Cost sharing blocks access to health care

The notion that health cost containment requires people to put “skin in the game” has a long pedigree. Requiring people to pay something through premiums or co-pays for health care, the theory goes makes them more discerning consumers about health services and eliminates unnecessary health care.

The problem is that they also stop  seeking care for things that require medical attention.

West Virginia about to fall to "Right to Work"

It looks like West Virginia's new Republican majority is about ram through a Right-to-Work (for less) bill.

It's not a surprise, that's what GOP majorities always do with anti-labor legislation. (See Wisconsin, Michigan, Indiana, and Michigan, oh, and Michigan again.) Once these bills surface, they rocket through the ledge to stop opposition and minimize the public discomfort their backers have to face.

West Virginia's legislative majority could use a visit

from these nice ladies.

In West Virginia, they're drawing on Orwellian inspiration to call it the "Workplace Freedom Act" Guh. Like all (so-called) Right to Work laws, it would give employees the right to stop paying dues to the labor union that represents them, but forces those unions to continue to represent the workers. The goal is to defund the unions, leaving workers out in the cold.

I've always been of the belief that if workers don't want to work in a union shop, they should quit and find an employer without a union. I mean, that's what management tells employees when they demand healthcare or higher wages or better working conditions, right?

Anyhow, back to West Virginia.

Proponents, backed by the usual third-rate think tanks, push the usual bad arguments about RTW improving West Virginia's economic prospects (because gutting workers' rights always improves things for residents). And anti-labor legislation debates always come with a few gratuitous shots at pro-labor protesters .

It was only a matter of time. I thought the GOP would wait until they elected one of their own as governor,  but the state's weak gubernatorial veto (simple majorities of the legislature can override as long as the legislature is in session) made it too tempting to not get done this year.

Kentucky is likely next up, with Missouri, New Mexico, Montana and Ohio potentially on the chopping block depending on how 2016 elections go.

Yes, I am depressed about this.  I'm doubly so because the battles in West Virginia's coal fields rocketed the United National Mine Workers to prominence. But the group has lost more than 90 percent of its membership in the last half century as coal-mining has died and the remaining operators rely on cheap bankruptcy tricks to undercut the few union minors left.

John Cole over at Balloon Juice has more on this and the other predictable horribleness that results when you let vandals take over your state legislature (like apparently now $100 for a five-year gun permit is an unconstitutional infringement on your right to pack heat).

Labor's prospects over the next several years look alarming

As another election year dawns, I find myself contemplating the future of the labor movement.

The immediate future looks grim.

That isn't to say that the labor movement is going to die, or that unions won't continue to play a role or help working people. And it certainly doesn't mean that activists should stop fighting for the rights of working people everywhere.

However,  it's much more likely than not that the labor movement is going to suffer some serious hammer blows in 2016 and the remaining years of the decade.

I'll focus narrowly in this post on the spread of (so-called) Right to Work (for less) laws (RTW).

RTW is an insidious concept that cloaks itself in righteous language to divide workers and drastically weaken the power of their organizations.  By the National Labor Relations Act and the state statutes that govern collective bargaining for state and local public employees, unions have to represent all employees in a bargaining unit.  In 25 states, the union has the ability to bargain to charge fair-share fees of all member of the unit, which represent the costs of collective bargaining.  Full dues, which represent political activities engaged in by the union, are only paid by individuals who want to be members who in turn have rights to vote and participate in the governance of the union.

In an aside, remember that in order to represent workers, unions have to win an election to become the bargaining agent, and they are controlled by the members through democratically elected officers. Finally, they can be decertified if a majority of workers vote in an election to remove or replace the union. This is a fact glossed by anti-worker forces.

What RTW laws do is allow workers to free ride of the union's efforts by banning fair share fees. The corporate-backed groups and think tanks pushing RTW argue that workers have a right to not join a union (though they are rather silent on a worker's right to join a union). Of course, though banning fair-share fees, RTW laws still compel a union to represent any one in a bargaining unit. As a result, we create a free-rider problem described by Mancur Olson: why should you pay for something you can get for free?

RTW is insidious because it only appears to cripple a small part of collective bargaining rights: in itself, it doesn't touch the ability to bargain for better wages or working conditions. But by undermining the union finances, it cripples the ability of a union to organize, bargain and protect strong contracts, which can lead to fewer members, which leads to further financial erosion. At worst, a death spiral happens, leaving a bunch of isolated, cynical workers in its wake -- who then can be easily exploited by unfettered bosses.

Currently 25 states have RTW laws, and 25 do not. Since 2011, when Scott Walker eviscerated public sector unions in Wisconsin, three states have jumped on the RTW bandwagon: Indiana, Wisconsin and Michigan.  From a worker's perspective this should be alarming, because all three of these states are in the industrial Midwest, which traditionally has a strong union presence. Michigan was the birthplace of the United Auto Workers (UAW), whereas the Association of State, County and Municipal Employees (ASCME) originally formed in Wisconsin.

As the parties have polarized and the remaining labor-friendly Republicans retire or are overwhelmed by their conservative colleagues, this momentum is likely to continue.

Extreme Risk:

West Virginia: I suspect it's pretty much all over in West Virginia. Like many Appalachian states over the last several election cycles, the legislature has become sharply more conservative, with the GOP breaking the dam in the 2014 elections. A RTW bill was shelved in 2015, but with GOP gains likely in both houses of the legislature and a Republican taking over the governor's chair very likely in 2016, in 2017, RTW's arrival will be a given.

