Category Archives: Benefits

HR 3962: Affordable Healthcare for America Act

I thought I would spend some time trying to read through the bill just introduced by the House.  Purely from a layperson's perspective, here are some notable elements (comments and corrections are welcome): 

It appears to make available an emergency "public option" ("the high risk pool program") beginning January 10, 2010 that will expire when the public option comes online.  Who is eligible? Those who don't have benefits from a program under the Social Security Act (Medicare?), employer benefits (excluding COBRA), has not had employer benefits for 6 months preceding application to the program, has applied for but been denied coverage, and has an eligible medical condition.  Quite frankly, it is very confusing and unclear.  Obviously, though, it does not just extend to everyone who is uninsured; there is a whole process involved to get this coverage.  It looks like 5 billion dollars has been allocated to this program (if the program runs out of money, they can increase premiums and reduce benefits!  Just like a private insurer!).  There will, then, be premiums, a maximum deductible of $1500 for individuals (but maximum cost sharing of 5K for individuals, 10K for families…how does that jibe with the 1500 deductible, I wonder?).

The bill also says that if the "medical loss ratio" (the amount of premiums that actually go to paying medical expenses, that is, paying claims [these are considered "losses"]–here is a great article explaining the Orwellian nature of this term) of insurers offering group plans falls below a certain amount (not less than 85%), the company has to pay a rebate to enrollees.  Hmmm…that sounds good.  But highly anti-capitalistic, I mean, what kind of law is it, that in the good old USA, would dare to limit profit, the extraction of surplus value from our bodies?  Ah, I found the loophole.  The same will only apply to individual plans as long as it does not "destabilize the market."  Capitalism regained.  I am only on page 28 of a 1990 page bill.  It's going to be a long night.

On rescission (i.e. an insurer dumping someone from an individual plan after they get an expensive illness, claiming they forgot to report a pre-existing condition–something like acne, a hangnail–before they enrolled): it appears to require notification before they are dumped and an opportunity for an independent third party review…sounds a like a tedious process to be going through while someone is gravely ill.  

Insurers have to submit a justification to the government for any price increase.  I'm sure our government, so independent from the insurance industry, will be really tough on insurers on this count.  Especially during our next Republican administration.

Group health plans have to cover "kids" until they are 27. 

Page 37…to be continued.

–Suzanne Verderber 

Report of November 5 Meeting

MEMBER BENEFITS

Two representatives from NYSUT attended our Union meeting on November 5 to explain many of the benefits of Union membership.  These include discounts (computers, books, office supplies, music and video equipment, car rentals, movie and theater tickets), additional insurance plans (disability, catastrophic coverage, rental, long-term care), and banking (savings and CD's) at favorable rates.  Get more information by clicking on THIS LINK , or stop by the Union office (110 North Hall) to pick up fliers.  The website address is www.memberbenefits.nysut.org.

UNION MEMBERSHIP VS. AGENCY FEE

At the meeting, there was also more discussion of what can be a confusing issue: what is the difference between checking off "agency fee" as opposed to "union member" on the yellow form distributed at the beginning of the semester?

First, a little history.  The first Collective Bargaining Agreement (CBA) at Pratt was signed in 1973.  From that time, until the most recent CBA (signed in 2008), membership in the Union was optional.  Faculty members had to elect to join and have Union dues deducted from their paychecks.  At the same time, even though only some faculty members joined the Union and paid dues, ALL faculty benefited from the protections and benefits enshrined in the Collective Bargaining Agreement.  For example, whether or not a faculty member had joined the Union and paid dues, the Union would gladly and willingly represent that faculty member in the grievance process.  More fundamentally, that faculty member's rights were enshrined in the CBA, protected, defended, and kept vital by the vigilance of the Union.  In short, a situation existed in which half (or fewer) faculty members were supporting a Union, in financial and other ways, that worked on behalf of ALL the faculty.  

I should add that a tremendous amount of the Union's energy and effort during this long period was continually directed towards gaining new members.  This was especially difficult in Pratt's part-time heavy environment, wherein a huge percentage of faculty are "visiting" and thus may only teach one course.  It was, quite simply, difficult to track down a faculty member who was on campus once a week, and who may have skipped semesters.  In short, the membership drive was an all-consuming Sisyphean task.

In the historic negotiation that took place in 2007, the UFCT 1460 obtained the right to ask for an "agency fee" from those faculty members who choose not to join the Union but who still benefit from the work of the Union and Union protection.  The agency fee represents an acknowledgment that even if a faculty member chooses not to become a Union member, he or she continues to benefit from the presence and work of the Union.  Because the agency fee and Union dues are initially equivalent (the agency fee payer can apply for a refund of monies used for political activity by the parent Union at the end of the school year), it makes logical sense to join the Union because of the additional rights and benefits that come with Union membership that do not come with electing to pay the agency fee.

The rights of a Union member differ from those of an agency fee payer.  The Union member can actively participate in the Union, helping to determine its direction and future.  The Union member can attend Union meetings, agitate for issues to be brought to the negotiating table, participate in Union elections either as a voter or as a candidate, and vote to approve or reject the CBA.  The agency fee payer is excluded from these activities.  Becoming a Union member gives the faculty member a VOICE.

In The Social Contract, Jean-Jacques Rousseau makes a distinction between the "subject" and the "citizen" that has some resonance here.  He writes: "With regard to the associates [those people who come together to create a sovereign state], they take collectively the name of people, and are called individually citizens, inasmuch as they PARTICIPATE in the sovereign power, and subjects, inasmuch as they are SUBJECTED TO the laws of the State."

Electing to become a Union member gives you the rights of the citizen; the agency fee gives one the rights of a subject.  The choice is clear. 

Another point: this is a confusing time of transition in the history our Union.  No question is too stupid.  Please call the Union office at (178) 636-3614, or write directly to me at sverderb@pratt.edu with ANY questions.

Sincerely,

Suzanne Verderber

UFCT 1460 Vice President

Associate Professor English & Humanities

More on Cuomo’s Investigation of Insurers

An editorial in the New York Times points out that the company used to estimate the cost of medical visits, estimates that are in turn used to determine the reimbursement of out-of-network benefits, is OWNED by one of the largest insurers in the US.  So, both the "estimators" and the insurers obviously have a vested interest in low-balling estimates, keeping profits high, and fudging the numbers, if necessary.   It's the same old corporate love story.  Does it really surprise us anymore?  Will a Democratic administration make an effort to clean these things up?  At least Cuomo is trying.

 –Suzanne Verderber