Archive for the ‘health care’ Category
Arizona takes back gifts it gave unmarried couples
Among the news reports filtering in during Unmarried and Single Americans Week, it is upsetting to find that the state of Arizona has rescinded the domestic partnership benefits it had just recently extended to state employees.
Although DP benefits are often wrongly described as a “gay rights” issue, the article points out that more than 3/4 of the employees receiving benefits were in different-sex couples. That fits what we hear all over. In 2006 the NYC media reported that different-sex couples made up 3/4 of NYC registered domestic partners.
In fact, Pablo, the AtMP intern working on plus-one benefits for federal employees, discovered these facts about state employees:
- Washington State – The Human Resources Department reported a positive boost in recruitment and retention since instituting benefits for both same- and different-sex partners.
- Vermont – the earliest state to champion equal benefits for both same-sex and different-sex partners, it found initial, marginal increases in premium costs but ultimately saw no effect on state costs.
- New York State – covers over 4,880 employees’ domestic partners, and the majority of these are different-sex partners. New York reports that the plan has been easy to implement.
Unmarried, uninsured, out of luck?
Hunter, our demographic research intern, has put together some important, disturbing and highly motivating statistics.
Unmarried people are concentrated in economically disadvantaged categories. For example, unmarried Americans are disproportionately
- African-American: 69.1% of blacks adults are unmarried; 19.8% of all unmarried Americans are black.
- Women: 56.4% of unmarried adults are female.
- Young: 33.7% of unmarried adults are 18-29 years old.
- Poor or low-income: 14.7% of unmarried people aged 16 years or older live below the poverty level; 38.6% of unmarried households earn under $30K.
- LGBT: 100% of people in same-sex partnerships are currently counted as unmarried (though it looks like the Census will start crediting same-sex marriages soon!); of course, many bisexuals and transgendered people are married to different-sex partners, as are some people who identify as lesbian or gay.
Not coincidentally, the demographic groups that are most likely to be unmarried are also the same groups that get less health care, get sick more and don’t get well as much as other Americans. Making health insurance more affordable for unmarried people, and taking other measures to increase their access to care, could decrease disparities and increase health equity.
Unmarried workers disproportionately lack health insurance: 40.5% of the workforce is unmarried, yet unmarried people constitute 59.7% of all workers without coverage and only 36.4% of workers with coverage. The impact of marital status is even more pronounced among part-time workers, who more frequently lack coverage: 67.1% of uninsured part-time workers are unmarried. Unmarried people are also the majority (56.4%) of the unemployed uninsured. In all, 59.8% of uninsured Americans are unmarried.
Obviously, these stats do not mean that all unmarried people are out of luck, and clearly getting married would not solve everyone’s problems. But they should make you wonder, why aren’t health care reformers promising equal costs and access to all Americans regardless of marital status?
Do something about it! Download our free one-page fact sheet or tri-fold brochure “Why You Should Care about Barriers to Coverage for Unmarried People” and get it into the hands of the health reform advocate you admire most – be it your doctor, your state health coalition, your Congressperson, or the President. And let us know what they say!
Illegitimacy and advance directives in the news
I keep an eye out for news that affects the cultural context surrounding AtMP’s efforts to reduce singlism and marital status discrimination, as well as news about specific projects we’re working on. This week two aspects of the attacks on President Obama and his health care reform efforts caught my eye.
First, the over-publicized, utterly fabricated stories about the President’s birth certificate. How could that nonsense possibly be relevant to us? I have a Google news alert for “illegitimacy + birth,” and I’m concerned any time I see an increase in the use of that outdated combination of words. It’s worth remembering that the concept of illegitimacy was abandoned just a few decades ago, and that some people (who prefer divisiveness to diversity) keep trying to bring it back. AtMP has consistently spoken out against calling children “illegitimate,” from educating the conservative Washington Times in 2001, to chastising an anti-immigrant group in 2007. The current lies about President Obama don’t call for our intervention. But, it is nice to recall that (after being born in the U.S.) he was raised in perfect picture of family diversity, experiencing a single mother, an extended family household, a step-parent, and half-siblings with a variety of geographic and cultural origins. Just like so many of us!
Second, the mis-representation of a very small, very good element of health care reform – a proposal to help more people write advance directives. AtMP spends a lot of energy informing people that we all have the right to name our medical decision-makers and state our wishes through advance directives, regardless of our marital status. Too few people take advantage of this power, so we’re glad to see that Barack and Michelle Obama have written their advance directives, and that legislation might encourage more people to do so. Here’s how it’s explained at Salon.com:
The legislation would order Medicare to pay for consultations between patients and doctors on end-of-life decisions, which it currently doesn’t cover. But the consultations wouldn’t be mandatory; if your grandmother doesn’t want to go talk to her doctor about end-of-life care, she won’t have to. Because Medicare doesn’t pay for this kind of planning now, only 40 percent of seniors who depend on the government insurance say they have an advance directive that tells healthcare providers what measures they do and don’t want used to prolong their life, even though 75 percent say they think it’s important. The lack of planning actually costs a lot of money. Medicare spends billions and billions of dollars annually on expensive treatment during the last year of a dying patient’s life. Without allowing Medicare to pay for end-of-life consultations, it’s hard to know whether patients even want to go to such expensive lengths.
