Health Access WeBlog

The National Federation of Independent Business this week unveiled their campaign to promote health reform from a business perspective. What I really liked was their "Faces of the Healthcare Crisis,'' a compilation of stories/testimonials of small businesses struggling with health care costs. The stories, not surprisingly, sound a lot like some of the consumer stories we get.

One guy, whose employees largely receive health care through their spouses, did not have insurance of his own. When he had chest pains, he delayed going to the ER. When the pain became excruciating, he finally relented and found he was having a heart attack, leaving him with $200,000 in hospital bills.(!!) Sounds like something out of our story database: uninsured, delayed care, high hospital bill.

We certainly empathize with many of the small businesses who want, very badly, to provide health care for their workers. It's expensive, and we have bills that can help:

Transparency (a la AB 2967 - Lieber, and which NFIB is supporting) allows health care buyers can gravitate toward providers that are effective and efficient.

Standardizing and organizing the individual market, a la SB 1522 (Steinberg), would cap out-of-pocket costs, ensure that every plan has doctors, hospitals, and preventive care. This would help give small businesses, who are worried about how much their workers can afford, more peace of mind.

Public insurer (SB 973 - Simitian) would allow small businesses to buy coverage from a public system that competes for business with private companies.

Anti-rescission (AB 1945 (De La Torre) and various other bills) would make harder for insurance companies to yank coverage from paying policy holders willy nilly.

Of course, (here's our 'I told you so' moment) what would have *really* helped was the 1993 Clinton Health plan, which was defeated with lots of help from NFIB. Through Clinton's plan, smaller businesses would have only had to pay up to 3.5 percent of payroll costs toward healthcare rather than the 20-plus percent they are now paying in a virtually unregulated market.

Labels: Employers, Underinsurance, Uninsured, YearOfReform

posted by Hanh Kim Quach | Permalink | 1:35 PM

American manufacturers pay more than twice as much per hour for health benefits as the manufacturers in countries we regularly trade with, according to a new report by the New America Foundation that found for every $2.38 an hour paid for benefits by US manufacturers, others pay about $0.96. It's a losing proposition all around that:

Makes our products more expensive -- read: less competitive. (ie. an American-made car costs $1,500 more due to health costs versus $900 more by foreign competitors.
Results in American businesses trying to ratchet down what they pay in health care costs, and resulting in crappier coverage for their workers. (for more money, I might add)

Results in jobs going overseas -- like Ford going to Canada as reported earlier this week.

The report runs through a litany of interesting stats, including:

In 1960, health benefits were only 1.2% of payroll. Now, it's more like 9.9% (averaged across all businesses, including those that *don't* provide coverage).

Since 2000, fewer employers are offering coverage (from 69% to 60%). But for workers that *do* get coverage on the job, it's costing more -- 102% more (from $135 to $273 monthly premium).

It also acknowledges that not all costs can be shifted to workers, either in higher premiums and out-of-pocket costs or lost wages, because it would affect a business' ability to be competitive in hiring good quality employees -- something all businesses must grapple with in order to stay competitive. And that the cost of health care can't depress wages -- particularly for those already making minimum wage ($5.85 or $8 in CA), or in cases where a labor contract acts as a backstop.

Labels: Employers, International, Research

posted by Hanh Kim Quach | Permalink | 2:24 PM

The New York Times had an excellent article this weekend about workers, who have health coverage through work, feeling financially strained.

The reason: businesses - unable to absorb higher health care costs - have decided that workers need to absorb more of these costs. Businesses are buying crappier coverage (this doesn't mean cheaper premiums, just cheaper than more comprehensive plans, but still expensive) and asking workers to pay a greater share of the premium. So not only are premiums for workers increasing, but the plans that they are getting are getting worse, which means higher copays, deductibles, and less coverage.

It used to be that worrying about how to pay for health care happened mostly if you didn't have insurance. Then, it started creeping into the ranks of the insured -- but only those who bought insurance on their own, without the benefit of a group buying in bulk to negotiate lower rates. Now, though, health cost worries are hitting the employer market -- where most Americans get their coverage.

One *insured* worker said he was losing the equivalent of a month's worth of pay with the higher premium and deductibles. That's in addition to the fact that the coverage isn't very good.

Another *insured* worker, who has diabetes, doesn't monitor her blood sugar regularly and can't afford to see an eye doctor on top of other normal everyday expenses.

The Times characterized these plans as "health insurance in name only.'' I like that: essentially people are paying to be uninsured under these plans.

My health plan colleagues would argue that having some kind of coverage is better than being uninsured. No?

But is it really? At what point does debt become so crushing that it doesn't matter if the number is $60,000 or $200,000 in debt, and accruing interest. Especially considering that families that are insured, earning more than 300% of the poverty level actually have negative (-$600) net financial assets according to the latest study by Health Affairs. On an annual income of $60,000, either way, you're screwed.

