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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.

What Are Your Workplace Rights When Entering Rehab?

Wednesday, October 10th, 2018

Drug and alcohol rehab have helped millions of Americans successfully recover from addiction and greatly improve their quality of life. But if you’re employed and struggling with substance abuse, a decision to enter rehab can often be complicated by anxious concerns about job security and if/how you should tell your boss. The good news is you have certain workplace rights that can alleviate many of these worries— even with respect to talking with your employer about a decision to pursue rehab.

Common Job-Related Concerns About Going to Rehab

Any full-time employee who has struggled with a serious health condition that requires treatment (and significant time away from work) has asked many of the same questions as employees with an addiction. Some of these questions include:

  • How will seeking treatment impact my career?
  • Do I qualify for medical leave?
  • Can I get fired for taking a leave of absence?
  • Can my company let me go after learning of my addiction?

What Are Your Workplace Rights?

While there is no cookie-cutter answer to these questions as everyone’s job situation looks different, knowing your workplace rights can help you both answer the above questions and prepare for a conversation with your boss.

  • A job-protected leave of absence from work – Alcoholism and other substance use disorders can qualify for a job-protected, unpaid leave of absence under the provisions of the Family and Medical Leave Act (FMLA). The FMLA requires that employers with 50 or more employees grant up to 12 weeks of family or medical unpaid leave to employees who have been in their employment for at least 12 months. Consult your employee manual and/or human resources department to verify that an FMLA leave of absence is an option available to you.
  • Insurance coverage for treatment – If you work full-time, you should have a private insurance plan that covers treatment for alcoholism and other drug addictions (if not in full, then partially).
  • Paid time off (PTO) – If you have been working for the same employer for a while, you have the right to use PTO in the service of time off for treatment. Depending on how much PTO you have accrued, you can get creative about how you use it to help you through rehab— for example, by scheduling detox and rehab over a long holiday weekend and using PTO to make up for the remainder of that time away from work. Alternatively, if an intensive outpatient program will suffice for your treatment needs, you may be able to spread out small chunks of PTO across several weeks instead of taking off a prolonged period of time.
  • The right to control what you share with your employer – You are not required to tell your employer you’re going to rehab, although in some cases this may be the best course of action. If you do tell your employer that you need to go to rehab, it is within their right to ask for supporting medical documentation — but the release of any of that private health information will still require your signed consent. In other words, you have a right to limit what, if any, disclosures you make about your medical history. You also have a right to request confidentiality with any medical records you agree to share.

How to Prepare for the Conversation with Your Boss

In addition to getting better familiarized with your workplace rights, here are some other things you can do to prepare for that conversation with your boss:

  • Get organized ahead of time. Know what the dates of your leave of absence will be, and be prepared to propose a plan for how to cover your job duties while you’re away.
  • Decide ahead of time whether to share that you’re going to rehab. If you do tell your boss, rehearse an honest but brief explanation. If you’re hoping to avoid mentioning that you’re going to rehab, you’ll still need a prepared response for any questions asked about why you need a leave of absence.
  • Keep the conversation positive and focus on how taking the time off will help you become a better, more productive employee. Avoid gratuitously mentioning any negative details of your addiction.

Nobody should have to forego rehab for an addiction that is ruining their life purely out of fear they’ll lose their job or be forever stigmatized. These tips can help anyone considering drug or alcohol treatment navigate the challenge of pursuing rehab while protecting their job.

About the Author: Anna Ciulla is the Chief Clinical Officer at Beach House Center for Recovery. Anna has an extensive background in psychotherapy and clinical management, including more than 20 years of experience helping individuals and families affected by addiction and co-occurring disorders find recovery. Learn more about Beach House’s different rehab programs by visiting their website.

New Arizona law pushes unemployed people to work at poverty wages or else

Thursday, May 17th, 2018

Arizona Republicans have hit on a way to make life worse for unemployed people. Currently, to collect unemployment insurance, people have to be looking for work and to accept “suitable” work if it’s offered. Under a new law, scratch that “suitable” part. People will have to accept any job they’re offered as long as it pays more than 20 percent more than their unemployment check—which means any job paying $288 a week or more.

You could be an engineer or a graphic designer or a skilled carpenter, but if McDonald’s or Walmart says they’ll have you, you have to take it or lose your benefits. Forget about looking for a job in your field that will pay you a living wage. You also don’t get to consider what’s suitable in terms of the “risk involved to the individual’s health, safety and morals.”

