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LOS ANGELES – The American Civil Liberties Union Foundation of Southern California (ACLU SoCal), the ACLU, and the law firm of Paul Hastings LLP today announced a historic settlement in Rosas v. Baca, a federal class-action lawsuit that alleged Los Angeles County Sheriff Lee Baca and his top staff condoned a long-standing and widespread pattern of violence and abuse by deputies against those detained in the jails. The L.A. County Jail system is the largest in the United States, with a current population of approximately 19,000.
“Today’s settlement is the culmination of an extraordinary campaign to bring daylight into a very dark place – the L.A. County jails,” said Margaret Winter, Associate Director of the ACLU National Prison Project. “Exposing the culture of savage abuse by deputies has been half the battle in putting an end to it – and the federal decree mandated by today’s settlement will take the parties the rest of the way towards a long-lasting and far-reaching change.”
Under the settlement agreement, the Sheriff’s Department will adopt a detailed and far-reaching plan – drawn up by a panel of three experts – to reform department policies and practices on use of force. As the ACLU documented in its 2011 report “Cruel and Usual Punishment,” the jails’ deputies regularly used excessive force on detainees, including those with mental illnesses, resulting in grave injuries and even death. This report prompted the Board of Supervisors in 2012 to convene the county’s Citizens’ Commission on Jail Violence, a blue-ribbon commission whose recommendations are reflected in today’s settlement. The corrective plan approved today is subject to federal court oversight and enforcement.
“For decades, the sheriff’s department has run the jails without any accountability or transparency,” said Peter Eliasberg, legal director of the ACLU SoCal. “This agreement addresses those problems by establishing clear policies and practices the department must implement, and creating an enforcement mechanism to ensure it does. Put simply, the sheriff’s department must now follow the law or risk court intervention.”
Additionally, under the settlement agreement, the expert panel will monitor the department’s compliance with all aspects of the remedial plan.
If ultimately approved by the court, the key changes mandated by today’s agreement include:
- The implementation of robust policies to prevent abuse of detainees with mental illness. A 2008 ACLU report concluded that use of force by deputies was disproportionately directed at detainees with mental illness. Former Sheriff Lee Baca confirmed that the ACLU’s conclusion still held in 2012.
- Greatly enhanced training in use of force for all deputies, veterans as well as new hires. The Citizens Commission on Jail Violence found that training for custody by the Los Angeles Sheriff’s Department is “far below both industry best practices and training standards in other corrections systems.”
- Radically enhanced methods for tracking and review of use of force incidents and detainees’ complaints and grievances.
“The settlement sends a clear message to our elected officials that we cannot tolerate the abuse of detainees in our jails,” said John Durrant, a partner with the law firm of Paul Hastings. “We expect this agreement to usher in a new era of oversight in the jails. It should significantly reduce the incidents of abuse and increase accountability when deputies apply excessive force. Paul Hastings is proud to have litigated this matter pro bono, to have done so vigorously, and to have worked alongside the ACLU in achieving this landmark settlement.”
The settlement comes nearly three years after the ACLU sued the county on behalf of Alex Rosas and Jonathan Goodwin, two pretrial detainees who were viciously beaten by deputies. The federal suit alleged violations of the detainees’ Eighth Amendment rights to be free of cruel and unusual punishment and the rights of pretrial detainees not to be punished prior to conviction.
With today’s milestone agreement, Los Angeles County has an unprecedented opportunity to bring lasting reforms to the nation’s largest jail system, together with the U.S. Justice Department’s efforts to ensure court oversight of the treatment of detainees with mental illness in the jails, the 2012 recommendations by the Citizens’ Commission, and the election of a new sheriff.
More information about today’s settlement and the ACLU’s fight to improve conditions in the Los Angeles County jails is available here:
Settlement agreement, implementation plan, and other documents:
More information about the ACLU of Southern California:
More information about the ACLU’s National Prison Project:
A Brigham and Women’s physician will become the next U.S. surgeon general.
Democrats squeaked out a 51-43 vote Monday to confirm Dr. Vivek Murthy, 37, in the waning days of their control over the U.S. Senate.
