The Case for Forcing a Floor Vote on Medicare for All
Briahna Joy Gray on why forcing Pelosi into a floor vote is one important part of a broader strategy for building progressive power.
On November 27th, YouTube pundit and comedian Jimmy Dore proposed a provocative plan to advance the Medicare for All movement: refuse to re-elect Rep. Nancy Pelosi D-CA as Speaker of the House until she brings Rep. Pramila Jayapal’s Medicare for All bill H.R. 1384 to a floor vote. Because last month’s elections whittled down the Democratic majority in the House, it would take only a handful of Democrats to hold Pelosi’s speakership hostage. The “Squad,” composed of Reps. Alexandria-Ocasio Cortez (D-NY), Ilhan Omar (D-MN), and Rashida Tlaib (D-MI), could theoretically find sufficient support from among the ranks of the nearly 100 members of the Progressive Caucus. And if successful, progressives could force an unprecedented public debate about the merits of an enormously popular policy that, because of the COVID crisis, Americans have never needed more.
Without a majority of votes in the House, the only way to bring a bill out of committee onto the floor where it can be publicly debated is if the Speaker of the House agrees to do so. (When it comes to Medicare for All, Pelosi never has.) And progressives worry that without a significant pressure campaign, elected Democrats will never be made to answer for why they stand well to the right of the public on the need for universal health care. “Now is the time for progressives to exercise their power, play hardball, and use their power for the benefit of their constituents,” Dore argued.
Public interest in the scheme spiked on Friday night when Rep. Alexandria Ocasio Cortez weighed in via a Twitter reply to Chargers running back Justin Jackson, who has adopted Jimmy Dore’s call to action. “If @AOC and the squad don’t do what @jimmy_dore has suggested and withhold their vote for Pelosi for speakership until Med 4 All gets brought to the floor for a vote… they will be revealing themselves,” he wrote. “Power concedes nothing without a demand.”
AOC disagreed with the proffered scheme on the basis that Jayapal’s Medicare for All bill is unlikely to pass at this time. “So you issue threats, hold your vote, and lose. Then what?” she asked. Instead of demanding a floor vote, AOC countered that progressives could “use leverage to push for things that can happen and change lives.” As an example, she offered a $15 minimum wage in the first 100 days, and “elevating longtime progressive champions to important positions in democratic leadership.”
But progressives pointed out that a $15 minimum wage is part of the Democratic Party platform. “Biden already supports a $15 min wage,” tweeted journalist Aaron Maté. “It won’t take progressive leverage to hold him/Pelosi to something Biden already supports. It’s the Senate that will decide it.”
And unlike other progressive priorities such as student debt cancellation or the provision of stimulus checks, initiating a floor vote is wholly within Nancy Pelosi’s purview: it’s a power she can exercise unilaterally to protect her position without relying on Biden to modify his policy priorities to protect her. (Recently leaked audio of a contentious meeting between Biden and the leadership of Civil Rights organizations exposed how unyielding Biden can be to any agenda not his own.)
Comprehensive health care coverage is the most pressing political issue of the moment. Since the beginning of the pandemic, over 14 million Americans have been kicked off their employer-based health insurance as they lost their jobs to the shutdown. After a Democratic primary race in which nearly every candidate fought to protect the private health care industry on the grounds that voters deserved a “choice,” millions of Americans are now experiencing the cruel caprice of a system that links health care access to one’s ability to work.
Perhaps unsurprisingly, support for Medicare for All has reached historic highs during the pandemic. Even a Fox News exit poll showed that 72 percent of Americans support a single payer system, and impressively, about half of Republicans support Medicare for All. But importantly for the purposes of the Dore proposition, a whopping 88 percent of Democrats support the policy. A floor vote on Jayapal’s bill could capitalize on the public’s overwhelming approval for Medicare for All, and expose the chasm between the policies Democratic voters want and the positions their elected representatives are willing to take. It’s difficult to imagine a better historical context for this fight.
Critics of the plan argue that demanding a floor vote for a bill that won’t pass the House, much less the Senate, wastes progressives’ political capital. “We already know who supports [Medicare for All],” argued Ryan Grim of the Intercept, “and I can promise you it would get zero press coverage because the press doesn’t cover bills that can’t pass both chambers.” But recent history offers a counterpoint to Grim’s claim that the media won’t cover a standoff over health care. Just a week ago, the passage of the House bill decriminalizing marijuana was covered widely as “historic,”—perhaps because, like Medicare for All, it’s an enormously popular policy with bi-partisan support. (It’s also unlikely to pass the Senate.) And that was without the added drama of the most powerful Democrat in the House being bent over the proverbial barrel by a squad of progressive upstarts.
Moreover, the Squad has a unique ability to attract media attention. Representatives Ocasio-Cortez, Katie Porter (D-CA), and other progressive members of Congress are famously adept at making viral moments out of congressional hearing testimony, and if they were to coordinate with the activists and protesters who helped to organize the historically large mass protests from this summer, it’s difficult to imagine they’d be ignored. (Leveraging organized labor and the threat of a general strike would make any effort to push Medicare for All impossible to brush off. And they should do exactly that.)
