New Orleans Part of the problem in understanding the real, core issues with the Affordable Care Act and the way in which employers, especially those specializing in lower waged workforces, are jacking with the system is separating the ideological polemics from the facts in order to see whose ox is really being gored. For example, take a story in the Wall Street Journal about some Sodexo workers losing their company insurance because the company has classified them as “variable” workers.
You might wonder what a “variable” worker is. Good question! Essentially, these workers are “tweeners,” not regular full-time, though sometimes they are working 40 hours or more a week, and not regular part-time, where they are working 20 or more, but folks whose schedules are, yes, you have it, variable. Seasonal workers at race tracks, amusement parks, and college campuses are all good examples, as are many hotel workers. Why is this important? Because remember the bright line test for mandatory coverage under the Affordable Care Act is a worker averaging 30 hours per week, and that’s where we find the rub. Under the Act the IRS allows a “look back” period of up to a previous year in determining whether or not a worker made the 30 hour average by January 1, 2015 to determine whether the company has to cover the worker. With me now?
Without a doubt Sodexo is a sucky company, and that’s nothing new. With 125000 workers in the US, the French-based global services company specializes in food service, janitorial, and similar contracts by cutting wages and displacing fulltime workers. They warrant no sympathy from anyone and have been targets over the years of extensive union organizing campaigns launched by UNITE HERE and SEIU. ACORN International partnered with these unions in researching worker conditions in Peru and India with our members there and found deplorable living and working conditions and numerous cases of wage theft so, let’s be clear, there’s no love lost.
Nonetheless Sodexo defends its reclassification of variable workers, who will now lose access to its company policy by saying they will now “be able to get access to benefits on the public exchanges in ways they couldn’t have before,” which is actually true. The worker whose story drives the Journal handwringing says she was paying $69 per week for her and her husband on the company plan or $296.70 per month. On the exchange she is now paying $231 per month. That’s actually $65.70 less per month. The article doesn’t say anything about her husband, but we are led to assume the comparison is apples to apples, because the criticism included by the reporter is that she now has a high deductible plan. The Journal is silent on what kind of plan Sodexo was offering, but trust me, it would be a miracle if Sodexo was not also offering a low premium – high deductible plan, since that’s the way the vast majority of large, lower wage employers have moved en masse in the wake of Obamacare. Furthermore, most of them were already there, so they didn’t have to move far, they just had to get their usually crappy plans that very few chose under 9.5% of gross income for the workers, which pushed premiums down and deductibles up.
Sodexo is claiming all of their shenanigans “on a net basis, are costing the company material amounts of money,” which in English means they are still whining. Who knows? And, who knows as well whether these workers might actually be better off with Obamacare in terms of cost and coverage than staying on the Sodexo. Certainly this story provides the politics without the proofs.
The only things we know for sure is that these workers need more hours and higher wages from Sodexo, because that’s the way the Sodexo business model works and the way these contracting outfits roll. The rest of the story on “variable” workers is a head scratcher with “”Eeny, meeny, miny, moe” being about as good as any way to tell if the workers’ health coverage is better with Sodexo or Obamacare, although I’d guess the better bet is actually Obamacare, rather than Sodexo.
New Orleans The Center for American Progress in Washington issued a report recently on the distribution of teachers within public schools which was deeply disturbing, even if not surprising. At the bottom line they found that public schools in high poverty areas were three times as likely to have teachers ranked as ineffective, and in public schools where there were greater percentages of minorities, teachers were two times as likely to be ineffective. Essentially, that says that public school administrators are allowing the gaps between rich and poor, white and non-white to create great systematic, permanent gaps in our populations, particularly in our cities.
Most of CAP’s research data comes from a close examination of teacher distribution data from those states that collect such data as a requirement of the No Child Left Behind legislation dating from the Bush Administration. All districts were required to reach a goal of having high quality teachers, or HQTs as they are called, by this point. Sadly, the distribution of teachers still seems solidly skewed away from poor and minority schools that arguably most need the best teachers available in public schools, since the one thing that virtually all educational experts agree on is that good teachers are the single most important factor in creating the best educational outcomes. Twenty-eight states submitted data requested, which is a poor showing, and, worse, only seven states submitted plans that were rated “acceptable” by the Department of Education. Furthermore most of the states would be graded as “incompletes.” The ones that fessed up did so for the most part in 2006 and though some reported modified plans in some in subsequent years, for the most part, most states just stopped coming to school on these standards.
