Obamacare Opens For Business, Shuts Out Labor

Obamacare Opens For Business, Shuts Out Labor August 01, 2013 / Jenny Brown, Labor Notes

When the Obama administration announced July 2 that it would give a breather to employers affected by the Affordable Care Act (ACA), angry unionists noticed a pattern.
Even before this delay, “every corporate interest that’s asked for regulatory relief has gotten it,” said Mark Dudzic, chair of the Labor Campaign for Single Payer, “but the concerns of union plans have been overridden.”
The requirement that employers provide health insurance or pay a fine will be postponed till January 2015 or later.
“Looks like ordinary workers will be forced to pay for health insurance on the original schedule [starting January 2014], while big business is off the hook for at least a year,” said Chris Townsend, political director of the United Electrical Workers (UE).
Justifying the delay, the Obama administration cited employers’ difficulties in reporting employee hours worked, pay, and their insurance offerings—all information needed to calculate whether a fine is due for not offering adequate insurance.

The Walmart Loophole

Some states are trying to patch up problems with Obamacare before it hits. California union groups are campaigning to eliminate the “Walmart loophole,” so called because it affects many employees working for the low-wage retail king.
Under the ACA, employers who don’t provide affordable insurance (defined as premiums no higher than 9.5 percent of your income for individual coverage) will be fined $2,000 per full-time worker if their employees have to go to the health insurance exchanges as a result.
It’s the basic pay-or-play idea: All employers with 50 or more full-time workers should put in something, either by covering their workers or by paying a fine. (It’s this fine that has now been delayed.)
But what if the employees, like many Walmart workers, are making so little they’re eligible for Medicaid? No similar fine applies.
Likewise, some employers are cutting hours to evade the “full-time” worker part of the law, which defines full-time as more than 30 hours a week or 130 a month.
The union-supported legislation would penalize big California employers (those with more than 500 employees) if their workers enroll in Medi-Cal, the state’s Medicaid program. The fine is pro-rated by the number of hours worked, so employers can’t evade it by cutting workers’ hours. The fine money would go to Medi-Cal, and there are penalties for employers who discourage workers from enrolling.

The delay won’t be cheap. It means the government will forego $10 billion in employer payments for 2014, according to the Congressional Budget Office.

ROUND AND ROUND

Meanwhile, unions have been asking for adjustments that would protect multi-employer health care funds, but getting nowhere.
As a result, even supportive unions such as the Food and Commercial Workers have started to freak out about the law.
UFCW, UNITE HERE, and the Teamsters have gone round and round with the administration about their multi-employer “Taft-Hartley” plans, which provide insurance to 20 million workers, including part-timers, retirees, and workers between jobs, in the construction trades, trucking, hotels, and grocery.
In a strongly worded letter to Democratic congressional leaders, the presidents of the three unions let fly: “Time is running out: Congress wrote this law; we voted for you. We have a problem; you need to fix it,” they wrote. “Our persuasive arguments have been disregarded and met with a stone wall by the White House and the pertinent agencies.
“Even though non-profit plans like ours won’t receive the same subsidies as for-profit plans, they’ll be taxed to pay for those subsidies,” the union leaders wrote. “Taken together, these restrictions will make non-profit plans like ours unsustainable.”
Under Obamacare, small employers could save money by pulling out of their Taft-Hartley plans and sending workers to the new “exchanges” to get a subsidy, said James McGee, director of the Transit Employees Health & Welfare Fund in Washington, D.C. As it stands, “employers will have every incentive to get out of the funds when union contracts expire.” Employers with under 50 workers, which include 93 percent of construction employers, don’t have to pay a penalty for not providing coverage.
(See more on Taft-Hartley plans in accompanying box.)

INTENDED CONSEQUENCES

Part of the reasoning behind Obamacare was to lower overall medical costs by forcing people to pay more for their care—causing them to visit the doctor less often.
“The consumer should continue to expect that their plan is going to be more expensive, and they will have less benefits,” said a consultant quoted in the New York Times.
That part is working. Employers are now seeing the ACA standards as a floor, and trimming back their plans to match the minimum.
The school system in Old Rochester, Massachusetts, went even further. The board demanded that the non-teaching staff such as cafeteria workers, represented by the UE, pay 50 percent of their premiums. Family coverage would have cost 80 percent of their income.

What’s Happening To The Taft-Hartley Plans?

