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Posts Tagged ‘Medicare’

Medicare for All’s jobs problem

Tuesday, November 26th, 2019

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

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

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

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

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

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

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

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

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

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

Having it both ways

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Extra dollars, extra life?

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

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

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

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

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

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

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

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

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

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

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

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

As for the insurance jobs?

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

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

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

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

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

Tuesday, November 19th, 2019

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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.

If you have a preexisting health condition, don’t even think about leaving your job

Tuesday, November 15th, 2016

If President-elect Trump follows through on his campaign promises, millions of individuals-immigrants, religious minorities, people of color-face a very grim four years. One of the worst hit groups will be Americans with significant health costs. The Trump transition team published a brief summary of the incoming president’s health plan on its website, and the news is not good for the elderly, the poor, and millions of Americans with preexisting conditions.

Much of the plan is vague. Trump plans to “Modernize Medicare,” for example, an unclear statement that is likely code for Speaker Paul Ryan’s (R-WI) plan to repeal Medicare and replace it with a voucher system that imposes much higher out-of-pocket costs on seniors. Similarly, Trump says he will “Maximize flexibility for States in administering Medicaid,” a statement that is probably code for Ryan’s plan to either “require states to provide less extensive coverage, or to pay a larger share of the program’s total costs, than would be the case under current law.”

A central prong of Trump’s plan, however, is to repeal the Affordable Care Act and replace it with, well, not much at all. Trump says he will “repeal the ACA and replace it with a solution that includes Health Savings Accounts,” which primarily benefit the rich and offer little or no benefits to low and middle income Americans. Trump will “enable people to purchase insurance across state lines,” a coded phrase which actually means that he will eliminate state regulation of insurance which requires coverage of treatments ranging from mammograms to maternity stays to well child care.

And then there’s his proposal for people with preexisting health conditions.

Prior to Obamacare, one of the most vulnerable groups was people with medical conditions who neither qualified for a government health program nor received insurance through their employer. Insurance companies would deny coverage to these individuals for conditions as severe as cancer or as routine as hay fever.

The reason why is that covering people with such conditions is expensive. A health insurance plan is a pool of money. Consumers contribute to that pool when they pay their premiums, and they take money out of that pool when they become sick or otherwise seek treatment. That means that, if someone tries to join the pool who has a preexisting condition, the insurer will try to keep them out because it will cost more to insure them than they will pay in.

The Affordable Care Act addressed this with a trio of reforms—a requirement that insurers allow everyone in, subsidies to help pay for coverage, and a financial consequence for people who fail to buy insurance. The final of these three reforms existed so that healthy people would not forego insurance, forcing insurers to cover only the most expensive individuals.

Trump plans to eliminate this framework and replace it with “high-risk pools,” essentially, a special insurance program for people with expensive preexisting conditions. In theory, high-risk pools can work to provide health coverage with such conditions, but they are an inefficient way to do so. And they have reliably failed when attempted by states.

At best, high risk pools are a way to maximize the insurance industry’s profits while shifting the costs of our health care system onto the taxpayers. If the government takes on the burden of insuring the most expensive individuals?—?and only the most expensive individuals?—?then that’s a bonanza for the insurance companies because they will be left with a pool of less expensive (and more profitable) consumers. Meanwhile, the costs of providing care for the most expensive health care consumers will fall upon whatever new government program President Trump creates to manage the high risk pools.

But that’s actually the best case scenario for Trump’s health plan. Because high risk pools take on the most expensive health care consumers, they are expensive to maintain. And when states attempted to set them up in the past, they did not fund them enough to cover more than a fraction of what was needed. As one report explained when Sen. John McCain (R-AZ) proposed high risk pools during his 2008 presidential bid, these pools “have not been a viable alternative for the medically uninsured because of high premiums…and inadequate funding to subsidize the full cost of providing insurance to a high-cost population.”