In a poorer and more minority district, you are more likely still to have unlicensed teachers and teachers who are teaching outside their areas of expertise. Not surprisingly teacher turnover is closer to 20% in such schools compared to single digit numbers in whiter, richer schools, all of which sentences students to poorer performance and reduced opportunity. In this regard the CAP study builds on years of similar studies, like those that ACORN produced on educational “apartheid” in New York City and other districts, and documents the depressing lack of fundamental progress in creating educational equity in public schools. The CAP report puts a game face on the numbers and correctly argues that there has been progress in teacher distribution, just not enough.
Part of the problem is that the federal government is essentially a lobbyist in the public school debate trying to leverage its 10% federal contribution to the great share of resources produced by local and state taxpayers. Importantly, the report does argue that specialized programs at the federal level, like Title I, which only targets lower income students, needs to have its comparability provisions strengthened to ensure that “schools that serve low-income students receive the same share of local and state dollars, before federal funds are added, as schools that serve higher income students.”
For my money, it’s a scandal to think that lower income and minority schools continue to fall behind and that higher income schools are picking their pockets at the state and local level, by perverting the formulas for distribution of Title 1 monies from their intended sources, while saddling them with the worst teachers to boot.
New Orleans The Pew Charitable Trust has an elections initiative that has been looking at election administration in the states over recent cycles. They began by looking at 2008 and 2010, and most recently released a report on 2012 comparing both Presidential elections. I won’t lie to you, it’s very dry reading, and given the contentiousness about elections these days, there’s little question that they made it deliberately boring. But in talking on Wade’s World on KABF to Sean Greene, the research director who put the pieces together for Pew, we couldn’t help but uncover some interesting nuggets, some of which provide hope for the future.
One caveat to keep in mind is that many of the anti-democratic voter suppression laws passed in recent years did not go into effect during the period of this study. That’s still a horror that awaits us. Nonetheless, the Pew report found that for most states election performance improved around the country, based on the 17 criteria they examined. That doesn’t mean that Florida still didn’t have an average 45 minute wait for voters, the worst in the country, but it does mean that their wait was somewhat shorter than it was – gee whiz! Neither does the report disguise the fact that Georgia, Texas, and Arkansas among others all did worse as election tinkering in those states increases.
When it came to finding reasons to hope for the future, Greene underscored one finding he found promising, which was the increasing number of states allowing voter registration via the internet. Between 2008 and 2012 the number of states with such provisions increased from only two to thirteen. Initially in talking to Greene, I scoffed at the fact that in poorer cities and the South, the lack of internet access canceled out some of the potential benefits from such a provision, potentially increasing the gap between eligible lower income voters and higher income constituents with internet access. While conceding the point, Green helpfully remarked that on-line registration significantly eased the process of third-party registration.
Bam! I got it then. The problems that plagued some of ACORN’s large scale registration efforts would be eliminated if registrars were able to immediately register new voters on-line where there would be no accuracy issues and no blowback from Mickey Mouse jokers. Looking later at the website for the National Conference of State Legislators, it appears the up-to-the-minute tally on states with full or partial on-line registration is growing rapidly. Their count was 16 had approved on-line registration through April 2014 with another 4, making 20, having passed the legislation, and another 6, simply waiting to enact, making 26. Unfortunately, the table that followed didn’t add up to 26, but was still stuck at 24, so let’s not quibble, we’re almost covering half of the country, which means a “direct outreach – on-line enabled” registration program could be huge, effective, and involve less organizational and reputational risk.
The states are a hodgepodge, but include some battleground states at some level including Missouri, Ohio, New Mexico, Arizona, Minnesota, Indiana, Virginia, Colorado, Maryland, and others. They are light on the South, but Louisiana and South Carolina are on the list, Georgia and West Virginia are coming on soon, and while looking for the list I found that even Mississippi is debating making the switch, largely because it’s cheaper, but, hey, any port in a storm. Of course you won’t find Texas, Florida, and Pennsylvania on this list yet, but Greene and the Pew team are right, there’s hope if there were ways and means to scale up an effort with these tools in place, and an iPad with a computer air card in hand, and you could do some damage in getting more folks registered of all incomes and persuasions.
