Posts Tagged ‘health care’
Monday, May 20th, 2013
If you don’t already know, the Affordable Care Act (“ACA”), a/k/a Obama Care, does not take effect all at once. (I say “if you don’t already know,” because a recent poll shows that 42% of Americans are unaware that Obama Care is currently the law of the land).
Title I of the Act, which is considered one of the most controversial parts of the Act, does not take effect until next year. Once it takes effect, employers may not make employment decisions based on an employee’s health care decisions. Employers will, of course, make decisions that impact employees negatively, because the ACA will increase employers’ costs and responsibilities associated with health care. This is why employees need to be aware of their new rights.
You have probably heard about the many employers who have started cutting employee hours to evade having to comply with Obama Care. If you’re one of them, you’re out of luck. The law doesn’t protect you yet.
Starting on January 1, 2014, an employer may not retaliate against you based upon your health care selections. Specifically, an employer cannot terminate, demote, discipline, intimidate, threaten, deny benefits or promotion, reduce pay or hours, blacklist, or fail to hire an employee based on the fact that the employee:
- Provided information relating to any violation of Title I of the ACA, or any act that he or she reasonably believed to be a violation of Title I of the ACA to the employer, the Federal Government, or the attorney general of a state;
- Testified, assisted, or participated in a proceeding concerning a violation of Title I of the ACA, or is about to do so;
- Objected to or refused to participate in any activity that he or she reasonably believed to be in violation of Title I of the ACA; or
- Received a credit under section 36B of the Internal Revenue Code of 1986 or a cost sharing reduction under section 1402 of the ACA.
If an employer retaliates against you for engaging in any of these activities after January 1, 2014, you may file a complaint with the Occupational Health and Safety Administration(“OSHA”). OSHA has a broad range of powers to help employees combat the “evildoer” employers, including the powers of investigation, enforcement, negotiation, settlement, and the ability to award damages. The employee’s first, and critical step, is to file a claim with OSHA within 180 days from the date of retaliation.
Unlike most employment discrimination cases, the standard for proving retaliation in these cases is much more employee-friendly. You only need to demonstrate you had a reasonable belief that the employer was retaliating against you. Further, you will only need to provide evidence that your health care decision was a factor in the retaliation, not the only factor in retaliation. Hopefully, employers will have a much more difficult time defending against these types of discrimination cases. With any luck, this will deter them from violating the ACA in the first place.
This article was originally printed on Screw You Guys, I’m Going Home on May 10, 2013. Reprinted with permission.
About the Author: Ryan Price is an Associate Attorney at Donna M. Ballman, P.A., Employment Advocacy Attorneys.
Friday, July 27th, 2012
LOS ANGELES—At a conference convened by the organization Reporting on Health at the University of Southern California this week, doctors and health care experts shed light on labor-related aspects of the health care field as the sweeping health care reform legislation is set to take effect after being upheld by the U.S. Supreme Court.
They provided a window into the workplace stresses and challenges doctors themselves have faced in our tumultuous and trouble-plagued health care system, and also the health care needs and challenges of low-income workers.
Marcia Sablan, a doctor in the tiny northern California town of Firebaugh, embodies both of these narratives. Marcia is one of many doctors who depended on a federal program that helps people afford medical school in exchange for working in under-served rural districts. After her residency at the University of Hawaii, she was assigned to Firebaugh, in the agricultural valley of Fresno County, with a population then of just over 3,000. She was accompanied by her husband, also a doctor and the first native of Saipan to graduate from a U.S. medical school.
Panelists at the conference noted that such programs will be increasingly important if the government wants to encourage more doctors to go into general primary care rather than becoming specialists. Specialists make an estimated $3.5 million more over their lifetimes, yet there will be an estimated shortage of 30,000 primary care doctors in coming years especially as more people become insured under the new health care law.
