Archive for the ‘health care’ Category

Neighbors, New Yorkers

The New York Times New Old Age blog offered another revealing story about unmarried caring relationships, and how important they are to our health. In brief, a not-young married couple provides food, company and transportation to their older neighbors. They are more important and reliable to their neighbors’ daily well-being than are their neighbors’ blood relatives.

Reading the comments on this story, I was fascinated by how many people said the neighbor deserves not only thanks and chocolate but also money to cover expenses (I agree). I was also glad one reader pointed out “… that the person who is so selfless may start demanding a decision-making role in determining how, when, where or what health care is given ….” The reader saw this as a negative “danger,” which of course it could be. But it also could be a positive, desirable situation to have a knowledgeable neighbor caregiver who takes part in health care decision making. The challenge is to permit the positive and prevent the negative.

Judging from the original post and the comments, people are comfortable with the idea that the neighbor caregiver has “already driven ailing neighbors to the emergency room several times.” People should not then be comfortable with the idea that hospital staff could stop the neighbor at the door and prevent her from visiting the elderly patient whom she delivered. This is the kind of situation that AtMP’s comment on the proposed federal visitation rule tries to address. There’s still time to submit your comment – please do!

So far a New York college radio station seems to be the only media outlet covering the visitation rule. WFUV plans to air a piece about it early Monday morning. We did a 10-minute interview with them today, but of course the coverage might last just a few seconds. Listen in if you can!

Dangers of marriage as policy ideal

AtMP has seen important progress on unmarried people’s rights since its founding in 1998. But now I worry that the trend might be starting to slip into reverse. Two recent court decisions – both hailed as gay rights victories – actually highlight the dangers of using marriage as an exclusive public policy ideal, instead of valuing all individuals, caring relationships and families.

While celebrating that California’s Prop 8 was overturned and same-sex couples may regain the right to marry there, our friends Rachel and Bella DePaulo point out that the judge and the winning lawyers elevated marriage and disparaged alternatives to marriage, to an extraordinary and unnecessary extent.

With far less fanfare, Arizona ruled that same-sex domestic partners of state employees could have their health benefits back, after taking them away last year. However, local news reports that

The ruling does not affect unmarried heterosexual couples who also gained coverage as part of a change in state policy pushed through by the administration of former Gov. Janet Napolitano. Absent some change in policy — or a different lawsuit — they will lose their domestic partner benefits at the end of this year. Attorney Dan Barr said the lawsuit did not cover these “straight’’ unmarried workers because they are in a different legal situation: Unlike gays, they can get married to obtain benefits.

In essence, both court cases say “if you can get married, you should, and the burden’s on you if you don’t.” We see parallels in the private sector: both Google and Syracuse University are reimbursing income taxes their employees pay on health benefits for same-sex but not different-sex partners.

Today I had a very pleasant and helpful conversation with an attorney at Lambda Legal. I learned that lawyers have a hard time making an equal protection claim for different-sex couples. To paraphrase, at least two courts have ruled that ‘choosing not to drive a Cadillac does not give someone the right to drive a Pinto.’

I’m not a lawyer, but my instinct says that a winning case would have to demonstrate that being domestic partners or staying single are better options than marriage for a significant group of people. We’d have to prove that marriage is the Pinto, not the Cadillac. Obviously, many AtMP members believe this is true for themselves. Can we build a legal argument to that effect? Can we build one that overcomes the lens of traditionalism through which judges and business leaders see the world?

Visitation victory within reach!

Back in April, President Obama introduced a hospital visitation memo, to ensure visitation rights for all patients. While the proposed rule is a great attempt, it still needs improvement in four key ways:

It should insure visitation protection

1) for legally appointed health care agents,

2) without discrimination on the basis of marital/relationship status,

3) for emergency patients, and

4) for patients who have not designated visitors and/or completed advanced directives.

We spent considerable time working on our public comment, incorporating some of AtMP’s members’ traumatic hospital visitation stories. It is now available to read and provide inspiration – we urge YOU to tell the Centers for Medicare & Medicaid Services (CMS) your story! The deadline to submit a comment is August 27 – don’t wait, show your support now!

