Archive for the ‘State News’ Category

This Cat Is Dead. Let It Stay That Way.

Friday, September 22nd, 2017

“Seriously. This is BANANAS” – Senator Chris Murphy, (D-CT), on Graham-Cassidy.

When I was in college I was part of a pretty successful folk group. We played all over, cut a few LPs. It was a great time. On college campuses we would sing a simple, little, nearly childish song that somehow actually became a bit of a hit. It was called The Cat Came Back.

Oh, the cat came back.
She didn’t want to stay.
She was sittin’ on the back porch
The very next day.

Well, there’s a new cat sittin’ on the porch, and it’s called Graham-Cassidy.

Every time we stick a fork in it and call it dead, a new zombie repeal and replace Obamacare horrendoma springs to life.

The selling point of this one, at least according to Senators Graham and Cassidy (and Vice President Pence yesterday morning on CBS), seems to be centered on the idea that passage of this bill will finally allow the states to plot their own health care futures.

That was also the position argued yesterday in a New York Times Op-Ed by Philip Klein, the Managing Editor of the Washington Examiner (Is this a coordinated effort?). In Graham Cassidy has One Great Idea Klein claims the different states have different healthcare needs and, consequently, should be able to address those needs through their own creativity rather than arbitrary requirements of  Washington.

A more flexible system would give states latitude to pursue healthcare programs that are a better fit for their populations’ ideological sensibilities. And there are practical reasons to think of healthcare as a state-based issue: Every one has its own demographics, health challenges and other unique characteristics.

“Ideological sensibilities?” Excuse me? Oh, well.

One thing that strikes me square in the jaw about the states rights argument is this: For the last 26 years, states have been able, with federal waiver approval, to craft their own Medicaid programs as long as the results are revenue neutral and comply with minimum requirements.

By way of explanation, Medicaid has been with us since 30 July 1965 when President Johnson signed it and Medicare into law. Medicaid has been a lifeline for the poor who, prior to the Affordable Care Act, were mostly uninsured for health care. The ER was their primary care physician. The Act had a number of goals, one of which was to lower the number of uninsured and underinsured Americans. Since these people were nearly all of the lower income variety, the Act provided federal funding for states to expand Medicaid. Thirty-one states plus the District of Columbia did that. And the numbers of uninsured dropped significantly in those states.

In 1991, the Social Security Act was amended to create federal waiver programs. States were given the authority, through what are known as Section 1115 waivers, to tailor their own Medicaid programs to their own population needs. As of September 2017, there are 33 states with 41 approved waivers and 18 states with 21 pending waivers. A subset of state waivers are aimed at healthcare delivery system reforms. They are known by the catchy title Delivery System Reform Incentive Payment waiversDSRIP waivers allow states to create innovative programs that reform how care is delivered and paid for. These are demonstration projects and come with federal funding. Lots of it. For example, one of Texas’s two DSRIP waivers, just concluded, provided $11.5 billion over five years. The Texas Health and Human Services Commission has applied for an extension and in May, 2017, submitted to the CMS its positive evaluation of the program’s results (Despite this deep drink at the federal trough, you might remember Texas’s very public, Alamo-like  rejection of federal money to expand Medicaid).

Personally, I think there are many reasons to bury the Graham-Cassidy cat so deep it never sees the sun again. Others have written and catalogued them (see America’s newest health care expert Jimmy Kimmel). But not much has been said to refute this ridiculous let-the-states-have-a-chance claim. The states already have, and have had for 26 years, autonomy to innovate and create programs, with the help of federal funding, that zero in on the needs of their particular populations within sensible federal limits. Graham-Cassidy would do away with those limits, significantly lower funding, force millions of our fellow citizens to become uninsured (again), drop the states down a deep well of chaos and put us all back in the wild west of health care.

Yesterday, in a highly unusual move, the Board of Directors of the National Association of Medicaid Directors (NAMD) issued a statement highly critical of Graham-Cassidy, saying it would place a massive burden on the states.

“Taken together, the per-capita caps and the envisioned block grants would constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country’s history.”

And last night, after learning of NAMD’s statement, Senator Chris Murphy (D-CT) tweeted, “You can’t get ALL 50 state Medicaid Directors to agree on anything else in health care. Seriously. This is BANANAS.”

America’s health care system is complicated (“Nobody knew healthcare could be so complicated!”) and full of inside baseball stuff. But it does allow states to chart their own destinies. So, here’s a question for Lindsay, Bill and Mike: What’s the real reason you’re trying so hard to resurrect this dead cat?