Sablan arrived in Firebaugh in 1981 and eventually founded her own private practice there, where she primarily serves low-income Latino farmworkers, about half of them immigrants, including many uninsured people who may or may not end up insured under the health care bill reforms. Doctors and experts at the USC conference echoed the widespread concern that due to the way the health care reform bill and Supreme Court decision played out, people living under the poverty line may not get insurance under the new law. That’s because the insurance exchanges and subsidies the law mandates are designated for people who make more than the poverty line, while people making below the poverty line (including childless adults —a change from the past) are all supposed to be covered by Medicaid.
States are ordered to expand their Medicaid programs to cover people making up to 133 percent of the poverty line, but the mandate doesn’t have strong teeth since it is unclear if or how the federal government can punish states that don’t expand their Medicaid programs to cover the newly eligible people. Many states say they cannot afford their share of the expansion plus the extra costs expected when currently eligible but un-enrolled people “come out of the woodwork” thanks to the publicity around the reform law.
Sablan notes that she never asks her patients about immigration status—she is not required to under California’s Medicaid law—and she typically charges a $50 fee which most patients pay out of pocket.
“Undocumented workers know not to leave a trail, not to leave bills,” she said.
But when her patients need specialty care, the seasonal nature of farm work can cause serious problems. Many of them do have insurance during the months they are employed, but not during the off-months, she said. In her early years in Firebaugh, many of the locals were migrant workers living in labor camps who returned to Mexico or otherwise left Firebaugh for half the year. But the labor camps have been demolished and now many farmworkers have bought homes and live year-round in the town with their families, even as they continue to depend on seasonal agricultural wages. Hence an illness or injury that keeps them away from work for days or weeks during the crucial seasonal employment period is especially devastating financially.
“What does an agricultural-based seasonal economy mean to a doctor practicing there?” Sablan asked, noting that Firebaugh’s population now numbers 6,741: 88 percent Latino, 22 percent living below the poverty line, more than a third unemployed and almost two-thirds without a high school diploma. “It means people have insurance and Medi-Cal (California’s version of Medicaid) at certain seasons of the year. But we know diseases don’t work like that. So this is a huge problem for us—seasonal workers have a very difficult time keeping up with chronic diseases.”
From a health perspective, Sablan is glad to see the valley’s once-thriving cotton industry decline, she said, since it involves heavy pesticide use that raised serious health problems for workers and other residents. Once she treated victims of what was known as the worst pesticide-poisoning case in state history—28 workers critically poisoned after being ordered to return to a field too soon after it had been sprayed with phosphates. Now almonds and pistachios are the main crops in the area, grown mostly by huge industrial farms. (Meanwhile a sustainable cotton project has been in the works.)
Sablan hopes the health care reform law will indeed result in better preventative care for low-income and currently uninsured people. She cites the case of one patient, a 54-year-old farmworker who had a heart attack and was prescribed medication which, at $400 a week, he could never afford. Also suffering from diabetes and lacking medication, he eventually had another heart attack and ending up needing permanent dialysis by age 60.
“When you think about the Obama plan, think about [the farmworker] – do we want to be upstream or downstream?” in health care spending, she asked. “Someone paid for him to be in the hospital two times and on dialysis, which costs about a million dollars a year. He’s totally disabled now, unable to work, from what should have been a preventable situation.”
Despite such challenges, Sablan and her husband feel lucky to work in an environment where they have treated three generations of patients —it gives them a sense of personal connection and continuity that other doctors say they lack when forced to see up to 30 patients a day, in the common “fee for service” health care model.
Dr. Ken Kim described the challenges of working in a typical profit-driven, urban system. He and other internists were disgusted to see how badly many of their patients were faring under the standard health care model. He described multiple diabetic patients with legs amputated because they were shuffled between specialists, waiting for months for appointments, while a “pin-sized” wound became infected and festered. And he described elderly patients unable to comply with a doctor’s orders because they lacked a ride to the clinic or couldn’t open medicine bottles with arthritic hands or ate high-sodium meals as shut-ins. Doctors and nurses want to help such patients with personalized care, he indicated, but the fee-for-service model and other aspects of the traditional insurance system create so much time pressure that patients fall through the cracks.
