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Posts Tagged ‘medicaid’

Don't Pass Huge Tax Cuts for the Wealthy on the Backs of Working People

Monday, November 27th, 2017

Republican leaders in the U.S. Senate have proposed a job-killing tax plan that favors the super-rich and wealthy corporations over working people. We cannot afford to let this bill become law.

Here’s why this plan is a bad idea:

  • Millions of working people would pay more. People making under $40,000 would be worse off, on average, in 2021; and people making under $75,000 would be worse off, on average, in 2027.
  • The super-rich and Wall Street would make out like bandits. The richest 0.1% would get an average tax cut of more than $208,000, and 62% of the benefits of the Senate bill would go to the richest 1%. Big banks, hedge funds and other Wall Street firms would be the biggest beneficiaries of key provisions of the bill.
  • Job-killing tax breaks for outsourcing. The Republican tax plan would lower the U.S. tax rate on offshore profits to zero, giving corporations more incentive to move American jobs offshore. 
  • Working people would lose health care. Thirteen million people would lose health insurance, and health care premiums would rise 10% in the non-group market. Meanwhile, Republicans want to cut Medicaid and Medicare by $1.5 trillion—the same price tag as their tax bill.
  • Job-killing cuts to infrastructure and education. Eliminating the deduction for state and local taxes would drastically reduce state and local investment in infrastructure and lead to $350 billion in education cuts, jeopardizing the jobs of 350,000 educators.

Republican tax and budget plans would make working people pay the price for wasteful tax giveaways by sending our jobs overseas; killing jobs in infrastructure and education; raising our taxes; increasing the number of uninsured; and cutting the essential public services we depend on.

Call your senator today at 844-899-9913.

This blog was originally published at AFL-CIO on November 27, 2017. Reprinted with permission.

About the Author: Kelly Ross is the deputy policy director at AFLCIO. 

GOP Smash-And-Burn Tax Plan Does Nothing for Workers

Friday, October 27th, 2017

Congressional Republicans are selling a trickle-down tax scam times two. It’s the same old snake oil, with double hype and no cure.

A single statistic explains it all: one percent of Americans – that is the tiny, exclusive club of billionaires and millionaires – get 80 percent of the gain from this tax con. Eighty percent!

But that’s not all! To pay for that unneeded and unwarranted red-ribbon wrapped gift to the uber wealthy, Republicans are slashing and burning $5 trillion in programs cherished by workers, including Medicare and Medicaid.

Look at the statistic in reverse, and it seems worse: 99 percent of Americans will get only 20 percent of the benefit from this GOP tax scam. That’s not tax reform. That’s tax defraud.

Republican tax hucksters claim the uber rich will share. It’s the trickle down effect, they say, the 99 percent will get some trickle down.

It’s a trick. Zilch ever comes down. It’s nothing more than fake tax reform first deployed by voodoo-economics Reagan. There’s a basic question about this flim-flammery: Why do workers always get stuck depending on second-hand benefits? Real tax reform would put the rich in that position for once. Workers would get the big tax breaks and the fat cats could wait to see if any coins trickled up to jingle in their pockets.

House Speaker Paul Ryan claimed Republicans’ primary objective in messing with the tax code is to help the middle class, not the wealthy. Well, there’s a simple way to do that:  Give 99 percent of the tax breaks directly to the 99 percent.

The Republican charlatans hawking this new tax scam are asserting the pure malarkey that it provides two, count them TWO, trickle-down benefits. In addition to the tried-and-false fairytale that the rich will share with the rest after collecting their tax bounty, there’s the additional myth that corporations will redistribute downward some of their big fat tax scam bonuses.

A corporate tax break isn’t some sort of Wall Street baptism that will convert CEOs into believers in the concept of paying workers a fair share of the profit their labor creates.

Corporations have gotten tax breaks before and haven’t done that. And they’ve got plenty of cash to share with workers right now and don’t do it. Instead, they spend corporate money to push up CEO pay. Over the past nine years, corporations have shelled out nearly $4 trillion to buy back their own stock, a ploy that raises stock prices and, right along with them, CEO compensation. Worker pay, meanwhile, flat-lined.