Murthy’s nomination stalled earlier this year when the National Rifle Association raised objection to Murthy’s characterization of guns as a health issue. Murthy said he would focus on childhood obesity, not guns, if approved as the nation’s top doctor. Many public health leaders and physicians fumed about the NRA’s influence, but the White House did not press for a vote and many of Murthy’s supporters assumed the nomination was dead.
Then on Saturday, Senate Majority Leader Harry Reid, using a procedural move, put Murthy’s nomination back in play. And on Monday he was approved by a single vote majority a year after being nominated and 17-months after the position was vacated.
“I can think of no one better suited for this important role and truly believe that we will be a stronger and healthier nation under his leadership,” Brigham and Women’s President Betsy Nabel said. “[Dr. Murthy] is a passionate advocate for improving access to quality health care and is driven by innate desire to help people all over the world achieve and maintain good health.”
Some senators say Murthy’s medical authority will be undermined because he’ll be seen as a political activist.
“The majority of his career has been spent not as a doctor treating patients but as an activist, an activist focused on gun control and political campaigns,” Republican Sen. John Barrasso, of Wyoming, said earlier Monday.
Murthy will become the nation’s top doctor as the U.S. responds to Ebola here and abroad, as Americans fight the flu and as Murthy’s priority, childhood obesity, threatens, in his words, “the next generation.” He will be the first Indian-American surgeon general.
Murthy is graduate of Harvard and Yale. He started two organizations: Visions Worldwide, which works on AIDS education in India, and Doctors for America, a pro-Obama physician group.
By Jessica Alpert
The images of five hostages escaping from the Lindt Chocolate Cafe in Sydney are striking. A woman runs into the arms of law enforcement, her trauma and fear palpable.
This story is still developing, but one thing is for sure: “It really doesn’t take much to instill fear,” says Max Abrahms, a professor of political science at Northeastern University and an expert on terrorism. “This one guy managed to shut down an entire city, divert many planes away from Sydney, and transfix the world in real time following this story.”
As of press time, police were reporting that the hostage taker and two people were killed. For those who survived, what lies ahead psychologically?
Dr. David Gitlin, Brigham and Women’s Hospital vice chair of clinical programs and chief of medical psychiatric services, says recent research suggests reliving or “debriefing” survivors is counterproductive and “actually may precipitate the development of PTSD.”
Instead, health professionals are encouraged to use a resilience model in the immediate aftermath of an event like this one, “helping people think about the things they need to do to feel safe and secure…to deal with things on their timetable,” says Gitlin. Of course, this may come into conflict with the needs of law enforcement, who are looking for further control of an event or preparing evidence for prosecution. As this siege has ended and it’s believed that the assailant acted alone, Gitlin hopes that those now released will not be interrogated at this time.
Gitlin, who led the Brigham’s psychiatric team after the Boston Marathon Bombings, explains that “people need to be surrounded by their loved ones, put into a safe environment, and only process this when they are ready to do so.”
Acute Stress Reaction and PTSD
There are two types of trauma, says Gitlin.
“Loss of control and fear really fits under the rubric of ‘acute stress reaction’ which also puts people at risk for post-traumatic stress or PTSD,” he says. The acute stress reaction comes during and immediately after an event like the Sydney siege. This can include agitation, flashbacks, sensitivity to noise, emotional distance and numbness. Some people will have no acute stress reaction but will develop symptoms of PTSD months later. The more intense the event, the more likely the PTSD, which can be diagnosed as early as one month after a traumatic event.
Our thirst and desire for more information doesn’t help the victims.
“I saw this a lot around the Boston Marathon events — the media exposure is so counterproductive,” remembers Gitlin. “There are a million people trying to get them [the victims] to tell their story…so the media has to struggle with the fact that the victims might be more victimized by this process.”
Gitlin was incredibly busy in the days after the Boston Marathon bombing, helping both staff and victims. He may not remember everything he did during that time but he is certainly convinced of this. “The most important thing I did was walk around the hospital and in the emergency department, the hallways, waiting rooms and patient rooms…I turned off the televisions.”Related:
By Jessica Alpert
Marion Tripp was what you might call a quintessential “Yankee.” From impeccable pie crusts to crackshot deer hunting, she regularly impressed people with her wide range of skills. When her daughter and son-in-law started an organic farm in rural Maine, she’d bundle up in a snowmobile suit and sell their rutabagas at the local farmer’s market. I never knew Marion but her grandson — my husband — loves to remember her this way.