 

 

Taking Credit When It’s Due (And When It’s Not)

Wednesday, September 20th, 2017

Politicians have proven over and over again to be the most adept people in the known universe at taking credit for good things happening with which they had absolutely no involvement and blaming others for bad things happening with which they were directly connected. Case in point is happening right now in the Hawkeye state of Iowa where workers’ compensation rates for 2018 are going down 8.7%.

About a nanosecond after NCCI announced the rate reduction, Republican Governor Kim Reynolds issued a press release claiming the rate decline to be the “direct result” of workers’ compensation legislative reforms that went into effect in July, which, if you happen to be counting, ended 51 days ago as I write this. Phew. That was quick.

Of course, while the new reforms may reduce costs in the future, they have nothing at all to do with the recently announced rate cut, which, according to NCCI, is predicated on a decrease in claim frequency and actuarial data from 2014 and 2015, which, if you’re still counting, is a full 18 months before the new reforms, to whose sticking post Reynolds has now glued himself.

It will be interesting to see, over time, if the new reforms reduce costs for Iowa’s employers and enhance care for its injured workers. That’ll be a neat trick for which Kim Reynolds can justifiably stand up and take a bow at some date in the future, say around 2019.

Here’s a little ditty to go out on:

It’s a little early for the Reynolds curtain call
But if things don’t work out, who takes the fall?

 

Workers’ Compensation’s Costly Psychosocial Issues (2)

Wednesday, February 1st, 2017

First, a review.

Yesterday, we described the challenges confronting claims adjusters and injured workers when psychosocial issues are present in a workers’ compensation claim. These issues impede recovery and exacerbate costs. We confidently picked up our saw and walked out on the proverbial limb to suggest this thesis:

Our nation’s current system for treating injured workers with mental health issues is uncoordinated, overly fragmented, highly wasteful and does not focus enough on speedy return to work. There is a critical need for a more systemic approach as well as an integrated coterie of clinicians and practitioners, trained in workers’ compensation, whose goals are to provide compassionate treatment with a steady return to work trajectory. 

Finally, we listed the serious factors that make finding a solution to this looming crisis tremendously difficult.

But early in 2015 in New Jersey two Neuropsychologists, Mary Ann Kezmarsky and Richard Filippone, had an idea. Over a couple of decades, they’d treated a number of workers’ compensation claimants and had been appalled by what appeared to be the lack of a coherent system to deal with the issues they saw in their patients. They weren’t exactly sure what to do about it – they didn’t know much about workers’ compensation – but they saw it as a business opportunity.

They contacted me, and over the next year we created a company, Work Comp Psych Net (WCPN), and built a systemically organized and integrated specialty network of workers’ compensation clinicians and therapists to treat injured workers in New Jersey who might have behavioral health issues delaying recovery. Here’s how we did it:

  1. Over the last half of 2015, we recruited, credentialled and vetted 44 mental health professionals covering 55 offices throughout New Jersey’s 21 counties. Providers within WCPN’s network include psychologists and neuropsychologists, as well as cognitive rehabilitation and biofeedback specialists. All of the clinicians and therapists gave up a weekend to attend Lynch Ryan training in workers’ compensation. They learned about the New Jersey law, as well as the way workers’ compensation works – how a premium is constructed and  what indemnity and medical benefits are. They now understand experience modification, maximum medical improvement and the law regarding injuries “arising out of and in the course of employment.” Further, they have been educated regarding early return to work and have agreed to work with employers, adjusters and nurses to effectuate modified duty wherever possible.
  2. We built (with difficulty, because it wasn’t easy) the nation’s first electronic Claimant Intake & Referral Portal that allows claims adjusters, nurse case managers and attorneys to refer a claimant instantly. The paperless portal’s referral system is geographically and specialty based, meaning that referrers are assured that claimants will not have to travel far to reach their assigned clinician. In the past, referrals and appointments took weeks, even months, to arrange, but they can now be finalized within minutes. In Beta Testing from May through October, 2016, the longest time from referral to Provider scheduled appointment was 27 minutes.
  3. We built (with even more difficulty) the nation’s first mental health Electronic Health Record system for workers’ compensation. The EHR is set up as a roadmap for all WCPN clinicians to follow, meaning reports have a consistently structured form. The EHR is paperless, HIPPA-compliant and cloud-based. Initial Psychological Evaluations and subsequent treatment reports reach claims adjusters in pdf form within five business days.
  4. Our clinicians are all highly qualified and experienced; they know how to treat workers with mental health issues delaying recovery. But to make the system work we needed to understand the needs of adjusters and defense attorneys who would be referring the injured workers the clinicians would treat. Consequently, we conferred with experienced adjusters and defense attorneys. After doing so we decided that every referral would begin with a thorough Initial Psychological Evaluation (IPE), which, although not technically an IME, would be done at the IME level (we priced the IPE at $450, and, since nobody’s complained, we now think that’s too low, but we’re sticking with it). If the Initial Psychological Evaluation determines the presence of one or more mental health issues which are deemed to be work-related and requiring treatment, the treatment prescribed is initially authorized for up to 12 sessions unless medically justified, extraordinary circumstances are present. Additional treatment requires the approval of the referring party.