Mass unemployment and the subsequent loss of employer-based coverage has stripped corporate Democrats of one of their most potent arguments against Medicare for All: that maintaining the for-profit health system offers much-desired stability. And commitments to cover COVID-related costs have exposed the hypocrisy inherent in defenses of our current system. The admission by party leadership that COVID treatment should be free for all is a slippery slope to universal coverage. After all, it’s not more inhumane to deny COVID treatment to those who can’t pay for it than to deny treatment to a cancer patient who can’t pay. (Cancer is a primary cause of bankruptcy in America.) Should progressives force a floor vote, they’d be well positioned to make a relatively unencumbered case for Medicare for All.
A floor vote and the debate that comes with it could spark a referendum on our failing health care system at a moment when no other issue takes credible priority. “Now is the time [progressives] have power,” Dore argued. “In two years, the Democrats are going to get wiped out in the House. They will lose their majority and their speakership. The only time the progressives are going to have any power is right now at this moment,” before the Speaker is elected in the first week of January. Dore’s prediction that Democrats will lose seats during the 2022 midterms is far from guaranteed, but given the party’s recent losses there is a certain pragmatism to his urgency.
Agitating for a floor vote also doesn’t foreclose making other demands at the same time. On his blog the Daily Poster, journalist David Sirota offered a number of alternative strategies to advance Medicare for All, including ousting Rep. Richard Neal (D-MA), a Medicare for All opponent, from his position as Ways and Means Chair. This is the type of concession AOC alluded to in her response to Jackson, and it’s a meaningful one. But ousting Neal—an obscure figure to the average American voter—is unlikely to generate the kind of movement energy that a Medicare for All floor vote could potentially inspire.
The argument is both and, not either or. But crucially, technocratic solutions must be wedded to the floor vote demand in order to spark the kind of public excitement that can galvanize labor, social movements and voters. Progressives are buzzing with excitement because Democrats might, for once, do something bold; they might fight for something not because the cost/benefit analysis demands it, but despite the potential political costs. And the threat of ousting Nancy Pelosi—who 3/4 of Americans believe should step down—practically guarantees breathless coverage from media figures on both sides of the aisle.
In her response to Jackson, AOC argued that the “opportunity cost” was too high to waste on a floor vote for a bill that wouldn’t ultimately pass. “The Dem votes aren’t there yet,” she tweeted. Why risk negative press from a failed vote if a clean victory is in sight? But a lengthy delay risks wasting the leverage progressives get from a narrow house majority and the exigency of the pandemic. Progressives want to force a vote now precisely because they believe the chance they can secure the votes for Medicare for All in the near future is remote. If barely half of House Democrats are willing to cosponsor Medicare for All even while it has the support of 88 percent of Democratic voters during a global pandemic, what are the odds the holdouts will be more amenable once the vaccine is distributed and life begins to normalize?
Importantly, even a failing floor vote would force Democrats to own their opposition to a life-saving, popular policy, and it would expose those Democratic House members who are thought to have cosponsored Medicare for All to burnish their progressive bonafides without ever intending to vote for the bill. For example, Kamala Harris and Cory Booker cosponsored the Senate version of the bill but reversed their positions during their presidential campaigns. Forcing a vote on H.R. 1384 would pressure House Democrats to either support the bill or defend their “no” votes as single-payer’s popularity spikes. (Recall how her Iraq war vote dogged Hillary Clinton in both 2016 and 2008, or how both Biden and Bernie Sanders’s votes for the 1994 Crime Bill continue to follow them.) “If [Jayapal’s bill] loses, then we know who is on our side and who is not,” Dore has argued. “Then we can put a marker down.”
“No” voters would also be forced to justify their position to primary challengers in 2022. “Would love for Democrats to be on the record denying their constituents healthcare during a pandemic,” tweeted Jackson. “Sounds like good politics for the progressive movement and our goals.” Recall that although establishment Democrats attempted to blame Medicare for All for last month’s congressional losses, no swing district candidate who supported Medicare for All lost on November 3rd. Despite the hand-wringing of pharma-backed corporate Democrats, Medicare for All is a winning issue.
The desire to push Pelosi into allowing a vote and to have hearings in the House on Medicare for All is born out of a longstanding frustration with the media, which historically shields Democrats from accountability to their constituents when it comes to health care. Mainstream outlets rarely challenge anti-Medicare for All Democrats on why they’re bearish on the policy their constituents overwhelmingly support. And pundits on liberal networks regularly adopt disproven right-wing talking points about the affordability of the program. Moreover, the relationship between candidates who oppose Medicare for All and their corporate-funded campaigns is rarely, if ever, examined, and voters are left to assume that their representatives decline to support Medicare for All because it’s not electorally viable, rather than because they’ve accepted significant sums from the pharmaceutical and private insurance industries to finance their campaigns.
As COVID raged last spring, President-elect Biden said that he would veto Medicare for All even if it were to pass the House and the Senate. He also received more money from insurance and pharmaceutical industry employees than any other candidate in the race, and his senior advisor is a former health care lobbyist. During the primary, he received crucial ninth inning support from Rep. Jim Clyburn of South Carolina, whose endorsement is considered to have been critical to Biden’s victory after a string of disappointing primary finishes. Clyburn is firmly against Medicare for All despite the fact that Black voters support the policy more than any other ethnic group. He is also the single highest recipient of pharmaceutical money in Congress. These connections are rarely made by the press.