The looming changes are already affecting grocery workers. In a contract negotiated this spring, 30,000 Stop & Shop workers in five locals in the Northeast gave up on keeping part-timers with less than 30 hours in the union’s Taft-Hartley plan.
Ratified in March, the contract instead gives a “benefit bonus” to workers who must seek insurance on the exchanges, and a contribution to a pre-tax Health Savings Account.
It also provides that Stop & Shop management can’t cut hours to evade federal health insurance requirements. Under the ACA, employers pay a fine if they don’t offer insurance to full-time workers, defined as 30 hours a week or more. This has led some employers, especially restaurants and retailers, to toy with cutting back employee hours as a way to avoid the fines.
One problem with putting some workers into the exchanges, said Mark Dudzic of the Labor Campaign for Single Payer, is that everyone will be in a different boat, even within the union.
“Instead of having a solidarity-based health care system, where everybody’s in, it’s individualized… it all depends on your situation,” he said. A single mother with three dependents would be fully subsidized on the exchange, whereas working next to her, a married worker with no children might pay a big premium.
“Some will be better off, some will be worse off, some will get lost in the mix,” Dudzic said.
For a detailed explanation of problems for Taft-Hartley plans, see the recent white paper issued by the International Brotherhood of Electrical Workers.

The now-delayed ACA provision says insurance premiums may cost no more than 9.5 percent of a worker’s income. That’s for an individual, though; there’s no limit on the cost of family coverage.
Many workers will face a Catch-22: insurance they can’t afford, but no access to Obamacare’s subsidies because their employer offers health insurance that the law deems affordable.
Because of union pressure, Old Rochester management backed off, but workers will still be left paying 30 percent of their premiums by 2016.
The Wendy’s hamburger chain noted that a majority of its low-paid workers already decline the high-deductible plan the company offers at $2.50 a week—so managers expect that when they start offering a better, Obamacare-approved plan at $25 a week, employees still won’t take it.
Popeye’s and Chipotle have made similar calculations.
In 2014, workers who opt out of such employer-offered insurance, and have no other insurance, will be hit with a fine of $95 annually and increasing in subsequent years.
Many employers will figure it’s cheaper to stop offering insurance, anyway. The annual fine to the employer per worker will be just $2,000—assuming the fines eventually kick in.
Workers so stranded by their employers can buy insurance on the soon-to-be launched insurance “exchanges,” now officially called “Health Insurance Marketplaces.”
There, on a state-run website (or one run by the feds if your state opts out), private plans that meet ACA standards will be listed, with out-of-pocket limits (deductibles and co-pays) of $6,350 for an individual and $12,700 for a family.
These approved plans may impose no caps on annual or lifetime benefits. Pre-existing conditions and gender can’t be considered, but premium prices may vary (within limits) based on smoking, age, the size of your family, and the area you live in.
Anyone can buy insurance from a company on the exchange. For workers whose jobs don’t provide “affordable” insurance, the government will subsidize the cost of buying private insurance for individuals or families making less than 400 percent of the poverty level—$45,960 for an individual and $94,200 for a four-person family in 2013. The subsidies are intended to keep a family’s insurance premiums from growing beyond 9.5 percent of its income.
- See the rest of the article at: http://www.labornotes.org/2013/08/obamacare-opens-business-shuts-out-labor#sthash.lLnO0cEW.dpufAugust 01, 2013 / Jenny Brown

Will Obamacare's Individual Health Coverage Mandate Survive Court Challenges? Holder Thinks So, but...

December 14, 2010, the day after a federal judge ruled against the individual mandate for coverage, Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sibelius wrote an opinion piece arguing, "Health reform will survive its legal fight," in the Washington Post.

But polls show that the mandate for individuals to get health insurance or face stiff financial penalties is proving to be a major part of the 2010 healthcare reform or overhaul that is highly unpopular.
A CNN poll earlier this week reported, "CNN Poll: Controversial health care provision unpopular:"
"According to the poll, six in ten oppose the requirement that all Americans get health insurance, with 38 percent saying they favor the provision."

This opposition can only worsen in the wake of Federal Judge Henry E. Hudson's (Virginia) striking down the health insurance mandate as unconstitutional.

***FRAMING THE ARGUMENT ESSENTIAL
The key is to frame the argument properly. The point needs to be disseminated, stronger and more widely, that health insurance is essential. Someone might not think that they need health care. But someday that surgery or other medical procedure, or hospital stay comes. Then, they owe 50,000 to 100,000 dollars.
The key is also to get the Americans and policy makers for that matter out of the myopic bubble of only looking at America. Obama, Harry Reid, Nancy Pelosi, and others should have emphasized how other countries that have model health care systems also have health insurance mandates. As wikipedia informs us, It is a common legal requirement in many countries such as Germany, France, the Netherlands, Republic of Ireland, Switzerland, and from 2014, the United States of America.