So Kim and other doctors formed an “accountable care organization” (ACO) wherein insurance companies like Blue Cross pay the organization a flat fee to provide care for a certain group of the insurance companies’ enrollees. Kim said that after floundering at first, the company, CareMore, where he now serves as chief medical officer, was able to provide holistic, preventative care to a patient base of mostly ailing senior citizens by subverting the fee for service model, focusing on prevention and making sure the various nurses and doctors working with a given patient communicate and develop a cohesive plan. He said that under their organization rates of hospital readmissions, amputations, mortality and other indicators have decreased drastically. Many hope this type of accountable care organization will become more common under the health reform law.
While the general public is obviously confused about the implications of the health care reform bill, doctors and health care experts are also uncertain about how the law will play out and what it will mean for their own work lives and those of their patients.
This blog originally appeared in Working In These Times on July 26, 2012. Reprinted with permission.
About the author: Kari Lydersen, an In These Times contributing editor, is a Chicago-based journalist writing for publications including The Washington Post, the Chicago Reader and The Progressive. Her most recent book is Revolt on Goose Island.
Friday, September 16th, 2011
To wax a bit conservative for a moment, while this Felix Salmon / Pedro da Costa thought experiment is fun, it’s simply not the case that “With $2 billion, you could employ 40,000 people for a full year at $50,000 each.” You’d have to pay Social Security tax, Unemployment Insurance, etc. Plus you’d probably have to carry all kinds of liability coverage. Depending on where you’re located there’s be other state/local stuff to deal with.
Then to wax back progressive again comes the big whopper: Health care. There’s a huge health insurance shaped wedge between what you think you make and what your employer thinks he’s paying you. To provide health insurance coverage to 40,000 people costs a lot more than $0. Ironically, if you were talking about paying your employees, less this wouldn’t necessarily be a problem as they’d be eligible for Medicaid. You’d be creating quintessential low-wage “bad jobs,” but you’d at least be creating a lot of them. But once you have the kind of workforce needs where you want to offer a decent wage, you’re either going to be restricting your pool to people who can get insurance through their spouse or else you have to tack a large extra employment cost onto the bill. What’s more, you’re bearing a weird kind of risk since if over time the cost of the insurance plan increases faster than your firm’s revenue and that causes you to make the plan less generous to your employees they’re going to view that as a mean cut in benefits that you initiated.
America got derailed from a long-term growth conversation by a financial crisis and a recession. Then we got derailed from a short-term jobs conversation by a ginned-up budget crisis. People in the know recognize that the health costs piece is critical to the budget issue, but the reality is that health care is critical to the long-term fate of the federal budget primarily because it’s critical to the long-term fate of the economy as a whole.
This post originally appeared on Think Progress on September 15, 2011. Reprinted with permission.
About the Author: Matthew Yglesias is a Fellow at the Center for American Progress Action Fund. He holds a BA in Philosophy from Harvard University. His first book, Heads in the Sand, was published in May 2008 by Wiley. Matt has previously worked as an Associate Editor at The Atlantic, a Staff Writer at The American Prospect, and an Associate Editor at Talking Points Memo. His writing has appeared in The New York Times, the Guardian, Slate, The Washington Monthly, and other publications. Matthew has appeared on Fox News and MSNBC, and been a guest on many radio shows.
Tuesday, August 2nd, 2011
Summer is a sleepy time at the Supreme Court as most of the justices exit the scorching Washington heat. Justice Stevens was known to keep busy on the tennis court while Justice Thomas often heads around the country in his RV. As for Justice Kennedy, he regularly teaches abroad and others hit the speaking circuit.
