that FinCEN clarify:

1. The definitions of “hosted” and “unhosted” wallets, and types of entities it considers to provide “hosted wallet services.” The NPRM never provides a single clear definition of a “hosted wallet” and uses inconsistent terminology when attempting to define it. The NPRM in one place describes hosted wallets as being “provided by account-based money transmitters” and also notes that “Bank can also be hosted wallet providers.” However, the NPRM also frequently uses the term, “financial institution” - a term that is broader than just banks and MSBs - when describing hosted wallet services, including when referring to entities located in countries on the Foreign Jurisdiction List. This inconsistent terminology may confuse banks and MSBs about whether a wallet they are interacting with is a hosted wallet for the purpose of complying with the measures set out in the NPRM. More specific definitions are essential to ensure effective compliance.

2. Its expectations regarding transactions that banks and MSBs may conduct with decentralized exchanges (DEXs) and other smart contract-based platforms. At present, the NPRM does not clearly define smart contracts as “unhosted wallets”, or otherwise address their status under these measures. As such, it is unclear how transactions with platforms such as DEXs that rely on smart contracts should be handled under the current proposal.

3. The extent of counterparty verification that would be required to satisfy the conditions for exemption from the requirements where a transaction involves an address with no spending history. In cases where a cryptoasset address does not have a history of transacting, a bank or MSB may not be able to rely on third party analytics solutions to ascertain whether the wallet is hosted or unhosted. In those cases, the bank or MSB would need to rely in part on their customer to provide an indication of whether the funds are bound for another financial institution or not. FinCEN should clarify the steps it expects banks and MSBs to take in these instances.

4. The nature and extent of due diligence that banks and MSBs should perform on their financial institution counterparties to satisfy the conditions for exemption from the proposed measures. The NPRM notes that FinCEN expects banks and MSBs to “determine that a counterparty wallet is a hosted wallet at either a BSA-regulated financial institution or a foreign financial institution that is not on the Foreign Jurisdiction List” and indicates that they can “apply reasonable, risk-based, documented procedures to confirm” the status of their financial institution counterparties. FinCEN should provide more specific guidance about the extent of counterparty due diligence it would regard as sufficient to make these determinations, and what level of verification must be undertaken in those instances

5. Provide further guidance on the data protection and privacy implications of these measures. This rule requires that banks and MSBs gather information on their counterparties, who may not be their own customers. Because of the underlying transparency of cryptoasset blockchains, both regulated businesses and law enforcement agencies would be in possession of an unprecedented amount of information about individuals and the extent of their financial flows. FinCEN should clarify what data protection measures the public sector will take to ensure that financial data of well-intentioned cryptoasset users is not jeopardized, and it should also clarify that banks and MSBs that gather this information would be provided with safe harbour.

The post US Treasury’s Unhosted Wallet Proposal Is Unnecessary, Ineffective And Counterproductive appeared first on ValueWalk.

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One city held a mass passport-getting event

A New Orleans congressman organized a way for people to apply for their passports en masse.

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While the number of Americans who do not have a passport has dropped steadily from more than 80% in 1990 to just over 50% now, a lack of knowledge around passport requirements still keeps a significant portion of the population away from international travel.

Over the four years that passed since the start of covid-19, passport offices have also been dealing with significant backlog due to the high numbers of people who were looking to get a passport post-pandemic. 

Related: Here is why it is (still) taking forever to get a passport

To deal with these concurrent issues, the U.S. State Department recently held a mass passport-getting event in the city of New Orleans. Called the "Passport Acceptance Event," the gathering was held at a local auditorium and invited residents of Louisiana’s 2nd Congressional District to complete a passport application on-site with the help of staff and government workers.

A passport case shows the seal featured on American passports.

Amazon

'Come apply for your passport, no appointment is required'

"Hey #LA02," Rep. Troy A. Carter Sr. (D-LA), whose office co-hosted the event alongside the city of New Orleans, wrote to his followers on Instagram  (META) . "My office is providing passport services at our #PassportAcceptance event. Come apply for your passport, no appointment is required."

More Travel:

The event was held on March 14 from 10 a.m. to 1 p.m. While it was designed for those who are already eligible for U.S. citizenship rather than as a way to help non-citizens with immigration questions, it helped those completing the application for the first time fill out forms and make sure they have the photographs and identity documents they need. The passport offices in New Orleans where one would normally have to bring already-completed forms have also been dealing with lines and would require one to book spots weeks in advance.