Labels: Employers, InTheNews, MedicalDebt, Underinsurance

posted by Hanh Kim Quach | Permalink | 2:01 PM

Another moment during the debate on the transparency bill, AB2967(Lieber) was when Assemblymember Ted Gaines questioned a key supporter of the bill, Laurie Sobel from Consumers Union, and asked "isn't this something that you should be doing?"

It's not a uncommon question for those who work at Consumers Union, publisher of Consumer Reports magazine--one of the one of the most read magazines in the country, and one of the most trusted. I've been proud to work alongside them in different roles in my decade-and-a-half of consumer advocacy.

Laurie had an answer: she thanked the Assemblymember for the confidence, but that as much as Consumer Reports would be happy to provide the same kind of evaluation of doctors and hospitals as they do for cars and ceiling fans, with the trademark circles, there's a limit to what they can do without this bill in place.

Most tellingly, no independent group can mandate reporting of doctors and hospitals, and it's hard to provide a meaningful and complete report with the largely voluntary reporting systems we have now. This is a governmental function. There might be a role for CU or other advocates in analyzing the data, but we need the government to collect it and appropriately categorize it.

There's often been several times in just the last few years when policymakers who oppose legislation to set consumer standards or provide more consumer information will say on the floor of the Assembly that this should be the role of Consumer Reports, not government. Yet these same policymakers never seem to follow the position of the actual publisher of Consumer Reports.

Labels: Employers, Hospitals

posted by Anthony Wright | Permalink | 11:05 PM

One of the surreal moments of the week was when lobbyist Beth Capell, in testifying in support of a bill, representing her clients Health Access California and SEIU, ceded half her time to... the NFIB.

The NFIB made it's name opposing the Clinton health plan in the early 1990s. Perhaps it's a sign of the times. The bill was AB2967 (Lieber), to allow for better transparency of cost and quality from health care providers. It's disappointing, although perhaps not surprising, that doctor and hospital associations opposed more reporting on themselves.

What was new and interesting was the unique coalition in support. That included consumer groups, like Consumers Union, AARP, Health Access, and CALPIRG; many labor unions including the California Labor Federation, SEIU, AFSCME, CTA, and yes, key employer groups, with Pacific Business Group on Health, Small Business Majority, and the NFIB.

It's makes sense that purchasers of health care--whether individuals, employers, or union trusts--would want better information on what they are buying. But these alliances are less frequent than that common interest would suggest.

It's a sign that the unique alliances around health reform last year were not a fluke, and not dependent on the Governor's urging. So let's see if this goodwill continues.

Labels: Employers, Legislation

posted by Anthony Wright | Permalink | 10:18 PM

Quick. What special interest is the most active opponent against comprehensive health reform?

While many compete for that distinction (insurers, doctors, drug companies, etc.), there's a strong argument that it is... the restaurants.

As the industry perhaps most likely not to provide health coverage to their workers, they have consistently opposed efforts that would require them to contribute a fair share to health care.

* Many have been actively opposed to single-payer at least since the 1994 ballot measure--with some even subjecting patrons to anti-Prop 186 table cards.

* Fast food and chain restaurants were the single largest opponents of SB2 and Prop 72, which would have required large employers to pay for their worker's health care. In fact, fast food and chain restaurants--from McDonald's and KFC to Applebee's and Cheescake Factory--made up over 70% of the opposition fundraising to Prop 72--most of the rest of the employer community stayed on the sidelines. Without the California Restaurant Association, Prop 72-which lost by less than a percetnage point--would have been enacted.

* Despite Governor Schwarzenegger's urging, they ultimately opposed AB x1 1. In opposing an minimum contribution for employers to health care, they graciously offered to support a sales tax--a tax they don't pay, but that their customers and other businesses do.

* In San Francisco, the Golden Gate Restaurant Association--rather than the Chamber of Commerce or broader business interests--has led a lawsuit to overturn Healthy San Francisco. The lawsuit is still pending, although there have been encouraging signs from the Ninth Circuit Court of Appeals and even the Supreme Court (in the most underplayed story of the year).

Marc Lifsher's new Los Angeles Times story places the spotlight on the restaurant's opposition to Healthy San Francisco--an innovative and groundbreaking effort to ensure universal access to care. (See a new one-sheet summary of Healthy San Francisco by the Kaiser Family Foundation.)

The article indicates that dozens of SF restaurants are now placing notices on menus, announcing additional costs--from $1 to $2 dollar flat fees to 1-4% surcharges--to help pay for the new health care requirements.

But the tactic, clearly designed to stoke public opposition to the law, may backfire:

* Of all the things that your dollars, it would seem that San Franciscans might think that a few extra dollars to go to the effort for universal health care is a good thing.

* The beneficiaries of the health care law are not faceless. They are the waiters and waitresses that diners interact with. And even for the kitchen staff--wouldn't you want the people handling your food to have health insurance? Especially since there is a correlation between being insured and health status?

