Peter Sullivan

“Right before the election, people would get notices of big premium increases, and that will certainly not reflect well on Democrats,” said Larry Levitt, a health policy expert at the Kaiser Family Foundation. 

Vulnerable Democratic lawmakers are trying to sound the alarm. A group of 26 House Democrats from swing districts, led by Rep. Lauren Underwood (D-Ill.), sent a letter to leadership last week urging the extra subsidies to be extended.  

“I’m worried that we’re running up on a cliff,” said Rep. Susan Wild (D-Pa.), one of the signers of the letter, who compared it to the expanded child tax credit that was allowed to expire at the start of this year. “We’re suddenly going to lose that ability. It’s similar to the child tax credit, which, you know, just kind of came and went, the expiration of it. I just don’t want to see that happen. I think it is absolutely game-changing.”

Given Republican opposition to any increased spending on ObamaCare, an extension of the subsidies would have to be included in a party-line package using the reconciliation process to bypass a GOP filibuster in the Senate.  

The problem for Democrats is that negotiations over that broader package with Sen. Joe Manchin (D-W.Va.), the key swing vote, have shown few signs of progress for months.   

But the health care cliff is adding increased urgency for Democrats to find a way forward on the package.

MacIver

It’s been 11 years since Wisconsin Republicans led by Gov. Scott Walker passed collective bargaining reform, and the savings to taxpayers have been piling up ever since.

Known as Act 10, the reforms were designed to permanently solve a financial crisis throughout Wisconsin’s public sector. State government alone was facing a $3.6 billion deficit in its next budget. The situation was even worse for local governments (including school districts). Act 10 required all public employees to begin making contributions towards their own health insurance and pensions.

Using the same methodology that we have always used and the same public data sources, we estimate Act 10 has saved Wisconsin taxpayers at least $15.3 billion statewide at the state and local level since 2011.

Mike Antonucci:

When I wrote that the National Education Association and its state affiliates were big business, I got it only half-right. It turns out they are small business, too.

Under public pressure, the federal government released a partial list of fund recipients from the Paycheck Protection Program, a project created as part of a package of economic relief for businesses suffering under COVID-19 shutdowns. Managed by the Small Business Administration, the program is “designed to provide a direct incentive for small businesses to keep their workers on the payroll.” If the money is used for that purpose, the low-interest loan will be forgiven.

The definition of “small business” turned out to be an expansive one. It didn’t take reporters long to discover that 16 billionaires received the loans, as well as the Catholic Church and, even worse, charter schools.

It’s this last group that led to breathless stories in The New York Timesand The Washington Post, but both newspapers failed to notice that another group also took advantage of government largesse: labor unions.

Unions and their subsidiaries on the government’s list received a minimum of $26 million and may have gotten as much as $51 million. By far the largest recipients among those unions were the Michigan Education Association and the health insurance subsidiary it created, the Michigan Education Special Services Association. They received a combined minimum of $11.4 million.

“An emphasis on adult employment“.

Scott Girard:

At the same time, MMSD has increased base pay more than surrounding districts in recent years, according to the presentation.

Board members said maintaining that competitive advantage in recruitment is important.

“Our health care is one of the biggest elements of competitiveness for staff in the area,” Toews said. “It’s an area I would really like to keep differentiated.”

Madison’s taxpayer supported K-12 school district, despite spending far more than most, has long tolerated disastrous reading results.

Health insurance costs have long been an issue in the Madison School District.

Administrators warned that benefits were unsustainable in 2014.

Scott Girard:

Madison’s taxpayer supported K-12 school district, despite spending far more than most, has long tolerated disastrous reading results.

Health insurance costs have long been an issue in the Madison School District.

Administrators warned that benefits were unsustainable in 2014.

Much more on the planned 2020 tax and spending increase Madison referendum.

A presenter [org chart] further mentioned that Madison spends about $1 per square foot in annual budget maintenance while Milwaukee is about $2.

Noam Levey:

Denise Wall, a Fresno-area schoolteacher with more than $2,000 in medical bills, was outraged to hear she could get free care if she quit her job and enrolled her family in Medicaid.
Brenda Bartlett, a factory worker in Nebraska, was so angry about $2,500 in medical bills she ran up using the coverage she got at work that she dropped insurance altogether.

“They don’t give a rat’s butt about people like me,” she said.

Sue Andersen, burdened with nearly $10,000 in debt through her family’s high-deductible plan, had to change jobs to find better coverage after learning she and her husband earned too much for government help in Minnesota.

“We are super middle class,” she said. “How are we stuck with everything?”

Health insurance — never a standard protection in the U.S. as it is in other wealthy countries — has long divided Americans, providing generous benefits to some and slim-to-no protections to others.

But a steep run-up in deductibles, which have more than tripled in the last decade, has worsened inequality, fueling anger and resentment and adding to the country’s unsettled politics, a Los Angeles Times analysis shows.

Locally, benefits consumed 25% of taxpayer supported Madison school district spending in 2014.

Mark Sommerhauser:

Wisconsin school districts ratcheted up health care costs on teachers and other employees after the state’s Act 10 collective bargaining changes, with the average district now requiring teachers to pay about 12 percent of their health insurance premiums, newly released data show.

Madison schools are near the low end of what districts now require for premium contributions, at 3 percent, according to the data, released by Gov. Scott Walker’s Department of Administration.

It’s the first time the state has released a comprehensive look at teacher health care costs in all 422 of the state’s public school districts after the 2011 enactment of Act 10.

And it’s one more example of the far-reaching scope of the law — in this case, how it paved the way for state and local workers to pay much more for benefits. The 2017-19 state budget required the Department of Administration to collect the data, which is from the 2017-18 school year.

Barry Forbes, associate executive director for the Wisconsin Association of School Boards, said the figures show health care costs for school district employees generally matching “what greater society is experiencing now.”

U.S. health care spending grew 4.3 percent in 2016, reaching $3.3 trillion or $10,348 per person. As a share of the nation’s Gross Domestic Product, health spending accounted for. More. Families in high-deductible plans must pay more than $2,600 out of pocket, $4,332 on average, according to the Kaiser Family Foundation. Once workers have surpassed their deductibles, they pay an average $24 copay for a primary care office visit, $37 for a specialty care office visit, and $308 for a hospital admission. Sep 22, 2015

“Unsustainable” benefit costs.

