New Report: Extensively Drug-Resistant Tuberculosis (XDR-TB): Quarantine and Isolation

Source: Kathleen S. Swendiman and Nancy Lee Jones, CRS Report for Congress, Order Code RS22672, June 5, 2007

The recent international saga of a traveler with XDR-TB, a drug-resistant form of tuberculosis, has placed a spotlight on existing mechanisms to contain contagious disease threats and raised numerous legal and public-health issues. This report will briefly address the existing law relating to quarantine and isolation, with an emphasis on the interaction of state and federal laws and international agreements. It will not be updated.

ACORN releases study on foreclosure epidemic

Source: Association of Community Organizations for Reform Now, Inc. (ACORN)

ACORN chapters around the country released reports identifying U.S. neighborhoods with the highest foreclosure rates.
The set of reports, titled Home Insecurity,” highlights more than 110 cities and counties with high foreclosure rates.
Last year there were 1.2 million foreclosures filed — an average of more than two foreclosures every minute.
That number represents a large increase from 2005, when there were about 900,000 foreclosures filed. The foreclosure problem is expected to get worse this year, with about 1.5 million foreclosure filings.

+ Metro area reports

IUF: A Workers’ Guide to Private Equity

Source: The International Union of Food, Agricultural, Hotel, Restaurant, Catering, Tobacco and Allied Workers’ Associations (IUF), May 2007

The IUF first drew the attention of the international trade union movement to the growing scale of private equity buyouts in the context of the “financialization” of corporate investment to deliver maximum short term financial returns to shareowners. The secretariat has briefed UK and European parliamentarians on the threat of private equity, established a unique website on private equity in the IUF and other sectors and assisted affiliates in responding to private equity buyouts.

The IUF secretariat has now published a A Workers’ Guide to Private Equity, a 36 page A5 brochure, aimed at IUF affiliates and trade unions and their members around the world.

Available in English, and shortly in French, German, Spanish and Swedish, the publication sets out in accessible language what private equity is, how it operates and the dangers it represents to workers and unions. It points to possible strategies in bargaining with the private equity funds who are becoming increasingly significant players as owners and employers in many IUF sectors. It explains how a specific political environment (deregulation) has made it possible for the funds to expand globally, and how political action can contain the funds.

New Medicaid Drug Payment Rule

Source: U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Press Release, July 6, 2007

A new method of setting limits on what the federal government will reimburse state Medicaid agencies for prescription drug payments — aimed at reigning in inflated drug product payments — was announced today in a final rule put on display at the Federal Register.

“This new payment formula allows Medicaid to pay more appropriately for prescription drugs dispensed to Medicaid beneficiaries,” said Leslie V. Norwalk, Esq., acting administrator of the Centers for Medicare & Medicaid Services (CMS).

The new regulation is expected to save states and the federal government $8.4 billion over the next five years. Even with this change, the Medicaid program is still expected to spend $140 billion for drugs over the same time period, fiscal years 2007 through 2011.

The change, part of the Deficit Reduction Act (DRA) of 2005, is in part a reaction to a series of reports issued in 2004 by both the Government Accountability Office (GAO) and the HHS Office of the Inspector General (OIG) showing that Medicaid payments to pharmacies for generic drugs were much higher than what pharmacies were actually paying for those drugs.

Both the GAO and the OIG found that states were overpaying for drugs because they were using commercial drug pricing guides as the basis for setting state reimbursement levels. The investigation of these drug “compendia” documented that these prices were artificially inflated, especially for generic drugs. Pharmacies, the reports showed, made the most profit on those generic drugs with the highest mark-up, creating an incentive to dispense those drugs.
+ Full text of rule

Change in Percentage of Families Offered Coverage at Work, 1998-2005

Source: Bianca DiJulio and Paul D. Jacobs, Kaiser Family Foundation, #7667, July 2007

Over 150 million individuals received health insurance through an employer in 2005, making employer-sponsored coverage the most popular form of health insurance coverage for the nonelderly in the United States. However, in recent years, there has been concern about erosion in the availability of employer-based health benefits for workers, and especially low-income workers. This paper analyzes data from the National Health Interview Survey (NHIS), an annual survey conducted by the U.S. Census Bureau for the National Center for Health Statistics, to assess changes between 1998 and 2005 in the percentage of families with workers that have at least one offer of health insurance through an employer. Results are broken out by family income relative to the federal poverty level.

Ill-Defined Benefits: The Uncertain Present and Brighter Future of Employee Pensions in Canada

Source: David Laidler and William B. P. Robson, C.D. Howe Institute Commentary, No. 250, June 2007

The problems of employer-sponsored defined-benefit (DB) pension plans in Canada raise two issues: the need for short-run measures to limit the damage; and the need for new pension models to prevent their recurring.

The DB sector’s immediate preoccupations are the result of changes in the economic environment — in particular, a decline in long-term interest rates — that caused their balance sheets to deteriorate, and of changes in accounting standards to more market-based methods that revealed the underfunded state of these plans in stark form.

The immediate policy challenge is to ensure the recovery and/or restructuring of sick plans, and the continued health of sound ones. Extra time and financial scope to work off deficits are good, but current limits on contributions to plans should rise or disappear, while legislation to establish clear title to surpluses for sponsors who must cover deficits is badly needed.

Accounting standards should remain strict, however, to ensure that emerging problems are seen and addressed. It would be a mistake to privilege government-employee plans by relieving them of the same solvency requirements that apply to private-sector plans. Another wrong turn would be resorting to government-sponsored insurance to backstop plans, since this approach creates moral hazards and future liabilities for taxpayers.