So the quiet period between late June and the first Monday in October, when the annual case argument schedule begins, presents vacation opportunities for those who cover the Court as well. But while little attention is paid to the Court during its annual “siesta,” appeals can and do get filed during this lull.
Amidst the hoopla over the debt-ceiling crisis, one of those appeals not surprisingly went almost unnoticed. In fact, it rated no better than a minor story on page A-18 buried in a recent edition of The New York Times. This appeal, though, will be front-page news if the justices choose to accept the case. That’s because it marks the first legitimate challenge to the new health care law, the Patient Protection and Affordable Care Act.
On July 27th, a petition was filed challenging a recent Sixth Circuit decision which upheld the constitutionality of the law. The 2-1 decision was notable because the Cincinnati-based appellate court tends to be conservative, and one of the judges in the majority was Jeffrey Sutton, a one-time law clerk with Justice Scalia.
While there have been a number of federal district court rulings on the health care law in the past year, the Sixth Circuit stands by itself as the lone appellate court to have addressed the issue. The Supreme Court typically agrees to hear a case only after there has been a circuit split among the appellate courts. But that does not mean the health care law’s supporters should take comfort that the justices will necessarily sidestep this appeal.
Cases such as Citizens United and the more recent Wal-Mart opinion are clear examples of the Court reaching out to decide hot-button disputes in the absence of a circuit split. And Chief Justice Roberts’ famed line about “wanting to decide cases on the narrowest grounds possible,” has not always matched his record or that of his colleagues. That’s a fact of which the appellants are well aware.
So there is reason to believe the Supreme Court could wade into the health-care controversy, and sooner rather than later. In fact, if the justices decided to grant this challenge, a ruling could come down late next spring as the 2012 presidential campaign season approaches its apex.
If there is one thing I learned from covering the Court for more than a decade, it is that predicting outcomes there is sometimes only slightly easier than taking your chances in Las Vegas or Atlantic City. Few people are privy to what the justices really feel, and journalists are hardly among them.
But if the justices upon their return to Washington take up the appeal of this Sixth Circuit ruling in the absence of a conflict, chances are they are not doing so to affirm the outcome. No matter what the result, however, it will have obvious ramifications for what health plans employers offer to their employees going forward.
Supreme Court review of some sort on the health care law eventually seems inevitable. But if it happens at this still relatively early juncture, another partisan battle is a near certainty. And things at the nation’s highest court will be quiet no longer.
About the Author: David Weisenfeld served as U.S. Supreme Court correspondent for LAWCAST from 1998 through June 2011. During that time, he covered every employment law case heard by the Court, and also wrote and co-anchored the company’s employment law newscasts. In addition, his work has appeared in the American Bar Association’s Supreme Court Preview magazine.
Tuesday, July 5th, 2011
Rite Aid workers from seven states last week rallied against management’s plan to make employees pay more for their healthcare and to show support for a 15-week “unfair labor practice” strike by Rite Aid employees at seven stores in Cleveland, Ohio. With strong support by the Pennsylvania AFL-CIO, United Students Against Sweatshops and the Harrisburg-area labor movement, the spirited rally took place immediately before the company’s annual shareholder meeting on June 23, 2011.
After the rally (video below), about 15 Rite Aid workers and union reps attended the shareholder meeting to voice their concerns directly to Rite Aid’s Board of Directors and top executives. Inside the meeting, I presented a shareholder proposal opposing management’s policy of paying the tax liabilities on its golden parachute deals with senior executives.
Christina Frymier, a striking Rite Aid worker from Cleveland, was the first to address CEO John Standley and the board of directors during the question and answer period. “I’m on strike because Rite Aid is trying to make our healthcare so expensive that nobody will be able to afford it. Rite Aid does most of its business with customers who are very much like me.” She continued:
When I talk to customers and tell them what Rite Aid is doing, they are angry, upset. They take their prescriptions and their business to CVS and other pharmacies. If the people who shop at Rite Aid’s 4,700 stores learn that management is trying to deny health care to its employees, Rite Aid’s reputation will be harmed. Do you really want to allow your management to continue on a path that will hurt Rite Aid’s business nationwide?
