Symptoms, diagnosis, treatment, & more

Progressive supranuclear palsy (PSP) is a rare, degenerative neurological condition. It usually starts in middle age and can cause symptoms similar to those of Parkinson’s disease.

PSP can cause Parkinson’s-like symptoms, including issues with balance and muscle stiffness. This similarity can delay a correct diagnosis of PSP.

There is currently no cure for PSP. However, working with a multidisciplinary healthcare team can help someone cope with the wide range of possible symptoms they may experience.

Read on to learn about PSP, its symptoms, risk factors, diagnosis, and more.

PSP affects the basal ganglia, cerebellum, and brainstem. As it advances, it can also affect the brain’s frontal and temporal lobes. It occurs due to damage to cells in parts of the brain that control movement and thinking.

The rare, degenerative neurological condition affects 5–6 in every 100,000 people and can cause problems with:

  • body movement
  • walking
  • balance
  • eye movement

It usually starts in late middle age and gradually worsens with time. People who develop the condition are generally over the age of 40, but the symptoms usually start at the age of 60 years.

During the early stages of the disease, PSP symptoms can mimic those of other conditions: commonly Parkinson’s disease and dementia. PSP typically causes cognitive changes that are more severe and start earlier than Parkinson’s symptoms, so doctors can easily mistake it for dementia.

The main signs of PSP include:

  • balance and mobility problems, including frequent falls
  • behavior changes — for instance, becoming irritable or apathetic
  • muscle stiffness
  • limitations in eye movements
  • slow, quiet, or slurred speech
  • dysphagia, or difficulty swallowing
  • cognitive impairment and memory problems

The symptoms of PSP gradually worsen over time. For instance, in the early stages, a person may suddenly lose balance while walking and fall over.

The mid-stages of the condition may cause them to have difficulty swallowing and moving their eyes in certain directions. In the latter stages, they may experience incontinence and require a feeding tube.

However, it is important to note that the rate of progression can vary from person to person.

The development of PSP has links to an excessive buildup of tau, a naturally occurring protein in the brain.

Tau usually breaks down before it reaches problematically high levels. However, people with PSP are unable to break it down typically, so the substance can accumulate and form tangles, or clumps, with neurons. These are the information messenger cells in the brain.

The amount and exact location of these clumps vary.

Although experts do not know the precise reason why PSP occurs, they know there is a link between the condition and certain genetic mutations. However, individuals do not inherit these mutations, so the condition likely does not run in families.

There is no definitive test for PSP, so doctors base the diagnosis on the pattern of a person’s symptoms. However, the wide range of possible PSP symptoms can make diagnosing the condition difficult, so it may take some time to reach a diagnosis.


Part of a doctor’s assessment involves ruling out other similar conditions such as Parkinson’s disease. A healthcare professional will also carry out a physical examination, as those with PSP would not have muscle weakness relating to the disease. They can use this exam to rule out a stroke, nutritional deficiency, or brain tumor.

Other tests a doctor may order include:

  • brain scans
  • cognitive tests of memory and thinking skills
  • mental focus tests
  • language comprehension tests

It is not uncommon for people with PSP to receive a delayed diagnosis. This delay can be due to a person putting off consulting a doctor because they do not see these early symptoms as anything to worry about.

The delay can also happen because doctors often misdiagnose PSP as Parkinson’s disease, Alzheimer’s disease, dementia, depression, or another neurodegenerative disorder.


In October 2015, PSP received a specific diagnostic code in the International Statistical Classification of Diseases, known as ICD-10.

ICD facilitates the reporting and coding of diseases and death worldwide, providing researchers with important insight into the extent, causes, and consequences of certain conditions. This new code may help healthcare professionals correctly diagnose PSP sooner.

Doctors do not have a cure for PSP, so treatments will focus on managing a person’s symptoms.

Some people may benefit from taking medicines typically for Parkinson’s disease in the early stages of PSP. Additionally, doctors may prescribe other medications depending on a person’s symptoms. For instance, these may include drugs to help with sleep problems.

This can involve a person taking a short course of a medication called levodopa. This can determine whether their symptoms represent PSP or Parkinson’s disease.

A team of healthcare professionals with a range of skills works together to treat someone with PSP.

For instance, a physical therapist can provide a safe exercise plan to help a person make the most of their mobility. Additionally, a speech and language therapist can help someone who experiences difficulty with talking or swallowing.

An occupational therapist can also suggest home modifications, such as grab handles beside the bathtub, to reduce a person’s risk of trips or falls.

People who develop eye movement problems due to PSP may benefit from Botox injections to help relax the muscles. Some people may need additional eye lubrication due to reduced blinking, while others can benefit from special glasses to help them look downward or to cope with bright light.

Pneumonia is the most common cause of death in people with PSP. However, with a supportive healthcare team and appropriate symptom management, a person can expect to live well into their 70s or longer.

Additionally, while recent clinical trials did not find an effective neuroprotective treatment for PSP, they led to better-designed ongoing trials.

If a person shows any signs or symptoms of PSP, such as trouble with balance, changes in mood or memory, or difficulty looking up or down, they should contact a doctor as soon as possible.

While there is no cure for PSP, proper symptom management from a multidisciplinary healthcare team can make living with the condition more comfortable. The sooner someone receives a diagnosis, the sooner they can receive the support they need.

PSP is a rare degenerative neurological condition that can cause a wide range of symptoms. In the early stages, the disease can mimic Parkinson’s disease and other conditions, so doctors often misdiagnose PSP.

Once a person receives a correct diagnosis, treatment focuses on managing their unique set of symptoms.

This may include medications, physical therapy, speech therapy, and nutrition advice. While living with the condition can bring various challenging symptoms for a person to deal with, it is possible to maintain a high quality of life with the right support.

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The Benefits of Link Building for Your Business with an Expert SEO Agency | India News

What is link building?

Link building is the process of acquiring hyperlinks from other websites to your own. These hyperlinks, also known as backlinks, help search engines understand the relevance and authority of your website. Backlinks are essentially votes of confidence from other websites that your website is a valuable resource and should be ranked higher on search engine results pages (SERPs).

Why is link building important for your business?

Improved search engine rankings

As mentioned earlier, backlinks are a key factor in search engine rankings. The more high-quality backlinks your website has, the more likely it is to rank higher on SERPs. This means that link building can significantly improve your website’s visibility and drive more traffic to your website.

Increased website traffic

By improving your website’s visibility on search engines, link building can drive more traffic to your website. This traffic is often high-quality and targeted, which means that visitors are more likely to be interested in your products or services.

Improved domain authority

Domain authority is a metric that indicates the overall strength and authority of your website. The more high-quality backlinks your website has, the higher your domain authority will be. This can improve your website’s credibility and make it easier to rank for competitive keywords on SERPs.

