Going for the gold: An Olympic edition of Health Wonk Review

February 16th, 2018 by Julie Ferguson

Steve Anderson has posted the Health Wonk Review for February 15, 2018: Going for the Gold Edition at HealthInsurance.org blog. It’s an entertaining and wide-ranging smorgasbord of health policy topics of the day.

Here are a few of the topics d’jour:

  • Amazon/Bershire Hathaway/PMorgan’s foray into healthcare
  • Unexpected ER bills
  • CMS attack on freedom of the press
  • Predictions about Alex Azar, newly appointed HHS Secretary
  • The ACA
  • Peruvian healthcare
  • A different kind of hospital coverage
  • A recap of Health Action 2018, Families USA’s annual meet for healthcare activists.

If you aren’t familiar with healthinsurance.org, you should be. Check out the impressive roster of contributing authors and the excellent state health guides.

And just a heads up: In 2018, Health Wonks are on a once-per month schedule so catch this issue – you won’t have a chance for more wonkery until March.

Who’d A Thunk It? Something Good Out Of DC!

February 12th, 2018 by Tom Lynch

Watching our legislators doing their thing in the nation’s capital, one can be forgiven for thinking Vlad the Impaler could learn a thing or two from these folks. But last Friday, in a rare Washington Kumbaya moment, peace broke out and the Bipartisan Budget Act zipped into law with the speed of an Olympic skater, Rand Paul notwithstanding.

The newly minted budget act has pork for everyone, but the pork I like is one little section that won’t get much press coverage, because it benefits poor people who are aging and sick: America’s Dual Eligibles. Duals are those among us who, by virtue of their age, health status and poverty are eligible for both Medicare and Medicaid benefits. The new budget act permanently re-authorizes Special Needs Plans aimed at caring for Duals.

Under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) [Pub. L. 108-173), Congress created a new type of Medicare Advantage coordinated care plan focused on individuals with special needs. “Special needs individuals” were identified by Congress as: 1) institutionalized beneficiaries; 2) dually eligible; and/or 3) beneficiaries with severe or disabling chronic conditions. The MMA allowed for the creation of “Special Needs Plans” for these populations. For example, to accommodate the new legislation, my state, Massachusetts, created the Senior Care Option health plan, which “covers all of the services normally paid for through Medicare and MassHealth (Medicaid).”

Medicare, because of the aging of the Baby Boomers, and Medicaid, because of increasing poverty and state expansion through the Affordable Care Act, have grown significantly since 2010, making Special Needs Plans more and more important. Trouble was, Congress had to re-authorize the plans every few years. That concern is now in the past. The Bipartisan Budget Act, with its permanent re-authorization of Special Needs plans makes sure the safety net created by the plans is solid, secure and long-lasting.

The new budget act also re-authorizes the Children’s Health Insurance Plan (CHIP) for another ten years, something that has long had bipartisan support.

Finally, this Congress has done something that will benefit our most vulnerable citizens. Let’s hope it’s not a one-off.

Check out 2018’s first Health Wonk Review at Paduda’s place

January 19th, 2018 by Julie Ferguson

The wonks are back with posts on the ACA, prescription drug costs, workers comp – all the topics and themes you missed over the holiday. Click on over to Joe Paduda’s Managed Care Matters to catch up at his post Ring in the New year with the latest and greatest …

Stop by for the health wonkery and stay for the informed commentary and analysis on Joe’s other blog posts. If you are extraterrestrial and therefore unfamiliar with Joe’s blog, remedy that today!

A look back, a look ahead

January 12th, 2018 by Julie Ferguson

2017 work comp recap, 2018 ook ahead

We thought we’d get a drone’s eye view of the work comp landscape and related matters with a retrospective of the 2017 goings on and a look ahead at predictions and trends for 2018.