We officially launched in November, 2016. Over the intervening three months  we’ve learned two things (among a lot of others): First, our solution works extremely well; referrers have been highly receptive and pleased. They appreciate the ease of referral and the EHR reports.  They appreciate even more the fact that our clinicians and therapists have been trained in workers’ compensation. We’ve signed contracts with insurers and TPAs. Second, this could be a national solution.

So, our solution is working in New Jersey, but every state workers’ compensation system is grappling with how to deal with psychosocial issues that frequently hobble recovery. This may be work comp’s final frontier. Time will tell whether our template and software could help others. Regardless, we will continue to improve our solution at Work Comp Psych Net, as well as report on our outcomes.

It’s taken us nearly two years to get to this point, so if any reader wants to take this issue on in another state, we’d be happy to offer the wisdom (and sometimes folly) of our experience.

 

 

Mike Manley On The Oregon Workers’ Compensation Premium Rate Ranking Study

Monday, October 10th, 2016

I have always tried to surround myself with people smarter than I. People such as Gary Anderberg, Peter Rousmaniere, Jennifer Christian, Joe Paduda, Bob Wilson, Mark Walls and Julie Ferguson, to name just a few of the legion. Mike Manley is in the group, too. Mike is Research Coordinator for the Oregon Department of Consumer and Business Services and co-author of what is known in the biz as The Oregon Study.

For three decades, the state of Oregon’s workers’ compensation research group has published this bi-annual study, which won the 2006 IAIABC Research Award. The executive summary of this year’s study is due to be released in the next few days, and the findings are closely watched in quite a few states. Unlike the National Academy of Social Insurance report, issued last week, the Oregon study takes the comparison beyond simple averages. Instead, Oregon derives average rates for what a hypothetical set of comparable employers would pay, thus factoring out much of the difference in states’ risk profiles.

With any comparison across states in the workers’ compensation arena, there are caveats and fine points to be considered. Naturally, there are questions that arise about the methods and interpretation of the findings.

At the Insider, it’s unusual  to have guest bloggers; we’ve only done it a handful of times over 14 years. But for important issues, we make exceptions. The Oregon Study is such an issue. So, I asked Mike if he would write something he wanted our readers to know about the upcoming study. He came up with a list of ten, and we’re going to publish every one of them right here right now. Who knows? You may be reading the latest study tomorrow, but if you are, you’ll be armed with Mike’s intelligent cheat sheet. What follows are the ten things to know about the Oregon Study, by Mike Manley.

