By John Schmitt
In 2010, over 38 percent of low-wage workers lacked health insurance from any source, up from 16 percent in 1979.
Coverage problems are particularly severe for Latino workers. Almost 40 percent of all Latino workers (not just low-wage workers) have no health insurance of any form. African American (about 22 percent) and Asian (about 17 percent) workers are also much less likely to have coverage than white
workers (about 12 percent).
Affordable Care Act of 2010
For simplicity, if we assume that all adults--workers and non-workers--have the same coverage rate, then under CBO?s projections, workers as a group would have a 5.8 percent non-coverage rate after the ACA. By comparison, in 2010, the actual non-coverage rate for all workers was about 17.7 percent. The CBO gives no guidance about how the coverage improvements for workers would be divided across the wage distribution. If, at the extreme, we assume that all of the uncovered workers are low-wage workers by our definition--that is that all 5.8 percent of workers remaining without coverage are in the bottom quintile--then the non-coverage rate for low-wage workers would be about 29.0 percent. This would be a reduction of one-fourth in the share of low-wage workers without coverage relative to the actual non-coverage rate for low-wage workers in 2010 (38.5 percent). A less extreme assumption about the distribution of non-coverage rates by wage level after the ACA would produce larger gains for low-wage workers.
For example, if instead we assume that the top 80 percent of workers have a fractional 3 percent non-coverage rate, then an overall non-coverage rate for workers of 5.8 percent implies a 17.0 percent non-coverage rate for low-wage workers, well short of universal coverage, but a non-coverage rate that is less than half of the current rate.
The ACA will not produce universal coverage for low-wage workers. But, if the ACA is not enacted--due to judicial or legislative action--every indication is that coverage rates will continue their three-decades-long decline.
The decline in coverage rates has its roots in two long-standing economic processes. The first is the rising cost of health care, which has squeezed workers' wages and made it less economical for firms to offer health insurance, especially to low-wage workers. In the absence of reforms to the existing health-care system, these costs--and implicitly the pressure on workers' after-health-insurance compensation--are projected to continue rising indefinitely.
The other force behind falling coverage rates, especially for low-wage workers, is the decline over the last three decades in the bargaining power of most workers. Beginning in the late 1970s, a set of structural changes in the economy has significantly reduced the bargaining power of workers, especially those at the middle and the bottom of the wage distribution. These structural changes include: a steep decline in unionization; an erosion in the inflation-adjusted value of the minimum wage; the deregulation of many historically high-wage industries (trucking, airlines, telecommunications, and others); the privatization of many state and local government functions (from school cafeteria workers to public-assistance administrators); the opening up of the U.S. economy to much higher volumes of foreign trade; a sharp rise in the share of immigrant workers, who often lack basic legal rights and operate in an economy that provides few labor protections regardless of citizenship; and a macroeconomic policy environment that has typically maintained the unemployment rate well above levels consistent with full employment. All of these changes have acted to reduce the bargaining power of workers, especially those at the middle and bottom of the wage distribution. As a result, workers as a group have seen their relative (and even absolute) wages fall and the availability and quality of health-insurance and retirement plans decline.
Comment by Don McCanne of PNHP: Conservatives who oppose health care reform often argue that
being uninsured is a consequence of the individual's own personal irresponsibility. Those individuals merely need to shape up and go out and get a job, and then they would have health insurance. The conservatives lose their credibility on this point when the actual data show that 38 percent of low-wage workers, who do go out and get a job, lack health insurance from any source.
Because of such deficiencies in our system reform advocates were able to muster the political support to pass the Affordable Care Act - a half-glass reform. Those who view this as a glass half full celebrate the fact that over half of these uninsured workers will become insured under ACA.
The advocates of reform who view this as a glass half empty bemoan the fact that ACA will still leave about 17 percent of low-wage workers without insurance. The diversionary half full, half empty debate is particularly tragic when you consider that a single payer national health program would have brought us a full glass.