McCain’s plan is informative regarding what a Republican proposal for high-risk pools is likely to look like. The Arizona senator proposed spending between $7 to $10 billion on these pools. But that would only cover a fraction of the Americans who would lose their health insurance if Obamacare is repealed. A national program “funded at $7 billion per year would cover only 875,000 people,” and that was in 2008. Alternatively, “even if participants had to pay half of their own premiums, as is generally the case today in state high risk pools, less than 2 million Americans would be covered.”

Obamacare provides health insurance to about 20 million Americans.

Of course, Trump’s proposal is vague on details and especially short on numbers. So maybe he plans to fund the high risk pools enough to fill the gap that will be created by repealing Obamacare. The likelihood that Republicans intend to replace a policy they denounced as socialism with what would likely be a significantly more expensive government program, however, is small.

If there is any ray of light in Trump’s proposals, it is that he doesn’t appear to have set his eyes on pre-Obama laws that protect workers with employer-provided health plans that have preexisting conditions. Nevertheless, Trump is, in effect, planning to reinstate a problem known as “job lock,” where people in jobs that they would rather leave are forced to stay in them because it is the only way that they can obtain health benefits.

That means fewer people starting businesses, more people working into the years when they would rather retire, fewer jobs opening up for younger workers eager for new opportunities, and more people simply stuck in jobs that they hate.

On November 7th, it seemed like workers were finally free to take risks without having to fear that they would lose their health coverage. Only a few days later, that freedom is likely to disappear.

This blog originally appeared in ThinkProgress.org on November 11, 2016. Reprinted with permission.

Ian Millhiser is the Justice Editor at ThinkProgress. He is a skeptic of the Supreme Court, hater of Samuel Alito, and a constitutional lawyer of ill repute. Contact him at  imillhiser@thinkprogress.org.

Krugman on ‘Sequester of Fools’

Saturday, February 23rd, 2013

Image: Mike HallPaul Krugman has a pretty straightforward plan to deal with the sequester that’s due to hit March 1. The New York Times columnist and Nobel Prize-winning economist says, “The right policy would be to forget about the whole thing.”

He bases his proposal on what Federal Reserve Vice Chair Janet Yellen said in her keynote address to the Trans-Atlantic Agenda for Shared Prosperity conference at the AFL-CIO headquarters in Washington, D.C., earlier this month. Fiscal austerity, such as the sequester and the latest doomsday alert from the Bowles-Simpson duo, is the enemy of real economic recovery. Writes Krugman:

America doesn’t face a deficit crisis, nor will it face such a crisis anytime soon. Meanwhile, we have a weak economy that is recovering far too slowly from the recession that began in 2007. And, as Janet Yellen, the vice chairwoman of the Federal Reserve, recently emphasized, one main reason for the sluggish recovery is that government spending has been far weaker in this business cycle than in the past. We should be spending more, not less, until we’re close to full employment; the sequester is exactly what the doctor didn’t order.

Read his full column, including his take on Erskine Bowles and Alan Simpson, “the famous fomenters of fiscal fear.”

The arbitrary, across-the-board sequestration cuts in everything from mental health services to public safety kick in next Friday, and House Speaker John Boehner (R-Ohio) and Republican lawmakers say they are willing to toss 750,000 people out of work and cut vital lifeline government services to ring massive concessions in cuts from Social Security, Medicare and Medicaid.

Working families are calling on their elected representatives to protect Social Security, Medicare and Medicaid from benefits cuts, repeal the sequester and make sure corporations and the wealthiest 2% pay their fair share through closing tax loopholes.

This post was originally posted on AFL-CIO on 2/22/2013. Reprinted with Permission.

About the Author: Mike Hall is a former West Virginia newspaper reporter, staff writer for the United Mine Workers Journal and managing editor of the Seafarers Log. He came to the AFL- CIO in 1989 and has written for several federation publications, focusing on legislation and politics, especially grassroots mobilization and workplace safety.

Bowles-Simpson 'B-S' Zombie Plan Tells Working People to 'Drop Dead'

Tuesday, February 19th, 2013

Jackie TortoraIt’s back. No matter how many times working people reject the Bowles-Simpson “B-S” budget plan that cynically claims it would “promote economic growth “—but would actually snuff out the recovery and cut lifelines for working families—it keeps coming back to the table.

