because amongst all else to read, learn, and inwardly digest, ya gotta see the JD Vance vid there!
Tag: Health
News about ACA
I read CBPP so I can write my congresscritters about things they should be doing in we the people’s house. Here is a piece from CBPP, about the good the ACA has done for we the people.
ACA Drove Record Coverage Gains for Small-Business and Self-Employed Workers
JULY 17, 2024, 10:06 AM
Millions of small-business and self-employed workers gained coverage under the Affordable Care Act (ACA). Their uninsured rates reached record lows in 2022, due in part to policies that stabilized Medicaid coverage and enhanced premium tax credits to lower the cost of health coverage for millions of people in the ACA marketplace. States that adopted the ACA Medicaid expansion also played an important role. Extending and building on these policies will drive further progress.
Self-employed workers and small-business employees have had persistently higher uninsured rates than employees of large businesses. Relatively larger shares of small-business and self-employed workers have lower incomes, making health insurance premiums less affordable. And small businesses have long been less likely to offer health coverage to their employees than large businesses, frequently citing lack of affordability, while facing higher administrative costs per worker and less ability to pool risk.
Before the ACA, small-business and self-employed workers were often limited to unaffordable coverage options in the individual and small-group markets. In the individual market, insurers could charge people with pre-existing medical conditions like cancer or diabetes much more — or deny them coverage altogether. In the small-group market, where many small businesses purchased health insurance, high medical costs for one enrollee could cause insurers to raise premiums for the whole firm.
The ACA addressed these challenges through several key provisions:
- It established marketplaces with financial assistance available to low- and moderate-income workers to help more people purchase affordable comprehensive coverage in the individual market. It made financial assistance available for people who lack access to affordable coverage through their employer, a common condition among small-business and self-employed workers.
- Insurers were prohibited from denying coverage and charging higher premiums for people with pre-existing medical conditions.
- Insurers in the individual and small-group markets were disallowed from charging higher premiums due to people’s health status or most other characteristics, including occupation or industry, and insurers were required to set premiums based on the health care costs broadly spread across their customers in the market. For example, in the small-group market before the ACA, one worker’s expensive illness could cause the premiums for the whole firm to spike.
- Small-business and self-employed workers with low incomes became eligible for coverage under the ACA’s Medicaid expansion, which let people with incomes up to 138 percent of the poverty level enroll in Medicaid in states that adopted expansion.
As the ACA’s major coverage provisions went into effect, the uninsured rate for employees of small businesses (those working for firms with fewer than 100 workers) dropped from 25.2 percent in 2013 to 17.4 percent in 2016. In recent years, their uninsured rate fell further, and in 2022 reached a record low of 16.3 percent. There were 4.9 million fewer uninsured employees of small businesses in 2022 than in 2013.
Trends for self-employed workers were similar, with their uninsured rate falling from 27.3 percent in 2013 to 18.4 percent in 2016, reaching a record low of 16.4 percent in 2022. The number of uninsured self-employed workers fell by 1.3 million from 2013 to 2022.
Together, more than 6.2 million small-business and self-employed workers have gained coverage since the ACA’s major coverage provisions were implemented.
Coverage improvements for both groups were driven by enrollment in the ACA marketplace and Medicaid. From 2013 to 2022, Medicaid coverage increased by 2.5 million for employees of small businesses and 1.3 million among self-employed workers, according to Census data. And 2.6 million marketplace enrollees aged 21-64 were small business owners or self-employed in 2021, an analysis of Treasury Department tax data found using definitions of small business ownership and self-employment based on income and other factors. That accounted for about a quarter of all marketplace enrollment.
These gains can be advanced further. Recent enhancements to premium tax credits in the ACA marketplace lowered the cost of health coverage for nearly all of the 19 million people receiving the credits, cut the number of people who are uninsured by 4 million, and helped drive record enrollment in the marketplace in 2024. These enhancements, set to expire after 2025, should be made permanent and built upon. And for workers below the poverty level, state or federal action is needed to close the Medicaid coverage gap in the states that have not adopted the ACA’s Medicaid expansion.
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A Biden rule on heat safety at work could take years — but if you’re pregnant, you’re already protected
New regulations likely won’t be implemented until 2026, but the Pregnant Workers Fairness Act already covers some employees.
Originally published by The 19th , republished per their instructions for republishing.
Earlier this month, the Biden administration announced a new rule that, if finalized, would become the first federal regulation specifically designed to protect workers from extreme heat both indoors and outdoors. It would trigger requirements for access to drinking water and rest breaks when the heat index reaches 80 degrees Fahrenheit. At 90 degrees, it would mandate 15-minute breaks every two hours and require employers to monitor for signs of heat illness.
The rule has taken years to draft and likely wouldn’t be implemented until 2026 — though it could be stymied if President Joe Biden fails to win re-election. But pregnant workers don’t have to wait for some of these protections, thanks to last year’s passage of the Pregnant Workers Fairness Act (PWFA).
While the law has been enforceable since 2023, it wasn’t until June that its final regulations went into effect. The act requires employers to provide “reasonable accommodations” to pregnant workers who need to modify some aspects of their duties or workspace to protect their health and pregnancy — as long as it doesn’t cause “undue hardship” for the employer. These include having a water bottle at their workstations, being able to sit instead of stand and taking more frequent breaks to eat, drink or use the restroom.