Not the way she was at the end.
Alzheimer’s ravaged Marion’s brain and left her confused, “mean,” paranoid, and violent. The last three years of her life, she had round-the-clock care since she rarely slept more than a few hours at a time. Her nocturnal habits were not unique. Indeed, in the world of Alzheimer’s, this tendency toward nighttime wakefulness is known as “sundowning.”
“Several things go awry with Alzheimer’s that affect the person’s brain chemistry and changes their circadian rhythm,” says Dr. Paul Raia, vice president of clinical services for the Massachusetts/New Hampshire chapter of the Alzheimer’s Association. He says there are various reasons for this nocturnal shift including lack of melatonin, diminished access to natural light and less rapid eye movement or REM sleep.
But it’s not just about being unable to sleep for long stretches of time. Like Marion Tripp, many Alzheimer’s patients are often agitated, angry, even violent. “During that period [of REM sleep], you are ridding the toxins from your brain and you’re stabilizing memory and you’re dreaming and essentially you are paralyzed with your body in a relaxing mode,” says Raia. “[The patients] may take a series of small naps throughout the day and when they wake up, they may not be fully awake. They can’t navigate well or negotiate well in their environment.”
When Patients Don’t Sleep, Nobody Sleeps
So, instead of coaxing patients back to sleep, one program has decided to flip things around, and turn nights into days with patients arriving at 7 p.m. and leaving at 7 a.m.
Here’s the backstory:
According to the Alzheimer’s Association, more than 5 million people in the United State had Alzheimer’s in 2013 and more than 15 million family members or friends provided 17 billion hours of unpaid care to someone with Alzheimers or a similar dementia.
The Hebrew Home in Riverdale, New York, spotted caregiver burn-out early on and 15 years ago started a program to address it.
According to Deborah Messina, vice president of strategic planning and business development at the Hebrew Home, family caregivers looking for services simply didn’t know where to turn. “They would put locks on the top of the doorjambs so their family members couldn’t get out or they would sleep right outside their door.” So it was decided that in addition to typical adult day care services for patients, the Hebrew Home would offer the same type of program — at night.
The idea is, says Messina, to “engage the behavior. We want to keep people in the community as long as possible. It’s the goal of the families, the goal of the individual and the goal of the regulatory bodies who are paying for these services.”
So how does this work?
When patients arrive at night, their hours are filled with activities, medical monitoring, recreation, physical therapy and more. On an average overnight, the program will accommodate 28-35 patients. There is a bed for each one in case someone wants to rest. The program is open seven days a week, 365 days a year. Most patient care is paid for by a long-term care provider — while a very small minority pay privately.
But it’s not just about keeping people busy at night. Since those suffering from the disease are often agitated by medical exams, Messina explains that the program tries to “take the exam table out of the exam. If we have a spa night, it’s a full pedicure, manicure and light massage. At that point, we are checking their skin integrity. A week after spa night, the podiatrist comes. So we know who will need to be seen. What we’re trying to do is give someone complete care.”
Rhoda Cohen has been in the Hebrew Home program since 2013. Suffering from dementia, Cohen hasn’t slept normally for years — rarely sleeping through the night. Carol Bauman, Cohen’s daughter, explains that the family had no choice but to look into institutional care options. “We were told by Medicaid that…the aid couldn’t work around the clock without sleep. We were pushed into it” says Bauman. Now Cohen goes seven nights a week.
“When she started the program she was a little more cognitively able to talk about it. She liked the activities…it was stimulating,” remembers Bauman. But seeing the decline of other patients was never easy. “It was hard for her to see people who were much more impaired.”
When Caregiving Hurts
When patients are offered alternatives in nighttime care, everyone can benefit. Dr. Raia of the Alzheimer’s Association has worked in the field for 27 years counseling families, professionals, programs and institutions. At the point when Alzheimer’s patients stop sleeping at night, he says, family members literally increase their chances of getting the disease. “Caring for someone with dementia is the most stressful caregiving condition that causes depression [and] depression is a risk-factor for the disease itself,” he says, adding: “Alzheimer’s doesn’t just attack the individual, it attacks families.”