Work Comp Wire: Leaders Speak: 2017 Year in Review, Part One and Part Two

Business Insurance: Most read workers comp stories in 2017

Business Insurance: Court rulings challenge workers comp sector in 2017

Risk Management: Year in Risk 2017

Insurance Information Institute: Global insured catastrophe losses could reach record in 2017

Insurance Journal: Top Insurance Journal National Stories of 2017

Insurance Insights: 2017 Recap – A Look Back at the Insurance Market

Joe Paduda: How’d I do on my 2017 workers’ comp predictions?

Evil HR Lady: The 2017 Employment Law Year in Review

Fistful of Talent: Events From 2017 That Will Make a Lasting Impact in the Workplace

MedRisk: 2017 Industry Trends Report

Business Insurance: Most read Off Beat stories in 2017

Insurance Thought Leadership: Insurtech: The Year in Review

Insurance Journal: 2017 ‘One of Worst’ for U.S. Weather with 15 Events Costing $1 Billion or More

PropertyCasualty360: 6 ways cybersecurity changed in 2017

Gizmodo: The Great Data Breach Disasters of 2017

Gallup News: The Best Workplace Articles of 2017

Fortune: 34 Business Books You Won’t Be Able to Put Down

USA Today: Year in review: The 50 stories from 50 states that moved us in 2017

The Atlantic: 2017 in Photos: How the First Months Unfolded, Part 2 and Part 3

Google: Year in Search – 2017

A look ahead at what’s in the cards for 2018

Joe Paduda: Predictions for work comp 2018 part 1 and 2018 part 2

Willis Towers Watson: Marketplace Realities 2018: Workers compensation

Marsh: Webcast: Workers’ Compensation: Looking Ahead to 2018

Sedgwick identifies risk and benefits industry trends to watch in 2018 (PDF)

Sedgwick: Navigating 2018 (PDF)

Think Advisor: 5 Big Questions About Health Insurance for 2018

Bloomberg: Health Insurance Marketplaces for 2018

Claims Journal: Tips on Setting Claims Goals for 2018

Gallup News: Are You Ready to Respond to 2018’s Biggest Healthcare Trends?

Littler: Ready or Not, Here It Comes! 2018 Brings New Labor & Employment Laws, Primarily at the State Level

Forbes: 10 Workplace Trends You’ll See In 2018

CNN: Here’s where the minimum wage is going up in 2018

HR Daily Advisor: 2018 Trends to Watch: 6 Trends That Will Impact Employers

Forbes: 3 pitfalls to enterprise risk management in 2018

Insurance Though Leadership: 2018 Predictions on Cybersecurity

Happy holiday Health Wonk Review

December 14th, 2017 by Julie Ferguson

Santa reading Health Wonk Review

First, let us go on record for saying that there is no sly political motive to our use of the term “holiday” in the title of this post. Admittedly, we have a bit of a liberal slant, but we have no aversion to using the phrase “Merry Christmas.” But ho, ho, ho, we do have an inordinate fondness for alliteration. Of course, we might have called it the Happy Hanukkah Health Wonk Review instead, but we wanted to encompass Hanukkah, Christmas, Kwanza, New Year’s, and even the dubious Festivus. Whatever your flavor or inclination, we wish you a merry, happy, joyful one. Pentatonix says it better than we ever could, so a bit of a seasonal interlude before we get to this week’s entries.

The Happy Holiday Health Wonk Review

*** First up, at Managed Care Matters, Joe Paduda is never one to shy away from calling it as he sees it and this week his submission takes on the GOP tax bill, which he describes as “a mess, riddled with math errors, contradictory language, and un-implementable directives.” Congressional leaders say they have reached some agreement and will vote before the end of the year, so Joe’s post will give context.

*** Roy Poses proves once again that the devil is in the details and he consistently makes it his blogging business to dig through the details to hold feet to the fire. At Heath Care Renewal, he tracks down more about a barely-reported Pfizer settlement for “alleged” anti-competitive behavior that nearly slipped through the radar. He says that the lack of negative consequences suggests that the impunity of top health care leaders is is worsening. Check out his post One Barely Noticed Settlement by Pfizer Suggests the Futility of Polite Protests about Health Policy.

