Walmart drops price of virtual visits from $40 to $4

Image result for telemedicine

Walmart is offering employees a 90 percent discount on telemedicine, dropping the price of a virtual visit from $40 to $4, The Denver Post reports.

The retailer reduced the cost of telemedicine services Jan. 1 to increase options for employees seeking care, a spokesperson confirmed to Becker’s Hospital Review. Walmart’s health benefits currently cover more than 1 million people enrolled it its Associates’ Medical Plan. Through this plan, virtual visits through the Doctor On Demand app are covered like a normal physician’s office visit.

Walmart is one of many employers to offer telemedicine benefits to workers. Eighty percent of large and midsize companies offered the benefit in 2018, according to the report. However, factors like emotion, forgetfulness and preference have kept utilization down. Just 8 percent of employees at large and midsize companies used telemedicine benefits in 2017, according to the report.

Read more here.  

300 nurses walk off job at Pennsylvania hospital

Image result for nurses strike

More than 300 Indiana (Pa.) Regional Medical Center nurses went on strike on Nov. 26, according to a KDKA report.

Nurses walked off the job at 7 a.m., despite hospital leaders previously asking them to cancel the strike due to the $1.5 million in estimated costs to hire temporary workers.

Nurses initially scheduled a one-day strike. But hospital leaders have said striking nurses who don’t report to work Nov. 26 won’t be able to return to work for an additional four days because of a minimum five-day commitment required to hire temporary staff.

According to the report, no scheduled surgeries and appointments were canceled due to the strike.

The hospital has been in negotiations with the Indiana Registered Nurses Association, which represents about 380 nurses at the hospital. Health insurance costs and wages reportedly have been key sticking points in the negotiations.

Both sides are scheduled to return to the bargaining table Nov. 29.

California Unions Secure 12% Raises from Kaiser Permanente, Dignity Health

Image result for flexing muscles

Under the terms of separate, five-year contracts, about 34,000 workers in the state expect their wages to rise at least 12%, with lump sum payments added thereafter.

Two labor unions in California announced Monday that they have reached separate contract deals with major providers in the state.

Oakland-based Kaiser Permanente, which operates 21 medical centers and other facilities in central and northern California, agreed to a 12% across-the-board wage increasefor the 19,000 registered nurses and nurse practitioners it employs, according to the California Nurses Association (CNA).

San Francisco-based Dignity Health, which operates throughout California, agreed to a 13% wage increase over five years for the 15,000 union members it employs as healthcare workers, according to SEIU-United Healthcare Workers (UHW) West.

The five-year deal with Kaiser Permanente is pending ratification by CNA members, while SEIU-UHW members already ratified their five-year deal with Dignity Health.

“Our new contract maintains employer-paid family healthcare and provides rising wages, and that security and peace of mind enables us to focus on caring for our patients,” Dennis Anderson, a laboratory assistant who works for Dignity at Mercy Hospital in Folsom, California, said in a statement.

The deal details: Kaiser Permanente

The tentative agreement with Kaiser Permanente will ultimately benefit patients, according to CNA Executive Director Bonnie Castillo.

“Protecting the economic security of our future RNs is essential to defending the health of everyone who will be a patient today and tomorrow,” Castillo said in a statement. “This agreement gives us a strong foundation for health security for Kaiser nurses and patients for the next five years in a turbulent time of health care in our state and nation.”

Key provisions of the contract, according to CNA, include the following:

  • Additional staffing: Kaiser will add 150 RN full-time-equivalents to assist in its migration to a new computer system, with 106 of those positions to be posted within 90 days of the contract’s ratification.
  • One wage scale: Kaiser agreed to withdraw a proposed four-tier wage scale for RN/NP new hires—a proposal the union said would otherwise “promote workplace divisions between current nurses and new RN graduates.”
  • Wage increases: The agreement calls for 12% wage increases for all RNs and NPs, with a 3% lump sum over five years.

The agreement also calls for 600 formerly non-union RN patient care coordinators to be included in the contract with the other RNs and NPs employed by Kaiser.

A spokesperson for Kaiser Permanente could not be immediately reached Tuesday for comment.

