Thursday, December 10, 2009, 10:46 PM - Political developmentsNow that you're thoroughly tired of reading about Tiger Woods, Adam Lambert and the debate over Climategate, you may be ready to spend a cold December eve by the fire reading some wonkish studies.
Settle into your armchair. Put your feet up. We have a study for you, the CHSWC Report on Self-Insurance Groups. The study, prepared in response to a request by Joe Coto, Chair of the California Assembly Insurance Committee, was approved today by CHSWC at its meeting in Oakland.
This study may put most folks to sleep, but you wonks know who you are.
Here's the study:
http://www.dir.ca.gov/chswc/Reports/200 ... Report.pdf
For those who want to gain a deep understanding of the comp system, dive in.
The study summarizes the history of group self-insurance in California, summarizes regulatory provisions, and makes extensive recommendations, including some draft legislative language.
I suspect we'll see many of the study recommendations included in coming legislation.
Tuesday, December 8, 2009, 10:55 PM - Political developmentsTonight's New York Times website has an article by Robert Pear noting that Harry Reid claims a deal has been reached on healthcare reform's "public option" concept. If so, the details are not yet publicly confirmed.
Reid has been convening a group of 10 Senators, 5 so-called progressives and 5 so-called moderates.
Apparently the deal is based on allowing a federal agency to negotiate nationwide health plans with insurance companies. The federal Office of Personnel Management already handles insurance for federal employees.
This is the plan that already covers members of Congress.
People aged 55 to 64 would be allowed to "buy in"to Medicare.
With so few details available, many senators and interest groups are in the dark tonight on this proposal.
The article in The Times notes that the American Medical Association and the American Hospital Association are concerned about the plan, fearing that Medicare payments does not adequately compensate their members.
The plan will be sent to the Congressional Budget Office for analysis.
But don't pop the champagne yet.
The lone Republican who voted to move the Senate bill forward, Maine's Olympia Snowe, is said to be wary of this latest emerging proposal:
Without Snowe's support, it's hard to see how Reid can reach the Holy Grail of 60 votes.
Snowe is apparently concerned about expanding Medicare and Medicaid. That plan emerged in part as a salve to liberals/progressives who have been demanding a "public option".
Meanwhile, abortion politics continues to shadow the healthcare reform debate. Today the Senate voted down Nebraska Senator Ben Nelson's amendment to restrict abortion coverage in health insurance exchanges created in the Senate bill. A similar provision (known as the Stupak amendment) did get included in the House healthcare bill.
But Nelson has threatened to vote against a bill that does not include such a provision.
The country's healthcare system may be forever reformed soon. Or not.
Sunday, December 6, 2009, 10:24 PM - Political developments(As the year winds down, Workerscompzone will be giving lots of attention to the national healthcare reform debate; that debate, which could have tangential impact on the workers' comp system, is in its critical phase....)
Recent polls have shown broad public support for elements of health care reform, but a majority in opposition to the House and Senate versions of health care reform. An average of polls noted by the site Real Clear Politics shows 40% of the public in favor and 49% opposed.
The public is undoubtedly hopelessly confused by competing arguments
and advertisements. Few Americans really understand the concepts being debated, much less the details. Disabled workers and the workers' comp "community" have a vital interest in what sort of national healthcare plan emerges. But I find that very few folks are discusing it, and most seem blithely unconcerned.
There's much more concern about the shenanigans of Tiger Woods than about a "public option".
What's up here?
Take a look at the excellent piece by analyst Jay Cost, who attempts to explain why it is that the public seems enthused by many of the benefits of health care reform, but concerned about other aspects. The article is "Why Does the Public Oppose Obamacare?"
http://www.realclearpolitics.com/horser ... e_oba.html
Cost argues that the public favors current reform plans for two reasons:
the possibility of increased control over healthcare costs and the promise of increased security, since exclusions for preexisting conditions would be banned.
On the negative side, he cites concerns which lead many to oppose reform:
-concern that premiums will actually rise
-concern over Medicare cuts
-concern that taxes will be increased
-concern that reforms will increase the deficit by increasing entitlement programs
-dislike of Congressional deals that are made to garner support of particular politicians
-intolerance for the risk inherent in changing the system
Cost is probably right about these concerns. The President and Congressional Democrats are not totally in control of the message.
Republicans have been almost uniformly negative on any reform package. Some of the Republican message has been principled; but some has been demagogic.
I think Ezra Klein of the Washington Post is right:
"...the greatest disappointment is that 5 or 10 Republicans didn't come together and create a voting bloc for a bill with better cost controls..."
So we have an ongoing process where Nevada's Harry Reid attempts to broker a bill which will garner 60 Senate votes.
Issue after issue pops up. Senators Lieberman, Collins and Specter seek to challenge deals Obama cut with the hospital industry. Their bill would impose penalties on hospitals with high infection rates.
North Dakota's Byron Dorgan pushes a bill to allow drug importation from Canada.
Florida's Bill Nelson pushes a plan to move millions of seniors from Medicare to Medicaid, saving billions by that maneuver (apparently Medicaid has more bargaining power over costs)
The AARP, with Congressional allies, focuses on the Independent Medicare Advisory Board. Why should the board focus only on Medicare? Why not look at all medical costs? Should the Advisory board be strengthened, or weakened?
Seniors (who vote is large numbers) are worried.
Blanche Lincoln of Arkansas pushes an amendment to limit deductibility for compensation on top insurance executives.
Nevada's John Ensign pushes a limit on contingency fees for plaintiff attorneys in malpractice suits.
