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The GOP’s Trojan Horse on Health Care Repeal

Wednesday, July 26th, 2017

On Tuesday, 50 Republican senators showed contempt for their constituents by voting to move forward on repealing our health care, with Vice President Mike Pence stepping in to break the tie.

Nine GOP senators later broke ranks in a late-night session to vote down the Senate’s toxic version of the bill, the Better Care Reconciliation Act (BCRA) – which would have rolled back much of the Affordable Care Act and gutted Medicaid, ending coverage for 22 million – but there are more votes to come, including one that may simply repeal care and and strip coverage from 32 million.

The final version of the bill may be nothing more than a placeholder – a Trojan horse for setting up a Republican Senate-House conference committee that will use yet another secretive, undemocratic process to craft yet another version of health repeal.

GOP leaders will want the new version to look just like their previous versions: cut taxes for corporations and the rich, raise the price of coverage for the rest of us, unravel Medicaid, and take health care from 22 to 24 million people.

Among Republicans, only Sen. Susan Collins of Maine and Sen Lisa Murkowski of Alaska had the courage to stand with their constituents and vote no on moving forward.

By voting to move ahead on the health care debate, Sen. Dean Heller of Nevada caved to pressure from Trump and casino mogul Steve Wynn. Almost 630,000 Nevadans get their health care through Medicaid and are now in jeopardy.

Sen. Shelley Moore Capito of West Virginia caved under the weight of right-wing donor money and attack ads. With three in 10 West Virginians getting their health care through Medicaid, Capito’s state will be harder hit than almost all other states the country.

Ohio’s Sen. Rob Portman also caved, representing a state where hundreds of thousands of people finally got coverage because of expanded Medicaid under the Affordable Care Act.

It was extremely irresponsible of Portman, Capito, and Heller – who have all expressed concern for constituents enrolled in Medicaid – to throw their weight behind this reckless process without a clear plan for protecting Medicaid coverage.

In statements, Capito and Portman have both said they’ll make good on their concern in the days to come, but both voted with their GOP colleagues for the BCRA on Tuesday night. Heller, who voted against the BCRA, said he wants the bill to be improved.

They need to show this is more than talk. Now more than ever, their constituents need them to stand strong, resist any bullying, and protect Medicaid and health care overall. They’ll do that, if they really do care about their constituents.

And let’s not forget the true heroes in this fight.

These heroes include the West Virginians who’ve been holding Capito’s feet to the fire for months with creative protests and civil disobedience. They also include the Mainers who delivered messages in a pill bottle to Sen. Collins and tracked Rep. Bruce Poliquin down at a Boston fundraiser and reminded him who he’s supposed to represent. And let’s not forget the seniors who braved a Great Lakes blizzard to protest in front of Speaker Paul Ryan’s Racine office.

Like these heroes, tens of thousands of people have shown up at protests and town halls, often speaking up for the first time in their lives. In every corner of the country, people have put their senators on speed-dial, camped out in congressional offices, and rallied friends.

We really are in a fight for our lives. Yet we’re motivated not just by fear but also by moral outrage. We know how fundamentally wrong it is to deprive people of health care.

And our fight isn’t over. Republican leaders wanted to put health care repeal on Trump’s desk in January. It’s the end of July, they’re still scrambling. That’s because of us.

In the coming days, let’s keep making calls and showing up at rallies and protests. Let’s track every vote this week, and raise the pressure on senators and representatives alike if repeal moves to a conference committee.

We’ve shown an incredible persistence in our fight. We’ll show plenty more when it comes to holding politicians accountable for a vote that favors big-money bullying over the people they’re supposed to represent.

This blog was originally published at OurFuture.org on July 26, 2017. Reprinted with permission. 

About the Author: Julie Chinitz is lead writer for People’s Action.

Kellyanne Conway says people who lose Medicaid should just find better jobs. It’s not that simple.

Tuesday, June 27th, 2017

During a Fox & Friends interview Monday morning, White House counselor Kellyanne Conway suggested that, for the people who lose Medicaid coverage because of the more than $800 billion in cuts included in the Senate’s health care bill, the solution is as simple as finding a better job.

“Medicaid is intended for the poor, the needy, and the sick,” she said. “And what it has done is, under Obamacare, it has expanded the Medicaid pool of people who, quote, qualified beyond that. So if you have an able-bodied American who again is not poor, sick, needy?—?we’re not talking about the elderly who benefit, the children, the pregnant women, the disabled?—?if you’re able-bodied and you would like to go find employment and have employer-sponsored benefits, then you should be able to do that, and maybe you belong, as Secretary Price has made clear, in other places.”

