Category Archives: Health Care

Evolution of Collaboration Among Federal, State, and Local Agencies

Source: Nathan Myers, Public Manager, Vol. 42 no. 2, Summer 2013
(subscription required)

… By the end of 2009, as seen in her public remarks, Sebelius had come to the conclusion that the United States must not have an ad-hoc approach to dealing with public health threats, but a flexible yet permanent system employing federal, state, local, private sector, and other types of resources that will allow us to bring the latest technology and our collective knowledge to bear on the latest contagion. However, with a traditionally decentralized federal public health system, creating and maintaining such a system will require a healthy dose of negotiation and relationship-building…

Laws Affecting Wellness Programs and Some Things They Make You Do

Source: Robert E. Boston and Brian M. Clifford, Employee Relations Law Journal, Vol. 39 no. 1, Summer 2013
(subscription required)

From the abstract:
The Affordable Care Act will present many employers with a choice: offer affordable health insurance coverage to all employees or face civil penalties. When implemented correctly, a wellness program can be an effective way to decrease the employer’s cost of insurance coverage. Employers should consider the various laws affecting wellness programs to decide whether and to what extent they are right for their business and its employees.

Are You an “Applicable Large Employer” Required to “Play or Pay” under the ACA’s Employer Mandate and the IRS’ Proposed Shared Responsibility Regulations?

Source: David N. Crapo, Employee Relations Law Journal, Vol. 39 no. 1, Summer 2013
(subscription required)

From the abstract:
This article addresses how to determine the number of full-time equivalent employees an employer has for purposes of the Patient Protection and Affordable Care Act of 2010 “Employer Mandate” and what an employer might do to prepare for the 2014 effective date of the Employer Mandate.

The Surrender of Oakland: The 2012 National Agreement between the Coalition of Kaiser Permanente Unions and Kaiser Permanente

Source: John Borsos, WorkingUSA, Volume 16, Issue 2, June 2013
(subscription required)

From the abstract:
A new, controversial agreement negotiated by the Coalition of Kaiser Permanente Unions (CKPU), led by the Service Employees International Union (SEIU) with Kaiser Permanente, the nation’s largest health maintenance organization, may portend a dangerous shift in labor relations in the U.S. In this case, it is the unconditional surrender of a union to a corporation’s agenda. The Surrender of Oakland—embodied in the 2012 Kaiser–CKPU national agreement—represents the complete capitulation of labor to management: in production, in marketing and capitalization, and even by allowing the employer to control Kaiser workers’ lives outside the workplace through an invasive wellness program. Abdicating their role as patient advocates, the new agreement requires SEIU and other coalition unions to promote wellness programs that may not be in anyone’s best interest except for employers trying to shift healthcare costs onto employees.

States Missing Out on Millions in Medicaid for Prisoners

Source: Christine Vestal,, June 25, 2013

Only a dozen states have taken advantage of a long-standing option to stick the federal government with at least half the cost of hospitalizations and nursing home stays of state prison inmates. The other states have left tens of millions of federal dollars on the table, either because they didn’t know about a federal rule dating to 1997 or they were unable to write the laws and administrative processes to take advantage of it….

…Why have so few states and localities taken advantage of the opportunity to collect millions in federal money to defray correctional health care costs? Like everything else connected with Medicaid, the rules are complicated and implementing the program requires cooperation among at least three separate agencies: corrections, Medicaid and local social services.

Another problem is that inmates don’t necessarily want to cooperate with prison personnel once they explain they are trying to defray some of their costs by drawing on federal funds….Another reason is that state corrections agencies didn’t find out about the ruling right away. The announcement first went from Washington to federal regional Medicaid officials who interpreted the ruling before sending it to Medicaid agencies in the states. Medicaid agencies then further analyzed the ruling before alerting the corrections agencies. Some corrections departments never got the memo.

Delaware, Louisiana and Oklahoma were the first states to use Medicaid for inmate hospitalization. As word of mouth traveled, a few more states enacted the needed laws and administrative procedures….As a result, most states likely will not be prepared to take advantage of it for the 2014 expansion, Strugar-Fritsch said. But once states understand how much federal money they’re leaving on the table, most will do what it takes to set up the needed systems, she predicted….