DP benefits are issues of health & justice, not orientation (updated)

Thanks to Jonathan for sending me the great news that Google will cover the extra tax costs for employees with same-sex partners whose domestic partner benefits coverage is treated as taxable income (unlike spousal benefits). It is infuriating that Google would level the playing field only for same-sex partners, leaving different-sex partners to pay more or “just get married.” This is one of my biggest pet peeves, and here is (a corrected version of) what I posted as a comment on the New York Times blog about the story.

As reported by HRC, Google extends benefits to the domestic partners of both same- and different-sex employees (as do 95% of companies that offer DP benefits).

According the US Census Bureau, there are three times as many different-sex unmarried partner households in the San Francisco – Oakland – Fremont Metro Area workforce than same-sex ones. Nationwide, different-sex partners comprise 88.6% of the 6.15 million households headed by cohabiting couples. In a 2006 study, Badgett of the Williams Institute (who is quoted in the main article) wrote that “people with different-sex partners who have domestic partner coverage [currently] outnumber the same-sex partners with domestic partner coverage by a nine to one margin” and that, if all US employers offered DP benefits, “out of every thousand employees, on average only one to four would sign up a same-sex partner, and another 13–21 would sign up a different-sex partner.”

This is not a “gay” issue, it is a public health and social justice issue. Again quoting Badgett, “Gay men and lesbians in couples are more likely to be uninsured than are married heterosexuals, and people with unmarried different-sex partners are the least likely to be insured.” In addition, different-sex partners are also more likely to be people of color, and to have lower incomes, than married or same-sex couples. (More on unmarried people’s access to health care.)

What a company as rich as Google should do is convert its entire family benefits structure to a plus-one model, in which every employee has an equal right to extend benefits to her/his economic dependents, children up to age 26 (per new federal law) plus one non-dependent adult regardless of relationship type.

Google’s new subsidy policy is a ridiculously wrong-headed move that will surely antagonize it’s workforce and should hurt its global reputation.

Healthcare.gov ignores unmarried partners

As an early step in implementing health care reform, the federal government has launched a new website intended to help you “Take health care into your own hands.” Unless you’re in an unmarried partnership, that is.

A search for “domestic partner” on the website returns ZERO information (a search for “spouse” returns 43 links). You can be a “family with children” or an “individual,” but you’ll have a hard time finding information for child-free couples and nothing for unmarried couples.

Rather than get mad, let’s take the feds at their word and help them improve. Many pages have a feedback box in the lower right corner that asks “Was this page helpful?” Click NO, and add a short note such as “I want information about domestic partner coverage.”

We’ll keep an eye on healthcare.gov to see whether they really improve.

Preserving great care time for federal employees

Interesting news on care time – my nickname for the right to take time off work to care for someone else’s health without getting fired.

Federal employees have long had one of the best care time policies – they have been allowed to leave to care for their “spouse, and parents thereof; children, including adopted children, and spouses thereof; parents; brothers and sisters, and spouses thereof; and any individual related by blood or affinity whose close association with the employee is the equivalent of a family relationship.”

AtMP has long encouraged this definition to be included in the Family and Medical Leave Act so it would apply to all workers.

This week the Office of Personnel Management issued a clarifying regulation “to promote consistent application of policy across the Federal Government, and to allow the Federal Government to serve as a model employer” by “making the definitions of family member and immediate relative more explicit to include more examples of relationships that are covered.” Fortunately, OPM notes

that it would be very difficult to list each and every type of family member or immediate relative, as it would be very difficult to consider all the variations of a contemporary family. The fact that a specific relationship is not expressly included in these definitions is not meant to diminish the familial bond, or to imply that leave may not be used to care for a person with that relationship.

It is also really great that OPM spells out that it

does not normally require proof of a domestic partnership for the purpose of leave administration. For example, an agency does not typically request specific documentation to prove an employee’s relationship with his or her family member (e.g., parent, spouse, sister, brother). We find that agencies are in the best position to administer their own leave programs and should follow the same procedure for all employees.

