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Posts Tagged ‘health care’

Pelosi brokers deal with liberals on drug pricing bill

Wednesday, December 11th, 2019

Sarah FerrisAdam CancrynHouse Democratic leadership on Tuesday clinched a deal to win progressive leaders’ support for a sweeping drug pricing bill that could clear its path for passage in the full House on Thursday.

The pact between Speaker Nancy Pelosi and progressive leaders includes an agreement to expand the government’s authority to directly negotiate drug prices under the legislation, ultimately requiring federal officials to hammer out the cost of at least 50 medicines a year, from the original 35.

“We’re likely to see the minimum number lifted, probably to 50,” said Michigan Rep. Dan Kildee, a member of Pelosi’s whip team. “My impression is that progressives will be good on this.”

Top Democrats are also restoring a progressive provision previously cut from the bill that would mandate the federal government eventually issue regulations restricting drugmakers’ ability to raise prices above the rate of inflation in workplace health plans, the largest source of coverage in the country.

The House Rules Committee later Tuesday night approved, 8-3, the rule that sets up debate on the bill, putting it on track for floor consideration. The panel also permitted a separate vote on Republicans’ bill, a measure GOP lawmakers have championed this week as a bipartisan alternative.

The chamber’s liberal wing had threatened to stall Pelosi’s bill if she refused to make a series of last-minute changes to the legislation, throwing the fate of Democrats’ top health care priority into doubt.

But the two sides brokered a tentative resolution this afternoon during a closed-door meeting that included Pelosi and Congressional Progressive Caucus co-leaders Pramila Jayapal (D-Wash.) and Mark Pocan (D-Wis.).

Jayapal called the deal a “huge win,” adding in a statement that “it shows what we can do when we stick together and all push hard for the American people.”

The changes represent a major victory for progressive leaders following a rare public showdown with Pelosi. They also come just one day after Pelosi and other senior Democrats warned progressive members against taking a hard-line stance on the bill.

Democratic leaders had long resisted making changes to the legislation that would push it further to the left, in part due to fears it could cost support from the dozens of moderate lawmakers key to keeping control of the House.

Many of those Democrats campaigned on lowering drug prices, and had pressed for weeks for a vote on the drug bill before the end of the year — while also warning against any last-minute efforts to make it more ambitious.

Yet top Democrats enraged progressives last week after eliminating the language authored by Jayapal that would have expanded certain price restrictions into the private sector, sparking talk of a rebellion aimed at tanking a procedural vote needed to put the bill on the floor.

In public, Democratic leaders this week expressed confidence that the bill could pass as originally written, insisting that it already represented “transformational” step toward slashing drug prices and that liberal lawmakers’ opposition would eventually collapse.

But Democratic leadership internally took the prospect of mass defections seriously, discussing it at several closed-door meetings on Tuesday.

Before leadership altered the bill, Rep. Alexandria Ocasio-Cortez told reporters Tuesday she would vote no on the legislation without changes. Rep. Lloyd Doggett, an outspoken critic of the bill as far too timid, had also previously threatened to vote against it. And progressive leaders in recent days warned they had enough votes to stop the key Democratic priority in its tracks with just days left on the congressional calendar this year.

Few if any of the chamber’s Republicans are expected to support the package, and it won’t get any traction in the GOP-controlled Senate. The White House on Tuesday issued an official veto threat against the House bill.

Sarah Owermohle contributed to this report.

This article was originally published by the Politico on December 10, 2019. Reprinted with permission. 

About the Author: Sarah Ferris covers budget and appropriations for POLITICO Pro. She was previously the lead healthcare and budget reporter for The Hill newspaper.

A graduate of the George Washington University, Ferris spent most of her time writing for The GW Hatchet. Her bylines have also appeared at The Washington Post, the Houston Chronicle and the Center for Investigative Reporting.

Raised on a dairy farm in Newtown, Conn., Ferris boasts a strong affinity for homemade ice cream, Dunkin Donuts coffee and the Boston Red Sox.

About the Author: Adam Cancryn is a health care reporter for POLITICO Pro. Prior to joining POLITICO, he was a senior reporter for S&P Global Market Intelligence, covering the intersection of money, politics and regulation across the financial services and insurance industries. He’s also written for The Wall Street Journal and Dow Jones Newswires, and got his start at the Philadelphia Business Journal.

Adam is a graduate of Washington & Lee University and a proud New Jersey native.

Medicare for All’s jobs problem

Tuesday, November 26th, 2019

Rachana PradhanDeanna Mazur, the daughter of a retired steel mill worker who works as a medical billing manager, finds some things to like about the “Medicare for All” policy that she’s been hearing politicians talk about. She likes the notion that all Americans would have health insurance. And it would simplify her own job quite a bit if there were only one place to send medical bills, instead of the web of private companies and government programs that she deals with now. “It would definitely be easier,” Mazur says.

Then again, if it were that easy, her job might not exist at all.

Mazur’s job and those of millions of others have helped turn health care into the largest sector of the nation’s economy, a multitrillion-dollar industry consisting in part of a huge network of payers, processers, and specialists in the complex world of making sure everything in the system gets paid for. If the health care system were actually restructured to eliminate private insurance, the way Medicare for All’s advocates ultimately envision it, a lot of people with steady, good-paying jobs right now might find themselves out of work.

“What if my job doesn’t exist anymore?” she asked in a recent interview.

This question has particular resonance in this part of Pennsylvania, a must-win swing state in the presidential race, which has already seen massive job dislocation from the decline of manufacturing. As Pittsburgh’s iconic steel industry has been gutted, the city’s economy has been hugely buoyed by health care, which has grown into the region’s largest industry — employing about 140,000 people, or 20 percent of the regional workforce. The city’s former U.S. Steel complex is now, appropriately enough, the headquarters of a mammoth hospital system, one of two health care companies deeply entrenched in the city’s economy.

There are lots of health reform ideas that wrap themselves in the “Medicare for All” label, ranging from a single government-run system to plans that maintain a role for private insurance companies. But under the most ambitious schemes, millions of health care workers would be at least displaced if not laid off, as the insurance industry disappears or is restructured and policymakers work to bring down the costs of the system by reducing high overhead and labor costs. The reform proposals being promoted by Democratic presidential candidates have barely grappled with this problem.

Initial research from University of Massachusetts economists who have consulted with multiple 2020 campaigns has estimated that 1.8 million health care jobs nationwide would no longer be needed if Medicare for All became law, upending health insurance companies and thousands of middle class workers whose jobs largely deal with them, including insurance brokers, medical billing workers and other administrative employees. One widely cited study published in the New England Journal of Medicine estimated that administration accounted for nearly a third of the U.S.’ health care expenses.

Even if a bigger government expansion into health care left doctors, nurses, and other medical professionals’ jobs intact, it would still cause a restructuring of a sprawling system that employs millions of middle-class Americans.

Claire Cohen, a Pittsburgh-based child psychiatrist, voted for Bernie Sanders, the architect of the most sweeping version of Medicare for All, in the 2016 Democratic presidential primary. She says the national discussion about single payer and its overwhelming focus on paying higher taxes or losing private insurance misses the point ? she argues individuals would see greater benefit from a health care system without premiums, copays and other costs that increasingly make health care out of reach. But the question about jobs, she says, is a “legitimate” issue ? one she says people haven’t completely thought through.

