Tag: Affordable Care Act

Posted on

Some 2020 Election Views: Jan Berger on Single-Payer Health Care

health care

Not surprisingly the future of the United States heath care system is already a huge topic of debate for next year’s presidential election.

Many of the 2020 Democratic nominees for president are supporting a single-payer or Medicare for All solution.

Since the United States has never had this type of health care, it’s helpful to sort out the myths from the facts, which is exactly what one woman did at an employer-centric health care conference recently.

Jan Berger, president and CEO of international health care consultancy Health Intelligence Partners, gave a presentation on single-payer health care at the Midwest Business Group on Health annual conference in May.

One of the first ideas Berger brought up is key. Every country in the world, including the United States, is having the same health care problems no matter what the financial model is being used, she said. These problems include rising costs and access issues. The only way the U.S. is different, she added, is that we’re the only country that has made health care “political warfare.” Also, in most other countries people don’t go bankrupt or homeless because of health care costs.

Meanwhile, Berger also debunked several myths about other countries’ single-payer systems. One key myth is that “health care is socialized medicine.” While some socialist countries do use a single-payer system, many non-Socialist countries do, too. Pulling the socialist card to dismiss the single-payer discussion is “a bullet people use to not discuss change,” Berger said.

Berger listed other misconceptions about single-payer health care:

  • Single-payer financial models are all the same. (None are the same.)
  • “Single-payer” applies to both the finance and delivery of health care. (Only four countries have fully integrated models.)
  • Single-payer means no cost to the consumer. (This is very rarely true. There are out-of-pocket costs in almost all countries that use single-payer.)
  • Single-payer means no focus on preventative care. (This is not true, Berger noted, giving the examples of Cuba, Costa Rica, Israel, Saudi Arabia and Australia.)
  • Single-payer dictates how doctors treat patients. (It doesn’t.)
  • Single-payer models destroy innovation. (Berger noted many examples of how this is not true. To name a few: The Netherlands, which has one of the most unique memory-care systems in the world; South Africa, with its automated pharmacy teller machine.)

health care costs“We don’t have to be somebody else, but we have to learn from somebody else,” Berger said.

One other idea that Berger mentioned was the need to know the definitions of key phrases if you’re going to have a conversation about the different health care proposals. For example, the difference between Medicare and the Medicare For All bills. While Medicare doesn’t cover vision or dental, the predominant Medicare for All Act in Congress covers a broader range of services, she said. While the word “Medicare” is used in this context, by definition Medicare for All does not mean the exact quality and coverage of Medicare expanded to each U.S. citizen.

It’s also necessary to understand the definition of universal health coverage, which the United States does not have even with the Affordable Care Act. The World Health Organization defines universal health coverage as “ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user the financial hardship.” It continues, “People need to be protected from being pushed into poverty because of the cost of health care”— a milestone the U.S. has yet to reach.

None of this is to say health care should be one way over another. But if we’re debating on what health care system works best for the country, then relying on facts rather than myths for information is a good start.

It’s possible to admit that the current employer-based health care system is not doing well in certain regards. Almost 24 million Americans enrolled in employer health plans must spend a large share of their income on health care. High-deductible health plans have the power to impact low-wage workers in much more detrimental ways than they impact high-wage workers. Contributing to HSAs like some employers promote just isn’t possible for many low-income employees; in fact, Bruce Sherman, medical director at the National Alliance of Healthcare Purchaser Coalitions noted at this same MBGH conference that only 1 percent of low-income employees contribute to HSAs.

Whatever the solution is to problems within employer-sponsored plans currently are, it’s not something that has been solved yet. There are going to be plenty of suggestions from the candidates.

As the 2020 election nears, we’re likely to hear a lot of hyped and a lot of misleading “facts” about certain health system proposals, and I’d encourage you to look at the facts instead of falling too deeply into the “political warfare” of U.S. health care.

Posted on

Benefits Roundup: The Employer Mandate and Fair Compensation

Andie Burjek, Working Well blog

When you write about topics as broad as benefits and wellness, it’s easy to have too many ideas and want to write about a million things at once.