           Ten things WC professionals should know about the Oregon Study

  1. This isn’t a report card! The study isn’t an overall evaluation of states’ workers’ compensation systems. There are other important aspects of workers’ compensation systems that are beyond the scope of this analysis. The study focuses on one aspect of workers’ compensation systems: rates paid by employers that purchase insurance.
  2. The study uses a consistent hazard mix across states. This is done by giving each state the same hypothetical distribution of risks, in order to control for the differences in risk across states. This distribution is most similar to Oregon (a national distribution doesn’t exist). Occasionally there have been concerns that this might create some kind of bias, so we’ve checked into that question. Looking at other methods that don’t use the Oregon risk distribution to standardize risk, we find no basis for this concern. The other studies have results that are very similar, once a consistent hazard mix is used.
  3. Rank values are useful, but they have major limitations for interstate comparison. So, we publish a second comparison factor, Percent of Study Median. We recommend using this measure, rather than rank values, for comparing states’ relative rate position over multiple studies.
  4. We study rates using a snapshot on January 1 of the study year. We look at where the rates are on the date of the snapshot, not whether they are going up or down.
  5. Index Rates are averages, sort of. The study’s Index Rate is different than a simple average rate. Premium rates within a state vary dramatically by the risk classification involved, and states’ economies have a different mix of these classifications. The study controls for these differences by looking at premium rates as if each state had the same mix of risks. This figure is the Index Rate, which is not the state’s actual average; instead it’s an average that has been weighted for comparability across states.
  6. High-wage or low-wage state? Don’t worry, wage rate differences across states have little or no impact on the results. Here’s why: rates in workers’ compensation are measured in dollars per $100 units of payroll. High-wage states may have higher benefit levels, but they also have higher wage bases. So, when both parts of the computation increase with higher wages, the resulting rate isn’t affected.
  7. Pure premium rates are a big part of the rate comparison, but only a part. The study also includes factors for insurer overhead and state administrative agencies’ assessments, when these can be put on a comparable basis.
  8. Study data don’t tell us why a state’s rates have been going up or down, or where they might be in the future. Nor do they tell us how effective a system is in minimizing disputes, getting injured workers back to work, paying out adequate benefits, or getting cost-effective medical treatment. Clearly, those are important performance areas too.
  9. The study doesn’t consider insurers’ profitability, discounts, dividends, or activity in the state’s assigned-risk plan. Those items aren’t available for all states, and even when they are available, they’re often incomplete during the year we’re studying. Employers that self-insure (or, in a few jurisdictions, opt not to insure) aren’t included in the study because they aren’t paying workers’ compensation premiums.
  10. Need more detail? We’ve got more! There are two publications that report Oregon’s findings in each study cycle:
  • a summary, typically published in the fall of even-numbered years, and
  • a full report with much greater detail, published the following winter.

Prior studies, both summary and full reports, are available at: http://www.oregon.gov/DCBS/reports/Pages/general-wc-system.aspx

 

The Bike Helmet Battle: Some Things never Change

Monday, August 29th, 2016

It’s been ten years since the Insider wrote a word about motorcycle and bicycle helmets. Shame on us. This Post provides a ten-year update and connects helmet use to workers’ compensation.

To review the bidding:

We “tackled” motorcycle helmets after Ben Roethlisberger, quarterback of the Pittsburgh Steelers (who, at the time, were reigning Super Bowl champions), had been seriously injured when, sans helmet, he drove head on into the side of a Chrysler New Yorker making a left turn in front of him in downtown Pittsburgh. Big Ben suffered serious facial and head injuries. He could easily have been killed. We ended that Post with this:

As a diehard New England Patriot fan, I really want to see Ben Roethlisberger on the field challenging my team for all he’s worth. So, I hope he makes a miraculously speedy recovery and is his old self by the start of training camp. But what would be really great, better than any football game, is if Big Ben, as soon as he’s sitting up and able to mouth coherent speech, were to make a big-time television public service announcement. A TV spot in which he would tell every kid and every football fan in America that he was wrong, that he was stupid, that he is not immortal and that he will never, ever again ride a motorcycle without wearing the best helmet made in the universe.

That didn’t happen. Quite the opposite, actually. For when media asked Mr. Super Bowl Superman if he would continue riding his bike (well, make that his new bike) and, if so, would he wear a helmet, he said “Yes” to the first and “No” to the second. It was at that moment that I knew we had lost the motorcycle helmet game in America.

With respect to bicycle helmets we reported on a New York City study (unfortunately no longer available) analyzing the 225 bicycle accident deaths that occurred over the most recent ten year period in the City. The study provided compelling evidence of life-saving properties of bicycle helmets. This from that Post:

  • Almost three-quarters of fatal crashes (74%) involved a head injury.
  • Nearly all bicyclists who died (97%) were not wearing a helmet.
  • Helmet use among those bicyclists with serious injuries was low (13%), but it was even lower among bicyclists killed (3%).
  • Only one fatal crash with a motor vehicle occurred when a bicyclist was in a marked bike lane.
  • Nearly all bicyclist deaths (92%) occurred as a result of crashes with motor vehicles.
  • Large vehicles (trucks, buses) were involved in almost one-third (32%) of fatal crashes, but they make up approximately 15% of vehicles on NYC roadways.
  • Most fatal crashes (89%) occurred at or near intersections.
  • Nearly all (94%) fatalities involved human error.
  • Most bicyclists who died were males (91%), and men aged 45–54 had the highest death rate (8.1 per million) of any age group.

So, where are we now?