Why work with an expert SEO agency for link building?

Link building can be a complex and time-consuming process, and it requires a significant amount of expertise and experience to do it effectively. Here are some of the reasons why it is important:

Quality over quantity

One of the biggest mistakes businesses make when it comes to link building is focusing on quantity over quality. While it is important to acquire a large number of backlinks, it is even more important to acquire high-quality backlinks from reputable websites. An expert SEO agency will have the knowledge and experience to identify high-quality websites for link building and can help to ensure that your backlink profile is diverse and natural.

Avoiding penalties

Search engines are constantly updating their algorithms to ensure that websites with low-quality backlinks are penalized. These penalties can have a significant impact on your website’s rankings and visibility.

Measurable results

Link building is an ongoing process, and it can take time to see measurable results. An expert SEO agency will have the tools and expertise to track the progress of your link building efforts and provide you with regular reports on your website’s performance. This can help you to understand the impact of your link building efforts and make adjustments to your strategy as needed.

How an expert SEO agency can help with link building

Conducting a link audit

The first step in any link building campaign is to conduct a link audit to identify any existing backlinks to your website. An expert SEO agency will analyse your current backlink profile and identify any low-quality or spammy backlinks that could be harming your website’s rankings.

Developing a link building strategy

Once your website’s backlink profile has been audited, an expert SEO agency will develop a customized link building strategy based on your business goals and target audience.

Creating high-quality content

Content is a key component of any successful link building campaign. An expert SEO agency will work with you to create high-quality content that is relevant to your target audience and that other websites will want to link to.


Link building is an essential component of any SEO strategy, and it can have a significant impact on the success of your Melbourne business. By working with an SEO agency, you can ensure that your link building efforts are effective, efficient, and tailored to your business goals. With the right approach to link building, you can improve your search engine rankings, increase website traffic, and build a strong brand that resonates with your target audience.



(Above mentioned article is a sponsored feature, This article is a paid publication and does not have journalistic/editorial involvement of IDPL, and IDPL claims no responsibility whatsoever.)

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National Environment Agency assesses law on Aquaculture

Tbilisi: The National Environment Agency of Georgia and the relevant international organizations and experts assessed the Georgian law on “Aquaculture”, which came into force from March 1, 2023. The primary assessment states that the law fully meets international standards.

 With the introuction of this new law, the goal of the state is to promote economically profitable aquaculture sector in the country. As the agency states, the compliance with aquaculture regulations defined by the laws in the country today, including the implementation of aquaculture permit, is really important for the development of local production in the mentioned area and to establish a significant place in international markets. 


As of today, up to 50 applications have been submitted to the National Environmental Agency for the acquisition of the  permit. The National Environment Agency can assist interested individuals with aquaculture farming in completing an aquaculture application. The detailed information on aquaculture permit can be obtained at the respective service of the National Environmental Agency, reachable at – (tel. 2 43 95 26).

 It is noteworthy that the development of the aquaculture sphere depends on the correct and effective use of natural water resources in the country. From 2024, the aquaculture farms will be effective that will be providing minimum rates for water resources.

 It should be emphasized that in all developed countries of the world water usage is priced for commercial purposes. In Georgia, the established water collections for aquaculture farms do not exceed 1% of farm profits. Paying the collector is once a year.

 It is noteworthy that, as a result of cooperation between the Ministry of Environment and Agriculture of Georgia and the Food and Agriculture Organization of the United Nations (FAO), the development of a long-term national strategy and action plan of aquaculture development has already been completed, which provides improvement of laboratory services, technical and technological model for aquaculture development

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Alaska legislators weigh in on gun control in wake of latest school shootings

ANCHORAGE, Alaska (KTUU) – Alaska was shocked by a school shooting 25 years ago, but recent incidents of gun violence across the country have prompted discussions about gun control measures in the state. This week’s Covenant School shooting left six people dead, prompting legislators to address the issue of school safety.

According to data from the Centers for Disease Control and Prevention, Alaska had a firearm death rate of 19.3 per 100,000 people in 2019 — higher than the national average of 11.7 per 100,000, but lower than some other states like Louisiana, Mississippi and Missouri.

Rep. Shelley Hughes (R-Palmer, Knik-Fairview) said in a written statement that she supports a range of measures to improve school safety, including more school resource officers, staff with concealed carry certification for school environments and regular training on drills with school resource officers, staff and local law enforcement.

Rep. Andy Josephson (D-Anchorage) wrote that he supports all efforts to protect a citizen’s constitutional right to life under the Fifth and 14th Amendments. While Josephson doesn’t support arming teachers, he is in favor of considering the placement of police officers in schools as an alternative.

Former legislator Geran Tarr supported “red flag” laws for Alaska, which would allow law enforcement to temporarily confiscate firearms from individuals who pose a risk to themselves or others. Although Tarr’s bill failed, she still believes there is common ground for both sides of the debate.

“I’m not offended by someone’s strong Second Amendment rights, I’m not concerned if you have a lot of guns at home, you use your guns for hunting, for safety,” Tarr said. “My only concern — and that’s where we can come together, I think ,as gun rights advocates and gun violence prevention advocates. It’s a very, very small percentage of people we’re worried about.”

Tarr believes red flag laws could combat gun-related suicides. She said if crafted thoughtfully, the laws do not necessarily infringe on the right to bear arms.

“I don’t want a policy that could be misused, I want a policy that works. So one way we address that is you can actually make it a misdemeanor crime for a false report,” Tarr said.

The conversation about gun control is complex and ongoing, but legislators across the nation are actively considering various measures to improve school safety and protect the rights of citizens. As the debate continues, it remains to be seen what changes, if any, will be made to Alaska’s gun laws.

The topic of gun control is a contentious issue in the United States, with arguments for and against stricter gun laws.

Some argue that gun control measures are necessary to prevent gun violence and protect public safety, while others believe that such measures infringe upon their Second Amendment-protected right to bear arms. Ultimately the decision on whether to implement gun control laws in Alaska or any other state is up to lawmakers and the public.

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Burke County schools celebrate music education

Brittany Schafer has known she wanted to be a music teacher since she was in fifth grade.

“It really started with my dad,” she told The News Herald. “My dad would just walk around the house and sing. That’s how he woke us up every morning, he would sing ‘You are my Sunshine.’”

From there, Schafer was encouraged through music programs at church and in school. She said her elementary school music teacher encouraged her love of music to the point that, by fifth grade, she knew she wanted to do the same for a new generation of students.

Now teaching music at Valdese Elementary School, Schafer is doing just that.

Earlier this month, the Burke County Board of Education approved a resolution to recognize March as “Music in our Schools Month” across the district. The move was made as a show of support for Burke County Public Schools music teachers, the work they put in to pass on their love of music and the accomplishments of the district’s music students.