Kentucky:  A slimmer and slimmer Democratic majority in the state House of Representatives is the only thing standing between RTW and Kentucky. The extreme conservative Matt Bevin's win as governor jumps this state from medium risk to extreme risk, as anti-labor policies are core to Bevin's identity -- in two of his first executive orders, he discarded higher minimum wage requirements for state agencies and issued a hiring freeze in filling unstaffed positions.

The Democrats may hang on to their house majority in 2016, since they were somehow able to cling to it in the low-turnout year of 2014.  However, the off-year election of 2018 is another animal entirely.

Several Kentucky counties have already tried to issue RTW laws on their own; these efforts are currently tied up in court, but the winds are very much blowing the wrong way for labor rights in this state.

High Risk:

Missouri:  Democratic Governor Jay Nixon vetoed a RTW bill in 2015 and the Democrats backed by a few nervous Republicans have managed to sustain those vetoes in the legislature, despite the GOP maintaining a supermajority in both chambers. Unlike West Virginia, the Democrats have a fighting chance in the governor's race in 2016, despite Missouri drifting further into the GOP orbit over the last decade. With a Democratic win in the governor's race, Missouri is likely safe for another four to eight years. With a GOP victory, RTW would likely be the very first thing on the government's agenda in 2017.

Medium Risk:

Ohio: With Republicans in strong command of both houses of the state legislature and the governorship for the foreseeable future and likely maintaining the governorship, Ohio would seem to be a likely candidate for a RTW bill -- and one is currently percolating in the legislature.

However, Ohio Republicans have a bitter memory of the last time they tried to push a major anti-worker bill through the legislature holding them back. In 2011,  Ohio Republicans pushed a Wisconsin-style bill designed to strip most collective bargaining rights from public employees. The bill passed, but  Labor and progressive groups gathered more than a million signatures to force a referendum, in which 62 percent of voters rejected the bill. 

That memory may be holding the GOP in check for now, but if other states continue to push through anti-labor laws, Ohio Republicans will likely eventually press forward.

Possible risk

Montana:  Montana's state legislature has been in solidly Republican hands since 2010, but Democrats have held the governor's chair. Incumbent Steve Bullock is in a reasonably strong position for the blue team, so hanging on to labor rights for at least four more years appears possible in this traditional mining state.

New Mexico: New Mexico currently has Democrats in control of the State Senate, but lost control of the House of Representatives in 2014.  Presidential year turnout will help protect the Democratic senate advantage in 2016 and perhaps help them retake the house.  But if Democratic power in the legislature erodes further, anti-labor legislation will be on the agenda when a Republican is governor.

New Hampshire and Pennsylvania might also be at risk. The Granite state occasionally gets massive GOP majorities in the two houses of its legislature, as it did after 2010. In that case a few moderate Republicans helped the Democrats in the house sustain Democratic governor John Lynch's veto of a RTW bill in the 2011-12 session. As long as the Democrats hold the governor's chair, they should be OK here, but elections are close and there is an open seat in 2016.  Pennsylvania is safe as long as Democrat Tom Wolf, elected in 2014 is in office, but the GOP has a built-in advantage in the state house and its majorities are becoming dominated more and more by extremely conservative ideologues.  Protecting Wolf in 2018 and drawing better districts in 2020 will be key to keeping the Keystone state working people from getting their collective bargaining rights curtailed.

The Supreme Court

This list doesn't count the worst probable hammer blow that's going to fall on labor this year. That would be Friedrichs vs. The California Teacher's Association, which has made its way to the Supreme Court a case set for oral arguments on January 11. The case will likely result in a 5-4 decision -- authored by Sam Alito--  overturning nearly four decades of precedent and invalidating fair share fees for all public sector unions on the specious grounds that collective bargaining with the government is a form lobbying (political speech), which cannot be compelled. Of  course, the union will continue to have to represent the interests of all of its members without their financial support, but I guess speech rights for dues payers aren't as important.

I so do weary of Alito's conception of Freedom of Speech in which it becomes much easier for wealthy owners to speak (see Citizens United) and much more difficult for working class people to organize so they can speak.

Again, we shouldn't despair from the likely reverses that are coming. The movement goes on and labor will continue that struggle. However, we should be aware that the struggle is likely going to become more difficult, though if we can win a few important elections -- we can blunt some of the blows.

And remember, that the only way to overcome RTW both legislatively and on the ground is to organize.

Solidarity.

Expanding the Umbrella: Medicaid Expansion 2015 Review and New Year's Preview

With 2016 right around the corner, and several new governors moving into office, it's as good of time as any to take stock of where the Medicaid expansion has gone and the prospects for progress in the new year.  Despite massive Democratic setbacks at the state level in the 2014 midterm elections, Medicaid expansion fared reasonably well in 2015, and 2016 posts several opportunities for new states to expand as well, as well as one at risk of backsliding.

First, we visit the ghosts of Medicaid expansion past:

As Chart I shows,  the ACA Medicaid expansion has proceeded at a similar overall pace to the original Medicaid take-up in the late 1960s, though the holdouts to Obamacare are likely to offer stiffer resistance than the late adopters of the initial program.

Democratic defeats in the 2014 elections likely prevented expansions in Maine and possibly Florida, and may have influenced resistance to expansion plans in several other states, including Tennessee, Utah and Wyoming. However, Four new states joined the expansion -- Indiana, Pennsylvania, Alaska, and Montana -- which increases the number of states fully expanding Medicaid from 26 to 30. 

Head below the fold for state-by-state analysis and a peak at 2016.