According to the Center for Responsive Politics, health care companies spent just shy of $568 million on lobbying in 2018—more than any other industry. And as Bernie’s primary campaign ramped up in the first quarter of 2019, the number of organizations hiring lobbyists to oppose Medicare for All increased by a factor of seven. Record numbers of Americans still support a single-payer system, but positive polls alone aren’t enough to induce congressional support for the policy as long as elected officials are paid to vote the other way. The system needs a jolt. And Dore believes he’s identified the necessary spark.
Ocasio-Cortez herself has alluded to the value of a floor vote on Medicare for All—regardless of whether it would pass. “The Democratic Party is not a left party,” she lamented this past January. “…We can’t even get a floor vote on Medicare for All. Not even a floor vote that gets voted down. We can’t even get a vote on it.”
At the end of the day, the moral case for action requires no strategic justification. As Kyle Kulinski, co-founder of Justice Democrats—the progressive PAC that backed AOC’s historic 2018 run—tweeted: “If your politics comes from a place of principle then all the strategy talk is pretty silly anyway. If you believe in something you fight for it & dot every i & cross every t. If you lose ok but the act of doing everything in your power to achieve it is the definition of morality.”
https://www.currentaffairs.org/2020/12/the-case-for-forcing-a-floor-vote-on-medicare-for-all
‘We need more’: Pointing to public health crisis, Mainers rally in support of Medicare for All
by Evan Popp - The Beacon - July 27, 2021
With the U.S. facing a resurgence of the worst public health crisis in a century, Mainers rallied over the weekend in support of Medicare for All, arguing that the current health care system is cruel and results in many people not getting the care they need.
The rally took place Saturday in Portland and was part of actions in support of Medicare for All in over 50 cities around the country. The event in Maine was organized by Maine AllCare, Mainers for Accountable Leadership, the Southern Maine Workers’ Center and the People’s Housing Coalition.
Medicare for All, popularized and championed by Sen. Bernie Sanders of Vermont during his presidential campaigns, would create a single-payer, national health care system to provide coverage to everyone, regardless of their ability to pay.
Such a system is long overdue, advocates argue, as the U.S. is the only industrialized country in the world without universal health care.
“We are the richest country on earth, yet we somehow make the excuse that we can’t provide health care for everyone,” Dr. Julie Keller Pease, co-founder of Maine AllCare, said at the rally. “It is time to stop accepting excuses and empty promises from our leaders. We must demand health care for everyone in our country.”
In Maine, census data from 2018 showed that more than 100,000 people in the state were uninsured. Given that, Maine Health Care Action, a project of Maine AllCare, has started gathering signatures to place a health care referendum on the November 2022 ballot. If passed, the initiative would direct Maine lawmakers to “develop legislation to establish a system of universal health care coverage in the state.”
State lawmakers appear open to that possibility, with legislators this year passing a joint resolution requesting that the Biden administration and Congress establish a federal waiver process for states to create a universal health care plan.
At the federal level, lawmakers have again introduced a Medicare for All bill, which has 117 House co-sponsors, including Rep. Chellie Pingree. Maine’s other House member, Jared Golden, is not listed as a co-sponsor of the bill. Golden’s spokesperson told Politico earlier this year that while Golden was once supportive of Medicare for All, he now opposes it.
The bill introduced in the House faces strong headwinds, as President Joe Biden and House Speaker Nancy Pelosi have both expressed qualms about Medicare for All.
‘We need 100 percent coverage’
Others at the Portland rally spoke about how access to good health care has a stabilizing impact.
“Health care is a human right that intersects with every aspect of our lives and how we relate to the world,” said Chloe Herrick, a member leader at the Southern Maine Workers Center. “The decisions we have to make to protect our health impact our freedom to live our lives, enjoy ourselves or be human.”
Patty Kidder of Springvale, a volunteer with Maine People’s Alliance (of which Beacon is a project), spoke about her personal experience, with her husband losing his health insurance as he was suffering from a number of maladies, including depression, chronic pain and diabetes. Kidder added that too many people who do have health insurance are also caught up in a system that prioritizes profit over care, explaining that her medical bills went to a debt collection agency when she couldn’t pay them.
In her speech, Kidder connected the fight for Medicare for All to the battle to expand Medicaid in Maine.
Lawmakers in the Maine Legislature passed bills to expand Medicaid half a dozen times during former Gov. Paul LePage’s time in office, only to see LePage veto the measures each time. Groups, including Maine People’s Alliance, then took the issue to the voters, who approved a ballot measure in 2017 to expand Medicaid, which LePage illegally refused to implement. After taking office in 2019, Gov. Janet Mills ordered that Medicaid be expanded, increasing access to health care for tens of thousands of Mainers.
“We didn’t give up,” Kidder said of that fight, encouraging participants to take the same view of efforts to pass Medicare for All.
With the COVID-19 crisis still looming over the country, Kidder added that the urgency to create a system where everyone has health care is clear.