In the longer run, policy should sustain and encourage a thriving occupational pension sector that helps individuals save for old age and helps finance the investment that underpins economic growth. But DB plans were in decline long before the recent crisis, and evidence is mounting that the classic single-employer DB plan has fatal agency problems — evident particularly in the tendency for these plans to mismatch assets and liabilities in ways that exposed them to risks far larger than sponsors or participants understood.

Working of Faith: A Labor Law Enforcement Report

Source: Ted Smukler, Interfaith Worker Justice

The Department of Labor and State Departments of Labor are important allies for working people. The Department of Labor and State Departments are responsible for enforcing the nation’s labor laws, and educating both workers and employers about the nation’s labor laws.

In the past few years, the Interfaith Worker Justice and local interfaith committees have been building partnerships with local, state, and national Department of Labor (DOL) staff. These partnerships have sought to:

• Inform workers, especially low-wage and immigrant workers, of their rights in the workplace. At the national level, bulletin inserts were jointly created in nine languages that have been and continue to be distributed to workers through congregations. In local communities, DOL staff have provided educational workshops to workers.

• Train advocates to better support workers in seeking justice in the workplace. Because many worker advocates—pastors, social workers, immigrant advocates, and community organizers— are unfamiliar with the basic labor laws, they often don’t recognize basic law law violations that workers experience. Local DOL staff have partnered with local interfaith groups to train advocates about labor laws, so they can be more effective advocates.

• Create safe spaces and ways for workers to file complaints with DOL offices. Many workers, especially immigrant workers, are fearful of government agencies. And no one would suggest that the DOL procedures are particularly user-friendly. Thus, many concerned DOL staff and religious advocates have partnered to find new ways to support workers in filing complaints. Some groups are testing new simplified complaint forms. Other groups are forming workers’ centers, where workers can drop in for help. Others are looking to revive parish-based labor schools that create a safe space for workers to both file complaints and learn to organize.

The Family and Medical Leave Act: A Report on the Request for Information

Source: U.S. Department of Labor, Wage and Hour Division, 2007

From press release:
The U.S. Department of Labor today released Family and Medical Leave Act Regulations: A Report on the Department of Labor’s Request for Information, a comprehensive review of the thousands of public comments received in response to the department’s December 1, 2006, Request for Information about the Family and Medical Leave Act regulations and their impact in the workplace.

“The 15,000 comments from workers, employers and others attest to the importance of family and medical leave for America’s caregiving workforce,” said Victoria A. Lipnic, assistant secretary of labor for the department’s Employment Standards Administration. “While family and medical leave is widely supported, we also heard from many workers and employers that there are challenges with the way certain aspects are being administered. This report provides information for a fuller discussion about how some of the key FMLA provisions and their interpretations have played out in the workplace.”

The comments highlight the prevalence with which unscheduled intermittent leave is being taken in certain workplaces. As the record indicated, this is the single most serious area of friction between employers and workers. Another major area of concern, on the part of workers, employers and health care providers, is the medical certification process.

The report is comprised of 11 chapters: 10 chapters on key regulatory issues, plus the first chapter, which describes the value of the FMLA to employees.

CBO’s New Special Collection on Health

Source: Congressional Budget Office, Health Unit

From the Director – Congressional Budget Office: “Rising health care costs and their consequences for federal health insurance programs constitute the nation’s central fiscal challenge. Such costs exert a significantly larger influence on the budget over the long term than other commonly cited factors, such as the aging of the population. If health care costs continued growing at the same rate over the next four decades as they did over the past four decades, federal spending on Medicare and Medicaid alone would rise to about 20 percent of gross domestic product by 2050–roughly the share of the economy now accounted for by the entire federal budget. Controlling those federal costs over the long term will be very difficult without addressing the underlying forces that are also causing private costs for health care to rise. A variety of evidence suggests that opportunities exist to constrain health care costs both in the public programs and in the rest of the health care system with little or no adverse health consequences. Given the central role of health care costs in determining the nation’s long-term fiscal balance, policymakers and the public need more analysis of the options for capturing those opportunities. CBO is therefore substantially augmenting its capabilities and work on health care issues–and this Web page collects many of the agency’s activities in the area.”

Medicare Advantage: Private health plans in Medicare

Source: J. Timothy Gronniger and Robert A. Sunshine, Economic and Budget Issue Brief, Congressional Budget Office, June 28, 2007

Medicare provides federal health insurance for 43 million people who are aged or disabled or who have end-stage renal disease. Most receive services through the traditional fee-for-service (FFS) part of the program, which pays providers a set fee for each covered service (or bundle of services). Participants can choose their providers and are not required to obtain prior authorization for any covered service.

Medicare beneficiaries have the option of enrolling in Medicare Advantage–the program through which private plans participate in Medicare–rather than receiving their care through the FFS program.1 They may choose to do so because such plans provide additional benefits beyond those available within traditional Medicare, including coverage for services not covered by FFS Medi- care (for instance, dental services) and cash rebates of premiums or reduced cost-sharing. As of June 2007, about 18 percent of beneficiaries are enrolled in Medicare Advantage plans.2 This brief describes how those private plans function, how they are paid, how their costs com- pare with the costs of traditional Medicare, and how those costs vary by geographic area.
See also: Testimony on the Medicare Advantage Program