***THE NEED FOR PROGRESSIVES TO CAPITALIZE ON POPULIST OUTRAGE
The public has reason to be angry at the powerful. The problem is that progressives have not been able to steer outrage at the proper targets: power-bloated abusive corporations and their lackey lobbyists and Demo-Republican politicians.
The failure for Democratic politicians to pursue a public option and instead, settle on the final form of the health care reform act, is the source of the problems with the discussion over Obamacare and problems with its fate.
There is no public entity (The public option) with which the private health corporations can compete, so as to hold back corporate chicanery in the form of price gouging of patients and prescription drug consumers. Advocates needed to have more vociferously pushed for the option, building coalitions, holding mass rallies. Instead, the health-care reform was an inside the Beltway affair. We can see this with the legislation's giveaway to the drug companies.
For a Huffington Post contribution on Obama's back-sliding away from the public option, see this Feb. 22 piece: "Obama Health Care Plan Drops Public Option."

(Obama first aired his support for the public option in September 2009, but some commentators, such as Ezra Klein in the Washington Post, have pointed to weaknesses in his push for the public option.)

Dare the Republicans to repeal these powerful health insurance reforms!

I just dare John Boehner and Mitch McConnell and the other Republicans to attempt to repeal these excellent reforms.

To be sure, these reforms are measly improvements, when compared to EVERY OTHER industrialized country (and some developing countries!). Congress should have enacted a single payer or a Medicare for all plan.

However, the Republicans' advocacy of the repeal of these reforms will be a delicious opportunity for the Republicans (and Blue Dog Democrats) to reveal themselves as lackeys, behold to the health care industry lobbyists. Just look at the reforms below, posted yesterday by Karen Davis on Huffington Post. The GOP will look heartless in the face of these essential reforms that will end the inhumane denial of health coverage to people that are too sick. Admittedly, too many of the other reforms are not scheduled to kick in until 2014.
(Wonder why the politicians are working for self-interested industry lobbyists, and not Joe and Jane policy-subscriber? See Dave Gilson's great article, "Who Owns Congress" in this month's issue of "Mother Jones" magazine for an article that graphically illustrates how corporate interests underwrite both the Republicans and the Democrats. [Follow the link at Dave Gilson, "Who Owns Congress," for a link to a page that will let you read the article if you provide your email address. Otherwise, support the magazine and buy the October 2010 issue!])
Now, here is the overview of the reforms that the Republicans intend to undo. The Republicans will look so foolish when they try to undo these. I'd like to know how they can rationalize calling preserving health care for children with pre-existing conditions amounts to a British-style socialized medicine!

The reform provisions that go into effect today will bring coverage, financial relief and health security to many, and will also impose important new rules on the insurance industry to prevent future abuses.

As of today, young adults up to age 26 will have the option to enroll in a parent's health plan. Young adults between the ages of 19 and 29 are one of the largest segments of the uninsured; 13.7 million lacked coverage in 2008. Young adults often lose coverage when they age out of their parents' coverage upon graduating from high school or college, or when they become ineligible for public programs like Medicaid and the Children's Health Insurance Program at age 19. In 2014, they will also be able to gain coverage under Medicaid expansion or through state health insurance exchanges with subsidized coverage for people will low or moderate incomes. One million young adults (and their parents) are likely to take advantage of these important changes.

As of today, insurers can no longer place lifetime limits on benefits, and annual limits are severely curtailed. More than 100 million people currently have lifetime limits on the amount that their health insurance will pay, and 18 million have annual limits.

As of today, insurers can no longer retroactively cancel, or rescind, coverage. In what often becomes a nightmare scenario for ill patients and their families, more than 10,000 people each year have their coverage rescinded -- frequently just at the moment they need the coverage the most. Rescissions are no longer allowed.

As of today, there are new options for as many as 400,000 people with preexisting health conditions, who will immediately be able to enroll in new state-based insurance plans, and for the parents of thousands of children with preexisting conditions, who can no longer be denied health insurance for these youngsters.

Medicare beneficiaries who hit the prescription drug coverage gap or "doughnut hole" this year have already begun receiving $250 rebates. And, as of today, Medicare will eliminate cost-sharing for preventive care, and will provide for an annual wellness visit with no copayment. Next year, Medicare will provide a 50 percent discount on brand-name drugs to Medicare Part D enrollees who spend enough on prescription drugs to enter the doughnut hole. And additional discounts on brand-name and generic drugs will be phased in to completely close the doughnut hole for all Part D enrollees by 2020.

A new era in American health care begins today, one that will usher in a new found health and economic security for millions who have struggled too long. But even with all the relief that will come starting today, the record losses in coverage experienced by millions of middle-income families point to the need to accelerate implementation of health reform to provide help faster.