According to the Insurance Institute for Highway Safety:

Currently, 19 states and the District of Columbia have laws requiring all motorcyclists to wear a helmet, known as universal helmet laws (Insider Note: in 2006, it was 20 states and the District of Columbia). Laws requiring only some motorcyclists to wear a helmet are in place in 28 states. There is no motorcycle helmet use law in three states (Illinois, Iowa and New Hampshire).

Regarding bicycles helmets, no state requires an adult to wear one, although 21 states and the District of Columbia require young riders to wear them.

Now, into this cranial hodgepodge of helmet laws ride researchers from the University of Arizona. Writing in the American Journal of Surgery, they report on their study, the largest ever done regarding the efficacy of bicycle helmets. This from the study’s Abstract:

Methods

We performed analysis of the 2012 NTDB abstracted information of all patients with an intracranial hemorrhage after bicycle related accidents. Regression analysis was performed.

Results

A total of 6,267 patients were included. 25.1%(n=1,573) of bicycle riders were helmeted. Overall 52.4%(n=3,284) patients had severe TBI (Traumatic Brain Injury), and the mortality rate was 2.8%(n=176). Helmeted bicycle riders had 51% reduced odds of severe TBI (0.49 [0.43-0.55]; p<0.001) and 44% reduced odds of mortality (0.56; 95% CI, 0.34-0.78; p=0.010). Helmet use also reduced the odds of facial fractures by 31%(0.69; 95% CI, 0.58-0.81; p<0.001).

Conclusion

Bicycle helmet use provides protection against severe TBI, reduces facial fractures, and saves lives even after sustaining an intracranial hemorrhage.

The good news from this study? In a bicycle accident you are more than 50% less likely to sustain a TBI, 44% less likely to die and 31% less likely sustain a facial fracture if you are wearing a helmet (Insider Note: Ask Ben Roethlisberger to describe the pain of a facial fracture).

The bad news? Despite the good news only 25% of bicyclists wear helmets. In ten years nothing has changed.

Does this have anything to do with workers’ compensation? According to Bureau of Labor Statistics data, if you’re one of the more than 73,000 bicycle messengers and couriers in the U.S. it might. And if you’re one of the more than 12,000 that navigate streets in southern California or one of the more than 5,000 that zip through Midtown Manhattan, or one of the 1,400 dodging traffic in Chicago’s Loop it might. Because, while all states require employers to provide helmets to their bicyclist employees, and while most states require employers to provide training that includes the benefits of helmets, no state requires the bicyclist to wear them. However, both New York City and Chicago have enacted local laws requiring employers to provide working cyclists helmets meeting either A.N.S.I. or Snell standards and further require the cyclists to wear them.  Although in the case of NYC, someone might want to pass the requirement on to the messenger and courier companies, the largest of which told me wearing a helmet is “totally up to the rider’s discretion.”

For now, we’re left with a mish-mash. Things are pretty much as they were back in 2006, along with the helmetless rider’s continuing mantra: “It’s all about the freedom of personal choice.” That may be true, but society, that’s you, I and everyone else, doesn’t have a choice about sending EMT Rescue Units to the scenes of cycle accidents and caring for those who sustain serious injury or death in the “Live Free Or Die” game.

 

 

It’s Been A Bumpy Ride Since 1972

Tuesday, June 14th, 2016

In its report to President Nixon, the 1972 National Commission on State Workmen’s Compensation Laws, created by the Occupational Safety and Health Act of 1970, concluded that workers’ compensation laws and benefits were vastly disparate among the states. Benefits in one state might be generous, while across the nearest border they’d be parsimonious.

Although Commission members differed on some points, they unanimously agreed parity among the states was highly desirable. They also recognized that to achieve this goal federal preemption as well as federal minimum standards were impractical for two reasons. First, the federal government had not demonstrated it was capable of successfully undertaking such an effort and, second, entrenched vested interests would fight to the death to preserve the status quo (I wonder what the members would say about today’s vested interests’ clawhold on the system?).

Consequently, in its report, the Commission made 84 coverage and benefit recommendations to the states, 19 of which it termed “essential” in order to establish an adequate workers’ compensation law. In the thirty-year period between 1972 and 2002, the states adopted an average of 12.9 of the 19 recommendations, or about 67% of them. The nationwide workers’ compensation crisis of the late 1980s and early 1990s put the brakes on any movement to adopt more of the recommendations.