“You don’t want to leave all these people in the lurch without jobs,” Cohen said.

Having it both ways

The idea of one national health plan covering all Americans has steadily grown more popular in public opinion polls over time, a sea change that coincides with Medicare for All becoming near orthodoxy for progressive Democrats. Prior to 2016, when Sanders made it the linchpin of his insurgent run for president, less than half of Americans supported setting up a such a system, according to Kaiser Family Foundation polling. Now, just over half of the public backs it.

When it comes to the costs of reform, taxes are the headline issue, and the movement’s advocates on the national stage ? Sanders and fellow Democratic presidential contender Elizabeth Warren, among others ? have largely had to defend Medicare for All against charges that middle-class taxes would have to go up to finance a new government-run system. But the question of what single-payer health care would do to jobs and the economy has largely been overlooked. In the past, Sanders has answered questions about the economic ramifications with vague claims about transitioning to other jobs in the health sector.

“When we provide insurance to 29 million people who today don’t have it, when we deal with the problems of high deductibles and copayments and more people get the health care that they want and they need, we?re going to have all kinds of jobs opened up in health care,” Sanders claimed during a 2016 CNN town hall when asked by a retired health insurance worker what would happen to jobs in the industry. “And the first people in line should be those people who are currently in the private health insurance industry.”

Economists dispute the extent to which this would occur. Robert Pollin, co-director of the Political Economy Research Institute at the University of Massachusetts-Amherst who has consulted with Sanders’ and Warren’s teams over Medicare for All, says that while people could be retrained for different jobs, there are no guarantees they’d work in the newly created government health care system, since one of the goals is to cut down on administrative overhead. “You can’t have it both ways. You can’t have savings through administrative simplicity and more jobs. The government won’t need these people,” Pollin said.

Health care workers are interwoven throughout the economy, employed by large institutions like hospitals, health insurance companies and nursing homes but also in places like small accounting firms that help clinicians get reimbursed for care, and as independent brokers who help sell insurance products to customers.

Mazur handles medical billing for physicians through Medicare, Medicaid and private insurance, the last of which is the most complicated. Under Medicare for All, “They don’t have to worry about, am I going to get paid for this service based on what insurance the patient has? It would be the same rules for everybody.”

In Pittsburgh, workers in the health care economy interviewed for this article weren’t necessarily against a single-payer system, even if it meant their work would be personally affected. But they did consistently say that Democratic candidates for president need to make the employment implications clearer.

Marc Schermer, a Pittsburgh-based insurance broker who sells health plans to individual customers as well as small businesses, says he’d likely experience a temporary setback but believes he’d manage since he sells other kinds of insurance, too. He even thinks single payer is an idea “he could get behind” because removing private insurance companies from the system would simplify things.

“I’m pretty well diversified so that if suddenly the ‘Medicare for All’ thing happened, and companies like United and Highmark and UPMC and Aetna were brushed aside, I would still have something to do,” Schermer said. “But there are a lot of people who are employed directly by those companies who would be up a creek.”

Medicare for All isn’t predicted to disrupt all job types and could even potentially benefit certain types of health care workers ? for example, by expanding the need for caregivers because of a proposed expansion of long-term care benefits. And Medicare for All would provide health benefits to tens of millions who are still uninsured, creating additional demand for doctors and other providers. Still, others are likely to be lost in the short term.

“We vilify the health care industry, but it provides jobs to a lot of people, and not just jobs for wealthy people but jobs for everyday people,” said Janette Dill, a researcher at the University of Minnesota who has studied the rise of health care-related employment among the working class. “That’s one thing it’s really good at.”

Health care jobs in Allegheny County, the region surrounding Pittsburgh, grew from roughly 90,000 in 1990 to around 140,000 this year, according to the Pennsylvania Department of Labor and Industry. Another 9,500 people work directly for health insurance companies and about 3,200 work for insurance agencies or brokerages, which includes people who sell health insurance policies.

The power of the health care industry in southwestern Pennsylvania is inescapable. Hospitals and clinics controlled by two competing health care behemoths, the University of Pittsburgh Medical Center and Highmark Blue Cross Blue Shield, dot Pittsburgh’s streets. The two companies have slowly moved in on the other’s territory and saturated Pittsburgh’s health care market, with the iconic UPMC brand operating a health insurance arm, and Highmark BCBS running the Allegheny Health Network system of hospitals and clinics.

Both companies declined to comment on the potential impact of Medicare for All on their workforces.

University of Massachusetts researchers who analyzed the 2017 version of Sanders’ Medicare for All bill estimated that nationwide more than 800,000 people who work for private health insurance companies and a further 1 million who handle administrative work for health care providers would see their jobs evaporate.

The workers generally earn middle-class wages, according to the November 2018 study forecasting the economic ramifications of Sanders’ plan. The median annual income of a worker employed in the health insurance industry is nearly $55,000; for office and administrative jobs at health care service sites, it’s about $35,000, researchers said.

“The savings don’t come out of the sky,” said Pollin. “The main way we save money is through administrative simplicity. That means layoffs. There’s just no way around it.”

Extra dollars, extra life?

Of course, the larger problem behind the question of job losses is just how much of the U.S. economy should be devoted to health care.

Economists say there isn’t a magic number for how large or small the health care sector should be. But they often express concern that the U.S. gets too little benefit for the amount of money it spends, with spending levels twice that of many other developed nations and actual health outcomes significantly lower. Much of that money goes to overhead, in the form of middlemen like insurers and the surrounding industries.

“The problem is you’re spending extra dollars right now, and it’s not at all clear you’re getting extra life for it,” said Katherine Baicker, a health care economist and dean of the University of Chicago’s Harris School of Public Policy.

Cutting those excess costs has appeal to economists, who prioritize efficiency and value for money. But politically it can be a challenge when what looks like an “excess cost” from a distance looks like a good-paying job to the person who holds it. Nationally, the growing health care sector was an economic bright spot even during the Great Recession, continuing to add jobs while others shed millions of workers, according to an analysis from the Bureau of Labor Statistics.

Medicare for All also wouldn’t be the first, nor likely the last, initiative that would cause economic upheaval for a major jobs engine. Baicker argues that the jobs piece isn’t a metric that people should use to judge whether single payer is worth it, because in a dynamic economy different sectors grow while others shrink.

“What you need is transition help for those people whose sectors are shrinking,” Baicker said. We may all be better off in the long run when we can produce all the food we need with many fewer people working in agriculture … that doesn’t mean that you can instantaneously turn a farmer into a software engineer or a nurse into a financial expert.”

There’s some precedent for federal programs that help individuals whose jobs have been upended because of broader economic policy decisions, including the Trade Adjustment Assistance program that helps workers displaced by global trade.

The latest Medicare for All bills in the House and Senate, championed by members in Democrats’ most liberal wing, include provisions addressing assistance for displaced workers. The House version spearheaded by Rep. Pramila Jayapal, a Democrat from Washington state, mandates that for up to five years at least 1 percent of the new health care program’s budget will be spent on efforts to prevent dislocation for health insurance administrative workers or individuals who perform related work at health care organizations.

“This happens every time there’s innovation,” said Jayapal, who co-chairs the House’s Progressive Caucus. “It happens with Lyft and Uber. It happens with movie cameras instead of still photographs. This is part of what happens as you make things better.”