[Republican Gov. Doug Ducey’s] press aide Daniel Scarpinato called it “common-sense reform.”

“It’s a job that the individual’s been offered, and it pays,” he noted, adding that Ducey supports the idea of people finding employment “who are getting off of benefits and finding value in work.”

Bear in mind that people don’t get unemployment insurance automatically: anyone collecting unemployment in Arizona was laid off or fired for reasons that weren’t their fault. No one just walked off the job to collect that sweet $240-a-week check. No one was fired for dealing drugs at work.

These are people who had jobs within the last few months and lost them without doing anything wrong. To keep getting UI, they are spending four days a week looking for work. They should be the poster children for the Republican obsession with the value of work. But instead, they’re being devalued and treated as shirkers whose professional skills do not matter—because in fact, Republicans just hate anyone who’s struggling. And they’d rather sentence people to low-wage jobs that don’t make use of their specific skills than pay for a few extra weeks or months of unemployment insurance to make sure that people’s skills are maximized in the economy.

This blog was originally published at DailyKos on May 17, 2018. Reprinted with permission.

About the Author: Laura Clawson is labor editor at DailyKos.

Prescription Drug Spending is Consuming a Bigger Share of Wages

Tuesday, July 4th, 2017

Prescription drugs are a large and growing share of national income. While it is generally recognized that drugs are expensive, many people are unaware of how large a share of their income goes to paying for drugs because much of it goes through third party payers, specifically insurance companies and the government.

The Centers for Medicare & Medicaid Services (CMS) produce projections of national expenditures on prescription drugs through 2025, along with historical estimates dating back to 1960. As shown below, prescription drug spending from 1960 to 1980 was equivalent to about one percent of total wage and salary income. In the years leading up to the passage of the Bayh-Dole act in 1980, wage income was rising faster than spending on prescription drugs. As a result, the share of wages spent on prescription drugs was actually falling, reaching a low in 1979 of 0.86%.

However, after 1980, prescription drug spending rose rapidly relative to wage income. The ratio of drug spending to wages rose each year from 1980 to 2007. In 2007 wage growth finally outpaced drug expenditures, with the ratio again increasing in the Great Recession. By 2010, prescription drug spending had climbed above four percent of wage income.

The three percent of annual wage income lost to higher drug spending over the past 40 years makes a big difference to working individuals and families. This increase in annual spending averages out to roughly $2,400 per household. CMS projections, combined with projections on wage income growth from the Congressional Budget Office, suggest that spending on prescription drugs will increase further through 2025. This ratio is expected to exceed five percent by 2024.

While an aging population has been a factor increasing spending on drugs, demographics alone cannot explain the sharp increase in prescription drug spending. Inflation-adjusted prescription drug spending per household has increased more than eightfold since 1980, far outpacing any demographic trend surrounding age. The share of people over age 65 in the population has increased from 9.2% in 1960 to 14.8% in 2015. This can at most explain a small part of the increase in spending on drugs over this period.

It is important to recognize that the high cost of drugs is the result of a conscious policy decision to give drug companies monopolies in the form of patents and other forms of exclusive marketing rights. Without these protections drugs would almost invariably be cheap, likely costing on average less than one fifth as much as they do now. Even worse, the perverse incentives resulting from patent monopolies distort the research process and can lead drug companies to misrepresent evidence on the safety and effectiveness of their drugs.

 This blog was originally published at CEPR on June 27, 2017. Reprinted with permission. 
About the Authors: Dean Baker co-founded CEPR in 1999. His areas of research include housing and macroeconomics, intellectual property, Social Security, Medicare and European labor markets. He is the author of several books, including Rigged: How Globalization and the Rules of the Modern Economy Were Structured to Make the Rich RicherGetting Back to Full Employment: A Better Bargain for Working PeopleThe End of Loser Liberalism: Making Markets ProgressiveThe United States Since 1980Social Security: The Phony Crisis (with Mark Weisbrot), and The Conservative Nanny State: How the Wealthy Use the Government to Stay Rich and Get Richer. His blog, “Beat the Press,” provides commentary on economic reporting. He received his B.A. from Swarthmore College and his Ph.D. in Economics from the University of Michigan. Brian Dew holds a B.A. in Psychology and Organizational Sciences from the George Washington University and an M.A. in Economics from American University. His previous research has focused on international trade, network analysis, and open-economy macroeconomics, while his current research interests include domestic trade, employment, and monetary policies. Brian worked previously for the International Monetary Fund.