Anna Wilde Mathews:

The average cost of health coverage offered by employers pushed toward $19,000 for a family plan this year, while the share of firms providing insurance to workers continued to edge lower, according to a major survey.

Annual premiums rose 3% to $18,764 for an employer plan in 2017, from $18,142 last year, the same rate of increase as in 2016, according to an annual poll of employers performed by the nonprofit Kaiser Family…

Karen Rivedal:

Employees of the Madison School District will have one fewer health insurance provider to choose from, requiring just over 1,000 employees to find a new primary care doctor.

But the estimated $3 million the district will save from dropping Unity, its highest-cost provider, will help bankroll increased compensation for the district’s roughly 4,000 employees, while covering any additional premium costs the new state budget may require them to pay.

The changes, which Superintendent Jen Cheatham recommended last month in her budget proposal for next school year, were approved in a special board meeting Monday and will take effect July 1. Members will vote on the full budget June 26.

Officials said early action on the insurance portion of the budget plan and some of its compensation provisions was important to ease teacher recruitment and to ensure a smooth transition for employees forced to switch coverage to GHC or Dean, the remaining providers.

“We need to educate (employees), allow time to complete enrollment paperwork, transition care and allow sufficient time for the insurance carrier to process the applications and send out insurance cards,” Deirdre Hargrove-Krieghoff, executive director of human resources, said in briefing documents for board members. “This all would need to happen prior to the ‘go-live’ date (of July 1).”

Healthcare costs have long been a significant budget and governance issue for our $18,000/student K-12 institution.

Amber Walker:

The board eliminated the third provider to bring health care costs down across the board, and starting July 1, employees will pay 12 percent of their health care premiums.

The vote was 4-1 to eliminate Unity. Nicki Vander Meulen voted against the measure citing the need for more time to make the decision. Board members Anna Moffitt and TJ Mertz recused themselves since their spouses are district employees and covered by the plan.

The HMO restructuring will save MMSD $3 million each year in HMO costs and the increased employee contributions frees up $4.5 million.

Although district employees will pay more out of pocket for their health insurance, MMSD said it will protect take-home pay by reinvesting the money it saves into across-the-board salary increases.

Assistant superintendent of business Mike Barry said most employees will see a pay bump and no employee should lose money as a result of the changes.

MMSD’s budget also calls for a $15 hourly minimum wage for employees who currently make less than that, increasing summer school pay from $16 to $25/hour for MMSD employees, and increasing beginning teacher pay to $41,096. The Madison School Board also approved those budget items at Monday’s meeting.

Related: Most of Aetna’s revenue now comes from government programs; by Bob Herman:

Here’s a nugget that encapsulates the health insurance industry, despite all the noise surrounding the future of the Affordable Care Act: In the first quarter of this year, Aetna collected more premium revenue from government programs (namely Medicare and Medicaid) than it did from commercial insurance for the first time ever.

Why this matters: Most people get their health coverage from their employer, and that historically has been the bread and butter of the insurance industry. But the aging population and expansion of Medicaid managed care means insurers are investing more time and money in the lower-margin (but still lucrative) government programs. Aetna, in particular, has invested heavily in Medicare Advantage.

Lisa Schencker:

Illinois consumers are one step closer to facing sky-high increases for individual health insurance plans purchased through the Affordable Care Act’s marketplace.

The Illinois Department of Insurance said Wednesday it has submitted rate increases to the federal government that for some types of plans average 43 percent to 55 percent.

The Center for Medicare and Medicaid Services will decide rates. But the numbers released Wednesday confirm the fears of consumers, who’ve already watched a number of insurance companies withdraw from the Obamacare exchange because of financial losses, limiting choices as people prepare to enroll for 2017.

Rates could increase by an average of 44 percent for the lowest-priced bronze plans, 45 percent for the lowest-priced silver plans and 55 percent for the lowest-priced gold plans, according to a preliminary analysis released by the state Wednesday.

Here’s what those percentages mean: A 21-year-old nonsmoker buying the lowest-priced silver plan in Cook County next year could pay a premium of $221.13 a month, up from $152.42 a month this year.

Swinn:

Premiums for employment-based health insurance this year will average about $6,400 for single coverage and $15,500 for family coverage, according to projections by the Congressional Budget Office (CBO) and the Joint Committee on Taxation.

In a new report, the CBO says average premiums for individually purchased insurance are also high, although not quite as high as employment-based premiums.

“Although premiums for private insurance have grown relatively slowly in recent years, they have usually grown faster than the economy as a whole and thus faster than average income,” the report says.

From 2005 to 2014, premiums for employment-based insurance grew by 48 percent for single coverage and by 55 percent for family coverage. The report projects similar growth rates over the next decade, although CBO notes that from 2014 to 2016 premiums grew more slowly than the historical norm.

The report also discusses the likely impact of the “Cadillac Tax” on high-cost health insurance, a tax Congress recently delayed until 2020. It will likely lead average premiums for affected enrollees to be about 10 percent lower that year — and up to 15 percent lower in 2025 — than they would have been otherwise.

25% of Madison’s 2014-2015 budget was spent on benefits.

Madison School District (PDF):

MMSD will spend $61 million on health insurance this year.

One of Every Six Dollars is Spent on Health Insurance in the MMSD budget.

Health Insurance premiums account for 16% of the MMSD budget.

Over 3,900 employees are enrolled in the MMSD plan

The MMSD plan design lacks common features that promote efficient utilization – the plan has no deductibles, no co-insurance requirements, and no employee premium contribution

Our multi-year claims experience (medical loss ratio) does not suggest that MMSD should expect less-than-market pricing

Medical trend (inflation) continues to grow at 7-8% annual increases (including 3-4% ACA fees)

Health insurance costs have long been an issue in the Madison Schools.