Sanders’ legislation appears to be more limited. The bill allows — but doesn’t require ? that such assistance be provided to workers and caps the amount at 1 percent.

Even in Pittsburgh, not everyone is worried that a national health care law would gut the area’s leading industry yet again. When manufacturing declined in the 1980s in the region, “nobody really cared” and workers were just told to “suck it up” in response to job loss, said Ed Grystar, a longtime union organizer and chair of the Western PA Coalition for Single-Payer Healthcare.

Grystar, who says he spent most of his life negotiating contracts for nurses, says Medicare for All represents a “monumental shift for social justice” to help people access something they deserve. The current system, with its out of control prices and dysfunction, “can’t go on.”

As for the insurance jobs?

“Who cares if [insurance companies] go out of business?’’ Grystar said in an interview. “This is a net positive for society as a whole.”

This article was originally published by Politico on November 25, 2019. Reprinted with permission. 

About the Author: Rachana Pradhan is a health care reporter for POLITICO Pro. Before coming to POLITICO, she spent more than three years at Inside Health Policy focusing on implementation of the Affordable Care Act. Prior to that, Pradhan worked at The Daily Progress in Charlottesville, Va., and spent most of her time covering city government (with the occasional foray into stories on urban chicken-keeping and the closure of neighborhood pools).

Pradhan is a rare local of the Washington, D.C., area and graduated from James Madison University. She was also news editor of JMU’s student newspaper, The Breeze.

Southern Workers Unite Around Medicare for All: “A Tremendous Liberation From Your Boss”

Tuesday, November 19th, 2019

Image result for Jonathan Michels freelance journalist based in Durham, N.C."A line of cars rolls up to the government center of the largest city in a state tied with neighbor South Carolina for least unionized in the country. Members of the Southern Workers Assembly (SWA) emerge from the cars and join a picket line of Charlotte city workers. They hoist a banner declaring “The City Works Because We Do” and chant “What do we want? Medicare for All! When do we want it? Now!”

SWA is a coalition of worker committees and labor unions, including National Nurses United (NNU), the International Longshoremen’s Association, and United Electrical, Radio and Machine Workers of America. Members from across the South converged September 21 to kick off a campaign for the immediate passage of Medicare for All, known in the House as H.R. 1384.

Although unionized workers typically have access to some type of employer-based insurance (and often pay less in deductibles than nonunion workers), skyrocketing premiums and poor coverage continue to ignite unrest in all types of workplaces. An estimated 23.6 million U.S. workers with employer-based coverage spend at least 10% or more of their income on premiums and out-of-pocket costs, while wages remain stagnant. According to a new report by the Kaiser Family Foundation, the average worker contribution for family coverage increased 25% since 2014 to a whopping $6,015 annually.

In Charlotte, Dominic Harris, 31, works as a utility technician and also serves as president of the Charlotte City Workers Union. Without Harris and his fellow workers, the gilded financial hub nicknamed Wall Street of the South could not function.

“We only have something to gain,” Harris says. Harris and other members of the SWA make it clear this is a worker-led fight to sever the chain between healthcare and employers.

Harris and other members of the SWA made it clear they do not see this as a fight for a handout; it’s a worker-led fight for a universal health program to sever the chain between healthcare and employers.

“Having Medicare for All is a tremendous liberation from your boss,” says Ed Bruno, former Southern regional director of NNU.

When nearly 50,000 United Auto Workers (UAW) walked off in September, one of their major grievances was the rising cost of health insurance. General Motors (GM) responded by canceling their benefits in an attempt to force workers back. GM restored health benefits 11 days later, and UAW finally reached an agreement with GM after more than five weeks of striking.

SWA members believe a worker-led campaign for Medicare for All has the potential to galvanize a working-class movement in the South after decades of anti-union legislation like so-called right-to-work laws. Just 2.7% of workers in North and South Carolina belong to unions. Meanwhile, health outcomes in the South lag too, and infant mortality rates remain the highest in the nation.

“Healthcare is a human right,” says Leslie Riddle, a state employee who traveled from West Virginia to join the picket line. Riddle, 44, receives coverage from the Public Employees Insurance Agency, the same state-based healthcare whose program incited West Virginia teachers to walk out in 2018. Riddle has Type 1 diabetes and is allergic to some forms of insulin, which means she could die without the correct formula. When Riddle’s insurance reclassified her insulin as non-formulary, her out-of-pocket cost rose dramatically. She survived only with financial support from her parents and free samples from her doctor.

Under Medicare for All, copayments, premiums and deductibles would be eliminated, removing financial barriers to care. This is vital for people with chronic health conditions.

SWA is focusing its efforts on reaching the overwhelming majority of Southern workers without a union. The group sets up workplace committees that help workers calculate how much of their wages are eaten up by healthcare expenses, demonstrating why Medicare for All would be a huge win. As the 2020 Democratic primary season draws closer, SWA members plan to organize town halls and petition government officials to pass resolutions in support of Medicare for All, to keep issue at the forefront of the debates.

Sekia Royall agreed to organize a workers’ committee in support of Medicare for All after she realized that guaranteed health care would allow her to focus on her dream job.

Royall currently works in the kitchen at the O’Berry Neuro-Medical Treatment Center in Goldsboro, N.C., preparing meals for patients with mental disabilities and neurocognitive disorders like Alzheimer’s disease.

In her free time, though, Royall runs a catering business specializing in Kansas City barbecue, a rarity among the famous smokehouses that dominate eastern North Carolina. While Royall appreciates the important role she fills for her patients at O’Berry, her passion lies in running her own company. But pursuing her dream feels unrealistic to Royall, in part because it would mean losing her healthcare coverage provided through her employer.

“One of the reasons that I haven’t tried to quit my job and go full-time with my catering is because I do need healthcare coverage,” Royall says.

roadening the labor struggle through the right to healthcare is what inspired Bruno and other veteran activists, like Black Workers for Justice co-founder Saladin Muhammad, to throw themselves into SWA’s campaign.

“Legislation has never preceded the social movement,” Bruno says. “It was always the upheaval that preceded legislation. You can pretty much take that to the bank.”

Though still in its infancy, the Southern Workers Assembly campaign could prove to be a critical test case for building the kind of large, grassroots movement that past campaigns have shown will be necessary to overcome the powerful corporate interests bent on defeating a universal, national health program.

Medicare for All supporters face stiff opposition from drug companies, private insurers and other medical profiteers who are already well-financed and unified in attacking reforms that would decrease their profit margins. One example is the Partnership for America’s Health Care Future, a corporate front group created to stymie the growing Medicare for All movement by pressuring Democratic lawmakers to protect the Affordable Care Act, steering the party away from Medicare for All in 2020.

SWA members believe they can overcome their well-heeled opposition by mobilizing enough workers.

“If we can get every worker in every workplace to support just one thing, then that thing will get passed,” Harris says. “There’s nothing that a combined group of workers can’t accomplish.”

This article was originally published at InTheseTimes on November 19, 2019. Reprinted with permission.

About the Author: Jonathan Michels is a freelance journalist based in Durham, N.C.

