Oregon Bill Bans Mandatory Anti-Union Meetings

by Mike Hall, Jun 9, 2009 When Oregon workers are choosing to form a union and bargain for a better life, they would not be forced to attend coercive, mandatory anti-union meetings by management under the Worker Freedom Act passed Monday by the Oregon State Senate. It now goes to the House, where it won approval in 2007. The legislation will make it illegal for an employer to discipline or fire a worker who chooses not to attend a meeting on politics, religion or union organizing during work hours. Says Oregon AFL-CIO President Tom Chamberlain: Workers should not have to give up their opinions or be lectured about their employer’s beliefs to get a paycheck. Almost all anti-union campaigns are marked by mandatory meetings where employers or their union-busting consultants use a variety of tactics to intimidate workers. In many cases, workers who speak out for the union are disciplined and even fired. Chamberlain says the forced meetings are not always about politics. One Oregon worker told the state federation that he was disciplined after walking away from a lunchroom after his employer started making anti-Catholic statements. During the last election campaign, Wal-Mart forced workers to attend meetings in which managers told them electing Democrats to the White House and Congress could threaten their jobs. Wal-Mart is one of the leading corporate voices in the multimillion campaign battling the Employee Free Choice Act that would allow workers to form unions free of that type of intimidation and harassment The Worker Freedom Act (S.B. 519) was passed, 16-14, by the Oregon Senate, with two Democrats, Ginny Burdick of Portland and Betsy Johnson of Scappoose, joining all 12 Republicans in opposing the bill. Oregon Gov. Ted Kulongoski has said he will sign the bill if it reaches his desk.

Labor Expert call for Minimum Labor Protections for Home Care Workers

"Federal reform is urgently needed to provide home care workers with the compensation and respect they deserve," says Peggie Smith. Smith, who is the Murray Family Professor of Law at the University of Iowa College of Law and a graduate of Harvard Law, is talking about a U.S. Supreme Court decision that excluded home care workers from protection under the federal Fair Labor Standards Act (FLSA). The court said the workers were providing companionship services. In Protecting Home Care Workers under the Fair Labor Standards Act, (PDF) the second in a series of Direct Care Alliance policy briefs, Smith says the decision “threatens to destabilize the home care industry, erode the precarious economic status of home care workers, and undermine the quality of care that they provide to home care clients.” She outlines two approaches the federal government could take to reverse the ruling: 1. Amend the FLSA to explicitly include home care workers; and 2. Revise Department of Labor (DOL) regulations to significantly limit the reach of the companionship exemption. Smith recommends that the government do both, with the DOL taking immediate action to revise the companionship exemption while Congress works to reverse the impact of the Supreme Court decision by passing the Fair Home Health Care Act. Fixing an injustice “Professor Smith points out that U.S. Department of Labor Secretary Hilda Solis can immediately fix this injustice by simply implementing rules that had already been developed by the Clinton Administration,” says Leonila Vega, executive director of the Direct Care Alliance. As the attorney who argued the case told the Supreme Court, it is unjust to deny home care workers a right that applies to other social servants. “[P]olice and fire personnel are covered, hospital employees are covered, nursing home employees are covered, and other providers of essential services are covered,” he wrote. ”Why should homecare workers uniquely carry the burden of society’s need for their services?” “Home care workers are some of the hardest working people I know,” says Direct Care Alliance board member Tracy Dudzinski, a CNA and home care worker who chairs the board of a worker-owned home care co-op in Wisconsin. “We often put in a ten-hour day to get paid for six. Not being granted basic minimum wage and overtime protection on top of that is just plain wrong. Most every other profession in the U.S. is granted these rights under the Fair Labor Standards Act. Ours should be too.” Ask U.S. Department of Labor Secretary Solis to include home care workers in the Federal Fair Labor Standards Act click on bold text for link Related news and resources The DCA board passes a resolution in favor of the FLSA fix The DCA sends a letter to Secretary Solis asking her to undo the FLSA exemption The DCA sponsors a trip to DC, where one of the asks is that Congresspeople sign a letter to Secretary Solis, asking her to undo the FLSA exemption 37 members of Congress sign the letter to Secretary Solis The Eldercare Workforce Alliance asks for the FLSA fix Elise Nakhnikian Communications Director Direct Care Alliance