*** How will the CVS purchase of Aetna affect the healthcare landscape? Jason Shafrin aka The Healthcare Economist weighs in with his informed observations.  And another of our regular wonks weighs in on the merger. David Williams of Health Business Blog posts CVS + Aetna. Are we sure this adds up? Despite talksthat this combo will lead to a revolution in care delivery, he remains a skeptic and talks about why.

*** Acknowledging that the individual market for health insurance has become unaffordable for many of the unsubsidized — particularly older would-be enrollees — Andrew Sprung outlines various ways to keep Modified Adjusted Gross Income (MAGI) below the subsidy line. Check out his post Steering clear of the subsidy cliff in the ACA marketplace at xpostfactoid.

***  Vincent Grippi of CareCentrix submitted a fun #CareTalk video podcast, featuring HWR regular David Williams teaming with John Driscoll of CareCentrix. In a point-counterpoint format, they spar about the implications of 2017 elections on healthcare (think Maine), move on to value-based healthcare and they close the 10 minute segment with a lightning round.

*** Brad Flansbaum of The Hospital Leader has an interesting post about Locums vs F/T Hospitalists, posing the question, do temps stack up? He reports on a JAMA study, adding his perspective. Now I must confess that the term “locums” was a new to me, but Brad gives it good context. But if you are curious to the origins, as I was, Wikipedia is your friend.

*** In his post The Positive Side of Sharing, InsureBlog’s Henry Stern has the latest on a reader’s experience with a Health Care Sharing Ministry. (He offers this spoiler alert: it’s actually been pretty good).

*** Shopping for individual health insurance or know someone who is? If your state uses HealthCare.gov, you have until December 15 to enroll, but in other states, you may be able to enroll as late as January 31. Victims of Hurricanes Irma and Harvey may also have extensions. Louise Norris has all the details in her  guide to buying individual health insurance at healthinsurance.org. For more, see Timothy Jost’s post on Health Affairs Blog: Open Enrollment Ends Friday—Except For Those Qualifying For Special Enrollment Periods.

*** For our post, we’re delving into our archives for an expose of a mysterious employer. Many have nothing but good to say about him, but others think he is not a good employer. Judge for yourself:

Santa’s workshop: “OSHA problems galore” say whistleblowers
The risks of being Santa
Is Santa Claus a bad employer?

 

Fresh Health Wonk Review and a big roundup of recent work comp news

November 30th, 2017 by Julie Ferguson

Andrew Sprung has the most recent compendium from the health wonks  at xpostfactoid:

Late Days of Empire Edition: Health Wonk Review. The wonks’ entries are reflecting the healthcare market chaos of the times – check it out! Also note that two weeks from today, we’ll be hosting the next edition here at Workers Comp Insider!

 

Other workers comp news of note along with general interest items that caught our attention:

Net neutrality & why you should care: If you are a blog afcianado – or if you just like a free an open internet, please make your voice heard about net neutraility. Don’t let the internet service providers do to the internet what cable companies did to TV – make your voice heard in favor of Net Neutrality which is at serious risk or being rescinded. See RIP net neutrality: FCC chair releases plan to deregulate ISPs. This requires immediate action: the vote is December 14. Make your voice heard.

Purdue Pharma: In this weeks’s HWR, Joe Paduda talks about how Purdue Pharma is trying to limit legal liability in the many state suits. Related, there was an excellent recent article in Esquire by Christopher Glazek that is well worth a read: The Secretive Family Making Billions From the Opioid Crisis.

Blankenship for Senate? Convicted coal baron Don Blankenship announced his intention to challenge Joe Manchin for a senate seat in West Virginia. We’re talking about Don Blankenship who was CEO of Massey Energy Co. at the time of a 2010 Upper Big Branch mine disaster that killed 29 miners. We have opinions on Blankenship that we’ve expressed over the years. Hint: thumbs down for the senate.

Grain Bin deaths: Over $1.8 Million in Proposed Fines Following Fatal Grain Dust Explosion – OSHA has proposed $1,837,861 in fines against Didion Milling Inc. following a May 2017 grain dust explosion that killed five workers and injured 12 others, including a 21-year-old employee who suffered a double leg amputation after being crushed by a railcar. We hope the fine will stick – see our prior post Walking down the grain – and the fines.