But that’s impossible. So these are some topics in the health and benefits space that have intrigued me these past few weeks. They relate to employee wellbeing based on compensation; the employer mandate; days off; and a wellness conference.

What’s been on your mind recently? Any trends, debates or legislation that you find especially fascinating? Let me know!

Unpaid Internships and the Government Shutdown

I had many reactions to the government shutdown, which doubtless made a lot of employees’ lives difficult, having to work in some cases while not getting paid while benefits were compromised and many people had to deal with things like not being able to afford basic necessities like food and rent. I recognize that the struggle this put on federal workers was very rough.

It made me think of unpaid internships. These interns must go through these exact same struggles (unless they’re wealthy, or their family is) of needing to work their asses off while not getting paid. A lot of students can’t take internships that would be good experience and look good on their resume because they need to make money and pay basic expenses. Proponents of the unpaid internship argue that they are a valuable learning experience or that students can get class credit.

But in my opinion as a millennial in the beginning of my career, most of us in college needed to take out loans to afford an education. Couple that with unpaid internships and entry-level jobs that for many fields pay minimally. The financial burden put on young people through education costs and unpaid work can be significant.

All I’m saying is, at least pay your interns minimum wage. It’s the least you can do. People should get compensated for the work they perform.

Some Employer Mandate News

I came across a couple of BenefitsPRO articles recently that highlight two opposing ideas of the same debate. In late 2018 the U.S. Department of Labor, Department of Health and Human Services and Treasury Department proposed a rule that employers could circumvent employer-mandate penalties by setting up a health reimbursement account that employees could use to purchase health care in the individual market.

The 2018 tax reform legislation struck down the individual mandate. But the employer mandate, an Affordable Care Act provision that states employers must provide affordable health insurance to employees or else face a fine, is still in place.

On the pro side: Large employees would realistically continue to offer group health plans to attract and keep talent. Meanwhile, it could potentially help smaller employers in the 50- to 100-employee range. Also, to avoid penalties, employers would have to make an HRA contribution such that “any remaining premiums the employee would have to pay wouldn’t exceed a percentage of his or her income to be considered affordable under the employer mandate.”

On the opposing side: Employers and employees may not fully understand the differences between employer-sponsored health care and the individual health insurance marketplace, and the limitations that exist between them. Also, the new rules could potentially incentivize employers to switch sicker, more expensive enrollees to the individual market.

“If employers could move sicker patients toward individual and short-term plans — some of which have more restricted coverage — the employer could save money. In addition, short-term plans often are more restrictive about pre-existing conditions,” the article states.

If these rules are finalized, they wouldn’t take effect until Jan. 1, 2020 at the earliest, according to BenefitsPRO.

What do you think?

Should the Super Bowl Be a National Holiday?

I want to give a shout out to a Twitter user and lawyer @SonyaOldsSom who responded to a Workforce tweet with something obvious but important. Also, it speaks to an even broader idea than what she was specifically talking about.

We posted a podcast in February 2018 in which hosts Rick Bell and Frank Kalman briefly discussed if the Monday after the Super Bowl should be a national holiday. That idea, simply, came from organizations’ frustrations that people often aren’t as productive as usual that day.

This was @SonyaOldsSom’s response:

Amen! Sure, National Super Bowl Monday is a cute idea to debate, but employers (and whoever decides what national holidays are) should consider the thing that’s been right under their noses for a long time. In general, for any organization, it can be easy to get swept up in trendy sounding ideas — whether that’s open office spaces, yoga classes or some other buzzword — but what’s more valuable to people are these straight-up practical ideas, like having voting day as an official holiday.