“The pandemic has shown us that the health of all of us is dependent on the good health of others, so we all need access to affordable health care whether we have a job or not. We need Congress and our president to pass improved Medicare for All now,” she said.
Biden opposed Medicare for All during his campaign and has not advocated for it as president. However, while stopping well short of universal coverage, Senate Democrats’ $3.5 trillion budget plan does contain an expansion of Medicare to include dental, vision and hearing benefits.
In Maine, an initiative to extend comprehensive dental benefits to those accessing health care through the state’s Medicaid program was included in the state budget, meaning over 200,000 low-income adults will now have access to full oral health coverage.
Kidder applauded such steps to increase access to health care. However, she said it’s still not enough to address the underlying issue.
“These successes at the state and federal level are huge and vital for so many Mainers,” she said. “But they are still just bandages on our hemorrhaging, broken health care system. We need more: We need 100 percent coverage with no deductibles, no co-pays, no matter our age. We need improved Medicare for All now.”
Hospital prices demand government attention
In an opinion piece for the Financial Times, a surgeon, Nisarg Patel, argues that hospital prices are the big problem with our health care system. Hospital prices demand government attention.
Hospitals spend crazy amounts on new glamorous buildings, fancy lobbies with luxurious stone finishes and all types of vegetation, PR, and executive compensation, driving up their prices. He’s right that “it is the prices stupid,” (as well as the administrative costs,) that are responsible for astronomical health care costs. But, Patel fails to acknowledge that Medicare for all is the only solution.
Patel writes that hospitals have become big businesses. At the same time, they have been huge beneficiaries of federal dollars, our taxpayer dollars. During the coronavirus pandemic, they received literally billions of dollars in aid.
Much like Wall Street after the great recession in 2008, which had become too big to fail, Patel argues that our healthcare system has become so large that it cannot serve patients’ needs any longer. It’s “too big to heal.” Hospitals have extraordinary influence in Congress. Many also have monopoly pricing power.
Hospital prices have more than doubled in 20 years, writes Patel. Inflation has averaged 60 percent over that same time period, less than half hospital price growth. These prices account for more than three times what the US spends on prescription drugs. And, collection agencies now hold $140 billion in medical debt.
Unless hospital prices come down, more people are going to be pushed into medical debt and poverty when they develop complex and costly conditions, even if they have insurance. Premiums are rising, as are deductibles and copays.
The biggest hospitals are cutting deals with the big insurers. These big hospitals, in turn, are crowding out the smaller ones. And, there’s little evidence that consolidation in the hospital industry improves health outcomes or benefits our health in any material way.
Patel offers three ways to protect against growing hospital power and address these challenges:
- Medicare should discourage, rather than encourage, hospital consolidation; Independent physicians should not be burdened with so much paperwork; Data on health care quality and cost should be available for public scrutiny.
- Government should promote investments in independent primary care and specialist care, as well as community clinics and other non-hospital based care.
- Government should block hospital mergers.
Patel’s proposals are all band-aids. They will not begin to fix out-of-control health care costs in the short or long-run. They are also not more likely to become law than Medicare for all. One incremental step on the hospital side that would make a difference is all-payer rate-setting. Much like drug price negotiation, it would rein in costs.
The only real solution to crazy high health care costs, if we care as a country about guaranteeing access to health care for everyone, keeping people from medical debt and improving health outcomes, is Medicare for all.
Don’t Want a Vaccine? Be Prepared to Pay More for Insurance.
by Elizabeth Rosenthal and Glenn Kramon - NYT - August 2, 2021
America’s Covid-19 vaccination rate is at around 60 percent, for ages twelve and up. That’s not enough to reach so-called herd immunity, and in states like Missouri — where a number of counties have vaccination rates under 25 percent — hospitals are overwhelmed by serious outbreaks of the more contagious Delta variant.
The vaccine resisters offer all kinds of reasons for refusing the free shots and for ignoring efforts to nudge them to get vaccinated. Campaigns urging Americans to get vaccinated for their health, for their grandparents, for their neighbors, to get free doughnuts or a free joint haven’t done the trick. States have even held lotteries with a chance to win millions or a college scholarship.
And yet there are still huge numbers of unvaccinated people. Federal, state and municipal governments, as well as private businesses continue to largely avoid mandates for their employees out of fears they will provoke a backlash.
So, how about an economic argument? Get a Covid-19 shot to protect your wallet.
Getting hospitalized with Covid-19 in the United States typically generates huge bills. Those submitted by Covid patients to the NPR-Kaiser Health News “Bill of the Month” project include a $17,000 bill for a brief hospital stay in Marietta, GA (reduced to about $4,000 for an uninsured patient under a “charity care” policy); a $104,000 bill for a fourteen-day hospitalization in Miami for an uninsured man; possibly hundreds of thousands for a two-week hospital stay — some of it on a ventilator — for a foreign tourist in Hawaii whose travel health insurance contained a “pandemic exclusion.”
Even though insurance companies negotiate lower prices and cover much of the cost of care, an over $1,000 out-of-pocket bill for a deductible — plus more for copays and possibly some out-of-network care — should be a pretty scary incentive.