Gripping read: Atul Gawande’s twitter pointed us to a remarkable story in Emergency Physician’s Monthly: How One Las Vegas ED Saved Hundreds of Lives After the Worst Mass Shooting in U.S. History. Hats off to the incredible medical teams!

Nail salons: US nail salons: the challenge to protect workers from toxic chemicals – Critics mock an EPA scheme to create ‘healthy salons’, but Julia Carrie Wong hears how it is tackling an ‘epidemic’ of health problems from staff, many of whom are Vietnamese immigrants.

Jennifer Christian posts Avoid “one-size-fits-all” thinking in evidence-based medicine, which challenges a blind spot in current thinking – worth a read. From our vantage, Dr. C is always in the forefront of new occ med thinking.

Bionic safety? medGadget has news that Ford is trialing the Exoskeleton to help prevent worker injuries. The device is made by Ekso, a company that devlops full-body exoskeletons for paralyzed people, but the firm thins the technology can prevent injuries in workers who perform physically difficult repeat tasks, such as operating the overhead machinery.

More news – quick links

The American Health Care Paradox: A Lot Of Money For Poor Results

November 29th, 2017 by Tom Lynch

Here’s something all Americans can agree on: Health care costs way too much. But way too much in reference to what? Well, how about the rest of the developed world? How about wealthy countries, our peers, in the OECD, the Organization for Economic Cooperation and Development?

The OECD was formed in 1961. Headquartered in Paris with a membership of 35 nations, the OECD’s mission is to promote policies that will improve the economic and social well-being of people around the world. Annually, it performs comparative analyses of issues affecting its members. One such issue is health care.

Want to know about health care spending around the world, infant mortality, life expectancy, doctors and nurses per capita and a host of other health care topics? The OECD is the place to go.

Which brings us to American health care, which I suggest is a classic paradox. On the one hand, on a per capita basis, we spend 41% more on health care than our wealthy nation peers in the OECD and 81% more than the entire 35-nation OECD average.

OECD Health Care Funding – 2015

(Light blue – Private Funding; Dark blue – Public Funding)

As you can see, while our public funding (Medicare, Medicaid, etc) is comparable to many of the other 34 countries in the OECD, Germany, France and the UK for example, private funding in the US is more than 100% greater than Switzerland, our closest competitor, and 300% greater than the OECD average.

This might be fine if we got what we paid for, but that is not the case. As an example, consider something that should be important to us all: life expectancy. In the US, life expectancy at birth is 78.8 years (76.3 for men; 81.2 for women). In the UK, it’s 81 (79.2 for men; 82.8 for women). In Japan, life expectancy at birth is a whopping 83.9 (80.8 for men; 87.1 for women).

What about infant mortality, the number of deaths of children under one year of age, expressed per 1,000 live births? Our infant mortality rate of 6.1 is 45% higher than the UKs, at 4.2, and 265% higher than Japan’s 2.3 rate.

Curious about obesity? Our obesity and overweight rate is exceeded only by New Zealand’s.

And stop for a moment and consider cancer. Judging by the television ads, one would think the US has more cancer treatment centers than golf courses. Yet our death rate from cancer per 100,000 people is 188. Mexico’s is 115; Japan’s, 177.

In fact, just about the only metric in which we lead the world is smoking cessation. So, yes, it’s paradoxical. Sort of like a big-market baseball team spending gazillions more for players than any other team, only to finish out of the running.

And now, into the fray trots the Republican tax reform plan, which is looking more and more like it will actually become law. This plan would cause 13 million people to  find health insurance unaffordable, which means their new PCP will be their old PCP, the local emergency room where costs are stratospherically higher than anywhere else. In addition, $25 billion will be cut from Medicare, which, although it’s only 4% of the total Medicare budget of $588 billion, can’t be good as more and more baby boomers age into Medicare.