The deal details: Dignity Health

The ratified agreement between SEIU-UHW and Dignity Health—which lasts through April 30, 2023—includes the following key provisions, according to the union:

  • Benefits: Union members employed by Dignity will keep their fully paid, employer-provided family healthcare.
  • Wage increases: Workers secured 13% raises over five years, with a 1% bonus in the second year.
  • Funding for training: Dignity also agreed to contribute another $500,000 annually to a joint labor-management training program designed to keep workers on top of the latest changes in healthcare, the union said.

This deal comes as Dignity Health prepares to merge with Catholic Health Initiatives, based in Chicago, which would form one of the largest nonprofits in the country.

A spokesperson for Dignity Health could not be immediately reached Tuesday for comment.

The erosion of worker compensation

Corporate profits have dramatically outpaced wages and health benefits since the turn of the century, leaving workers on the hook for more of their health care costs even as their purchasing power falls, according to a review of federal data.

Key quote: “If I were a middle-class American, I’d be outraged,” said Regina Herzlinger, a professor at Harvard Business School. “I’d demand much greater transparency about how much I’m getting in health insurance and wages.”

The bottom line: American workers have not seen their wages grow in tandem with the success of their employers.

Meanwhile, health spending has been growing faster than the broader economy. Health benefits consequently are getting more expensive for employers to offer, and companies are responding by making employees shoulder more of their own health care costs — either through higher premiums or higher out-of-pocket costs, like deductibles and copays.

What it means: Health care is eating up a bigger share of paychecks that already don’t go as far as they used to.

  • “Plans are getting less generous because (employers) are paying more in absolute dollars,” said Michael Chernew, a health economist at Harvard Medical School.
  • “Your health benefit being 10% of your compensation isn’t as meaningful today as it was 15 years ago because spending on health care has grown more quickly,” added Erin Trish, a health policy professor at the University of Southern California.
  • “If a hospital visit is expensive, someone — either the employer or the worker — is going to pick up that cost,” said Matt Fiedler, a fellow at the Brookings Institution.

Yes, but: Economists say reducing the generosity of employer health plans is not necessarily a bad thing, because generous plans might encourage people to use more health care services than they need.

Plus, “the idea that an employer should be deciding what kind of health care benefits an employee gets is kind of crazy,” said Dean Baker, an economist at the Center for Economic and Policy Research. But, Baker adds, there has to be a viable health care alternative for workers.

What to watch: Whether employee compensation increases more quickly, especially as companies predict even bigger profits under the GOP tax plan.

  • There is no evidence the temporary, one-off bonuses announced by many companies, and attributed to the Republican tax cut bill, will drastically change the stagnant trajectory of worker compensation.

The details: The data are from the U.S. Bureau of Economic Analysis. The growth of three economic indicators — corporate profits, wages, and money employers spent on health insurance for their employees — were compared with overall economic growth over the past 16 years. Health coverage and wages were singled out because workers often value those compensation items most when they take a job.

The analysis showed:

  • Corporate profits were 4.7% of the U.S. economy in 2000 and climbed to 9.1% by 2016.
  • Employer health coverage mostly stayed flat, going from 3.2% of GDP in 2000 to 3.7% in 2016.
  • Salaries and wages decreased quite a bit. They represented almost 47% of the economy in 2000 and dropped to 43.4% in 2016.

Judge rules against Berkshire Medical Center in court battle over planned nurse strike

Image result for nurse strike

Pittsfield, Mass.-based Berkshire Medical Center lost its court battle to avert a planned Oct. 3 nurse strike, according to a report on

The 298-bed community hospital filed a legal request for an injunction to avert the planned strike last month. However, U.S. District Judge Mark Mastroianni in Springfield, Mass., denied Berkshire Medical Center’s request Friday, meaning the 24-hour walkout is still scheduled, according to the report.

In response to the judge’s ruling, the Massachusetts Nurses Association, which represents nearly 800 Berkshire Medical Center nurses, told Becker’s via email: “If the hospital was really serious about doing anything to stop the strike, they would negotiate in good faith over the patient care conditions nurses are seeking. As [the] federal judge’s ruling shows, nurses have a legally protected right to advocate for themselves and their patients. BMC nurses are prepared to strike for 24 hours, but still hope that management does this right thing, returns to the bargaining table and seeks a fair agreement.”

