Our Common Good

After making a big deal of publicly supporting the Affordable Care Act, Walmart—the nation’s largest private sector employer—is joining the ranks of companies seeking to avoid their obligation to provide employees with health insurance as required by Obamacare.

It was not all that many years ago that Walmart announced, in response to harsh criticism over the low pay provided to Walmart ‘associates’, that the company would provide a healthcare benefit to its part-time, low earning employees. The uncharacteristically generous nod to worker needs was short lived as the company partially pulled back on the commitment in 2011, citing premium rate increases that Walmart deemed beyond their capacity to pay.

Now, Huffington Post is reporting that the party is over for many more existing Walmart employees, along with all employees hired after February 1, 2012 that the company can classify as “part-time.”

According to the 2013 Walmart “Associate’s Benefit Book”— the manual for low-level Walmart employees—part-time workers who got their jobs during or after 2011 will now be subject to an “Annual Benefits Eligibility Check” each August.

Employees hired after Feb. 1, 2012, who fail to average the magic 30-hours per week requiring a company to provide a healthcare benefit, will lose their healthcare benefits on the following January. Part-time workers hired after Jan. 15, 2011, but before Feb. 1, 2012, will be able to hang onto their Walmart health care benefit if they work at least 24 hours a week.

Anyone hired before 2011 will not be cut off from the company provided health insurance.

Of course, Walmart carefully controls employee work schedules and will have the opportunity to design worker hours in a manner that will keep employees at a level below the threshold required to accomplish company healthcare benefits pursuant to the law.

While there have been increasing reports of American employers reacting to the requirements of the Affordable Care Act by making plans to cut employee work hours so that these companies may deny health insurance as a benefit of employment—particularly in the restaurant and fast food industries—it appears that Walmart has been planning this move all along.

Federally-funded community health centers (CHCs) are a significant part of the safety net. They provide care to low-income Americans, most of whom either have no health insurance or rely on Medicaid. The G.W. Bush Administration expanded CHCs dramatically, and the Affordable Care Act signed by President Obama does so even further, to the point they may serve as many as 30 million Americans a year in the near future. While seeing CHCs as laudable, many progressive health care policy analysts have fretted that the care provided in these centers is not at the same level of quality as that received by privately insured patients in other settings. A new study published in the American Journal of Preventive Medicine shows that this is indeed the case.

The research team examined over 30,000 ambulatory care visits to assess quality measures such as providing adequate medications for chronic illnesses, screening for high blood pressure, counselling patients about the need for exercise and the like. The quality of care provided in CHCs was compared to that provided by primary care doctors in private practice.

The difference in health care quality across the two settings was profound: CHCs provide much better primary care than do private practice doctors. Of the 18 quality measures examined, CHCs were superior on 11, equal on 6 and inferior on 1. When the researchers adjusted the findings for difference in patient characteristics, private sector care was not superior in any respect, and was on most indexes significantly worse.

Consumers saved nearly $1.5 billion in 2011 as a result of rules in President Obama's healthcare law that limit what insurance companies can spend on expenses unrelated to medical care, including profit, a new analysis shows.

Much of those savings — an estimated $1.1 billion — came in rebates to consumers required because insurers had exceeded the required limits.

The study by the New York-based Commonwealth Fund also suggests that the Affordable Care Act forced insurers to become more efficient by limiting their administrative expenses, a key goal of the 2010 law.

In some cases, insurers passed savings on to consumers in the form of lower premiums and higher spending on medical care, the researchers found. This was primarily true in the individual market, where consumers buy health insurance on their own.

The rules “appear to be producing important consumer benefits,” concluded the report’s authors, Michael McCue, a professor of health administration at Virginia Commonwealth University, and Mark Hall, a healthcare law professor at Wake Forest University.

Darden Restaurants, the company that owns Olive Garden and Red Lobster, revised earning projection downwards today. The culprit, at least in part: Negative media attention that the company received after promising to test limiting workers’ hours as a way to dodge Obamacare’s insurance mandate.