New Orleans Driving through Texas, the highways are littered with signs, mile after mile, reminding the driver to “not mess with Texas.” When it comes to the Affordable Care Act and enrollment of the millions of people who have no health insurance though, the state does nothing but push boulders into the road.
You will remember that at one point the Governor and Presidential candidate wannabe, Rick Perry, was ranting at the Texas Department of Insurance to come up with almost impossibly strict guidelines for navigators who were assisting in Obamacare enrollment. At one point he wanted all navigators to take classroom and on-line tests before the sign-up deadline to stall the whole process, pay $800 for the testing, endure fingerprinting and police background checks, and any number of other things, just to monkey wrench the process. At least they were honest. They just wanted to slow down enrollment. Plain and simple.
Unfortunately, the governor and his drooling, mad dog supporters had a problem since the standards they had for assistors for Medicare and insurance agents themselves were not as burdensome as what they were requiring for navigators who were limited to only helping people get on the website and enroll. At the end of the day they pushed back the new requirements to May 1st after the March 31st deadline for Affordable Care, and the costs were more in the range of $130 or 150 per test. Oh, yeah, you still had to get fingerprinted and police checked, but that was more harassment than anything else.
So what is this new rigorous testing and instruction really like? Talking to some of the navigators who are going through the three hour a day, instructed on-line teaching, most of them are finding it something of an “out of body” experience. As one wrote me,
The TDI class is unbearable. 90% has nothing to do with being a navigator or ACA. It seems to be a course to encourage people to NOT be navigators. All the presenters are lawyers and spend most of their time quoting state law and acting like we are becoming insurance agents. Every so often they will say, “This part is important for ACA.”
Truth to tell, they are clearly just faking it, so that they can say to someone that they piled it on these poor navigators. Everyone is just marking time and some Republican legal-beagle donors are making some easy bucks pretending to teach.
And, truth to tell, this is also a complete political charade, not only because of the obvious, which is the fact that the main 2014 enrollment period is now over until October opens up for 2015, but also because the navigation program was only funded by Congress for one year and times out in August 2014. Talk about kicking a dead horse! Unfortunately for the millions of people that need them to help get on Affordable Care, there just won’t be any federally funded navigators ready to help for 2015.
This will be just another Texas tall tale of how they whooped it to the navigators so they couldn’t help sign up any more people to that darned Obamacare, when in truth the politicians were just beating a dead horse and play acting for the cheap seats the whole time anyway. Hey, it’s only about life and death, so in Lone Star cynicism, who cares anyway, and the devil take the hindmost.
New Orleans It’s only a matter of time before someone sues James O’Keefe, the video scammer, for false advertising to prevent him from calling his operation Project Veritas, since veritas means truth in Latin, and he has no clue what that is.
O’Keefe’s latest tempest in a teapot had been his accusations against the Battleground Texas voter registration project. He and his associates had memorably called the group something on the order of the “new ACORN” so that obviously attracted my interest and enthusiastic support for them right “from hello.” Once you stripped down all of the hyperbole, allegations, accusations, and his general cry that the “sky was falling” on democracy in Texas, the kernel of his argument was that somehow the Battlegrounders were keeping the phone numbers of folks they registered in order to call and remind them to vote when the next election came nigh. Oh, and the O’Keefers also said this was all done at the behest of Wendy Davis, one of the Democratic candidates for Governor, once Rick Perry is done.
The O’Keefers filed their complaints amidst hubbub from the Republican Tea-people and the general red meat crowd so a Texas judge appointed a couple of special prosecutors to look into the mess, including one who was a Republican, since fair is fair still, even for some folks in Texas. Needless to say, there was “no there, there.” In his dismissal of all charges the judge administered a slap down in his conclusion:
The Veritas video was little more than a canard and political disinformation. The video was particularly unprofessional when it suggested that the actions of Battleground Texas were advocated by a Texas gubernatorial candidate and that the actions of a single volunteer deputy registrar may even involve private health data, which is not involved in the voter registration process.
Oh, yeah, did I forget to say that while they were taking shots at ACORN, in equally scattershot fashion they had alleged that somehow their complaints were also connected to hanky-panky by the Battlegrounders with Obamacare. Invoking Obama’s name on the O’Keefe besotted wacko-right is a clue that the fur is about to fly, so you can’t fire off an angry screed without connecting the dots back to Obama, ACORN, etc, etc, etc,
As for the actual allegation, well to quote MSNBC.com’s report
… the special prosecutors wrote that the prohibition on recording phone numbers only applies to the official county registrar, not volunteer registrars like Battleground Texas activists.