Discrimination complaints hit group fighting Trump's health policies

Friday, August 16th, 2019

Rachana PradhanSome of its employees have described an environment allowing mistreatment of minority and LGBTQ employees.

A legal aid organization leading the fight against several Trump administration policies, including health care for LGBTQ and low-income people, is facing its own internal allegations of discrimination.

The National Health Law Program, or NHeLP, was founded in 1969 to advocate for health care rights of underserved people. It has grown more prominent in the Trump era, taking on causes like fighting Medicaid work requirements. But some of its employees have described an environment allowing mistreatment of minority and LGBTQ employees, including instances of bullying black women; employees telling “off-color jokes” about women and Jewish people; and a “sense of not belonging among LGBTQ staff,” according to a 2018 assessment on its workplace culture obtained by POLITICO.

Elizabeth Taylor, a former Justice Department attorney who became the group’s executive director in 2014, said leadership has worked, and continues to work, to fix problems flagged by the 53-pageassessment, which the organization commissioned amid high staff turnover and concern about workplace culture.

“We appreciate the urgency of addressing racism both internally and in our outward facing work,” said Taylor. She said remedies include diversifying leadership, bringing in a human resources company to do management training, convening all-staff retreats focused on equity issues and establishing ground rules for conduct during meetings and other workplace interactions.

But a half dozen individuals who work or have worked for the social justice nonprofit claimed workplace inequities persist. All of them worked there after the January 2018 report.

NHeLP employs roughly three dozen attorneys, policy experts and administrative staff across its three offices in Washington, Los Angeles and CarrboroN.C.

“They say we hear you and we understand you but then don’t see results,” said one employee who called the pace of change too slow. “Things have to change.” That employee, as well as other current and former employees who spoke to POLITICO, asked to remain unidentified.

Taylor acknowledged that improvements may not occur quickly enough for certain employees — but that the changes can’t be rushed if they are to be done correctly and sustainably.

The January 2018 report, in addition to interviews with several former and current employees, depict an organization struggling to create an equitable workplace even as it battles the Trump administration over policies it says are discriminatory or punitive to low-income people and other marginalized groups.

The legal group is not alone in grappling with these issues; many sectors of society including Hollywood, Congress, the media and both the corporate and nonprofit worlds are uncovering mistreatment, abuse andemployee discrimination.

Since 2016, 14 people have left NHeLP, including eight people of color, according to figures the organization provided to POLITICO. Four of them left this year, including two individuals who are ethnic minorities.

It is unclear whether all these departures were related to the issues raised in the report. POLITICO was unable to reach some of the people who left in recent years; others did not respond to queries.

One employee who left after the 2018 assessment told POLITICO there were challenges around the retention of minority staff and lack of leadership opportunities.

“I think that there are situations that they are trying to improve. I just think it’s a long road ahead,” said the individual who left after concluding there was no opportunity for advancement.

NHeLP for decades has fought in court for patient access to a range of health care services, such as medications for severe chronic illness, children’s mental health benefits and abortion. It has also advocated for legislation expanding health insurance coverage. The group’s profile — along with its fundraising — has grown in the Trump era, its work seen as indispensable among health care advocates who oppose a range of Trump policies they believe will weaken the health care safety net for millions of people.

The organization has led successful lawsuits blocking the Trump administration from allowing the first-ever Medicaid work requirements in three states, though the Justice Department has appealed and other states are still planning on adding work rules. NHeLP is also likely to challenge the administration’s looming rollback of civil rights protections for LGBTQ patients, which the nonprofit helped shape as part of the Affordable Care Act.

The organization raised $8.3 million in 2017, more than triple the $2.6 million it raised in 2014, according to tax documents (though below the nearly $11 million that came in during 2013.) In 2017, as Republicans in Washington sought to repeal the Affordable Care Act, the group hired 11 people, about three times as many as the year before. Despite staff turnover, the organization grew.

NHeLP has stood out as a rare legal organization that is primarily led by womenYet it has struggled with retaining a diverse staff, even as it expanded.

“We know that we still have work to do and we’re doing it,” Taylor said.

Many nonprofits as well as for-profit entities struggle with boosting diversity and installing leadership that is more representative of the populations they serve.

“This is something that’s urgent and most every nonprofit in the country is struggling with,” said one individual in the nonprofit sphere who has worked with NHeLP for years. “Figuring out a way to address it is vital.”

Taylor said the departures in 2016 of three employees of color who worked on policy issues was one reason NHeLP stepped up its diversity and equity efforts, including hiring an outside firm to examine its workplace culture. That review by the Management Assistance Group produced the January 2018 assessment.

“There were certainly things in it that resonated with me,” said Wayne Turner, a senior attorney based in Washington, declining to give specifics. But he added, “I think for people who have been here for a while, it’s kind of history and we’ve moved beyond that.”

The group’s board in 2017 also adopted a strategic plan that included priorities to boost equity internally as well as in other areas, including partnering with organizations that represent the interests of people of color.

Then the January 2018 report came. The report, which is based on interviews and observations provided by current and former staff as well as board members, detailed management styles that alienated staff of color and LGBTQ workers.

The report noted the perception among some employees that “there were instances where women of color had more experience but white staff were identified as more capable.” It also relayed descriptions of instances when individuals acted “surprised when a person of color is a good writer.”

“Management issues are so bad and pervasive,” the report quotes one employee saying. “While I’ve benefited from being a white woman, it is hard to see it because it is such a challenge. It is worse for people of color.”

The report said people observed “bullying” of black female employees, but it did not provide details or indicate how many individuals witnessed it. Nor did it provide more details about off-color jokes.

“There were things in there that were shocking as leaders of the organization to read,” Taylor said.

The report said NHeLP’s emphasis on maintaining a workplace culture of “niceness” and avoiding conflict can prevent employees from raising concerns related to treating workers equally. Managers also “often” meant to create an inclusive atmosphere, but those efforts backfired at times, the report said.

“We learned that managers often have the best intentions to make staff feel included and welcome, however due to miscommunication, disparate management styles, and assumptions about what people want, are skilled at, and need, their actions do not land as intended, and too often create an atmosphere of unintended hostility,” the report reads.

Not all employees perceived that hostility; the report found most staff believed NHeLP’s offices were pleasant and knew their colleagues had “the best intentions in mind.” Many of the current and former employees interviewed by POLITICO, who represented a diverse group, also had a positive impression.

“It was a pretty decent organization,” said one former employee who nonetheless witnessed staff turnover and people of color voicing concern about the workplace environment. This individual said that managers attributed staff departures to millennial “job hop,” rather than looking at deeper issues.

“There was definitely that brush off — ‘oh, that age group,’” the former employee said.

Taylor said she had never heard anyone on the management team make such a remark.

She said the organization views the effort to improve workplace culture as a “long-term commitment.” Employees said NHeLP set up committees to address various issues, from improving partnerships with organizations led by people of color to hiring, retention and office culture.

“I feel like staff was given a lot of leeway from management to come up with a staff-driven process on how to address these issues that were going on,” said one employee who had not personally witnessed bullying but did occasionally hear off-putting jokes at work. This individual was concerned that co-workers might be impatient and “lose faith.”

“It’s not a short-term process,” the person said. “Doing something on a consensus basis, staff-led process is going to be slower.”

Two individuals who work or have worked at the organization viewed some of the remedies as inadequate. “We have all of these committees and I honestly just don’t know why,” said one.