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Walmart, the nation’s largest private employer, plans to begin denying health insurance to newly hired employees who work fewer than 30 hours a week, according to a copy of the company’s policy obtained by The Huffington Post.

Under the policy, slated to take effect in January, Walmart also reserves the right to eliminate health care coverage for certain workers if their average workweek dips below 30 hours — something that happens with regularity and at the direction of company managers.

Walmart declined to disclose how many of its roughly 1.4 million U.S. workers are vulnerable to losing medical insurance under its new policy. In an emailed statement, company spokesman David Tovar said Walmart had “made a business decision” not to respond to questions from The Huffington Post and accused the publication of unfair coverage.

Labor and health care experts portrayed Walmart’s decision to exclude workers from its medical plans as an attempt to limit costs while taking advantage of the national health care reform known as Obamacare. Among the key features of Obamacare is an expansion of Medicaid, the taxpayer-financed health insurance program for poor people. Many of the Walmart workers who might be dropped from the company’s health care plans earn so little that they would qualify for the expanded Medicaid program, these experts said.

“Walmart is effectively shifting the costs of paying for its employees onto the federal government with this new plan, which is one of the problems with the way the law is structured,” said Ken Jacobs, chairman of the Labor Research Center at the University of California, Berkeley.

For Walmart, this latest policy represents a step back in time. Almost seven years ago, as Walmart confronted public criticism that its employees couldn’t afford its benefits, the company announced with much fanfare that it would expand health coverage for part-time workers.

But last year, the company eliminated coverage for some part-time workers — those new hires working 24 hours a week or less. Now, Walmart is going further.

(Read More)

It felt, a bit, like stepping into a scene in “Mad Men”: A dimly lit room with three rows of chairs, all hidden behind a two-way mirror. There, experts watched focus groups shuffle in and out in 90-minute intervals. They pointed at logos they did like, logos they didn’t like and tried to explain the difference between the two. 

These focus groups were not under the supervision of Don Draper, but rather Enroll America.  And the nonprofit was trying to figure out how to sell a product that was never available in the 1960s: Universal health insurance.

My story in Wednesday’s paper looks at the how little the public knows about the Affordable Care Act, with those most likely to gain new coverage options least aware of the changes ahead.

Enroll America is one nonprofit trying to change that: It was founded last year with the express goal of maximizing insurance enrollment come 2014. Before that heavy lifting starts, they still need to figure out how to convince people to sign up.

Hence, the focus groups. Enroll America held 10 of them, across the country last week, all with Americans likely to qualify for new coverage options in 2014. I attended two in Philadelphia last week. I found them a hugely interesting window into how Americans think about health insurance, and what that means for the Affordable Care Act.

The knowledge gap was clear from the beginning: None of the 31 participants knew about the health law’s new coverage options, like subsidies for those earning below 400 percent of the poverty line, and Medicaid for the lowest income Americans. It was not, however, a complete knowledge vacuum: When a researcher asked how many people had heard about the mandate to buy insurance, a flash of hands went up.

“Virtually no one who is uninsured understand how health reform will affect their lives,” Ron Pollack, who chairs Enroll America’s board, told me after the focus groups. “While some focus group participants have heard the term Obamacare, literally none of them have an inkling about whether, and how, their lives will be affected.”

This is a huge challenge for the health-care law but it’s not necessarily surprising. The health-care law is complex, and the big benefits don’t even roll out until 2014. For most Americans, it’s hard to see a practical reason to become informed when the benefits don’t yet exist. 

Rather, what I found most interesting was the deep skepticism of the health law’s benefits as the researchers began to explain them.

Part of the problem, experts say, is that people who will be affected don’t realize the urgency because the subsidies won’t begin for another year. But policy decisions are being made now that will affect tens of millions of Americans, and the lack of public awareness could jeopardize a system that depends on having many people involved. Low enrollment could lead to higher premiums, health policy experts say. Hospitals worry that, without widespread participation, they will continue getting stuck with patients’ unpaid medical bills. And advocates say the major purpose of the Affordable Care Act – extending health insurance to more Americans – will go unmet if large numbers of vulnerable people don’t take advantage of it.