Berkshire Medical Center expressed disappointment in the judge’s ruling.

“This strike does not serve anyone’s best interests — not the nurses, not the hospital’s and not the community’s, and can only serve to harm all three,” the hospital said in an emailed statement to Becker’s. “We are fully prepared to provide uninterrupted care throughout the five-day period and have been preparing for this eventuality for several months. The fact that this is the third such strike by the MNA since June makes it evident that this is a tactic the union is using to promote its statewide political agenda.”

Both sides have been negotiating for about a year, with key sticking points including staffing and health insurance. The 24-hour strike is scheduled to begin at 7 a.m. Oct. 3 and last until 7 a.m. Oct. 4. At that point, hospital officials have said nurses won’t be able to return to work for another four days because Berkshire Medical Center hired replacement workers for a minimum five-day contract. The MNA has also scheduled a “patient safety vigil” Oct. 2 prior to the planned strike.


The Real Reason the U.S. Has Employer-Sponsored Health Insurance

Image result for The Real Reason the U.S. Has Employer-Sponsored Health Insurance

The basic structure of the American health care system, in which most people have private insurance through their jobs, might seem historically inevitable, consistent with the capitalistic, individualist ethos of the nation.

In truth, it was hardly preordained. In fact, the system is largely a result of one event, World War II, and the wage freezes and tax policy that emerged because of it. Unfortunately, what made sense then may not make as much right now.

Well into the 20th century, there just wasn’t much need for health insurance. There wasn’t much health care to buy. But as doctors and hospitals learned how to do more, there was real money to be made. In 1929, a bunch of hospitals in Texas joined up and formed an insurance plan called Blue Cross to help people buy their services. Doctors didn’t like the idea of hospitals being in charge, so some in California created their own plan in 1939, which they called Blue Shield. As the plans spread, many would purchase Blue Cross for hospital services, and Blue Shield for physician services, until they merged to form Blue Cross and Blue Shield in 1982.

Most insurance in the first half of the 20th century was bought privately, but few people wanted it. Things changed during World War II.

In 1942, with so many eligible workers diverted to military service, the nation was facing a severe labor shortage. Economists feared that businesses would keep raising salaries to compete for workers, and that inflation would spiral out of control as the country came out of the Depression. To prevent this, President Roosevelt signed Executive Order 9250, establishing the Office of Economic Stabilization.

This froze wages. Businesses were not allowed to raise pay to attract workers.

Businesses were smart, though, and instead they began to use benefits to compete. Specifically, to offer more, and more generous, health care insurance.

Then, in 1943, the Internal Revenue Service decided that employer-based health insurance should be exempt from taxation. This made it cheaper to get health insurance through a job than by other means.

After World War II, Europe was devastated. As countries began to regroup and decide how they might provide health care to their citizens, often government was the only entity capable of doing so, with businesses and economies in ruin. The United States was in a completely different situation. Its economy was booming, and industry was more than happy to provide health care.

This didn’t stop President Truman from considering and promoting a national health care system in 1945. This idea had a fair amount of public support, but business, in the form of the Chamber of Commerce, opposed it. So did the American Hospital Association and American Medical Association. Even many unions did, having spent so much political capital fighting for insurance benefits for their members. Confronted by such opposition from all sides, national health insurance failed — for not the first or last time.

In 1940, about 9 percent of Americans had some form of health insurance. By 1950, more than 50 percent did. By 1960, more than two-thirds did.

One effect of this system is job lock. People become dependent on their employment for their health insurance, and they are loath to leave their jobs, even when doing so might make their lives better. They are afraid that market exchange coverage might not be as good as what they have (and they’re most likely right). They’re afraid if they retire, Medicare won’t be as good (they’re right, too). They’re afraid that if the Affordable Care Act is repealed, they might not be able to find affordable insurance at all.

This system is expensive. The single largest tax expenditure in the United States is for employer-based health insurance. It’s even more than the mortgage interest deduction. In 2017, this exclusion cost the federal government about $260 billion in lost income and payroll taxes. This is significantly more than the cost of the Affordable Care Act each year.