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The month of March was a whirlwind of activity for local music students with concert bands from all four traditional high schools as well as several high school chorus programs attending adjudication last week. Middle school programs attend adjudication this week, and the district held its fifth-grade honors chorus at Walter Johnson Middle School on March 17.

Throughout the year, the district also offers music education to students in every school, though some of the smaller elementary schools share a music teacher, according to BCPS Public Relations Officer Cheryl Shuffler. The idea, especially in elementary school, is to expose students to as many different things as possible. Shuffler said this helps them find their niche.

“The more that we can offer students to where each student can find their own niche … then that student is more likely to be more successful throughout school and to stick with school,” she said.

For Schafer, music was part of her life from a very early age, but she knows all students are not as fortunate as she was.

“I’ve got some kids who I can tell have never been sung to,” she said.

She said research shows early exposure is the best way to help children develop musical abilities.

“A lot of it has to do with what they’ve done at home,” Schafer said. “Once you hit about age 7, your musical ability is kind of set. It can move a little bit, but the research shows that if you’ve got a whole lot of great musical experiences between birth and 7, you’re going to be much more musical.”

And it goes beyond music. Schafer said research also points to the benefits of music education across academic disciplines.

“It’s one of the subjects that has been shown to increase kids’ abilities in math and reading just by participating,” she said. “It doesn’t matter if you’re rich or poor, none of that stuff matters.”

She cited a recent study from MIT showing music education has more benefits across disciplines than coding.

“One of the things music does is it helps develop your aural sense, to help you better hear sounds and words,” Schafer said. “So, of course, if you have a better phonemic awareness then you can better spell the words and better say the words.”

At Patton High School, Chad Higdon knows a thing or two about the benefits of music education, too. On Oct. 29, Patton High School’s Panther Regiment, directed by Higdon, won the Grand Champion award at two different band competitions in a single day. Still, he said, despite the on-field success his students have experienced, behind the scenes is where the real magic occurs.

“I love the process,” Higdon said. “To me, one of the most exciting things is behind the scenes, during rehearsals. It might be something you’ve been working on for weeks and then, all of the sudden, they get the ‘a-ha’ moment where it clicks. To me, that’s more fun than the actual accolades and performances.”

Higdon agreed with Schafer, saying research shows music students do better in school across disciplines. He thinks the focus and concentration it takes to become a good musician is a major reason behind this.

“They’re required to focus for 90 minutes a day during class,” he said. “We have a lot, in our society, where we’re doing two or three different things at once but we’re missing sections. To really focus on one task, we don’t have a lot of things in our society that teach that right now, and I think that’s why music education is more important now than it ever has been.”

Still, Higdon said music is more than just a means to an end — it is an integral part of a well-rounded education. Over the years, he has seen students go on to play in prestigious college band programs, but even for those whose musical career ends with high school graduation, he said music education can be a difference-maker for a lifetime.

“My goal is not for them all to be music teachers, my goal is for them to just have a lifelong love of music,” Higdon said.

He said he also feels honored and proud to teach in a district with a long history of quality music education and top tier music educators.

“Burke County has a very strong history in music education,” Higdon said. “We’ve had really strong music programs in our county and strong music teachers, and I’m really just proud to be a part of it.”

Higdon said music and music education still enriches his life in many different ways.

“I became a better student and a better leader (in school),” he said. “(Music) has given me opportunities to meet wonderful people, to travel. It has definitely given me so many opportunities I would not have had if I hadn’t been involved in music.”

Jason Koon is a staff writer and can be reached at or 828-432-8907.

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Chicago brings losing streak into matchup with New Jersey

New Jersey Devils (47-20-8, second in the Metropolitan Division) vs. Chicago Blackhawks (24-45-6, eighth in the Central Division)

Chicago; Saturday, 8 p.m. EDT

BOTTOM LINE: The Chicago Blackhawks play the New Jersey Devils after losing seven straight games.

Chicago is 24-45-6 overall and 14-21-3 in home games. The Blackhawks have allowed 269 goals while scoring 181 for a -88 scoring differential.

New Jersey has a 26-7-4 record on the road and a 47-20-8 record overall. The Devils have given up 203 goals while scoring 257 for a +54 scoring differential.

Saturday’s game is the second meeting between these teams this season. The Devils won 3-0 in the last meeting.

TOP PERFORMERS: Seth Jones has 10 goals and 23 assists for the Blackhawks. Taylor Raddysh has scored four goals and added two assists over the past 10 games.

Jack Hughes has scored 40 goals with 47 assists for the Devils. Nico Hischier has two goals and eight assists over the last 10 games.

LAST 10 GAMES: Blackhawks: 2-8-0, averaging 1.9 goals, 2.9 assists, 2.7 penalties and 6.8 penalty minutes while giving up 3.3 goals per game.

Devils: 4-4-2, averaging 2.7 goals, 4.1 assists, three penalties and 7.1 penalty minutes while giving up 2.6 goals per game.

INJURIES: Blackhawks: Colin Blackwell: out for season (groin), Jujhar Khaira: day to day (illness), Philipp Kurashev: out for season (shoulder), Jonathan Toews: out (illness), Anders Bjork: out (undisclosed), Andreas Englund: out (hamstring), Cole Guttman: out for season (shoulder), Jarred Tinordi: day to day (hip), Petr Mrazek: day to day (head).

Devils: Jonathan Bernier: out (hip), Nathan Bastian: day to day (upper body), Curtis Lazar: out (lower body).


The Associated Press created this story using technology provided by Data Skrive and data from Sportradar.


Conversations are opinions of our readers and are subject to the Code of Conduct. The Star
does not endorse these opinions.

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DeBrincat’s OT winner lifts Senators past Flyers 5-4 – Hockey

OTTAWA — The Ottawa Senators will continue to have to battle the odds as they have all season.

Alex DeBrincat scored the game-winning goal 1:36 into overtime to halt Philadelphia’s comeback effort and the Ottawa Senators took a 5-4 victory over the Flyers Thursday night. Although the win kept the Senators’ slim hopes of securing the final wild-card spot in the Eastern Conference alive, they lost both Travis Hamonic and Derick Brassard to injuries in the process.

Ottawa was already without defencemen Thomas Chabot and Jakob Chychrun.

“Yeah, both guys, not good,” said Senators head coach D.J. Smith. “We’ll know more in the morning, but neither were able to return and it doesn’t look like they’ll be able to return anytime soon, but we’ll know more in the morning.”

Hamonic was injured midway through the first period and Brassard late in the second.

Tim Stutzle, with a goal and an assist, Austin Watson, Shane Pinto and Claude Giroux also scored for the Senators (37-33-5). Cam Talbot had a quiet night stopping 7-of-11 shots.

