Bigger Health Care Providers Mean Bigger Profits, But Not Always Better Care

Nov 24, 2014Emily Cerciello

Hospitals are buying private physician practices left and right, and state attorneys general should consider whether such mega-providers violate anti-trust laws.

Hospitals are buying private physician practices left and right, and state attorneys general should consider whether such mega-providers violate anti-trust laws.

In 2002, only 22 percent of private physician practices were owned by hospitals. Today, this number has climbed to more than 50 percent, and 75 percent of newly hired physicians are entering the workforce as hospital employees. As the physician population ages, the behaviors of young physicians will have long-term impact on the organization and norms of care delivery.

Amid declining reimbursements and a shift toward value-based payment models in which physicians are reimbursed for quality rather than quantity of services, health care providers are facing pressure to reduce costs and improve outcomes. An increasing number of physicians are selling their practices to hospitals, and hospitals are aggressively buying to remain competitive.

Two chief catalysts that are driving hospitals to purchase physician practices include the recent economic downturn and passage of the Patient Protection and Affordable Care Act (ACA).

In this economic environment, hospital survival is a matter of cost cutting and care organization. The ACA requires compliance with new quality regulations, including curbed readmission rates and a reduction in hospital-acquired infections, and facilities are compelled to spend money in efforts to meet those requirements. Hospitals are acquiring physician practices to increase scale for better negotiating positions with insurers, further penetration of local markets, the ability to integrate IT systems, and the improvement of purchasing power with suppliers.

Physicians are selling their practices to hospitals for greater access to capital and fewer administrative responsibilities amid reform, an improved work-life balance, and recruiting incentives by hospitals.

But when hospitals purchase physician practices instead of contracting with physicians, the results can be costly. A recent Health Affairs study gives authority to the issue: hospital ownership of physician practices increases hospitals’ pricing power, and prices rise for privately insured patients. A one-standard-deviation increase in market share can increase prices by 3 percent, and a one-standard deviation increase in hospital Herfindahl-Hirschman Index (a statistical measure of market concentration), can increase prices by 6 percent.

In central North Carolina, Duke University Health System has been aggressively converting nearby clinics into Duke-affiliated outpatient centers. State Attorney General Roy Cooper is examining whether antitrust laws or new legislation can be used to reduce growing hospital prices.

In January, a federal judge blocked a major purchase of Idaho’s largest physician practice by the state’s largest hospital system. In light of that case, the FTC has suggested it will show greater scrutiny of healthcare provider consolidations.

In theory, true integration of physician practices into hospital systems can provide substantial gains for both parties. By reducing barriers to patient information and care coordination, facilities can improve quality and generate cost-savings in the long-term. Truly integrated practices employ a well-managed infrastructure, aligned incentives, coordinated IT tools, and a culture of partnership and collaboration. But there is a great possibility that hospitals are primarily motivated by the prospect of greater bargaining power with insurers, and are not truly integrating.

State Attorneys General should renew a focus on anti-trust legislation to protect the strained wallets of healthcare consumers in states where transactions are occurring. In a time of seismic shifts in care delivery and payment mechanisms, we need to keep the patient at the center of health activity and ensure that transactions do not further burden consumers in an already expensive system.

Emily Cerciello is the Roosevelt Institute | Campus Network Senior Fellow for Health Care, and a senior at the University of North Carolina at Chapel Hill.

 

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Daily Digest - November 13: When Government Intervention is the Best Remedy for a Health Crisis?

Nov 12, 2014Rachel Goldfarb

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

Ebola and Inequality (Liberian Observer)

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

Ebola and Inequality (Liberian Observer)

Roosevelt Institute Chief Economist Joseph Stiglitz says the Ebola crisis reveals the absolute need for a government role in health care. Drug companies aren't creating cures for diseases that primarily impact the poor.

Don't Forget the Kinda Unemployed (U.S. News & World Report)

Mike Cassidy points out the workers who are missed by the traditional unemployment rate: involuntary part-timers and marginally attached workers. While unemployment has improved, underemployment is still elevated.

Is Wage Stagnation Killing the Democratic Party? (Vox)

While Ezra Klein agrees that wage stagnation is a major issue today, he doesn't think it impacted the midterms as much as the difference between midterm and presidential year electorates.