* It's clear that some of the traditional arguments against employer requirements don't apply to San Francisco restaurants--people aren't going to go across the Bay Bridge to get a burger, or a fine dinner, simply to avoid a small surcharge. Rather, the minimum requirement helps level of the playing field between a coffee place that does provide health benefits, and one down the street that doesn't.

* The article quotes at least one patron that didn't mind the surcharge. So, if the surcharge is truly passed on to consumers, this undermines the restaurant's argument that the requirement will put cuts into their profits or put them out of business. They can't have it both ways.

Any health coverage expansions--from employer mandates to single-payer to hybrid "shared responsibility" plans--are going to ask employers who don't cover their workers to contribute more than they do now. It's an issue not just of financing, but of fairness--to the many employers who cover all their workers. It's also a practical issue: without a minimum contribution, policymakers fear "crowd-out," where those employers currently offering coverage drop it so their workers take advantage of a public program expansion.

Fast food and chain restaurants will eventually have to be share in the solution, rather than spending their time raising money against reform, pursuing legal attacks, and even trying to make political points on menus. But it looks like that may be a longer wait than what's at the trendiest San Francisco restaurant.

Labels: Employers, ExpandingCoverage, SanFrancisco

posted by Anthony Wright | Permalink | 10:31 AM

Republicans have been caterwauling for more than a year about the inclusion of an employer mandate in health reform plans.

They call attempts to level the playing field between employers who provide coverage and those who don't a "tax'' that will crush businesses and cause an exodus of industry from the state.

UC Berkeley Labor Center is working on an analysis on the impact of ABx1 1 on business -- an update of an earlier analysis on various health proposals on business. They have shared a preliminary analysis, however, that shows the impact of ABx1 1 on payroll costs. You can find their preliminary analysis here.

Interesting findings:

Nearly half of all businesses (47.3%) will not have to pay anything more, having already met or exceeded ABx1 1 health care spending requirements.
Only 1.7% of businesses in all of California will bear an increase in costs (between 4% and 6.5%)

To the idea that small businesses, in particular will suffer:

90% of very small firms (between 3-9 employees) will have their health care costs increased by less than 1%.
Nearly 70% of small firms (between 10-99 workers) will have their health care costs increased less than 1%.

Labels: Employers, Research, YearOfReform

posted by Hanh Kim Quach | Permalink | 10:52 AM

In light of last week's San Francisco Superior Court ruling on the Healthy San Francisco plan, I think we should take take Michael Pollan's nonfiction hit The Omnivore's Dilemma a step further.

The Golden Gate Restaurant Association contested the portion of the Healthy San Francisco Plan which requires the city's employers with more than 50 workers to provide health coverage or pay an assessment to the city, which would then give employees access to the city's network of medical services. Healthy San Francisco aims to provide health coverage to the city's 82,000 uninsured residents. The GGRA won the first round, meaning that approximately 26,000 middle-income workers will remain uninsured -- and presumably many of those are also toiling over the range, serving up food, greeting guests and washing dishes.

The association's website claims it has more than 800 members. Clicking through, I'd say it included about 600 restaurants, including uniquely San Francisco gems like The Slanted Door, Green's and Citizen Cake and chain restaurants such as Hooters, Pasta Pomodoro and Il Fornaio.

The trend among the health conscious is knowing the origins of food: where it comes from, what impact its production had on the environment, whether it had to travel far to arrive at your table.

Let's make part of that "knowing,'' discovering whether the food is served by someone who has access to a doctor when they need it (and can afford it). And if it isn't? We have the ability to walk away.

Labels: Employers, InTheNews, SanFrancisco

posted by Hanh Kim Quach | Permalink | 12:45 PM

What's the impact of the court ruling in San Francisco?

As the San Francisco Chronicle reports today, the immediate impact is that Healthy San Francisco will not be able to extend to it full potential, restricting access for 26,000 middle-income San Franciscans. That's the unforunate human impact of the decision. Whether it has a long-term impact on the financing of the rest of the program has yet to be seen, but it's a concern.

But maybe not for long. There's no guarantee of what will happen on appeal. As the Workplace Prof Blog sees it, "I expect an appeal to the Ninth Circuit where all bets are off and panel composition will be key."

As for state health reform? A ruling on one type of health reform is a ruling on... one type of health reform. What was proposed in San Francisco is different in detail, structure, and scope from what is proposed at the state level.

It's not a surprise that a George W. Bush-appointed judge with a background as a corporate lawyer struck down a San Francisco ordinance, based on a ambiguous federal law that this very judge quotes is a "veritable Sargasso Sea of obfuscation."

Despite the fact that "the task of developing a clear rule to identify whether ERISA preempts a particular state law 'has bedeviled the Supreme Court'", this judge took an expansive view of ERISA pre-emption. But even in ruling against San Francisco and the labor unions who intervened, he keeps the door open, and proposed something that could pass muster:

He then describes the very structure in SB2/Prop 72 of 2004, and what is essentially what is expected to be part of the financing of AB x1 1: Assess all employers, but provide a credit/reduction for those who make health expenditures directly for their workers.