Health Care Spending Disparities Stir a Fight

By ROBERT PEAR New York Times June 9, 2009 WASHINGTON — President Obama recently summoned aides to the Oval Office to discuss a magazine article investigating why the border town of McAllen, Tex., was the country’s most expensive place for health care. The article became required reading in the White House, with Mr. Obama even citing it at a meeting last week with two dozen Democratic senators. “He came into the meeting with that article having affected his thinking dramatically,” said Senator Ron Wyden, Democrat of Oregon. “He, in effect, took that article and put it in front of a big group of senators and said, ‘This is what we’ve got to fix.’ ” As part of the larger effort to overhaul health care, lawmakers are trying to address the problem that intrigues Mr. Obama so much — the huge geographic variations in Medicare spending per beneficiary. Two decades of research suggests that the higher spending does not produce better results for patients but may be evidence of inefficiency. Members of Congress are seriously considering proposals to rein in the growth of health spending by taking tens of billions of dollars of Medicare money away from doctors and hospitals in high-cost areas and using it to help cover the uninsured or treat patients in lower-cost regions. Those proposals have alarmed lawmakers from higher-cost states like Florida, Massachusetts, New Jersey and New York. But they have won tentative support among some lawmakers from Iowa, Minnesota, Montana, North Dakota, Oregon and Washington, who say their states have long been shortchanged by Medicare. Nationally, according to the Dartmouth Atlas of Health Care, Medicare spent an average of $8,304 per beneficiary in 2006. Among states, New York was tops, at $9,564, and Hawaii was lowest, at $5,311. Researchers at Dartmouth Medical School have also found wide variations within states and among cities. Medicare spent $16,351 per beneficiary in Miami in 2006, almost twice the average of $8,331 in San Francisco, they said. The Senate Finance Committee recently suggested that one way to pay for health care overhaul would be to reduce geographic variations by cutting or capping Medicare payments in “areas where per-beneficiary spending is above a certain threshold, compared with the national average.” Another proposal would spare health care providers in low-spending, efficient areas from across-the-board cuts in Medicare payments. The committee chairman, Senator Max Baucus, Democrat of Montana, and the panel’s senior Republican, Senator Charles E. Grassley of Iowa, are from lower-spending states. But the proposals are not just pork-barrel politics. They are based on the research by Dartmouth experts who have documented wide geographic variations in health spending. The research has become phenomenally influential on Capitol Hill since it was popularized by Peter R. Orszag, as director of the Congressional Budget Office and then as President Obama’s budget director. Aides said Mr. Obama had been intrigued by regional variations in health spending since before his inauguration. The topic came up at a meeting with Mr. Orszag in Chicago late last year. The magazine article, by Dr. Atul Gawande in the June 1 issue of The New Yorker, said a major cause of the high costs in McAllen was “overuse of medical care.” Dr. Elliott S. Fisher, one of the Dartmouth researchers, diagnosed the problem this way: “Medicare beneficiaries in higher spending regions are hospitalized more frequently, are referred to specialists more often and have a much smaller proportion of their visits to primary care physicians.” In his blog last month, Mr. Orszag wrote, “The higher-cost areas and hospitals don’t generate better outcomes than the lower-cost ones.” But other researchers and politicians are not so sure. They say it would be a mistake to cut or cap Medicare payments without knowing why spending in some places far exceeds the national average. “There is too much uncertainty about the Dartmouth study to use it as a basis for public policy,” said Senator John Kerry, Democrat of Massachusetts. “Researchers can’t explain why some areas of the country spend more on health care than others. There are many reasons spending could vary: higher costs of living, sicker people or more teaching hospitals.” “States like Massachusetts are concentrated centers of medical innovation where cutting-edge treatments are tested and some of the nation’s finest doctors are trained,” Mr. Kerry added. “This work might cost a little more, but it benefits the entire country.” Madeline H. Otto, an aide to Senator Bill Nelson, Democrat of Florida, said he was “adamantly opposed” to the proposed cuts in higher-spending areas because the cuts did not distinguish between necessary and unnecessary care. Mr. Orszag says health spending could be reduced by as much as 30 percent, or $700 billion a year, without compromising the quality of care, if more doctors and hospitals practiced like those in low-cost areas. The supply of hospitals, medical specialists and high-tech equipment “appears to generate its own demand,” Mr. Orszag has said. A Democrat from a low-spending state said critics were trying to “blow holes in the Dartmouth analysis.” Dr. Michael L. Langberg, senior vice president of Cedars-Sinai Medical Center in Los Angeles, is among the critics. “The statement that Medicare costs can be cut by 30 percent has been repeated so many times that it has come to be viewed as a proven fact by some,” Dr. Langberg said in a recent letter to the Senate Finance Committee. “It is not a fact. It is a gross oversimplification of an untested theory.” Dr. Langberg endorsed the goal of covering the uninsured, but said, “We do not believe that rushing to make large cuts in Medicare payments to hospitals is the right way to fund that coverage.” The Dartmouth team has cited Cedars-Sinai as having very high Medicare spending per beneficiary. Research by Dr. Robert A. Berenson and Jack Hadley of the Urban Institute suggests that much of the geographic variation in health spending can be explained by differences in “individual characteristics, especially patients’ underlying health status and a range of socio-economic factors, including income.” “Some patients may benefit from higher spending,” said Mr. Hadley, who is also a professor at George Mason University in Virginia. “They could be adversely affected if they live in geographic areas where payments are cut.” Dr. Berenson, who was a Medicare official in the Clinton administration, said, “There remains too much uncertainty about the Dartmouth findings to ground public policy on them.”