Tyler Kleven, making his NHL debut, picked up his first career assist on Giroux’s goal.

“What a fun game,” said Kleven. “I felt calm out there and felt like I played my game and need to learn the systems a little bit better, but for my first game I thought I did pretty well.”

Tony DeAngelo, Cam York and Noah Cates, Owen Tippett replied for the Flyers (29-32-13). Felix Sandstrom made 41 saves.

Philadelphia was outshot 27-5 after two periods, but found a way to score three unanswered goals in the third to tie the game and send it to overtime.

After Giroux made it 4-1 for Ottawa 2:28 into the third period, York scored an unassisted marker at 5:22 for his second of the season. 

Cates then cut the deficit to one at 9:54 with a power-play marker.

Tippett netted his 23rd of the campaign with 2:39 remaining to tie the contest at 4-4.

“I thought we showed a little bit more poise (in the third),” said Flyers associate coach Brad Shaw. “I’m glad it was a pretty upbeat bench. … You look up at the shot clock and it’s kind of demoralizing, but we stayed with it.”

Despite it being far from ideal, the Senators didn’t seem phased by the comeback effort.

“We were a little frustrated, obviously, for letting them come back in the game,” said Giroux. “But it’s a tie game going into overtime so you have a chance to get the two points, so for us, we just had to go out there and play the 3-on-3.”

DeAngelo’s power-play goal 2:51 into the second period came on Philadelphia’s third shot of the game. The Flyers only put two more on net through the end of the period.

“They’re a quick team and they take away chances pretty fast,” said Tippett. “Obviously, we kind of shot ourselves in the foot a little bit there, too. 

“We could’ve made some more simple plays and put more pucks on net, but when you get limited to that many shots, it’s something that you have to look at on both sides of it.”

Stutzle restored Ottawa’s two-goal lead scoring on a Nick Holden rebound at 7:43.

DeBrincat then stunned the crowd by dropping the gloves against Joel Farabee and more than held his own.

Listed at five-foot-eight and 178 pounds, DeBrincat isn’t expected to drop the gloves, but his teammates gave him full marks for his tilt.

“People like the fight better it seems like,” said DeBrincat when asked if he got more recognition for the overtime winner or his fight. “I feel like whenever I get in a fight usually I have more texts than if I do something else good in the game. It’s what the people like I guess.”

Pinto made it 3-1 at 16:50 when he tipped a Mathieu Joseph shot in. Moments earlier, Brassard suffered an ankle injury that required him to be helped off the ice.

The Senators outshot the Flyers 17-2 in the opening period and led 1-0 thanks to Watson’s unassisted goal. On the very same play, however, Hamonic suffered a lower-body injury and was done for the night.


Flyers head coach John Tortorella decided to watch the game from the press box with interim general manager Danny Briere to get a perspective from up top and give Shaw a chance to run the bench.


Talbot returned to action after missing 12 games with a mid-body injury. Defenceman Tyler Kleven made his NHL debut. … Sandstrom made consecutive starts for the first time this season for the Flyers. Goalie Carter Hart did not travel to Ottawa and missed his second straight game and remains day-to-day.


The Senators host the Toronto Maple Leafs Saturday night.

The Flyers host the Buffalo Sabres Saturday night.

This report by The Canadian Press was first published March 30, 2023.

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Former Tigers closer roughed up in Philadelphia debut

After one game, both the Detroit Tigers and Philadelphia Phillies could get failing grades for their off-season trade.

The Tigers, who traded closer Gregory Soto to the Philadelphia Phillies, received outfielder Matt Vierling and infielder Nick Maton. In Detroit’s 4-0 loss Thursday to Tampa, Vierling was 0-for-3 with a strikeout, while Maton was 0-for-1.

Soto, meanwhile, lit up the scoreboard in Texas … for the Rangers. The left-handed reliever entered the game with two outs in the fourth inning and did not retire any of the four batters he faced, throwing just 19 pitches, eight for strikes.

After a walk to Josh Smith, Soto gave up a bloop single to Marcus Semien. A walk to Kyle Seager loaded the bases, and Nathaniel Lowe’s dribbler in front of the plate went for an RBI single, ending Soto’s Philadelphia debut.

“Honestly, I felt a little unlucky today,” Soto said through an interpreter on “That soft hit, the blooper – there were a couple plays that could have gone in our favor, but they didn’t.”

The 28-year-old reliever played the last four seasons with Detroit, earning 30 saves in 2022 after an 18-save season in 2021. Soto pitched in two all-star games while with the Tigers.

While Soto struggled, another former Tiger had a big game for the Rangers. Robbie Grossman started in left field for Texas and hit a three-run homer off Philadelphia starter Aaron Nola.

The Tigers traded Grossman to the Atlanta Braves in August last season for pitcher Kris Anglin. Grossman became a free agent after the season and signed with the Rangers.


Tigers shut out on Opening Day for first time since 1989

Mets place Justin Verlander on injured list hours before season opener

Tigers’ 2 veteran relievers relish path to 2023 roster spot

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Rams Called Fit for Surprisingly Still Available Speed DE



Sean McVay and the Rams staff look on during their road game on December 19, 2022 in Green Bay.

The first wave of free agency became what would be perceived by many fans as a low tide involving the Los Angeles Rams. No marquee signings were made and the Rams had a rather tranquil start to the 2023 cycle.

But the Rams still have a chance to make a late splash — as one of the fastest and most consistent pass rush artists remains available.

Heavy NFL senior reporter Matt Lombardo rolled out his listings of the five best free agents still remaining in this current free agency cycle on Thursday, March 30. Shockingly, Yannick Ngakoue has yet to be asked to help bolster someone else’s pass rush.

“It is a bit surprising that Ngakoue, who has surpassed at least 5.0 sacks per season over the past three years, remains available,” Lombardo said.

Ngakoue Still Speedy & Consistent Despite Multiple Stops

For Ngakoue, he’s unfortunately heading toward playing in his sixth NFL city in a career that began in 2016.

However, he’s zipped through offensive tackles as one of the faster speed rushers in the league when called upon. And the result has been Ngakoue consistently being a threat to surpass eight sacks.

Even on his fifth NFL franchise the Indianapolis Colts, the 28-year-old Ngakoue still proved he can generate pressure and get after the quarterback.

“During the 2022 campaign, Ngakoue generated 44 pressures to go with 9.5 sacks, as one of the Colts’ most dominant front-seven defenders,” Lombardo wrote.

In fact, his sack total in Indy tied for his third-highest total in a single season — as he’s produced that same number in 2018 with his first team the Jacksonville Jaguars. He also got his sacks in 2022 while playing and starting in 15 games.

But here’s the proof behind his consistency: In every season of his career, Ngakoue has always ended the year with eight sacks or higher. And his highest mark was the 12 he produced in his lone Pro Bowl season of 2017.

