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

ACA Section: New Women's Healthcare Coverage Expands Today

"New health insurance plans for women now include services without co-pays" [Scroll down for birth-control coverage story from Julie Rovner of NPR.]
* Affordable Care Act
* August 1, 2012, By: Elizabeth SanFilippo

From Examiner.com:

* Affordable Care Act
* Women's Health
* August 1
* contraception


President Obama's Affordable Care Act was passed in 2010, but it wasn't until today, August 1, that women on new insurance plans gained access to new health benefits, many of them related to preventative services, without having to owe a co-pay.

Of the new health insurance offerings, Senator Barbara Mikulski of Maryland said:

"Women will be able to have access to essential preventive services that will provide early detection and screening for those situations where they're most at risk, and also provide opportunities to care and services that they need as wives and mothers."

The new services offered include breastfeeding supplies and counseling, gestational diabetes screenings, STD screenings, contraceptives, prenatal tests, pap smears, as well as annual wellness exams. Prior to August 1, many insurance companies were charging women extremely high co-payments, which can incredibly discourage women from seeking services that prevent diseases and health issues later in life.

One foundation, Raising Women's Voices for the Health Care We Need, is touting the enormous benefits to so many women.

"These are services that women need across the lifespan and that many women postpone or just don't get because of the high cost. Women of all ages and races stand to benefit tremendously from this provision of the health care law," said Raising Women's Voices co-founder Lois Uttley.

Unfortunately this huge movement forward for women's rights and women's health still isn't completely set in stone. Republicans continue to vote against the new health care law and vow to get rid of all funding for these provisions in the 2013 budget.
Not only that, but insurance plans that existed prior to the health care reform law may have "grandfathered" status and are not be required to offer these free services until the plan is renewed. VP of health policy at the Kaiser Family Foundation, Gary Claxton, explained: "You may or may not have them offered to you, and if they're offered, you may have to pay cost sharing. In other words, you may have to pay a portion of the costs."
Even so, August 1, 2012 is a huge step forward for women's health. According to the Department of Health and Human Services, 47 million women in the U.S. stand to benefit from these new policies.
© Elizabeth SanFilippo 2012

From Examiner.com "Under Health Law, 'No-Cost' Birth Control Starts Today" -Julie Rovner of NPR, August 1, 2012

The 14 States with Health Exchanges On the Way; Key Flaw Opens Exemption to Health Care

There are 14 states that are on their way to getting health care exchanges.

These are the states that have passed legislation to establish health care exchanges, in cooperation with the Affordable Care Act:
First there are not too many surprises:
the West coast states: Washington, Oregon and California,
some New England states: Massachusetts (the pioneer), Vermont (it is on its way to establishing the nation's first single payer system), and Connecticut,
and in the Middle Atlantic states there is Maryland and West Virginia.
But there are some surprises: in the West, Nevada, Utah and Colorado.
States that have health care exchanges by executive order include:
Indiana, New York and Rhode Island.
Governors in New Jersey and New Mexico vetoed such medical exchange legislation.

Reference: National Conference of State Legislatures, "State Actions to Address Health Insurance Exchanges" http://www.ncsl.org/issues-research/health/state-actions-to-implement-the-health-benefit-exch.aspx
Liz Goodwin, July 19, 2012 in Yahoo News, "Experts argue Obamacare mistake could doom key part of law" http://news.yahoo.com/blogs/ticket/experts-argue-obamacare-mistake-could-doom-key-part-212811734.html

States could dodge a key part of the health care reform law because of a little-noticed mistake in the lengthy bill, according to a white paper by conservative health care experts Michael Cannon and Jonathan Adler.
A missing word in the law's definition of a health insurance exchange could prevent the federal government from doling out crucial subsidies to aid middle class and lower-income people in buying insurance in states that refuse to set up their own exchanges. (Only 14 states are close to setting up exchanges so far. The federal government will set up back-up exchanges in states that don't have their own by 2014.) If Cannon and Adler are right, the federal government would also not be able to fine large employers in states without exchanges if their lack of coverage leads employees to buy insurance in a federal exchange.
The law defines a health insurance exchange as a "governmental agency or nonprofit entity that is established by a state" in one section of the law, and then says later that individuals who participate in exchanges under that definition are eligible for subsidies. Because the law only says a "state" and not "a state or the federal government," Cannon and Adler argue that the federal government cannot legally dole out subsidies or tax breaks to people who buy insurance from federal exchanges.

The Obama administration has said that the intention of the law is clear, and that they fully plan on handing out subsidies when they set up federal exchanges in states that do not set up their own. (Other legal experts agree. Tim Jost, a law professor at William and Lee University, told Yahoo News the pair's thesis is "wishful thinking.") But Cannon and Adler argue the "mistake" was an intentional choice to push states to set up exchanges, and that the administration must deal with the consequences.

If the law's opponents sue over the missing language and win (both big hypotheticals), it would mean considerably fewer people will gain health insurance under the law than was planned--because the lack of subsidies means those without insurance would not be forced to purchase coverage. (If the cheapest plan available costs more than 8 percent of a person's income, that person is no longer penalized under the law if he or she remains uninsured.)
But, there may be a compelling reason for opponents of the law to hold their fire. Another part of the law says that no state can cut their existing Medicaid rolls until an exchange is up and running in their state. Under the new, narrower definition pushed by Adler and Cannon, that would mean that no state could ever tighten up its eligibility requirements for Medicaid unless it first sets up a health care exchange of its own.

Washington Post's go-to site (& book) explaining 2010 health care reform law

Here's a great book by the Washington Post staff, explaining in simple, straight-forward terms, how Patient Protection and Affordable Care Act, the March 23, 2010 health care reform law helps Americans.

See also this handy Washington Post interactive website "What does the health care bill mean to me?," explaining how the health care reform law affects you. The search tool has individualized features such as consideration of your marital status and your income level.

The health-care overhaul will change the way millions of Americans get health insurance and require nearly everyone to have health insurance or face penalties. A number of factors - including income, age, location and family size - will determine how it specifically impacts your life. This tool estimates what it could mean for your health coverage and taxes based on your income, family size and current insurance status.

These are essential tools for activists and voters, for understanding the health care reform law ("Patient Protection and Affordable Care Act"), in advance of Tuesday's midterm U.S. Congressional elections, November 2, 2010. The election will be a referendum, in part, on the legislation.