Erskine Bowles and Alan Simpson released another tired plan today that would cut Social Security COLAs to pay for lower tax rates for corporations and the wealthiest Americans, among other things.

AFL-CIO President Richard Trumka released the following statement:

Once again, Bowles and Simpson have produced a plan that tells working people to “drop dead.” In December 2010, Bowles and Simpson put forward a budget blueprint that proposed to cut tax rates for corporations and the richest Americans and eliminate taxes on overseas corporate profits, and then pay for these lower tax rates by cutting Social Security benefits, shifting Medicare costs to individuals, taxing health benefits and cutting federal employees’ pay, benefits and jobs. The updated budget blueprint Bowles and Simpson put forward today cuts tax rates for the richest Americans and corporations and pays for these lower tax rates by cutting Social Security COLAs, taxing health benefits and cutting federal employees’ health and retirement benefits. For working people and the future of our nation, it is dead on arrival.

In recent actions and a call-in day to Congress, working families have urged their representatives and senators to:

  • Protect Social Security, Medicare and Medicaid from benefit cuts.
  • Repeal the “sequester” and close loopholes for Wall Street and the wealthiest 2% of Americans instead.

This post was originally posted on AFL-CIO on Feb. 19, 2013. Reprinted with Permission.

About the Author: Jackie Tortora is the blog editor and social media manager at the AFL-CIO.

Hey, Let's Fix Health Care

Thursday, May 24th, 2012

Written by CEPR

Former White House adviser Ezekiel Emanuel offered in a recent New York Times column his bipartisan solution to Medicare, Medicaid and Social Security reform: Graduated eligibility for Social Security and Medicare, or linking “the age of eligibility to lifetime wealth.” The idea, according to Emmanuel, is that “[t]he richer you are, the older you would have to be to be eligible for Social Security and Medicare.”

As Dean Baker notes over at Beat the Press, there are two problems with this approach. First, the budget deficit is a health care problem, not a Social Security problem. Lumping Social Security in with Medicare and Medicaid certainly makes it look like a problem, but if you replace “Social Security” with “muffins,” suddenly we are experiencing explosive growth with muffin costs.

Second, Emanuel’s proposal states:

People in the bottom half of the lifetime earnings distribution would become eligible for normal retirement benefits at age 65 for Medicare and 66 for Social Security, just as they are today. But people in the next quarter of the lifetime earnings distribution would become eligible for the respective programs at 67 and 68, and those in the top quarter would become eligible at 70 and 71. All eligibility ages would increase over time, as they are scheduled to now.

Dean points out that “Emanuel’s proposed cuts in these programs would hit people with average lifetime earnings of $40,000 and above.”* Dean and Hye Jin Rho wrote a paper about means testing last year, which you can find here.

* See Social Security data on Average and Median Amounts of Net Compensation.

This blog originally appeared in Center for Economic and Policy Research on May 22, 2012. Reprinted with permission.

On Labor Day, Work to Save the Middle Class

Wednesday, September 8th, 2010

Leo GerardThis Labor Day feels gloomy. It’s a celebration of work when there is not enough of it, a day off when too many desperately seek a day on.

America has commemorated two Labor Days since this brutal recession began near the end of George Bush’s presidency in December of 2007. Now the relentless high unemployment, the ever-rising foreclosures, the unremitting wage and benefit take-backs have replaced American optimism and enthusiasm with fear and anger.

Happy Labor Day.

On this holiday, we can rant with Glenn Beck, kick the dog and hate the neighbor lucky enough to retain his job. Or we can do something different. We can join with our neighbors, employed and unemployed, our foreclosed-on children, our elderly parents fearing cuts in their Social Security lifeline and our fellow workers worrying that the furlough ax will strike them next. Together we can organize and mobilize and create a grassroots groundswell that gives government no choice but to respond to our needs, the needs of working people.

We can do what workers did during the Great Depression to provoke change, to create programs like Social Security and achieve recognition of rights like collective bargaining. These changes were sought by groups to benefit groups. In a civil society, people care for one another. And America is such a society – one where people routinely donate blood to aid anonymous strangers, children set up lemonade stands to contribute to Katrina victims and working families find a few bucks for United Way.