But Conway’s talking point mischaracterizes the life circumstances of most Medicaid recipients, a majority of whom work low-income jobs that don’t offer health insurance and that keep them near the poverty line.

According to the Kaiser Family Foundation (KFF), 59 percent of Medicaid adults have jobs, and nearly 80 percent are part of working families. While many of those people might prefer to take advantage of employer-offered health care, a large percentage do not have that option. Only 46 percent of employers offer health care coverage, according to the latest KFF data.

Conway also ignored the fact that the Senate health care bill only requires insurance companies to pay for 58 percent of costs, a significant reduction from the standard under Obamacare. That means that low-income people kicked off Medicaid as a result of the Senate bill’s $800 billion in cuts would be required to pay much more out of pocket for their health care even if they can purchase private insurance.

It’s also not true that the Medicaid cuts included in the Senate health care bill wouldn’t have a negative impact on elderly people, children, pregnant women, or disabled people, as Conway suggested. By imposing per capita caps on benefits and eventually basing the amount of money states receive each year for Medicaid on the consumer price index (instead of inflation within the health care market, for instance), the Senate bill’s cuts will negatively impact all beneficiaries of the program, including the 35 percent who cite an illness or disability that prevents them from working.

Conway’s comments on Fox & Friends come the day after she appeared on This Week and flatly denied that the Senate bill’s $800 billion reduction in Medicaid spending constitutes a “cut.” Instead, she said the bill “slows the rate for the future, and it allows governors more flexibility with Medicaid dollars.”

The administration’s misinformation is having an impact?—?a recent poll indicated less than 40 percent of Americans know that the health care plan being pushed by Republicans includes any Medicaid cuts.

This piece was originally published at ThinkProgress on June 26, 2017. Reprinted with permission. 

About the Author: Aaron Rupar is an editor at Think Progress. He came to DC from Minneapolis, where he wrote for the City Pages and Fox 9, among other outlets.

Veto the Cold-Hearted Health Bill

Monday, June 26th, 2017

Donald Trump is right. The House health insurance bill is “mean, mean, mean,” as he put it last week. He correctly called the measure that would strip health insurance from 23 million Americans “a son of a bitch.”

The proposal is not at all what Donald Trump promised Americans. He said that under his administration, no one would lose coverage. He said everybody would be insured. And the insurance he provided would be a “lot less expensive.”

Senate Democrats spent every day this week pointing this out and demanding that Senate Republicans end their furtive, star-chamber scheming and expose their health insurance proposal to public scrutiny. That unveiling is supposed to happen today.

Republicans have kept their plan under wraps because, like the House measure, it is a son of a bitch. Among other serious problems, it would restore caps on coverage so that if a young couple’s baby is born with serious heart problems, as comedian Jimmy Kimmel’s was, they’d be bankrupted and future treatment for the infant jeopardized.

Donald Trump has warned Senate Republicans, though. Even if the GOP thinks it was fun to rebuff Democrats’ pleas for a public process, they really should pay attention to the President. He’s got veto power.

Republicans have spent the past six years condemning the Affordable Care Act (ACA), which passed in 2010 after Senate Democrats accepted 160 Republican amendments, held 110 bipartisan public hearings and conducted 25 consecutive days of public floor debate. Despite all of that, Republicans contend the ACA is the worst thing since Hitler.

That is what they assert about a law that increased the number of insured Americans by 20 million, prohibited discrimination against people with pre-existing conditions and eliminated the annual and lifetime caps that insurers used to cut off coverage for sick infants and people with cancer.

The entire cavalry of Republican candidates for the GOP nomination for President promised to repeal the ACA, but Donald Trump went further. He pledged to replace it with a big league better bill.

In May 2015, he announced on Twitter: “I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid.”

In September 2015, he said of his health insurance plans on CBS News’ 60 Minutes, “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”

In another 60 Minutes interview, this one with Lesley Stahl last November, he said, “And it’ll be great health care for much less money. So it’ll be better health care, much better, for less money. Not a bad combination.”

In January, he told the Washington Post, “We’re going to have insurance for everybody.” He explained, “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

But then, the House Republicans betrayed him. The nonpartisan Congressional Budget Office said the measure they passed, called the American Health Care Act (AHCA), would cut more than $800 billion from Medicaid. It said people with pre-existing conditions and some older Americans would face “extremely high premiums.”

Extremely high is an understatement. Here is an example from the CBO report: A 64-year-old with a $26,500 income pays $1,700 for coverage under the Affordable Care Act (ACA), but would be forced to cough up more than half of his or her income – $16,000 – for insurance under the House Republican plan. Overall, premiums would increase 20 percent in the first year. And insurers could charge older people five times the rate they bill younger Americans.