It's unfortunate that the decision will impact San Franciscans trying to get care, at least until the appeal. But it shouldn't impact state efforts, whether for AB x1 1 or SB840, and might even offer an opening...

(Largely cross-posted from a discussion at Calitics).

Labels: Employers, SanFrancisco, YearOfReform

posted by Anthony Wright | Permalink | 1:07 PM

The San Francisco court decision and the ERISA issue in general raises the question: why do health reforms seek to raise money from employers, rather than other sources of funds? (The Sacramento Bee's Daniel Weintraub is like a broken record on this point.)

In front of the LA Times editorial board, Mayor Gavin Newsom gave a good answer a few months ago, in talking about the Healthy San Francisco program:

So $104 million's there; $56 million comes from individuals in point-of-service fees, which are these co-pays and monthly premiums based on ability to pay.

And the rest comes from — and here's the controversy, and this, there's always gotta be a controversy with health care — there's a mandate to businesses, starting with businesses with 50 employees or more. Incidentally, those represent, the mandate will represent only 13% of the businesses in the city, because 87% fall into the category of 50 employees or more or they fall into a category where they don't already provide a baseline of services. So you're affecting about 13% of businesses above 50 employees or more that aren't necessarily investing in the health care of their employees. It works out to a de minimis cost of the overall $196 million. It's about $28 million, the business mandate.

The reason we have a business mandate, again, is for no other reason, it's not intended for the money so much as to create a floor of expenditure. Here's the reason: I've got about 19 small businesses I've created, started restaurants and hotels. If the city said, as I have, that we're gonna take care of health insurance, I'd say fantastic. I'll dump all my health care; city picks it up. Then our uninsured population goes from 82,000 back to 190,000, 200,000, 300,000, and the system collapses. So we create a floor so there's no dumping out. And this is the controversy. The restaurant association, of which I'm a former member and large contributor with our nine restaurants, have sued us. And we'll see if they're successful. And if they are we'll have to be more creative.

AB x1 1 also doesn't raise very much new money from employers, but the employer contribution standard is an important component for practical reasons. The majority of Californians get coverage through their employer, or the employer of a family member. Even if we were to switch to another type of health care system, you would need some mechanism to keep that significant investment in the health system.

Mayor Newsom mentions the issue known as "crowd-out:" The more that a state or city offers coverage up the income scale, the more likely they might replace the coverage of employers that already offer coverage. In a world of limited resources, that'a problem, but can be solved by setting a minimum employer contribution.

Finally, the issue is fairness. Policymakers could simply have a flat tax that impacted all employers, regardless of whether they provide coverage. No one would question that arrangement under ERISA--but that would be grossly unfair to those employers who did offer coverage and were already paying for their workers, in essence asking them to pay more to help pay for the workers of those employers who don't offer coverage.

And that's the irony of the Golden Gate Restaurant Association's lawsuit. Despite their rhetoric, they aren't actually attacking employer contributions for health care. They are attacking the ability to provide some equity for employers who actually cover their workers.

And now, they is undermining San Francisco's important health program, and some of the uninsured that were going to be helped. Hopefully--appeals pending--not for long.

Labels: Employers, SanFrancisco, YearOfReform

posted by Anthony Wright | Permalink | 3:59 PM

On his blog, the Sacramento Bee's Daniel Weintraub opines on the Judge White's decision on Healthy San Francisco.

In reading the decision, he notes something that I noticed as well: that even this George W. Bush-appointed judge, with his very expansive view of ERISA pre-emption, left the door open for state and local health reforms. He even suggested what he thought might pass muster:

"The Court is not convinced that other alternatives for creating a program for providing public health care are not viable. Defendants propose an increased general tax requirement, but state the unfairness of not taking existing health care expenditures into account. Without wading into legislative dominion, the Court can envision such a tax program that take existing health care expenditures by private employers into account in the form of tax credits."

Such a structure was exactly what was proposed in SB2/Prop 72 in 2004, and it's a version of what is being proposed with the financing to AB x1 1.

There's lots of ways to structure an employer contribution requirement, and Maryland was different than San Francisco, which is different from Massachusetts, which is different from SB2, which is different from AB x1 1.

Some legal experts believe that the Ninth Circuit has on-point cases that may lead this case to be overturned on appeal. But even this ruling provides an opening.

Labels: Employers, SanFrancisco, YearOfReform

posted by Anthony Wright | Permalink | 3:36 PM

A marauding tiger may not be only bad thing to come out of San Francisco this week.

This evening, a Judge Jeffrey White ruled with the Golden Gate Restaurant Association and against San Francisco and a key part of the ordinance that created the Healthy San Francisco program. Here's the San Francisco Chronicle coverage.