Harry Reid convenes a group of 10 Senate moderates and 10 Senate progressives. One focus will be on developing a non-public option option based on the Federal employee health plan, which would be expanded.
And that's not to mention arguments over how reforms will deal with abortion coverage and illegal immigrants. Could the whole enterprise go down in flames over those hot button issues?
As you can see, Harry Reid has his hands full.
Crunch time is coming. Personally, I see Reid as a historic figure. You might think he is bumbling, but he's the consummate deal-maker.
I do believe there will be a bill.
Details of the Senate version are changing as we speak. But here is a worthy analysis by the UC Berkeley Labor Center, which compares the House and earlier Senate versions:
http://laborcenter.berkeley.edu/healthp ... mary09.pdf
Friday, December 4, 2009, 07:08 AM - Political developmentsIn a recent post I examined California's workers' comp user funding assessments:
http://www.workerscompzone.com/index.ph ... 129-222117
Those assessments provide a dedicated revenue stream for operation of the WCAB and its programs. And they also provide a dedicated fund for
safety and labors standards enforcement programs.
Carrie Nevans, the DWC acting administrator, expounded on the user funding concept in a recent letter to David DePaolo of Workcompcentral:
"User funding provides a fully vetted, stable funding source for Department of Industrial Relations (DIR) programs, which help ensure employers in California have a level playing field on which to do business. There has never been a more important time to be sure that California’s legitimate, law abiding employers are not undercut by scofflaws who do not provide workers’ compensation insurance, create effective health and safety programs or pay benefits to their injured workers.
"Mr. DePaolo’s assertion that user funding constitutes taxation without representation is patently false. The Legislature, which is elected by the people and represents the people, creates, reviews and approves the state budget—including the DIR budget. Being user-funded doesn’t mean nobody is scrutinizing the budget—it simply means the DIR’s budget money is in an account that is separate from the General Fund. "
"Any proposed changes to DIR’s baseline budget (the budget amounts already approved by the Legislature) are reviewed in a very public process: First, all proposals are reviewed by the Department of Finance before they are incorporated into the governor’s proposed budget each January. Upon release of the January budget, the proposals are likewise reviewed by the Legislative Analyst’s Office, which provides advice and recommendations to the Legislature. The Senate and Assembly each have budget committee meetings, during which the budget proposals are scrutinized. Department staff is called in to these committee meetings to answer questions and provide information about budget changes. Public testimony is received by the Legislature during budget hearings as well. Ultimately, a final bill is crafted through joint committee meetings and sent to the governor for final approval. "
"Nothing is hidden here: The governor’s proposed budget is a public document, the Assembly and Senate proposed bills are public—even the committee meetings are public. "
"It is important to note that the Workers’ Compensation Administration Revolving Fund (WCARF) assessments have fluctuated up and down since 2005 to reflect budget needs: there was a 2% decrease in WCARF assessments between 2005 and 2006, a 21% increase between 2006 and 2007, a 15% decrease between 2007 and 2008 and a 20% increase between 2008 and 2009."
"Additionally, while overall workers’ compensation claims frequency has decreased—and that’s a positive result of workers’ compensation reforms enacted by the Schwarzenegger Administration—the tail of disputed cases, and all the attendant liens, being heard before the Workers’ Compensation Appeals Board represents the bulk of the DWC’s workload. Even with reforms, an average of 20% of all claims are still disputed, so until the decrease in claim frequency results in a decrease in the number of disputed cases being opened—likely a few years off—the division will still be adjudicating a large number of cases annually. "
"User funding is an investment in the present and the future. In the present, DIR is able to level the playing field for legitimate employers through effective enforcement and education—a vital process for the state’s economic well-being. And it allows the department to modernize and build sustainable systems and create efficiencies for California’s future. "
Generally, I agree with Nevans on user funding. But I can also see some merit in the thrust of DePaolo's concerns. Users (workers, insurers, attorneys, employers, lien claimants) at the WCAB are getting less service, with the impact of furloughs on the WCAB. Nevans and DIR head John Duncan were obviously not able to convince the Governor to exempt the WCAB and other DIR entities from furloughs.
Were efforts made to do that? If not, why not? I'm sure that the answer is politics, the politics of the budget crisis. Other non-workers' comp state agencies with targeted funding programs have furloughs, I believe.
The Governor was not willing to use a scalpel rather than a sword.
But it's understandable that some within the comp community might be cranky.
At the end of the day though, let's be glad we are user funded.
Thursday, December 3, 2009, 08:19 AM - Political developmentsYesterday the NFL announced a new policy on player concussion injuries.
This comes after mounting evidence that there may be links between concussions and dementia in former players. It's an issue I blogged about
earlier this fall:
http://www.workerscompzone.com/index.ph ... 929-222652
Many of these NFL players will wind up in California's workers' comp system.
Here is the NFL's statement announcing stronger concussion guidelines:
http://blogs.nfl.com/2009/12/02/league- ... uidelines/
However, it appears that many NFL players often hide head injuries. This year the Associated Press interviewed approximately 10% of current NFL players. 30 of 160 players interviewed admitted that they had "Hidden or played down the effects of a concussion".
Here's the article by Howard Fendrich:
http://www.sfgate.com/cgi-bin/article.c ... 1AMR9V.DTL
But with all the increased focus on the concussion issue, will players be more willing to admit to concussion problems? That's the thesis of an article by AP sportswriter Rachel Cohen in an article carried in the San Francisco Chronicle:
http://www.sfgate.com/cgi-bin/article.c ... 256S04.DTL
How all this is handled will be very important to the future of football.
If the NFL can't regulate itself and these concerns escalate, we'll see calls for more public regulation.