AtMP submits congressional testimony on DP benefits
Last week, thanks to the quick work of a new intern, AtMP submitted written testimony about domestic partner benefits for federal employees to the House Subcommittee on the Federal Workforce etc. In sum, we told Congress that
The Domestic Partnership Benefits and Obligations Act of 2009 offers an important opportunity to give unmarried Americans who work for the federal government better access to health coverage. However, by offering to include only same-sex partners, it falls short not only of the needs of federal employees but also of the standard set by competing employers.
The committee website also offers links to testimony by other organizations, labor unions and individuals.
This afternoon, we’re watching the webcast of the hearing. We had a brief moment of glee when Representative Chafetz of Utah expressed concern about discrimination against unmarried different-sex couples. Of course, the moment quickly passed when his comments made clear that he is more interested in “protecting” “traditional marriage” than recognizing family diversity. (Hear his comments roughly around 44 minutes and 1 hour 22 minutes into the webcast. Nonetheless, we’ll try reaching out to him to persuade him that discrimination is real and, unlike what Representative Baldwin said, not “easily cured” by getting married.
Federal employment benefits for whom?
A lot of cooks are stirring the pot these days, trying to cook up more inclusive federal employment benefits. I’m hoping they’ll ultimately dish out a truly satisfying dish that allows federal employees to define and take care of their own families.
Most recently, President Obama hinted that he’d let same-sex partners share benefits via executive order. AtMP members reacted quickly and strongly, sending him over 110 emails saying
All federal employees should be allowed to put one adult on their health plan along with their children. At a minimum, benefits should go to both different-sex and same-sex partners of government employees.
In fact, Obama changed only a few rules, not touching the big prize: the Federal Employees Health Benefits Program.
The executive branch believes it does not have the right to broaden the definition of family in its personnel policies.
The legislative branch has proposed both sweeping and targeted expansions. The Domestic Partnership Benefits and Obligations Act was re-introduced in both House and Senate in May. It would give same-sex partners blanket access to everything that spouses get. A more specific bill addresses benefits for foreign service officers.
The judicial branch is handling a case in which federal employees who married their same-sex partners in MA are suing for spousal benefits. Back in February a court decided in favor of a federal employee’s suit for benefits for his same-sex partner.
So far, all three branches look to be cooking up a thin broth that will be tasty only to people in same-sex married or marriage-like relationships. AtMP calls on all decision-makers, whether executive, legislative or judicial, to recognize that the real problem is treating conjugal (romantic, sex-based) relationships differently from all the other relationships in federal employee’s lives. We’d like to propose the Sergio A. Olaya Equal Benefits for All Employees Act, by which all federal employees would be allowed to put one non-dependent adult on their benefits plan along with their dependents. (And, we’d like to propose single-payer, truly universal health care!)
Care time: another face of discrimination in health care
I often check the New Old Age blog, because anecdotes suggest that unmarried people may be tapped (more than their married siblings or peers) to become caregivers for elderly parents. Today’s post caught my eye: families can write contracts to compensate the caretakers for lost income. That’s a good idea for people who leave their jobs entirely. But what about people who “just” take time off work to care for parents, siblings or anyone not their spouse?
I call “being able to take time off work to care for a family member without being fired” care time for short. Care time improves the health and economic well-being of workers and their families. Although unmarried people have real family care needs and responsibilities, they disproportionately lack care-time because
- their employers are allowed to penalize employees for taking care-time, or
- their employers are mandated to provide some kind of care-time, but are allowed to use marital status to determine which employees get care-time.
The Family and Medical Leave Inclusion Act would greatly improve people’s right to care for non-spouses. It would amend the Family and Medical Leave Act of 1993 to permit leave to care for a same-sex spouse, domestic partner, parent-in-law, adult child, sibling, or grandparent who has a serious health condition. Congress tried to pass it in 2007 but didn’t get anywhere. It was re-introduced on April 28th with more co-sponsors, and is now in committee.
A related proposal, the Family Leave Insurance Act would provide up to 12 weeks of paid leave benefits to workers who need to care for an ill family member (child, parent, spouse, domestic partner, grandchild, grandparent, or sibling) or new child, to treat their own illness, or to deal with an exigency caused by the deployment of a member of the military.
AtMP is seeking a volunteer to track the progess on these bills and help us further develop our care time strategy. Though I love to meet our volunteers, this work can be done anywhere via phone and email. If you’re interested, please post here or send me an email.