This system is regressive. The tax break for employer-sponsored health insurance is worth more to people making a lot of money than people making little. Let’s take a hypothetical married pediatrician with a couple of children living in Indiana who makes $125,000 (which is below average). Let’s also assume his family insurance plan costs $15,000 (which is below average as well).

The tax break the family would get for insurance is worth over $6,200. That’s far more than a similar-earning family would get in terms of a subsidy on the exchanges. The tax break alone could fund about two people on Medicaid. Moreover, the more one makes, the more one saves at the expense of more spending by the government. The less one makes, the less of a benefit one receives.

The system also induces people to spend more money on health insurance than other things, most likely increasing overall health care spending. This includes less employer spending on wages, and as health insurance premiums have increased sharply in the last 15 years or so, wages have been rather flat. Many economists believe that employer-sponsored health insurance is hurting Americans’ paychecks.

There are other countries with private insurance systems, but none that rely so heavily on employer-sponsored insurance. There are almost no economists I can think of who wouldn’t favor decoupling insurance from employment. There are any number of ways to do so. One, beloved by wonks, was a bipartisan plan proposed by Senators Ron Wyden, a Democrat, and Robert Bennett, a Republican, in 2007. Known as the Healthy Americans Act, it would have transitioned everyone from employer-sponsored health insurance to insurance exchanges modeled on the Federal Employees Health Benefits Program.

Employers would not have provided insurance. They would have collected taxes from employees and passed these onto the government to pay for plans. Everyone, regardless of employment, would have qualified for standard deductions to help pay for insurance. Employers would have been required to increases wages over two years equal to what had been shunted into insurance. Those at the low end of the socio-economic spectrum would have qualified for further premium help.

This isn’t too different from the insurance exchanges we see now, writ large, for everyone. One can imagine that such a program could have also eventually replaced Medicaid and Medicare.

There was a time when such a plan, being universal, would have pleased progressives. Because it could potentially phase out government programs like Medicaid and Medicare, it would have pleased conservatives. When first introduced in 2007, it had the sponsorship of nine Republican senators, seven Democrats and one independent. Such bipartisan efforts seem a thing of the past.

We could also shift away from an employer-sponsored system by allowing people to buy into our single-payer system, Medicare. That comes with its own problems, as The Upshot’s Margot Sanger-Katz has written. She also has covered the issues of shifting to a single-payer system more quickly.

It’s important to point out that neither of these options has anything even close to bipartisan support.

Without much pressure for change, it’s likely the American employer-based system is here to stay. Even the Affordable Care Act did its best not to disrupt that market. While the system is far from ideal, Americans seem to prefer the devil they know to pretty much anything else.

Taking A U-Turn On Benefits, Big Employers Vow To Continue Offering Health Insurance

Taking A U-Turn On Benefits, Big Employers Vow To Continue Offering Health Insurance

The shrinking unemployment rate has been a healthy turn for people with job-based benefits.

Eager to attract help in a tight labor market and unsure of Obamacare’s future, large employers are newly committed to maintaining coverage for workers and often their families, according to new research and interviews with analysts.

Two surveys of large employers — one released Aug. 2 by consultancy Willis Towers Watson and the other out Tuesday from the National Business Group on Health, show companies continue to try to control costs while backing away from shrinking or dropping health benefits. NBGH is a coalition of large employers.

“The extent of uncertainty in Washington has made people reluctant to make changes to their benefit programs without knowing what’s happening,” said Julie Stone, a senior benefits consultant with Willis Towers Watson. “They’re taking a wait-and-see attitude.”

That’s a marked change from three years ago, when many big employers — those with 1,000 employees or more — contemplated ending medical benefits and shifting workers to the Affordable Care Act’s marketplaces.

In 2014, only 25 percent of big companies were “very confident” they would have a job-based health plan for employees in 10 years, according to the Willis Towers Watson survey.

This year, 65 percent expected to offer health benefits in a decade. And 92 percent said they were very confident a company-based health plan would exist in five years.

Many managers once eyed Obamacare marketplaces as workable coverage alternatives despite the law’s requirement that employers offer health insurance, analysts said.

But problems with marketplace plans, including fewer offerings, rising premiums and shrinking medical networks, have made employers think twice, they said.

