Archive for November, 2016

Reading the tea leaves: The Trump administration and OSHA

Wednesday, November 30th, 2016

depositphotos_81825950_s-2015

Employers are in a state of limbo between one presidential administration and another, trying to intuit the potential impact as potential names of candidates for the  cabinet and key administrative posts are floated, debated and named. Much is still in the realm of speculation.

One thing is becoming clear: Despite the ambiguity that Trump’s recent comments about possibly preserving some parts of Obamacare, it’s clearly on the chopping block. Any doubts were laid to rest in naming Representative Tom Price of Georgia as the secretary of Health and Human Services. An orthopedic surgeon, Price is an ardent foe of the ACA. He is likely to set his sights on Medicare and Medicaid,  too.

But what of other workplace issues? A key indicator will be naming a prospective Secretary for the Department of Labor. Several names have been floated, but as of this writing, no definitive pick has been named. PA congressman Lou Barletta has been cited by many as leading the pack of those under consideration – there are some reports that he has been offered the position, but no confirmation yet. Other possible contenders include Andy Puzder, CEO of CKE Restaurants (parent company of Carl’s Jr. and Hardee’s) and Victoria Lipnic, a commissioner on the Equal Employment and Opportunities Commission and former assistant labor secretary under George W. Bush. Wisconsin Governor Scott Walker’s name has also been raised by some, a selection that would be chilling to labor unions.

At EHS Today, Sandy Smith offers a not-to-be-missed insider view of Transitioning to a Trump Administration: What It Could Mean for the Department of Labor and OSHA.

Her article offers informed perspective by Former Assistant Secretary of Labor Edwin G. Foulke Jr., who spearheaded OSHA under George W. Bush. He also was the chair of Occupational Safety and Health Review Commission (OSHRC) during the transition from George H. Bush to Bill Clinton.

Foulke talks about the immediate process, offering a detailed look at the steps and timeline involved in the transition. He also offers his thoughts on what labor and OSHA issues he expects that the Trump administration will revisit. Here are the items he lists, but click through for the details.

  • Walking-Working Surfaces Standard
  • Respirable Silica Standard
  • Recording and Reporting Occupational Injuries and Illnesses
  • Whistleblower Statutes
  • Increased OSHA Penalties
  • OSHA Enforcement
  • Non-Company Personnel Participation in OSHA Inspections
  • Restroom Access for Transgender Workers
  • Compliance Assistance
  • Fair Pay and Safe Workplaces
  • The Occupational Safety and Health Review Commission

For another take on this, labor and employment law attorney Mark S. Kittaka also looks at Trump’s Potential Impact on OSHA in an article in the National Law Review. Kittaka rehashes some of Trump’s stated priorities and notes that,

“Even without changing a single regulation, Trump could simply limit OSHA’s enforcement ability by cutting their budget. This was a tactic used by President Ronald Reagan and with a Republican majority in both the House and Senate, this is a distinct possibility.”

He identifies the following areas as likely to come under scrutiny:

  • Electronic Recordkeeping/Non-Discrimination Provisions
  • Recordkeeping as a Continuing Violation
  • Silica
  • Interpretation Letters

In other news, CNN reports that Trump will tap billionaire Wilbur Ross for Commerce secretary, As the administration’s chief business advocate, he’s the type of appointment Trump promised: a non-politican executive from the business community. Ross would be expected to help Trump reshape global trade and revive steel and coal, both industries in which he has experience.

But in coal industry, there were some problems. According to CNN:

Ross’s foray into the coal industry, however, ran into trouble in January 2006 when 12 miners were killed after an explosion at the Sago Mine in West Virginia. His company, the International Coal Group, had taken over the mine a couple months earlier.

According to federal reports, the mine had recorded 96 safety violations in 2005 that were deemed “serious and substantial.” The mine was fined nearly $134,000, an amount later reduced in court.

Read another profile of Ross from our go-to coal industry expert, reporter Ken Ward Jr., who speculated about a potential Ross appointment on his Coal Tattoo blog earlier in the month. Ward notes

“It is worth pointing out that if he got either the Commerce or Treasury slot, Ross would not be in charge of coal mine safety and health regulation for the Trump administration. Folks who are concerned about those issues would obviously be better off watching to see who President-elect Trump makes Secretary of Labor — and then who exactly is chosen to by Assistant Secretary of Labor for Mine Safety and Health.”