Seven Miami-Dade hospitals fell below national standards for combating infections acquired by patients in hospitals, and patients at one hospital — North Shore Medical Center in Miami — were more likely to develop infections than patients at any other hospital in South Florida, according to data collected by the federal government as part of a national effort to reduce such infections.
The Centers for Disease Control and Prevention tracks how hospitals around the nation perform on preventing six types of frequently occurring infections, including bloodstream and urinary tract infections that result from catheters and surgical site infections that develop after colon and hysterectomy operations.
North Shore Medical Center did worse than national standards in controlling four types of infections.
Only one other Florida hospital, UF Health Jacksonville, a teaching hospital in Duval County, underperformed the CDC benchmarks in more than two categories, and only seven hospitals in the nation underperformed in four categories.
Cristy Martinez Paez, a spokeswoman for North Shore Medical Center, wrote in an email that the hospital provides “high-quality patient care” and is engaged in an “ongoing effort to reduce hospital-acquired infections by implementing proven methods such as a comprehensive safety program on every unit.”
She wouldn’t provide details of the safety program, saying only that “we continue to work toward a goal of zero cases.”This copyrighted story comes from the Miami Herald, produced in partnership with KHN. All rights reserved.
The CDC collected the data on infections from 4,683 hospitals around the county, including 179 in Florida, between October 2012 and September 2013.
“These kinds of infections usually occur because of fairly simple problems and errors by healthcare providers — and they have simple solutions that can be easily enacted,” said Robert Brooks, a patient safety expert who served as secretary of the Florida Department of Health between 1999 and 2001.
One in 25 patients develop an infection on any given day while in hospital care and one in nine people infected will die in the hospital, according to the CDC.
“We as a society need to continue to bring attention to facilities that don’t meet community standards in relation to medical errors or hospital-acquired infections,” said Brooks, who is also an adjunct professor at the University of South Florida.
In Miami, North Shore did worse than national benchmarks in four categories: central-line bloodstream infections, catheter-associated urinary tract infections and infections from two types of antibiotic-resistant bacteria, MRSA and C. diff.
Tenet Healthcare, the Dallas-based company that owns North Shore, did not respond to a request for comment.
UF Health Jacksonville, part of the University of Florida health system, also underperformed in four categories.
“Safety-net hospitals like ours tend to be at a disadvantage in these studies when compared to other hospitals because of our unique patient population,” said Daniel Leveton, a spokesman for UF Health Jacksonville, in a statement.
Leveton said the hospital tends to treat patients with more severe conditions who haven’t had adequate access to preventive care. “Treating them can be more of a challenge, one we accept as part of our mission in helping this community,” he said.
Jackson Memorial Hospital in Miami, also considered a safety-net institution, exceeded expectations for bloodstream and urinary tract infections but failed to meet them for MRSA.
Nancy Foster, vice president of patient safety at the American Hospital Association, said the CDC data were by and large “very well crafted,” but it might be penalizing to hospitals that aggressively diagnosed and treated infections. She also said the overuse of antibiotics could lead to problems.
“We don’t want to over-prescribe antibiotics because that leads to even more antibiotic resistant organisms,” Foster said.
As a whole, Florida hospitals are performing significantly better than national benchmarks in three areas: bloodstream, urinary tract and colon infections, according to CDC data released in March.
Bruce Rueben, president of the Florida Hospital Association, a trade group, said hospitals in the state were working together to find effective strategies for reducing infections and other hospital-related injuries like falls and medication overdoses. Patients and providers would benefit from focusing on the problems, Rueben said, in part because hospitals have higher treatment costs when patients develop complications under their care.
The federal government compiles scores for individual hospitals based on a broad range of patient safety measures, including hospital-acquired infections.
In December, the government will announce the first round of financial penalties, assessed through Medicare payments, for hospitals with low safety scores. The program was established as part of the Affordable Care Act.
The government is also expected to release updated infection rates for hospitals by the end of December.
Standardizing procedures that nurses and doctors perform on patients can help prevent infections, said Dr. Robert Goldszer, chief medical officer at Mount Sinai Medical Center in Miami Beach.
“More variation means more opportunities for things to go wrong,” Goldszer said. “We’re trying to design the easiest way to provide our patients with the right care all the time.”