Madison Teachers, Inc., via a kind Jeanie Kamholtz email (PDF):

MTI Executive Director John Matthews and MMSD Asst. Superintendent for Finance Mike Barry, along with District HR Director Deirdre Hargrove-Krieghoff and Benefits Manager Sharon Hennessy, have met with representatives of the three firms (Unity, GHC and Dean Health) which provide health insurance for District employees, to plead the case that premiums should be frozen for the ensuing fiscal year. Contract renewals for the insurers are effective July 1.

In the meetings, Matthews & Barry stressed that because of the impact of State revenue controls on school boards and Governor Walker’s proposed budget, the District and its employees face severe financial problems. One way to provide relief to employees, they told insurers, is to hold health insurance premiums at their current levels. The firms pledged to respond by the end of April. While Matthews talked about the large negative impact of Act 10 on wages, Barry told the firms that Walker’s proposed Budget would cause the District a shortfall of $12.5 million and he said District management would not recommend its employees contribute to the health insurance premium.

Christ Rickert

The Madison School District won an historic concession from its teachers union over the last two years — the ability to require that teachers pay part of their health insurance premiums.
It came as the district was quickly extending union contracts before a law eliminating most collective bargaining rights took effect, and again while that law was held up in court.
But now as the district goes about crafting a 2013-14 budget that — among other cost-savings measures — reduces maintenance spending, freezes equipment budgets and includes no money for new efforts to close the district’s achievement gap, it doesn’t appear there’s much interest in implementing the concession.
The budget proposal from new Superintendent Jennifer Cheatham doesn’t subject teachers to health insurance premiums, and that’s fine with School Board President Ed Hughes.
“Because of our recent transitions, this was not the budget to take up significant changes to our structure of salary and benefits,” he said in an email. “I and other board members are looking forward to an in-depth review of salary and benefit levels as part of next year’s budget, when we’ll have the benefit of input from Jen Cheatham and (assistant superintendent for business services) Mike Barry, as well as from our affected teachers and staff. I’m sure that health insurance contributions will be part of that discussion.”
“Recent transitions” didn’t keep Cheatham from proposing changes to the district’s salary schedules, though.

Madison’s expensive approach to healthcare benefits are not a new subject.
Much more on the Madison School District’s 2013-2014 plans for spending and property tax increases, here.
Mr. Hughes in 2005

Madison Teachers, Inc. Solidarity Newsletter, via a kind Jeannie Bettner email (PDF):

Since the late 1960’s, MTI members have had the benefit of the best health insurance available. Stressing the importance of having quality health insurance in providing economic security, members have made known that health insurance is their #1 priority via their responses to the Union’s Bargaining Survey. And, the Union not only was able to bargain specific benefits, such as acupuncture and extended mental health coverage, as demanded by MTI members, but due to a 1983 MTI victory in the Wisconsin Supreme Court, MTI was able to have an equal voice in which insurance company would provide the plan. This is important because varied insurance companies have different interpretations of the same insurance provisions.
Unfortunately, the District Administration took advantage of the increased leverage in negotiations enabled by Governor Walker’s Act 10, and forced concessions in health insurance and other Contract provisions, in exchange for agreeing to Collective Bargaining Agreements for MTI’s five bargaining units through June 2014.
Members who elected Physicians Plus health insurance under the revisions made by the District, will now lose that coverage June 30, 2013. For coverage effective July 1, options available are via Dean Health Plan, Group Health Cooperative and Unity. Each offers an HMO and a Point of Service Plan. The Point of Service enables greater coverage options, but at a higher premium.
Note: The three current carriers enabling a special open enrollment/annual choice to add or change coverage to members of ALL five MTI bargaining units until April 26, 2013. Changes in coverage will be effective July 1, 2013. The deadline for application to change coverage must be received in Human Resources by 5:00 p.m., April 26, 2013. The District has scheduled two health insurance information sessions for those with questions to seek answers from the above-referenced plans.
Health Insurance Information Sessions:
April 8 – La Follette Room C17 – 4:00 to 6:00 p.m. April 9 – Memorial Neighborhood Center – 4:00 to 6:00 p.m.

Madison Teachers, Inc. Solidarity Newsletter (63K PDF), via a kind Jeanie Bettner email:

Since the late 1960’s, MTI members have had the benefit of the best health insurance available. Stressing the importance of quality health insurance in providing economic security, members have made health insurance their #1 priority via their responses to the Union’s Bargaining Survey. And, the Union not only was able to bargain specific benefits, such as acupuncture and extended mental health coverage, as demanded by MTI members, but due to a 1983 MTI victory in the Wisconsin Supreme Court, MTI was able to have an equal voice in which insurance company would provide the plan. This is important because different insurance companies have different interpretations of the same insurance provisions.
Unfortunately, the District Administration took advantage of the increased leverage in negotiations enabled by Governor Walker’s Act 10 forcing concessions in health insurance and other Contract provisions in exchange for them agreeing to extend MTI’s five Collective Bargaining Agreements through June 2013.
Members of MTI’s teacher bargaining unit, who elected WPS health insurance under old Contract terms, will now lose that coverage June 30, 2012. The District is in the process of distributing materials by which members of the teacher bargaining unit can become familiar with the options available for coverage commencing July 1. They are Dean Health Plan, Physicians Plus and Group Health Cooperative. Each offers an HMO and a Point of Service Plan. The latter carries a higher premium, but enables broader choices for services.
The District has scheduled five sessions for those with questions to seek answers from the above-referenced plans.
April 9 – Doyle Auditorium -1:00-3:00 p.m.
April 11- La Follette C17 – 4:00-6:00 p.m.
April 17 – Memorial Wisconsin Center – 4:00-6:00 p.m.
April 19 -West LMC – 4:00-6:00 p.m.
April 23 – East LMC – 4:00-6:00 p.m.

The Madison School District’s support of the costly WPS health insurance option has been quite controversial over the years.