Ngakoue Wouldn’t be Too Costly

Ngakoue wouldn’t command the kind of revenue that Javon Hargrave or Daron Payne got. He shouldn’t come with a hefty price tag — especially this late into the 2023 free agency cycle.

Lombardo believes that the former third rounder out of Maryland would qualify more in a “prove it” scenario for his next team.

“At this stage of free agency, and of Ngakoue’s career, there is a chance that he winds up signing a one-year prove-it deal and could prove to be a bargain for a contending team looking for pass-rush help,” Lombardo said.

Count the Rams as still needing that extra help next to Aaron Donald.

The edge rush room no longer has veteran and the team’s sack leader Leonard Floyd, who was released before the start of free agency. Super Bowl 56 members Terrell Lewis and Justin Hollins were also waived during the season. Michael Hoecht remains as one of the edge rush options having moved out of his natural interior defensive lineman spot.

The Rams could still use the draft to address this position. As it is, head coach Sean McVay mentioned at the NFL Owner’s Meeting how the Rams plan to pivot toward the more needed areas for 2023 — in this case offensive line, edge rusher and cornerback — first in the 2023 NFL Draft. Several mock drafts have listed the Rams starting with an edge rush option — with one of the more recent ones from ESPN analyst Jordan Reid predicting the Rams will take Felix Anudike-Uzomah of Kansas State first.

But Ngakoue has to be worth going the veteran route. His speed next to “A.D” would bring a tidal wave for the Rams.

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Federal State Local Tax Burden, Government Transfers

Key Findings

  • The U.S. system of taxes and transfers is highly progressive.

  • Measuring comprehensive income, inclusive of market-based income and government taxes and transfers, illustrates the total fiscal burden created by a fiscal system.

  • Income transfer programs amplify the U.S. federal tax system’s progressivity, move the state and local system from moderate regressivity to moderate progressivity, and result in a highly progressive fiscal system overall.

  • The lowest quintile experienced a combined tax and transfer rate of negative 127.0 percent, meaning that for each dollar they earned, they received an additional $1.27 from the government, netting transfers (gains) and taxes (losses), while the top quintile had a rate of positive 30.7 percent, meaning on net they paid just under $0.31 for every dollar earned.

  • The top quintile funded 90.1 percent, or $1.6 trillion, of all government transfers in 2019. For each dollar of taxes paid, the top quintile received $0.11 in gross government transfers.

  • Government transfers account for 59 percent of the bottom quintile’s comprehensive income. For each dollar of taxes paid by the bottom quintile, they received $6.17 in gross government transfers.

  • Before transfers, total effective fiscal incidence rates were generally progressive: 24.6 percent for the bottom quintile, 24.7 percent for the middle quintile, and 34.5 percent for the top quintile.

  • After transfers, total effective fiscal incidence rates were markedly progressive: 10.1 percent for the bottom quintile, 22.4 percent for the middle quintile, and 41.4 percent for the top quintile.

  • Including transfers in income decreased the effective state and local fiscal incidence rate for the bottom quintile by more than 11 percentage points to 7.8 percent. The middle quintile saw a 1 percentage point decrease to 9.9 percent, while the top quintile saw an increase of 2 percentage points to 12.1 percent.

  • About one-sixth of the tax burden borne by households in the lowest quintile is not personal taxes—like income, sales, and property taxes—but taxes remitted by businesses that are economically borne by taxpayers—like corporate income taxes, tariffs, severance taxes, and a variety of taxes on capital. Property taxes account for nearly one-third of the tax liability for this cohort, which includes both property taxes remitted directly by lower-income homeowners and those borne indirectly by renters.


When policymakers or taxpayers discuss tax policy, the conversation inevitably turns to who pays, who should pay, and how much they should pay. To help inform the discussions, departments of revenue, policy organizations, and other researchers have analyzed where tax revenue comes from and how tax policy affects different groups of taxpayers.

Unfortunately, many studies about tax burdens and the progressivity of the tax system are incomplete—they fail to discuss how government transfers affect households’ tax burdens, and they neglect or insufficiently account for the economic incidence of some taxes that are ultimately borne by households. In 2007, the Tax Foundation produced a working paper examining the distribution of government spending and its impact on effective fiscal incidence rates between 1991 and 2004.[1] Now we are updating the study with the latest data, from 2019.

We find that the overall tax and transfer system in the United States is robustly progressive. The lowest quintile of Americans receives a net of 127 percent of their market income through the tax and transfer system, accounting for both the taxes they pay and the transfers they receive. At the other end of the spectrum, the top quintile gives up 31 percent of their market income due to taxes and transfers. Residents at both ends of the income spectrum pay taxes—directly and indirectly—and receive the benefit of government transfers, but for high earners, tax liability vastly outstrips the value of benefits received, whereas for low income-earners, tax payments pale in comparison to the value of transfers received.

Overall US Tax and Transfer System Is Highly Progressive

At the federal level, both taxes and transfers are highly progressive, while at the state level, progressivity is largely achieved through transfers. This is unsurprising given the need for states to compete for jobs and investment and given the outsized role of the federal government in creating progressivity.

Our paper examines the burden and distribution of federal, state, and local tax and transfer systems. We first discuss the American approach to progressivity in the tax and transfer systems, then examine the distribution of taxation along the income spectrum before transfers. Later sections explore the implication of these transfers, the relationship between taxation and transfers, and their impact on the American tax systems’ progressivity at the national, state, and local levels. We conclude by highlighting some limitations of the study and summarizing the key findings, though one limitation is worth explaining here.

Household income is an annual “snapshot” measure, and thus corresponds imperfectly to wealth or ability to pay. A career middle-income earner might experience a year in the top quintile when selling a home or business, even though this is not representative of their “normal” income. More significantly for this study, some households of comfortable means have little or no income in a given year. There is a certain amount of statistical noise in the lowest quintile, which includes not only low-income, low-net-worth households, but also some affluent or even quite wealthy households that experienced income losses that year. A multimillionaire with a year of significant capital losses can show up in the bottom quintile but still have substantial property holdings and consumption subject to tax. This phenomenon is part of the reason the bottom quintile experiences higher effective rates of the pre-transfer tax burden than the second quintile: it includes some taxpayers who are not, by any measure, poor.

Finally, detailed tables, a glossary of terminology and concepts, and methodological notes can be found in the appendix for readers seeking a better understanding of this study’s inputs, but it should be noted here for all readers that our study focuses on the economic, not legal, incidence of taxes. It does not measure who remits tax payments to the government, but rather who is economically affected by a tax. A low-income family that rents an apartment, for instance, is understood in our study to bear a portion of the property tax burden levied on that unit.

