Category Archives: Health Care

State Prison Health Care Spending

Source: Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation, State Health Care Spending Project, July 2014

From the summary:
This report finds that state spending on prisoner health care increased from fiscal 2007 to 2011, but began trending downward from its peak in 2009. Nationwide, prison health care spending totaled $7.7 billion in fiscal 2011, down from a peak of $8.2 billion in fiscal 2009. In a majority of states, correctional health care spending and per-inmate health care spending peaked before fiscal 2011. But a steadily aging prison population is a primary challenge that threatens to drive costs back up. The share of older inmates rose in all but two of the 42 states that submitted prisoner age data. States where older inmates represented a relatively large share of the total prisoner population tended to incur higher per-inmate health care spending.

Key Findings:
∙ $7.7B Price Tag
41 States experienced growth in their correctional health care spending from fiscal 2007-2011, with a median increase of 13%.
∙ driving up costs
39 States saw per-inmate health care spending rise from fiscal 2007-2011, with a median growth of 10%.
∙ Spending Peak
34 States saw their total correctional health care spending peak before fiscal 2011.
∙ Graying Prison population
40 Of 42 states surveyed experienced a rise in the share of older inmates from fiscal 2007-2011

GovExec State & Local

Source: GovExec, July 2014

Get the latest news and analysis on innovation at the state, county and city levels of government. …

From the introductory letter:
….Our coverage centers on innovation in government operations, and how it’s being applied to public services, infrastructure, health care, security and budgeting – to name just a few areas we’ll be following.

In just our first week, you’ll find reports on innovative efforts in technology, finance and transportation in states like Ohio, New Mexico and Colorado and local jurisdictions like King County in Washington state, Indianapolis and Tecumseh, Michigan.

Our focus is less on politics and campaigns and more on the core functions of state and local government. We want to be a place where best practices, ideas and common challenges are communicated across jurisdictional boundaries on multiple platforms. We seek to engage with practitioners, decision makers and others aiming to make a difference in how their jurisdictions overcome obstacles and serve the public.

As befits an innovation-centric publication, we’re a digital operation. We’re starting with a channel on, but we’ll quickly branch out with online assessment tools, apps, ebooks and other digital initiatives. We’re building a nationwide network of correspondents and contributors….

After ‘Harris v. Quinn’: The State of Our Unions

Source: Eileen Boris, Jennifer Klein, Joel Rogers, Joshua Freeman and Jane McAlevey, The Nation, July 2, 2014

After one of Supreme Court’s most anti-union rulings in recent years, is there still time for organized labor to save itself?…

….To help sort through these and other questions, we have gathered up a group of scholars and activists and asked them to expound. They include Eileen Boris and Jennifer Klein, Joel Rogers, Joshua Freeman and Jane McAlevey. Their pieces range from meditations on what Harris v. Quinn means for the vast corps of women (particularly women of color) who make up this new “partial public employee” category to the way the Court has warped the First Amendment into a scythe to slice apart some of our most basic social protections. And if the meditations are not always cheery, well, this isn’t a particularly cheery topic. Then again, it’s not hopeless either. As McAlevey argues, labor still has time to save itself.

Reducing Labor to Love” by Eileen Boris and Jennifer Klein

How Harris v. Quinn and Burwell v. Hobby Lobby Turned the First Amendment into a Weapon” by Joel Rogers

Is Harris v. Quinn a Threat to Labor Peace?” by Joshua Freeman

Labor’s Only Real Choice: Beating Harris v. Quinn and Right-to-Work Attacks from the Inside Out” by Jane McAlevey…

Why the Supreme Court’s Attack on Labor Hurts Women Most

Source: Michelle Chen, The Nation blog, July 7, 2014

…..According to a CEPR analysis of the “union advantage” and gender inequality, union women are more likely to have decent family leave policies, retirement benefits and wages. Unionized female health aides generally earn wages that are 16 percent higher than that of their non-union counterparts. Meanwhile, though the union workforce is shrinking nationwide, women are becoming the majority and have especially high representation in public service jobs, thanks in large part to the immigration-driven growth in Asian American and Latina workers.