Fixing health care in America is going to take time and a lot more money, but we have to start somewhere, sometime. It’s hard to see where the Republican tax plan even approaches trying to do that.

Health Wonk Review and a tribute to our veterans

November 10th, 2017 by Julie Ferguson

At Healthcare Economist, Jason Shafrin has posted the latest compendium of posts from the health policy bloggers: Health Wonk Review: Quote-of-the-day Edition. He frames each submission with a pithy quote. While the overall shape and politics of the healthcare debate are still a primary theme of posts, there are other entries, including two videos. Grab a coffee and catch up on the latest thinking from the wonks.

This weekend, we pay tribute to our veterans and thank them for their service and sacrifice. We end with this advice: How to honor veterans: Hire one!

Job Loss, Wage Stagnation, Low Productivity: We’re Great Again!

October 30th, 2017 by Tom Lynch

A couple of years ago, as he finished his Gatling Gun presentation to conclude the Workers’ Compensation Research Institute’s annual conference in Boston, I asked the big-brained, really smart Bob Hartwig if he was alarmed at all that in the last 40 years inflation-adjusted hourly wages had risen only 4%. His answer: “Yes. Very.”

Since then, regardless of the playground-like antics in our nation’s capital, or maybe because of them, not much has changed. So, in this post I want to discuss some of the factors and trends that have contributed  to this economic wage crisis and suggest it played a powerful role in the rise of Donald Trump who, with rhetoric as sharp as the edge of an axe, seized on the frustration and outrage within the lower wage working classes whose nearly biblical devotion led to his election.

That it is a crisis has been borne out over time by a mountain of complex research that cannot be explained in a tweet. The latest brick in this ugly house was laid last week with the release of a study from The Hamilton Project at the Brookings Institution.

In The Hamilton Project at Brookings report, Jay Shambaugh, Ryan Nunn, Patrick Liu and Greg Nantz offer Thirteen Facts About Wage Growth with solid research buttressing each fact. The point of the paper is to explain why wages for production and non-supervisory workers have been stagnant for so long.

In order to explain the why, they first had to prove the point. To do that they divided the period since 1981 into four business cycles: 1981-90, 1990-2001, 2001-07 and 2007-17. They found that in the first three of those business cycles nominal wage growth (wage growth without any adjustment for inflation) averaged just a bit above 3%. In the last cycle, which started at the beginning of the Great Recession, growth has been 2.34%.

However, when one considers real wage growth (growth adjusted for inflation) each business cycle saw wages increase significantly less than 1%. Despite this 36-year run of bottom-of-the-bird-cage wage growth, according to the Bureau of Labor Statistics’s Inflation Calculator, what you bought for $1.00 36 years ago in 1981, the first year of this study, cost you $2.84 in September of 2017. This puts American workers in the position of trying to outswim a Navy Destroyer. Every moment they fall farther and farther behind.

The authors point out that our long-term wage stagnation can be traced to many trends, including the decline in US workers’ share of income.

The portion of national income received by workers fell from 64.5 percent in 1974 Q3 to 56.8 percent in 2017 Q2. Over the past few years the U.S. labor share has ceased falling, but this might reflect the ongoing economic recovery rather than any change in the long-run downward trend.

A number of factors have played a role in the fall in Labor’s share of income, including, but not limited to:

  • The long-term and continuing offshoring of labor intensive production;
  • The decline in union membership;
  • The decline in the real minimum wage;
  • The growth of non-compete contracts for even low-skilled workers;
  • The growth in income inequality between the top and bottom earners;
  • The continuing increase in the “education wage premium.”

To elaborate on a few of these factors:

Union Membership:  In 1956 about 28 percent of all workers belonged to a union; in 2016 that number was a little more than 10 percent. In the private sector, union membership has dropped to 5%. Regardless of what you think of unions, the fall in union membership directly correlates to an increase in wage inequality.

The Real Minimum Wage:  The Project Hamilton Report demonstrates how insidiously the federal minimum wage has limited wage growth among low wage earners. Since 1968 the real minimum wage (minimum wage adjusted for inflation) has fallen more than 20%.