These are the countries with the highest-ranking passports in 2024

According to Carter Sr.'s communications team, those who submitted their passport application at the event also received expedited processing of two to three weeks (according to the State Department's website, times for regular processing are currently six to eight weeks).

While Carter Sr.'s office has not released the numbers of people who applied for a passport on March 14, photos from the event show that many took advantage of the opportunity to apply for a passport in a group setting and get expedited processing.

Every couple of months, a new ranking agency puts together a list of the most and least powerful passports in the world based on factors such as visa-free travel and opportunities for cross-border business.

In January, global citizenship and financial advisory firm Arton Capital identified United Arab Emirates as having the most powerful passport in 2024. While the United States topped the list of one such ranking in 2014, worsening relations with a number of countries as well as stricter immigration rules even as other countries have taken strides to create opportunities for investors and digital nomads caused the American passport to slip in recent years.

A UAE passport grants holders visa-free or visa-on-arrival access to 180 of the world’s 198 countries (this calculation includes disputed territories such as Kosovo and Western Sahara) while Americans currently have the same access to 151 countries.

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International

The millions of people not looking for work in the UK may be prioritising education, health and freedom

Economic inactivity is not always the worst option.

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Taking time out. pathdoc/Shutterstock

Around one in five British people of working age (16-64) are now outside the labour market. Neither in work nor looking for work, they are officially labelled as “economically inactive”.

Some of those 9.2 million people are in education, with many students not active in the labour market because they are studying full-time. Others are older workers who have chosen to take early retirement.

But that still leaves a large number who are not part of the labour market because they are unable to work. And one key driver of economic inactivity in recent years has been illness.

This increase in economic inactivity – which has grown since before the pandemic – is not just harming the economy, but also indicative of a deeper health crisis.

For those suffering ill health, there are real constraints on access to work. People with health-limiting conditions cannot just slot into jobs that are available. They need help to address the illnesses they have, and to re-engage with work through organisations offering supportive and healthy work environments.

And for other groups, such as stay-at-home parents, businesses need to offer flexible work arrangements and subsidised childcare to support the transition from economic inactivity into work.

The government has a role to play too. Most obviously, it could increase investment in the NHS. Rising levels of poor health are linked to years of under-investment in the health sector and economic inactivity will not be tackled without more funding.

Carrots and sticks

For the time being though, the UK government appears to prefer an approach which mixes carrots and sticks. In the March 2024 budget, for example, the chancellor cut national insurance by 2p as a way of “making work pay”.

But it is unclear whether small tax changes like this will have any effect on attracting the economically inactive back into work.

Jeremy Hunt also extended free childcare. But again, questions remain over whether this is sufficient to remove barriers to work for those with parental responsibilities. The high cost and lack of availability of childcare remain key weaknesses in the UK economy.

The benefit system meanwhile has been designed to push people into work. Benefits in the UK remain relatively ungenerous and hard to access compared with other rich countries. But labour shortages won’t be solved by simply forcing the economically inactive into work, because not all of them are ready or able to comply.

It is also worth noting that work itself may be a cause of bad health. The notion of “bad work” – work that does not pay enough and is unrewarding in other ways – can lead to economic inactivity.

There is also evidence that as work has become more intensive over recent decades, for some people, work itself has become a health risk.

The pandemic showed us how certain groups of workers (including so-called “essential workers”) suffered more ill health due to their greater exposure to COVID. But there are broader trends towards lower quality work that predate the pandemic, and these trends suggest improving job quality is an important step towards tackling the underlying causes of economic inactivity.

Freedom

Another big section of the economically active population who cannot be ignored are those who have retired early and deliberately left the labour market behind. These are people who want and value – and crucially, can afford – a life without work.

Here, the effects of the pandemic can be seen again. During those years of lockdowns, furlough and remote working, many of us reassessed our relationship with our jobs. Changed attitudes towards work among some (mostly older) workers can explain why they are no longer in the labour market and why they may be unresponsive to job offers of any kind.

Sign on railings supporting NHS staff during pandemic.
COVID made many people reassess their priorities. Alex Yeung/Shutterstock

And maybe it is from this viewpoint that we should ultimately be looking at economic inactivity – that it is actually a sign of progress. That it represents a move towards freedom from the drudgery of work and the ability of some people to live as they wish.

There are utopian visions of the future, for example, which suggest that individual and collective freedom could be dramatically increased by paying people a universal basic income.