In 2020, before there were Covid-19 vaccines, most major private insurers waived patient payments — from coinsurance to deductibles — for Covid treatment. But many if not most have allowed that policy to lapse. Aetna, for example, ended that policy on Feb. 28; UnitedHealthcare began rolling back its waivers late last year and ended them by the end of March.
More than 97 percent of hospitalized patients last month were unvaccinated. Though the vaccines will not necessarily prevent you from catching the coronavirus, they are highly effective at assuring you will have a milder case and are kept out of the hospital.
For this reason, there’s logic behind insurers’ waiver rollback: Why should patients be kept financially unharmed from what is now a preventable hospitalization, thanks to a vaccine that the government paid for and made available for free? It is now in many drugstores, popping up at highway rest stops and bus stops and can be delivered and administered at home in parts of the country.
A harsher society might impose tough penalties on people who refuse vaccinations and contract the virus. Recently, the National Football League decreed that teams will forfeit a game canceled because of a Covid-19 outbreak among unvaccinated players — and neither team’s players will be paid.
But insurers could try to do more, like penalizing the unvaccinated. And there is precedent. Already, some policies won’t cover treatment that results from what insurance companies deem risky behavior, such as scuba diving and rock climbing.
The Affordable Care Act allows insurers to charge smokers up to 50 percent more than what nonsmokers pay for some types of health plans. Four-fifths of states in the U.S. follow that protocol, though most employer-based plans do not do so. In 49 states, people who are caught driving without auto insurance face fines, confiscation of their car, loss of their license and even jail. And reckless drivers pay more for insurance.
The logic behind the policies is that the offenders’ behavior can hurt others and costs society a lot of money. If a person decides not to get vaccinated and contracts a bad case of Covid, they are not only exposing others in their workplace or neighborhoods; the tens or hundreds of thousands spent on their care could mean higher premiums for others as well in their insurance plans next year. What’s more, outbreaks in low-vaccination regions could help breed more vaccine-resistant variants that affect everyone.
Yes, we often cover people whose habits may have contributed to their illness — insurance regularly pays for drug and alcohol rehab and cancer treatment for smokers.
That’s one reason, perhaps, why insurers too have so far favored carrots rather than sticks to get people vaccinated. Some private insurers are offering people who get vaccinated a credit toward their medical premiums, or gift cards and sweepstakes prizes, according to America’s Health Insurance Plans, an industry organization.
Tough love might be easier if the Food and Drug Administration gives vaccines full approval, rather than the current emergency use authorization. Even so, taxpayer-financed plans like Medicaid and Medicare must treat everyone the same and would encounter a lengthy process to secure federal waivers to experiment with incentives, according to Larry Levitt, executive vice president of KFF, a nonprofit focusing on health issues. (Kaiser Health News, where Rosenthal is editor-in-chief, is one program under KFF.) These programs cannot charge different rates to different patients in a state.
KFF polling shows such incentives are of limited value, anyway. Many holdouts say they will be vaccinated only if required to do so by their employers.
But what if the financial cost of not getting vaccinated were just too high? If patients thought about the price they might need to pay for their own care, maybe they will reconsider remaining unprotected.
https://www.nytimes.com/2021/08/02/opinion/health-insurance-unvaccinated.html?action=click&module=Opinion&pgtype=Homepage
‘In tears before I even logged in’: Cigna call center workers challenge working conditions
Employees started a petition demanding improvements, including lifting a pay raise freeze and removing pressure to meet metrics
by Michael Sainato - The Guardian - August 3, 2021
Call center workers at Cigna, one of the largest health insurance corporations in the US, are reporting poor working conditions driven by high production demands, fear of being fired, lack of training, and long processing times for customers to receive reimbursement for Covid-19 testing costs.
The unrest comes as Cigna’s profits in 2020 increased to $8.5bn from $5.1bn in 2019. David Cordani, the CEO of Cigna, received nearly $79m in compensation in 2020, a raise of $13.4m from the previous year. In March 2021, Cigna announced plans to increase expenditures on stock buybacks to $8bn over the next four years.
Cigna is closing offices around the US, switching several positions and departments to remote work permanently.
Several months ago, workers started an online petition demanding Cigna improve working conditions, including lifting a pay raise freeze, stopping constant harassment of workers to meet production metrics and providing a way for workers to report abusive callers.
“Customer management requires us to handle phone calls within a specific amount of time,” said a call representative at Cigna in the midwest who requested to remain anonymous for fear of retaliation. “The numbers are hardcore. They’re constantly on you about them and to me, that doesn’t really meet the customers’ needs. The phone call metrics could go down if customer service advocates were trained better and we had better resources.”
The worker explained they often receive phone calls from customers who have called repeatedly without any resolution to their problem, and that they are constantly being monitored by apps and prompted to move on to the next call.
“I always get pressured on every end. There were days that I would almost be in tears before I would even log in for work, I just mentally, emotionally and physically cannot handle that anymore,” the representative added. “There were times when I was the sixth customer service advocate that they’ve talked to in the last couple of weeks, and nothing is getting resolved. Nothing. This is a customer who has called multiple times and they’re upset. This is their health insurance. This is something that’s important. And when you can’t resolve it for either lack of training or lack of time because you’re having to meet metrics, that gets old.”