NHeLP’s director of health policy Leonardo Cuello said the organization is making changes deliberately and doesn’t view improving diversity and equity as “a check the box thing.”

“You have to do things in the right order and you have to do it with professional support, and you have to do it thoughtfully and kind of in accordance with the model practices. And that takes time,” he said.

“We’ve been working on it for two years and there’s a reason for that.”

This article was originally published by Politico on August 16, 2019. Reprinted with permission. 

About the Author: Rachana Pradhan is a health care reporter for POLITICO Pro. Before coming to POLITICO, she spent more than three years at Inside Health Policy focusing on implementation of the Affordable Care Act. Prior to that, Pradhan worked at The Daily Progress in Charlottesville, Va., and spent most of her time covering city government (with the occasional foray into stories on urban chicken-keeping and the closure of neighborhood pools).

Pradhan is a rare local of the Washington, D.C., area and graduated from James Madison University. She was also news editor of JMU’s student newspaper, The Breeze.

Inside the Bitter Battle to Defend Workers and Patients at a Low-Income Clinic

Wednesday, July 31st, 2019

Image result for nan levinsonWhen Whittier Street Health Center unveiled its glass-sheathed, six-story, environmentally-advanced, state-of-the-art, new facility in 2012, it was seen by its Boston community as a commitment to the neighborhood and the people it serves. With brightly painted walls and expansive views across the city, it sits at the heart of Roxbury, extending an invitation of convenience and care to a population that is mostly Black or Latinx and among the poorest and least healthy in the city.

Of Whittier’s patients, 91 percent live in poverty; 50 percent deal with food insecurity; two-thirds have been diagnosed with diabetes, hypertension, cancer, asthma or obesity; 35 percent of adults are without health insurance; and life expectancy for the area served is 58.9 years. Everyone agrees that this is a vulnerable population in need of highly trained, consistent and committed healthcare. Not everyone agrees that this population is getting it.

The reasons are a mix of difficulties shared by many community health centers, including political maneuvering, funding constraints and societal disregard for the poor. But some problems are distinct to Whittier: Staff and patients have complained that ill-advised, high-handed and destabilizing management practices interfere with and disrupt clinical care.

The dominant feelings among the many employees who have left or were pushed out seem to be anger and disappointment, much of that aimed at Frederica Williams, the president and CEO of Whittier since 2002. Last summer, increasingly sour management-clinician relations led to the formation of the first labor union of professional staff at a community health clinic in Massachusetts. The union became necessary, its supporters say, to protect their patients, their jobs and even the health center itself.

Through her then-P.R. consultant, Williams cited restrictions on what she can say about patients under HIPAA or the unionization effort under the Wagner Act. She responded to some questions in writing last October, but declined repeated requests to comment further, instead referring In These Times to the health center’s published reports and her public statements and letters to patients and staff. That left medical providers who have moved on, been fired or forced to leave—and unhappy patients—to largely tell the story. That story is one of alleged intimidation and union-busting by Williams and her administration, which has roiled the health center and highlights the challenges to providing good patient care to an underserved community. It also points out the limitations of current labor laws to protect workers at any level.

Last month, a year since the union became a reality, the antagonism between its supporters and Whittier management reached a climax, as a trial, an advanced step in the National Labor Relations Board’s unfair labor practice determination, got underway in Boston.

Organizing drive

The union came from the organizing efforts of John Jewett, a doctor; Bill Dain, a clinical social worker; and Caitrin MacDonald, a nurse practitioner. Dain, who had been at Whittier for 14 years, had experience with another union, so he was all in when Jewett and MacDonald said, “Let’s do it.” In March 2018, the trio began getting signatures on cards authorizing a union election under the guidance of 1199 Service Employees International Union (SEIU), which represents some 56,000 healthcare workers in Massachusetts. In mid-May, they filed notice with the National Labor Relations Board (NLRB) to begin a union campaign among Whittier’s professional clinical staff. The goal was to foster a working partnership with management, which would involve the entire staff, then numbering about 300, in the organizational decisions that controlled their work environment and the healthcare they provided. But as a practical decision, Jewett says, they started with this smaller, collegial group, several of whom had had issues with management and felt particularly frustrated by the responses they got. When the union began, it had more than 60 members; as of this May, it had 50. (The decrease reflects cutbacks in Whittier staffing

Jewett, age 62, has a degree in medicine with a focus on public health. He came to Whittier because he was fed up with the paperwork in private care and liked the one-to-one interaction in community health. Dain, 77, who loved the intense relationship of individual therapy and the chance to use his fluency in Spanish, also fell into this older category. Younger providers, including MacDonald and Sherar Andalcio—a doctor who was active in the union organizing from a different community health center, having been fired from Whittier the year before—were no less committed.

MacDonald, 40, came to Whittier in 2016, and said, “My dream work is community health…serving patients who represent all of Boston, not privileged people like me.” For Andalcio, 36, who grew up nearby, “My dream job was to come back and give back to the community.” These are highly-trained professionals who could opt for easier, more remunerative positions, but chose to work under the demanding and difficult conditions of community health care, where burnout is common.

Asked last November about the dissatisfaction among the clinicians, Williams answered in an email to In These Times,“Whittier Street is far from alone among Massachusetts health centers in experiencing financial challenges and employee turnover. … We have been enhancing our recruitment efforts to ensure that we are hiring staff who truly understand and are committed to fulfilling our mission of providing quality care to the vulnerable populations we serve.” But the dispute, which resulted in the organizing drive, seemed less about mission buy-in on the part of providers than about how that mission would be carried out day-to-day. The providers charged that problems arose when they made suggestions, challenged abrupt and unexplained changes in policies, asked for greater involvement in decisions affecting their work and their patients, or held management to the terms of their contracts.

Williams’ description of the difficult context in which Whittier exists is accurate. Since it began as a well-baby clinic in 1933 and even in the late 1960s when Boston led the nation in neighborhood health centers, funding has been a challenge. Today, it relies heavily on grants and federal funding. Still, Williams could point then with well-earned pride to her accomplishments: running a health center with a $25 million budget, over 30,000 patients a year, some 40 programs, and a perfect score on its most recent federal audit measuring statutory and regulatory compliance; and building the new facility, which no one had managed to do before. “She’s really brilliant at building programs and getting money for them,” said Jewett. “She’s great on the language of poverty and economic disparity,” noted Andalcio. MacDonald added that when she interviewed for her job, Williams “seemed like an engaging and compelling human being.”

Williams was born in 1958 in Sierra Leone and studied management in England and Massachusetts. As one of the city’s few women of color in top management positions, she is a highly visible, much-awarded champion of women in leadership. She sits on corporate boards, appears on notable-leader lists, and cultivates friendships with local politicians and powerbrokers. She even appeared in Mitt Romney’s infamous “binders full of women.” It cannot be easy to be a powerful black woman in a Boston still reckoning with racism and sexism, but her detractors charge that having to deal with these obstacles doesn’t excuse what they see as her demoralizing management style and actions; they claim these undermined their work at Whittier. Andalcio, who is also black, summed up this sentiment by saying, “If a man was doing what Frederica is doing, it would still be 110 percent wrong.”