There seems to be some confusion about the negotiations between MTI and the school district. The Board WILL be negotiating health insurance with MTI; the Board has NOT taken health insurance off the table. The Voluntary Impasse Agreement (VIA) does NOT eliminate this as a subject of negotiation. The VIA DOES set up a structure for negotiations: a schedule, agreement by MTI that teachers will not engage in job actions, dates for the start of mediation if a settlement hasn’t been reached, name of the mediator, a date for binding arbitration if mediation is not successful and name of the arbitrator. IF no voluntary settlement is reached and we go to binding arbitration, MTI agrees that it will not propose a change to the salary schedule and the Board agrees not to change health insurance. Those agreements are meant to make binding arbitration less attractive to both sides – and to put the emphasis on reaching a voluntary agreement.
Because the Board has not yet provided MTI with our proposals I cannot discuss them in public. I can however talk about the settlement we have reached with our custodians who are represented by AFSCME. The custodians agreed to change their health insurance to a choice of 3 HMO’s (Group Health, Physicians Plus and DeanCare). The savings from this change allowed a greater salary increase (2.5%). A small amount of the savings ($15,000) went back to the budget. These savings are realized only in the first year – thereafter, the base for figuring future costs uses the lower health insurance costs.
One of the most dramatic changes of the last 5 years (and one that has been little noted) is the movement of teachers from WPS to Group Health. This year more than 50% of the teacher’s unit take Group Health Insurance – the lowest priced HMO in the community.
A more complete discussion of this issue can be found at: http://www.madisonamps.org/component/option,com_jd-wp/Itemid,31/p,51/
Carol Carstensen

Anna Wilde Mathews:

Health-insurance costs are climbing at the steepest rate in years, with some projecting the biggest increase in more than a decade will wallop businesses and their workers in 2024.

Costs for employer coverage are expected to surge around 6.5% for 2024, according to major benefits consulting firms Mercer and Willis Towers Watson, which provided their survey results exclusively to The Wall Street Journal.

Such a boost could add significantly to the price tag for employer plans that already average more than $14,600 a year per employee, driving up health-insurance costs that are among the biggest expenses for many American companies and a drain on families’ finances.

Employers worry the hike might signal a new trajectory, with health costs resuming the rapid upward march of the early 2000s. Now, though, big increases would come on top of a total annual cost per covered family that is often equivalent to the purchase price of a small car. These increases come at a time when employers are reluctant to add to out-of-pocket charges that have left some of their workers in debt or unable to get care they needed.

“It’s much worse than we’ve seen over the last decade,” said Elizabeth Mitchell, chief executive of the Purchaser Business Group on Health. “It comes out of wages and core business.”

John Torinus:

One small governmental entity has shown the way. The West Bend School District went self-insured years ago, then bid out its network needs, then went CDHP and now is putting in its own on-site clinic. It’s in the vanguard in learning from the private sector payers about what works and being a fast-follower.
Result? It is delivering first class health care for less than $10,000 per employee. That’s half of what many districts are playing for fully insured plans.
Think about the numbers. At a savings of $10,000 per employee and about 1000 employees, it is saving the taxpayers $10 million per year.
The district is giving raises; it has found funds for deferred maintenance; it found $5 million in reserves to put against a $25 million bond program for school construction.

Smart, anti-orthodoxy thinking.

Charlie Bilello:

The average family health insurance premium in the US is up 249% since 2000.

——

The budget includes a tax levy increase of 13.6% driven primarily by increased debt service costs. Property taxes on the average-value Madison home will increase by about $147, according to the County Board. That’s on top of an estimated $110 increase from the cityof Madison and about a $250 increase from the Madison Metropolitan School District, taking into account a citywide revaluation of properties this year.

John C. Goodman and Beverly Gossage:

When Democrats passed the Affordable Care Act of 2010, President Obama and lawmakers made the same claim over and over: The act would make good, affordable health insurance available to people with pre-existing conditions. The actual result has been the opposite. ObamaCare makes health insurance as good as possible for the healthy and as bad as possible for the sick.

According to President Biden, health insurance in America is free or almost free (“as little as $10 a month or less” after subsidies) for about 80% of people who acquire it in an ObamaCare exchange. Most preventive care—the only kind of care healthy people require—is also free.

If you are sick, things are different. Consider a hypothetical middle-aged couple in Dallas earning $70,000 a year. Suppose they have two children, both of whom have serious birth defects. Although this family will pay no premium for a Blue Cross bronze plan in the ObamaCare exchange, they will face a $9,100 deductible for each child. Their total out-of-pocket exposure is $18,200 a year.

It gets worse. Patients with serious diseases often require the care of highly trained specialists who usually work at centers of excellence. But that family in Dallas will discover that their Blue Cross plan isn’t accepted at leading cancer providers nearby, including Baylor University Medical Center and the University of Texas Health Science Center, or MD Anderson Cancer Center in Houston.

Scott Girard:

After the district’s insurance consultant, M3, received word from GHC in February about its premium increase, district officials and M3 worked with Quartz to see if there was a better solution. They were left with two options, according to the letter, neither of which raises the amount staff will pay for premiums this year:

• Continue to provide employees with GHC-SCW health insurance, with no rate increase for employees in the 2023-2024 school year, but a 16.2% increase to the district, effective July 1, 2023, for an extra $5.6 million in the budget

• Change insurance carriers to Quartz, effective July 1, 2023, with no rate increase for employees in the 2023-2024 school year, but a 13.1% increase to the district, effective July 1, 2023, for an extra $4.1 million in the budget

Logan Wroge:

Increasing the amount staff pay for premiums would see teachers paying 6% of a HMO family plan — up from 3% — to about $44 more a month. Certain hourly employees, such as special education assistants, would pay 2.5% of an HMO family plan instead of 1.25%, or $8.53 more per month.

Scott Girard:

Madison’s taxpayer supported K-12 school district, despite spending far more than most, has long tolerated disastrous reading results.

Health insurance costs have long been an issue in the Madison School District.

Administrators warned that benefits were unsustainable in 2014.

Much more on the planned 2020 tax and spending increase Madison referendum.

A presenter [org chart] further mentioned that Madison spends about $1 per square foot in annual budget maintenance while Milwaukee is about $2.

Logan Wroge:

Madison’s taxpayer supported K-12 school district, despite spending far more than most, has long tolerated disastrous reading results.

Health insurance costs have long been an issue in the Madison School District.

Administrators warned that benefits were unsustainable in 2014.

Kaiser Family Foundation:

A new KFF analysis that looked at both premiums and other out-of-pocket costs shows that families with coverage through a large employer paid 67 percent more for their health benefits and care in 2018 than a decade earlier.