Veto the Cold-Hearted Health Bill

Monday, June 26th, 2017

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A veto threat would get their attention.

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

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

The Trump administration has started rolling back the birth control mandate

Thursday, June 1st, 2017

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Is Your Workplace Wellness Plan Worth the Risk?

Tuesday, April 5th, 2016

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

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

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

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

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

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

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

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

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

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

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

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

How to Handle a Group Life Insurance Claim Denial

Wednesday, June 3rd, 2015

Tatiana KadetMany employees receive life insurance coverage as part of their employee benefits. A group life insurance has many advantages over private life insurance policies.

First, group life insurance coverage is usually offered at low prices and is available not only to employees, but also to their qualified dependents.

Second, the employee does not have to keep track of monthly premium payments as the employer withdraws life insurance premiums from the employee’s paycheck and transfers them to the insurer regularly. This protects the employee from a possible missed payment which could result in a policy lapse.

Finally, the employer’s human resource department acts as a liaison between the employee and the insurer, so if there are questions or changes, the employee can simply turn to the employer for help.

What leads to denied life insurance claims?

Ideally, the employee should be given accurate information about his life insurance benefits and any changes in the employee’s status should be handled promptly and efficiently.

Unfortunately, it’s not uncommon both for insurance companies and employers to make mistakes regarding life insurance benefits, provide wrong information, fail to update records and fail to maintain or forward documents to the appropriate department.

These practices often lead to a denied life insurance claim when the employee or his dependent dies.

When a group life insurance claim is denied, the beneficiary may find himself struggling with paying funeral expenses and other financial obligations associated with the death of a loved one.

A family who loses the only breadwinner and receives a denial letter from the life insurance company may feel despair. However, beneficiaries whose life insurance claims have been denied are not left without recourse.

Every unfair life insurance claim denial can be disputed and appealed.

A better Understanding of ERISA

Most group life insurance polices are controlled by ERISA (“The Employee Retirement Income Security Act of 1974”). ERISA provides a wide range of protections for employees and their families.

One of the main purposes of ERISA is to protect the interests of participants and beneficiaries by establishing standards of conduct, responsibility, and obligation for fiduciaries (usually employers and insurance companies) and provide for appropriate remedies and ready access to federal courts.

ERISA imposes high standards of fiduciary duty upon administrators of an ERISA plan. ERISA’s fiduciary duty encompasses three components:

  1. The first is a duty of loyalty which requires that all decisions regarding an ERISA plan must be made with an eye single to the interests of the participants and beneficiaries;
  2. ERISA imposes a prudent person fiduciary obligation, which is codified in the requirement that a plan fiduciary exercise his duties with the care, skill, prudence, and diligence under the circumstances then prevailing that a prudent man acting in a like capacity and familiar with such matters would use in the conduct of an enterprise of like character and with like aims.
  3. ERISA requires that a fiduciary act for the exclusive purpose of providing benefits to plan beneficiaries.

In addition, ERISA entitles employees to free access to all the documents pertaining to their life insurance policies. This means that upon the employee’s request, the employer and/or the insurer must provide a copy of the life insurance policy, proof of premium payments and all relevant documents.

There can be many ways in which the insurance company and the employer breach their fiduciary duties.

How to recognize unfair life insurance claim denial

Below is a list of some practices that may result in an unfair life insurance claim denial:

  1. Employer failed to update its employment records after an employee became part-time, disabled, was terminated, etc.;
  2. Insurance company continued to charge premiums after it had received an employee’s waiver of premium application;
  3. Insurance company extended coverage without requesting evidence of insurability and later claimed that no coverage should have been issued;
  4. Employer or insurance company made material misrepresentations about coverage;
  5. Employer and insurance company failed to inform an employee about his rights to convert or port coverage;
  6. Employer failed to provide a copy of the life insurance policy to its employees;
  7. Employer failed to advise an employee that his/her dependent is not considered a qualified dependent under the policy and collected premiums for the dependent coverage.

ERISA allows beneficiaries whose claims have been denied to file an administrative appeal and request reconsideration. Since ERISA imposes strict deadlines and other restrictions during the appeal process, we encourage all employees and their families to consult a life insurance attorney before considering filing an administrative appeal.