“We think that these accommodations will almost always never cause an undue hardship” to an employer, said Sharyn Tejani, associate legal counsel for the U.S. Equal Employment Opportunity Commission, the agency responsible for enforcement. The Pregnant Workers Fairness Act also makes it clear that these types of basic accommodations don’t require a doctor’s note, something advocates say used to cause unnecessary delays.
Other options available to pregnant workers include access to a personal cooling device, a change in work hours to avoid the hottest parts of the day, a temporary reassignment to a job with less heat exposure or the ability to work remotely.
“The last possible option an employer can provide is [unpaid] leave, but that should really be a last resort,” said Kameron Dawson, senior staff attorney with A Better Balance, a nonprofit that advocates for improving workplace conditions for caregivers. This would only be an option if the accommodation presented an undue hardship on the employer, which Dawson says is a high bar to clear. First, the employee and employer are supposed to discuss all possible options and show they made a genuine effort to find a solution. “We want to make sure workers have job protection,” she said.
Before the act passed, Dawson said, providing unpaid leave would have been a quick out for employers, but a huge financial burden for a worker who couldn’t afford to lose any paychecks. The effects were disproportionately felt by women of color, who are significantly more likely to be the main breadwinners for their families.
Pregnant people need accommodations at work because they are more vulnerable to illnesses like heat stroke or heat exhaustion, said Dr. Marya Zlatnik, an OB-GYN at the University of California, San Francisco. That’s because a pregnant person’s heart is working overtime to supply blood to the placenta, which carries nutrients and oxygen to the growing fetus. This makes it harder for their body to cool down.
“So a pregnant woman in the third trimester who’s just sitting there, it is almost like she’s working out,” Zlatnik said. “Maybe her pulse is at 90 when she’s perfectly at rest. On a not particularly hot day, if she walks a block, her pulse may be 120. And if it’s a really hot day, her pulse could jump up to a dangerously high level.”
A pregnant person is also more susceptible to becoming dehydrated, which increases their risk of going into preterm labor, she said. Studies have also found a link between extreme heat and an elevated risk of developing preeclampsia, a serious pregnancy complicationwhich causes persistently high blood pressure, as well as risk of delivering low birth weight babies.
Heat exposure is a concern for pregnant women who work in industries like manufacturing, construction and agriculture, said Dawson. And this summer, as heat has enveloped large swaths of the country, A Better Balance has also received calls on its hotline from employees at big retailers and bakeries, where heat also has the potential to affect their pregnancy, she said. But, she added, the Pregnant Workers Fairness Act “does offer that safeguard now, while OSHA and other agencies are working on the final rule for the heat standard.”
The Occupation and Safety Health Administration, or OSHA, a federal agency whose mission is to protect workers, first announced it was working on the new rule in 2021. It was one of several initiatives the Biden administration spearheaded to combat the dangers of extreme heat. Others include the formation of a heat working group and a plan to increase workplace inspections for heat-related hazards. An OSHA spokesperson said the agency “is working swiftly and responsibly to ensure that the rulemaking process continues effectively,” though would not speculate on when the final rule will be published. The rule can only be finalized after a public comment period and hearings.
In the meantime, the act offers a good buffer, but there are still limitations to its effectiveness for those most vulnerable to the heat, Zlatnik said. One is that it only covers pregnant workers, who are a small share of the total workforce. Also, some pregnant workers may be afraid to request accommodations under the law. “Most people who are maybe undocumented — or maybe they’re citizens, but they are still sort of on the margins — are not excited about entering into some kind of legal battle, right?” she said. “Even if now legally, they have more rights, they don’t really have a way to satisfy them.”
Because the act is still fairly new, one of the main barriers to its use is that employers, employees and even healthcare providers don’t know much about what it means, though that’s beginning to change. “A lot of it is about education,” Tejani said. “When you talk to people about this law, it is a pretty common sense situation.”
To fill that knowledge gap, a Better Balance has been reaching out to doulas, midwives and doctors to help them advocate for their patients. OSHA has also released its own guidance on preventing heat illness for pregnant workers. The Equal Employment Opportunity Commission also has been hosting webinars about the new regulations and disseminating its own materials to employers and advocacy groups.
Ultimately, Tejani hopes the Pregnant Workers Fairness Act will level the playing field. “People like me who work in an office, I can go to the bathroom when I want, and I work in air conditioning,” she said. “It’s just such a great thing that there’s now a law for the entire country that applies to all types of workers, including those who work in situations where those things that office workers totally take for granted are not the common thing.”
Rep. Madison Cawthorn To Divorce His Earthen Vessel
“People will call me a radical for believing that, you know, you should be a Christian, you should get married young, you should have as many kids as possible, you should be as successful as you possibly can,” he said on Monday. “They’ll say I’m an extremist for that.”
“And I just look at ’em and said: How can you believe that?” he said.
Cawthorn’s political career has been marked by multiple controversies. Prior to his election last November, several women he went to college with accused him of sexual misconduct. In February, he attempted to board a plane with a gun and a loaded magazine. More recently, Cawthorn has positioned himself as an anti-mask, anti-vaccine firebrand, and has attended school board meetings across North Carolina to advocate against mask and vaccine mandates.
In April, Cawthorn missed 15 votes in Congress while away on honeymoon, which he defended by saying he was fulfilling his “service as a husband.”
Two days before his divorce announcement, Cawthorn had advocated for marrying young at the “Americafest” conference run by Turning Point USA.
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