In 2018, a typical family of four with large employer coverage spent $4,706 on their share of health premiums and $3,020 on cost sharing (such as deductibles, copayments and coinsurance) for a combined cost to the family of $7,726, the analysis finds. That was up from $2,838 in premiums and $1,779 in cost sharing in 2008, for a combined cost to the family of $4,617 a decade ago.

The rise in health costs borne directly by families outstripped the growth in wages (31%) and inflation (21%) over the 10-year period, according to the analysis. Over the same ten-year period, employers’ contributions toward their workers’ health insurance premiums increased 51 percent (from $10,008 to $15,159).

Dominic Chopping:

As an increasing number of people live longer in retirement, the cost of providing pension and healthcare benefits can rise. Those increased costs are paid for by taxes collected from of the working-age population – who make up a smaller percentage of the population than in decades past.

In 2018, those aged 65 or over made up 21.4% of Finland’s population, the fourth highest after Germany, Portugal, Greece, and Italy, according to Eurostat.

Finland’s welfare system is also generous in its provisions, making it relatively expensive. Attempts at reform have plagued Finnish governments for years.

Madison spent 25% of its 2014-2014 taxpayer supported K-12 budget on benefits.

Max Roser:

The graph below shows the relationship between what a country spends on health per person and life expectancy in that country between 1970 and 2015 for a number of rich countries.

The US stands out as an outlier: it spends far more on health than any other country, yet the life expectancy of the American population is not longer, but actually shorter than in other countries that spend far less.

If we look at the time trend for each country, we first notice that all countries have followed an upward trajectory—the population lives increasingly long lives as health expenditure increases. But again, the US stands out by following a much flatter trajectory: gains in life expectancy from additional health spending in the U.S. are much smaller than in the other high-income countries, particularly since the mid-1980s.

Madison spent 25% of it’s 2014-2015 budget on benefits…

The Economist:

“I LIKE CATS, unicorns and peace, but I love my teacher!” declares one sign, with two rainbows, held by a young pupil at Crocker Highlands Elementary School in Oakland on a weekday morning. She should have been at school, but instead she joined her mother and thousands of Oakland’s teachers outside City Hall. Oakland’s teachers are asking for higher salaries, support staff and more. Teachers in nearby Sacramento may be next to put down chalk and pick up placards.

Such strikes have become a national phenomenon. Teachers in Los Angeles, Denver and West Virginia have gone on strike this year, after action in Arizona, Colorado, Kentucky, North Carolina and Oklahoma in 2018. Last year around 375,000 teachers and staff went on strike. They accounted for about three-quarters of the total number of American workers who downed tools. As a result, 2018 saw the highest number of workers involved in strikes since 1986.

The complaints differ by school district, but one common refrain on picket lines is that teachers are not paid enough for their hard work. The wage gap between teachers and similarly educated workers has certainly widened since the mid-1990s. In many states teachers are paid less than other public-sector employees, such as prison guards and police officers.

Madison spent 25% of it’s budget on benefits in 2014…

John Tozzi:

For many Americans, 2018 was the year that health care reached a breaking point.

Insurance was still too expensive to buy. It didn’t cover nearly enough. And as the country’s politics festered, the government once again failed to solve the insurance conundrum, even as a large majority of Americans who flocked to voting booths said health care was their top concern.

My colleagues and I spent much of this year talking to people who had weighed the health benefits against the financial burden of purchasing insurance. Most decided to risk it, betting that going without made more sense than paying for coverage.

<a href=”https://madison.com/wsj/news/local/health-med-fit/mental-health-programs-help-madison-area-schools-address-behavior-causes/article_4a55309a-fc7a-5132-b84b-84ee3daedb44.html”>David Wahlberg</a>:<blockquote> Catholic Charities of Madison operates both programs, and Children’s Hospital of Wisconsin also started to help run Behavioral Health in Schools this year. 

While Building Bridges doesn’t provide therapy in schools, the 90-day program helps families secure proper food and housing, navigate insurance plans, get transportation to therapy appointments and advocate for themselves during and after appointments, among other support services, said Jerilyn Robinson, director of family programs at Catholic Charities.

“We break down all of those barriers,” Robinson said.

Through Building Bridges, four two-person therapist teams work in the Madison School District, with each team serving one of the district’s four high school attendance areas. Dane County is spending nearly $1 million this year on the program, with matching funds contributed by the school districts. </blockquote> 

Marshall Allen:

With little public scrutiny, the health insurance industry has joined forces with data brokers to vacuum up personal details about hundreds of millions of Americans, including, odds are, many readers of this story. The companies are tracking your race, education level, TV habits, marital status, net worth. They’re collecting what you post on social media, whether you’re behind on your bills, what you order online. Then they feed this information into complicated computer algorithms that spit out predictions about how much your health care could cost them.
 
 Are you a woman who recently changed your name? You could be newly married and have a pricey pregnancy pending. Or maybe you’re stressed and anxious from a recent divorce. That, too, the computer models predict, may run up your medical bills.
 
 Are you a woman who’s purchased plus-size clothing? You’re considered at risk of depression. Mental health care can be expensive.
 
 Low-income and a minority? That means, the data brokers say, you are more likely to live in a dilapidated and dangerous neighborhood, increasing your health risks.
 
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 “We sit on oceans of data,” said Eric McCulley, director of strategic solutions for LexisNexis Risk Solutions, during a conversation at the data firm’s booth. And he isn’t apologetic about using it. “The fact is, our data is in the public domain,” he said. “We didn’t put it out there.”
 
 Insurers contend they use the information to spot health issues in their clients — and flag them so they get services they need. And companies like LexisNexis say the data shouldn’t be used to set prices. But as a research scientist from one company told me: “I can’t say it hasn’t happened.”

Annys Johnson:

The school board’s Committee on Accountability, Finance and Personnel will take up two other cost-saving proposals on Tuesday, including one to restructure employee health care benefits. According to the administration’s analysis, that proposal would save up to $17.4 million by:

Eliminating coverage of spouses who have access to insurance elsewhere or charge employees extra to keep them on their plan ($7.9 million).