Frymier was followed by UFCW Local 1776 member Donna Weber, a 16-year veteran at Rite Aid’s Tobyhanna, Pa., store. Weber, a pharmacy technician, described how the company has cut staffing to dangerously low levels.
Weber compared the executive’s huge salaries and benefits – including free use of the corporation’s jet for their personal use – to the reality she faces in the store. “Many days I’m working on the phone with insurance companies to resolve a customer’s prescription problem while other customers are waiting to be checked out,” Weber said. “These jobs take a lot of concentration. It seems that if we can afford these high executive salaries and a free jet plane we should be able to adequately staff our stores.”
Referring to ongoing negotiations for a new contract, Weber said, “We shouldn’t have to choose between health care or food for our families.”
Weber was followed by Local 1776 President Wendell W. Young, IV, who described how 3,000 Local 1776 Rite Aid members in Pennsylvania have worked for nearly three years under the terms of an extended contract because the company is insisting that workers assume an impossibly high portion of the cost of their health care benefits.
“We are calling on Rite Aid to bargain in good faith to reach agreements on new contracts,” said Young, who called the company’s behavior, “wrong at a time when the loyal men and women of Rite Aid have worked so hard to help the company weather this economic down turn and contributed to its growth throughout the past four decades.”
“The solidarity rally and action at the shareholders meeting in Harrisburg sent a message to the Board of Directors and top managers that shifting the burden of healthcare benefits to Rite Aid workers—and taxpayers—won’t solve their financial problems or make the company profitable,” said UFCW Local 880′s director of collective bargaining Carl Ivka, who is leading the strike at seven Rite Aid stores in Ohio.
Rite Aid workers from the International Longshore & Warehouse Union, SEIU 1199, Teamsters and UFCW have attended three previous shareholder meetings.
Rite Aid workers’ union summit
The day before the annual meeting, Rite Aid union leaders met for a national summit to share information and develop common strategies for dealing with the company’s plan to shift health insurance costs to workers and taxpayers.
The meeting was attended by Rite Aid leaders from the 1199 SEIU, International Longshore & Warehouse Union (ILWU), RWDSU, UFCW Local 21, UFCW Local 880, UFCW Local 1360, UFCW Local 1776, and the UFCW International. Also on hand were supporters from United Students Against Sweatshops, Jobs with Justice, Change to Win and the AFL-CIO’s Center for Strategic Research.
In conjunction with the summit meeting, two leading workers’ rights groups released an “Investor Alert” on the mismanagement and corporate greed that has led to Rite Aid’s poor performance. The report is available from Jobs with Justice at and United Students Against Sweatshops.
Summit participants also celebrated the first contract victory by Rite Aid workers, who formed their union with ILWU Local 26 at the Lancaster, California Distribution Center more than five years ago. ILWU Organizing Director Peter Olney reported on the struggle by the workers to win their collective bargaining rights and a first contract.
“Winning our first union contract required a comprehensive campaign with customers and the community on the outside and strong leadership and rank and file action on the inside. Working together, we overcame vicious anti-union attacks and more than a year of surface bargaining by Rite Aid management. It took an incredible amount of perseverance, determination and creativity to win, but thanks to the support from everyone in this room and many more locals that couldn’t be here, we did it.”
Pictures from the summit meeting and the march and rally at the shareholders meeting are viewable on Flickr here.
This article originally appeared on the Working In These Times blog on June 30, 2011. Reprinted with permission.