Thanksgiving And Freedom From Want

Tuesday, November 22nd, 2016

During his 1941 State of the Union address, Franklin Roosevelt articulated what he considered humanity’s four essential freedoms: Freedom of Speech, Freedom of Worship, Freedom from Fear and Freedom from Want. In American recent history those freedoms have been attacked in different ways and in different degrees. At this moment we are a hurting country in many respects.

But right around the corner comes Thanksgiving, my favorite holiday. A holiday on which families come together, put aside their petty disagreements and bond once again with love. No one tries to sell Thanksgiving paraphernalia, except maybe a recently sacrificed turkey. And for a few hours the Christmas shopping season that kicked off around Labor Day doesn’t exist.

Following Roosevelt’s Four Freedoms speech, American artist Norman Rockwell set out to depict them on canvas. Rockwell was a humble man; he called himself an “Illustrator,” not an artist. Didn’t think he was good enough for that.

On 3 March 1942, his Freedom From Want graced the cover of The Saturday Evening Post magazine. He decided the best way to portray Freedom From Want was through a family’s Thanksgiving dinner. His painting, as well as the three other Freedom covers he painted for The Saturday Evening Post that year, has become iconic.

freedom-from-want

We whose job it is to push the workers’ compensation rock up the Sisyphean mountain, all the while trying our best to help men and women who have had their lives interrupted by workplace injury or illness, have taken it on the chin lately. We’re not alone in that, of course.  So many of our fellow citizens are bruised also. Perhaps we, and all Americans, should put that aside and take a moment to ponder Roosevelt’s Four Freedoms and Rockwell’s sometimes loving, sometimes searing, portrait of them and recommit ourselves to the existential exceptionalism that is the American Dream. Perhaps we should grasp tightly the good feelings that ooze out of Thanksgiving and in that moment dedicate ourselves to helping not only those who place their trust in our professional competence but also all who are momentarily lost and searching for better lives for themselves and their loved ones.

Happy Thanksgiving.

The election’s impact on health care: ACA, workers comp, Medicare

Monday, November 14th, 2016

Joe Paduda posted a roundup of opinions on the results of last week’s election, with contributors sharing their thoughts on how the GOP’s sweep will affect health care, health reform, and the health care system: The election’s impact on health care – experts opine.

Before wading in to the fray, Joe reminds us that health care accounts for one-sixth of our GDP, and that it is an incredibly complex, deeply entrenched business.

Joe is a brave man with his crystal ball. Also on his blog, today he takes a look at Trump and workers’ comp. Last week, he offered his initial take on TrumpCare.

Over the weekend, we learn that Paul Ryan plans to phase out Medicare in 2017. Ryan says “What people don’t realize is because of Obamacare, medicare is going broke, medicare is going to have price controls because of Obamacare, medicaid is in fiscal straits.” His proposed “phase in” is contemplated as part of the plan to repeal Obamacare.

Josh Marshall notes:

First, Ryan claims that Obamacare has put Medicare under deeper financial stress. Precisely the opposite is true. And it’s so straightforward Ryan unquestionably knows this. The Affordable Care Act actually extended Medicare’s solvency by more than a decade. Ryan’s claim is flat out false.

Second, I’ve heard a few people say that it’s not 100% clear here that Ryan is calling for Medicare Phase Out. It is 100% clear. Ryan has a standard, openly enunciated position in favor of Medicare Phase Out. It’s on his website. It’s explained explicitly right there.

People voted for change, but it’s not clear that they contemplated a private Medicare system as part of that change.

A Poem To Get You Through Today And Beyond

Tuesday, November 8th, 2016

Out of the night that covers me,
Black as the Pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul.

In the fell clutch of circumstance
I have not winced nor cried aloud.
Under the bludgeonings of chance
My head is bloody, but unbowed.

Beyond this place of wrath and tears
Looms but the horror of the shade,
And yet the menace of the years
Finds, and shall find me, unafraid.

It matters not how strait the gate,
How charged with punishments the scroll,
I am the master of my fate:
I am the captain of my soul.

Have courage, friends. Whatever happens, we will prevail.

Pre-election Health Wonk Review & other news of note

Friday, November 4th, 2016

Brad Wright has a super excellent edition of Health Wonk Review: The Game 7 of Politics Edition. His post skillfully ties two of America’s favorite and most contentious pastimes together: sports and politics. Many good entries from the web’s best health wonks: the ACA, the rigged healthcare system, the Internet of Things and more – check it out.