Readers will recall that O’Keefe is in Texas largely at the behest of Brietbart.com which is hoping there and in the United Kingdom that their brand of hate-agation can stir up confusion for upcoming elections in both places.
MSNBC reminded readers that it’s all about voter suppression of course and that there’s plenty at stake:
Texas has one of the lowest turnout rates in the country. And because Hispanics in the state are registered to vote at a significantly lower rate than other ethnic groups, boosting their participation rate is crucial to Democratic hopes. For the GOP, hampering that effort is a key strategy for holding onto power. Already, Texas Republicans have made registration more difficult: A 2011 law required that anyone registering voters complete an extensive training program, and imposed other restrictions. And the state’s strict voter ID law, currently being challenged by the Justice Department, has been shown to disproportionately affect hurt non-whites.
I couldn’t have said it better myself, but trust me on this, O’Keefe’s total lack of a moral compass and disregard for anything resembling the truth, makes him immune from embarrassment since his only interest is in drawing blood at the first, deepest cut, not whether or not he suffers some scrapes himself. Nonetheless as his base continues to narrow, we can count the months until his minders, less immune to the damage, finally cut him off at the funding stream, which is the only thing he’ll ever notice.
New OrleansIt’s easy to see why the American Medical Associations, the powerful AMA, the doctors’ closed shop union, wanted to keep the wraps on how doctors collected $77 billion worth in Medicare payments from the nation’s elderly.There’s just nothing that seems right about one single Florida-based ophthalmologist raking in $21 million all by his lonesome.Hey, the eyes have it for goodness sakes, but he’s not doing brain surgery for crying out loud, but luckily all of our eyes are now going to be on his practice to see if it he’s padding the bills.
143,000 elderly are getting treatments for macular degeneration that cost over $1 billion.These treatments can occur as frequently as monthly and involve a shot with a needle into the eyeball, which I know from my own dear mother, is also very painful.Meanwhile there’s a drug that may be just as good and that is a whole lot cheaper and perhaps less painful as well.I’m not saying these docs are putting a bunch of old folks through the ringer, but I definitely want to know for sure that this is the right thing they are doing, so having a lot of light shining on the issue is very important.
It was also pretty shocking to see that only 2% of the doctors sucked up nearly a quarter of the payments totally $15.1 billion of the $77 billion.Maybe there will be a big argument about inequality among the docs now, too!
As this kind of information for doctors, clinics, which were not included in these totals, and hospitals is processed, I have two feelings.On the one hand we’re going to finally have some real tools to try and avoid the rip-off folks and hopefully to shame some of these institutions into dialing back some of the bill padding especially for needless procedures.On the other hand I’m already getting mad though because, frankly, I’m not convinced that any amount of shaming will impact them because so much of the medical market is based on location and scarcity and therefore can easily hold desperate patients in a predatory position with the government paying for the pain and privilege.
The best news I could see was at the end of the coverage in the New York Times:
Regulators and others are also likely to seize on some of this information to find those doctors who perform an unusually high volume of services, raising the question of whether every test or procedure … was medically necessary. “There’s a lot of potential for whistle-blowers and justified worry for fraudsters,” said Steven F. Grover, a lawyer who represents whistle-blowers who sue doctors and hospitals who they claim have committed fraud against the Medicare program. “There’s going to be a lot of litigation over this,” he said.The Office of Inspector General for the Department of Health and Human Services, which serves as a federal watchdog on fraud and abuse for the agency, released a report in December recommending greater scrutiny of those physicians who were Medicare’s highest billers. The report recommended that Medicare establish a threshold to look more closely at the high billers. Regulators have also said they are scrutinizing the use of high-paying codes in places including the emergency room.
It’s too late for me to be a rich man or in this case a doctor when I grow up, but being a whistleblower sounds like something right up my alley.Time to buy a green eyeshade, calculator, and better glasses, and all of us start pouring through these records and seeing who is fair and square and who is crooked and sleazy, and making the latter pay for a change, rather than getting paid big change.Big data might be our friend and at our fingertips.Did you know you can even go on the Center for Medical Services website and check on your doctor now?Caveat emptor is going down, and OG’s with a doctor’s license better start remembering the motto about “do no harm.”