Labor Campaign for Single Payer

October 2015 Chicago

Preparation for your presentation - Think about your audience

• While there are common themes, some unions are dealing with specific issues:

• Excise Tax• Part time workers• Retiree H&W• Trust Funds• Right now, we have to

deal with jobs, or the election, or, or, or, or

• Research and ask questions –

• Develop a couple of slides that will speak to your specific audience

• Tailor your presentation to the amount of time you are given

• Always ask them how they think we can move program

Some Sources for Information• Kaiser Family Foundation• Commonwealth Fund• California Health Care

Foundation• California Nurses

Association• Physicians for a National

Health Program (PNHP)• Labor Campaign for Single

Payer• UCLA Center for Health

Policy Research• UC Berkeley Labor Center

Guarantee Healthcare for Every Worker by Guaranteeing Healthcare for All

What’s the Climate for Bargaining Benefits?The Downward Pressure is Tremendous!

Cumulative Increases in Health Insurance Premiums, Workers’ Contributions to Premiums, Inflation, and Workers’ Earnings,

1999-2015

SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2015. Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), 1999-2015; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 1999-2015 (April to April).

* Estimate is statistically different from estimate for the previous year shown (p<.05).

NOTES: Average general annual deductible is among all covered workers. Workers in plans without a general annual deductible for in-network services are assigned a value of zero. SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006-2015.

Average General Annual Deductible for Covered Workers Enrolled in Single Coverage, 2006-2015

The Industry’s Explanation for Higher Costs• “80% of all claims are lifestyle related”

- a quote from a Blue Cross of California representative

• Excess utilization• New technology• Irresponsible consumers who use too

much because they don’t pay enough• Aging population

8

I didn’t do it!

9

Source: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

US Life Expectancy

10

Source: OECD Health Spending 2013. Data represents 2010 or most recent year available.

Number of Physicians

Average Annual Number of Physician Visits per Capita

11

Source: OECD Health Spending 2013. Data represents 2010 or most recent year available.

Tobacco Smokers

How Does the US Compare on Cost and Quality?

12

12

Pay More and Get Less Quality?

Bargaining for health insurance is a failed bargaining strategy1980s – PPOs were goingto control the cost of care1990s – Consolidation and Organized Health Systems (HMOs) were going to control the cost of care2003– Consumer Quality efforts were going to improve cost and qualityACA - Accountable Care Organizations- Financial incentives to encourage providers to keep patients healthy rather than treating illness. After paying bonuses to the strong performers, the ACO program resulted in a net loss of nearly $3 million to the Medicare trust fund, government records show. 2015 - Value Based Purchasing – CMS measures hospitals using 12 clinical process-of-care. Hospitals are now putting patients in outpatient observation and outpatient surgery centers to avoid being penalized

Some Research for Unions on Retiree H&W

Strategies Used by Employer to Constrain Retiree Health Costs•Surveys conducted by the Kaiser Family Foundation document a trend among employers providing retiree health coverage of modifying their programs in an ongoing attempt to control retiree health costs

• In addition to outright terminations of coverage, key changes reported by employers over the years include:•Capping the employer’s contribution (or limiting the amount of the employer share of the total cost) for retiree health benefits;•Tightening eligibility requirements, e.g., raising minimum age and service requirements;•Raising retirees’ premiums and cost sharing, including changes that essentially eliminated first-dollar coverage for retirees;•Eliminating coverage for future retirees, typically first for new hires, in some cases for current employees and, far less frequently for current retirees; •Optimizing savings from Medicare prescription drug coverage.

• In June, GASB issued new standards. The effect on public employers and employees with large unfunded liabilities could be severe.

• There are three provisions of the new GASB OPEB standards require public employers to take important steps in to reduce the financial impact of the provisions. The new standards will require:

– Public employers to recognize their OPEB liabilities on the face of their financial statements, not simply in the notes.

– OPEB expenses will be recognized over a shorter period of time than under existing standards.

– Without an OPEB trust, liability is determined using the general obligation municipal bond rate – a rate of return about 1% and will significantly increase GASB liability.

PITTSBURGH, Feb. 22 /PRNewswire/ -- LTV Steel has informed the union that the Voluntary Employee Beneficiary Association (VEBA) trust -- which has paid for part or all of retired Steelworkers' healthcare and life insurance benefits since June 2001 -- will not be able to assure payment of health-care claims past March 31, 2002, and all LTV hourly retiree healthcare and life insurance benefits will end on that date, the United Steelworkers of America announced here today.