Another big reason to maintain rich coverage is “the strength of the economy,” said Paul Fronstin, director of health research at the Employee Benefit Research Institute, an industry group. “Employers are doing what they have to do to get the right workers.”

Unemployment has fallen from 9.9 percent when Obamacare became law in 2010 to 4.3 percent last month, which equaled a 16-year low reached in May.

With such a steep decline, he added, “employers are thinking, ‘We need to offer this benefit for recruitment and retention.’”

Second Thoughts On High-Deductible Plans

Companies are even rethinking the long-standing expedient of shifting a portion of rising medical costs to employees through high-deductible plans and a greater share of the premium bill, other research shows.

“Employers are beginning to recognize that cost sharing has its limits,” said a June report from PwC, a multinational professional services network. Low unemployment and competition for workers mean “employers have less appetite for scaling back benefits and continuing with a plan design that has proven largely unpopular.”

At Fidelity Investments, a Boston-based financial firm with more than 45,000 employees, worker contributions have grown to about 30 percent of total health costs.

Jennifer Hanson, the company’s benefits chief who sits on NBGH’s board, doesn’t see that continuing.

As costs grow, “if you continue to shift more of a bigger number to employees, health care becomes unaffordable,” she said in an interview. “As employers, we really do need to pay attention less to who’s paying for what and more to how much everything costs.”

More than half of Americans with job-based insurance face deductibles — out-of-pocket costs for most care before insurance kicks in — of more than $1,000 for single-person coverage. Family deductibles can be much higher.

High On The To-Do List: Controlling Drug Costs

Big employers’ planned changes for next year focus on controlling drug costs and improving health results through telemedicine and steering patients to efficient, high-quality hospitals, noted the Willis Towers Watson report and the NBGH survey.

Employer health costs continue to rise, but not at the double-digit clip seen for many plans sold to individuals and families through the ACA marketplaces.

Employers expect health costs to increase 5.5 percent next year, up from 4.6 percent in 2017, according to the Willis Towers Watson report.

Companies in the NBGH survey predicted health costs will rise 5 percent next year, up from an average 4.1 percent increase for 2016.

That’s still far faster than inflation, which is less than 3 percent, and overall wage growth.

By many accounts, soaring costs for specialty pharmaceuticals used to treat cancer, rheumatoid arthritis, hemophilia and other complex conditions are the biggest factor.

“These are very expensive drugs,” said Brian Marcotte, NBGH’s CEO. “They cost thousands or tens of thousands per treatment.”

Often these drugs require infusion into the blood in a clinical setting, which can drive up their price tag.

For instance, hospital-based infusions have been found to cost as much as seven times more than those performed in, say, a doctor’s office.

Employers are working hard to steer patients to the least expensive, appropriate site, Marcotte said.

Big employers are also offering more on-site nurses and doctors; setting up accountable care organizations with incentives for doctors and hospitals to control costs; and striking deals with particular hospitals for high-cost operations such as transplants and joint replacements, the NBGH survey found.

Job-based insurance covers some 160 million people younger than 65, according to Census and Labor Department data, far more than the 10 million or so insured by plans sold through Obamacare marketplaces.

Government employers and companies with at least 500 workers, which historically have been more likely to offer health benefits than smaller employers, cover more than 90 million employees and dependents.

Willis Towers surveyed 555 large employers with about 12 million workers and dependents. NBGH surveyed 148 large companies with more than 15 million employees and dependents.

California Employer Health Benefits: Prices Up, Coverage Down

Image result for California Employer Health Benefits: Prices Up, Coverage Down

Since 2000, the percentage of employers offering health benefits has declined in California and nationwide, although coverage rates among offering firms have remained stable. Only 55% of California firms reported providing health insurance to employees in 2016, down from 69% in 2000. Implementation of the Affordable Care Act (ACA) in 2014 does not appear to have impacted the overall trend in employer offer rates.

Nineteen percent of California firms reported that they increased cost sharing in the past year, and 27% of firms reported that they were very or somewhat likely to increase employees’ premium contribution in the next year. The prevalence of plans with large deductibles also continues to increase.

California Employer Health Benefits: Prices Up, Coverage Down presents data compiled from the 2016 California Employer Health Benefits Survey.