The U.S. Approach to Progressivity

Government fiscal policies can be progressive in two ways: either by imposing higher taxes and fees on higher earners or by devoting a greater share of government expenditures to lower-income households. In practice, governments invariably practice both, though the balance varies from country to country and state to state.

While European countries are generally, and correctly, regarded as having more progressive fiscal policies than the United States, this does not generally hold for their tax codes, which generate a far greater share of their revenue from low- and middle-income households than do tax systems in the United States. Instead, under systems of comparatively high and frequently regressive taxes on all residents, these countries achieve high levels of progressivity through generous systems of public transfers.

In this, European countries operate much like U.S. states, where systemwide progressivity is achieved through spending. The U.S. federal government, by contrast, combines a highly progressive tax system with a highly progressive transfer system. Local governments, which we treat in combination with state governments, generally have the least progressive systems, because they are not responsible for large-scale social welfare programs, which are within the purview of federal and state governments.

Given the high level of progressivity in the federal tax and transfer system, it makes sense for states to focus more of their efforts on the expenditure side of the ledger. States are in active competition with each other for people, jobs, and investment—all of which are considerably more mobile at the subnational than the international level. Critiques of the regressivity of state and local tax codes, which are often overstated, tend to ignore the progressivity of the state and local tax and transfer system in its entirety. They also tend to treat state fiscal policy in a vacuum, despite the substantial role of the federal government in the American system.

When considering the economic incidence of taxes on earners across the income spectrum, it becomes apparent that progressive intentions do not always yield a progressive reality. Income and capital-based taxes on business activity, tariffs on imported goods, and property taxes on rental units are all borne by taxpayers across the income spectrum, even if they are not the ones legally obligated to remit the tax.

After accounting for transfers, effective fiscal incidence rates are highly progressive, with the bottom quintile facing an effective federal, state, and local rate of 10.1 percent, while the middle quintile bears 22.4 percent, and the top quintile faces a 41.4 percent burden. Even though much of this progressivity stems from the federal government, a similar effect is visible at the state and local level as well, with state and local effective rates ranging from 7.8 percent for the bottom quintile to 12.1 percent for the top quintile.

Finally, to say that the lowest quintile has a total federal, state, and local effective fiscal incidence rate of 10.1 percent is not to say that the tax and transfer system reduces that person’s income by about one-tenth. Rather, this is the effective tax burden on their total income including transfers, which account for 59 percent of the bottom quintile’s effective income.

Households in the bottom quintile received an effective net tax-and-transfer benefit of $1.27 for every dollar they earned in income—in other words, a tax-and-transfer rate of -127.0 percent. Households in the top quintile, on the other hand, experienced an effective reduction of $0.31 for every dollar they earned in income. Due to the highly progressive tax and transfer system, a household in the bottom quintile earned an average of $22,491 in pre-tax and transfer income but had approximately $54,900 in post-tax and transfer income, since they received an estimated $32,409 in net government transfers.

The Distribution of Tax Burdens

The comprehensive burden of a tax system can be assessed in three ways: by nominal amounts of tax borne; by effective fiscal incidence rates excluding government transfers; and by effective fiscal incidence rates including government transfers. We look at each measure in turn as well as the distribution of government transfers.

Estimated Tax Burden in Nominal Dollars

We begin by examining the amount of tax borne by each household income quintile in 2019. The top quintile bears the majority of the total tax burden, bearing five times more than the middle quintile and nearly 23 times the bottom quintile. At the state and local level, the top quintile bears an amount nearly as large as all other quintiles combined, bearing $3.23 trillion in taxes, compared to $142 billion borne by the lowest quintile.

On average, households in the top quintile had a total estimated tax burden of $125,748 in 2019, consisting of $89,055 in federal taxes and $36,693 in state and local taxes. The middle and bottom quintiles bore a much smaller total tax burden of $24,451 and $5,524, respectively.[2] Notably, these tax burdens include taxes paid on economic activity underwritten by transfer payments, not just on their pre-transfer market income, which makes more of a difference for low-income households.

Table 1. Federal, State, and Local Tax Burdens by Quintile and Household, 2019
  Bottom Quintile Second Quintile Third Quintile Fourth Quintile Top Quintile
Total Tax Burden (Billions) $142 $292 $628 $1,145 $3,230
Total Federal Tax Burden (Billions) $32 $104 $351 $733 $2,288
Total State Tax Burden (Billions) $110 $188 $277 $413 $943
Total Tax Burden per Household $5,524 $11,386 $24,451 $44,580 $125,748
Federal Tax Burden per Household $1,248 $4,053 $13,678 $28,516 $89,055
State and Local Tax Burden per Household $4,275 $7,332 $10,773 $16,064 $36,693

Source: Bureau of Economic Analysis; Tax Foundation calculations.

Effective Fiscal Incidence Rates on Market-Derived Income

A second approach to examining the burden of a tax system is to consider effective fiscal incidence rates on market-derived income. Effective fiscal incidence rates illustrate the estimated tax burden as a share of income. Market-derived income includes all earned income from active participation in a job or business venture as well as all passive income resulting from the receipt of dividends, interest, or rent and excludes public or private transfers.

Figure 2 illustrates the effective fiscal incidence rates at each level of government absent the impact of income transfer programs. In the absence of transfers, the federal tax system is progressive, while the state and local tax system is regressive. The result is an overall tax system that resembles something of a fishhook, where incidence rates at the bottom quintile are slightly higher than at the second quintile, after which the progressive pattern resumes. Part of this effect can be explained by high-net-worth households that experienced negative income flows in the snapshot year.

US federal tax burden progressive but state and local tax burden is regressive before government transfers

Prior to government transfers, the bottom quintile faced an effective federal fiscal incidence rate of 5.6 percent, the middle quintile 13.8 percent, and the top quintile 24.4 percent.

Isolating state and local government effective fiscal incidence rates before transfers, the subnational system is markedly regressive. The bottom quintile of households realized a tax burden equivalent to 19 percent of their market-derived household income, the middle quintile’s burden was 10.9 percent, and the top quintile’s burden was 10.1 percent.

A key reason for the regressivity in the state and local system is the inclusion of more consumption-based taxes, which tend to be borne by consumers. While consumption taxes are economically efficient in that they only tax people for what they use, the burden falls harder on lower-income households because they consume a larger portion of their income than higher-income households do. Additionally, many of the services consumed by higher-income households are excluded from sales tax bases. Though in dollar terms, higher-income households pay more in total consumption taxes, effective fiscal incidence rates for state sales taxes are higher for lower-income households.[3] Moreover, commercial property taxes are often higher than residential property taxes, which actually works against many lower-income households despite superficially seeming like a progressive measure targeting businesses, since multi-unit rental properties are assessed as commercial rather than residential properties.