Mass firings

A typical response to feeling that you’re losing control is to try for more control. In June 2018, less than a week before the union vote was scheduled, Williams abruptly fired Jewett, Dain, MacDonald and 11 others whom Jewett knew to be union supporters. They say they were hustled out of the building as their patients waited for appointments. Williams maintained that the firings were necessitated by a budget shortfall, and cited the loss of two anticipated grants, which she declined to name, equaling over $600,000. By the end of that fiscal year, the deficit would reach $1.35 million, Whittier’s first operating loss in 18 years.

The next day, Friday, Whittier staff, patients, supporters and local politicians demonstrated resolutely outside the building, demanding that the staff members be rehired immediately. It was hard to miss the swarm of purple SEIU T-shirts, and the media soon arrived to cover the protest. In response to the outcry and bad optics, Boston’s mayor, Martin J. Walsh, stepped in to craft a settlement, which Williams described in a letter to the WSHC community as “a pathway forward that will put Whittier on a stable financial footing for now.” The employees were told on Sunday that they had been reinstated, though it is unclear by whom, as became clear in the  testimony and cross-questioning of Ragan McNeely, a behavioral therapist, at the NLRB trial, and Williams announced publicly that she would take a voluntary pay cut. According to a report on WBUR, a local NPR station, her salary before the cut outstripped those of CEOs at community health centers in similar Boston neighborhoods, although they served more patients.

The drama continued on Monday, when several of the supposedly rehired staff tried to inquire about their status and, as McNeely testified, were not allowed to enter the building past the security desk. The employees were finally permitted to return to work on Wednesday, when the vote took place as planned. It was 50 to 9 in favor of unionizing. Less than three weeks later, in a remarkably tone-deaf move, the board of directors voted to honor Williams by naming the building after her.

Like most stories with differing perceptions of what’s fair, right or necessary, trying to pin down who did what to whom is a study in yes-buts. Williams emailed, “The primary reason for this deficit was the failure of specific staffers to reach industry-standard productivity levels.” Data compiled by Jewett for the pro-union website, “Whittier staff, union and community news,” show WSHC’s expected productivity levels for 2017 to 2018 to be higher than Massachusetts and national levels. Jewett worked with data from a 2017 report by the federal Health Resources and Services Administration (HRSA). However, both the Health Center Program at HRSA and the Massachusetts League of Community Health Centers, where Whittier is a member and Williams was on a board, said in separate emails that they have no productivity standards for providers.

And while there had been a decline in clinic visits from 2016 to 2017, they rose slightly to 115,448 in 2018. Jewett calculated that Whittier doctors generate significantly more revenue than they cost, so he argues that cutting their number is counterproductive to attracting and retaining patients.

In the summer of 2018, Williams eliminated the center’s urgent care clinic and the orthodontics program that fall, cut some clinical and administrative positions and instituted a hiring freeze, defending her decisions, for instance, in a December 2018 letter to staff, as necessary cost-cutting measures. She announced then that Whittier was on a “break-even budget,” and some vacancies have since been filled, though the current WSHC website shows a stripped-down clinical staff.

The targeted employees, however, read those moves as the kind of retaliatory measures that had been going on for a long time and added up to what MacDonald described as a toxic workplace. When Andalcio, the doctor who had come on staff with high expectations, felt underprepared to treat his HIV-positive patients and requested more training, he contended that his request was denied. When Jewett suggested ways to engage management productively—for example, instituting set meeting times for staff to exchange ideas and discuss problems—he was criticized for not going through channels and asking questions out of turn, a claim he reiterated in his affidavit for the NLRB. And MacDonald reported that after a goodbye party for Andalcio, a doctor and another staff member were sent a photograph taken there of the staff in attendance, with a black arrow and a question mark pointed at her head. Given the tensions at Whittier, it looked to her like a threat.

Perhaps most telling was the unusually high rate of turnover among clinicians. By Andalcio’s count, 20 doctors, nurses and physician assistants in primary care and obstetrics left between October 2016 and October 2018. Of the 22 who had worked there in 2016, only three are still at Whittier less than three years later. Because new hires are less productive than experienced providers, Jewett estimated that the cost of turnover in primary care in that time was at least $1.4 millionOther, unquantifiable losses included institutional memory and shared knowledge of how things work, but a bigger problem was the damage to patients, who were shuffled from provider to provider, with missed follow-ups and tracking of cases.

Patients impacted

Whittier touts its high scores on patient satisfaction surveys, but some patients have been skeptical of their validity. They lauded their providers, but complained about the culture. Shondell Davis came to Whittier in 2013 after a difficult search for responsive care. Her son had been killed and she was close to a breakdown when she found Ragan McNeely, the behavioral health therapist. He was a godsend. Over the next several years, Davis said, he provided “a comfort zone every Tuesday.” Just looking at his phone number between appointments made her feel better. McNeely was fired last October, which Davis said she learned only when she came for her appointment. “No calls, no follow-up, no warning,” she said a couple of months later. “To me it was unethical. I don’t have a therapist now. I don’t want to start over again. I just know from my experience, I really felt hurt. I don’t think I will ever trust there again.”

Marlon Wallen, a multiracial, HIV-positive activist from Trinidad, who lived nearby, became a patient at Whittier in 2016. Wallen reported that he was asked to be an outreach worker and appointed to the Patient Advisory Board. But when he objected that it was a conflict of interest for the chair of Whittier’s board of directors to also sit on the patient board, in addition to raising other grievances, he said he was “fired”—from the board and as a patient—and banned from the building. With HIV patients, especially, he maintained, the constant shifting of doctors undermines trust and treatment. He suggested grimly that Whittier’s patients put up with it because, “Where they come from, they’re used to this stuff.”

At a “patient rights hearing” organized by the labor-friendly coalition, Massachusetts Jobs With Justice, this past March, Davis and Wallen were among the some 60 people who testified about their experiences at Whittier. Nearly all talked of feeling betrayed and abandoned and reiterated complaints about valued clinicians disappearing without warning or explanation; difficulty getting someone to answer the phone, let alone getting an appointment; and undue burdens caused by closing urgent care and the orthodontics department. Some managers attended, but Williams did not.

Local politicians had rallied in support of the fired clinicians the summer before and met with union activists afterwards, but of several who were asked to speak to the issues in the following months, the only one who agreed to talk with In These Times was the doyen of Boston politics, Mel King, a former legislator and respected community activist. In a phone interview last October, he summarized the Whittier situation simply: “It’s an incredibly important institution in the community. To have an issue like this continue is unconscionable. People’s health is at stake.”

Contract fight

Forming a union is one thing; successfully negotiating a contract is another.

Unlike many union fights, salaries are not a central concern here. Last fall, Filaine Deronnette, vice president of Health Systems at 1199SEIU, said in a phone interview, “The issues are dignity and respect.” She emphasized that they were aiming for respectful lines of communication between management and staff. “The goal is to utilize the union to make it a better place for patients and staff.” In the early days, management met with the union and its members as scheduled. Then, according to Marlishia Aho, regional communications manager for 1199SEIU, the union stopped talking publicly, management started challenging who could be on the union’s negotiating committee, and one-by-one, union activists were pushed out. Dain and McNeely were fired; Jewett was placed on administrative leave, then laid off and also banned from the building; and MacDonald, needing stable employment, left for another job, albeit sooner than she wanted. By late October 2018, Jewett counted only a handful of the union supporters who had been fired and rehired that previous June still at Whittier.