But because “Obamacare” has been so controversial, and its fate caught up in the presidential campaign, there has been little public discussion about the specifics of putting it into action. States such as Texas and Florida, where opposition to the legislation was strong, have been slow to embrace the law and critics have been loath to promote it.

Initial White House efforts at outreach caused congressional Republicans to accuse the administration of using taxpayer money for political gain. In mid-November, Ways and Means Committee Chairman Dave Camp (R-Mich.) subpoenaed Health and Human Services Secretary Kathleen Sebelius, demanding information about how her agency has used federal money to promote the Affordable Care Act. The administration is preparing a final budget for an outreach program focused on the opening of the exchanges in October.

[…]

Even as Congress was finishing the debate that led to the law, a coalition of health-care advocates formed to help promote it. Led by Families USA co-founder Ron Pollack, the group started Enroll America, a nonprofit largely funded by health-care industry and philanthropy groups.

In the coming months, the group will begin an advertising campaign meant to encourage Americans to sign up for the health-care law’s subsidized insurance coverage. Still in its planning stages, it is likely to start in the summer or fall of 2013, just before the state-based insurance marketplaces open for enrollment.

The still-unnamed campaign is likely to put more intensive resources toward a handful of key states. Those could include Florida and Texas, which have a combined 10 million uninsured residents, and have made little effort to do such outreach.

The group has raised $6 million from a coalition that includes the American Hospital Association, pharmacy chain CVS-Caremark, physician groups and individual health insurance companies. Although that initial funding has covered survey research and the hiring of seven staff members, board chairman Pollack said the group hopes to raise “tens of millions” more for the outreach campaign.

“We know now that the Affordable Care Act has to be implemented,” said Rachel Klein, Enroll America’s executive director. “It’s imperative that the people who will benefit hear about the new coverage available and learn how to sign up.”

Currently, 48.6 million U.S. residents lack health insurance. The Congressional Budget Office estimates that 30 million will gain coverage. That would leave nearly 19 million uninsured.

About a quarter of those are illegal immigrants, who aren’t eligible for the reform law’s subsidies. Two million, the CBO projects, live in states that will opt out of the Medicaid expansion.

The rest, however, probably are eligible for new benefits. The CBO, for example, expects that nearly 6 million of those newly eligible for Medicaid just won’t sign up for the program.

Even though the subsidies for currently uninsured people won’t go out until Jan. 1, 2014, the state exchanges that will offer health plans are being set up now, and participants will need to start signing up next Oct. 1. Supporters of the health-care law say the plan won’t be a success without a massive public relations campaign to build awareness.

Americans for Prosperity, a conservative organization backed by the billionaire Koch brothers, took aim at Florida Gov. Rick Scott (R) on Monday, accusing him of working against his state’s interests with his apparent change of heart on Obamacare.

In a statement, AFP said that Scott’s recent signal that he was willing to consider implementing key provisions of President Barack Obama’s health care reform law was a step in the wrong direction.

[…]

Scott had stood as one of the most stubborn adversaries of Obamacare, even in the wake of the president’s reelection, which effectively secured the law’s existence. But after first vowing to reject moves to set up a state-run health insurance exchange and expand Medicaid rolls under the Affordable Care Act, Scott said last week that he was ready to “have a conversation.” Leaders in the state legislature have also signalled a willingness to take steps toward implementation.

The Obama administration moved forward today to implement provisions in the health care law that would make it illegal for insurance companies to discriminate against people with pre-existing conditions. The provisions of the Affordable Care Act also would make it easier for consumers to compare health plans and employers to promote and encourage employee wellness.

“The Affordable Care Act is building a health insurance market that works for consumers,” said Health and Human Services Secretary Kathleen Sebelius. “Thanks to the health care law, no one will be discriminated against because of a pre-existing condition.”

“The Affordable Care Act recognizes that well-run, equitable workplace wellness programs allow workers to access services that can help them and their families lead healthier lives,” said Secretary of Labor Hilda L. Solis.  “Employers, too, can benefit from reduced costs associated with a healthier workforce.”