Senate Feels Ted Kennedy’s Absence on Health Bill

By DAVID M. HERSZENHORN New York Times June 9, 2009 WASHINGTON — The run-up to major health care legislation is now a full-on frenzy, and some of the main power players were in yet another marathon meeting on Monday afternoon in the not-so-secret hideaway office of Senator Edward M. Kennedy. But Mr. Kennedy, the Democratic chairman of the Health, Education, Labor and Pensions Committee, who has been closely identified with the issue of health care over his nearly 47 years in the Senate, was back home in Massachusetts, where he is still being treated for brain cancer. Though Mr. Kennedy continues to work closely on the unfolding legislation and is in constant touch with staff members and colleagues, he is not expected to return to the Capitol as formal debate begins this month, either for committee hearings or when the legislation moves to the Senate floor. “I think we would all like to see Senator Kennedy here for many, many reasons,” said Senator Jack Reed, Democrat of Rhode Island and a member of the health committee. “But we are going to move forward.” Mr. Kennedy’s close friend, Senator Christopher J. Dodd, Democrat of Connecticut, who is the No. 2 Democrat on the health committee, has taken on the main role. He is supported by the leaders of three health care “working groups” that Mr. Kennedy created in November, which is when he tapped Mr. Dodd to be his “chief deputy.” Mr. Dodd met with Mr. Kennedy about the health legislation and had dinner at his home on Sunday. Mr. Kennedy is also in touch by phone with President Obama. Mr. Dodd, in a conference call with reporters, said he was holding out hope for Mr. Kennedy’s return. “My hope is he’ll be back at any, any one of these days,” he said. “There is also a spirit he brings to, a dynamic that is hard to quantify,” Mr. Dodd said. “And so, he’ll be missed when he’s not there. But my hope is that he will be back as frequently as he can to play that role.” Mr. Kennedy’s absence has raised alarm among Democrats and Republicans who say that his gravitas and the force of his personality, particularly his ability to usher colleagues past minor disputes in pursuit of larger goals, will be missed as the debate heats up. “He is the only guy who can bring us together, temper the demands of liberal advocacy groups and steer people toward a pragmatic solution,” said Senator Orrin G. Hatch, Republican of Utah, who is a member of both the health committee and the Finance Committee and is a longtime collaborator with Mr. Kennedy on health legislation. A draft of a bill by Mr. Kennedy began circulating late last week, including provisions that would guarantee health coverage for all Americans and would penalize employers who do not help provide insurance. Republicans say such a guarantee is unaffordable. As critics began to level sharp criticism of the proposal on Monday, Mr. Kennedy was not on hand to rebut it. A spokesman for Mr. Kennedy, Anthony Coley, said in an interview that the senator is “doing well and balancing his work on health care reform with his treatment plan.” In a statement, Mr. Coley said that universal health coverage for Americans is the “cause of his life” and that “he continues to lead.” He added, “That doesn’t depend on location.” The majority leader, Senator Harry Reid of Nevada, had raised hopes that Mr. Kennedy would return for the health care debate, telling reporters last month that both Mr. Kennedy and Senator Robert C. Byrd, Democrat of West Virginia, who at age 91 is the oldest senator, were recovering from illnesses. But neither man has been able to return, and Mr. Byrd’s staff said Monday that he remained hospitalized for treatment of an infection.