In addition to all of that cash, U.S. corporations are currently sitting on another nearly $2 trillion. But CEOs and corporate boards aren’t sharing any of that with their beleaguered workers, who have struggled with stagnant wages for nearly three decades.

Still, last week, Kevin Hassett, chairman of the President’s Council of Economic Advisers, insisted that the massive corporate tax cut, from 35 percent down to 20 percent, will not trickle, but instead will shower down on workers in the form of pay raises ranging from $4,000 to $9,000 a year.

Booyah! Happy days are here again! With the median wage at $849 per week or $44,148 a year, that would be pay hikes ranging from 9 percent to 20 percent! Unprecedented!

Or, more likely, unrealistic.

Dishonest, incompetent, and absurd” is what Larry Summers called it. Summers was Treasury Secretary for President Bill Clinton and director of the National Economic Council for President Barack Obama.

Jason Furman, a professor at the Harvard Kennedy School who once held Hassett’s title at the  Council of Economic Advisers, called Hassett’s findings “implausible,”  “outside the mainstream” and “far-fetched.”

Frank Lysy, retired from a career at the World Bank, including as its chief economist, agreed that Hassett’s projection was absurd.

Hassett based his findings on unpublished studies by authors who neglected to suffer peer review and projected results with all the clueless positivity of Pollyanna. Meanwhile, Lysy noted, Hassett failed to account for actual experience. That would be the huge corporate tax cuts provided in Reagan’s Tax Reform Act of 1986.

Between 1986 and 1988, the top corporate tax rate dropped from 46 percent to 34 percent, but real wages fell by close to 6 percent between 1986 and 1990.

Thus many economists’ dim assessment of Hassett’s promises.

The other gob-smacking bunkum claim about the Republican tax scam is that it will gin up the economy, and, as a result, the federal government will receive even more tax money. So, in their alternative facts world, cutting taxes on the rich and corporations will not cause deficits. It will result in the government rolling in coin, like a pirate in a treasure trove. That’s the claim, and they’re sticking to it. Like their hero Karl Rove said, “We create our own reality.”

Here’s Republican Sen. Patrick J. Toomey, for example: “This tax plan will be deficit reducing.”

If the Pennsylvania politician truly believes that’s the case, it’s not clear why he voted for a budget that would cut $473 billion from Medicare and $1 trillion from Medicaid. If reducing the tax rate for the rich and corporations really would shrink the deficit, Republicans should be adding money to fund Medicare and Medicaid.

While cutting taxes on the rich won’t really boost the economy, it will increase income inequality. Makes sense, right? Give the richest 1 percenters 80 percent of the gains and the remaining 99 percent only 20 percent and the rich are going to get richer faster.

Economist Thomas Piketty, whose work focuses on wealth and income inequality and who wrote the best seller “Capital in the Twenty First Century,” found in his research no correlation between tax cuts for the rich and economic growth in industrialized countries since the 1970s. He did find, however, that the rich got much richer in countries like the United States that slashed tax rates for the 1 percent than in countries like France and Germany that did not.

This Republican tax scam is a case of the adage that former President George W. Bush once famously bungled: “Fool me once, shame on you. Fool me twice, shame on me.”

This blog was originally published at OurFuture.org on October 27, 2017. Reprinted with permission.

About the Author: Leo Gerard, International President of the United Steelworkers (USW), took office in 2001 after the retirement of former president George Becker.

The GOP’s Trojan Horse on Health Care Repeal

Wednesday, July 26th, 2017

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tuesday, June 27th, 2017

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

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

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

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

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

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

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

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

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

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

Veto the Cold-Hearted Health Bill

Monday, June 26th, 2017

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A veto threat would get their attention.

