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

Taxing the Poor: A Report on Tobacco, Alcohol, Gambling, and Other Taxes and Fees That Disproportionately Burden Lower-Income Families

Source: Michael L. Davis, National Center for Policy Analysis, NCPA Policy Report No. 300, June 2007

Press release
As Congress seeks to fund the expansion of government-provided health care for children by increasing taxes on tobacco and possibly alcohol, a new report from the National Center for Policy Analysis (NCPA) notes these taxes disproportionately impact the poor. The report notes that governments at all levels are raising revenues in a number of regressive ways, particularly through a lottery and excise taxes on products such as alcohol and tobacco and essential services such as utilities and gas.

Many States’ Poor Populations Lose If Cigarette Taxes Are Hiked to Pay for Health Insurance

Source: The Tax Foundation, News Release, June 29, 2007

Most states will pay more in tax than they receive in federal spending from Senator Gordon Smith’s proposal to expand federal health spending with money from a higher federal excise tax on cigarettes.

The five states that would come out furthest ahead are New Mexico, Alaska, Kansas, Arizona, and California. They combine comparatively low smoking rates with fairly large populations of households eligible for the State Children’s Health Insurance Program (SCHIP).

The five states that would fare the worst are New Hampshire, Vermont, Missouri, Massachusetts, and Iowa. Iowa and Vermont have low levels of children in poverty and above-average cigarette consumption, while Missouri has a very high smoking rate.

The study is titled “A State-by-State Estimate of the Impact of SCHIP Expansion and a 156 Percent Cigarette Tax Hike,” by Tax Foundation economist Gerald Prante. It is number 88 in the Tax Foundation Fiscal Fact series.

The Blogging Revolution: Government in the Age of Web 2.0

Source: David C. Wyld, IBM Center for the Business of Government, E-Government Series, 2007

Dr. Wyld examines the phenomenon of blogging in the context of the larger revolutionary forces at play in the development of the second-generation Internet, where interactivity among users is key. This is also referred to as “Web 2.0.” Wyld observes that blogging is growing as a tool for promoting not only online engagement of citizens and public servants, but also offline engagement. He describes blogging activities by members of Congress, governors, city mayors, and police and fire departments in which they engage directly with the public. He also describes how blogging is used within agencies to improve internal communications and speed the flow of information.

Based on the experiences of the blogoneers, Wyld develops a set of lessons learned and a checklist of best practices for public managers interested in following in their footsteps. He also examines the broader social phenomenon of online social networks and how they affect not only government but also corporate interactions with citizens and customers.
Subject: Public Sector

Occupational Cancer / Zero Cancer : Work started it. Unions will stop it.

Source: International Metalworkers’ Federation, March 23, 2007

The International Metalworkers’ Federation has launched a global union campaign, “Occupational Cancer/Zero Cancer.”

Occupational cancer is the most common work-related cause of death. The International Labor Organization estimates the human toll at over 600,000 deaths a year – one death every 52 seconds. At least 1 in every 10 cancers – probably many more – is the result of preventable, predictable workplace exposure. Today, more people face a workplace cancer risk than at any other time in history. It’s just that most of them don’t know it. Unions have won recognition of causes of occupational cancer, restrictions on their use and compensation for their victims. By finding out about workplace risks and taking action to eliminate, substitute or control the risks, workers and their unions can make the workplace safer. Occupational Cancer/Zero Cancer is a global union campaign to prevent occupational cancer. On this campaign page you will find links to campaign materials, background information and other relevant resources.

Medicaid Funding for Nonprofit Healthcare Organizations

Source: Courtney Burke, The Aspen Institute, June 2007

Medicaid, a publicly funded health insurance program, paid for approximately 16 percent of all healthcare delivered in the United States in 2005.1 Because nonprofit organizations comprise a notable percentage of health providers, and because many of these nonprofits disproportionately rely on Medicaid as a payment source, revenue for nonprofit organizations is inextricably linked to Medicaid. The percentage of healthcare providers that are nonprofit varies depending on the service they provide and the state in which they operate. For instance, nonprofits make up a larger percentage of all hospitals in comparison to their prevalence among all nursing homes. They are more common in Northeastern states compared with Southern and Western states. This is due to several factors, including states’ laws and regulations governing nonprofits, the competitiveness of the marketplace, and differences in states’ policies governing coverage and payment for healthcare services.

There is no doubt that the financial relationship between Medicaid and nonprofit organizations has significant implications for their missions, management and budgeting tactics. The effect of Medicaid funding on the mission of an organization is particularly striking in instances where less medically oriented social-service providers change their service delivery model to meet Medicaid reimbursement criteria. Understanding the extent of the financial affiliation between Medicaid and nonprofits is the first step in understanding the organizational effects—but doing so is difficult because the monetary relationship may vary by the type of service provided, state, or industry. Adding to the difficulty of estimating and understanding the financial relationship between Medicaid and nonprofits is the fact that there is no single database to track the flow of Medicaid money to nonprofits. The lack of a dedicated data system necessitates use of various sources to estimate the amount of Medicaid money going to nonprofits.

Each source has several caveats and only allows for imprecise estimates. Taking these caveats into account, this paper uses existing literature, analyses from industry trade organizations, and data from state officials, the Census Bureau, and Medicaid to make rough estimates of the potential amount of Medicaid money going to nonprofit healthcare providers.

The financial relationship between Medicaid and nonprofits may have additional effects on nonprofit organizations. Understanding the financial relationship between Medicaid and nonprofits can further illuminate the possible organizational effects and demonstrate Medicaid’s role in shaping the healthcare marketplace. This paper shows how and how much Medicaid funding flows to nonprofits, that Medicaid expenditures impact a significant number of nonprofits and a large portion of funds for nonprofit healthcare organizations, and that various trends and changes in the marketplace may affect nonprofit healthcare providers in different ways.

How Much Is Too Much?: A Framework for Evaluating Health Care Affordability

Source: David Carroll, California Budget Project Budget Brief, May 2007

The Governor and legislative leaders have proposed to substantially expand health coverage for uninsured Californians. These proposals would require individuals to purchase or share in the cost of coverage.1 However, these proposals may not go far enough to make health coverage affordable for California families

Interpreting Local Government Financial Statements

Source: Stephen J. Gauthier, Government Finance Review, Vol. 23 no. 3, June 2007

The published financial report of a local government provides a wealth of information to anyone with an interest in the government’s economic condition. Taking advantage of this information, however, poses a real challenge to many users of these reports. This article aims at helping potential users of local government financial statements to meet this challenge.