MemphisIt was only a matter of time before some of the paradoxes embedded in the Affordable Care Act began to make too many employers, both good and bad, wonder if they couldn’t do better when they pay for health insurance.We’ve talked about some of the problems before, especially the incongruities around the loopholes within the definition of affordable and therefore qualified health plans.
The big issue for us with lower income workers has been that a low premium, exorbitantly high deductible plan offering essentially NO coverage past the minimum guarantees could be classified as affordable and qualified solely based on the fact that the monthly premium was under 9.5% of gross wages, regardless of the embedded barriers to actually using the health plan within your income if the deductibles were $3000, $4000, or $5000, all of which aren’t considered when it comes to affordability.And, yes, that’s crazy!
The same thing is true for spouses and dependents.If your employer provides you with qualified health insurance, then unless your children are eligible for Medicaid because of your lower income, they and your spouse are dependents on your policy. There are no reasonable limits on the cost of dependent coverage.They are not barred from purchasing separate insurance with the state or federal marketplace, but they are barred from receiving premium tax credits or cost sharing, which is what makes getting insurance attractive for millions.I’ve heard conversations about separations and whether or not filing taxes separately would allow spouses to access the marketplace in such situations, but none of these schemes are allowable.
Interestingly some smaller employers with less than 50 workers are starting to look at this in the way we knew would be inevitable.There are no fines for them not offering coverage and indeed surveys indicate that such smaller enterprises are now only providing employee health coverage in 38% of such outfits compared to 47% only a decade ago.With a blend of lower waged workers, they are realizing that they may be able to spend the same amount of money and actually help their workers and their workers family by adding their expenditure to pay envelopes or separate health purchase funds so that their employees can get better insurance for the whole family by purchasing on the exchange and benefiting from the subsidies and tax credits.
Are these loopholes or broken pieces that need to be fixed?My view is these are things that should be fixed.Unfortunately, as long as Congress is divided and the Republicans see Obamacare as something between the Alamo for the President or their own Waterloo, everyone is just pushing this thing down the road and hoping it will get there rather than trying to see how to make it work better for everyone.Employers are critical to the success of the Affordable Care Act but there are too many bells and whistles they are hearing that are encouraging them to game the system rather than making it work.Help!
Little RockIt seems straightforward.If you are going to ask for and, if fortunate, receive government money, then you are going to have to follow the law.Some Senators though had their staff undertake a study of federal contractors only to find that many of these big business were delighted to get the dollars, but somehow believed that they only had to follow whatever laws they felt like, especially when it came to their workers’ wages and health and safety:
“The report found that 32 federal contractors were among the leading companies in the amount of back pay assessed for wage violations between 2007 and 2012.‘Overall, the 49 federal contractors responsible for large violations of federal labor laws were cited for 1776 separate violations of these laws and paid $196 million in penalties and assessments.In fiscal year 2012, these same companies were awarded $81 billion in taxpayer dollars.”
You know, that’s just plain wrong, but equally appalling is the obvious conclusion that when the federal government is giving out these contracts it really doesn’t care whether or not the laws are being followed, especially when it comes to the tens of thousands of workers involved.I would almost bet money that this is the tip of the iceberg when it comes to real violations, especially on wage issues, since the work of really monitoring whether or not something like the Service Contract Act was being followed to the nickel on assuring that workers were receiving proper amounts under area wage determinations would have been exhausting and difficult.
The whole point of prevailing wage statutes like SCA or Davis-Bacon or the McCarran shipbuilding act is to make sure that the federal government sets the standard as a fair and safe employer.An Obama administration plan to give preference to bidders that provided what they determined to be “good wages and benefits” was shelved, according to Times’ labor reporter, Steven Greenhouse, so perhaps this is another pipe dream, but it shouldn’t be, should it?Frankly, I think they should establish themselves and their contractors as “model” employers and provide the benchmarks in these areas, but even if not that, the least we should expect is fairness and attention to the letter, if not the spirit, of laws that are meant to protect worker-citizens.