Mount Sinai performed worse than national benchmarks in preventing MRSA and post-surgical colon infections but exceeded for urinary tract and C. diff infections.
Goldszer said Mount Sinai had worked with the Florida Hospital Association and other healthcare institutions to identify ways to improve its fight against infections including increased hand-washing, special soaps to clean a patient’s skin before surgery, avoiding the over-use of catheters and investigating how every new infection occurs.
He said the hospital had reduced the frequency of colon infections from 20 cases in 2013 to five as of September this year, and had also seen a moderate drop in its rate of MRSA infections.
“We need to continuously measure and assess our progress,” Goldszer said.
The following is an article written by Mark Hartsell, writer-editor for The Gazette, the Library of Congress staff newsletter.
The court’s decision in Bush v. Gore, 531 U.S. 98 (2000), brought an end to the contested presidential election of 2000, and in the aftermath, Breyer noted, there were no riots, no acts of violence, no guns, no deaths.
“We have decided to decide our major disagreements under a system of law,” he said Tuesday in the Coolidge Auditorium. “That is a remarkable thing, that people actually follow that. It has a long history, and that history does begin 800 years ago with [Magna Carta].”
Philanthropist David Rubenstein interviewed Breyer in the Coolidge as part of a Library of Congress symposium marking Magna Carta’s 800th anniversary and exploring how the charter’s political and legal traditions carried into modern times.
The program, sponsored by the Law Library, featured four panel discussions: “Drafting Modern Constitutions,” Proportionality Under the 8th Amendment,” “The Enduring Value of Magna Carta” and “Rule of Law in the Contemporary World: Civil Liberties and Surveillance,” a panel that included Reps. Jerrold Nadler (D-N.Y.) and F. James Sensenbrenner Jr. (R-Wis.).
Sir Robert Worcester, chairman of the Magna Carta 800th anniversary commemoration committee, also provided an international perspective on the Great Charter’s legacy.
Since, Rubenstein said, one rarely gets an opportunity to interview a Supreme Court justice, he asked Breyer about a wide range of subjects – Magna Carta, his experiences as a special counsel in the Senate, the inner workings of the court, cameras in the courtroom (“too many uncertainties”) and his beginnings as a lawyer.
“You may not remember this – you’re not old enough – but there was a time when you tended to do what your parents said,” Breyer said to laughter, noting that his own father was a lawyer. “It’s completely foreign to this entire audience, such an idea.”
Breyer served as a law clerk to Supreme Court Associate Justice Arthur Goldberg, a special assistant in the Justice Department, an assistant special prosecutor on the Watergate Special Prosecution Force and, in the late 1970s, as counsel to the Senate Judiciary Committee, working for Sen. Ted Kennedy – an experience he called “fabulous.”
“I learned a lot from him,” Breyer said. “He was wonderful to work for. … It was fun. It was interesting. You wanted to accomplish something good. Every minute, though, there are things that pop up. It’s a wonderful place to work.”
“For any lawyer to become a federal judge, lightning has to strike. It really does,” he said. “To be on the Supreme Court, it has to strike twice in the same place.”
Breyer said he often is asked about the way in which the high court makes its decisions: People will ask, Aren’t you just “junior-league politicians”? Don’t you just decide cases however you like?
“I never do what I like,” Breyer quipped. “Are you kidding? It’s like being married.”
About half the court’s cases are decided unanimously, he said, and only a very small minority are decided according to what media would think is a liberal-conservative breakdown.
But those decisions, he said, are informed less by ideology than simply by a lifetime of professional and personal experiences that shape each justice’s views and the way he or she grapples with difficult, complicated constitutional questions.
“You cannot jump out of your own skin, and you shouldn’t,” he said. “Therefore, on that basis, you will find differences and you will find a coalescing around certain basic things. …
“It’s not such a terrible thing to go on the Supreme Court of the United States. Over long periods of time, you have people who think quite different basic views about how this document should be interpreted. It’s OK.”
Breyer also discussed the most basic principles American law derived from Magna Carta: No person shall be deprived of life, liberty or property without due process of law.
“It’s such a simple idea,” he said. “But that’s what people are all over the world today trying to see if they cannot embody in institutions.”