And that brings us back to why Illinois home attendants were a perfect target for the anti-union movement. Union-supported homecare demonstrates how women, “big government” and consumers can effectively work together, so naturally, the right is fighting to destroy this model before it catches on in more states.

Hobby Lobby revealed how companies can lord over working women’s reproductive freedom in a deeply inequitable insurance system. Harris struck from another angle—eroding union women’s labor power and threatening public health services in the process. Unions are a tool for resistance; although unionization alone won’t overcome greed or religious chauvinism in corporations, a strong collective bargaining system would give women a platform to hold bosses accountable and thwart reactionary attacks on health programs for workers and the poor…..
Harris v. Quinn Is About the Right of Home Care Workers to Improve Their Wages
Source: Ross Eisenbrey, Economic Policy Institute, Working Economics blog, May 20, 2014

Responding to the Affordable Care Act: A Leadership Opportunity for Social Workers in Employee Assistance Programs

Source: Susan Frauenholtz, Health & Social Work, Advance Access, First published online: June 25, 2014
(subscription required)

From the abstract:
Until recently, estimates indicated that more than half of Americans obtain health insurance through their employers. Yet the employer-based system leaves many vulnerable populations, such as low-wage and part-time workers, without coverage. The changes authorized by the Affordable Care Act (2010), and in particular the Health Insurance Marketplace (also known as health insurance exchanges), which became operational in 2014, are projected to have a substantial impact on the provision of employer-based health care coverage. Because health insurance is so intricately woven with employment, social workers in employee assistance programs (EAPs) are positioned to assume an active leadership role in guiding and developing the needed changes to employer-based health care that will occur as the result of health care reform. This article describes the key features and functions of the Health Insurance Marketplace and proposes an innovative role for EAP social workers in implementing the exchanges within their respective workplaces and communities. How EAP social workers can act as educators, advocates, and brokers of the exchanges, and the challenges they may face in their new roles, are discussed, and the next steps EAP social workers can take to prepare for health reform–related workplace changes are delineated.

Unintended Consequences: Medicaid Expansion and Racial Inequality in Access to Health Insurance

Source: Christina Andrews, Health & Social Work, Advance Access, First published online: June 20, 2014
(subscription required)

From the extract:
The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148), commonly referred to as the Affordable Care Act (ACA), has sparked dramatic change in health care in the United States. It has an ambitious and far-reaching agenda: to improve the accessibility, quality, and cost-effectiveness of health care and prevention services in United States. Among the most significant policy changes within the ACA is expansion of Medicaid, the nation’s major public insurance program for low-income citizens. The ACA eliminated categorical restrictions on Medicaid eligibility that have traditionally limited enrollment to parents, children, the elderly, and disabled people. As a consequence, any citizen who meets income eligibility criteria, regardless of age, health, or parental status, qualifies for Medicaid. As the ACA was originally designed, approximately 17 million people would become eligible for the program—34 percent of the 50 million uninsured (Congressional Budget Office, 2012). This revision of eligibility requirements represents the greatest expansion of Medicaid in its history and marked a major victory of advocates for expanded health insurance coverage for the poor.

Yet, the promise of expanded insurance access for low-income Americans through Medicaid has only been partially realized. The ACA—and the Medicaid expansion it established—came under attack as soon as it was enacted. Within hours of the legislation’s passage, several states filed constitutional challenges to the law with the U.S. Supreme Court. These challenges were considered by the court in June 2012 in the National Federation of Independent Business vs. Sebelius case (SCOTUSblog, 2012). One of several major objections voiced by the plaintiffs was regarding Medicaid expansion: The plaintiffs argued that it was unduly coercive to require states to expand Medicaid or lose federal matching funds for their current Medicaid enrollees. In their final decision, the Supreme Court agreed with the plaintiffs on this point, ruling that it …

The Latest Challenge to Health Privacy: Health Care Consolidation

Source: Mark A. Rothstein, University of Louisville School of Law Legal Studies Research Paper Series No. 2014-16, May 13, 2014

From the abstract:
The American health care industry is undergoing a transformation in several respects, including the substantial integration and consolidation of health care providers. Three of the leading ways in which this is taking place are through mergers of hospitals and health systems, development of accountable care organizations (networks of providers that share responsibility for coordinating patient care), and hospitals purchasing physician practices. There has been considerable discussion about the effects of consolidation on health care cost and quality, but there has been virtually no discussion about the significant effects of consolidation on health privacy.

