Author Archives: afscme

State Options for Making Wise Investments in the Direct Care Workforce

Source: Madeline Twomey, Center for American Progress, April 10, 2019

From the introduction:
Policymakers must invest in strengthening the direct care workforce in order to improve the quality of care delivered to patients and to achieve better value for every dollar spent on long-term services and supports.

This report outlines a number of actions that lawmakers can take to support the existing direct care workforce while increasing the number of available workers. Several states have already taken innovative approaches to addressing workforce shortages, including implementing payment reform to incentivize workforce initiatives. Additionally, states have increased wages and invested in workforce development and training in order to attract and retain direct care workers. In order to meet the growing demand for LTSS, state lawmakers should prioritize policy changes addressing workforce challenges, and the federal government should make investments to support states implementing meaningful reform.

Launches Dispute Financing Library

Source: Center on Civil Justice at NYU School of Law, 2019

From the press release:
The Center on Civil Justice at NYU School of Law has launched a comprehensive digital library of documents relating the third-party litigation funding industry.

The third-party litigation funding industry is young and growing quickly in size and importance. Its supporters maintain the industry, when run properly, provides needed resources to improve the delivery of civil and commercial justice. The industry has also attracted significant detractors. There is a need for careful, comprehensive, independent analysis of and reporting about the industry.

A threshold need is to establish a neutral, quality repository for the collection of information and data about the industry. The Library includes information supplied by both supporters and critics, and it is freely available to the public. From statutes and case law to journal articles and bar reports, from best practices to news stories, the Library contains the documents needed for industry insiders to conduct their business and for industry outsiders to learn as much as possible.

Exposed: Discrimination Against Breastfeeding Workers

Source: Liz Morris – Center for WorkLife Law, Jessica Lee and Joan Williams – University of California Hastings College of the Law, January 1, 2019

From the abstract:
Due to the medical consensus that breastfeeding reduces major health risks to both babies and mothers, the United States is waging an ongoing struggle to improve breastfeeding duration rates. Yet legal protections for breastfeeding parents in the workplace have not kept pace with the U.S.’s public health goals. Based on a review of workplace breastfeeding legal cases from the last decade, an analysis of all federal and state workplace laws protecting breastfeeding workers including coverage statistics, and interviews with women who faced workplace discrimination, this report documents the anemic legal landscape of breastfeeding rights at work. Discrimination against breastfeeding workers often forces them to stop breastfeeding or lose their jobs, at a devastating cost to their families. Almost three-fourths of breastfeeding discrimination cases studied involved economic loss, and nearly two-thirds ended in job loss. The legal tools to prevent and respond to such discrimination are lacking in both efficacy and scope. The report offers policy solutions to fix the gaps in our patchwork of laws to protect breastfeeding workers.

Cities make slow progress in addressing retiree healthcare liabilities

Source: Sunny Zhu, Thomas Aaron, Eric Hoffmann, Leonard Jones, Moody’s, Sector In-Depth, Local government – California, March 18, 2019
(subscription required)

Similar to pensions, other post-employment benefits (OPEB) — principally retiree healthcare — are liabilities that pose credit risks for some local governments. With rising healthcare costs, longer life spans and aging workforces, OPEB costs are escalating rapidly in some casesand unfunded liabilities are becoming a material source of balance sheet leverage. Positively,numerous California (Aa3 positive) cities, including San Jose (Aa1 stable), San Francisco (Aaa stable) and San Diego (Aa2 stable), have taken proactive steps to curb OPEB costs. Few cities have meaningfully reduced these liabilities to date because most cost-containment strategies will take years to provide substantial savings. If unaddressed, rising OPEB expenses threaten to curtail other local government spending priorities.

Reliance on top earners exposes states and downstream entities to revenue volatility

Source: Matthew Butler, Emily Raimes, Nicholas Samuels, Timothy Blake, Moody’s, Sector In Depth, State and local government – US, March 20, 2019
(subscription required)

The high-income states of California (Aa3 positive), Connecticut (A1 stable), New Jersey(A3 stable) and New York (Aa1 stable) rely heavily on tax revenue from their biggest earners to fund services. Such earners make up between 1% and 3% of these states’ taxpayers but account for more than 40% of personal income taxes. This dependence exposes the states to the volatility in high earners’ income, particularly as tax increases enacted since the 2007-09 recession have fallen predominantly on the top earners.

Automation and a Changing Economy

Source: Conor McKay, Ethan Pollack & Alastair Fitzpayne, Aspen Institute, Future of Work Initiative, April 2019

Automation is an important ingredient driving economic growth and progress. Automation has enabled us to feed a growing population while allowing workers to transition from subsistence farming to new forms of work. Automation helped moved us from a craft system to mass production, from blue-collar to white-collar to “new collar” work—with better work, higher wages, more jobs, and better living standards.

But without adequate policies and institutions, automation can also have negative effects on individuals and communities. Emerging technologies—including artificial intelligence, machine learning, and advanced robotics—have the potential to automate many tasks currently performed by workers, leading to renewed questions over what the future holds for the American workforce. We must ensure the proper support structures are in place to promote opportunity and prosperity for all.
Automation and a Changing Economy is divided into two sections.

Part I, Automation and a Changing Economy: The Case for Action, explores how automation impacts the economic security and opportunity of the American worker…..

Part II of this report, Automation and a Changing Economy: Policies for Shared Prosperity, outlines a program to address automation’s challenges and opportunities……

Related:
Executive Summary

Do prices vary with purchase volumes in healthcare contracts?

Source: Robert B Handfield, Jaikishen Venkitaraman, Shweta Murthy, Journal of Strategic Contracting and Negotiation, OnlineFirst, April 4, 2019
(subscription required)

From the abstract:
Hospitals are facing severe increases in the cost of clinical supplies, and a common strategy is to drive economies of scale achieved by hospital consolidation. The supply strategy of “volume leveraging” involves sourcing through contracts with Group Purchasing Organizations (GPOs) for commercial distributors and manufacturers of medical products. This study seeks to document the empirical benefits associated with volume leveraging, through analysis of purchasing data from three large hospitals. The dependent variables include a number of factors that are used to justify volume leveraging approaches, yet the study finds no significant explanatory factors that determine price variation related to the volume purchased. Interviews with physicians and clinicians suggest that poor data quality leads to lack of transparency, and an inability to aggregate volumes across inventory SKUs may be preventing volume-based cost savings from materializing. The results also suggest that lack of transparency results in low levels of utilization, which increases costs.