Right now state minimum wages range from a low in Georgia of $5.50 to a high in the District of Columbia of $12.50. A number of states have passed legislation to gradually increase their minimum wage  over the next few years. Others have indexed theirs to the CPI. Regardless of what the states do, their minimum wage cannot be lower than the the federal minimum wage of $7.25 for any worker covered by the National Fair Labor Standards Act. If a worker in Georgia isn’t covered by the Act, however, $5.50 reigns.

The Education Premium:  The wage benefit of a college degree increased dramatically during the last two decades of the 20th century, leveling off around 2000 at an historically high level.

Bachelor’s degree holders ages 25 to 54 in 1979 could expect to earn 134 percent of the wages received by those with only a high school education, and advanced degree holders could expect to earn 154 percent. By 2016 the wage premiums for a bachelor’s degree and an advanced degree had risen to 168 and 213 percent, respectively.

Another way to look at the wage value of higher education is this: Although only 40% of the nation’s workers hold four-year college degrees (23% in 1979), in the top two earnings quintiles college graduates make up a clear majority, 78% in the top quintile. Only 15% of the bottom quintile are college graduates.

One last point about the Education Premium: In its most recent survey of college pricing, the College Board reports that a “moderate” college budget for an in-state public college for the 2016–2017 academic year averaged $24,610 (tuition, board and fees). It’s true that financial aid is available to most students. However, with the income of today’s low-wage earners falling farther and farther behind workers sitting serenely much higher on the economic pyramid, how do you think they’re going to manage to send their children off on a quest for a four year college degree, even at an in-state public college? This is a self-perpetuating educational death spiral.

Maybe you’re asking what this has to do with workers’ compensation?

Well, if US workers on the bottom half of the income scale have seen their wages lag behind the CPI for four decades, they are right now hard pressed to contribute to the country’s economic growth and viability. Moreover, when one of them suffers a lost-time injury at work, that worker will suddenly see his or her take home pay reduced because of state workers’ compensation laws, which will make it even harder to support a family. Research shows this, among other things, contributes to underreporting of workplace injuries.

For more information on this issue, see Bureau of Labor Statistics data and a recent New York Times economic report by Ben Casselman.

I have a hard time believing decades-long negligible wage growth, especially for those on the lower end of the income scale, can be anything but harmful for America, its economy and the quality of life of its workers. I suggest this is a significant cause of the frustration and outrage that led to the rise of the Tea Party and Freedom Caucus. Donald Trump saw this frustration, this outrage, as a mammoth opportunity and continues to feed it like red meat to a hungry lion. That type of divisive behavior can be nothing but destructive. But until our elected officials grow enough spine to do something meaningfully constructive and productive about it, I fear this situation will continue to divide and erode us as a nation.

That is terribly sad to contemplate.

 

 

 

Fresh Health Wonk Review, Disaster Edition

October 26th, 2017 by Julie Ferguson

Check out the latest Health Wonk Review: Disaster edition freshly posted by David Williams at Health Business Blog. David is a long-time HWR host and his business blog is a strong and authoritative voice in the health business sector – if he isn’t on your regular reading list, you should change that!

Just a few other quick updates:

A quick shout-out to esteemed colleague Joe Paduda of Managed Care Matters who is running for office in his home area of Onondoga County, New York. November 7 is pretty quick upon us. You can find out more at Paduda for Progress – if you are on Facebook, you can show him some love there ;-)

Because we’ve written about him quite a bit in the past, we didn’t want to miss this update on Don Blankenship of the Massey Coal Mining disaster infamy:  Supreme Court lets criminal conviction stand against coal executive Blankenship

Another issue we’ve posted about previously is the death of cell tower workers. We were interested to see that Washington state recently adopted tower safety worker rules – the third state in the nation to do so.

“North Carolina and Michigan also have telecommunication safety rules, but federal OSHA does not have comparable, specific regulations relating to communication tower work, according to L&I. “We hope our rules can serve as a model for other states to quickly stop these fully preventable worker fatalities,” Soiza said.”