Last fall, the union filed a series of complaints about unfair labor practices at Whittier with the National Labor Relations Board, charging that three members—Jewett, Dain and McNeely—had been laid off in retaliation for their union activities. The NLRB eventually determined that 30 of the 32 complaints about how Whittier responded to the unionization effort, an unusually long list, were substantiated enough to be brought to trial. While not a finding of guilt, this was a significant step, since the vast majority of complaints the board receives are dismissed, withdrawn or settled out of court.

As the trial began on June 17, both sides had dug in: Jewett described intense negotiations between the union and management the week before as progressing from very far apart to merely far apart, and at the trial, Jim Lee, Whittier Vice President, CFO and part of the management team representing the health center, declined to comment on the proceedings or a desired outcome.

For three intense days, the fired clinicians testified and were cross-examined by Whittier’s legal team. Then, on the morning of the fourth day of testimony, the judge, Paul Bogas, put the trial on hold to allow for further negotiations. According to Laura Sacks, a regional attorney of the NLRB, administrative judges can have many reasons for temporarily disrupting a trial for settlement discussions, but it may be because they expect it to be extremely long and complicated with risk for both sides. Sacks outlined the many potential steps to a final decision, which include appeals, briefs, and an open-ended timeline for a judge to issue an opinion. “I can only agree that it’s a lengthy process,” she concluded.

Most everyone else involved seems to have underestimated how lengthy this particular process would be. Originally calculated in months, it is now talking several years. In a difficult conversation, Jewett, McNeely and Dain considered their options. What made it so hard was that all three had to agree to the same response and, until recently, they had held out hope of returning to their jobs, their patients and their colleagues. Ultimately, they bowed to reality and forged a settlement: They would not return to Whittier and Whittier would pay each 15 months’ salary. When those pay-outs are added to Whittier’s legal fees for the case, resisting a union will have been an expensive battle to pursue.

On the rest of the NLRB charges, Whittier must post at the health center a short list of employee rights and a long list of “we will nots.” A few provisions are ameliorative, while most are pledges that Whittier will not do in the future what the NLRB alleged they had done in the past to discourage the union and punish its supporters. It is not clear what would happen if the health center did not live up to these promises. Williams, through her former P.R. consultant, again respectfully declined to comment.

Last winter, Jewett said he would go back to Whittier in a heartbeat. “I feel like I started something,” he explained. “It’s an opportunity to build something I could be proud of, if it gets done.” He fluctuated then between hope that pressure from the NLRB and the union would result in providers having a greater say in how care is delivered at Whittier and worry that Williams would just wait out the union until no supporters were left working there. He recalled “shooting the bull with [Williams] in the hall,” when he claimed she said, “John, I will never negotiate with the union.”

These days, contract negotiations are progressing, and one of the most postive outcomes of the settlement is that Whittier agreed to meet for bargaining sessions more than twice as often as before. But with so many of the original members gone and a significantly smaller staff, it’s an open question how committed to the union new hires or those who have stayed will be.

“You can’t just assume that if you vote for a [union] election it’s going to work out,” Jewett said, ruefully, a few days after agreeing to the settlement. “One sobering realization is that the NLRB legal system is not really set up to protect workers. It was fairly amazing to me to learn that that safety net isn’t there.”

Jewett’s partners in the labor complaint aren’t exactly singing a rousing chorus of “Union Maid” either. McNeely—who likes to quote Dain’s saying about the drawn-out NLRB process, “Slow justice is no justice”—is ready to move on. “There’s nothing to go back to,” he said. He and Dain count only four people remaining of the 18 who were in their Behavioral Health department when they formed the union. “I’m fearful for what’s left,” he concluded.

Dain, has a slightly more optimistic take on the outcome. Although their agreement allows Whittier to avoid culpability for the way they were fired, he believes they are vindicated because it points up the contradiction in Whittier’s public statements. “Their claim was that they needed to cut back on staff, unrelated to union activity,” he said. “Then why would you pay us off not to come back when you have all these job openings?”

As for the other problems the dispute highlighted—the high rate of clinician turnover, fraught management-staff relations, inconsistent patient care—it appears to be a matter of solving the legal issues while leaving the human ones raw. Yet, when asked if their fight was worth it, all three men give a qualified yes. For McNeely, because it can encourage “professional and knowledge worker groups” to organize, which he thinks is the future for unions. For Dain, “You keep up the struggle, even if you lose a particular battle.”

And for Jewett, who had staked so much on the success of the union? “Yes, it was worth it,” he agreed. “But it was much harder than I ever imagined.”

This blog was originally published at In These Times on July 30, 2019. Reprinted with permission.

About the Author: Nan Levinson is a journalist in Boston. Her latest book is War Is Not a Game: The New Antiwar Soldiers and the Movement They Built.

New Bill Seeks to Protect Health Care and Social Service Workers from Workplace Violence

Monday, November 19th, 2018

Workplace violence is a serious and growing problem for health care and social service workers. Nurses, emergency room doctors, social workers, psychiatric facility aides, and other health care and social service workers frequently face violence that leads to serious, life-altering injuries, loss of productivity and death. In 2016, working people petitioned the Occupational Safety and Health Administration for a workplace violence standard and, in 2017, OSHA granted that petition; yet there has been no action by the Trump administration to develop a national standard to protect workers from violence.

Some key facts about workplace violence:

  • It is responsible for more than 850 worker deaths and 28,000 serious injuries each year and is on the rise.
  • One of every six workplace deaths each year are from workplace violence.
  • It is now the second leading cause of death on the job.
  • Health care and social service workers are at greatest risk: They are nearly five times more likely than other workers to suffer a workplace violence injury.
  • Last year, workplace homicides doubled for health care and social service workers.
  • Two of every three workplace violence events are suffered by women.
  • Workplace violence is foreseeable and preventable.

Today, Reps. Joe Courtney (Conn.) and Bobby Scott (Va.) introduced legislation aimed at protecting health care and social service workers from workplace violence. In a letter supporting the legislation, Courtney said:

To address these rising rates of violence, I am introducing the Workplace Violence Prevention for Health Care and Social Service Workers Act. This legislation will require the Occupational Health and Safety Administration (OSHA) to issue a workplace violence prevention standard requiring employers in the health care and social service sectors to develop and implement a plan to protect their employees from workplace violence. These plans will be tailored to the specific workplace and employee population, but may include training on de-escalation techniques, personal alarm devices, surveillance and monitoring systems, or other strategies identified by the employers and employees to keep workers safe. While OSHA has already issued voluntary guidance to employers on how to prevent violence in these workplaces, data from [the Bureau of Labor Statistics] as well as personal testimony from workers about continuing violence shows that voluntary guidance is not sufficient. An enforceable standard is required to prevent the types of violence that are prevalent in too many of our hospitals, nursing homes and social service settings.

This blog was originally published by the AFL-CIO on November 19, 2018. Reprinted with permission. 