A second customer service advocate in the midwest explained a whole new set of issues arose once the Covid-19 pandemic hit and workers were allowed to work from home. Paid time off was taken from workers for any technical issues they experienced while working remotely, and staff handled a huge volume of calls from customers irritated about the delays in processing Covid-19 testing reimbursement claims.
“The process was unbelievable. It could have been six months before reimbursement and it was going to be in a multitude of checks. We’re given 15 minutes to make outbound phone calls to doctor offices, provider offices, and they get taken away because of the call volume metrics,” the worker said. “The numbers are constantly driven down your throat. Email, after email, after email – check your numbers, make sure you hit your numbers and everything. Our manager would post our numbers daily so everybody on your team knows whether or not you’re meeting your metrics.”
In addition to the increased workloads and frustrating processes, the worker explained that customer service advocates did not receive a raise this year.
“After a year of Covid, and all of us making adjustments for Covid and everything. They were like, ‘Well, sorry, you’re not getting a raise, you know, you’re just out of luck this year,’” one worker said.
Workers said human resources held focus groups in response to the online petition, but that nothing has changed. Several workers have quit.
“Burnout is very high and these jobs, the metrics they have to meet in many cases are impossible to meet, particularly if they’re talking to a health plan enrollee who has a complicated case. But they’re on the clock and there’s an expectation they will handle a certain number of calls in a day,” said Wendell Potter, who worked at Cigna from 1993 until he retired in 2008 as vice president of corporate communications and became a whistleblower on the industry.
Potter added: “You have to deal with people who are in a difficult spot and in many cases angry, trying to figure out their health plan, benefits and why something was denied or why they had to get prior authorization for something. In my view, it’s one of the most stressful jobs in a health insurance company.”
Jordyn Emeree, who worked as a call representative at Cigna in Illinois for two years, quit last month over the stressful working conditions and because she says a manager discriminated against her for being a transgender woman, telling her that she shouldn’t expect everyone at work to accept her transition.
“In the two years being with Cigna I never got a bonus as we’re supposed to get one every quarter. I had to fight for my yearly raise last year as it was not given to me,” said Emeree. “They let the members emotionally abuse us and we can’t do anything about it besides wait for a supervisor to become available to take the call.”
A Cigna spokesperson declined to comment on any individual complaint, but said in an email, “Cigna takes all feedback seriously, including external petitions such as this one. We have a wide range of tools to ensure our employees’ voices are heard. We regularly survey all employees covering topics like workload, conditions, and stress, host town halls, conduct focus groups, and actively encourage our managers to have open and honest discussions with their teams about how we can better support our colleagues. We’re proud of the culture we’ve created, but know there’s always room to improve, so appreciate all feedback we receive.”
https://www.theguardian.com/money/2021/aug/03/cigna-call-center-poor-working-conditions-profits
One Medical Employees Say Concierge Care Provider Is Putting Profits Over Patients
by Tim Mak - NPR - August 4, 2021
The health care company One Medical, under government scrutiny for allegedly using vaccine distribution to increase its bottom line, is facing a new challenge from within: employees who accuse the company of placing profits over patients.
Dozens of One Medical employees are trying to unionize as a response to what they say has been mismanagement of the organization's COVID-19 response, poor working conditions for staff and, they allege, a declining focus on patients.
One Medical officials strongly deny that the company's primary focus is anything other than patient care. "Delivering quality care to our patients is our number one priority," the company said in a statement. "Our success is measured not in membership numbers, but instead in the satisfaction and well-being of our patients."
Still, employees point to several changes in company policies that, they say, place profits over patients, including requirements for shorter doctor visits, less time to respond to patient concerns at the company call center and rushed schedules for laboratory employees.
One Medical has a reputation for being a high-end health care provider, and it typically charges its relatively affluent clientele a $199 annual fee — before members use insurance or pay out of pocket. The company promises a tech-driven scheduling and telemedicine experience along with a more personal relationship with medical providers. The company has a market capitalization of more than $3.9 billion and more than 500,000 members across the United States.
NPR spoke to 10 current and three former One Medical employees who described their work experiences. Almost all requested anonymity due to fears about their job or legal repercussions as a result of speaking out. Some but not all of those interviewed were part of the union-organizing effort.
The employees describe a company that they say fundamentally changed its focus after its initial public stock offering in January 2020, with increasing revenue and reducing costs taking center stage.
"The minute we went IPO, we pivoted away from patient care to membership volume," said one administrative staffer at One Medical. "It's about membership numbers and showing the investors our membership numbers have gone up." Added another employee, "Ever since we went public as a company, profit matters over employees and patients."
Richard Minter, a union organizer for Workers United who's in contact with employees at One Medical, said those changes are behind the unionization effort.
"[Company leadership] did things that helped foster a sentiment within the workforce that One Medical had forgotten about its staff — and that One Medical had, as a for-profit institution, turned their back on what was most important," he said.
A One Medical spokesperson called the assertion "entirely false and baseless ... our patients' health and well-being has always been, and will always be, our highest priority."