House Republicans said states could permit insurers to squirm out of federal minimum coverage requirements, and in states where that occurred, the CBO said some consumers would be hit with thousands of dollars in increased costs for maternity care, mental health treatment and substance abuse services.

In the first year, the House GOP plan would rob insurance from 14 million Americans.

So much for covering everyone with “great health care at much less money.”

It’s true that President Trump held a party for House Republicans in the Rose Garden after they narrowly passed their bill. But it seems like he did not become aware until later just how horrific the measure is, how signing it into law would make him look like a rank politician, a swamp dweller who spouts promises he has no intention of keeping.

By last week when President Trump met with 15 Senate Republicans about their efforts to pass a health insurance bill, he no longer was reveling in the House measure. He called it “cold-hearted.” He asked the senators to be more “generous,” to put “additional money” into their version.

Senators told reporters that President Trump wanted them to pass a bill that is not viewed as an attack on low-income Americans and provides larger tax credits to enable people to buy insurance.

Now that sounds a little more like the Donald Trump who repeatedly promised his health insurance replacement bill would cover everyone at a lower cost. Still, those goals remain amorphous.

The House bill is stunningly unpopular, almost as detested as Congress itself. President Trump seems to grasp the enormity of that problem. But even his calling it a “son of a bitch” doesn’t seem to have been enough to persuade senators that he’s serious about getting legislation that achieves his promises to leave Medicaid intact, cover everyone and lower costs.

Republican senators deciding the fate of millions of Americans must hear from Donald Trump that passing a health insurance bill that doesn’t fulfill his campaign promises is, shall we say, a cancer on the Presidency.

A veto threat would get their attention.

This blog originally appeared at OurFuture.org on June 21, 2017. Reprinted with permission. 

About the Author: Leo Gerard is president of the United Steelworkers.

The House GOP health care bill is a job killer, says a new report

Wednesday, June 21st, 2017

 In addition to potentially increasing the number of uninsured by 23 million and being unequivocally unpopular, House Republicans’ Obamacare replacement plan could leave nearly a million people unemployed.

That’s according to a new study published Wednesday by the Milken Institute School of Public Health at George Washington University and The Commonwealth Fund projects, which finds that the U.S. economy could see a loss of 924,000 jobs by 2026 if the American Health Care Act (AHCA) becomes law.

The study concentrated on coverage-related and tax repeal policies included in the AHCA. Some of the key provisions it said could add to job losses would:

  1. Phase out enhanced funding for Medicaid expansion by restricting eligibility in 2020, and imposing either a block grant or per capita caps.
  2. Replace premium tax credits with age-based tax credits. The premiums can be five times higher for older individuals, compared to the current threefold maximum.
  3. Allow states to waive key insurance rules, like community rating and essential health benefits. (The study does account for the Patient and State Stability Fund, a $8 billion grant meant to relieve states of high-cost patients.)
  4. Eliminate the individual mandate tax penalty and premiums hikes for people who do not maintain continuous coverage.
  5. Repeal numerous taxes and tax increases, like a tax on high-cost insurance (i.e. the “Cadillac tax”).

Short-term gain, long-term pain

Federal health funding stimulates the economy and job creation. Health funds pay hospitals, doctor’s offices, and other providers, and these facilities pay for their own respective employees and other goods and services, like rent and equipment. Health care employees and private businesses then use their earnings to purchase consumer goods like housing and transportation, circulating this money through the larger economy.

The GWU study found government spending or subsidies stimulate the economy more than tax cuts. Tax cuts do help, but only in the short term. The way AHCA is set up is that the tax cuts take effect sooner than federal funding cuts, which is why some states see net job growth by 2018. Then, when federal dollars are eventually pulled, states begin to see job losses by 2026.

Who’s most affected:

The employment rate among states that expanded Medicaid eligibility could disproportionately be affected, because those states received more federal dollars. New York, a state that expanded Medicaid, could be among the hardest hit with 86,000 job losses by 2026.

Between April 2016 and April 2017, New York added 76,800 jobs and the educational & health services sector saw the largest job gains, at 46,600 jobs. “The Affordable Care Act [ACA] contributed to that [growth],” Ronnie Kauder, senior research director at the New York City Labor Market Information Service, told ThinkProgress.

Kauder emphasized that the ACA wasn’t solely responsible for New York’s job growth, even in the health care sector. Uncontrollable factors like the state’s growing aging population and increasing life expectancy contribute to job growth as well.

New York has reaped the employment benefits of comprehensive health care, said Kauder. That’s in part because ACA encouraged states to test new models of health care delivery and shifted from a reimbursement system based on volume of services to value of services.