We've outlined in previous posts about the line of reasoning about how health reforms might withstand an ERISA challenge. The question of that federal law's impact on state and local health reforms has split judges--such as the appeals court in Maryland--and it's unfortunate that this particular judge sided against San Francisco's important health reforms.

Both sides were prepared to appeal to the Ninth Circuit, and the city is expected to file their appeal on Thursday. The city should appeal: San Francisco has a strong case to make on behalf of its residents, to improve their health care system while giving employers different options to meet their obligations.

Some will over-read this decision, both its implications for health reform in San Francisco and California: This is far from the final word on health reform; it's actually just the first round.

First, there will be an appeal in this case. As for state reforms like AB x1 1 (or SB840, etc.), they have different structures than the ordinance in San Francisco, which had a different framework than previous efforts in other states and counties. A ruling about one does not necessarily impact the other.

The proposed health reform in the California legislature would continue to allow multi-state employers to have a national benefits package for their workers, which is the focus of federal ERISA law. Like other state reforms, it needs to be vetted by the courts, but with its specific language and specificity.

San Francisco should and must appeal; The efforts of California and other states must continue; What's the alternative? Health reform is too important and too urgent to wait for the federal government.

Labels: Employers, SanFrancisco, YearOfReform

posted by Anthony Wright | Permalink | 6:56 PM

Sharing.

A story in the Wall Street Journal today describes new health plans that provide fixed premiums for employers. The plans, geared toward small- to medium-sized businesses, the businesses to sign a fixed-price contract with an insurer for a few years. But insurers have to make up the money somehow -- and that's where the concept of sharing -- or not -- comes in.

Under the plans, worker deductibles could soar between $50 to $2,500. Co-pays for visits would increase as well.

So while the business' prices are fixed; employees' aren't.

As it is now, both businesses and employees alike share in the pain of rapidly increasing costs. A survey last month showed premiums are increasing 8.7 percent. Employees are paying a total of 10 percent more for premiums plus out-of-pocket costs.

This new arrangement shifts all increases solely onto the shoulders of the employees.

So what happened to shared responsibility?

Labels: Employers, YearOfReform

posted by Hanh Kim Quach | Permalink | 11:53 AM

The Wall Street Journal has an interesting story on how a stalwart Republican base, business, is defecting. Why? In part, because of social issues, such as environment and health care.

"....In manufacturing sectors, such as the auto industry, some Republicans
want direct government health with soaring health-care costs, which
Republicans in Washington have been reluctant to provide..."

As costs continue to become unbearable, this gap will likely become more pronounced. Already, polls are showing that the majority of businesses believe in some kind of government role in health care reform.

A recent poll by the Small Business Majority found that 55% of business owners polled supported paying into a statewide pool -- run by the state, mind you -- to provide coverage for their workers. More (47%) favored reform efforts put forth by the governor and Legislative leaders than opposed (31-33%).

As we go forward on reform, though, this means meaningful changes that help everyone -- not just one group or another. That means reducing the underlying cost of health care -- by making the system more efficient, reducing medical errors, oversight of premium rate increases, etc. That helps everyone: small businesses pay less; consumers pay less.

What doesn't help everyone is this idea that's constantly brought up by Republicans to do away with "costly" mandates, like mammograms, the right to second opinions, childhood immunizations. They say this helps small business by allowing them to band together with similar businesses across state lines, and buy -- say -- a cheap policy from Mississippi, Texas or Alabama, which have fewer consumer protections. No offense to those states, but we never really want to follow their lead on anything else -- why start with health care. And while not having to pay for actual health care might make insurance really cheap, that doesn't help anyone.

Labels: Employers

posted by Hanh Kim Quach | Permalink | 11:12 AM

The New York Times shines a national spotlight on the Healthy San Francisco program.

It shows that it is off to a good start...

Does San Francisco offer lessons for the special session? The article goes into all the ways that San Francisco is advantaged, including a relatively small uninsured population, and an already heavy investment in caring for them through a robust safety-net of clinics and hospitals. In other words, the opposite of California as a whole.

Yet even with this program--which is not coverage and does not offer access to coverage outside of San Francisco, they needed to take a second step--place a minimum spending requirement for employers, to prevent certain employers from abandoning their contribution to their workers' health care. The issue is called "crowd out."

Most employers provide health care, to attract and retain workers, and because it is expected. But if workers would get benefits anyway, why would employers spend the money to provide it? That means some employers would drop or scale back coverage. The issue is that the public program gets more expensive, since it is now covering more folks. It's not an issue if you can get enough money from the employer to actually pay for the care provided to his/her workers.

So when we hear of proposals to "replace" the employer fee in AB8 or the Governor's plan with another revenue source, the main issue is not some attachment to employer-based coverage; it's that you have to raise a lot more money to make up for it. There's also an equity issue, between those employers who provide coverage, and those who don't.