In the recent past, workers’ compensation reform has percolated again, only this time in the opposite direction. For example, the October, 2015, Propublica/National Public Radio series, echoing back 43 years to 1972, once again threw a stark light on the continuing lack of uniformity in state benefits. In a kind of circle-the-wagons, and if that doesn’t work, head-to-the-bunker reaction, the series was roundly and caustically criticized by members of the workers’ compensation industry. But, as John Adams said in his summation when courageously defending British soldiers following the Boston Massacre, “Facts are stubborn things.” And one, inescapable fact is that in terms of the generosity of workers’ compensation benefits, in 2016 it matters greatly in which state an injury occurs.

Then there’s opt-out. Given the complexity and bureaucracy of the workers’ compensation system, I certainly cannot blame employers for saying, “We want out.” However, if employers are allowed to create their own systems, what happens, as I’ve written before, “down the street, around the corner at Kenny’s Citgo when one of Kenny’s five employees is injured on the job?”

And now, in a little uphill blowback, the Florida Supreme Court has ruled it is unconstitutional to cut off temporary total disability benefits at 104 weeks to a worker who remains totally disabled and unable to work and has not reached maximum medical improvement. This harkens back to the 1972 Commission’s Recommendation 3.17, which said total disability payments should be paid for the duration of the disability without regard for dollar amount or time. It will be interesting indeed to see how Florida deals with this ruling. It is a serious setback for employers.

I have to admit a nationwide lack of uniform benefits makes no sense to me. I just don’t get it. The 1972 Commission also had a remedy for this. It recommended, “that compliance with these recommendations should be evaluated July 1, 1975, and, if necessary, Congress, with no further delay in the effective date, should guarantee compliance.” Well, that never happened did it?

So, where are we?

We’ve advanced some distance, but, as John Burton, the Chair of the 1972 Commission, suggests, if we continue to advance at this rate, the 19 essential recommendations will be law throughout the land sometime in the 23rd century.

As with everything else in business, this all comes down to money.

It’s A Colorado Rocky Mountain Low

Monday, May 23rd, 2016

Since 2003, when Julie Ferguson and I created Workers’ Comp Insider, we’ve tried to keep bias off the keyboard. Careful objectivity is “a consummation devoutly to be wished.”

For reasons you’ll understand as you read, I want to assure readers that in this post we try to hold to that rule.

Last week, we wrote of actual and metaphorical earthquakes shaking Oklahoma to its core. Today, we write of another metaphorical earthquake, but now it’s Colorado’s turn. It’s a story about a three-car crash involving some well-meaning, but perhaps shortsighted, Coloradans, the state’s leading workers’ compensation insurer and Bernie Sanders. Yup. That guy.

Colorado is a lovely state with wonderful people who just happen to be the fittest in America. Although the obesity rate is 21.3%, it’s the lowest in the nation. Blue sky, clean air, great outdoors, what’s not to love?

In Colorado, the well-meaning, but perhaps shortsighted, people have succeeded in getting on the November ballot Amendment 69 to the Colorado constitution. Amendment 69 creates ColoradoCare, which is universal health care for all Colorado residents, illegal aliens included. Nice idea, you probably think. Good for them, eh?

I wish it were that simple.

The known and unknown unintended consequences of Amendment 69, as well as the profound way it impacts and is impacted by a host of other programs, regulations and laws, both federal and state, are overwhelmingly mind-numbing.

But don’t take my word for it. If you’re up for it, read this cogent, well-written, 38-page, highly detailed legal analysis of Amendment 69 by Gerald Niederman and Jennifer Evans, Attorneys with the Polsinelli law firm. The pair were commissioned by the Colorado Health Foundation to dig deep into the crease of what enacting ColoradoCare will mean for the state, and a lot of it will make your eyes roll. Here’s an image. Imagine for a moment a great big camel. Now imagine two or three hundred of Colorado’s fittest trying to push the south-bound end of the north-bound camel through the very small eye of a teeny-tiny needle and you’ll get the point.

Which brings us to the state’s leading workers’ compensation insurer, Pinnacol Assurance, because one of ColoradoCare’s  provisions (discussed on page 34 of the Niederman Evans analysis) is to take over medical care for all work injuries, medical care that since 1915 has been provided through Colorado’s workers’ compensation statute. As you might imagine, this does not sit well with Pinnacol. Pinnacol has many reasons for not being a fan of Amendment 69, all of which are spelled out in Amendment 69 Would Demolish Colorado’s Stable Workers’ Comp System, by Edie Sohn, Pinnacol’s Vice President of Communication and Public Affairs.

At this point, enter, stage left, Senator Bernie Sanders.