Moderates in Congress feel health care push

By John Fritze USA TODAY June 9, 2009 WASHINGTON — As Congress considers an overhaul of the nation's health care system, pressure is mounting on a small circle of Senate moderates who helped advance President Obama's economic stimulus this year. Centrists in both parties, including Sen. Susan Collins, R-Maine, and Sen. Ben Nelson, D-Neb. — both of whom played a critical role in shaping the stimulus — are being courted by interest groups and the White House as lawmakers seek a way to provide health care to 46 million uninsured people. "On the Senate side, there is more outreach … to Republicans than was the case during the early days of the stimulus," said Collins, who said she has heard frequently from the administration and Sen. Max Baucus, D-Mont., a key architect of the health care effort. "It's in everyone's interest to try to advance a bipartisan bill." Baucus, chairman of the Senate Finance Committee, said he hopes to have a draft bill this month. A separate proposal by Sen. Edward Kennedy, D-Mass., began circulating last week. Lawmakers have negotiated for weeks over controversial provisions such as a government-run insurance program and how to pay for the more than $1 trillion the proposal may cost. Democrats, including Baucus, say they want Republican support, but the effort has been strained as the White House has pushed aggressively for a government plan. Nine Republicans on the Finance Committee sent a letter to Obama, released Monday, arguing that such a plan would lead to "a federal government takeover of our health care system." The only GOP member of the committee who did not sign the letter is a moderate: Sen. Olympia Snowe of Maine. If Democrats want Republican support, they will probably need 60 votes, the threshold required to stop filibusters and proceed to a final vote. Democrats can count on 59 votes, but it is not clear whether all Democrats will vote for whatever proposal emerges. "I assume they'll place a great emphasis on trying to get to 60 votes, in which case moderate support will be very important," said Sen. Evan Bayh, D-Ind., who formed a coalition of centrist Democratic senators in March. "That's the ideal situation." Interest groups have been airing advertisements in states represented by moderates, including Maine, Nebraska, Indiana and Pennsylvania, where Sen. Arlen Specter abandoned Republicans to become a Democrat in April. MoveOn.org, a group that raises money and organizes for liberal causes, used a series of radio ads to seek support for the government-run insurance option. Those ads ran in six states, including Maine and Oregon. "We made a conscious decision to put that argument in front of senators who have a real role to play in securing this public health care option," said Ilyse Hogue, a MoveOn spokeswoman. One group, the Consumers Union, knocks on doors in Maine to talk with constituents about health care. Conservatives have also focused on centrists. The Americans for Prosperity Foundation has aired ads in Indiana, Arkansas, Montana and Nebraska, among other states, likening Democratic proposals to state-run health care in Canada. "We're bringing education to … where the education is going to matter," spokeswoman Amy Menefee said. Approval of the $787 billion economic stimulus bill in February hinged on the Senate's ability to find 60 votes. Three Republican senators, Collins, Specter and Snowe, voted for the bill. If bipartisanship fails, moderates may not be as important because Democrats can rely on a tactic known as reconciliation. If used, supporters could pass a bill with 51 votes, meaning Republicans might not be needed. Baucus and other Democrats have said they would prefer to find a compromise. "The moderates will be very important," said Richard Kirsch, national campaign manager for Health Care for America Now, which has run ads in several states represented by moderates. But, he added, Democrats have significantly more leverage because of the reconciliation option. Reconciliation, though, could be thorny. Democrats would have to secure fewer votes but "there's a huge, capital letter B-U-T," said Robert Dove, a former Senate parliamentarian. The minority party can put up roadblocks, some of which require 60 votes to overcome.

