While vacationing in Hawaii, conservative radio talk show host Rush Limbaugh had chest pains and as a result had a stay at the Queens Medical Center–which is the hospital where Barack Obama was born (as was my wife as well.) But that’s not the only irony.
At a press conference talking about his stay, he made comments which were widely interpreted to take a dig at efforts to reform the health care system, saying he was availed of “the best health care the world has to offer.” Limbaugh continued, “Based on what happened here to me, I don’t think there’s one thing wrong with the American health care system. It is working just fine, just dandy.”
I have a post at The New Republic’s The Treatment (which was highlighted by Politico’s LivePulse and Karen Tumulty at Time’s Swampland) which points out that Limbaugh seems to be endorsing the care he got in Hawaii–which has had a version of health reform for the past 35 years!
Many people pointed this out, including Ben Armbruster at ThinkProgress and Paul Abrams at the Huffington Post over the weekend, and others today (after I had submitted my piece to TNR), including the San Francisco Examiner, the Baltimore Sun, and the SEIU Blog–which also points out the hospital was unionized.
My post takes a look at some of the new research about the Hawaii Pre-Paid Health Care Act of 1974, and its central requirement for employers to provide health coverage to their workers: it shows positive results in improving access with no measurable impact on jobs. If Rush Limbaugh is endorsing an employer mandate, the House and Senate leadership may want to take another look at beefing up its requirements.
One lesson from Hawaii beyond Limbaugh’s visit and unintended endorsement of reform I want to spotlight:
* Beyond the level of the assessment, the structure of the employer assessment is key, so there aren’t broad loopholes that allow employers to avoid any contribution whatsoever. In this regard, the Senate’s complicated “free rider” provision needs to be fixed. The House version has a simple test of whether an employer is providing adequate coverage, and the assessment for those that don’t is a percentage of payroll, based on a sliding scale capped at 8%. The Senate is more convoluted, and the most problematic part is that employers could avoid much of the penalty by shifting workers to part-time status.
As Elise Gould and Ken Jacobs writing for the Economic Policy Institute indicate, “Studies of Hawaii’s health insurance mandate have found that the state has a disproportionate number of employees working slightly under 20 hours a week, the number of hours at which that requirement becomes effective. The 30-hour cut-off in the Senate Finance bill is more likely to encourage reductions in work time, since it is easier to restructure work to fewer than 30 hours a week than to fewer than 20 hours a week.” As the researchers note, work shifts in this range are common in the restaurant, retail, and nursing home industries–the very ones that are less likely to provide coverage and leave their workers uninsured. The experience from Hawaii is strong evidence that the final employer responsibility provisions should be closer to the House than the Senate.
This issue of the structure of an employer requirement—and especially how to cover and pay for part-time workers—was a crucial unresolved issue in the California debate around health reform in 2007. The House bill gets this right–and better than what we had in the final Schwarzenegger-Nunez negotiated bill, partially because we didn’t have the constraints of ERISA. The Senate version, however, needs to be fixed in order for it to work as intended.