Outten & Golden: Empowering Employees in the Workplace

Posts Tagged ‘eligibility’

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.

How Does the Fall of DOMA Impact the FMLA and Other Employee Benefits?

Friday, June 28th, 2013

Jeff NowakUnless you’ve been securely wedged under a rock over the past 24 hours, you know that the U.S. Supreme Court has declared unconstitutional the Defense of Marriage Act (DOMA), which had established a federal definition of marriage as a legal union only between one man and one woman.

Yesterday, as Justice Anthony Kennedy read the opinion of the Court in U.S. v. Windsor, I can only imagine that his thoughts were consumed completely by the manner in which the extinction of DOMA would impact the future of the Family and Medical Leave Act. Right?

But let’s not leave this to chance.  In the unlikely event that Justice Kennedy (and the rest of the Court’s majority) didn’t fully appreciate how the FMLA might be impacted, we’ve got the Court’s back, as we discuss the issue more fully below:

How FMLA is Impacted after the Fall of DOMA

As we know, the FMLA allows otherwise eligible employees to take leave to care for a family member with a serious health condition.  “Family member” includes the employee’s spouse which, under the FMLA regulations, is defined as:

a husband or wife as defined or recognized under State law for purposes of marriage in the State where the employee resides, including common law marriage in States where it is recognized.  29 C.F.R. 825.102

Initially, this seems to suggest that the DOL would look to state law to define “spouse.”  Not so fast. According to a 1998 Department of Labor opinion letter, the DOL acknowledged that the FMLA was bound by DOMA’s definition that “spouse” could only be a person of the opposite sex who is a husband or wife.  Thus, the DOL has taken the position that only DOMA’s definitions could be recognized for FMLA leave purposes.  As result, FMLA leave has not been made available to same-sex spouses.

That changed yesterday, at least in part.

What’s Clear about FMLA After the Court’s Ruling

In striking down a significant part of DOMA, the Supreme Court cleared the way for each state to decide its own definition of “spouse.”  Thus, if an employee is married to a same-sex partner and also lives in a state that recognizes same-sex marriage, the employee will be entitled to take FMLA leave to care for his/her spouse who is suffering from a serious health condition, for military caregiver leave, or to take leave for a qualifying exigency when a same-sex spouse called to active duty in a foreign country in the military.

What’s Unclear about FMLA After the Court’s Ruling

But what about employees who live in a state that does not recognize same-sex marriage?  Are they entitled to FMLA leave to care for their spouse?

As an initial matter, the regulations look to the employee’s “place of domicile” (state of primary residence) to determine whether a person is a spouse for purposes of FMLA.  Therefore, even if the employee formerly lived or was married in a state that recognized the same-sex marriage, he/she is unlikely to be considered a spouse in the “new” state for purposes of FMLA if the state does not recognize the marriage.  This is no small issue, since 30+ states currently do not recognize same-sex marriage and some don’t go all the way (e.g., Illinois, which recognizes same-sex unions, not marriages).

Surely, some might argue that the United States Constitution requires other states to recognize the marriage; however, this issue is far from settled.  My friend and Indiana University Maurer School of Law professor Steve Sanders writes a compelling article for SCOTUSblog contending that an individual married in one state maintains a “significant liberty interest” under the 14th Amendment’s Due Process Clause as to the ongoing existence of the marriage.

Here, employers clearly need some help from the DOL.  Might the DOL draft regulations on how employers administer the FMLA in situations where the employee’s spouse is not recognized under state law?  If so, we could see the DOL give life to concepts such as a “State of Celebration” rule, in which a spousal status is determined based on the law of the State where the employee got married.

Without more guidance, it still is too early to tell where this question is heading.  Nevertheless, the employer community looks forward to helping shape these rules.

Other Key Benefits Affected by the DOMA Decision

FMLA is not the only federal law impacted by the fall of DOMA.  If federal regulations follow through, some of the notable federal laws and benefits impacted may include:

  • Taxes: Same-sex spouses likely will share many federal benefits and be able to manage tax liability in a way that opposite sex spouses typically do.  For instance, an inheritance, which was taxed under DOMA, will no longer be taxed for a same sex spouse (this was the factual scenario at issue in the decision). Income taxes, payroll taxes, health insurance benefits, and tax reporting may also be impacted.
  • Affordable Care Act and COBRANPR reports that the Court’s decision will impact how the Affordable Care Act (affectionately referred to as Obamacare) is carried out, though many details remain unclear. Moreover, same-sex spouses may be eligible for continuation of health insurance benefits (COBRA) even though the spouse may lose his/her job.
  • Employee benefits: Same-sex spouses likely will be treated equally when it comes to employee benefits, including a 401(k) plan.
  • Social security benefits: The Court’s decision also paves the way for social security survivor benefits to continue onto a legally married same-sex partner.
  • Citizenship:  According to NBC News, some 28,000 same-sex spouses who are American citizens will now be able to sponsor their non-citizen spouses for U.S. visas and can qualify for immigration measures toward citizenship.

For future updates on the impact of DOMA on FMLA and employee benefits generally, feel free to follow me on Twitter or Linkedin.  I’ll be posting more there.  You also can subscribe to this FMLA Insights blog on the right hand side of this page.  Just enter your address and I’ll email you my updates directly.

This article was originally printed on FMLA Insights on June 27, 2013.  Reprinted with permission.

About the Author:  Jeff Nowak is a management side attorney at Franczek Radelet P.C. and author of the FMLA Insights blog.

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