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

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

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

Wednesday, June 21st, 2017

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

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

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

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

Short-term gain, long-term pain

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

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

Who’s most affected:

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

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

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

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

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

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

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

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

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

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

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

Congress’ Cuts in Health Care Will Hit Women Harder

Tuesday, March 7th, 2017

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

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

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

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

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

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

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

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

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

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

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

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

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

"A week later I got my Medicaid card in the mail, and now I have healthcare again."

Tuesday, December 3rd, 2013

seiu-org-logoElizabeth Aviles works as a Certified Nursing Assistant in Waterbury, Conn. She is also a member of SEIU Local 1199NE. Since Aviles works only 22 hours a week, she is not able to purchase health insurance, which is especially troublesome since she has some serious medical issues that require immediate attention. So when a fellow member of 1199NE knocked on her door one day as part of an outreach effort, Aviles had no idea how her life would change over the next 30 minutes.

He explained how she might be eligible for Medicaid–under the expanded program the state was instituting thanks to the new healthcare law. He had Aviles dial the number to the state’s call center, and then she was placed on hold for 20 minutes.

“Once I got someone on the line, I was approved for Medicaid in about 5 minutes,” Aviles said. “A week later I got my Medicaid card in the mail, and now I have healthcare again.”

Aviles is relieved, because now she can get the medical help she needs. In addition, to an upcoming surgery she is scheduling, Aviles will be able to take care of some of the other lingering issues she has had. “At my job I’ve had to help treat clients who are suffering from back pain, when I’m suffering from the same thing myself and without the resources to get it treated,” she said.

The goal of President Obama’s Affordable Care Act has always been to give people access to medical care regardless of income and without putting them into serious debt. For millions of working American’s like Aviles who previously couldn’t afford care, that goal is becoming a reality.

This article was originally printed on SEIU on November 22, 2013. Reprinted with permission.

Author: SEIU Communications

Caring for Workers Who Care for Our Loved Ones

Monday, August 19th, 2013

Michelle ChenFor many seniors, growing older means facing new kinds of stress—such as fragile health, a tight budget on a fixed income, or the travails of living alone.

And for the people who care for the aging, the stress can be just as severe. When her client is going through a rough time, one domestic worker says she lives through every minute of it, too: “Sometimes we stay there for five days…and we don’t know what’s outside…You cannot leave the job.”

Stories like this one, recorded as part of a survey of New York’s care workers, form the invisible pillar of an evolving industry that is making the private home the center of public health, and in the process, reshaping our relationships of family, work, community and social service. Yet the home care workforce, which is driven largely by poor women of color, mirrors inequities embedded in the low-wage economy. At work, caregivers manage the lives of our loved ones while often facing exploitation and abuse, and after a long day of delivering comfort to vulnerable clients, many struggle themselves to cope with ingrained poverty their communities.

To open a conversation about the economics and ethics of caregiving, ALIGN (Alliance for a Greater New York) has partered with the national advocacy campaign Caring Across Generations, along with various community and labor groups, to study New York City’s more than 150,000 home care workers. The surveys and investigations published by ALIGN reveal structural problems in the industry and identify potential for reforms that work for those who give and those who receive care.

In New York, the home care industry is booming as more seniors opt to live at home rather than in institutions. Thousands across the city earn their living by taking care of seniors and people with disabilities. Overall, according to the study, the sector “will be the single biggest driver of employment in the city in the coming years.”

On a typical day in New York, these workers, mostly women of color and immigrants, act as both therapists and companions, managing medications, bathing and feeding, and helping seniors feel dignified even on the days they can’t get out of bed. On top of this, the workers have to negotiate with stressed families about hours and pay–and typically take home low wages that keep them and their families mired in poverty.

And yet it turns out that consumers and providers of care want the same things. ALIGN’ssurveys of New Yorkers, including both caregivers and care “consumers,” show strong concern about decent pay for workers, along with retirement and healthcare benefits. These labor conditions are many cases dictated by insurance companies and Medicaid, not by the families receiving care.

The fact that consumers and caregivers both recognize that labor should be fairly valued “really does challenge this zero-sum notion that good jobs and affordable care can’t coexist,” says ALIGN policy analyst Maya Pinto. “And it suggests that people understand the connection between the quality of care and the quality of jobs.”