More about the NY Family Health Care Decisions Act
Tuesday was a successful and educational day in Albany. AtMP co-founder Marshall Miller and I met with nine state lawmakers and/or their legislative staff, and met dozens of fellow members of the Family Decisions Coalition. In total, Coalition members visited 59 legislators.
We learned a great deal about the Act and its history. Most important: it does provide a challenge mechanism for potential surrogates, so we revised AtMP’s recommendations.
Most incredible: the Act has been proposed every year for the past 16 years! This year it has the best chance of passing, because most key factions have been mollified. For example, one faction had long opposed giving domestic partners the same status as spouses. In recent years, however, bills on hospital visitation and burial that treat domestic partners and spouses equally have successfully passed both houses and been signed into law.
Nicky at NY state capitol building to support passage of FHCDA
Hospital rights in NY to be gained through law, not marriage
Members of AtMP’s email list may have noticed that we’re paying a lot of attention to hospital rights (a catch-all term for people’s ability to visit and make medical decisions for each other in emergency situations). As a native New Yorker myself, I was shocked to discover that New Yorkers have fewer medical decision-making rights than most other Americans.
Advocates of marriage equality talk about health care decision making as if it depends on the right to marry. For example, a leading NY marriage equality web page says “We are routinely denied access to such fundamental protections as medical decision-making authority.” The linkage of medical decision making to marriage is misleading. Married New Yorkers do not have the right to make medical decisions for their spouses in the absence of written directives, except in ‘do not resuscitate’ situations. Neither parents, siblings nor close friends have this right – it does not exist in NY State.
(Of course, all competent NY adults do have the right to designate health care proxies and to choose whether to have extraordinary resuscitation using state-approved documentation. Unfortunately, few New Yorkers do the paperwork. And, unmarried New Yorkers have great protections for hospital visitation.)
A proposal called the Family Health Care Decisions Act would fix this situation. I’ll present AtMP’s recommendations for making it even stronger when I visit lawmakers in Albany next Tuesday.
If you live in NY, please urge your state senators to co-sponsor the act.
Third Principle: Maintain Coverage When Relationships Change
Just as people get married to get onto their spouses’ job-based health insurance, they often lose that coverage when they get divorced. Divorced people are more likely than the general population to be uninsured (21% of divorced people lack coverage, compared to 16% of the general population). Young adults often delay marriage so they can stay on their parents’ health plans, or opt out of coverage altogether (30% of married 19-25 year olds lack health insurance). Almost half the states now require insurance providers to extend coverage of unmarried, dependent children well into their 20s (to age 30 in New Jersey). The narrow definitions of family used by most employer health plans mean that an ex-spouse or a married child is no longer considered to be part of the employee’s family and therefore can’t be covered, even if they can’t afford coverage on their own.
- State laws should be amended to prohibit employers and insurers from automatically terminating the family status of child who marries or forms a domestic partnership. The Federal Employees Health Benefits Program (FEHBP) should also allow otherwise-uninsured adult children to stay on their parents’ plans, regardless of marital status.
- New Hampshire’s 2008 Divorce Health Access Law prohibits employers and insurers from automatically terminating the family status of divorcing spouses of covered employees. States should adopt this model law, and the FEHBP should incorporate the same principle. The end of a domestic partnership should be treated the same way as a divorce.
Second principle for universal coverage: Treat Covered Relationships Equally
There is no national right to health insurance, and the federal Employee Retirement Income Security Act (ERISA) prohibits states from requiring that employers provide health insurance. Nonetheless, numerous laws encourage and shape job-based coverage through taxes, fines, and continuing coverage rules. Some examples:
- The IRS does not collect income taxes on the money that companies or workers spend on premiums for job-based health insurance, thus lowering the total cost of coverage.
- Several states give employers the option of either providing insurance or paying into a fund that is used to subsidize insurance for non-covered workers.
- Under the federal Consolidated Omnibus Budget Reconciliation Act (COBRA), people may stay on their employer’s group plan by paying the full premium (both the employer’s and the beneficiary’s share) for up to 18 months after a “triggering event” makes them ineligible for the job-based coverage. Although COBRA applies only to employers with 20 or more employees, 41 states have COBRA-like laws that apply to smaller employers.
None of these laws currently takes into account the increasing prevalence of coverage for non-marital relationships. As a result, unmarried partners pay more for coverage, and lose coverage more often, than spouses do.
- The IRS should exempt domestic partner or plus-one benefits from income taxes. COBRA should require continuing coverage for everyone who is on a job-based plan. (Over 120 of you wrote to Congress urging them to update COBRA during the stimulus package debate.) These changes require acts of Congress, because the Defense of Marriage Act prevents federal agencies from extending spousal benefits to non-spouses. Congress should repeal the Defense of Marriage Act.
- State COBRA-like laws should require that all insured beneficiaries have equal access to continuing coverage.
- State “pay or play” health reforms should make employers who cover spouses but not unmarried partners contribute to state funds to subsidize insurance for those partners.