Healthy San Francisco is showing the way.

Labels: Employers, SanFrancisco, YearOfReform

posted by Anthony Wright | Permalink | 5:33 PM

Fact check #3...

Don't believe anybody who tells you that small businesses are against health reform. Interesting articles in the San Francisco Chronicle and the San Diego Union-Tribune.

As a consumer advocate, I've been frustrated over the years about the positions of the lobbying organizations representing businesses, like the Chamber of Commerce and the NFIB.

I think it is a reflexive instinct for an organization to oppose any requirement or tax on their constituency, even if they should be considering the long-term benefits. But these organizations even oppose cost containment measures on insurers, hospitals or drug companies, even though the direct beneficiaries would be employers, as purchasers of health care. A lot more could get done if employers recgonized their interest in promoting some key policies.

Is it that there's a conflict of interest between these business organizations, representing the health industry over their base of employers? Is it ideological?

Regardless, there's a new poll out today that suggests that California small business owners are in a very different place than their representatives about the health reform ideas on the table.

The poll is sponsored by Small Business Majority, and unlike other surveys, it polls small business owners at random, rather than from membership lists of any organization. The ideological spread was broad: Democrat-38%; Republican-30%; Independent-29%; Other-3%. The August survey of over 500 respondents is scientifically significant, with a margin of error of 4%.

The poll is here:
http://www.smallbusinessforhealthcare.org/

Small business owners expressed strong support for a range of the proposal on the table, that are in AB8, the Governor's plan, or otherwise in the conversation:

* 75% favored requiring health insurers to spend at least 85% of their premiums on care -- vs. 8% opposed.
* 70% favored offering health insurance regardless of health status – vs. 9% opposed.
* 67% favored requiring insurers to offer coverage to small businesses regardless of the workforce’s health status – vs. 10% opposed.
* 63% favored a requirement that employers offer Section 125 plans – vs. 11% opposed.
* 62% favored requiring insurers and HMO’s to get state approval prior to raising premiums – vs. 15% opposed.
* 58% favored expanding current public health programs – vs. 15% opposed.
* 56% favored setting a timeline for hospitals and doctors having electronic medical records – vs. 10% opposed.

This is impressive, given that small businesses are portrayed as anti-government zealots, that small businesses see a role for government. What is more remarkable is that employers expressed support for reforms that even required them to contribute:

* 67% felt that employers should be required to pay something to provide healthcare to their employees -- almost four times as many as those who felt that employers should not have to contribute anything (17%). Of those who agreed that employers should contribute, over half felt that they should be required to pay more than 4% of payroll costs.

* Also, 46% were in favor of a one percent sales tax to make healthcare more affordable – vs. 35% who were opposed.

When the poll asked about the three plans on the table, with short descriptions but that seem to include a straight-out statement about the cost to employers, the plans still got a plurality of support.
· Governor’s proposal -- 47% in favor; 31% opposed
· AB 8 -- 47% in favor; 33% opposed
· SB 840 -- 42% in favor; 40% opposed

They seem to be willing to be part of the solution.

Note that they even supported AB 8, proposed by Assembly Speaker Fabian Núñez and Senate President pro Tem Don Perata, at the same level of the plan by Governor Arnold Schwarzenegger, even though it asks for a higher minimum contribution. They seemed to pick up the nuance that employers would get a bigger benefit for that 7.5% amount--the benefit of having all their workers covered. The notion that anything over the Governor's 4% standard is "too much" doesn't seem to be bourne out by the survey.

And despite strong employer opposition over the last five years by business groups, a slim plurality said that they favored the single-payer plan (SB 840) authored by Senator Sheila Kuehl.

It's an important contribution to the debate.

Labels: Employers, YearOfReform

posted by Anthony Wright | Permalink | 10:06 AM

You know you're in trouble when an "occasional'' rabbi from Mormon country sees it as his divine mission to segment the health care market.

"I feel I'm doing God's work switching people from group plans to individual
insurance,'' said Paul Zane Pilzer.

Pilzer, an economist who authors books with titles like "God Wants You to Be Rich,'' and his medical mission are spotlighted on the front page of the Wall Street Journal.

Pilzer's advice is this, according to the Journal: "Employers should stop providing group health insurance and help employees get individual policies instead.''

Never mind, of course, that individual policies are far more expensive and
offer far fewer consumer protections than a person buying through their employer
-- or through a government program.

Never mind, of course, that a huge chunk of people won't be able to get coverage at any price because they're sick.

And never mind that it could be illegal -- discriminating against sicker
workers.

What I found interesting/annoying was that he pointed to the shift from pensions to 401ks as a success. (This ignores the fact that workers feel less secure about their financials as they reach their retirement years and businesses are increasingly getting consultants to help employees with their 401ks. If it was such a success, why the insecurity? and why the need for the helping hand?)