One example of what some employees believe illustrates a focus on costs rather than patient care is that One Medical patient physicals and preventive care appointments were cut from 40 minutes per appointment to 30 minutes after the IPO.
Providers and staff were given talking points in case patients questioned why they were limited to 30 minutes, and workers were encouraged to tell patients that the shorter visits were part of a "redesigned Physical," according to a copy of the talking points reviewed by NPR. Medical providers were advised in this document that they should use two minutes to "connect and ask the patient what they want to achieve today," 10 minutes to take the patient's history, six minutes to take vital signs and other measurements and then six additional minutes to finish the visit. Five minutes were allocated for walking the patient out and cleaning the room.
One Medical asserted that there had been no decline in patient standards, that the company did not change the total number of patients seen each day and that average visit duration remained the same. The Medical Group Management Association, a trade organization for doctor practices, told NPR that the average time for preventive care visits nationally was 30 minutes in 2019, the most recent year for which figures are available.
Work practices have also changed for One Medical administrative staff tasked with answering phone calls from patients, employees said. These calls involve things like setting up appointments or dealing with patient questions.
Company leadership began demanding that the staff meet strict targets on the number of calls taken per day, as opposed to the prior approach in which employees determined how long calls should be, employees told NPR.
Three individuals who have done this work described six-hour shifts in which employees were given a lunch break and an additional 10-minute break and were expected to take phone calls at all other times, with management watching to ensure they met strict metrics.
Employees at a One Medical call center in Phoenix said they were constantly monitored on the number of calls taken each day, the percentage of time they were on the phone and the number of tasks completed each day. The company expects staff to be on the phone for 65% of each shift, the staff said.
"You're just sitting there, looking at a metric, trying to meet a percentage. It's super anxiety inducing," said one of these workers. "The idea used to be that if you had a phone call from a patient, you'd have ... time to figure out how to help them."
Employees said many tasks that involve helping patients didn't count as time on the phone: messaging patients online, seeking medication authorization or following up with health insurance billing, for example.
"One Medical prides itself on being patient centered. ... We don't have time to message patients back. We don't have time to follow up. ... It's become an impossible job," said an employee whose job it is to answer patient phone calls.
One Medical disputed this characterization, saying in a statement that all contact centers have metrics that they measure. The company also said that the 65% figure was "not a requirement," but instead an average, and that the company "purposefully set[s] goals that provide a generous amount of time" for completing tasks that don't involve being on the phone.
"While we have always had performance expectations for virtual work, we have recently focused on providing additional clarity and transparency into those expectations to support our employees in their efforts to deliver the best possible customer care for our patients," One Medical said.
Those engaged in medical roles were also put under pressure. This year, One Medical phlebotomists, who specialize in drawing blood, had their morning preparatory period withdrawn, leaving little time to get equipment ready in the morning as patients waited, phlebotomists told NPR.
In response, One Medical said that there is no evidence patient care was adversely affected by the change and that the change was necessary to "make lab hours consistent across clinics in each market."
Approximately 30 employees are on an organizing committee to seek union representation and are being represented by Workers United. In late June, they announced their intent to request that One Medical voluntarily recognize the union. Failing that, these employees plan to seek the approval of the majority of administrative staff and phlebotomists to unionize — approximately 530 staff members, by their count. Doctors and nurses are not part of this organizing effort.
One Medical said that it would not voluntarily recognize the union without a vote. "We have no indication that a majority of these employees wish to unionize or agree with the reported assertions," a company spokesperson said. "If the affected employees vote to unionize through the government-run, secret-ballot election, we will recognize the union and work with it for everyone's benefit."
In a companywide meeting on July 23, One Medical CEO Amir Dan Rubin told employees to consider what he viewed as a downside of unionization.
"We think the best way to effect positive change is to work together directly, rather than through the filter of a union, which is unlikely to share our vision and brings a number of their own priorities to any situation. That said, we respect the official process and right to choose or oppose unionization," he said. "Before any of you involved in this make such a decision, make sure you fully understand what it means from a cost perspective. I'm sure you're all familiar that there are union dues."
One Medical faces these internal matters even as it confronts other external challenges: This year, numerous county and state departments of health halted cooperation with One Medical over allegations that the company provided COVID-19 vaccines to then-ineligible patients.
Further reporting yielded allegations that the company helped those with connections to company leadership skip the COVID-19 vaccination line and that the company may have sought a commercial benefit by collecting data from nonmembers it was vaccinating. Following this, the House Select Subcommittee on the Coronavirus Crisis started its own probe into the San Francisco-based company.
NPR was also made aware of a second probe initiated by the California Department of Consumer Affairs after the agency reached out to NPR in March and late July as part of its investigation on behalf of the Medical Board of California (the board would not confirm or deny whether its investigation was ongoing).
In a May filing with the Securities and Exchange Commission, One Medical acknowledged that it was also the subject of inquiries from the California attorney general, the Alameda County District Attorney's Office and the Federal Trade Commission.
One Medical's stock is trading at around $28 a share, down from its high of nearly $60 in February, before the various investigations began.
It’s Hard Enough to Have a Child With Cancer. It Shouldn’t Crush Families Financially.