I certainly hope that more employers will look to OPM as a model!

making the definitions of family
member and immediate relative more explicit to include more examples of
relationships that are covered

An update on housing, hospital visitation and health insurance.

AtMP is currently tracking three important measures:

1) S.3182 Equal Access to COBRA Act: a federal bill that would give same-sex partners, same and different-sex domestic partners, as well as qualified siblings, parents and grandparents the ability to purchase health insurance through COBRA.

2) H.R. 4820 The Fair and Inclusive Housing Rights Act : a federal bill that would prohibit housing discrimination on the basis of sexual orientation and gender identity.

3) Presidential Memorandum on Hospital Visitation (4/15/10): an order to instruct hospitals that participate in Medicare or Medicaid to make

clear that designated visitors, including individuals designated by legally valid advance directives (such as durable powers of attorney and health care proxies), should enjoy visitation privileges that are no more restrictive than those that immediate family members enjoy. [And] that participating hospitals may not deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability.

While AtMP really likes the COBRA bill, we believe the visitation and housing items should include the term, “marital status.” We’ll request this change in the visitation rule during the 60-day public comment period expected to start at the end of June. My conversations with Congressional staff suggest they will be open to adding “marital status” to the housing bill; however, that bill is not moving at the moment.

***PLEASE STAY TUNED FOR YOUR OPPORTUNITY TO TAKE ACTION!***

Data show marital status impact on health coverage but not health

My inner geek is having a great week (at the expense of my less robust inner fundraiser – please help me restore psychic harmony by making an easy, secure, tax-deductible donation to support this work)!

New data on the impact of Massachusetts’ 2006 health reform law demonstrates the link between women’s marital status and health coverage:

… roughly 60,000 women aged 18 to 64 were uninsured in fall 2009. Moreover, one in every five women reported problems obtaining care or paying for the care they needed. … The women who were uninsured … were disproportionately young (ages 18 to 25), Hispanic, and single.

My quick crunching of the new data on MA women produced some eye-opening numbers:

for every 100 women who are living with their unmarried partners and who have health insurance, there are 150 uninsured cohabiting women;
for every 100 ever-single women with health insurance, there are 223 uninsured ever-single women;
for every 100 divorced, separated, or widowed women who have all their health care needs taken care of, there are 135 divorced, separated, or widowed women with some unmet need for health care;
for every 100 cohabiting women who had no trouble finding a doctor, there are 137 cohabiting women who are having difficulty finding a doctor (or finding one who accepts their insurance or new patients). Thanks, Rachel, for checking my math!

This report reaffirms findings about both men and women which were released by the same research team late last year. Of course, coverage and access differentials correlate to numerous variables, but the difference between married and unmarried MA residents’ health care is so big that it keeps showing up in the reports’ opening lines.

I was bothered by the 2009 report’s implication that young single men preferred to be uninsured, so I checked in with Tom, an AtMP member who is an MD-MPH in Boston. He wisely said “I suspect that “never married’ is the least of the reasons that young men choose not to be insured. Un/underemployment, poverty, and feeling invulnerable are much more important reasons. “Never Married” most likely popped out of the data analysis software (which) will correlate everything unless you tell it not to.”

MA’s health reform legislation was an important model for national health reform, so everyone is watching MA’s results because they may predict what we’ll see nationwide. So far, it looks like the failure to create a single-payer system or to help everyone get equal access to coverage regardless of martial status will recreate the inequality we’ve been living with for years: unmarried people are more likely to lack access to affordable health care.

That stinks, not only because it’s unjust but also because it could fuel the next perennial wildfire of sloppy media reports claiming that ‘marriage makes you healthier.’ Luckily, a new study on people in the UK offers a big bucket of water to throw on that fire. In sum, it “finds that the effect of cohabitation on health is not statistically different from the effect of marriage….”