VW to Allow Labor Groups to Represent Workers at Chattanooga Plant (NYT)

Steven Greenhouse reports on Volkswagen's new policy, which will create formal structures for groups representing at least 15 percent of plant workers to meet with company officials.

If Democrats Want to be the Party of the People, They Need to Go Full Populist (The Week)

It's time to reject neoliberal commitment to markets and convince the American people of the power of economic populism and income transfer programs, writes Ryan Cooper.

  • Roosevelt Take: Roosevelt Institute Senior Fellow Richard Kirsch points out that the populist narrative was key in Democratic midterm wins.

Did Obama Shoot Himself in the Foot on Net Neutrality? (MoJo)

Erika Eichelberger suggests that the president may have lost the fight on net neutrality back in 2013, by appointing a Federal Communication Commission chairman who is so friendly to the industry.

Study: Social Welfare Programs Help Fight Poverty in America (The Guardian)

Jana Kasperkevic looks at a new study showing just how important social safety net programs are in reducing poverty; without food stamps, another 8 million Americans would be in poverty.

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Daily Digest - November 10: Could an Obamacare Brawl Help the Democrats?

Nov 10, 2014Rachel Goldfarb

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

There will not be a new Daily Digest on Tuesday, November 11, in observance of Veterans Day. The Daily Digest will return on Wednesday, November 12.

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

There will not be a new Daily Digest on Tuesday, November 11, in observance of Veterans Day. The Daily Digest will return on Wednesday, November 12.

The Fight Against Obamacare Continues (Melissa Harris-Perry)

Roosevelt Institute Fellow Dorian Warren says that if the Republican-controlled Senate pushes to end subsidies on the federal exchange, it could prove an electoral advantage for the Democrats.

U.S. High-Speed Internet Lags Behind on Price, Cost (Science Friday)

Roosevelt Institute Fellow Susan Crawford says that with little federal action, it's mayors who are pressuring Internet providers to offer faster and cheaper service.

Minimum-Wage Workers Just Got a Raise, But Will Bosses Steal It? (The Nation)

Michelle Chen points out that rampant wage theft in low-wage fields could eliminate the gains from minimum wage increases, making regulation and enforcement even more important today.

Unemployment Is Down: Why Aren’t Americans Buying the Good News? (New Yorker)

Vauhini Vara says that voters may be right in their worries about the economy, as expressed in last week's exit polling, because labor force participation and wages remain flat.

  • Roosevelt Take: Roosevelt Institute Fellow Mike Konczal points out that economic growth was slower in 2013, which helps put the midterm results in context.

U.S. Unemployment Rate Falls to Lowest Level Since 2008 (The Guardian)

Heidi Moore evaluates the October jobs report. While the numbers look good, many are cautioning that the labor market is certainly not yet back to normal.

Labor Board Says Cablevision Chief Tied Raises to Vote Against a Union (NYT)

Steven Greenhouse reports on the National Labor Relations Board's charges against Cablevision, which is accused of three years of bargaining in bad faith since workers voted to unionize.

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Daily Digest - November 4: How the Growth of Finance Shrank the American Dream

Nov 4, 2014Rachel Goldfarb

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

Frenzied Financialization (Washington Monthly)

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

Frenzied Financialization (Washington Monthly)

Roosevelt Institute Fellow Mike Konczal introduces the concept of financialization as a source of inequality, and lays out steps to reduce the financial sector's size and power.

Slow Growth and Inequality Are Political Choices. We Can Choose Otherwise. (Washington Monthly)

In the concluding article for Washington Monthly's special issue on inequality, Roosevelt Institute Chief Economist Joseph Stiglitz presents a policy path to reduce inequality.

  • Roosevelt Take: In his article, Stiglitz references his 2014 white paper, "Reforming Taxation to Promote Growth and Equity," available here.

Why the GOP Won't Touch Obamacare (Politico)

Roosevelt Institute Senior Fellow Richard Kirsch says that it's too late for anything but minor changes to the Affordable Care Act, because people like having health insurance.