My infant daughter was diagnosed with a brain cancer nearly a year ago. She endured several surgeries and horrific side effects from her chemotherapy, which ultimately took her life on Christmas Eve. And yet, my family was one of the lucky ones.
We had ample savings and excellent health insurance. Our employers mostly continued to pay us. Though the total tab for her four-month battle came to a staggering $1.8 million, insurance covered most of our hospital bills.
We were also able to raise over $100,000 from friends, family and many kind strangers through crowd funding. That cushion went to cover the many costs that even excellent insurance doesn’t. It allowed us to move from New York to Boston, to rent a large minivan to transport all of our belongings for an exorbitant $1,000 for one way. It covered our $4,000-a-month furnished apartment — the cheapest option we could find available within walking distance of the hospital where we lived while our daughter got world-class treatment from a brain tumor expert.
The vast majority of childhood cancer families have a very different experience. On top of the earth-shattering news that their child has cancer, they must struggle with the financial burden incurred by trying to keep their kid alive. Many lose at least one parent’s income. Some eventually file for bankruptcy. Others have their utilities shut off.
Lawmakers on both sides of the aisle are proposing various ways to lessen that burden — including providing tax credits for family caregivers, letting the parents of a child with cancer take paid parental leave for an extended period of time, and making it easier for children with cancer on Medicaid to get treatment in another state.
Action can’t come soon enough. Doctors have improved survival rates for some types of childhood cancer in recent years, but it remains the No. 1 disease-related killer of children. Meanwhile, while all our children experience different types of cancers and treatments, the financial strain is nearly universal: A 2018 National Children’s Cancer Society survey of 449 families found 95 percent said their child’s cancer caused a financial burden on their family. A 2009 study in the American Journal of Medicine found that 14.6 percent of medical bankruptcies were caused by the illness of a child. Other studies have shown that children of poorer families have worse survival rates and higher rates of early relapse.
A 2018 survey of 1,743 families by the American Childhood Cancer Organization found that over 75 percent of respondents said they either left work or had to cut back work hours to care for their child during treatment.
Many families in the tight-knit childhood cancer community have relayed similar stories to me. Moms have stepped away from their careers for months — or years — to care for their child full time. Others are forced to keep working, lest they lose their family’s insurance. Families max out credit cards and go into debt, just to give their child the best chance of surviving.
Auburn Curry, whose son is battling leukemia in Kentucky, was fired when her unpaid medical leave ran out. “I got a cold call from H.R. that said, ‘You’re terminated effective immediately and all your benefits expire at midnight.’ We went from 50K a year to zero,” Ms. Curry commented on my Facebook post asking parents about their struggles.
It doesn’t even end with death: Families also regularly are forced to crowd fund their children’s funeral costs. One mother, Emma Lipnicky, told me she left the hospital after her daughter died to find their family had $3000 in parking fees.
For those whose children do survive, immediate and lifelong challenges related to their cancer and treatments are a continued financial burden. Even with insurance, parents will often then face tens of thousands dollars in out-of-pocket medical costs related to physical, speech, and emotional therapy.
“My wife left her job to care for our son full time while he was in treatment. Some fund-raisers hosted by friends and communities helped, but we ended up leaving treatment with debt,” Tym Rourke, whose son survived brain cancer, explained to me on Facebook. “However, our story is the unending financial strain that goes with survivorship. We’re 15 years from diagnosis, and this year we’ve had over $4,000 in out-of-pocket costs for my son’s ongoing medical care,” he said. “It’s never ending. The financial burden of treatment and survivorship can be lifelong, and as my son gets older I fear his own economic mobility will be hampered by his own costs.”
Recognizing those costs means also finding legislative solutions to ease the burden.
The Family and Medical Leave Act policy — passed all the way back in 1993 — hasn’t really budged in over 25 years. It offers certain employees 12 weeks of unpaid leave, and a guarantee of one’s job. But unpaid leave is not an option for all families.
“Everyone should be fortunate enough to know that if their child is diagnosed with a life-threatening condition, that our country has their back; that’s the least of what we should do,” Sen. Patty Murray, a Democrat, told me. Murray hopes to increase family leave nationally from 12 weeks of unpaid leave to 12 weeks of paid leave — thus allowing families to care for their child full time at the beginning of their treatment without worrying about lost income.
Another proposal working its way through Congress with bipartisan support, the Credit for Caring Act, would provide a nonrefundable tax credit of up to $5,000 that could benefit parents who become caregivers for their sick children. The tax credit could be used toward transportation, home modifications to accommodate a family member, medication management services, and training or education for the family caregiver.
For families on Medicaid, bipartisan legislation also hopes to make it easier to move to a new state for medical care, removing the burdensome red tape required to receive care in a different state under a different Medicaid plan.
Our financial burden was easier than most. The money left over from our crowdfunding we donated to childhood cancer organizations, including our own fund for childhood cancer research, the Team Beans Infant Brain Tumor Fund housed at Dana-Farber Cancer Institute.
I will carry the pain of Francesca’s loss with me for my entire life. But I was one of the lucky ones.
Andrew Kaczynski is an investigative reporter and founder of CNN’s KFile Team.
No comments:
Post a Comment