Obama Urges Quick Action on Insurance

New York Times By ROBERT PEAR and SHERYL GAY STOLBERG Published: June 2, 2009 WASHINGTON — President Obama on Tuesday affirmed his support for the creation of a government-sponsored health insurance plan, but he acknowledged that such a plan would sharply reduce the chances for Republican support of legislation to overhaul the health care system, Democratic senators said. The senators, who met with Mr. Obama at the White House, said he also set forth a timeline, calling on Congress to send him a comprehensive health care bill by October. “He wants the bill through the Senate and the House before the August recess, so we can conference and have it done in September and signed in October,” said Senator Barbara A. Mikulski, Democrat of Maryland. “He said we need to be unflinching and unflagging.” In remarks just before the meeting, Mr. Obama said: “This is going to be a heavy lift. I think everybody understands that. But I’m also confident that people want to get this done this year.” The Senate Democratic leader, Harry Reid of Nevada, said he believed that the full Senate should be able to take up the health care bill and “hopefully finish it” next month. “But, you know, I don’t know,” Mr. Reid added. “We’ll have to see how long things take.” In response to a question from Senator Jeff Bingaman, Democrat of New Mexico, Mr. Obama said that it was important to include a public plan option and that such a plan could help control health costs. Senator Sheldon Whitehouse of Rhode Island, one of two dozen Democratic senators who met with Mr. Obama, said the president “spoke very enthusiastically about a public plan” that would compete directly with private insurers. The president’s words were comforting to Democrats like Senator Sherrod Brown of Ohio. “The sentiment in the room, with the president and the rest of us, was that a public plan option will keep the insurance industry honest, will give people more choices in their health care and can save significant amounts of money,” Mr. Brown said. But other senators at the meeting reported that Mr. Obama also said he wanted a bipartisan health care bill, and they said he recognized that Republicans were strenuously opposed to a government-sponsored plan. Reid H. Cherlin, a White House spokesman, declined to characterize the president’s comments. Other Democrats said Mr. Obama suggested that as “a show of good faith,” Democrats might work with Republicans on other issues, like medical malpractice. Many Republicans would like to limit the amount or types of damages available to patients who sue doctors, hospitals and other health care providers. Another topic at the White House meeting was how to pay for covering millions of the uninsured. Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee, said Mr. Obama indicated that he “might consider” the idea of taxing some employer-provided health benefits, a proposal favored by Mr. Baucus. “It’s on the table,” Mr. Baucus said. “It’s an option.” The White House pushed back, saying Mr. Obama “made it very clear” that he preferred his own revenue proposals. Mr. Obama campaigned against taxing health benefits last year. Labor unions and many employers adamantly oppose a limit on tax-free health benefits. But in a report on Tuesday, the Center on Budget and Policy Priorities, a liberal-leaning research and advocacy group, said, “Congress is unlikely to be able to finance health reform legislation that includes universal coverage unless it limits the exclusion of employers’ health insurance payments from workers’ income and payroll taxes.” Senator Edward M. Kennedy, Democrat of Massachusetts, who is battling brain cancer, did not attend the White House meeting and is not expected on Capitol Hill this week. But the Committee on Health, Education, Labor and Pensions, of which he is chairman, met for more than an hour Tuesday to sift through options. To help control costs, the administration indicated support on Tuesday for a proposal to strengthen a federal panel that recommends how much Medicare should pay doctors, hospitals, nursing homes and other health care providers. Senator John D. Rockefeller IV, Democrat of West Virginia, recently introduced a bill that would expand the role of the panel, the Medicare Payment Advisory Commission, and give its recommendations the force of law. Senators said Mr. Obama and his aides had expressed general support for such a change, which would establish the panel as an independent rate-setting body in the executive branch. Several senators said Mr. Obama had conveyed a sense of urgency and spoken emphatically about the importance of revamping the health care system in a way that would reduce costs. “The president made clear that history will judge us by whether this bill controls health costs,” said Senator Ron Wyden, Democrat of Oregon.