The MBGH Wellness Forum

I recently attended an employer-only wellness forum hosted by the Midwest Business Group on Health, and although I’ve already written about some of the major takeways, there were a few other ideas that came up that are worth exploring:

  • I spoke to a man who expressed to me one of his greatest frustrations in the workplace wellness space: when companies go gaga over wellness programs without addressing cultural concerns like an abusive or toxic work environment. I agree!
  • One of my unlikely tablemates was Bruce Sherman, medical director for the National Alliance of Healthcare Purchaser Coalitions. I’ve coincidentally already interviewed him for a story coming up in our March issue! At this conference, he gave a talk about addressing employees with multiple chronic conditions [note: “multimorbidity” is the coexistence of multiple chronic conditions] in your wellness programs. One of his ideas: disease management programs that specifically address one chronic condition oftentimes do not sufficiently help employees with multimorbidity!
  • Sherman also mentioned that while people in the health care industry tend to have a narrow, clinical mindset with patient health, patients have many more focuses and stresses in their life. Personal health is just one of them — and, according to one survey, it’s not even the highest priority. Ranking factors that stress people out, “personal health” is No. 8, below other factors like finances, family health and work schedule. Personal health is not something that exists in a vacuum for employees!
Posted on

Elder Care — You Can’t Buy, Pray or Prescribe Your Way Out of It

elder care

Ed Frauenheim is on assignment.

I had been looking forward to lunch with my friend Kate for some time. During the past few years we’ve bonded over the travails of raising teenagers, the challenges of balancing work and home and the exhausting job of caring for elderly parents. We laugh a lot when we’re together too, but those topics always seem to creep into our conversations—the last one with increasing frequency.

We’ve tried to get together several times in the last year but as any working mom knows, coordinating schedules with friends often means planning so far in advance several holidays can go by before you actually see each other. But this time the planets had aligned and our lunch date was set. I was looking forward to it.

The day before she sent me an email that began with: “Well, things with my parents have gone to hell in a hand basket and I’m heading to Tennessee for a week.” Her mom is struggling with dementia and her father is in failing physical health. Watching their decline has been devastating for Kate and her family.

So it goes with the life of a caregiver. There are good days and there are bad days and there are days when all hell breaks loose. One minute you’re on the phone with your mom planning a trip to the mall and the next minute you’re in the emergency room praying that she didn’t have a stroke or break her hip or catch pneumonia. A million things can go wrong when our bodies start to fail us.

It’s a wild and unpredictable ride and eventually, most of us will climb aboard. Or as Greg Johnson, director of family care giving at New York-based EmblemHealth, Inc. says, “you can’t buy, pray or prescribe your way out of it.” When a parent needs help few of us have much choice other than stepping up and doing the best we can.

And that’s exactly what 65 million people are doing every day — caring for an elderly relative, often while holding down a full-time job. Any many of them are also raising children — the sandwich generation as they are called. I am one of them. I have two amazing teenagers and one loving 86-year-old mother, and all three are at a stage in their lives where they need me more than ever.

Trying to meet their needs while working full time often leaves me feeling drained and in need of some care myself. Luckily, I have understanding editors who allow me to work from home when I need to, but not everyone is so lucky. Just ask the telecommuters at Yahoo!

With people living longer the number of caregivers in the workplace is rising rapidly and that costs companies up to $34 billion a year due to absenteeism and lost productivity. That doesn’t include health care costs, which are higher for caregivers who are more likely to suffer from heart disease, depression and other health issues than noncaregivers. At the same time the number of companies offering elder care programs and services has declined.

That means more employees are using lunch breaks to drive dad to the doctor or sort out medical bills. Employees at companies without elder care referral services or flextime or other supports must navigate the confusing world of Medicare and Medicaid and nursing homes and in-home care alone and during any spare moment, including vacation time. Not surprisingly, burnout and fatigue are higher for caregivers than for other workers.

But there is much that employers can do to help those workers, like offering flextime and resource-and-referral services. Some companies, like Johnson & Johnson in New Jersey, are taking it a few steps further, offering free geriatric care services to its employees. Caregivers work with a case manager who checks in regularly and will even visit nursing homes and other facilities with the family.

While many employers can’t afford such extensive supports, just offering flexible schedules and a little understanding can go a long way in helping workers stay healthy and in boosting retention and loyalty.

The issue of elder care will gain more attention as more workers become family caregivers—a role typically dominated by women. And as more women move into executive positions the problem of caring for mom or dad will become just as pressing as finding good child care.

Johnson of EmblemHealth calls caregivers “the backbone of the world.” But the weight of supporting kids and parents can be crushing. By providing elder care support employers can do a lot to lighten their load.