The Midterm Minimum-Wage Mandate (WaPo)

Minimum wage ballot measures will be progressives' big win today, predicts Katrina vanden Heuvel, a member of the Roosevelt Institute's Board of Directors. The direct impact on workers matters.

Obamacare Could Have Turned Millions of Uninsured Americans Into Voters (MoJo)

Erika Eichelberger points out that the navigators who help people sign up for insurance on the ACA's exchanges could have been required to train to register voters as well.

New on Next New Deal

Election 2014: Women's Rights in the Balance

Roosevelt Institute Fellow Andrea Flynn's series on the close-call races that will impact women's health and economic security concludes with the Kansas Senate and gubernatorial races.

Guest Post: A Review of Fragile By Design

David Fiderer argues that the book distorts the realities of the financial crisis in a manner that could be dangerous, should it become conservative's central text on the topic.

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Will Kansas Voters Choose to Continue Their Governor's Economic Experiments?

Nov 3, 2014Andrea FlynnShulie Eisen

In the past four years, Governor Brownback has brought radical tax cuts to Kansas, and the gubernatorial election will show if Kansans approve of the result. Read the other state-by-state analyses in this series here.

In the past four years, Governor Brownback has brought radical tax cuts to Kansas, and the gubernatorial election will show if Kansans approve of the result. Read the other state-by-state analyses in this series here.

Kansas governor Sam Brownback – one of the most conservative leaders in the nation – is in a close fight to prevent State Representative Paul Davis (D) from taking his seat. Four years ago Brownback took office with hopes of making Kansas a "real, live experiment" to create a mid-western conservative utopia. He has slashed business regulations; privatized Medicaid delivery; cut taxes for the wealthy; and practically eliminated income taxes, a move that Mother Jones recently described as putting the state into “cardiac arrest.”

The Kansas City Star recently wrote that Brownback’s dream is far from a reality. Since his radical tax cuts took effect “31 other states have added jobs at a faster clip than Kansas,” state revenue is hundreds of millions less than expected, and Kansas’ public services – particularly K-12 education – are seriously imperiled. And as a result, Brownback’s leadership is also in peril. Recent polls have the two candidates virtually tied. The victor on Tuesday will dramatically influence a number of important issues in Kansas, perhaps none more than those that have a disproportionate impact on women and their families. And the candidates couldn’t be further apart on those issues.

Where do women in Kansas stand?

As we described in our analysis of the Kansas Senate race, women in that state face high rates of poverty, un- and underemployment, and a persistent wage gap. Many still lack insurance coverage, suffer from a lack of paid sick and family leave, and have an unmet need for quality, affordable health care, particularly reproductive healthcare. Kansas is not participating in Medicaid expansion under the Affordable Care Act (ACA), leaving nearly 80,000 adults currently uninsured, half of whom are women, who would have otherwise qualified. Kansas is also the only state in the country that saw its uninsured rate significantly increase in the last year.

Where do the candidates stand?

Affordable Care Act

Governor Brownback has refused federal funds to participate in Medicaid expansion under the ACA, and signed a bill that devolved the authority for Medicaid expansion to the legislature, where hell might freeze over before one of the main pillars of President Obama’s signature policy achievement is fulfilled. This move has guaranteed that even if Davis wins, Kansas is unlikely to see an expansion of Medicaid anytime soon, even though 52 precent of Kansans are in support of it. Forty-one percent have said that Brownback’s failure to expand Medicaid would make them less likely to vote for him.

Davis has said that expanding Medicaid is “the right thing” for Kansas to do.

 

Family Planning

Under Brownback’s leadership, Kansas passed a law in 2011 blocking all federal Title X family planning funds to clinics and other entities providing abortions, drastically limiting financial support for Planned Parenthood and other providers. 

Paul Davis has been endorsed by Planned Parenthood Advocates of Kansas and Mid-Missouri.

 

Abortion

Kansas has passed a number of restrictions on abortion, much of it under Brownback’s leadership, including, among other restrictions, a 24-hour waiting period; state-directed counseling; the requirement that an optional rider must be purchased at additional cost for abortion coverage in private insurance; the prohibition of telemedicine for medication abortions; parental consent for a minor; and an ultrasound requirement. Many of these requirements were passed in an omnibus bill, KS HB 2253, in April 2013 and are currently being challenged in two different lawsuits.