This study’s American authors tried to take into account the way peoples’ health changes over time, and to

disentangl[e] the selection effect (healthy people make better marriage partners, ceteris paribus) versus the so-called protective effect of marriage (married people are healthier because they have a spouse who can monitor their health behaviors, care for them when they are ill, and discourage them from engaging in risky behaviors, such as smoking and drinking). It is the latter effect that is of interest to economists as it represents the causal effect of marriage on health. …

The striking result is that once we control for both selection and health dynamics cohabitation and divorce are insignificantly different in their effect on health than marriage for all sub-samples. Never married is only weakly significantly worse for health and only for all women and women under age 40. … our results suggest that both males and females may gain comparable protective effects from cohabitation and the negative health effects of divorce found by some researchers may be overstated. …

Of course, don’t forget that they studied people who all enjoy equal access to the UK’s national health system – no Brit ever gets married to get health insurance! Interestingly, they found that income still affects health despite the national health system, partly because lower income people are exposed to more health hazards (low-quality food or housing, for example).

for every 100 divorced, separated, or widowed women who have all their health care needs taken care of, there are

135

divorced, separated, or widowed women with some unmet need for health care.

Hospital visitation rights for everyone? (updated)

Appropriately for National Healthcare Decisions Day, today’s big news is that President Obama issued an executive order instructing hospitals that participate in Medicare or Medicaid to make

clear that designated visitors, including individuals designated by legally valid advance directives (such as durable powers of attorney and health care proxies), should enjoy visitation privileges that are no more restrictive than those that immediate family members enjoy. [And] that participating hospitals may not deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability.

Wait, where’s marital / relationship status? Does Obama really mean to say that a close friend or unmarried partner can be kept from a patient’s bedside, if the patient hasn’t completed a legal advance directive (or otherwise designated that person in advance) and as long as the hospital can prove the exclusion wasn’t motivated by race, color, national origin, religion, sex, sexual orientation, gender identity, or disability?

Have you or anyone you know been kept from visiting a loved one in the hospital because of martial status? Your story must be told! Click here to send your story confidentially to AtMP, or post it for the public to read in the comments section below.

NEW! Read AtMP’s comments on the regulation, and add your support!

Did you get time off to care for your new child?

AtMP has heard from many people who were denied leave from work to care for their ill unmarried partner or to attend the funeral of their unmarried partner’s parent. Now we’re helping our colleagues collect stories about workers who were denied parental leave.

Have you been denied paid parental leave due to your marital status, or for any other reason? If so, please consider sharing your story with Human Rights Watch. This is how they describe their project:

Parental leave with pay when a new child joins the home is an important support for working families, yet most U.S. private sector workers do not have this benefit. In the United States, the national Family and Medical Leave Act requires only unpaid leave. Only two states (California and New Jersey) currently offer paid parental leave, and a handful of others offer temporary disability insurance to birth mothers after childbirth. States that do offer such paid leave generally fund their programs through small payroll deductions into a state-wide insurance fund, minimizing the impact on any particular business.

For the most part, it is up to employers to decide whether to offer this benefit. Some employers, especially larger ones, do so with good results. Other employers would like to, but can’t without the help of a social insurance fund. As of 2008, only 9 percent of civilian U.S. workers had paid family (including parental) leave, and among the lowest-income workers, only 3 percent had such leave. Some workers can apply other paid leave when they have children, such as sick or vacation leave, but such leave is far from universal, especially among low-wage employees. Non-biological parents face additional hurdles in accessing any parental or family leave, even unpaid leave.

Human Rights Watch, a nongovernmental human rights group, is interviewing parents in the U.S., including LGBT parents, about their experiences with unpaid parental leave, and the impact on their families. The interviews will be used for a report (using pseudonyms, not actual names of interviewees) and for making recommendations on U.S. law and policy. Interviews last about 25-30 minutes.

HRW’s Janet Walsh is coordinating the interviews. To spare her email account from being massively spammed, AtMP will forward your information to her. Please click here if you have experienced parental leave with limited or no pay and are willing to be interviewed.

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