… and in other news that caught our attention:

Drug spend is down by 8.7% – according to CompPharma’s 13th Annual Survey of Prescription Drug Management in Workers’ Compensation. “Payers credited tighter clinical management, better integration with their pharmacy benefit managers, and prescriber interventions for the decrease. All have opioid management programs to limit the number of initial opioid prescriptions and/or decrease morphine equivalents across as many claims as medically appropriate.”

Will Zika be a work comp issue?
That’s an issue being raised by two Miami Beach police who believe their illness was work related. One cop “…was originally granted workers’ compensation, only for the city to yank it away from her days later. The other officer was denied outright.” Their union is going to bat for them. Union Says Miami Beach Cops Caught Zika on Duty, But City Won’t Pay Their Bills

Injury rates are plummeting, insurance premium rates are flat or dropping, medical costs are down as well. Joe Paduda talks about what’s really happening in workers’ comp.

If I knew then: Conference Chronicles offers Lessons Learned from Retiring Insurance Executives, a panel at the 2016 PCI Annual Meeting.

Roberto Ceniceros offers kudos to employers who are building injured-worker advocacy programs.

At Working Immigrants, Peter Rousmaniere keeps us up-to-date about demographics and trends. His latest post of note offers a perspective on the Hispanic vote on November 8.

Quick takes

Highlights: Fall NCCI Issues Report

Wednesday, November 2nd, 2016

“NCCI just released its Workers Compensation 2016 Issues Report: Fall Edition. It’s a robust 68-page edition, an important barometer of industry results and trends that we think should be on everyone’s reading list. In addition to updated State of the Line results for the workers compensation for 2014 and 2015 and preliminary estimates for Calendar Year 2016, this edition includes articles and reports on a number of key issues. It’s available in both PDF and virtual flipbook style. It’s also available via individual article, which gives an overview of the contents.

We haven’t fully digested the whole report, but we point you to a few highlights and excerpts that caught our eye.

Workers Compensation Financial Results Update (PDF)
Some key findings:

  • “NCCI’s current estimate for 2016 net written premium is $41.2 billion, a new high-water mark for the workers compensation line. This represents a 3.8% growth over the 2015 premium level.”
  • “The 2015 net combined ratio for workers compensation of 94% marked the fourth consecutive year of improvement. NCCI’s preliminary estimate is that the combined ratio will hold steady at 94% in 2016. This represents three consecutive years of underwriting gains for an industry that has posted combined ratios of less than 100% in only two other years since 1990. The estimate for 2016 is based on private carrier direct calendar year incurred losses, direct earned premium, and historical net-to-direct ratios.”

Investigating the Drivers of the 2015 Workers Compensation Medical Severity Decline (PDF)

  • “NCCI reported at its 2016 Annual Issues Symposium that workers compensation lost-time medical severity decreased by an estimated 1% in Accident Year (AY) 2015. This marks the first time in more than two decades that medical severity has declined.”
  • “A 3% decline in paid costs per claim for physician services accounts for most of the medical severity decline in AY 2015—a 3% decline in utilization of physician services is a major driver.”

Workers Compensation and Prescription Drugs 2016 Update (PDF)

  • “NCCI estimates that for every $100 paid for medical services provided to workers injured in 2014, $17 will be paid for prescription drugs.  Furthermore, the prescription drugs portion of medical costs increases rapidly as claims age. For every $100 of medical services paid on claims older than 10 years, approximately $45 to $50 will be for prescription drugs.”

2016 Legislative and Regulatory Outlook

  • “While more than 700 bills addressing workers compensation issues were introduced, only about 10% of these measures were enacted and none of the enacted laws made significant system changes. It is of note that legislatures in MT, ND, NV, and TX do not convene in even numbered years.”
  • “Going into these elections, Republicans hold their strongest state presence ever, with a majority in roughly 70% of state legislative chambers and full legislative dominance (holding the majority in both chambers) in 30 states. In addition, a Republican occupies the governor’s mansion in 31 states, 23 of which have a Republican sweep—the party holds sway in both chambers of the legislature and the governor’s office. There are only seven states where Democrats hold that coveted trifecta.
    Come November 8, however, those numbers are likely to change.”

Impacts of the Affordable Care Act on Workers Compensation
Key Findings

  • “The ACA has had no discernible impact in crowding out workers compensation claimants from access to primary care services through 2014, the first full year of expanded medical insurance coverage under the ACA.”
  • “68% of primary care services provided during the first 90 days of a workers compensation claim occur during the claim’s first 10 days.”

These excerpts are just a peek under the covers – many other worthwhile articles are also available,  such as an analysis of the OK Opt-out decision, an update on marijuana legalization, and more.