As we all know, Senator Sanders’s proposals are highly idealistic. And his supporters are certainly, shall we say, rather exuberant. Regardless, I doubt if either the Senator or those supporters have ever seen Amendment 69. Still, that didn’t stop him from opining the following:

“Colorado could lead the nation in moving toward a system to ensure better health care for more people at less cost,” Senator Sanders said in a statement to The Colorado Independent.”

Say what? “Less cost?” Hmmm. Even proponents of ColoradoCare say it will cost $25 billion, will double the size of the state budget, will be paid by a 10% tax increase on employers and employees and will make Colorado the highest tax state in the nation.

And what will it do to workers’ compensation? Here’s how Pinnacol’s Edie Sohn describes what she considers to be the coming catastrophe:

Why is Pinnacol concerned about changing the health care system? Under current law, workers’ comp insurance covers the health care needs of injured workers and replaces their lost wages for as long as they are out of work. But ColoradoCare would bring the medical payments of workers’ comp under its umbrella.

The proponents of the amendment say that doing so will save Colorado businesses money because their work comp premiums will go down. Of course, those costs aren’t going away, they’re simply being shifted to the health care system. And any workers’ comp savings will be eroded quickly by lower worker productivity and increased indemnity costs. That’s because ColoradoCare won’t have mechanisms in place to do all the things Pinnacol does: work with employers to keep workers safe and minimize the potential for injury, and work with doctors to help injured workers get back to work in a timely and safe way.

Even allowing for a bit of rhetorical spin, Ms. Sohn makes a compelling case, especially in the area of return to work.

For a somewhat contrarian and intelligent view, you may want to read this blog post from the highly-respected Charles Gaba: COLORADO: OK, Single Payer Fans: Here’s your chance to make it happen. Mr. Gaba points out that he is a “fan” of the single payer concept, but does not believe it has the support to happen on a national scale for quite some time. Rather, he thinks the way to achieve it is through individual states, and, although not endorsing ColoradoCare, he thinks, “It’s more realistic and far better thought out than Bernie’s national plan is.”

One thing on which we can all agree is this: November 2016’s election day will be interesting, indeed. I can only hope it is also peaceful and shows off American democracy in its very best light.

 

 

 

In Oklahoma, The Times, They Are A’Changin’

Tuesday, May 17th, 2016

In Oklahoma, we are now witness to a confluence of events, unintended consequences of perhaps misguided political and business decisions, that are shakin’ the windows and rattlin’ the walls, to paraphrase the great Bob Dylan. And I’m talking actual and metaphorical.

On the actual side, consider this. Prior to 2009, Oklahoma averaged two earthquakes a year of a magnitude greater than 3.0. Last year, there were more than two a day. Cornell University Seismologists studying this say the rise in earthquakes is unprecedented in terms of sheer volume as well as in how fast the number grew. A 60 Minutes investigation revealed that Oklahoma’s biggest industry, Oil and Gas production, is the likely culprit. Why? Because when oil is pumped out of the ground, wastewater comes with it. A lot of wastewater. Billion of gallons of the stuff. So, rather than put the state under water, industry pumps all that wastewater back deep into the ground where it seeps into and around the faults and techtonic plates causing plate shifting which results in all the earthquakes.

A 2015 earthquake study from Stanford University reported:

“Stanford geophysicists have identified the triggering mechanism responsible for the recent spike of earthquakes in parts of Oklahoma – a crucial first step in eventually stopping them,” wrote Ker Than for the Stanford Review.

“In a new study published in the June 19 issue of the journal Science Advances, Stanford Professor Mark Zoback and doctoral student Rall Walsh show that the state’s rising number of earthquakes coincided with dramatic increases in the disposal of salty wastewater into the Arbuckle formation, a 7,000-foot-deep sedimentary formation under Oklahoma.”

As I write this, the U. S. Geological Survey reports a 3.8 magnitude quake hit about 28 miles northeast of Oklahoma City on Sunday. And for good measure, two other slightly less severe quakes struck within eight hours earlier than the 3.8 quake.

On the metaphorical side, a different kind of earthquake, a political one. And by that I mean the abrupt turnaround of Oklahoma’s Governor Mary Fallon and the Republican controlled legislature regarding adopting Obamacare. Seems the state is nearly bankrupt in terms of funding health care. Hospitals and nursing homes face closure. It is a crisis of monumental proportion. But wait – there’s the Obamacare cavalry coming over the crest of the hill! Politicians now realize that federal funding for Medicaid expansion (Governor Fallos says it’s not an “expansion;” it’s a “realignment.”) looks like a pretty good port in the storm. Naturally, critics are lining up to decry the move, but the legislature appears to be coming around to it.