About the Author: Rand Wilson is communications coordinator at the AFL-CIO Organizing Dept.’s Center for Strategic Research. He has worked as a union organizer and labor communicator in the United States since the 1980s. For more information about Wilson, visit http://en.wikipedia.org/wiki/Rand_Wilson
Thursday, January 13th, 2011
This morning, the Institute of Medicine began its second day of deliberations into defining what would constitute “essential health benefits” under the Affordable Care Act. Even though the law identifies general categories that insurers will have to cover beginning in 2014 — emergency services, mental health care, outpatient and inpatient care — these meetings are designed to help HHS reach more specificity on the issue. The agency is also required to ensure that the scope of essential health benefits “is equal to the scope of benefits provided under a typical employer plan.”
During the second session, John Kingsdale — the former director of the Massachusetts Connector Authority — predicted that defining “essential health benefits” will be “one of the more challenging parts in implementing the ACA” and warned the agency against “overreaching” in detailing which benefits insurers will have to provide:
KINGSDALE: The nation is highly divided by this and so whatever is put into the essential health benefits package that can be portrayed by those who tend to oppose ACA as unfairly burdening those employers or individuals, who want a different benefit package will be used as political fodder to tear down the ACA and I strongly believe that overreaching…could doom implementation. [...]
There is a tendency to think about benefits in the context of negotiation for something more someone else would pay for and I think it continually surprises people to understand, ‘oh there are real people who cannot afford what we consider to be an ideal benefit package and they actually have to pay for it in premiums. ….This was very much about giving people decent coverage as opposed to primarily a policy of it just being about raising the standards of coverage and it seems to me when you have to make close calls about benefits, it’s important to return to that principle. Secondly, obviously, most benefits cost dollars no matter what you will hear about how they will save money and that the ACA will live or die on affordability. And thirdly, that there is a fair degree of consensus about minimum benefit steps and so that you will find most states don’t even mention most of the things that are covered typically by commercial insurance and there are additionally very few benefits that significantly improve [inaudible] or save dollars. So, I think it’s not difficult to find that essential minimum benefits package and then, as you can tell from my other principles, I would advise you to be very conservative about adding on to it. [...]
My experience suggests revisiting and learning from cases and some flexibility and even phasing in would all be very helpful as you go down the path of defining a minimum benefit that will be extremely controversial.
Indeed, as CQ Healthbeat reported, it’s still unclear “if officials will seek a specific list of treatments or ask insurers to mirror benefits in particular plans, such as the Federal Employee Health Benefits Program.” Either way, they will have to balance Kingsdale’s suggestions with the concern that too loose of a definition would allow insurers to design plans differently — possibly even in such a way that would lead to adverse selection.
IOM will publish recommendations for HHS “by September, and HHS will issue its proposed rules by the end of the year, giving insurance companies time to adjust plans before the provisions take effect.”
This article was originally published on Wonk Room.
About The Author: Igor Volsky is Health Care Editor for ThinkProgress.org and The Progress Report at the Center for American Progress Action Fund. He also writes on LGBT Equality issues. Igor is co-author of Howard Dean’s Prescription for Real Healthcare Reform. Prior to joining the Center, Igor blogged at BodyPolitik.org and interned with ThinkProgress, Fairness and Accuracy in Reporting (FAIR), and the Hudson River Valley Institute at Marist College. Igor grew up in Russia, Israel, and New Jersey. Igor has appeared on MSNBC, CNN, Fox Business, and CNBC television, and has been a guest on many radio shows.
Monday, December 20th, 2010
Politifact, the fact-checking web site of the St. Petersburg Times, announced the biggest lie of 2010. But it doesn’t stop there, the NYTimes, FactCheck.org and a number of other experts agree with Politifact’s analysis.
The lie? That the government will be taking over health care.
I’ll leave it to Politifact to debate the “why.” I’m more interested in the “how” and what we can learn from this that will help us to survive today’s challenging workplace.
Repetition was probably the one factor that pushed this phrase to the top of the list. In 2010 alone, “government takeover” was mentioned 28 times in the Washington Post, 77 times in Politico and 79 times on CNN. Add to this countless times on a variety of congressional and activist web sites.