2 Democrats Spearheading Health Bill Are Split

New York Times By ROBERT PEAR Published: May 29, 2009 WASHINGTON — A significant split has developed between the two Democratic senators leading efforts to remake the nation’s health care system. They disagree over the contours of a public health insurance plan, the most explosive issue in the debate. One of the senators, Edward M. Kennedy of Massachusetts, reasserting himself after months of treatment for brain cancer, made clear this week that he favored a robust public health care plan, a government-sponsored entity that would compete with private insurers. As a starting point for his bill, Mr. Kennedy favors a public plan that looks like Medicare, the government-run program for older Americans created in 1965, when he was a young senator. By contrast, Senator Max Baucus, the Montana Democrat who is chairman of the Finance Committee, has been working for months with the panel’s senior Republican, Charles E. Grassley of Iowa, in the hope of forging a bipartisan bill, which would probably play down the option of a public plan. Mr. Grassley opposes creation of a new government insurance program and says “we cannot afford the public health plan we have already,” referring to Medicare. President Obama has championed a public plan, saying it would help “keep the private sector honest,” though he has indicated he will be flexible on the details. House Democratic leaders, including three committee chairmen drafting the House bill, are close to Senator Kennedy’s position. Democrats on the Finance Committee said Mr. Baucus was exploring a possible compromise. Under this proposal, the public plan would be created only if private insurance companies had not made meaningful, affordable coverage available to all Americans within several years. Senate Democrats said they believed that Mr. Baucus might settle for this “fallback plan,” which could win some support on both sides of his committee, from people like Senator Ron Wyden of Oregon, a Democrat, and Senator Olympia J. Snowe of Maine, a Republican. Passage of comprehensive health legislation this year is a top priority for Mr. Baucus and Mr. Kennedy, the chairman of the Committee on Health, Education, Labor and Pensions. So they may be able to resolve their differences, aides said. The split reflects not only political differences between the two men but also differences between their committees, racing to write the most ambitious health care legislation in the nation’s history. Over all, Democrats on the Finance Committee tend to be more moderate than those on the health committee, which includes more Democrats who identify themselves as liberals or progressives. The two Senate panels are drafting separate bills that are to be merged before going to the Senate floor. Describing his plan this week, Mr. Kennedy said: “Americans want the choice of enrolling in a health insurance program backed by the government for the public good, not private profit. So that option will be available.” Consumers, he said, will be able to enroll in “a publicly sponsored and guaranteed plan.” Senator Charles E. Schumer of New York, the third-ranking member of the Senate Democratic leadership, said Friday, “It’s pretty certain that Senator Kennedy could not support the Baucus plan, and Senator Baucus could not support the Kennedy plan.” But Mr. Schumer said “it’s possible” that both could support a version he is developing. Under Mr. Schumer’s proposal, any new public plan would have to comply with all the rules and standards that apply to private insurance. A public plan would also have to be self-sustaining, would have to rely on premiums and would not have a pipeline into the federal Treasury. Mr. Baucus said last month that while a government-run insurance plan was still on the table, “it might be a bit on the side of the table.” Erin Shields, a spokeswoman for Mr. Baucus, said Friday, “The Finance Committee has not decided or settled on what a public plan option would look like, if one were to be included in the bill.” Public opinion polls suggest that many consumers would like to have the choice of a public plan. But insurance companies and Republican lawmakers say a public plan could drive private insurers out of business and lead eventually to a single-payer system run by the government. Supporters of a public plan have been putting pressure on Mr. Baucus. Mr. Kennedy and 28 other senators signed up last week as co-sponsors of a resolution supporting creation of a public insurance option. “Health care reform must include insurance reform, and health insurance reform must include the option of a federally backed health insurance plan,” said Senator Sherrod Brown, Democrat of Ohio, the chief sponsor of the resolution. Many doctors and hospital executives fear that a public plan would pay them at Medicare rates, which are often lower than those paid by commercial insurers. Under Mr. Kennedy’s proposal, the government-sponsored plan might pay more than Medicare, perhaps 10 percent more, but less than private insurance. Under the House bill, the public plan would use Medicare fee schedules in setting payments to health care providers. Republicans denounce such rate-setting techniques as price controls or “administered prices.”