Who knew? Perhaps when next I look out my 3rd story window pigs will be flying by.

John Geaney: Setting A High Bar For New Jersey’s Bar

Thursday, April 14th, 2016

John Geaney’s been a friend for years. And why not? He’s a Holy Cross and Boston College Law School grad, as well as a Red Sox fan. So, in a way we’re Boston Brothers.

But that’s not important. What is important is that John Geaney is recognized as the pre-eminent New Jersey attorney focusing on workers’ compensation. He heads the workers’ compensation practice for Capehart Scatchard, one of New Jersey’s foremost law firms. There are nearly 40 attorneys in John’s practice department.

John is the author of “Geaney’s New Jersey Workers’ Compensation Manual for Practitioners, Adjusters, and Employers,” and updates it annually. If you have anything to do with workers’ compensation in New Jersey, you need to have John Geaney’s Manual.

In addition to representing a great number of New Jersey’s premier employers, writing a Lexis Nexis Top Blog (a really good one!) and creating the aforementioned Manual, John, teaming with Millennium Seminars, puts on three seminars each year for New Jersey professionals specializing in workers’ compensation.

I’m writing this from today’s seminar in Mount Laurel. I’m attending with Richard Filippone and Mary Ann Kezmarsky, founders of Work Comp Psych Net, a seminar exhibitor and a Lynch Ryan client.

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There more than 100 New Jersey workers’ comp pros here, and all of them are highly engaged. Moreover, Geaney’s seminars are always fully subscribed. Attendees keep coming back, and that doesn’t happen by chance. Geaney is charismatic on the podium. The presenters are interesting, articulate and well-regarded. It’s considered a high compliment to be invited to present here.

Around the nation, most states have one, perhaps two, people who set the professional standard for everyone else in their state. In New Jersey, that person is John Geaney.

 

WCRI: Day One, Part Three: The 2nd Opt-Out Session

Thursday, March 10th, 2016

Bruce Wood, of the American Insurance Association, led off the second Opt-Out session by reminding participants that the 1972 National Commission “considered and rejected employer or employee choice of benefit plans.” So, right away we knew where Mr. Wood was heading. He boarded the Trey Gillespie train and left the station smartly. His conclusions:

  • Opt-Out raises fundamental issues of public policy that policymakers have failed to consider;
  • Opt-Out lacks an organizing principle that reflects acceptable social policy; and,
  • Opt-Out is flawed and should not be enacted.

You know where Mr. Wood stands.

The second presenter was Elizabeth Bailey, VP of Workers’ Compensation & Safety for Waffle House, Inc. Waffle House, headquartered in Georgia,  is in a number of states, Texas being one of them. The company has been a Texas Non-Subscriber (it’s Opted-Out) since 2002, and, according to Ms. Bailey, has enjoyed spectacular results ever since. Such as:

  • Within one year, claims cost per restaurant dropped 57%;
  • Indemnity claims went from 15.03% of total claims to 3.23%;and,
  • Indemnity costs declined 99%

Wow!

Ms. Bailey described how Waffle House has increased its safety and health efforts while providing equivalent benefits as those required by the workers’ compensation statute. The company’s economic results are certainly stellar, but at what cost to employees? We were left wondering. However, as David Deitz pointed out in the question period, Ms. Bailey was the only Opt-out presenter who “presented” any data.

 

The third presenter, Alan Pierce, is a Massachusetts plaintiffs attorney, but that doesn’t begin to describe his standing in the legal community. He is one of the nation’s foremost advocates for injured workers and is the past chair of the Workers’ Compensation Section of the American Bar Association and the Massachusetts Bar Association. As expected, he offered an eloquent precis suggesting that workers’ compensation is not a benefit, but rather an employee right. He, too, cited the 1972 National Commission pointing out that most of its recommendations have never been adopted. Mr. Pierce is always interesting.

The last presented was Oklahoma Insurance Department Chief of Staff James Mills. I was somewhat surprised to hear him defend the Oklahoma Opt-Out statute. Essentially, Attorney Mills said that he was open to any program or law that might have the chance of benefiting both employers and employees and likened the statute, which had 57 legislative authors, to some other ideas that needed time to grow and prosper. Who knows? Maybe that’s what will happen to Opt-Out.

But I wouldn’t hold my breath waiting for that to happen.