Category Archives: Health Care

Fake-Work Ideology Will Kill People in Arkansas and Elsewhere

New Orleans    Study after study details the fact that with 45 million Americans employed in low-paying service sector jobs paying usually minimal wages for often part-time hours in a period of almost record low unemployment hovering around 4%, work in this age of excruciating inequality is simply not enough to get a family out of poverty.  A lengthy New York Times magazine article by Matthew Desmond of Evicted fame piled on as well.  Let’s face it, there is a work-myth that has gained ideological dominance for the last almost 50 years in a straight line from Ronald Reagan to many lesser rightwing conservatives today.  The heart of the myth is that there is a magic bullet that will eliminate poverty, as if they really cared, and that bullet is work, no matter how little it pays, how large the family, or where you live.

In these dark times states regularly bumping their butts on the bottom of the income ladder are competing to see how draconian they can be in punishing the poor for their own poverty.  West Virginia seemed to be winning the race for quite some time, and jumped out ahead of this rat pack in requesting an exemption from the federal Center for Medical Services (CMS) so that they could require a work test to receive the expanded Medicaid healthcare benefits allowed to the working poor under the Affordable Care Act.  Arkansas though jumped to the front of the death march in both securing the exemption and trumpeting their own cruelty.

Governor Asa Hutchinson recently lauded the fact that the state had been able to jettison 4300 from the expanded Medicaid program in the state for failure to report on their efforts to find work.  The requirements are 80-hours of something work-like such as training, job searches, or their equivalency.  If reports are not timely and correctly filed for three months, then the state has seized the right to bar you from health insurance for some period of time, regardless of the circumstances or in fact your health.  Many of the recipients were exempted from this requirement because of infirmities recognized by the state or the fact that their children were too young, but the rest had their backs against this work-vs-welfare ideological wall.  The governor claimed that 1000 got jobs, but lord knows whether that made them less poor and it certainly did not necessarily mean that they were off of Medicaid.  There are 16,000 Arkansas families that are on the bubble, and these 4300 are the ones that hit the 3-month mark of failing to get their reports into the state in a timely fashion.

Experts and observers nationally and in Arkansas are asking CMS to suspend approval of these work requirements until there is more information on why so many are being disqualified.  Is it inability to access the internet, difficult forms, illiteracy, distance from state offices, or what?  Studies in other programs and states have established that simply requiring regular reporting period will reduce the rolls for entitlement programs.

There is no doubt on one score.  People will die without healthcare and while conservative ideologues tout their success in punishing the poor.  Who will ever wash the blood off of their hands?


Now is the Time to Press Hospitals for Community Benefit Agreements

New Orleans       Community benefit agreements have increasingly become part of the conversation in cities throughout the country when it comes to major developments at the intersection of private interest and public authority, regulations, and landholding.  Few large cities under assault from major and minor sports interests to support stadium projects have not found themselves engaging in negotiations around community benefit agreements for example.  There are other opportunities though, as we discussed with Enid Eckstein on a recent Wade’s World radio interview that was triggered by her article in Shelterforce advocating for community benefit agreements with hospitals, particularly nonprofits.

Eckstein knows the healthcare industry well, both inside and out.  She was an officer in SEIU’s giant healthcare local, 1199, based in Boston, and more recently has been a researcher and advocate focusing on the role of hospitals and healthcare in communities.  The notion of community benefit agreements or CBAs has gained a lot of traction in Massachusetts in no small part, Eckstein argued, because of aggressive work by the Attorney General of the state in stepping up to regulate and codify the requirements under Massachusetts law that hospitals provide community benefits that were something other than developments of their own programs and self-interest, whether expanding a clinic or marketing their services.

Massachusetts is pathbreaking in this area, partially because they were a leader in providing mandatory health care in the state that was an inspiration for the Affordable Care Act.  The ACA also sets the stage for activity in this area because it requires that hospitals do a community assessment survey of health needs every three years, and mandates that the assessment integrate the community itself into the process.  The amendments offered by Senator Chuck Grassley (R-IA) put the Internal Revenue Service in this play because of his concern that nonprofit, tax exempt hospitals need to prove that they were providing charity care and if not, the IRS should pull their exemption.

The IRS has only recently begun enforcing some of the ACA regulations on penalties for smaller businesses not providing insurance for their workers, so it is unlikely that they are doing much in this area yet either.  Nonetheless, as Eckstein argues from the Massachusetts experience the opportunity is there for organizations of all shapes and sizes to start pushing hospitals to do right and do more.

And, why not?  One of the most compelling examples she offered in her Shelterforce piece occurred in Portland, Oregon, which like so many cities nationally, is facing an affordable housing crisis.  As part of a hospital CBA, $21 million was set aside by the hospital to build affordable housing and that leveraged almost $70 million for the project.

Now is the time to start pressing everywhere for hospitals to open up the doors to community organizations and others to be part of their required community assessment process.  Once in the door, we all need to press for real community benefit agreements while we have the opportunity.