The self-righteous Right is all about individuals pulling themselves up by their bootstraps. That proposition – the do-it-all- by-yourself-winner-takes-all philosophy – clearly failed because so many Americans are jobless, homeless and too penniless to afford boots.

Over the past decade, the winner who took all was Wall Street. The banksters gambled on derivatives and other risky financial tomfoolery and won big time. Until they lost. And crashed the economy. After the American taxpayer bailed them out, those wealthy traders returned to making huge profits and bonuses based on perilous schemes.

Still, they believe they haven’t taken enough from working Americans. They’re lobbying to end aid for those who remain unemployed in a recession caused by Wall Street recklessness. And they’re demanding extension of their Bush-given tax breaks. This is the nation’s upper 1 percent, people who earn a million or more each year, the 1 percent that took home 56 percent of all income growth between 1989 and 2007, the year the recession began.

Since 2007, 8.2 million workers have lost jobs. Millions more are underemployed, laboring part-time when they need full-time jobs, or barely squeaking by on slashed wages and benefits. Since the recession began, the unemployment rate nearly doubled, from 5 percent to 9.6 percent, and that does not include those so discouraged that they’ve given up the search for jobs, a decision that is, frankly, understandable when there are only enough openings to re-employ 20 percent of the jobless. Five unemployed workers compete for each job created in this sluggish economy.

And American workers weren’t prepared for this downturn, having already suffered losses in the years before it began. The median income, adjusted for inflation, of working-age households declined by more than $2,000 in the seven years before the recession started.

At the same time, practices like off-shoring jobs and signing regressive international trade deals contributed to the loss of middle class, blue collar jobs. A new report, “The Polarization of Job Opportunities in the U.S. Labor Market,” by the Center for American Progress and The Hamilton Project, says:

“The decline in middle-skill jobs has been detrimental to the earnings and labor force participation rates of workers without a four-year college education, and differentially so for males, who are increasingly concentrated in low-paying service occupations.”

The recession compounded that, the report says:

“Employment losses during the recession have been far more severe in middle-skilled white- and blue-collar jobs than in either high-skill, white-collar jobs or low-skill service occupations.”

What that means is high roller banksters are living large; lawn care workers and waitresses subsist on minimum wage, and working class machinists and steelworkers are disappearing altogether.

The researchers found the U.S. economy is increasingly polarized into high-skill, high-wage jobs and low-skill, low wage jobs. America is losing the middle jobs and with them its great middle class.

No wonder the rising anger in middle America.

But fury doesn’t solve the problem. This Labor Day, we must organize to save ourselves and our neighbors. We must stop America from descending into plutocracy. We must demand support for American manufacturing and middle class jobs. That means terminating tax breaks for corporate outsourcers, ending trade practices that violate agreements and international law and punishing predator countries for currency manipulation that subverts fair trade by artificially lowering the price of products shipped into the U.S. while artificially raising the price of American exports.

We must demand support for American industry, particularly manufacturers of renewable energy sources like solar cells and wind turbines that create good working class jobs, increase America’s energy independence and reduce climate change.

We must insist on policies that support the middle class, including preserving Social Security and Medicare, extending unemployment insurance while joblessness remains high, and enforcing the health care reform law so that every American worker and family can afford and is covered by insurance.

On this Labor Day, we should all have a picnic, invite neighbors, friends and family, and over hot dogs and potato salad, organize to save the American middle class.

Mobilize to end the gloom and restore American optimism.

***

For help: the Union of the Unemployed, the AFL-CIO, USW, Working America. Join the One Nation March for jobs Oct. 2 in Washington, D.C.

About The Author: Leo Gerard is the United Steelworkers International President. Under his leadership, the USW joined with Unite -the biggest union in the UK and Republic of Ireland – to create Workers Uniting, the first global union. He has also helped pass legislation, including the landmark Canadian Westray Bill, making corporations criminally liable when they kill or seriously injure their employees or members of the public.

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