The Impact of Transfer Programs on Effective Fiscal Incidence Rates

A third approach to examining a tax system’s burden is assessing effective fiscal incidence rates including government transfer programs. Government transfers can account for a significant portion of many lower-income households’ ability to pay for goods and services. Because money is fungible, meaning a dollar from one source can be interchanged with a dollar from another, households can shift market-derived income to other uses when they receive government transfers. As households consume other goods or services they would not otherwise have been able to afford, they may also end up paying more in taxes.

Transfers at both levels of government have progressive distributions. The bottom quintile receives the largest share of gross transfers from the federal government (27.8 percent) and from state and local government (38.7 percent), while the top quintile received the smallest shares of federal and state and local gross transfers, 6.7 and 12.2 percent, respectively. Gross federal transfers made up the largest share of transfers for the top four quintiles, while the bottom quintile had a larger share of state and local transfers, the result of the state portion of Medicaid and other means-tested social assistance programs.

Gross Government Transfer Payments

As Figure 3 illustrates, federal transfers are much larger in dollar terms than state and local transfers. The average household in the bottom quintile received an estimated $34,092 in total gross government transfers, made up of $29,159 in federal transfers and $4,933 in state and local transfers. By comparison, the average household in the middle quintile received $22,510 in transfers, while the average household in the top quintile received $13,621.

US government transfers are progressive at every level

The gross transfer figures do not consider associated taxes that pay for the various programs. Before funds can be distributed to qualifying households, they must first be collected through taxation. To avoid double counting income, the tax cost of government transfers must be subtracted from the amount of transfers received. Failing to do so would make government transfer programs appear less progressive than they actually are.

It may be surprising to learn that the top quintile accrued nearly $350 billion in government transfers, programs normally thought of as helping lower-income earners.[4] It is perhaps less of a surprise when one considers that the measure includes Medicare and retirement programs like Social Security, which have broad eligibility criteria.

Overall, households earned $18.2 trillion of market income, with $7.8 trillion going to the top quintile, $2.8 trillion to the middle quintile, and $1.4 trillion to the bottom quintile after transfers.

Table 2. Total Comprehensive Household Income by Quintile, 2019
  Bottom Quintile Second Quintile Third Quintile Fourth Quintile Top Quintile
Total Comprehensive Household Income (Billions) $1,410 $2,107 $2,807 $4,097 $7,801

Source: Tax Foundation calculations with BEA, SSA, USCM, CMS, and VA data.

Including income transfer programs presents a more complete picture of how the fiscal system affects households, as illustrated in Figure 4. It becomes clear that all levels of the U.S. tax and transfer system have a progressive impact on taxpayers. After transfers, the top quintile had a combined effective fiscal incidence rate of 41.4 percent compared to 22.4 percent for the middle quintile and 10.1 percent for the bottom quintile.

A careful comparison between Figure 2 and Figure 4 shows the effective fiscal incidence rates of the top and bottom quintiles changed dramatically after transfers. The top quintile’s total effective fiscal incidence rate increased by nearly 7 percentage points while the same rate for the bottom quintile fell by 14.5 percentage points. This is because, after accounting for the taxes necessary for redistribution to occur, the transfer system effectively redistributed $1.7 trillion, which dramatically alters the denominator in each quintile.

US tax burdens increase at all levels of government after transfers

The top two quintiles were responsible for the income redistributed to the bottom three quintiles, with the top quintile responsible for funding 90.5 percent ($1.6 trillion). In all, the bottom quintile received $832.5 billion of redistributed income. The second and third quintiles of households received the remaining net transfers.[5]

With transfers included in income, the effective federal and combined fiscal incidence rates for the bottom three quintiles decreased while the rates for the top two quintiles increased relative to the respective pre-transfer rates.

The effective state and local tax rates also become progressive across the income distribution. The effective fiscal incidence rate for the bottom quintile decreased more than 11 percentage points to 7.8 percent. The middle quintile saw a 1 percentage point decrease in its effective rate to 9.9 percent, while the top quintile saw an effective state and local fiscal incidence rate increase of 2 percentage points to 12.1 percent.[6]

When the cost of government transfers was subtracted from gross transfers received, the fiscal incidence of the tax and transfer system becomes even clearer. After accounting for the tax burden to fund transfer programs attributable to transfer income, the bottom quintile came out $32,409 ahead, on average. A household in the middle quintile came out $10,180 ahead, while the average top quintile household paid $60,989 to fund transfer programs.[7]

Table 3. Household Effective Fiscal Incidence Rates before and after Transfers
  Bottom Quintile Second Quintile Third Quintile Fourth Quintile Top Quintile
Before Transfers          
Effective Fiscal Incidence Rate 24.6% 19.9% 24.7% 26.9% 34.5%
Effective Federal Fiscal Incidence Rate 5.6% 7.1% 13.8% 17.2% 24.4%
Effective State and Local Fiscal Incidence Rate 19.0% 12.8% 10.9% 9.7% 10.1%
After Transfers          
Effective Fiscal Incidence Rate 10.1% 13.9% 22.4% 28.0% 41.4%
Effective Federal Fiscal Incidence Rate 2.3% 4.9% 12.5% 17.9% 29.3%
Effective State and Local Fiscal Incidence Rate 7.8% 8.9% 9.9% 10.1% 12.1%

Source: Tax Foundation calculations with BEA, SSA, USCB, CMS, and VA data.

The effective transfer rates, measured as net transfer amounts divided by comprehensive household income, across the income distribution are also highly progressive. Figure 7 illustrates that 59 percent of comprehensive income for households in the bottom quintile came from government transfers. The share declines sharply across the rest of the income distribution. For the second quintile, 30 percent of comprehensive household income came from net government transfers compared to only 9 percent of income for the middle quintile. Meanwhile, the taxes used to fund transfer programs reduced the top quintile’s market-derived income by 16.7 percent, an amount equivalent to 20 percent of its comprehensive household income.[8]

Put differently, for every dollar borne in taxes, the average household in the bottom 20 percent received $6.17 in gross income transfers, the average household in the middle 20 percent received $0.92, and the top 20 percent received $0.11. In totality, the current tax and transfer system is highly progressive.

US tax and transfer system progressive tax code and federal state local tax burden

Finally, it is possible to combine these data to calculate an effective fiscal incidence rate as a percentage of pre-tax income. Households in all quintiles benefit from gross government transfers, since some transfer programs, like Social Security and Medicare, are broadly available. However, social spending is concentrated among lower- and middle-income households, while tax burdens are concentrated on higher earners, resulting in a tax-and-transfer system that more than doubles the income of households in the bottom quintile while reducing after-tax and transfer income by 30.7 percent for the top quintile of filers. The middle quintile pays slightly more in taxes than it receives in government transfers.