Raising co-pays for doctors visits to $35, urgent care to $50 and emergency rooms to $175 ($4.3 million).

Increasing employee contributions for their health care to 7% for low-wage workers and as much as 19% for those earning $101,000 or more (up to $3.2 million).
Eliminating a long-term disability benefit that has cost the district about $2.3 million in premiums since January 2017, but reaped benefits for just four employees totaling $47,534 ($2 million).
The committee also will consider a proposal to explore the creation of near-site health clinics for employees that could save an estimated $700,000 annually.

25% of Madison’s 2014-2015 budget was spent on benefits.

Sarah Kliff:

On September 28, 2016, a 3-year-old girl named Elodie Fowler slid into an MRI machine at Lucile Packard Children’s Hospital in Palo Alto, California. Doctors wanted to better understand a rare genetic condition that was causing swelling along the right side of her body and problems processing regular food.

The scan took about 30 minutes. The hospital’s doctors used the results to start Elodie on an experimental new drug regimen.

Fowler’s parents knew the scan might cost them a few thousand dollars, based on their research into typical pediatric MRI scans. Even though they had one of the most generous Obamacare exchange plans available in California, they decided to go out of network to a clinic that specialized in their daughter’s rare genetic condition. That meant their plan would cover half of a “fair price” MRI.

They were shocked a few months later when a bill arrived with a startling price tag: $25,000. The bill included $4,016 for the anesthesia, $2,703 for a recovery room, and $16,632 for the scan itself plus doctor fees. The insurance picked up only $1,547.23, leaving the family responsible for the difference: $23,795.47.

25% Of Madison’s 2014-2015 Budget was spent on benefits. Madison now spends nearly $20,000 per student.

Julie Rovner::

Paul Melquist of St. Paul, Minn., has a message for the people who wrote the Affordable Care Act: “Quit wrecking my health care.”

Teri Goodrich, of Raleigh, N.C., has the same complaint. “We’re getting slammed. We didn’t budget for this,” she said.

Millions of people have gained health insurance because of the federal health law. Millions more have seen their existing coverage improved.

But one small slice of the population — including Melquist and Goodrich — are unquestionably worse off. They are healthy people who buy their own coverage but earn too much to qualify for help paying their premiums. And the premium hikes that are being announced as enrollment looms for next year — in some states, increases topping 50 percent — will make their situations more miserable.

Angela Hart:

The price tag is in: It would cost $400 billion to remake California’s health insurance marketplace and create a publicly funded universal heath care system, according to a state financial analysis released Monday.
 
 California would have to find an additional $200 billion per year, including in new tax revenues, to create a so-called “single-payer” system, the analysis by the Senate Appropriations Committee found. The estimate assumes the state would retain the existing $200 billion in local, state and federal funding it currently receives to offset the total $400 billion price tag.
 
 The cost analysis is seen as the biggest hurdle to creating a universal system, proposed by Sens. Ricardo Lara, D-Bell Gardens, and Toni Atkins, D-San Diego.

Tap for a larger version.

March, 2017 School Board Presentation (PDF).

Notes and links: health insurance.

2015: Health Insurance premiums account for 16% of the Madison School District budget

MMSD will spend $61 million on health insurance this year.

One of Every Six Dollars is Spent on Health Insurance in the MMSD budget.

Health Insurance premiums account for 16% of the MMSD budget.

Over 3,900 employees are enrolled in the MMSD plan

Stephen Pimpare:

Third — and conveniently, perhaps, for people like Chaffetz or House Speaker Paul D. Ryan (R-Wis.) — this stubborn insistence that people could have more money or more health care if only they wanted them more absolves government of having to intervene and use its power on their behalf. In this way of thinking, reducing access to subsidized health insurance isn’t cruel, it’s responsible, a form of tough love in which people are forced to make good choices instead of bad ones. This is both patronizing and, of course, a gross misreading of the actual outcome of laws like these.

There’s one final problem with these kinds of arguments, and that is the implication that we should be worried by the possibility of poor people buying the occasional steak, lottery ticket or, yes, even an iPhone. Set aside the fact that a better cut of meat may be more nutritious than a meal Chaffetz would approve of, or the fact that a smartphone may be your only access to email, job notices, benefit applications, school work, and so on. Why do we begrudge people struggling to get by the occasional indulgence? Why do we so little value pleasure and joy? Why do we insist that if you are poor, you should also be miserable? Why do we require penitence?

Just because what Chaffetz is saying isn’t novel doesn’t mean it isn’t uninformed and dangerous. Chaffetz, Ryan and their compatriots offer us tough love without the love, made possible through their willful ignorance of (or utter disregard for) what life is actually like for so many Americans who do their very best against great odds and still, nonetheless, have little to show for it. Sometimes, not even an iPhone.

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Madison School District Administration Slides (PDF):

Compensation:

Prior Years Strategy
– Funded step advancement, lane movement, & base wage increase (varies), offset by multiple reductions in personnel / non-personnel areas

For 2017-18:
– With referendum resources, provide for step advancement, lane movement, and base wage increase (TBD), without multiple offsetting reductions

– Additionally, looking for a win-win on health insurance design which could provide additional employee compensation

Madison Schools’ budget priority items (PDF).

David Barnes:

ObamaCare won’t work without young Americans like me, and the Obama administration knows it. That’s why the president is holding a Millennial Outreach and Engagement Summit focused on the Affordable Care Act at the White House on Tuesday. But no matter what the president says, many young Americans simply aren’t buying what he’s selling—mainly because we can’t afford it.

The administration has targeted my generation to sign up for ObamaCare for one reason: We’re healthy. The health-insurance companies selling plans on the law’s exchanges need us to pay a pretty penny in premiums without using much medical care. We’re supposed to subsidize the system so that it stays afloat. That was the plan, anyway. It fell apart when we didn’t sign up in droves like the White House expected.

Ricardo Alonso-Zaldivar:

Growth is projected to average 5.8 percent from 2015 to 2025, below the pace before the 2007-2009 economic recession but faster than in recent years that saw health care spending moving in step with modest economic growth.

National health expenditures will hit $3.35 trillion this year, which works out to $10,345 for every man, woman and child. The annual increase of 4.8 percent for 2016 is lower than the forecast for the rest of the decade.