STOCKTON - Franklin Advisers Inc., a global investing firm, and Wells Fargo bank ... Bankruptcy judge: Stockton can stop paying for retiree health care - 8/6/12 ...

Retiree H&W is not a mandatory subject of bargaining

City of Stockton

Stockton filed for bankruptcy on June 28 and on July 1 adopted a budget that included unilaterally reducing retiree health benefits. That illegally impaired the city's contract with retirees, the plaintiff's claimed.

U.S. Bankruptcy Court Judge Christopher Klein disagreed. The key sentence in his 40-page opinion on Aug. 6 fleshed out a shorter ruling for the city he issued several weeks ago.: "In sum, even if the plaintiffs' benefits are vested property interests, the shield of the Contracts Clause crumbles in the bankruptcy arena.”

http://blogs.sacbee.com/the_state_worker/2012/08/column-extra-judge-says-stockton-bankruptcy-can-break-retiree-health-guaran.html#storylink=cpy

Kodak to end healthcare benefits, solves $1.2 billion liability

(Reuters) - Bankrupt Eastman Kodak Co said on Wednesday it was ending retiree healthcare and

survivor benefits at the end of the year, allowing it to resolve a $1.2 billion liability, one of its biggest

obligations. The benefits, which include medical, dental, life insurance and survivor income benefits, will end

December 31.

Reuters 10/10/2012 8:13:32 PM ET 2012

Retiree H&WGenerally Not Vested

• While pension benefits are generally vested for employees at a certain point, health and welfare benefits for retirees are generally not. Where there is not unambiguous contract language providing for vesting, courts usually place the burden on the employees or retirees to show vesting of retiree health benefits was intended.

The Affordable Care Act

• Not much help for union negotiated plans:

– Excise Tax – Final regulations to be released in early 2016

– The underwriting cycle has slowed growth, but costs continue to exceed CPI

– Union negotiated plans will compete with high deductible plans on the Exchange

– Even the ACA experts project 3 – 4 million uninsured by 2019

Conservatives have captured the public with the frame….

• I live on a minimum wage, why shouldn’t you?

• I don’t have a pension, why should you?

• I don’t have health insurance when I retire. Why should you? Worse, why should I pay taxes for yours?

“We All Do Better When We All Do Better”

“I don't believe there's any problem in this country, no matter how tough it is, that Americans, when they roll up their sleeves, can't completely ignore.”

AFL-CIO 2009 ConventionRESOLUTION 34

The Social Insurance Model for Health Care ReformSubmitted by Alameda Labor Council (Calif.), California Nurses

Association/National Nurses Organizing Committee and International

Longshore and Warehouse Union

“Whatever the outcome of the current debate over health care reform in the 111th Congress, the task of establishing health care as a human right, not a privilege, will still lay before us. We continue to believe the social insurance model should be our goal, and we will continue to fight for reforms that take is in that direction.”

Is Your Health a Commodity?Competition: Which insurance company is competing for ill patients?

Hospitals-For profit –avoid careNot-for-profit (fancy tax avoidance accounting game)

Physicians – new payment arrangements allow them to keep what they don’t use

No health planning!Do we build hospitals where we need them, or where they can profit, or have enough insured lives to survive?

Are we going to allow Wall Street to control our health?

It’s About Solidarity!

Unions in other countrieshave figured out the only way they are going to keep what they have is byadvocating everyone get it!

Are We Organizers or Bean Counters?

Are we going to keep nibbling around the edges attempting to fix a system that can’t be repaired?

OR

“Significant social change comes from the bottom up, from an aroused opinion that forces our ruling institutions to do the right thing”

Senator Paul Wellstone

Framework for Health Care

• Lead with a moral message of • Health Care is a Human Right or we need Guaranteed Health Care for All

Start with agreeing on a common set of values and economic principals

•Everyone should be treated by a medical professional if they are ill•Medical care should be returned to the hands of medical professionals, not insurance company bean counters•Everyone should pay their fair share

•No one should profit from people’s suffering

•Pricing for medical services should not be a secret. We need public transparency and disclosure

•There should be no barriers to our health – everyone is covered

Keep it simple

•Unions can’t deliver healthcare or a wage increases until we get everyone under one plan and control costs

•Start an education campaign with your membership

Get your union to join another advocacy group or have your union lead a group

A Proper Sense of PrioritiesDC - 1968“On some positions cowardice asks the question, it is safe? Expediency asks the question, is it politic? Vanity asks the question, is it popular? But conscience asks the question, it is right? And there comes a time when one must take a position that is neither safe, nor politic, nor popular, but must take it because conscience tells him it is right.”

Thank You!