Following in the steps of the disappearing pension would be a huge mistake -- as the dreamy Yale economist Jacob Hacker has written of in his Great Risk Shift.

I'm thinking Pilzer might want to take on a different task from God.

Labels: Employers, Underinsurance

posted by Hanh Kim Quach | Permalink | 4:36 PM

The LA Times reports that grocery workers have reached a tentative agreement with Southern California's supermarket chains, avoiding strikes that crippled the industry for 141 days in 2003-04.

While neither side has said what agreements were reached, the Times reports that new workers would not have to wait as long to become eligible for health insurance. During the last contract, new employees had to wait 18 months (and their families nearly three years) before getting health coverage.

The result is that health coverage for workers fell to 54 percent (from 94 percent), according to the UC Berkeley Center for Labor Studies. Turnover also increased to 32 percent (from 19 percent.)

According to the Times, the new waiting period would be 6 months. If this is true, it's a significant step.

Among those who are working and uninsured, 25% are not eligible for coverage by their employers -- either because they are in waiting periods or are a classification of employee that does not qualify for benefits.

Often, these are low-wage workers who would literally have to choose between putting food on the table, paying utilities and rent. There's no way they could afford premiums for coverage purchased on their own -- the most expensive way to buy coverage.

Stay tuned for more details on the grocery worker contract.

Labels: Employers, Uninsured

posted by Hanh Kim Quach | Permalink | 10:17 AM

In my last post, I talked about how AB8(Nunez/Perata) was a better deal for employers than 2003's SB2(Burton), less burdensome yet more comprehensive. For those employers that provide coverage, and those that want to, it provides a new, affordable option for them.

How about in comparison with the Governor's proposal? Many reports simply compare the minimum employer contributions in the two plans, 4% in the Governor's plan, 7.5% in the legislative leader's plans. Especially since most employers are spend 8-14% of payroll, it seems superficially that the Governor's plan lets employers off much easier.

But the real question is what employers get in return. As consumer advocates, we just don't argue for the lowest price, but the best value for the dollar.

Under the Governor's plan, those employers that don't provide any health coverage would have to pay a 4% fee. But they wouldn't get any special added value whether they paid the fee or not. The Governor's plan does broadly expand public coverage programs for families up to 250% of the federal poverty level, around $25,000 a year for an individual, or $50,000 for a family of four. For those employers who don't provide coverage and thus pay the fee, their workers over 250% of the poverty level are left to buy coverage on their own.

In contrast, under AB8, the employer who doesn't provide private coverage and pays the 7.5% fee gets to cover his entire workforce (including full-timers and part-timers) through the statewide purchasing pool. That employer gets the benefit of a fully-insured workforce, one that is healthier, more productive, and has less turnover and thus fewer retraining costs.

Most employers have workers at a range of incomes, from entry-level and lower-skill workers to managers and specialists. For these employers, the structure of AB8 seems to be a much better value.

Of course, if the employer doesn't want to provide any coverage, then these details don't matter: they will simply oppose any reform. But for the vast majority of employers that do, or that want to, provide coverage, these different structures of the proposals make a difference, much more than a comparison of 4% and 7.5%.

Labels: Employers, ExpandingCoverage, Legislation, Nunez, Perata, Schwarzenegger, Uninsured, YearOfReform

posted by Anthony Wright | Permalink | 12:34 PM

There's still more work to do on the newly revamped AB8(Nunez/Perata). A delegation of top consumer advocates will be meeting with Speaker Nunez and other key legislators on Monday.

But it's important to acknowledge that the proposal has improved, not just from where it is now, but from some past proposals. Many have compared this to 2003's SB2, but this structure is significantly different, at once less less burdensome on the employers impacted, and much more comprehensive for California consumers.

Under the concept of "shared responsibility," AB8 doesn't just set a minimum employer contribution to health care, as some articles have suggested. It includes contributions not just from employers but from individuals, reinvested state dollars, and new federal funds. It expands and streamlines public programs. It has significant reforms on insurers, in general and in particular in the individual market. Any of these provisions, by themselves, would be a major, headline-worthy, health initiative in any other year.

Most employers will not have to make any changes under AB8. And many employers will benefit. They will now have a new, affordable option to cover their workforce, at significantly less than what they pay now, or what is available on that market. Some will be relieved to no longer have to administer a health benefit. The amount, 7.5%, is by definition as a percentage, scaled to the size of payroll, which provides additional benefit to smaller and low-wage firms. Even for those that don't provide coverage now, they will pay a set amount and in return get a healthier, more productive workforce with less turnover and less retraining costs.

Let's contrast that with SB2, which Health Access California strongly supported as a step forward to getting Californians coverage and security. On businesses, SB2 would have simply required that employers have to provide 80% of the cost of a premium for a standard HMO pack. Many employers do that, and many, many employers were neutral on SB2, given that it really wouldn't have impacted them.