 

About the Author: The author’s name is Tatiana Kadetskaya. Tatiana Kadetskaya runs a Law Firm devoted to the practice of life insurance law, experienced in all aspects of life insurance law, including ERISA claim denials and claims against insurance companies and employers.

Drug Tests for Welfare Bills Come to Three More States

Saturday, February 9th, 2013

Laura ClawsonLooking at the range of drug testing-for-benefits bills being pushed in state legislatures across the country, you almost have to suspect Republicans of some kind of urine fetish. In addition to all the states that are debating or have passed bills requiring people applying for unemployment insurance benefits to pee in cups, drug-testing bills aimed at welfare applicants are being introduced in three states. The specifics would be ripe for comedy if we weren’t talking about a concerted effort by the powerful to stigmatize vulnerable people as drug addicts, as if that’s the only reason a person might need help in an economy in which there are still more than three job-seekers for every job opening:

The Ohio State Senate held a second hearing Thursday night on a proposal to establish pilot drug-testing programs in three counties. Under the proposal, applicants would be required to submit a drug test if they disclose that they have used illegal substances. The proposal was first introduced in the spring, but pressure from opponents led Gov. John Kasich to squash the bill in May.Virginia Republicans are also reviving a bill that was shelved earlier this year. The 2012 version failed after the state estimated it would cost $1.5 million to implement while only saving $229,000. The bill’s sponsor, Delegate Dickie Bell, has not introduced the updated version yet, but says he’s found more cost effective options.

Those would have to be some pretty damn significant changes to the cost structure to erase a nearly $1.25 million deficit. Virginia wasn’t the first to run into that kind of problem; a Florida law mandating drug-testing of welfare applicants cost the state money because so few people’s tests were positive, leaving the cost of the tests higher than the savings from denying people benefits. And that’s leaving aside the cost of the lawsuits for a law that was ultimately found unconstitutional.

Both Ohio and Kansas legislators are trying to pretend the goal is to help people rather than to associate welfare recipients with drug abuse in the public debate, claiming that they just want to be sure people get the help they need. Bear in mind that in Florida, just 2.6 percent of applicants didn’t pass their drug tests. So when you have Republican legislators who don’t show any signs of wanting to help any kind of working-class or middle-class people, even, suddenly dripping with concern for welfare applicants … well, you just have to call bullshit.

This article was originally posted by The Daily Kos on February 8, 2013. Reprinted with Permission.

About the Author: Laura Clawson is a Daily Kos contributing editor since December 2006 &  the Labor editor since 2011. She lives in Washington, D.C.

3,000 Workers at 14 Industrial Laundry Sites Get Wage Gains, Keep Free Health Insurance

Friday, December 7th, 2012

Industrial laundry workers, who wash linen for New York’s hotels, hospitals and restaurants, voted overwhelmingly to ratify a new master contract between 14 laundries in the New York Metro area and the Laundry, Distribution and Food Service Joint Board, Workers United/SEIU.

The contract includes significant wage gains for laundry workers, a majority of which are African-American women and Latina immigrants.  New York Metro area laundry workers will also continue to have free employer paid individual medical, dental and vision insurance and a pension. Laundry workers will be part of one multi-employer contract, which sets the standards for a majority of laundries in the New York Metro area.

“This contract makes real improvements for laundry workers and their families and continues to raise standards for the industry,” Wilfredo Larancuent, Regional Manager of the Laundry, Distribution and Food Service Joint Board, Workers United/SEIU, told the bargaining committee comprised of drivers and production workers from area laundries, “You can feel proud of what we have accomplished.”

Elected worker representatives from the laundries bargained the contract with employer representatives for over a month.  A strike vote was held at the laundries, but the contract was settled prior to the strike deadline. Workers and the employers were able to come to an agreement and both were satisfied with the contract.

The Laundry, Distribution and Food Service Joint Board, Workers United/SEIU represents nearly 70% of all industrial laundry workers in the New York Metro area.  In August, laundry workers at JVK Operations in Long Island voted to join the Laundry, Distribution and Food Service Joint Board, Workers United/SEIU and the Joint Board continues to organize the remaining laundries in the New York Metro area in order to bring all laundry workers up to the standards of their membership.

This article was originally published on SEIU on December 7, 2012. Reprinted with Permission.

About the Author: Service Employees International Union is an organization of 2.1 million members united by the belief in the dignity and worth of workers and the services they provide and dedicated to improving the lives of workers and their families and creating a more just and humane society.

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