For example, New York received ACA grant funding to test effective ways to incentivize Medicaid beneficiaries, who struggle with chronic diseases, to participate in prevention programs and change their health risks. With that grant, New York created new programs at existing managed care organizations, which required new hires. The grant created positions like care coordinators, who connect and follow-up up with patients and providers in the program, said Kauder. “They are heavy on the training, but not licensed professionals,” she said.

But while she attributed some of New York’s job gains to the ACA, Kauder was skeptical that the GOP replacement plan would kill as many of them as the GWU study projects. “We don’t know what the state response will be,” he said. “It could be worse in Kentucky.”

The largest health care provider in New York, Northwell Health, hires on average 150 people a week. Northwell chief public relations officer Terry Lynam told ThinkProgress he doesn’t think the ACA directly contributed to a spike in job growth; however, it did help expedite the provider’s move from hospitals to outpatient care centers, also called ambulatory care, in an effort to slow rising health costs.

“What [ACA] has done was contribute to the ambulatory net growth [by cutting costs],” said Lynam. Northwell Health has 550 outpatient locations.

Northwell Health has qualms with the House GOP bill; specifically its cuts to Medicaid and change in coverage rules. “We are in a stronger financial position to survive that kind of reduction in revenue,” said Lynam. “But what about small providers serving low income areas, who need those Medicaid [dollars]?”

This blog was originally published at ThinkProgress on June 15, 2017. Reprinted with permission. 

About the Author: Amanda Michelle Gomez is a health care reporter at ThinkProgress.

The Trump administration has started rolling back the birth control mandate

Thursday, June 1st, 2017

Federal officials, under orders by President Donald Trump, have drafted a rule to roll back the Obama-era mandate that birth control be included under all employer insurance plans.

The final shape of roll back is still uncertain: The White House Office of Management and Budget (OMB) website says that it is reviewing the “interim final rule” to relax the requirements on preventative services. The rule change is specifically aimed at accommodations for religious organizations, some of whom have strongly objected to requirements that they include birth control coverage under their insurance for employees.

Typically, when an agency considers changing a rule?—?which can have immediate and sweeping policy impacts?—?they publish a preliminary version, solicit comments from the public, and incorporate the feedback into revisions before handing down the final change. If the OMB is reviewing the interim final rule, however, that means the rule has already been drafted by the relevant agencies and is in the last step before being published, according to the National Women’s Law Center.

“We think whatever the rule is, it will allow an employer’s religious beliefs to keep birth control away from women. We are sure that some women will lose birth control coverage,” Gretchen Borchelt, the vice president of the National Women’s Law Center, told the New York Times.

Under the current rules, implemented under President Obama, birth control coverage is considered part of preventative medical care and must be covered by all insurers with no co-pay. The mandate has guaranteed an estimated 55 million women access to birth control and other preventative services at no additional cost to them, regardless of their employer.

In 2013, the mandate saved women $1.4 billion on birth control pills, and since the law went into effect, there has been a nearly 5 percent uptick in birth control subscriptions, according to the NWLC. The increased access to contraceptives has also correlated with a sharp drop in unintended pregnancy and abortion rates.

These public health outcomes make it easy to see why the requirement has been widely lauded by women’s health advocates and providers.

“Without question, contraception is an integral part of preventive care; women benefit from seamless, affordable access to contraception, and our health system benefits as well,” the American College of Obstetricians and Gynecologists (ACOG) said in a statement about the mandate. “ACOG strongly believes that contraception is an essential part of women’s preventive care, and that any accommodation to employers’ beliefs must not impose barriers to women’s ability to access contraception.”

The law has been hotly contested, however, by religious organizations who object to having to include birth control in their insurance plans. Trump seized on their complaints while campaigning for the presidency, and in early May, fulfilled his pledges to evangelical Christian supporters by handing down an executive order on “religious freedom” that aimed to do two things: To make it easier for faith leaders to preach politics, and to allow employers to claim a religious exemption against providing contraceptive coverage for their employees.

Trump made the proclamation alongside representatives of Little Sisters of the Poor, an order of nuns who have been some of the most vocal opponents of Obamacare’s mandate that insurance include birth control coverage?—?taking the fight up all the way up to the Supreme Court.

“Your long ordeal will soon be over,” Trump told them when he announced the order.

Secretary of Health and Human Services Tom Price immediately issued a statement saying that he’d be happy to take have the opportunity to reshape the requirements on birth control coverage.

“We welcome today’s executive order directing the Department of Health and Human Services to reexamine the previous administration’s interpretation of the Affordable Care Act’s preventive services mandate, and commend President Trump for taking a strong stand for religious liberty,” he said in a press relief.

Price has long been a vocal critic of the birth control mandate on grounds of religious freedom, and has also been dismissive of its benefit to women.