Under AB8, most employers also wouldn't have to change a thing. The differences are beneficial to the employer: under AB8, the minimum contribution is 7.5%, which takes into account size of payroll. Paying the fee to have your workers covered in the statewide pool is less than the average 12-14% than employers pay on average now. They have a new affordable option to provide coverage to their workers. If the 7.5% goes up, it does so only after a public process and deliberation--rather than the status quo, which is to have the costs go up automatically as a percent of premium.

This assistance to employers is possible because of public programs and reinvested state dollars, from aggressive use of bringing in California's fair share of federal funds, and by having the statewide purchasing pool bargain for the best rate. There are also several cost containment components of these bills, and more clearly should be done on that front. We would hope that employers, and the groups that represent them, would support many of the efforts that consumer groups have fought for in past year to help control costs.

Some employers are less inclined to provide coverage to their workers, and will oppose any health reform, no matter how litle is required. But for employers that provide coverage, and those that want to provide coverage, AB8 is not a burden, but a benefit.

Labels: Employers, ExpandingCoverage, Nunez, Perata, Uninsured, YearOfReform

posted by Anthony Wright | Permalink | 8:41 AM

The Chamber of Commerce's research organization, the California Foundation for Commerce and Education, released a study today on the "hidden tax." It's the second study on the subject from the same Hoover-affliated author, Daniel Kessler, attempting to undermine the rationale for health reform.

While I could question the motive and the substance of the study, it might be a moot point: as we have said before, it seems to me there are more important reasons to support health reform, for employers and employees.

The study states that the cost-shift in the health system is mostly made up of the underpayments to providers by public programs like Medi-Cal, rather than care provided to the uninsured. The first point is not original: the New America Foundation's estimate (which Governor Schwarzenegger uses) is that premiums are 7% higher because of the cost-shift due to California's low Medi-Cal payments, and then another 10% higher because of the cost-shift associated with the uninsured, adding to a grand total of 17%.

So the Chamber thinks Medi-Cal rates are a bigger deal than covering the uninsured. We at Health Access California think both are important, but I'll take the common ground of having the Chamber's implicit support to increase Medi-Cal rates. Those with Medi-Cal coverage have serious issues getting access to providers and services because the rate reimbursement is so low.

What I want to know is, how would the Chamber of Commerce fund a Medi-Cal rate increase? By their own research, their members, especially those that provide coverage, are paying it now through premiums. Will they support a tax or other revenue source to help improve Medi-Cal and the health system as a whole, and lessen that burden on their members?

Labels: Employers, Research, YearOfReform

posted by Anthony Wright | Permalink | 6:10 PM

The National Federation of Independent Businesses (NFIB), which made significant membership gains actively opposing President Clinton's health reforms in the early 1990s, released some responses from a membership survey, which had predictably skewed questions and predictably skewed answers, with a remarkably consistent 68-70% of respondents opposed to anything: HMO consumer protections (called "mandates on small businesses"), an individual mandate, even a subsidized pool for those who can't afford coverage.

The one response that wasn't predictable:

"...on whether or not the state should require health insurers to issue policies regardless of pre-existing medical conditions: A little more than half, 54%, said, ‘Yes,' 32% said ‘No,' and 14% were undecided."

Even this crowd, responding to a less-than-friendly question, thinks that there is a bigger role for the state to oversee the insurers.

Labels: Employers, ExpandingCoverage, GuaranteedIssue, IndividualMandate, Insurers, YearOfReform

posted by Anthony Wright | Permalink | 12:20 PM

If only...

Wednesday, July 30, 2008

Rebuilding our muscle

Thursday, May 08, 2008

Healthcare Armageddon

Tuesday, May 06, 2008

Bush vs. San Francisco...

Thursday, April 17, 2008

Consumer reporting on health care...

Thursday, April 10, 2008

Transparent motives...

Eating out in San Francisco

Monday, March 17, 2008

Business impact of ABx1 1

Wednesday, January 16, 2008

Knowing where your food comes from....

Wednesday, January 02, 2008

The actual impact of the SF ruling...

Friday, December 28, 2007

Why employers matter...

Thursday, December 27, 2007

An opening?

When judges attack...

Wednesday, December 26, 2007

The Status Quo

Thursday, December 20, 2007

The lessons we learned in preschool...

Tuesday, October 09, 2007

True Democracy

Tuesday, October 02, 2007

A SFO-LGA cross country connection...

Thursday, September 13, 2007

Small Businesses of California, Unite!

Friday, August 24, 2007

Medical Mercenary or Meathead?

Monday, July 30, 2007

Health care on aisle 5...

Wednesday, July 18, 2007

A better deal for employers, part II

Sunday, June 24, 2007

The ghost of SB2

Saturday, June 23, 2007

Taking the next step...

Wednesday, June 06, 2007

But will they lobby on it?

Tuesday, June 05, 2007

Questions for next week...

Friday, June 01, 2007

The "hidden" reasons for reform...

Tuesda