Showing posts with label Ohio. Show all posts
Showing posts with label Ohio. Show all posts

Wednesday, April 6, 2016

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.

Saturday, February 6, 2016

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).


Monday, January 4, 2016

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.

Sunday, March 8, 2015

Obamacare is about People, not States



On January 30, Ezra Klein posted an insightful Vox piece about one of the great ironies of the Affordable Care Act.  After a lot of thought of my own, however, I don’t think it’s much of an irony at all. 

Klein’s analysis noted that the original ACA – supported heavily by Democrats – featured a massive redistribution of wealth from Blue States to Red States.  The people helped by Obamacare’s Medicaid expansion and exchange subsidies were disproportionately concentrated in the states of the ex-Confederacy that had low-wage economies with skimpy existing Medicaid programs. (An old joke in Mississippi claims that you have to be legally dead to qualify).

The irony that Klein points out has been that Republicans are fighting tooth and nail to turn the ACA into a program that drains money from Red states and transfers it to Blue States. When the Supreme Court held that the Medicaid Expansion had to be optional for states, many states dominated by Republicans declined the expansion while Blue States snapped it up, shifting the benefits flow from Red States to Blue States If the Supremes decide the case of King vs. Burwell in favor of the forces of darkness, it will declare subsidies on exchange marketplaces illegal – but only in the states on the federal exchange, which of course are disproportionately Red States. As a result, higher earners in Texas will be sending their increased Medicare taxes to poor and working-class people in states like New York and California while their own states lose out.

It’s an interesting puzzle, but I think it can be explained quite easily – at least on the liberal side of the equation – by changing our unit of analysis. Klein looks at states, but I think it makes more sense to look at people to explain this paradox. On some issues, perhaps it makes sense to look at issues as state vs. state.  If a major manufacturer decides to leave one state and move to a second, for example then pretty clearly the second state is better off relative to the first. Politicians will act accordingly and line up state against state.  

But the motivating purpose behind the Affordable Care Act wasn’t about New York vs. Texas, it was about 48 million people in the United States who didn’t have health insurance. Ohio Senator Sherrod Brown didn’t refuse to take federal health insurance because Florida got more Medicaid dollars than Ohio, but rather in solidarity with millions of Floridians and Ohioans who didn’t have access to health care at all. If Mississippi took $14.5 billion in federal money over the next decade to expand Medicaid, I wouldn’t be mad that that money wasn’t going to Pennsylvania, my latest state of residence; I’d be celebrating because 169,000 of my fellow citizens got access to health care.

On the flip side, the logic is perhaps more difficult to explain for a Red State GOP governor like Rick Perry or Mississippi’s Phil Bryant. There’s the potential that they just don’t understand it. Perry recently suggested that millions of Texans liked not having insurance, which may represent a weak dodge or actual ignorance of reality. But there’s also the possibility it’s about people for them too – specifically “those people” who are poor and likely have a darker hue of skin and are viewed as undeserving of federal benefits. Politicians used to be able to wrangle earmarks and pork for their state , which reduces the role of ideology, but ideological sorting and polarization has been getting stronger over the last 40 years. As a result, politicians who rely on bringing home federal dollars to get votes find themselves facing tough primaries – like the one Thad Cochran barely survived in Mississippi in 2014.

We can solve Klein’s puzzle then by re-imagining the pieces. It’ not about cash flows to states, it’s about people – and whether a state official’s ideological blinkers permit those without access to health care to be seen as human beings deserving of compassion or dignity.

Saturday, December 21, 2013

Court upholds Ohio Medicaid expansion

Good news, via Ideastream (NE Ohio's public broadcaster)

The state’s highest court says it is constitutional to allow the controlling board, a panel of legislative leaders, to allow the Medicaid department to accept the federal funds that would allow for expansion of Medicaid. 

The Ohio General Assembly didn't vote to expand Medicaid, but Gov. John Kasich used the state's budget controlling board -- made up by several legislative leaders (several handpicked by Kasich) to accept the federal grants. The state Supreme Court ruled 4-3  that the board acted within its rights to accept the money for Ohio's Medicaid.