The addendum explains the roots of the decline in coverage rates - an important concept indicating that our battle for health care justice is only a part of the offensive that must take place to expedite social justice throughout the United States.
By Timothy Jost
The FAQ do go some distance toward clarifying a number of the issues left open by the initial bulletin, in particular how plan flexibility will (and will not) work, that states will not establish a new EHB every year, and that a state?s commercial plan EHB need not apply to Medicaid. The approach selected by HHS will allow states to maintain their coverage mandates (or at least those that apply to the small group market) until 2016, but will preclude the addition of new mandates. It is still hard to imagine how this is all going to work out in practice, however, and more to the point how plan compliance will ever be monitored, given the ability of plans to substitute services within categories. One must wonder whether in the end it might not have been more straightforward simply to come up with a federal menu of services.
CMS - FAQs on essential health benefits:
Comment by Don McCanne of PNHP: Being the fine gentleman he is, Professor Jost politely states, "One must wonder whether in the end it might not have been more straightforward simply to come up with a federal menu of services."
You don't have to wonder. Not only should we have a national standard calling for comprehensive benefits for everyone, we also should have simplified the financing system to make it more equitable and much more efficient so that health care would be accessible and affordable for everyone.
--Medicare, Social Security and Medicaid.
Get your organization (or better yet, coalition) to ask all candidates sign a pledge.
Since 1965, Medicare has given Americas seniors access to health care which only the wealthier senior demographic could pay for before it was implemented. It covers all needed care, and is frugally administered with only 3% administrative expenses.
In the interests of my constituents the men, women and children who are Medicares current and future beneficiaries I pledge to:
Oppose unconditionally the Ryan/Wyden proposal to incrementally turn Medicare into a voucher program; and
Oppose unconditionally any proposal to raise the Medicare eligibility age; and
Oppose any and all efforts to reduce the federal deficit on the backs of the sickest and most vulnerable members of our population.
Medicare is currently under attack by many in Congress, and seniors in your district are very concerned that this vital program remain intact and not be subject to cuts which force more cost sharing for the sickest and most vulnerable members of this population.
The Ryan/Wyden plan to gradually voucherize Medicare means that the program as we know it will be destroyed. A coupon for a discount to be applied to the same kind of insurance that the elderly could not afford before Medicare was enacted will only result in the elimination of access to health care for significant numbers of older people.
In addition, some have proposed increasing Medicare eligibility from age 65 to 67. Not only will this bankrupt more people, but it will not even save money. Studies have shown that, relative to those with insurance before age 65, those without insurance prior to Medicare eligibility spent much more money on health care after they became Medicare eligible. In other words, people wait to get care until their Medicare kicks in. This is bad both for health and for the federal governments bottom line.
We are requesting that you sign the enclosed pledge to defend Medicare.
(Your organization here)
Take this simple questionnaire to find out.
1. What I know about my friends and neighbors
a) What Congressional Districts they live in.
b) That, plus what state legislative districts they live in.
c) Hell, I know what precincts they live in.
2. My legislators
a) I know who they are.
b) I occasionally write them about issues of concern.
c) They know who I am.
3. My radio dial is mostly tuned to
a) Music or sports.
b) 94.9 FM (NPR).
c) 1090 AM (Air America).
4. I do household chores
a) Daily. Maintenance tasks are an essential part of a balanced life.
b) Once a week, whether they need to be done or not.
c) Whenever I notice that a new life form has evolved at the bottom of my kitchen sink
5. The last time I was at Safeco Field, I
a) Watched the Mariners play. Its a baseball diamond, right? Duh.
b) Collected signatures for Initiative 1068.
c) Leafleted or participated in a demonstration, and multitasked by collecting signatures for one or more initiatives also.
6. The last movie I saw was
a) A whole bunch of them at the film festival.
b) One of this months new releases.
c) Whatever documentary was shown at Friday Night at the Meaningful Movies.
7. The number of different political campaigns I have donated to this year is
a) 0 to 5.
b) About five.
c) Way more than five.