In the meantime, for plenty of working age people, economic inactivity is a direct result of ill health and sickness. So it may be that the levels of economic inactivity right now merely show how far we are from being a society which actually supports its citizens’ wellbeing.

David Spencer has received funding from the ESRC.

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International

Illegal Immigrants Leave US Hospitals With Billions In Unpaid Bills

Illegal Immigrants Leave US Hospitals With Billions In Unpaid Bills

By Autumn Spredemann of The Epoch Times

Tens of thousands of illegal…

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Illegal Immigrants Leave US Hospitals With Billions In Unpaid Bills

By Autumn Spredemann of The Epoch Times

Tens of thousands of illegal immigrants are flooding into U.S. hospitals for treatment and leaving billions in uncompensated health care costs in their wake.

The House Committee on Homeland Security recently released a report illustrating that from the estimated $451 billion in annual costs stemming from the U.S. border crisis, a significant portion is going to health care for illegal immigrants.

With the majority of the illegal immigrant population lacking any kind of medical insurance, hospitals and government welfare programs such as Medicaid are feeling the weight of these unanticipated costs.

Apprehensions of illegal immigrants at the U.S. border have jumped 48 percent since the record in fiscal year 2021 and nearly tripled since fiscal year 2019, according to Customs and Border Protection data.

Last year broke a new record high for illegal border crossings, surpassing more than 3.2 million apprehensions.

And with that sea of humanity comes the need for health care and, in most cases, the inability to pay for it.

In January, CEO of Denver Health Donna Lynne told reporters that 8,000 illegal immigrants made roughly 20,000 visits to the city’s health system in 2023.

The total bill for uncompensated care costs last year to the system totaled $140 million, said Dane Roper, public information officer for Denver Health. More than $10 million of it was attributed to “care for new immigrants,” he told The Epoch Times.

Though the amount of debt assigned to illegal immigrants is a fraction of the total, uncompensated care costs in the Denver Health system have risen dramatically over the past few years.

The total uncompensated costs in 2020 came to $60 million, Mr. Roper said. In 2022, the number doubled, hitting $120 million.

He also said their city hospitals are treating issues such as “respiratory illnesses, GI [gastro-intenstinal] illnesses, dental disease, and some common chronic illnesses such as asthma and diabetes.”

“The perspective we’ve been trying to emphasize all along is that providing healthcare services for an influx of new immigrants who are unable to pay for their care is adding additional strain to an already significant uncompensated care burden,” Mr. Roper said.

He added this is why a local, state, and federal response to the needs of the new illegal immigrant population is “so important.”

Colorado is far from the only state struggling with a trail of unpaid hospital bills.

EMS medics with the Houston Fire Department transport a Mexican woman the hospital in Houston on Aug. 12, 2020. (John Moore/Getty Images)

Dr. Robert Trenschel, CEO of the Yuma Regional Medical Center situated on the Arizona–Mexico border, said on average, illegal immigrants cost up to three times more in human resources to resolve their cases and provide a safe discharge.

“Some [illegal] migrants come with minor ailments, but many of them come in with significant disease,” Dr. Trenschel said during a congressional hearing last year.

“We’ve had migrant patients on dialysis, cardiac catheterization, and in need of heart surgery. Many are very sick.”

He said many illegal immigrants who enter the country and need medical assistance end up staying in the ICU ward for 60 days or more.

A large portion of the patients are pregnant women who’ve had little to no prenatal treatment. This has resulted in an increase in babies being born that require neonatal care for 30 days or longer.

Dr. Trenschel told The Epoch Times last year that illegal immigrants were overrunning healthcare services in his town, leaving the hospital with $26 million in unpaid medical bills in just 12 months.

ER Duty to Care

The Emergency Medical Treatment and Labor Act of 1986 requires that public hospitals participating in Medicare “must medically screen all persons seeking emergency care … regardless of payment method or insurance status.”

The numbers are difficult to gauge as the policy position of the Centers for Medicare & Medicaid Services (CMS) is that it “will not require hospital staff to ask patients directly about their citizenship or immigration status.”

In southern California, again close to the border with Mexico, some hospitals are struggling with an influx of illegal immigrants.

American patients are enduring longer wait times for doctor appointments due to a nursing shortage in the state, two health care professionals told The Epoch Times in January.

A health care worker at a hospital in Southern California, who asked not to be named for fear of losing her job, told The Epoch Times that “the entire health care system is just being bombarded” by a steady stream of illegal immigrants.