The converse is also true: When workers are miserable, it shows up in their work. Nearly 40 percent of people receiving care complained that the quality of services was “fair” to “very poor.”

But from a workers’ standpoint, this is the consequence of a job that treats them poorly. One worker described her situation bluntly: “It is a very difficult job at times because there are patients who think the home care workers are slaves.” Workers reported being subject to verbal and physical abuse, sometimes racial slurs, on the job.

Nonetheless, many care workers feel deep devotion to their job—they just want to their labor to be appreciated and duly compensated. “I do my work well…and the person I care for is very satisfied with my work,” said one worker. “It is very dignified work but it needs to be paid better.”

A priority across all respondent groups was providing appropriate training and monitoring–indicating that workers, contrary to stereotypes, are not instinctively resistant to greater accountability and oversight, and that all stakeholder groups realize the depth and complexity of responsibilities involved in caring for vulnerable seniors.

One area of divergence between consumers and workers was the importance placed on career advancement. The issue was a higher priority for caregivers, especially domestic workers who serve seniors but lack the official credentials of “formal sector” workers—a category that includes certified “home health aides” and “home attendants,” and who are generally employed through an agency. Lacking the formal qualifications associated with specialized, better-paying positions, domestic worker-caregivers (who are disproportionately low-income immigrant women, both documented and undocumented) often remain stuck in the most grueling, precarious jobs.

Some of New York’s privately employed home care workers benefit from a recently enacted domestic workers’ “Bill of Rights” that provides stronger workplace protections and wage standards than does federal labor law. However, domestic workers overall, who include nannies and housekeepers as well as direct caregivers in private households, still suffer from poverty, discrimination and exploitation. According to ALIGN’s survey of caregivers’ household incomes, about nine in 10 domestic workers earn less than $25,000 annually, compared to six in 10 formal sector workers. That is, despite the strides that domestic workers made with the Bill of Rights, in material terms, they still lag behind those employed through agencies or with more formal credentials.

ALIGN recommends several reforms to ensure dignity for both caregivers and people receiving care. More training and certification options–such as programs equipping domestic workers with emergency medical skills–would expand workers’ access to more formal and higher-paying positions and lift up standards for the workforce overall. On a policy-making level, the report calls for a expansion of publicly funded insurance programs so care workers, many of whom cannot afford medical coverage, can safeguard their own health as they care for others.

Since so many families struggle to pay the cost of community-based elder care, especially if they fall outside the income-eligibility bracket for Medicaid, the report recommends a more comprehensive publicly supported insurance program as an alternative to private long-term care plans. Noting that the current rollout of the Affordable Care Act and Medicaid overhaul present an opportunity for fudamental reforms in home care funding, ALIGN suggests creating a broadly accessible long-term care benefit that would be funded through payroll contributions, like Social Security.

The report also highlights why workers need not just laws but organization and collective bargaining power. In recent years, SEIU and the National Domestic Workers Alliance have organized tens of thousands of workers to win fairer contracts for workers and to press for reforms to extend labor protections for care workers. Meanwhile, some workers are changing how care is delivered in their communities by forming their own cooperatives.

ALIGN cites the worker-owned cooperative model as a system that can empower caregivers, by enabling them not only to share in the ownership and profits of the enterprise but also to access training, negotiate better working conditions, and “improve compensation for workers while keeping the cost of care relatively low.” One impressive case study is New York’s Cooperative Home Care Associates, one of the country’s leading cooperatives with about 2,000 workers, half of whom own a part of the business.

Despite the sometimes harsh conditions, Vilma Rozen, a 52 year-old home care worker, remains unshakably devoted to her job and embraces the challenges. “If you want to take care of elderly people, you have to keep your feelings very in touch [with] the person, because the elderly people in some cases are very alone and very depend[ent],” she says. At the same time, she adds, many seniors “suffer so much, because the home-carers, they have a very sad life, very underpaid… They don’t have happiness.” Rozen, a native of Costa Rica, says that if Americans want to place their elders in the care of attentive, dedicated people, “they need to change the system.”