“Bring me one woman who has been left behind. Bring me one. There’s not one,” Price said about women having trouble paying for birth control in an interview with ThinkProgress in 2012. “The fact of the matter is this is a trampling on religious freedom and religious liberty in this country.”

According to a recent survey by polling form PerryUndem, 33 percent of American women said they couldn’t afford to pay any more than a $10 copay for their birth control. Fourteen percent said that if they had to pay for birth control at all, they couldn’t afford it.

This article was originally published at ThinkProgress on May 30, 2017. Reprinted with permission.

About the Author: Laurel Raymond is a reporter for ThinkProgress. Previously, she worked for Sen. Patrick Leahy (D-VT) and served as a Fulbright scholar at Gaziantep University in southeast Turkey. She holds a B.A. in English and a B.S. in brain and cognitive sciences from the University of Rochester, and is originally from Richmond, Vermont.

Congress’ Cuts in Health Care Will Hit Women Harder

Tuesday, March 7th, 2017

Republican leaders in Congress are working on plans to cut health benefits for tens of millions of people. The harms from these cuts are likely to have the biggest impact on women, both for their own health benefits and as they try to manage health care for their families.

Every major source of health coverage is now at risk under the Republican health plans. This includes individual coverage bought through the Affordable Care Act, workplace health plans, Medicaid benefits for people struggling to make ends meet, and Medicare for seniors and people with disabilities.

The ACA included important changes in the law requiring women to be treated fairly. Repealing the ACA outright, as Republican leaders say they want to do, could mean going back to the days when insurance companies could legally discriminate against women by charging them higher monthly premiums for individual coverage than men.

Repeal also could mean getting rid of protections requiring individual policies to cover pregnancy and pay for preventive services, like women’s well visits and birth control.

Republican leaders also are intent on slashing Medicaid by more than a half trillion dollars over 10 years, which will take health coverage away from millions of people and cut benefits for many others. This government health program for people struggling to make ends meet pays for one-half of all childbirths in the United States. It also covers the bill for more than three-in-five nursing home residents—a group made up disproportionately of older women who otherwise might have nowhere to go.

The fallout for women does not stop there. Women already are much more likely than men to be the ones navigating our complicated health care system for their families and dealing directly with its high costs. Women make about 80% of their family health care decisions, like deciding on the right care and how to pay for it. They also are far more likely than men to be caregivers, including for older adults, such as parents or spouses.

When the Republican health care cuts come, women are likely to have to deal with the consequences in their daily lives.

When they can no longer afford a private insurance policy or they get dropped from Medicaid, women likely will be the ones struggling to figure out how to get and pay for the care needed by a small child with an ear infection.

When Medicaid support is cut for seniors who need help so they can stay in their homes or who need to go to a nursing home, women are likely to be the family members who are figuring out how to care for an elderly parent with dementia.

When family paychecks are smaller or health benefits are cut back because Republicans have taxed workplace health plans, women are likely to be the ones at the doctor’s office figuring out how to pay the family health care bill.

Yes, women will be hit harder by the Republican health care cuts.

This blog originally appeared in aflcio.org on March 6, 2017.  Reprinted with permission.

Shaun O’Brien works for AFL-CIO.  His interests include retirement security and health care. Follow him on twitter @ShaunOBrien30.

What’s Happening to Your Health Care: 3 Things to Know Right Now

Friday, February 17th, 2017

There is definitely lots of talk about how President Donald Trump and Congress are planning to make major changes to Americans’ health benefits. That’s because Trump and Republican leaders in Congress have said that repealing the Affordable Care Act is one of their top priorities. Although it is not clear when they will act or exactly what they will do, here are three things to know right now:

1. Your health benefits are at risk, no matter where you get them:

  • Medicare: A straight-up repeal of the ACA would eliminate some Medicare benefits by reinstating the full Medicare prescription drug donut hole and taking away free preventive care. House Speaker Paul Ryan (R-Wis.) is still pushing his plan to turn Medicare into a voucher system, meaning benefits would no longer be guaranteed and health costs for seniors and people with disabilities would go up dramatically.
  • Workplace Health Benefits: Kevin Brady (R-Texas), the powerful chairman of the tax writing committee in the U.S. House of Representatives, wants to tax part of the cost of workplace health benefits by including the cost in working people’s taxable income. So does the person Trump hired to be in charge of health care, Health and Human Services Secretary Tom Price. If you get your health benefits on the job, this will raise your taxes and lead to even higher deductibles and co-pays. Some employers could even cancel their health plans in response.
  • Health Insurance You Buy Yourself: Most media coverage is focused on what impact repeal of the ACA will have on the approximately 10 million people who now buy individual health coverage through the ACA’s health insurance marketplaces, often with the help of federal tax credits. A straight-up repeal of the ACA would not just take away the tax credits that help people buy health insurance. Full repeal also would eliminate the ACA’s protections that require insurance companies to treat people fairly, to give them meaningful insurance without tricks and traps, and not to discriminate against anyone because they have a pre-existing condition or even because of their gender.
  • Medicaid: Medicaid is the health plan run by states with significant federal funding that enables 74 million people to get the medical care they need. One-in-three kids in the United States get their health coverage from Medicaid or the Children’s Health Insurance Plan. Millions of seniors and people of all ages with disabilities also count on Medicaid for nursing home care and the long-term supports and services that allow them to live independently in their homes and communities. A straight-up repeal of the ACA would take health coverage away from some 11 million people who now have benefits because the ACA allowed states to expand Medicaid. Trump and Republican leaders in Congress also want to cut Medicaid for everyone who receives it by imposing new limited caps on what the federal government will contribute, even if the cost of health care keeps going up much faster than prices in the rest of the economy. That will shift costs onto states and likely force cuts in benefits.

2. People are speaking up, and that’s having an impact on Washington: Lots of people are showing up to meet with their members of Congress about health care and to let them know just how important it is to them personally. Many people are asking their members of Congress tough questions. For example, check out this article about a Tennessee high school teacher who attended a town hall and watch the video showing her tough question for Rep. Diane Black (R-Tenn.), Meet the Teacher Whose Powerful, Christian Defense of Obamacare Made a GOP Town Hall Go Viral. The hard questions and strong show of concern from voters are affecting what’s going on in Congress. What once was a mad dash to repeal the ACA right away has slowed to a crawl for the moment, and there now is a split among Republicans in Congress. While many congressional Republicans still want to repeal the ACA immediately regardless of whether they have a replacement, at least a few are saying they want to figure out what the impact will be on real people and how they might address the harm that will do.

3. We’re still waiting to hear what the plan for repealing and replacing the ACA is: In mid-January, Trump said he had a plan that was finished except for some finishing touches and that he was just waiting for Price to be confirmed by the Senate as his HHS secretary. Price was confirmed last Friday, so maybe we will see his plan soon. Congressional Republicans are still trying to figure out what their plan should be. Some Republicans want to go ahead with repeal of the ACA now and figure out whether and how they might replace it later.

This blog originally appeared in aflcio.org on February 16, 2017.  Reprinted with permission.

Shaun O’Brien works for AFL-CIO.  His interests include retirement security and health care. Follow him on twitter @ShaunOBrien30.

Social Media is a Danger Zone for the Healthcare Industry

Thursday, February 2nd, 2017

Social media can cause big problems for healthcare workers and their employers. Because of HIPAA rules and other concerns, posting something as seemingly harmless as a selfie with a patient could ruin careers, or worse. Healthcare professionals do form bonds and friendships with some of their patients and because social media has become a place where people share details of their lives and their friends’ lives, it is understandable that a healthcare worker might slip up and post something that he or she shouldn’t. Understandable, but not excusable.

Blurred Lines

Healthcare workers are advised of HIPAA rules and know that information about their patients is confidential, but that hasn’t stopped some healthcare workers from getting into trouble for their social media posts. For example, when a police officer was brought into an emergency room and the staff was unable to save him, some posted their condolences on Facebook, complete with the name of the deceased officer. To make matters worse, the officer’s family had yet to be notified.

Certainly, the ER staffers were reacting to the heartbreak of losing a patient and doing what felt natural in the moment—sharing thoughts and feelings on social media. They were acting out of kindness.

Intent Doesn’t Matter

A post that is meant to be kind is still not OK. The bottom line is this: sharing any information about a patient is a HIPAA violation even if the social media account has the highest possible privacy settings (which are never 100% reliable), and even if the post is mourning the loss of a patient.

As Ed Bennett, director of Web strategy at University of Maryland Medical System points out, “We already have guidelines; social media is simply another form of communication. It’s no different from e-mail or talking to someone in an elevator. The safe advice is to assume anything you put out on a social media site has the potential to be public.”

What About Free Speech?

A recent social media conduct survey found that 41.2% of Americans believe that getting fired because of a social media post is an infringement of their First Amendment rights. In the private sector, it’s usually not.

The First Amendment affords Americans the right to free speech, which means they can express themselves without interference or constraint by the government. The First Amendment does not protect employees from private sector disciplinary action.

Healthcare professionals can get fired for a post, even one that does not violate HIPAA laws, as a Philadelphia hospital employee learned when she posted a racially-charged rant on social media. Word spread (because social media is not private!), someone started a change.org petition to demand that the hospital fire the employee (for a post that had nothing to do with her job) and the worker was fired.