About the Author: Kenneth Quinnell is a long-time blogger, campaign staffer and political activist. Before joining the AFL-CIO in 2012, he worked as labor reporter for the blog Crooks and Liars

Here Are the 10 Worst Attacks on Workers From Trump’s First Year

Wednesday, January 24th, 2018

January 20th marks the one-year anniversary of President Donald Trump’s inauguration. Since taking office, President Trump has overseen a string of policies that will harm working people and benefit corporations and the rich. Here we present a list of the 10 worst things Congress and Trump have done to undermine pay growth and erode working conditions for the nation’s workers.

1) Enacting tax cuts that overwhelmingly favor the wealthy over the average worker

The Tax Cuts and Jobs Act (TCJA) signed into law at the end of 2017 provides a permanent cut in the corporate income tax rate that will overwhelmingly benefit capital owners and the top 1%. President Trump’s boast to wealthy diners at his $200,000-initiation-fee Mar-a-Lago Club on Dec. 22, 2017, says it best: “You all just got a lot richer.”

2) Taking billions out of workers’ pockets by weakening or abandoning regulations that protect their pay

In 2017, the Trump administration hurt workers’ pay in a number of ways, including acts to dismantle two key regulations that protect the pay of low- to middle-income workers. The Trump administration failed to defend a 2016 rule strengthening overtime protections for these workers, and took steps to gut regulations that protect servers from having their tips taken by their employers.

3) Blocking workers from access to the courts by allowing mandatory arbitration clauses in employment contracts

The Trump administration is fighting on the side of corporate interests who want to continue to require employees to sign arbitration agreements with class action waivers. This forces workers to give up their right to file class action lawsuits, and takes them out of the courtrooms and into individual private arbitration when their rights on the job are violated.

4) Pushing immigration policies that hurt all workers

The Trump administration has taken a number of extreme actions that will hurt all workers, including detaining unauthorized immigrants who were victims of employer abuse and human trafficking, and ending Temporary Protected Status for hundreds of thousands of immigrant workers, many of whom have resided in the United States for decades. But perhaps the most striking example has been the administration’s termination of the Deferred Action of Childhood Arrivals program.

5) Rolling back regulations that protect worker pay and safety

President Trump and congressional Republicans have blocked regulations that protect workers’ pay and safety. By blocking these rules, the president and Congress are raising the risks for workers while rewarding companies that put their employees at risk.

6) Stacking the Federal Reserve Board with candidates friendlier to Wall Street than to working families

President Trump’s actions so far—including his choice not to reappoint Janet Yellen as chair of the Federal Reserve Board of Governors, and his nomination of Randal Quarles to fill one of the vacancies—suggest that he plans to tilt the board toward the interests of Wall Street rather than those of working families.

7) Ensuring Wall Street can pocket more of workers’ retirement savings

Since Trump took office, the Department of Labor has actively worked to weaken or rescind the “fiduciary” rule, which requires financial advisers to act in the best interests of their clients when giving retirement investment advice. The Trump administration’s repeated delays in enforcing this rule will cost retirement savers an estimated $18.5 billion over the next 30 years in hidden fees and lost earning potential.

8) Stacking the Supreme Court against workers by appointing Neil Gorsuch

Trump’s nominee to the Supreme Court, Neil Gorsuch, has a record of ruling against workers and siding with corporate interests. Cases involving collective bargaining, forced arbitration and class action waivers in employment disputes are already on the court’s docket this term or are likely to be considered by the court in coming years. Gorsuch may cast the deciding vote in significant cases challenging workers’ rights.

9) Trying to take affordable health care away from millions of working people

The Trump administration and congressional Republicans spent much of 2017 attempting to repeal the Affordable Care Act. They finally succeeded in repealing a well-known provision of the ACA—the penalty for not buying health insurance—in the tax bill signed into law at the end of 2017. According to the Congressional Budget Office, by 2027, the repeal of this provision will raise the number of uninsured Americans by 13 million.

10) Undercutting key worker protection agencies by nominating anti-worker leaders

Trump has appointed—or tried to appoint—individuals with records of exploiting workers to key posts in the U.S. Department of Labor (DOL) and the National Labor Relations Board (NLRB). Nominees to critical roles at DOL and the NLRB have—in word and deed—expressed hostility to the worker rights laws they are in charge of upholding.

This list is based on a new report out from the Economic Policy Institute.

This article was originally published at In These Times on January 19, 2018. Reprinted with permission.

About the Author: The Economic Policy Institute (EPI) is a nonprofit, nonpartisan think tank created in 1986 to include the needs of low- and middle-income workers in economic policy discussions.

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.

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.

A Winning Week for Corporations and Wall Street—Paid for by Your Health and Retirement

Friday, May 12th, 2017

Corporations and Wall Street won big last week, and working people will pay a high price for it. Here are three things Congress did for Big Business that will harm working people’s health care and retirement:

1. 7 million fewer people will get workplace health benefits. Last Thursday, the U.S. House of Representatives passed the so-called American Health Care Act by a vote of 217-213. This is the bill that President Donald Trump and House Speaker Paul Ryan (R-Wis.) are using to repeal much of the Affordable Care Act and that will cut health coverage for some 24 million people. The U.S. Senate now has to vote.

Professional lobbying groups that represent employers, like the U.S. Chamber of Commerce, are behind this bill because it guts the Affordable Care Act’s requirement that large and mid-size employers offer their full-time employees adequate, affordable health benefits or risk paying a penalty. According to Congress’s budget experts, within 10 years, this bill will result in 7 million fewer Americans getting employer-provided health insurance. Corporate interests also like the huge tax cuts in the House bill, especially the $28 billion for prescription drug corporations and $145 billion for insurance companies.

Big company CEOs—the people who now earn 347 times more what front-line workers earn—are probably salivating over the huge personal tax cuts they will get from the Republican bill. One estimate is that those with million-dollar incomes will receive an average yearly tax cut of more than $50,000. The 400 highest-income households in the United States get an average tax cut of $7 million.

2. As many as 38 million workers will be blocked from saving for retirement at work. The Senate voted 50-49 last Wednesday to stop states from creating retirement savings programs for the 38 million working people whose employers do not offer any kind of retirement plan. The House already had voted to do this, and Trump is expected to sign off on it.

In the absence of meaningful action by the federal government, states have stepped in to address the growing retirement security crisis. But groups that carry water for Wall Street companies, like the Securities Industry and Financial Markets Association, have been actively lobbying Congress and Trump to stop states from helping these workers.

3. More than 100 million retirement investors may lose protections against conflicted investment advice. The House Financial Services Committee approved the so-called Financial CHOICE Act on a party-line vote last Thursday. It now goes to the full House of Representatives, and then to the Senate. In addition to gutting the Consumer Financial Protection Bureau that protects working people from abusive banking practices and ripping out many of the other financial reforms adopted after the 2008 financial crisis, this bill overturns key investor protections for people who have IRAs and 401(k)s. A massive coalition of Wall Street firms and their lobbying groups has been fighting to undo these retirement protections by any means possible.

About the Author: Shaun O’Brien is the Assistant Director for Health and Retirement in the AFL-CIO’s Policy Department, where he oversees development of the Federation’s policies related to Medicare, Medicaid, Social Security, and work-based health and retirement plans. Immediately prior to joining the AFL- CIO, he held several positions at AARP, including the Vice President for the My Money Portfolio and Senior Vice President for Economic Security. O’Brien holds a Bachelor of Arts degree from American University and a law degree from Cornell Law School.

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