Whether they give or receive care, everyone wants dignity–both seniors and their aides want to look forward to seeing each other every day in a relationship of mutual respect. The labor issues in senior care show the consequences of neglecting shared needs, but also open space for creating a fairer system of care, by making the home a more welcoming workplace.

This article originally appeared on Working in These Times on August 17, 2013.  Re-posted with permission. 

About the Authory: Michelle Chen is a contributing editor at In These Times, a contributor to Working In These Times, and an editor at CultureStrike. She is also a co-producer of Asia Pacific Forum on Pacifica’s WBAI.

Florida Governor Inflates Cost Of Medicaid Expansion By 2,500% To Avoid Implementing Obamacare

Wednesday, January 9th, 2013

Internal email messages uncovered by Health News Florida reveal that Gov. Rick Scott (R-FL) is knowingly citing inaccurate cost estimates to justify his refusalto expand Florida’s Medicaid program. Though the governor’s office is fully aware that the numbers are wrong, Scott continues to use them anyway, the documents show.

Florida, which has one of the highest rates of uninsurance in the nation, could extend health coverage to about one million low-income residents by accepting Obamacare’s optional Medicaid expansion. But the governor — an ardent Obamacare opponent — has repeatedly said that expanding Medicaid would just be too expensive, claiming it would cost the state $26 billion over the next 10 years.

As Health News Florida reports, however, that figure from Florida’s Agency for Health Care Administration (AHCA) is inflated because it doesn’t take into account the full amount that the federal government will reimburse states for choosing to expand Medicaid. A more accurate analysis found that expansion would cost the state around $1 billion:

But those numbers are based on a flawed report, state budget analysts say. A series of e-mails obtained by Health News Florida shows the analysts warned Scott’s office the numbers were wrong weeks ago, but he is still using them. […]

The Act says the federal government will pay the lion’s share of the cost for new Medicaid eligibles if a state agrees to expand its program — a decision the Supreme Court left up to the states. The federal contribution for the new eligibles would be 100 percent between 2014 and 2016, then would taper after that to 90 percent by 2020 and stay there.

But the AHCA report assumes the federal match for the new patients would be much lower, about 58 percent. It came up with that by averaging the match amount over the past 20 years. The report doesn’t say why the authors made that assumption. […]

As Health News Florida reported on Dec. 21, the AHCA estimates were huge in comparison to a study released by the Urban Institute and Kaiser Family Foundation, two neutral research groups that specialize in Medicaid studies. Their study estimated that if Florida agreed to expand Medicaid, about 1 million uninsured people would gain coverage at a 10-year cost to the state of around $1 billion.

According to the email chain that Health News Florida obtained, state officials began calling the AHCA’s $26 billion cost estimate into question as early as December 20. One member of the House Health Care Appropriations Subcommittee even pointed out that, since the health reform law specifies that the federal government will help fund Obamacare’s Medicaid expansion, it would actually break Florida state law to expand Medicaid without using the federal dollars mandated for that purpose.

Nevertheless, Scott has continued to repeat his false claim that Florida can’t afford to provide its low-income residents with the health coverage they need. Scott met with U.S. Health and Human Services Secretary Kathleen Sebelius on Monday to express his concerns about what expanding Medicaid would mean for his state’s bottom line. “Growing government, it’s never free,” Scott explained to reporters. “It always costs money.” Just not as much money as Scott says it does.

This article was originally posted on Think Progress on January 8, 2013. Reprinted with Permission.

About the Author: Tara Culp-Ressler is an editorial assistant at ThinkProgress.org. Before joining Think Progress, Tara deepened her interest in progressive politics from a faith-based perspective at several religious nonprofits, including Faith in Public Life, the National Religious Campaign Against Torture, and Interfaith Voices. Tara first came to D.C. to study Communications and Spanish at American University, where she also wrote for the student newspaper and advocated for women’s issues on campus. She is originally from Lancaster County, Pennsylvania.

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