The charter’s influence, he said, clearly can be found in contemporary issues. Supreme Court Associate Justice Anthony M. Kennedy, Breyer said, cited Magna Carta in a decision that determined prisoners at the Guantanamo Bay military detention camp have the right to come into civilian courts.
“We have a constitution that doesn’t just guarantee democracy,” Breyer said. “It guarantees democracy, basic human rights a degree of equality, separation of powers, and it guarantees a rule of law.”
Breyer and his law clerks toured the “Magna Carta: Muse and Mentor” exhibition in the Jefferson Building in late November and, on Tuesday, he urged the audience to visit as well.
“It’s fabulous, partly because you see the document. … Partly because as you go through that exhibition it will force you to think about the time that has passed, the people who have been involved, a few of the ups and downs,” Breyer said. “Think of this country. We lived in a period of slavery. We had a terrible Civil War. We had 80 years of government-backed racial segregation.
“We’ve had all kinds of ups and downs, and it’s taken a very long time before those words in the Magna Carta have come to be accepted in the customs and habits of the people.”
[We will provide a link to the symposium webcast soon.]
The Library of Congress is commemorating the 800th anniversary of Magna Carta with an exhibition – Magna Carta: Muse and Mentor, a symposium, and a series of talks starting this year. Through January 19, 2015, the Lincoln Cathedral Magna Carta, one of four remaining originals from 1215 is on display along with other rare materials from the Library’s rich collections to tell the story of 800 years of its influence on the history of political liberty.
That kiss last night? You may have left with more than butterflies. According to Dutch researchers, the average 10-second french kiss can result in the exchange of around 80 million pieces of bacteria.
And they have the data to prove it.
Twenty-one couples recently volunteered to kiss for science. This all went down at the Amsterdam Royal Artis Zoo in 2012. The Dutch researchers studying bacteria surveyed the kissing habits of each partner in each couple with questions like, “How often do you kiss? and “When did you last kiss?” Researchers then swabbed each partner’s tongues for “salivary microbiota,” before and after a “controlled kissing experiment” (read: a tightly timed 10 seconds).
Then there was a second kiss. One member of the couple was asked to swig some probiotic yogurt beforehand. This made it easier to look at the bacteria from the yogurt both on the tongue of the person who drank it — and the tongue of the person who didn’t.
So what do we learn?
Turns out shared microbiota can actually survive on another person’s tongue. Samples of oral flora from the partner were more similar than those drawn from randomly selected passersby.
But despite this robust sharing of bacteria, not all of it is there to stay. Professor Remco Kort of the Netherlands Organisation for Applied Scientific Research (TNO), the group that conducted the study, told the BBC that “only some bacteria transferred from a kiss seemed to take hold on the tongue.”
Kort explained that in the end, kissing may be the least important factor. “It didn’t matter whether the couples said they french kissed nine times a day or nine times a year. Obviously, there are other important factors involved such as sharing the same diet or using the same toothpaste for example.” Nevertheless “these types of investigations may help us design future bacterial therapies and help people with troublesome bacterial problems.”
Now this knowledge can be yours. The researchers partnered with Micropia, the world’s first microbe museum, to create an exhibit called the “Kiss-O-Meter” which allows couples to take a look at their own shared bacteria.
For two decades Atlanta restaurant owner Jim Dunn offered a group health plan to his managers and helped pay for it. That ended Dec. 1, after the Affordable Care Act made him an offer he couldn’t refuse.
Health-law subsidies for workers to buy their own coverage combined with years of rising costs in the company plan made dropping the plan an obvious – though not easy – choice.
“I had a lot of regrets going into it,” Dunn, who owns three Italian Oven restaurants in suburban Atlanta, said of his decision. “I don’t think I have as many now — only because I’ve seen the affordability factor for my managers improve.”
Dunn and five managers are now covered under individual plans bought on healthcare.gov. How many other owners make the same decision will help set the future of small-business health insurance. Although the evidence so far is mixed, brokers expect more firms to follow in the next few years.
Companies like Dunn’s — those with fewer than 50 workers — provide medical coverage to roughly 20 million people. Unlike larger employers, they have no obligation under the health law to offer a plan. Now they often have good reason not to.