The Obama administration issued:

  • A proposed rule that, beginning in 2014, prohibits health insurance companies from discriminating against individuals because of a pre-existing or chronic condition.  Under the rule, insurance companies would be allowed to vary premiums within limits, only based on age, tobacco use, family size, and geography.  Health insurance companies would be prohibited from denying coverage to any American because of a pre-existing condition or from charging higher premiums to certain enrollees because of their current or past health problems, gender, occupation, and small employer size or industry. The rule would ensure that people for whom coverage would otherwise be unaffordable, and young adults, have access to a catastrophic coverage plan in the individual market.  For more information regarding this rule, visit: http://www.healthcare.gov/news/factsheets/2012/11/market-reforms11202012a.html.
  • A proposed rule outlining policies and standards for coverage of essential health benefits, while giving states more flexibility to implement the Affordable Care Act. Essential health benefits are a core set of benefits that would give consumers a consistent way to compare health plans in the individual and small group markets. A companion letter on the flexibility in implementing the essential health benefits in Medicaid was also sent to states.  For more information regarding this rule, visit http://www.healthcare.gov/news/factsheets/2012/11/ehb11202012a.html.
  • A proposed rule implementing and expanding employment-based wellness programs to promote health and help control health care spending, while ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status.  For more information regarding this rule, visit: http://www.healthcare.gov/news/factsheets/2012/11/wellness11202012a.html

House Republicans like to talk about the need to find common ground with President Obama to make progress on important national issues, especially after the election. Yet within days, they were setting an agenda to eliminate an important element of his signature domestic achievement, the Affordable Care Act.

Representative Eric Cantor of Virginia, the majority leader, recently proposed that House Republicans set their sights on repealing the part of the law that creates an independent board that is supposed to help limit growth in Medicare spending. Increases in Medicare spending have already slowed substantially, but the board will be needed to make sure that they stay low after 2014, when most of the law takes effect.

[…]

If the projected growth rate in per capita Medicare spending exceeds specified targets pegged initially to an average of general and medical inflation and later to gross domestic product, the board must recommend changes (most likely cuts in payments to health care providers) to bring the growth rate back in line. Congress can override the board’s recommendations, but it must still find equivalent savings.

The Congressional Budget Office has estimated that repealing the board might drive up federal spending on Medicare by $3.1 billion over a decade. Without pressure from such a board, Congress is apt to be weak in resisting demands by powerful health care groups and industries for higher Medicare reimbursements.

Mr. Cantor apparently believes that throwing around the false charge that the board will harm patient care will persuade enough members of the Democrat-led Senate to follow the House, which has voted twice to repeal the board. In a recent letter to House Republicans, Mr. Cantor said that “one of our most successful critiques” of the president’s health care reforms was that “Obamacare put the government between doctors and patients.”

Mr. Cantor has suggested that seven Democratic senators who will be up for re-election in 2014 in states that the Romney-Ryan ticket just carried might yield to Republican pressure. They would be foolish to fall for the scare tactics and force Mr. Obama to have to veto a repeal bill that would eliminate a crucial cost-saving measure.

Papa John’s CEO John Schnatter’s recent statement that the Affordable Care Act will force the pizza chain to raise prices came as good news to Nick Martin.

Martin, a part owner of Ian’s Pizza, a pizza shop with four locations in Wisconsin, said his business has offered full heath care coverage to its 50 full-time employees for years, making it all the more difficult to compete with national chains like Papa John’s that pay workers low wages without health benefits.

"This may level the playing field for us,” Martin said of the Papa John’s price hike. “If they have to pay for benefits, and that pushes their prices up closer to ours, it will justify what we’ve been paying for and what we’ve been fighting to do the past few years.” (Ian’s knows a bit about fighting, having fed demonstrators free slices during last year’s protests in Madison.)

Like many of the 60 percent of small businesses that pay employees health benefits, Ian’s Pizza has struggled to compete with national chains that enter local markets and undercut existing prices. But Obamacare may give local businesses some breathing room as national chains lose the advantage they once wielded through not providing health insurance, according to Jonathan Gruber, a professor of economics at the Massachusetts Institute of Technology.