Headaches All Around

An inappropriate social media post can become a major headache for everyone involved. According to the AMA:

Criminal penalties for a violation of HIPAA are directly applicable to covered entities—including health plans, health care clearinghouses, health care providers who transmit claims in electronic form, and Medicare prescription drug card sponsors. Individuals such as directors, employees, or officers of the covered entity, where the covered entity is not an individual, may also be directly criminally liable under HIPAA in accordance with principles of “corporate criminal liability.”

HIPAA was enacted in 1996 and social media didn’t begin to hit its stride until Facebook opened to the public in 2006. Since employers are liable, and HIPAA doesn’t explicitly address social media, many deem it prudent to have a very clear social media policy. As a healthcare employee, you should be aware of your employer’s policies, which may go above and beyond HIPAA.

Conclusion

The healthcare provider/client relationship is like no other. Healthcare professionals know the most personal details about their patients, and they care about their patients, yet they’re expected to maintain a professional relationship.

According to the US Department of Labor, “Employment of healthcare occupations is projected to grow 19 percent from 2014 to 2024, much faster than the average for all occupations, adding about 2.3 million new jobs. Healthcare occupations will add more jobs than any other group of occupations.” Workers of the future who have grown up with social media and habitually post random moments of their days on Snapchat or Instagram will have to learn to curb that behavior if they intend to get a job in the healthcare field—and keep it.

 

Ellen Gipko is a marketing analyst for white label SEO firm HubShout, and a writer specializing in the topics of social media and digital marketing. She has contributed content to Social Media Today, Search Engine Watch, Search Engine Journal and other industry websites.

AFL-CIO Tells Congress No Repeal Without Replacement of ACA

Thursday, January 12th, 2017

Today, as Congress debates the future of the Affordable Care Act, the AFL-CIO sent a letter to Senate Majority Leader Mitch McConnell (R-Ky.), Speaker of the House Paul Ryan (R-Wis.) and all members of the U.S. Senate and House of Representatives.

Signed by AFL-CIO President Richard Trumka, the letter urges Republican leaders to abandon plans to roll back coverage protections and declares it “reckless to repeal the ACA without providing an immediate replacement.” The letter also details how the core components of the Republican health care plan pose serious threats to working people in America.

Some key passages in the letter:

You are now poised to repeal the Affordable Care Act (ACA) with breathtaking speed at the beginning of the new Congress, without providing replacement coverage to the 30 million Americans who will become uninsured as a result. This action appears to mark just the first stage of a massive Republican plan to cut federal support for health coverage….

It is reckless to repeal the ACA without providing an immediate replacement. This approach will cause the individual insurance market to collapse, destroying coverage for millions of Americans, even if Congress provides itself with a “transition period” to try to enact an alternative to the ACA….

Workplace insurance is the leading source of health coverage for Americans, covering 178 million people. The major Republican plans levy destructive new taxes on this coverage; and their sponsors endorse the belief of most economists that these new taxes will drive employers to cut back on the health benefits they provide by increasing the out-of-pocket expenses working people and retirees are required to pay….

Medicare beneficiaries will be forced to pay a greater and greater share of the cost of coverage as excessive health care cost growth outpaces the new Republican limits on federal support for Americans’ earned health benefits. As with the other major rollbacks, the federal government would retreat, leaving beneficiaries to fend for themselves in the hopes that “market forces” will temper the growth of costs….

The major Republican plans also make substantial cuts to Medicaid, even though it currently pays for most nursing home and community-based long-term care for America’s seniors and, in conjunction with the Children’s Health Insurance Program, ensures that more than a third of America’s children can get the medical care they need….

Read the full letter.

This blog originally appeared in aflcio.org on January 9, 2017.  Reprinted with permission.

Kenneth Quinnell: I am a long-time blogger, campaign staffer and political activist.  Before joining the AFL-CIO in 2012, I worked as labor reporter for the blog Crooks and Liars.  Previous experience includes Communications Director for the Darcy Burner for Congress Campaign and New Media Director for the Kendrick Meek for Senate Campaign, founding and serving as the primary author for the influential state blog Florida Progressive Coalition and more than 10 years as a college instructor teaching political science and American History.  My writings have also appeared on Daily Kos, Alternet, the Guardian Online, Media Matters for America, Think Progress, Campaign for America’s Future and elsewhere.  I am the proud father of three future progressive activists, an accomplished rapper and karaoke enthusiast.

Is Your Workplace Wellness Plan Worth the Risk?