Hobby Lobby and the Pathology of Citizens United

Source: Ellen D. Katz, University of Michigan Public Law Research Paper No. 413, June 10, 2014

From the abstract:
This Essay explores a distinct way Citizens United v. Federal Election Commission promises to influence pending challenges to the Patient Protection and Affordable Care Act (ACA), and a host of cases to come. Specifically, the way Citizens United approached precedent will likely affect, and radiate well beyond, the current ACA challenges. Citizens United read a number of prior decisions to adopt rules those decisions deliberately chose not to espouse. While this is not an entirely new move for the Court, the contribution of Citizens United was to normalize this disconcerting stance. The Roberts Court seems increasingly comfortable approaching precedent just as it did in that case. This Essay identifies this move as a consistent practice across a number of decisions, and explains why it is cause for deep concern.

A State Policy Framework for Integrating Health and Social Services

Source: Tricia McGinnis, Maia Crawford, and Stephen A. Somers, Commonwealth Fund, Issue Brief, Commonwealth Fund pub. 1757 Vol. 14, July 2014

From the summary:
A State Policy Framework for Integrating Health and Social ServicesThere is growing recognition that social factors — such as individual behavior, socioeconomic status, and the physical environment — have a greater impact on health outcomes than medical care. More and more states are seeking to rethink traditional health care delivery and, in doing so, integrate health care, public health, and social services to help achieve improved population health, better care, and reduced cost of care. This brief from The Commonwealth Fund, authored by the Center for Health Care Strategies, describes three essential components for integrating health — encompassing physical and behavioral health services and public health – and social services. These components are: (1) a coordinating mechanism; (2) quality measurement and data-sharing tools; and (3) aligned financing and payment. The authors present a five-step policy framework to help states move beyond isolated pilot efforts and establish the infrastructure necessary to support ongoing integration of health and social services, particularly for Medicaid beneficiaries. The brief draws from conversations with state officials and health policy experts across the country.

Trends in Health Coverage for Part-Time Workers, 1999-2012

Source: Paul Fronstin, Employee Benefit Research Institute (EBRI), EBRI Notes, Vol. 35, No. 5, May 2014

From the abstract:
This paper reviews recent trends in coverage for workers by hours worked and firm size. It examines data from the U.S. Census Bureau’s most recent Current Population Survey. It examines trends in coverage for workers employed full time, 30-39 hours, and fewer than 30 hours. The Patient Protection and Affordable Care Act of 2010 (PPACA) requires that employers with 50 or more full-time workers pay a penalty if they fail to provide health coverage to full-time workers in 2014. Although enforcement has been delayed by the Obama administration, it has raised concern that employers may respond by cutting back on health coverage for part-time workers or by increasing the proportion of part-time workers employed. The recent recession has already resulted in an increased use of part-time workers. However, since enactment of PPACA there has been a slight drop in the use of part-time workers. Part-time workers have experienced a much larger decline in coverage than full-time workers. While the recent erosion in coverage for workers employed 40 or more hours per week was stronger in small firms than in large firms, the opposite was true for workers employed less than 30 hours per week. Between 2008 and 2012, workers employed fewer than 30 hours in a small firm experienced an 11 percent decline in coverage while those in a large firm experienced a 15 percent decline. Among workers employed 30-39 hours per week, both those who worked for a large employer and those who worked for a small employer experienced a 9 percent decline in coverage between 2008 and 2012. Overall, those employed by a large firm were slightly more than twice as likely as those employed by a small firm to have coverage through their own job. In 2012, 45.1 percent of these workers employed by a large employer had coverage through their own job compared with 20.5 percent among workers employed by a small employer. While PPACA may affect whether part-time workers get coverage through their job, and employers may adjust the mix of full-time and part-time workers in the future, unemployment rates and the strength of the economy may play a larger role on workforce patterns than PPACA.