Beyond your beliefs about health care, and the politics surrounding, is one simple fact, views can be shaped by a message being said over, and over, and over again.
Which reminds me of a previous blog that I wrote about Google. Remember, Google is not an arbiter of what’s true or not true, it’s fancy algorithms only can tell you what’s popular.
If you’ve ever locked horns with a nemesis at work, you’ll learn this lesson painfully. When someone has a lot of anger and time, they can do a huge amount of mischief at work by simply repeating something over and over again.
Which is why when someone starts spreading a mistruth about you at work, you need to respond to it. Because what could seem outrageous to everyone today, can become a “health care takeover” juggernaut in just a matter of days.
Listen to the grapevine. And take out your pencil to try to erase the parts that aren’t true, while you still can.
I’d hope that most of you don’t take this as a strategy to get ahead, but rather as insight about the dynamics of how negative messages can resonate. And more importantly, how their damage can be limited.
About The Author: Bob Rosner is a best-selling author and award-winning journalist. For free job and work advice, check out the award-winning workplace911.com. Check the revised edition of his Wall Street Journal best seller, “The Boss’s Survival Guide.” If you have a question for Bob, contact him via email@example.com.
Monday, October 25th, 2010
Okay, the election is right around the corner. The purpose of this column is not to tell you who to vote for, or even what to vote for. It’s simply to try to help you to clarify what is important to you. If I do a good job, you won’t even know my political leanings.
Foreclosures — Do you think that the cash support should go to the bankers or the people being foreclosed on? Ironically words like responsibility can be applied or not applied to both sides of this equation.
Sure we’re all mad at the banks. They took huge risks, kept their profits and stuck us with their losses. Which candidates are most inclined to hold the banks accountable? And which candidates are inclined to take contributions from said bankers? The rhetoric isn’t as important as the money flows, in my humble opinion.
Health Care — Health care is another popular political piñata today. Do you long for the old system of health care? Or do you think it makes sense to have someone looking over the insurance companies’ shoulders?
The wars — Is this a question of pride and winning or is it more of an issue of cutting our losses?
Unemployment assistance — 99 weeks does seem like a long time to get help for being unemployed. Too many too long. But if you know people who’ve been out of work that long, you know the struggle that they’re facing.
Political theater or political action — Which candidates are inclined to roll up their sleeves and work to get things done?
This shouldn’t be done from the hip. Definitely take out your voting pamphlets and do some research on your options. Your steady hand is needed on the ship of state’s rudder.
About The Author: Bob Rosner is a best-selling author and award-winning journalist. For free job and work advice, check out the award-winning workplace911.com. Check the revised edition of his Wall Street Journal best seller, “The Boss’s Survival Guide.” If you have a question for Bob, contact him via firstname.lastname@example.org.
Wednesday, April 14th, 2010
A Massachusetts court yesterday blocked premium increases—some as high as 40 percent—sought by six state health insurers. The action by the Suffolk Superior Court was the second time the insurance companies’ bid to boost rates was rejected. The state Division of Insurance rejected the rate hikes last month, calling them “excessive.”
The insurance companies then filed suit claiming the state has no authority to block the premium increases and sought an injunction to prevent the state from regulating premiums until the suit comes to trial. The judge rejected the request.
In an interview with the Boston Globe, Gov. Deval Patrick (D) praised the court’s decision.
Unless insurers can give us a good reason, when everything else is flat, that they deserve 20 percent, 30 percent and in some cases 40 percent increases, they’re going to be denied.
The judge said the Massachusetts companies must exhaust all their administrative appeals within the Insurance Division before the suit over the state’s ability to regulate premium costs can go forward.
The case is drawing national attention because, in 2006, Massachusetts passed a health care reform law that has several similar provisions to the recently enacted national health care reform law, including regulating premium increases.