Bad actors like Tyson Food, Imperial Sugar, and British Petroleum are legendary in these reports, yet it seems the feds don’t even keep a database up to date on compliance and infractions.Maybe we need to ask the NSA with its vast computing and database capacity to take this on to keep them out of mischief and provide real worker protections as part of the package on the $307 billion in federal contracts awarded.
In the meantime it’s all about the money for these folks while the workers take the risks and we all get the hindmost.
Little RockOne of the interesting claims by the conservative right, most recently directed at the Affordable Care Act and the myriad website enrollment snafus, has been essentially that the federal government is the gang that can’t shot straight.Among the claims has been that states and certainly private businesses can do a wonderfully better job.
In light of that it was interesting to see a couple of buried tidbits in the news by way of very important, but widely neglected, follow-up.
Take the hugely controversial federal bailout in the great recession of banks, automakers and others, started by Bush and continued by Obama.It seems that in the soaring stock market and the revived profitability of the car companies, the government off loaded the last of its stock in General Motors.What was good for GM might not have been a great investment for the government in pure terms since they lost about $10 billion of the almost $50 billion they put up for the stock, though obviously that doesn’t count the hundreds of thousands of jobs saved, therefore taxes paid, and communities stabilized.For the whole bailout though the government seems to have been a winner.Of the $422 billion invested the federal government can report pure profits on the investment now of $433 billion, clearing $11 billion.Yes, they might have done better in the stock market, but $11 billion is real money and, once again, doesn’t count the impact of jobs retained and therefore income taxes collected, which is the government’s real revenue stream.
How about the states?On the same day the government was reporting profits, the states were still raking in money from tobacco sales taxes and other revenues including the billions they got from the legal settlement from the tobacco companies several years ago.
The Campaign for Tobacco-Free Kids, the Robert Wood Johnson Foundation and four other organizations estimated that states would earn about $25 billion next year in revenue that is linked to tobacco, including $7 billion from settlements between states and leading tobacco companies. But the groups said that states were expected to spend only $481 million on programs intended to prevent or curb tobacco use, well below the $3.7 billion recommended by the Centers for Disease Control and Prevention. It is also a marked decrease from 2002, when the states devoted $750 million to those efforts.
So, $7 billion from the tobacco settlement alone and only $481 million to actually use the settlement money for its intended purpose, saving lives of smokers and doing the education and field work to stop the increase of smokers.Only Alaska and North Dakota spent the level of money recommended by the federal government on prevention.
The rest of the states reallocated the money to balance their budgets, essentially on the back of the lives of their citizens.It goes without saying that many of these same states are also the ones that are yelling about not want to expand Medicaid in their jurisdictions because of the supposed additional healthcare costs involved and therefore essentially taking almost $7 billion that should have been used for better healthcare and transferring the costs over to the federal government at the same time they piss on the program.
The buck has to stop somewhere, but clearly the governors don’t want it to stop at the statehouse no matter what the conservatives claim, it’s still all about the facts, Jack.
DallasFigures released by the Federal Reserve indicate that citizen wealth by some indices is recovering almost to pre-recession levels.According to the Wall Street Journal:
The net worth of U.S. households and nonprofit organizations—the values of homes, stocks and other assets minus debts and other liabilities—rose 2.6%, or about $1.9 trillion, in the third quarter of 2013 to $77.3 trillion, the highest on record, according to the Federal Reserve.
The Fed’s figures aren’t adjusted for inflation, but even after accounting for rising costs—using the Fed’s preferred inflation gauge—Americans’ net worth is at record levels. The figures also aren’t adjusted for population growth, and the nation’s wealth is roughly 1% short of its peak according to another commonly used gauge, the consumer-price index.
So, that’s the good news.
The bad news is that these record setting levels are masking the fact that the same upward sweep is increasing inequality, the gap between the richer and the poor, since these good times are being disproportionately enjoyed by those folks with money in the stock market, and that’s not the poor, and equity has risen for homeowners, who were able to hang on, but that’s also no longer a tide rising lots of boats.With homeownership gains for African-American and Latino families having been rolled back to levels of thirty years ago obliterating the advances, and wiping out all of their equity, these are gains being felt by the more well off survivors of the housing crash or those lucky enough to have the resources to hang on.