Household Effective Rates of Government Taxes and Transfers, 2019
  Bottom Quintile Second Quintile Third Quintile Fourth Quintile Top Quintile
Household Effective Rates of Gov’t Taxes and Transfers -127.0% -31.0% 2.0% 15.9% 30.7%


This study only considered the impact of cash and in-kind transfer programs on effective tax burdens. Other studies, including the 2007 Tax Foundation working paper, considered the effect expenditures on a broader range of public goods had on effective fiscal incidence rates. However, since public goods are by definition nonrivalrous and nonexclusionary they present unique data limitations. It is difficult to derive how much benefit the average household receives from such public goods as national defense, fire protection, or road networks for example. Attempting to derive that value would be a significant undertaking and unlikely to add meaningfully to a household’s economic income. As a result, we focused exclusively on government expenditures that took place through the government transfer programs specified earlier.

As mentioned previously, the bottom income quintile likely includes several wealthy households. Aggregating data into quintiles, while a common way of analyzing the income spectrum, can mask important observations that may become apparent at the decile or centile level. This is especially salient in a study of income where wealthy households may end up in the lowest quintile simply because significant financial losses offset the revenue earned that year. Income is not wealth, yet many taxes, particularly property taxes, can be paid out of or reflect a household’s accumulation of wealth. Some indications in this study that suggest this may be the case include the number of vehicles owned and the education level attained by the members of households in the lowest income quintile. Examining this quintile in greater detail is an opportunity for future research.

In-kind and cash transfers are important factors to consider in any discussion of household income. Especially among lower-income families, transfers amount to a large share of their comprehensive income. As our study illustrates, a complete measure of federal, state, and local taxes and transfers reveals a highly progressive fiscal system. Though in isolation, certain components of the system, such as state and local taxes, are regressive, a complete accounting of tax and transfer policies shows the final outcome is highly progressive. Leaving transfers out of the picture understates the tax burden on high-income earners, overstates the burden on low-income earners, and fails to inform the policy debate over who should pay and how much.


The importance of accurately defining taxpayers’ burdens lies in the implications for the economy and the motivation for the transfer system. Tax policies are often evaluated on their progressivity or regressivity in a vacuum, without an adequate understanding of the broader system in which they operate. When, at times, progressivity is in tension with other goals, including neutrality and an orientation toward economic growth, policymakers deserve to have a proper understanding of the overall progressivity of the tax and transfer system, and the different levers that are used to achieve it, so they can better evaluate if and how to prioritize progressivity in discrete cases.

States compete with each other for residents, jobs, and capital investment, all of which are much more mobile at the subnational than at the international level. To a significant degree, the federal government has long been the primary source of progressivity—through both taxes and transfers—enabling state governments to pursue other worthy aims through their own tax codes. This does not end the conversation about progressivity in state and local taxes, particularly when a proposal lacks clear benefits along other dimensions. But the overall U.S. tax and transfer system is overwhelmingly progressive, and understanding the extent—and source—of that progressivity is essential for lawmakers considering the trade-offs associated with each tax policy decision.

Note: To read the full methodology and appendix, click “Download the PDF” above.

[1] Andrew Chamberlain and Gerald Prante, “Who Pays Taxes and Who Receives Government Spending? An Analysis of Federal, State and Local Tax and Spending Distributions, 1991-2004,” Tax Foundation, March 22, 2007,

[2] See Appendix C, Table 4, for a detailed breakdown of household tax burdens by tax type.

[3] See Appendix C, Table 5 for a detailed account of effective fiscal incidence rates by type of tax for each income quintile before transfers.

[4] To see how much each quintile received in total gross transfers and at each level of government, refer to Appendix F, Figure 1.

[5] Refer to Appendix F, Figure 2 for each quintile’s share of redistributed market income after taxes.

[6] Refer to Appendix C, Table 6 for a detailed account of effective fiscal incidence rates by type of tax for each income quintile after transfers.

[7] Refer to Appendix F, Figure 3 for the average net transfer amount per household by quintile.

[8] Refer to Appendix F, Figure 4 for effective government transfer rates by quintile.

[9] See U.S. Bureau of Labor Statistics, “Consumer Expenditure Survey, CE Methods,” last updated Sept. 9, 2021,

[10] See United States Census Bureau, “Annual Social and Economic Supplement (ASEC) of the Current Population Survey (CPS),” last updated Oct. 8, 2021,

[11] Sarah Flood, Miriam King, Renae Rodgers, Steven Ruggles, J. Robert Warren, and Michael Westberry, Integrated Public Use Microdata Series, Current Population Survey: Version 10.0 (Minneapolis, MN, 2022),

[12] U.S. Bureau of Labor Statistics, “Consumer Expenditure Surveys: CE Methods, PUMD Data Files,” last updated Nov. 8, 2022,

[13] For the full list of NIPA tables referenced, see Appendix A.

[14] Centers for Medicare and Medicaid Services, “Financial Management Report for FY 2019,” last updated December 6, 2022,

[15] Social Security Administration, Annual Statistical Supplement to the Social Security Bulletin, 2020, last updated Dec. 6, 2022,

[16] U.S. Department of Veterans Affairs, “National Center for Veterans Analysis and Statistics: 2019 Expenditures,” last updated Dec. 6, 2022,

[17] See Bureau of Economic Analysis, “Net National Product,”

[18] Andrew Chamberlain and Gerald Prante, “Who Pays Taxes and Who Receives Government Spending? An Analysis of Federal, State and Local Tax and Spending Distributions, 1991-2004,” Tax Foundation, March 2007.

[19] For specific transfer amounts see Appendix B, Table 3.

[20] Price elasticity relates the percentage change in quantity demanded (or supplied) to the percentage change in price. If a good is price inelastic, then a 10 percent increase in price would result in a less than 10 percent decrease in the quantity of goods purchased. A good is price elastic when a 10 percent increase in price results in a greater than 10 percent decrease in the quantity of goods purchased. A good is unit elastic if a 10 percent increase in price would result in a 10 percent decrease in the quantity of goods purchased. Elasticity is thus a function of a consumer’s (or a producer’s) willingness to pay for a good or service (or business input) and can be affected by such things as necessity, preference, or substitutability. If the price elasticity of supply is greater than the price elasticity of demand, the consumer will bear a greater share of the tax than the producer. Conversely, if the price elasticity of demand is greater than the price elasticity of supply, the producer will bear more of the tax. The ability of a producer to pass on a tax to a consumer and the willingness of the consumer to bear a tax is thus a function of overall price competitiveness, the preferences of individual consumers, and the availability of suitable substitutes.

[21] Factors of production include land, labor, and capital. (Some also include entrepreneurship as a factor of production.)

[22] See Bureau of Economic Analysis, “Net National Product,”

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