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.


Surprise, High Health Deductibles Defer Treatment and Kill People!

New Orleans     Sometimes the gap in understanding the impact of wealth differentials, or what in the old school we called class differences, is so stark that it just blows the top of my head off.  An example today in The New York Times was so clear that it forces me back to beating a drum I was hitting all too recently about the impact of high deductibles for so called “skinny” health plans that were allowed by Congress and the Obama administration to qualify under the Affordable Care Act.

The headline was promising: “High Deductibles, Deferred Treatment.”  Ok, it was a “no, duh” thing, but sometimes there’s no harm in stating the obvious until people get the point.  Then reporter Reed Abelson provides this assertion about deductibles, writing, “High-deductible plans have become commonplace, a deterrent used by companies to lower health care costs by discouraging unnecessary tests or treatments.”  He doesn’t challenge that claim.  He offers it for all of us to swallow whole, hook-line-and sinker!  No, Reed, high-deductible plans are not a “deterrent” to “lower health costs.” Among other things they are a way being used by companies to force their lower waged workers to elect NOT to take the measly, but “qualified” health policy they offer their workers, so that they have NO insurance whatsoever saving the company 100% of the costs and allowing them to avoid 100% of the penalties.  Wakeup and look around at what is happening to lower income, service-based workers in nursing homes, home care, mental health facilities, janitorial, wait staff and other jobs, please!

The story tries to recover.  Since the reporter can’t fathom the millions of workers priced out of health coverage by their low wages and their companies’ draconian health plan, he does understand some random study since it has a Harvard connection and, lo and behold, finds that women with insurance deductibles of at least $1000 will delay or defer treatment.  I could provide the names of literally thousands of women working in nursing facilities under contract with our union that would jump at the chance to have health insurance with only a $1000 deductible.  Instead, the economics of the situation make it more financially attractive to pay the penalty for not having health insurance than to pay 9% of their gross wages and thousands of dollars in deductibles before they access any health benefits.  Need I mention once again that this is all about the company avoiding 100% of any health care costs for its hourly workers and not about “discouraging unnecessary tests and treatment.”

Abelson helpfully notes that half of all “covered” workers are enrolled in plans with a deductible “of at least $1000” and that 11% of covered workers have a deductible of $3000 or more.  The phrase “covered workers” is the critical one here.

The tragedy in the failure of our national health program and the loopholes it allowed employers is in the uncounted millions of workers and their families who are deliberately priced out of care.  Perhaps you can imagine the intended consequences for millions of working families who have deferred necessary tests and treatments because there are caught in the gap between not qualifying for Medicaid and their companies’ skinflint policies.  We could start with the hundreds of thousands of headstones in the nation’s cemeteries of men and women dead before their time of preventable causes.

Write that story in the New York Times!