Unemployment numbers continue to be high and underlying these numbers are significant levels of structurally permanent unemployment with four million workers unemployed more than six months and increasingly dropping out of the job market entirely.Since these gains in citizen wealth are coming from ownership rather than employment, it also masks wage stagnation for the vast majority of working families, even as high end, big rollers have regained pay levels at the top.
Even when there’s some good news, it’s impossible to be happy about Federal Reserve statistics that essentially establish that American citizen wealth is increasing to record levels but only for some people, not for everyone.
Houston Reading the papers about the efforts to enroll the uninsured in Obamacare, two directly contradictory themes emerge these days. First, it is clear that there is consensus that the website, www.healthcare.gov is working much, much better, even if not perfectly. Secondly, it also is clear that there continues to be wildly competing direction at work on how to achieve maximum eligible participation forcing almost daily, game day modifications in enrollment strategies.
Clearly, the website’s earlier problems have depressed the enrollment figures from the government’s original estimates. Been there, done that, and let’s go forward.
The government seems to have understood during the website crisis that written applications were important and encouraged the various health centers, assistors, and navigators to move people into paper applications. Navigators are reporting to the Associated Press that paper applicants have not received enrollment follow-up, even while the government is saying that all paper applications have been processed. What are the facts, Jack?
Meanwhile the government has discontinued printing paper applications, even in Spanish despite the fact that there is no Spanish language access to the online enrollment process, in order to encourage full utilization of the website. Some of this is situational since there is virtually no way that a paper app could be processed completely in a two-week period before Christmas in order to ensure coverage by the first of the year. Meanwhile the problem of the digital divide and the language gap is unresolved for the coming year’s enrollment, so we can almost predict different public guidance will be coming, hopefully after the first of the year.
Reports in the Times discussed something that the government is informally calling “orphan” enrollments, which is very disconcerting news. The so-called “orphans” are enrollees who believe that they have successfully completed all steps of the process and are now good to go, but in fact are in a limbo-land where even though they have been fully processed a glitch in the system may have not gotten their information fully to the insurance company, therefore leaving them still without insurance, even though they think they are ready to roll. The same article indicated that 25% of all enrollments may have errors sufficient to block enrollment. The government reports that it is solving this, so we can hope this is a tree falling in the health care forest that we wish we hadn’t even heard about.
Another rumor I could have lived without are unconfirmed reports that there may be rightwing and Republican hacking at the healthcare.gov site contributing to the problems. I honestly doubt this is happening, but the strength of the rumor alone could dissuade people already tentative and uncertain in dealing with the website to approach it even more gingerly, if at all.
We’re dealing everywhere with voter suppression. It seems right now we need to deal with Obamacare suppression even more aggressively.
Houston Yesterday in talking with Brian Johns, the organizing director of Virginia Organizing on “Wade’s World” on KABF about his forthcoming article with Ellen Ryan for Social Policy called “Leadership Development is Not a Deliverable,” we were trying to follow the curiously circuitous paths of private philanthropy as it moves from grants supporting community organizing’s mission of empowerment to limited contracts directing specific work, A calamitous evolution, we thought.
All of which made it impossible not to read closely an op-ed in the Times by Ray Madoff, a professor at Boston College’s Law School.
He made several inarguable points:
Tax deductions for charitable giving by the rich and others taxpayers making enough money to make it worthwhile to itemize deductions is essentially cost to the government of $40 billion in lost tax revenues.
Numerous nonprofit hospitals with tax exemptions provide less charitable care than for profit hospitals and are indistinguishable from big for profit corporations. Senator Grassley (R-Iowa) thinks they should have to provide more charitable care. Who can disagree?
Conservation easements are being abused by big time developers to subsidize their developments.
Too many donor advised funds have become vehicles for parking money to escape taxation for an unlimited period of time. The professor suggests a cap of seven (7) years which doesn’t seem unreasonable.
There hasn’t been a Congressional review of charitable deductions since 1969.
It’s hard to argue that the rich, hospitals, and developers should at least have to work for billions of dollars’ worth of benefits, rather than have the rest of us subsidize them. Then maybe if we can make it matter, we can also make sure some of the real donations go to make real change.