8. I see a dentist
a) The recommended once every six months.
b) Whenever their office calls and bugs me about it.
c) Only during odd-numbered non-election years.
9. Wow! October already! Time to
a) Enjoy the World Series and the start of football season.
b) Get ready to vote in the general election.
c) Walk my precinct for the general election.
10. The websites I have bookmarked are
a) Less than 10% political.
b) 10-70% political.
c) More than 70% political.
11. On Saturday nights, my spouse (or partner or boyfriend or girlfriend) usually says
a) Why dont we slip into something a little more comfortable?
b) How about dinner and a movie?
c) Another meeting? Youre kidding, right?
12. Since the November 2000 elections my aerobic conditioning has
b) Stayed pretty much the same.
c) Gone dramatically downhill.
Score one point for every a) answer, three points for every b) answer and five points for every c) answer.
46-60: You are skating perilously close to major physical and/or mental breakdown. How about one of those Balancing Life and Work classes?
29-45: You are a good citizen, and it probably wont drive you nuts.
12-28: Dammit, neofascists and racist Talibaggers are running the country right into the ground! Get off your ass and do something about it!
To: HHS Secretary Kathleen Sebelius
From: Neil Trautwein, National Retail Federation
Re: Request for Information on the Essential Health Benefits Bulletin
The Essential Health Benefits Coalition ("EHBC" appreciates the opportunity to provide comments in response to the "Essential Health Benefits Bulletin" as issued by Department of Health and Human Services' (HHS's) Center for Consumer Information and Insurance Oversight (CCIIO) on December 16, 2011.
We urge HHS to consider an approach that balances reasonably comprehensive benefits with affordability for employers and individuals. A definition that does otherwise will make health coverage more expensive for employers and individuals to purchase and make jobs more difficult for employers to create.
Excerpt from recommendations:
Specifically, we urge the Department to reiterate that the Bulletin
reflects the statutory requirements that:
* The EHB package does not dictate cost sharing requirements.
* Use of benefit limits included within benchmark plans is not barred.
* Future state mandates will not be added to the benchmark plan.
* Use the benchmark plan only to define the 10 categories of EHBs required
by the ACA, and not any additional benefits that the benchmark may cover.
Members of the Essential Health Benefits Coalition Steering Committee:
American Osteopathic Association
America's Health Insurance Plans
Blue Cross Blue Shield Association
Express Scripts Inc.
National Association of Health Underwriters
National Association of Manufacturers
National Association of Wholesaler-Distributors
National Federation of Independent Business
National Retail Federation
Pharmaceutical Care Management Association
Retail Industry Leaders Association
U.S. Chamber of Commerce
Commentby Don McCanne of PNHP: HHS has proposed that "essential health benefits" for plans under the Affordable Care Act need meet only the minimal standard of state regulated plans in the small group market. Now a coalition of the usual suspects which push self-serving reforms is proposing to further weaken the "essential health benefits" standard.
The details of their recommendations are not nearly as important as the fact that this maneuver represents what has been wrong with the reform process all along. The vested interests have been in the front seat while the guileless patients have had to accept their work product - a mandate to purchase unaffordable under-insurance, amongst many other flawed policies.
Instead of fighting over the definition of minimal essential benefits in a highly flawed health financing program, we should be joining with the nation's patients in demanding that our elected leaders quit listening to these self-serving interests and instead enact a program that puts patients in the front seat - an improved Medicare for all.
Addendum: Members of the American Osteopathic Association (AOA) may want to advise their leadership that, as a patient-oriented organization, AOA should immediately withdraw from this dastardly coalition.
Profile InformationGender: Female
Hometown: Washington state
Home country: USA
Current location: Directly above the center of the earth
Member since: Sat Aug 16, 2003, 01:52 AM
Number of posts: 51,907
About eridaniMajor policy wonk interests: health care, Social Security/Medicare/Medicaid, election integrity
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