A case study of a workplace wellness program that offers financial incentives for weight loss

Source: John Cawley, Joshua A. Price, Journal of Health Economics, Volume 32, Issue 5, September 2013
(subscription required)

From the abstract:
Employers are increasingly adopting workplace wellness programs designed to improve employee health and decrease employer costs associated with health insurance and job absenteeism. This paper examines the outcomes of 2635 workers across 24 worksites who were offered financial incentives for weight loss that took various forms, including fixed payments and forfeitable bonds.

We document extremely high attrition and modest weight loss associated with the financial incentives in this program, which contrasts with the better outcomes associated with pilot programs. We conclude by offering suggestions, motivated by behavioral economics, for increasing the effectiveness of financial incentives for weight loss.

The Big Squeeze: Retirement Costs and School District Budgets

Source: Dara Zeehandelaar and Amber M. Winkler, Fordham Institute, June 2013

From the summary:
When it comes to pension reform in the education realm, it’s hard to stay positive. Here, we’re saddled with a bona fide fiscal calamity (up to a trillion dollars in unfunded liabilities by some counts), and no consensus about how to rectify the situation. No matter how one slices and dices this problem, somebody ends up paying in ways they won’t like and perhaps shouldn’t have to bear. All we can say is that some options are less bad than others. In The Big Squeeze: Retirement Costs and School-District Budgets, we analyze and project how big an impact the pension and retiree health care obligations will have on the budgets of three school districts: Milwaukee Public Schools, Cleveland Metropolitan School District, and the School District of Pennsylvania. The Big Squeeze: Retirement Costs and School-District Budgets is a summary report by Dara Zeehandelaar and Amber M. Winkler, based on three technical analyses performed by Robert Costrell and Larry Maloney to be released by the end of Summer 2013.

Criminalized Women and the Health Care System: The Case for Continuity of Services

Source: Susan Sered, Maureen Norton-Hawk, Journal of Correctional Health Care, Vol. 19 no. 3, July 2013
(subscription required)

From the abstract:
Drawing upon research with criminalized women in Massachusetts, this article examines barriers to health care before, during, and after incarceration. Although very few of the surveyed women reported having had to forgo medical treatment because of an inability to pay, almost all of them reported being unable to access consistent, ongoing health care services. Typically, the women recalled sequential contact with dozens of providers at dozens of facilities, treatment plans that had been developed but never executed, psychotherapy that opened wounds but was terminated before healing them, and involuntary interruptions in legally prescribed courses of psychiatric medications. Acknowledging that these problems are related to wider structures of health care delivery in the United States, this article ends with a modest proposal for developing a role for health care advocates assigned to coordinate care for those with complicated medical problems to help them manage their health care needs over a long period of time.

The Role of Job Insecurity in Explanations of Racial Health Inequalities

Source: Andrew S. Fullerton, Kathryn Freeman Anderson, Sociological Forum, Volume 28, Issue 2, June 2013
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From the abstract:
The literature documenting substantial health differences for racial minorities in the United States is well developed and has considered a multitude of explanations for such disparities. However, the literature seldom addresses the health effects for racial minorities produced in the workplace. This study bridges these two literatures in order to understand the mediating role of job insecurity in explanations of racial health disparities. Our central argument is that racial differences in job insecurity resulting from the marginalized labor market positions of racial minorities are partially responsible for racial disparities in health. This study utilizes adjacent category and partial adjacent category logit models of general health using data from the 2000 to 2010 General Social Survey in order to test this claim. Overall, the results from this study indicate that there are substantial racial differences in job insecurity, and both race and job insecurity are important predictors of general self-rated health. Additionally, racial differences in job insecurity help explain a portion of the racial disparities in health. We conclude with a discussion of the implications for the study of health disparities in the United States.

State Level Progress in Implementation of Federally Facilitated Exchanges: Findings in Three Case Study States

Source: Linda J. Blumberg, Shanna Rifkin, Urban Institute, June 14, 2013

From the abstract:
This paper focuses on states’ roles in implementation of FFEs. We start by providing an overview of recent regulations issued by CCIIO that describes the possible roles both for states and the federal government in the FFEs. We then provide in-depth descriptions of each of the specific FFE options as implemented in three states-Alabama, Michigan, and Virginia-with an eye to each state’s role in developing mechanisms to carry out their new responsibilities and progress in creating relationships with the federal government in order to ensure successful implementation of the three types of federally facilitated exchanges.