“Our healthcare system is so overwhelmed, and then add on top of that tuberculosis, COVID-19, and other diseases from all over the world,” she said.

A Salvadorian man is aided by medical workers after cutting his leg while trying to jump on a truck in Matias Romero, Mexico, on Nov. 2, 2018. (Spencer Platt/Getty Images)

A newly-enacted law in California provides free healthcare for all illegal immigrants residing in the state. The law could cost taxpayers between $3 billion and $6 billion per year, according to recent estimates by state and federal lawmakers.

In New York, where the illegal immigration crisis has manifested most notably beyond the southern border, city and state officials have long been accommodating of illegal immigrants’ healthcare costs.

Since June 2014, when then-mayor Bill de Blasio set up The Task Force on Immigrant Health Care Access, New York City has worked to expand avenues for illegal immigrants to get free health care.

“New York City has a moral duty to ensure that all its residents have meaningful access to needed health care, regardless of their immigration status or ability to pay,” Mr. de Blasio stated in a 2015 report.

The report notes that in 2013, nearly 64 percent of illegal immigrants were uninsured. Since then, tens of thousands of illegal immigrants have settled in the city.

“The uninsured rate for undocumented immigrants is more than three times that of other noncitizens in New York City (20 percent) and more than six times greater than the uninsured rate for the rest of the city (10 percent),” the report states.

The report states that because healthcare providers don’t ask patients about documentation status, the task force lacks “data specific to undocumented patients.”

Some health care providers say a big part of the issue is that without a clear path to insurance or payment for non-emergency services, illegal immigrants are going to the hospital due to a lack of options.

“It’s insane, and it has been for years at this point,” Dana, a Texas emergency room nurse who asked to have her full name omitted, told The Epoch Times.

Working for a major hospital system in the greater Houston area, Dana has seen “a zillion” migrants pass through under her watch with “no end in sight.” She said many who are illegal immigrants arrive with treatable illnesses that require simple antibiotics. “Not a lot of GPs [general practitioners] will see you if you can’t pay and don’t have insurance.”

She said the “undocumented crowd” tends to arrive with a lot of the same conditions. Many find their way to Houston not long after crossing the southern border. Some of the common health issues Dana encounters include dehydration, unhealed fractures, respiratory illnesses, stomach ailments, and pregnancy-related concerns.

“This isn’t a new problem, it’s just worse now,” Dana said.

Emergency room nurses and EMTs tend to patients in hallways at the Houston Methodist The Woodlands Hospital in Houston on Aug. 18, 2021. (Brandon Bell/Getty Images)

Medicaid Factor

One of the main government healthcare resources illegal immigrants use is Medicaid.

All those who don’t qualify for regular Medicaid are eligible for Emergency Medicaid, regardless of immigration status. By doing this, the program helps pay for the cost of uncompensated care bills at qualifying hospitals.

However, some loopholes allow access to the regular Medicaid benefits. “Qualified noncitizens” who haven’t been granted legal status within five years still qualify if they’re listed as a refugee, an asylum seeker, or a Cuban or Haitian national.

Yet the lion’s share of Medicaid usage by illegal immigrants still comes through state-level benefits and emergency medical treatment.

A Congressional report highlighted data from the CMS, which showed total Medicaid costs for “emergency services for undocumented aliens” in fiscal year 2021 surpassed $7 billion, and totaled more than $5 billion in fiscal 2022.

Both years represent a significant spike from the $3 billion in fiscal 2020.

An employee working with Medicaid who asked to be referred to only as Jennifer out of concern for her job, told The Epoch Times that at a state level, it’s easy for an illegal immigrant to access the program benefits.

Jennifer said that when exceptions are sent from states to CMS for approval, “denial is actually super rare. It’s usually always approved.”

She also said it comes as no surprise that many of the states with the highest amount of Medicaid spending are sanctuary states, which tend to have policies and laws that shield illegal immigrants from federal immigration authorities.

Moreover, Jennifer said there are ways for states to get around CMS guidelines. “It’s not easy, but it can and has been done.”

The first generation of illegal immigrants who arrive to the United States tend to be healthy enough to pass any pre-screenings, but Jennifer has observed that the subsequent generations tend to be sicker and require more access to care. If a family is illegally present, they tend to use Emergency Medicaid or nothing at all.

The Epoch Times asked Medicaid Services to provide the most recent data for the total uncompensated care that hospitals have reported. The agency didn’t respond.

Continue reading over at The Epoch Times

Tyler Durden Fri, 03/15/2024 - 09:45

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