In February, when Anthem Blue Cross in California announced it was raising premiums by as much as 39 percent, Secretary of Health and Human Services Kathleen Sebelius said, “Too many Americans are at the whim of private, for-profit insurance companies.”
Anthem Blue Cross’ parent company, WellPoint, posted $4.9 billion in profits in 2009. Sebelius said health insurance companies like WellPoint “are raking in billions in profits each year, while policyholders struggle to make ends meet in this tough economy.” In a letter to Anthem President Leslie Margolin, she demanded the company provide justification for the increases.
The extraordinary increases are up to 15 times faster than inflation. Your company’s strong financial position makes these rate increases even more difficult to understand.
Following public outcry, the company agreed to postpone the rate hikes until May, pending a review by an outside actuary appointed by the state insurance commissioner.
*This article originally appeared in AFL-CIO on April 13, 2010. Reprinted with permission.
About the Author: Mike Hall is a former West Virginia newspaper reporter, staff writer for the United Mine Workers Journal and managing editor of the Seafarers Log. I came to the AFL- CIO in 1989 and have written for several federation publications, focusing on legislation and politics, especially grassroots mobilization and workplace safety. When my collar was still blue, I carried union cards from the Oil, Chemical and Atomic Workers, American Flint Glass Workers and Teamsters for jobs in a chemical plant, a mining equipment manufacturing plant and a warehouse. I’ve also worked as roadie for a small-time country-rock band, sold my blood plasma and played an occasional game of poker to help pay the rent. You may have seen me at one of several hundred Grateful Dead shows. I was the one with longhair and the tie-dye. Still have the shirts, lost the hair.
Tuesday, March 23rd, 2010
The President signed the Senate health care bill into law at noon today.
This year, over 4 million small businesses will get tax credits worth up to 35% of their health care costs. This year, seniors will get $250 towards closing their coverage donut hole. This year, young Americans will be able to stay on their parent’s insurance plan until they are 26. This year, lifetime caps on benefits will be a thing of the past. And this year, the people with pre-existing conditions who can’t get health care now at any price will be able to buy into high-risk pools until the exchanges are set up in 2014.
But we are not done. Right after the House passed the health care bill on Sunday, they passed a package of improvements that now head to the Senate for an up-or-down vote.
The fixes heading to the Senate are mostly focused on making health care affordable to middle class families.
First, the package vastly improves the excise tax on “Cadillac” insurance plans, raising the threshold at which a plan will be affected to $10,200 for individual plans and $27,500 for family coverage. It also delays the implementation of the tax until 2018. As a result, the burden on middle tax families will be dramatically reduced.
To make up for the loss in revenue, the fixes broaden the Medicare payroll tax on on rich investors, taxing net investment income for those who make more than $250,000 per year.
And second, the package increases the subsidies available in the exchanges for middle class families and lowers their cost sharing. With the package, a lower percentage of a family’s income will be spent on health care costs – both premiums and out of pocket.
And there are more provisions in the package that would help broad swaths of the American public:
- The package fully closes the donut hole for seniors over time
- It freezes Medicare Advantage overpayments to private insurers and requires private insurers to pay 85% of money in to benefits in Medicare Advantage, to match the levels for all insurance plans in the health care bill
- It strikes the deals Senators like Ben Nelson received and replaces them with increased Medicaid funding to all states
- And it funds student loans for millions of young Americans
The Senate, after a string of favorable parliamentary rulings, is expected to take up the improvements under budget reconciliation rules today, with the goal of a final vote at the end of this week before the Easter recess.
*This post originally appeared in Health Care For America Now on March 23, 2010. Reprinted with permission.
About the Author: Jason Rosenbaum is a writer and musician currently residing in Washington D.C. He is interested in the intersection of politics and culture, media consolidation issues, and making sense out of our foreign policy disasters. He currently works for Health Care for America Now and he is also the webmaster for The Seminal.