Tuesday, April 5th, 2016

Tina Bio picAs healthcare costs continue to soar, many employers are using wellness programs as a way to help curb their costs. In addition, employees who enroll in wellness programs also enjoy the program’s great health incentives and rewards, however, unbeknownst to them, the personal information collected may also be used for other undisclosed financial or discriminatory purposes.

This is important as the Americans with Disabilities Act (ADA) generally protects employees from discrimination based on health status or disability. The ADA specifically prohibits employers from generally requiring mandatory health examinations and also prohibits the disclosure of an employee’s protected health information. However, these exams are allowed if they are part of a voluntary employee health program or if classified as a “business necessity.”

The U.S. Equal Employment Opportunity Commission (EEOC), or the federal agency that enforces these federal laws also recently raised concern about wellness programs

and published a Notice of Proposed Rulemaking (NPRM) explaining how ADA applies to employer wellness programs that are also apart of group health plans. The NPRM explicitly prohibits employers from requiring employees to participate in a wellness program and also prevents the employer from disciplining or denying health coverage based on refusal. Although other federal laws prevent discrimination, the existing laws only apply to certain wellness programs under certain circumstances and as a result, some employers allow wellness program companies to share and use an employee’s information. Therefore, the proposed rule would not only help align federal laws to cover most wellness plans but would also require confidentiality and provide employees notice on how information is used and collected.

In a recent example, Houston city employees who participated in a wellness program were required to disclose their disease history, blood pressure, weight, drug and seat belt use to a wellness company. However, unknown to the employees, the contracted wellness company was also permitted to share the data with “third party vendors acting on [their] behalf.” Although the employees were permitted to refuse or opt out of the screening, they were subject to a $300 a year penalty for medical coverage. Therefore, the employees who “voluntarily” participated in the program in order to avoid the penalty, also unknowingly waived their privacy rights as the information shared could lead to discrimination by employers, lending institutions or even life insurance companies.

In another example, an employer required an employee to submit to medical testing and assessment in connection with a wellness program or “face dire consequences.” When the employee refused to comply with the mandatory program, the employer shifted responsibility for the payment of her entire health insurance premium and ultimately fired the employee shortly thereafter. This initiative unfortunately has many unintended consequences and as the Regional Attorney for the EEOC in Chicago noted, “having to choose between responding to medical exams and inquiries — which are not job-related — in a wellness program, on the one hand, or being fired, on the other hand, is no choice at all.”

While wellness programs have positive effects on employees and the workplace in general, these programs should not provide barriers to healthcare benefits or force penalties on those who cannot participate. Instead, these programs should also provide alternatives for employees who have disabilities and should not be implemented as a new way to determine insurance premium rates.

Another closely connected issue relates to privacy and the disclosure of employee data. Data companies such as Castlight Health, praised for their ability to help inform smarter decisions, are being hired by employers or wellness program companies to handle and process employees’ data. Whether it is being used, correctly or incorrectly, to identify which employees are likely to get sick, have surgery or get pregnant, these companies are using personal data and third party healthcare apps to monitor an employee’s personal information. However, even more concerning is how unregulated access to big data is.

Although some may think that the Health Insurance Portability and Accountability Act (HIPAA) applies, the privacy rule in HIPAA only applies or protects an individual’s identifiable health information held by either a covered entity or business associate. Therefore, depending on how the wellness program is administratively structured and whether the wellness program is offered as part of a group health plan, the identifiable health information may or may not be protected under HIPAA rules.

While some employers have structured wellness program incentives to comply with some federal laws, the exceptions in others have made achieving privacy while protecting civil rights difficult. Despite the EEOC’s best efforts to strike a balance between encouraging workplace wellness plans and compliance with federal laws, the “results appear to please no one, as the EEOC’s efforts to ensure only voluntary disclosure of private health information…drew sharp criticism from agency stakeholders.” In addition, despite legislation such as the “Preserving Employee Wellness Programs Act” introduced by Representative John Kline to offer clarity on incentives consistent with the ACA final rule not violating the ADA, the effect of these promulgated rules remains unknown as poorly designed wellness programs continue to have unintended consequences.

Although wellness programs offer attractive health and wellness benefits, until the various issues with discrimination, data privacy, and uniformity with all federal laws are addressed, employees may still be at risk of discrimination.

Tina Jadhav is an attorney barred in Maryland. Tina is actively involved in health law as a member of the American Health Lawyers Association as well as the American Bar Association-Health Law section. Tina recently earned her Law and Government LL.M. degree from American University Washington College of Law in 2014 and her Juris Doctor degree from Florida Coastal School of Law. Tina also served as a Health Policy Fellow for U.S. Senator John D. Rockefeller IV, Legal Intern at Inova Health System Office of General Counsel and the Office of the Attorney General for Commonwealth of Virginia.

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