[…]

Still, small business owners who already offer employees health insurance reported feeling a sense of vindication upon hearing that large restaurant chains are now being forced to consider a cost that they’ve shouldered for years.

“I’d tell Papa John’s’ CEO, ‘Welcome to the club,’” Martin said. “We’ve battled the whole way giving health insurance to employees ever since we could afford to do it 9 years ago, as a two-year-old business.”

To drive home their blackmail efforts, the industry has launched a television and print campaign telling us what is going to happen to our jobs if we remove their subsidies.

You know what? Enough already.

How does any American avoid the reality that these are the very people who claim to despise welfare unless that welfare is corporate welfare?

Restaurant owners who whine about paying the cost of their employees’ health care are leaving it to you and I to do the job for them with every monthly health insurance premium we pay, thereby subsidizing their bottom lines whether we buy their products or not. How is that not corporate welfare? Oil companies who threaten to take their jobs and go elsewhere if we dare to cut back on their research and development subsidies, all the while pointing the finger at single mothers who get government help.

I’m sorry, but this is nuts.

It is no secret that American patriotism was, for many people, long ago replaced by something these folks consider far more important—personal and shareholder profit.

I like profits. But I also like living in a country where our commitment to the betterment of our nation and the lives of our people takes precedence over the desire to give away a few million pizza pies.

If these companies are permitted to get away with this effort to hold hostage their employees—and the American public at large—in order to get their way because they lost an election…or if they can successfully threaten to pick up their ball and take it to a different field because we might just ask them to forgo some R&D subsidy money for the national betterment…America has a problem far more dramatic than paying an extra fifteen cents for a slab of carbohydrate drenched in sugar filled tomato sauce and then covered with artery clogging meat.

I can only hope that Americans will have the good sense to show these businesses what we think of their tactics and their notion of patriotism by choosing to support businesses who believe in a more basic yet evolved sense of values.

It doesn’t require massive efforts or campaigns involving staging boycotts or creating other types of mischief. It is far simpler than that.

The next time you are taking the family out for dinner, do a quick Google check to see if your destination is a place where they are punishing their workers to make a political points as they ask you to subsidize their profits by requiring you to pay higher health insurance premiums due to the costs of emergency rooms treating their employees because they have no coverage.  If you find that your planned destination is such a business, maybe you can think of another, similarly priced restaurant that your family might enjoy.

These business have made their choice and their choice is to politicize their businesses.

Fine. Now, let’s make our choices.

Add Texas Gov. Rick Perry, Maine Gov. Paul LePage, Ohio Gov. John Kasich, Kansas Gov. Sam Brownback and Wisconsin Gov. Scott Walker to the list of Republican governors who are continuing to protest Obamacare by refusing to establish health insurance exchanges, in the process forcing the federal government to step in and create the exchanges itself. Starting in Oct. 2013, the exchanges will be the marketplace for individuals to obtain insurance if they do not have coverage through their employer, Medicare, or Medicaid. Beginning Jan. 2014, the new insurance plans will take effect, giving nearly every American citizen health care coverage.

I may be wrong, but it seems to me that these Governors are essentially helping create the “public option” the Republicans in Congress fought so hard against.

Lt. Gov. Mary Taylor said Ohio plans to let the federal government run the new health insurance exchange required to be up and running in 2014.

Following a speech Tuesday to the Columbus Association of Health Underwriters, Taylor said state officials will send a letter Friday telling the federal government that it can run the exchange, but the state wants to retain its traditional regulatory authority.

For example, the state would still decide who is eligible for Medicaid in Ohio.

Health care markets, called exchanges, would help people and small businesses find affordable health care coverage. The exchanges would be used to help low-income Ohioans enroll in Medicaid as well as set rules for premiums and provide consumer protection guidelines.

Ohio officials would have until mid-February to submit a more detailed outline of what functions they want to retain as the feds step in to run the exchange in 2014, under the Affordable Care Act.