I'd have rather it gone through the legislature, but I'll take it -- as will the 275,000 Ohioans who are going to get health insurance.

Also, there's a long-term issue here -- the board has the power to accept grant money, but it has very limited power to expend state funds. Starting in 2017, the legislature is going to have to vote state monies to cover the state's share of the expansion or lose the federal money. By then of, course, we hope that the expansion will be tough to take away and the ledge will come in line. 

Monday, October 21, 2013

Ohio accepts Medicaid expansion

This is very, very good news.  The plan means another 275,000 people get insurance coverage.

Via the Toledo Blade (which by the way, is a great name for a newspaper):

A little known budgetary panel today voted 5-2 to accept $2.56 billion in federal funds to pay for the controversial expansion of the federal-state health insurance of last resort.
Two Republicans joined the panel’s two Democrats and Gov. John Kasich’s appointed chairman to do what the 132-member General assembly would not — expand eligibility for Medicaid to some 275,000 additional Ohioans.
Kasich found himself in a similar position to fellow Republican Michigan Gov. Rick Snyder. He understood that accepting the Medicaid expansion was the right thing to do from a budget standpoint, but had to overcome the ideology of conservatives in the legislature.  Snyder was able to cut a deal between moderate Republicans, Democrats and the Department of Health and Human Services to pass an expansion.

Kasich couldn't get the legislature to take it seriously, so he outflanked them by using this legislative panel that generally acts to review budget grants and accept federal funds that become available after a two-year budget is passed.

Credit where credit is due; I'm no Kasich fan, but he did the right thing here (with a bit of help from moderate Republicans, Democrats and a whole bunch of activists and experts pushing for him to accept the expansion).

A little known budgetary panel today voted 5-2 to accept $2.56 billion in federal funds to pay for the controversial expansion of the federal-state health insurance of last resort.
Two Republicans joined the panel’s two Democrats and Gov. John Kasich’s appointed chairman to do what the 132-member General assembly would not — expand eligibility for Medicaid to some 275,000 additional Ohioans.

Read more at http://www.toledoblade.com/State/2013/10/21/State-budgetary-panel-votes-to-accept-2-56B-in-federal-funds-for-Medicaid-expansion.html#Xe4UK5EXhgQswPxc.99
A little known budgetary panel today voted 5-2 to accept $2.56 billion in federal funds to pay for the controversial expansion of the federal-state health insurance of last resort.
Two Republicans joined the panel’s two Democrats and Gov. John Kasich’s appointed chairman to do what the 132-member General assembly would not — expand eligibility for Medicaid to some 275,000 additional Ohioans.

Read more at http://www.toledoblade.com/State/2013/10/21/State-budgetary-panel-votes-to-accept-2-56B-in-federal-funds-for-Medicaid-expansion.html#Xe4UK5EXhgQswPxc.99
A little known budgetary panel today voted 5-2 to accept $2.56 billion in federal funds to pay for the controversial expansion of the federal-state health insurance of last resort.
Two Republicans joined the panel’s two Democrats and Gov. John Kasich’s appointed chairman to do what the 132-member General assembly would not — expand eligibility for Medicaid to some 275,000 additional Ohioans.

Read more at http://www.toledoblade.com/State/2013/10/21/State-budgetary-panel-votes-to-accept-2-56B-in-federal-funds-for-Medicaid-expansion.html#Xe4UK5EXhgQswPxc.99
A little known budgetary panel today voted 5-2 to accept $2.56 billion in federal funds to pay for the controversial expansion of the federal-state health insurance of last resort.
Two Republicans joined the panel’s two Democrats and Gov. John Kasich’s appointed chairman to do what the 132-member General assembly would not — expand eligibility for Medicaid to some 275,000 additional Ohioans.

Read more at http://www.toledoblade.com/State/2013/10/21/State-budgetary-panel-votes-to-accept-2-56B-in-federal-funds-for-Medicaid-expansion.html#Xe4UK5EXhgQswPxc.99