A stronger economy, faster growth in medical prices and an aging population are driving the trend. Medicare and Medicaid are expected to grow more rapidly than private insurance as the baby-boom generation ages. By 2025, government at all levels will account for nearly half of health care spending, 47 percent.

The report also projects that the share of Americans with health insurance will remain above 90 percent, assuming that President Barack Obama’s law survives continued Republican attacks.

James Wigderson:

Despite the administration’s plan to make sure no employee experienced a net loss in pay in the coming year, Loumos wanted the district to cover the cost of the employee contributions for the first year so every employee could have the full amount of their raises.

“What would it be if we held, if we gave everybody the true raise and added their co-payment on top? That’s what I want,” Loumos said.

However, the other board members balked at the idea of finding another $1.3 million in the budget to cover the employee health-insurance premium contributions.

“My goal was no one takes a net pay cut and I’m happy that we can find $300,000, which achieves that goal,” said board member Ed Hughes.

David Belk:

Without increased transparency and protection from over-billing, no reform will effectively reduce our healthcare costs or even slow the rate in which they’re increasing. Increased transparency in health care costs would make it very difficult for health care providers and insurance companies to continue operating the way in which they do now.

Most of all, remember: All healthcare reform in this Country will be met with strong opposition from inside the healthcare industry. They’ll say anything to prevent it simply because they’re protecting their own bottom line. If you’ve learned anything from this website, you should know, you can’t always believe what the health industry “experts” are saying.

Alex Leary:

The Senate plan, championed by Democrat Steve Geller, mandated insurers cover autism. But insurers in the state’s exchange under Obamacare are exempt. Clinton’s campaign said more than 30 states require the coverage under exchanges. “Clinton’s plan calls on Florida to make this coverage a requirement for all plans offered in their state-run health insurance exchange,” according to the campaign.

Her proposal also calls for:

– A nationwide early screening outreach campaign to ensure that all children, and in particular children from underserved backgrounds, can get screened for autism.

– An “Autism Works Initiative” to extend new resources and establish public-private partnerships that will ensure a post-graduation transition plan for every student with autism aging out of school-based services.

– Enacts the “Keeping All Students Safe Act” to protect children from abusive practices in their school by banning bans the use of mechanical and chemical restraints, and physical restraints that restrict breathing; and other reforms to protect children with autism from abusive treatment in the schools.

Susan Cohen:

Finnegan’s blood glucose monitor arrived last month, and it should make a big difference in his life. The eight-year-old has diabetes, and now, instead of having his finger pricked eight times a day, his parents will be able to track his blood sugar levels painlessly.

Finnegan’s mother, Kayleigh Cassella, and stepfather, Arran Phipps, are both Ph.D candidates in UC Berkeley’s physics department, and like thousands of others, they’re enrolled in the school’s Student Health Insurance Plan (SHIP). Their kids are on it, too; the comprehensive policy helps offset the costs of Finnegan’s new monitor. “I can’t imagine not having [the monitor],” Phipps said. “Just the supplies for that would be $150 a month, and with the insurance I only have to pay $50 a month. I literally would not be able to afford this without the SHIP dependent insurance.”

Pat Schneider:

“I will consider contributions to health care, depending on what we see in terms of costs and the budget,” Burke said. “But we need to look at compensation in its entirety to make sure we remain competitive while we are accountable to the taxpayers.”

The school district is in the process of preparing to hire a consultant to conduct a study of employee compensation, she said.

Representatives of Madison Teachers Inc. say the fully paid health care premiums are a benefit bought with concessions on salary increases over the years.

That’s exactly why it’s so important to look at the district’s compensation as a whole, Burke said.

“We want to make sure the school district is a place that can attract quality people. That’s why the survey will not only compare us to other school districts, but also to other professions,” she said.

The Madison Metropolitan School District’s three major health insurance providers — Group Health Cooperative, Dean Health Plan and Unity Health Insurance — each agreed to hold the line on premiums next year. That helped the school district hold the line on a major expense — more than $61 million annually — in a budget round that saw operating expenses up nearly 11 percent as state aid dropped.

Madison’s 2015-2016 budget and its long term disastrous reading results, here. Note that Madison has long spent more than double the national average per student.

Yevgeny Feyman, via a kind reader:

Last year, as part of a contract deal with the teachers’ union, Mayor Bill de Blasio announced that he and the city’s unions had agreed to cut $3.4 billion in worker health-care costs over four years. Even with these “savings,” though, Gotham’s health-insurance spending is projected to grow 6 percent annually through 2018—totaling a whopping $6.2 billion that year. According to the Citizens Budget Commission, more than 90 percent of city employees are enrolled in plans that require no premium contributions from workers. Most other city governments require employees to pay something toward their health-care costs. In the private sector, such contributions are standard.

The massive cost of paying full freight for nearly half a million employees’ health care is one reason why the city budget will run a $1.4 billion deficit in 2018, according to de Blasio administration projections. Even without the looming Cadillac Tax, the city’s budgetary status quo is unsustainable. Making these expensive benefits even more costly is a recipe for fiscal disaster.

The ACA imposes a 40 percent excise tax on the value of health insurance costing $10,200 or more for individual plans and $27,500 or more for family plans. And because the tax is indexed to the general rate of inflation rather than to faster-growing health-care inflation, it will hit more plans each year. Researchers from the Johns Hopkins School of Public Health estimate that the tax will affect 75 percent of employer-provided plans within a decade of its implementation. It likely won’t take that long for the tax to hit New York’s typical HMO coverage plans for city workers. In 2013, one plan offered to workers cost $6,600 annually for individual coverage. Assuming that these premiums grow at the same rate as overall costs for the city’s health insurance, such a plan would cost over $9,000 annually by 2018. In just a few years, these plans would cross the Cadillac Tax threshold. Who will bear the burden? With no required contributions from city employees, local taxpayers will be on the hook.

David Wahlberg:

Madison Teachers Inc. and five other Madison-based unions are so concerned about significant financial losses at Group Health Cooperative of South Central Wisconsin, they’re urging members to vote for particular candidates in Group Health’s board election Thursday.