If employees qualify for government subsidies, like the managers who switched from Italian Oven’s corporate insurance to individual Obamacare coverage, everybody can win.
Owners don’t have to pay premiums, meaning they can give workers raises, invest in equipment or add to profits instead. And employee take-home pay can rise if subsidies — available even to families with middle-class incomes — are worth more than what a company was contributing.
Whether to cancel a company plan and let workers buy insurance on healthcare.gov or another online exchange “is something that I would say comes up in every conversation with a small-group” employer, said Adam Berkowitz, a consultant with Caravus, a benefits firm based in St. Louis.
“I just had another [small] business call in today and say, ‘You know, we can’t do it. We’re packing it in,’” said Roger Howell, head of Howell Benefit Services in Wilkes-Barre, Pa.This KHN story can be republished for free (details).
Anthem, the largest seller of small-business health insurance, lost almost 300,000 members in such plans — many more than expected — in the first nine months of the year. That was 15 percent of the enrollment. Many of those consumers are presumably switching to individual plans sold through exchanges, including those offered by Anthem, officials said.
It’s far from clear, however, that most companies will take the same steps as Italian Oven.
Many small employers see health coverage as an essential piece of compensation. They note that premiums in company-sponsored plans are tax-deductible — for workers as well as employers — while the tax advantages of individual plans are limited.
“I feel like we have to have a medical plan in order to hire people and keep them employed,” said Dan Allen, head of a 15-worker engineering firm in Decatur, Ill. Allen Engineering renewed its Coventry Health Care plan for 2015 even though the premiums rose 21 percent, he said.
No other major insurer has reported cancellation of small-business plans at the same rate as Anthem.
“We didn’t see that,” said Rick Allegretti, vice president of marketing at Health Care Service Corp., operator of Blue Cross plans in five states including Illinois and Texas. “We actually saw our [small-group] business grow slightly — mind you it’s probably a tenth of a percent.”
Businesses shifting workers into the individual exchanges tend to be the very smallest, employing a handful of people, said Skip Woody, a partner at Hill, Chesson & Woody, a North Carolina benefits firm. “Anything above 15, we haven’t had any dropping coverage,” he said.
Instead, many small companies are taking advantage of rules letting them maintain insurance bought before the health law took effect. President Barack Obama, who promised consumers they could keep coverage they liked, allowed carriers to extend noncompliant plans after facing fierce criticism over their imminent extinction.
Most, but not all, states approved the adjustment. Because older policies may lack features required by the health law and because their rates are often set according to employee health history, not community-wide costs, they can be less expensive than compliant plans, say brokers and consultants.
“I haven’t sold one of the new plans yet” to a small employer, said John Jaggi, an Illinois broker and consultant. Faced with price increases of as much as a third or more for new plans, all 40 or so of his small-business clients including Allen Engineering renewed older coverage for 2015, he said.
Heavy renewal of old plans plus workers shifting to individual coverage help explain why the health law’s online portal for new small-business plans has attracted only modest interest, analysts say.
For some companies there is logic to ending coverage altogether.
For Italian Oven’s Dunn, “it made sense to recommend that he drop coverage,” said Elena Merino, CEO of the Meridian Group, a benefits firm in Alpharetta, Ga. “It hurts me. But that was the responsible thing to tell him.”
Italian Oven employs the equivalent of about 30 people — less than the 50-worker threshold that would get it fined for not sponsoring insurance. The company does not offer coverage to servers and kitchen staff, but full-time managers have always had a plan.
All are eligible for tax credits to buy insurance on healthcare.gov, said Dunn. Next year, the subsidies are available for individuals with income of up to $46,680 and families of four with income of up to $95,400.
With subsidies factored in along with unrelated pay increases, the managers “are going to be saving money out of the deal” while getting coverage comparable to what they had before, Dunn said. “My managers actually got excited about it because they’re saving money on their health insurance.”
Brokers expect more small businesses to make the same move, especially after the ability to extend older, noncompliant plans expires between now and the end of 2017, depending on state policy. Allen, the engineering firm executive, is concerned premiums could rise even higher next year than they did for the 2015 renewal.
“If it’s up in the 25- to 30-percent increase [range] — I’ve heard as high as 40 — we’ll just have to drop it,” he said. “Turn everybody loose.”