De Blasio’s Plans to Reduce Worker Health Costs Have a Carrot and a Stick
By STEVEN GREENHOUSE and NIKITA STEWART
When Mayor Bill de Blasio announced his first labor agreements with New York City unions this spring, he was sharply criticized for granting long-awaited wage increases in exchange for promises of unspecified though sizable savings on health care expenses.
Now, some of the specifics are coming into focus: City officials and union leaders say they hope to push municipal workers to use walk-in clinics more and emergency rooms less, order generic drugs more often than brand-name ones, and buy them through the mail rather than at retail pharmacies to achieve bulk discounts.
The city hopes the unions will agree to steer workers to use centralized, cheaper centers for blood tests, X-rays or M.R.I.s, rather than having those tests performed in doctors’ offices or at costly physician-owned facilities. Patients who resist could face higher copayments, while savings would be passed on to the city in lower premiums.
The cost-cutting comes with high stakes: If the city and unions are unable to save a total of $3.4 billion on health care by 2018, a mediator will be empowered to order increases in workers’ premiums to cover the shortfall, officials said.
As an added inducement, if the unions help the city exceed that goal, the first $365 million in additional savings would be distributed as lump-sum bonuses to workers, officials said. Any savings beyond that would be split evenly between the city and its employees.
In interviews, Harry Nespoli, chairman of the Municipal Labor Committee, the umbrella group of city unions, and Robert W. Linn, the city’s labor relations commissioner, disclosed several of the cost-saving measures being discussed as the two sides draw closer to a deal.
For example, union officials are meeting with EmblemHealth, an insurer that covers many municipal union members, to negotiate increased access for employees to EmblemHealth’s more than 40 walk-in clinics across the city.
Arrangements like that could reduce costly emergency-room visits not only for the city’s 350,000 workers but also for their dependents — a total of about one million people, the officials said.
Missing from the labor contracts with teachers and other city workers that were announced beginning in May was any requirement for union members to begin contributing toward their health insurance premiums. That prompted some critics to say Mr. de Blasio was not being tough enough at the bargaining table.
Do You Own a Gun? In Florida, Doctors Can’t Ask You That
A few weeks ago, I had my yearly physical. As part of her history-taking, my doctor asked if I was sexually active with my wife. Then she asked if I was sexually active with anyone other than my wife. She does this every year.
She’s not asking to be intrusive. Nor is she a voyeur. She knows that having multiple sexual partners significantly increases one’s chance of contracting a sexually transmitted infection. Asking about that allows her to see if I’m at risk, and then to address that risk with me.
I’m not offended that she asks me. Asking me is part of what makes her an excellent physician. Doctors are supposed to ask about sensitive things in order to help keep us safe. This is especially true for pediatricians. This kind of exchange is how we engage in prevention, sometimes called anticipatory guidance, and study after study shows it can prevent harm.
When pediatricians ask you about using car seats, they’re trying to prevent injuries. When they ask you about how your baby sleeps, they’re trying to prevent injuries. When they ask you about using bike helmets, they’re trying to prevent injuries. And when they ask you about guns, they’re trying to prevent injuries, too.
But not, perhaps, everywhere. In Florida, in 2011, a law was signed that made it illegal for doctors to ask patients if they owned a gun. If doctors violate this law, they can be disciplined, leading to fines, citations and even a loss of their license.
A lower court struck down the law in 2012. But last week, a panel of judges on the United States Court of Appeals for the 11th Circuit upheld it. In their ruling, the judges declared that the law regulates physician conduct “to protect patient privacy and curtail abuses of the physician-patient relationship.” The clear assertion of the judges is that there is no legitimate health reason to be asking about gun ownership.
Almost 20,000 people committed suicide in the United States with firearms in 2011. More than 11,000 were killed by firearms that year, and more than 200 were killed in accidents with guns. In 2009, almost 7,400 children were hospitalized because of injuries related to guns.
Health premiums soared, Insurance Commissioner Dave Jones says
The cost of health insurance for individuals skyrocketed this year in California, with some paying almost twice what they did last year, the state's insurance commissioner said.
But Insurance Commissioner Dave Jones predicted that insurers will ease up in the coming year to prevent California voters from approving tough new rate controls on the November statewide ballot as Proposition 45.
Insurers and opponents of Proposition 45 dismissed Jones' comments as misleading and politically motivated.
At a news conference Tuesday, Jones said individuals this year paid between 22% and 88% more for individual health insurance policies than they did last year, depending on age, gender, type of policy and where they lived.
The increases did not affect poor people, whose policies are heavily subsidized, Jones said. The study results released Tuesday did not include group policies such as those offered by employers.
Jones said he authorized the study of health insurance rates after receiving numerous complaints about rising costs.
"The rate increase from 2013 to 2014, on average, was significantly higher than rate increases in the past," Jones said.
The hardest-hit were young people, he said. In one region of Los Angeles County, people age 25 paid 52% more for a silver plan than they had for a similar plan the year before, while someone age 55 paid 38% more, Jones said.
The state examined policies issued by the state's four largest health insurers: Anthem Blue Cross, Blue Shield of California, Kaiser and Health Net.
Jones took time Tuesday to lobby for Proposition 45, a statewide initiative on the November ballot that would give his office new authority to regulate proposed health insurance increases. He said California is among a minority of states that do not regulate health insurance costs.
Maine Heritage Policy Center honors DHHS Commissioner Mary Mayhew
By Mario Moretto, BDN Staff