“MTI cannot stand idly by and watch GHC disappear,” John Matthews, the teacher union’s executive director, wrote in a letter last month to members.

Group Health lost $18.7 million last year after losing $15.7 million in 2013 and $5.5 million in 2012, according to financial statements filed with the National Association of Insurance Commissioners.

Kevin Hayden, Group Health’s CEO, is on leave for reasons the HMO won’t explain.

Group Health made $364,000 the first quarter of this year and expects a “substantial improvement over 2014,” a statement by board president Ken Machtan said.

The losses were covered by “substantial reserves so no debt was accumulated,” Machtan said. Group Health “continues to maintain a healthy reserve,” he said.

Details.

Healthcare costs have long been a significant issue in the Madison School District’s budget.

Stephanie Armour:

Americans increasingly have to dig into their own pockets to pay for medical care, a shift that is helping to curb the growth in health spending by employers and the government.

The trend is being accelerated by the Affordable Care Act because many private plans sold by the law’s health exchanges come with hefty out-of-pocket costs, which prompt some people to delay or put off seeking care.

For the exchanges’ 2015 policies, which went on sale last month, “bronze- level” plans have an average deductible of $5,181 for individuals, up from $5,081 in 2014, according to a November report from HealthPocket, which publishes health insurance market analyses. Bronze plans generally cover 60% of consumers’ medical expenses.

While surveys show steeper out-of-pocket costs lead some people to defer even routine medical care, economists say the trend brings an important upside: It is helping fuel a period of historically low growth in health-care spending, which eases the federal deficit.

The federal government said Wednesday that 2013 was the fifth consecutive year in which health spending grew at less than 4%. The 3.6% rate is the lowest since the government began tracking such spending in the 1960s. While economists initially credited the recession for the soft spending growth, the trend continued even as the economy improved.

Pew Charitable Trusts:

Medicaid is the largest health insurance program in the United States, covering both acute and long-term care services for over 66 million low-income Americans—children and their parents, as well as elderly and disabled individuals.1 This report focuses on the impact of Medicaid on the states, including trends in spending and enrollment, and the anticipated effects of the Affordable Care Act.

Jenna Ashley Robinson:

Across the country, student health centers are showing signs of financial bloat and costly mission creep. Funded by both hefty campus health fees and payments from students’ insurers, university health centers spend their extra cash on boutique services and progressive programs.

In universities’ early days, the campus infirmary was simple. As a primary care practice on campus, it was a convenience for students who caught the flu or a cold at school. The infirmary’s services were available to insured and uninsured alike. Now, however, all students must carry health insurance. Many schools, including the 16 campuses of the University of North Carolina system, put in place an “individual mandate” years before the Affordable Care Act. With the Act’s passage, all students must be insured.

And they are–often with “Gold” plans that cover everything from maternity care, to prescription drugs, to substance abuse counseling. If they use the student health center, students’ co-pays are waived. But at many schools, they pay through the nose for the privilege. Saving $25 in co-pays hardly seems to justify paying health fees ranging from $50 to nearly $1,000.

Harvard and Stanford are two of the worst offenders. At Harvard, the student health fee is $958.00. Health insurance, which students must also purchase, is $2,190. At Stanford, the fee is a more modest $573 for the 2014-15 academic year. But the student health insurance plan costs a whopping $3,936 per student!

Mark Peters & Douglas Belkin:

The federal health-care overhaul is prompting some colleges and universities to cut the hours of adjunct professors, renewing a debate about the pay and benefits of these freelance instructors who handle a significant share of teaching at U.S. higher-education institutions.
The Affordable Care Act requires large employers to offer a minimum level of health insurance to employees who work 30 hours a week or more starting in 2014, or face a penalty. The mandate is a particular challenge for colleges and universities, which increasingly rely on adjuncts to help keep costs down as states have scaled back funding for higher education.
A handful of schools, including Community College of Allegheny County in Pennsylvania and Youngstown State University in Ohio, have curbed the number of classes that adjuncts can teach in the current spring semester to limit the schools’ exposure to the health-insurance requirement. Others are assessing whether to do so, or to begin offering health care to some adjuncts.

Associated Press:

The University of Wisconsin System overpaid for health insurance premiums and pension contributions by nearly $33 million over the last two years, including $8 million for more than 900 employees who had already left their jobs, according to a report released Thursday.
The Legislative Audit Bureau’s findings prompted state lawmakers to call for a deeper review of UW System’s payroll and benefit protocols.
“This is a $32 million error,” said Rep. Samantha Kerkman, R-Powers Lake, co-chairwoman of the Legislture’s audit committee. “My initial response was I’m shocked. I’m really disappointed.”

Mary Niederberger:

To Community College of Allegheny County’s president, Alex Johnson, cutting hours for some 400 temporary part-time workers to avoid providing health insurance coverage for them under the impending Affordable Health Care Act is purely a cost-saving measure at a time the college faces a funding reduction.
But to some of the employees affected, including 200 adjunct faculty members, the decision smacks of an attempt to circumvent the national health care legislation that goes into effect in January 2014.
“It’s kind of a double whammy for us because we are facing a legal requirement [under the new law] to get health care and if the college is reducing our hours, we don’t have the money to pay for it,” said Adam Davis, an adjunct professor who has taught biology at CCAC since 2005.

Erica Breunlin:

The Greendale School District’s high-deductible plan has been in place for the past four years but was not available to teachers until last year. When the district first offered the plan, nonunion employees agreed to try it out but teachers declined, Green said. Once Act 10 came into effect, the district offered the high-deductible plan to teachers again. The district allowed teachers to choose between the high-deductible plan and the traditional plan this school year, and 70% decided to go the high-deductible route after seeing how it was working for other staff members, Green said.
The district runs the plan in conjunction with a health reimbursement account.
In addition to a wellness plan, the Greendale district provides an on-site nurse practitioner from Aurora Health Care.
Green said the high-deductible plan significantly reduces the price of health insurance plans for school districts. When factoring in the cost of the high-deductible plan each year plus what the district is putting into the health reimbursement account, the total is about $1,000 less per family plan per year than the traditional plan.

Related: The Madison School District recently ended their longtime support of a costly WPS healthcare plan.