Brownback is one of the country’s staunchest abortion opponents. In his 2014 State of the State address, he went so far as to equate recent anti-abortion protests with the abolitionist movement and abortion with slavery (he was later criticized roundly for it).

Davis’s record on abortion is mixed but he is seen as largely pro-choice, and was endorsed by Planned Parenthood Advocates of Kansas and Mid-Missouri. He has voted for a state requirement that abortion providers report the medical basis for their determination to perform an abortion to the Kansas Secretary of Health and Environment, but he has voted against a number of other state restrictions, including a state ban on so-called partial birth abortion and the 2013 bill, KS HB 2253.

Minimum wage and the social safety net

In 2007 and 2009, while serving as U.S. Senator (1996-2011), Brownback voted against the Lilly Ledbetter Fair Pay Act (meant to restore protections against pay discrimination on the basis of sex, race, national origin, age, religion, or disability). Under Brownback’s leadership, 15,000 people have been kicked off welfare rolls. He also cut child tax credits, eliminated tax rebates for food and rent that had been aimed at the poorest residents, cut taxes for the rich and raised them for the poor, and changed the state’s food stamp rules, pushing 20,000 unemployed Kansans out of the program.

There is no public information on Paul Davis’s stance on these issues.

 

Economy

Brownback stands by his sweeping income tax cuts. "The state's economy is good and growing," Brownback said recently. "Overall, this economy in this state is performing well." The Kansas City Star reported that the state has seen “more robust growth in private-sector employment since Brownback took office in January 2011.” In the past few years the state gained more than 70,000 private sector jobs and its gross domestic product rose by 6.1 percent, a bit more than the United States overall. However, the paper also pointed out that “Kansas’ private-sector job growth was less robust than the nation's as a whole … And the state's private-sector job growth slowed after the tax cuts took effect in 2013 and has been about half the national figure since December 2012.” Additionally, unemployment rates have fallen less than in neighboring states, while payrolls have increased less. More people moved out of the state than moved in, and the tax cuts are blamed for the massive cuts in education spending – the state spent $100 million less on schools in 2014 than in 2009. But it appears as though Brownback would stay the course if re-elected.

Davis has argued that Brownback’s economic policies are a “failed ideological experiment that is bleeding state government while endangering public education and many other services.” But Davis is reluctant to say what policies he would put into place to address the state’s economic woes. He recently said that he is “spending a lot of time talking to business leaders and community leaders about how they believe we ought to grow the economy.”

Read the rest of this series here.

Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn.

Shulie Eisen is an independent reproductive health care consultant. Follow her on Twitter @shulieeisen.

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Control of the Senate Could Lie With Kansas

Nov 3, 2014Andrea FlynnShulie Eisen

The Kansas Senate race could determine control of Congress - but there isn't a Democrat involved. Read the other state-by-state analyses in this series here.

The Kansas Senate race could determine control of Congress - but there isn't a Democrat involved. Read the other state-by-state analyses in this series here.

Kansas is in the midst of not one, but two, close-call midterm races: the Senate race between Senator Pat Roberts (R) and Greg Orman (Independent), and the Governor’s race between Governor Sam Brownback (R) and State Representative Paul Davis (D). The Senate race has been closely watched since the Democratic candidate, Chad Taylor, dropped out in September, launching Orman, running for Senate as an Independent, into the hot seat and giving the political landscape in Kansas an extra dose of unpredictability. Orman bills himself as “fiscally responsible and socially tolerant,” and it is unclear which party he would more closely align himself with if elected. What is clear is that Kansas voters are still undecided, with almost every poll predicting a different election outcome. The race for this Senate seat in Kansas may very well decide which party controls Congress, and women voters in Kansas could determine which way the tide turns.

Where do women in Kansas stand?

  • As in most states, women in Kansas face higher poverty rates than men, and women of color experience rates almost twice that of white women.
  • Over 40 percent of female-headed households live in poverty.
  • Kansas is the only state in the country that saw its uninsured rate significantly increase in the last year. Fourteen percent of women (18 percent of African Americans and 28 percent of Latina women) in Kansas (age 19-64) are uninsured.
  • Kansas is not participating in Medicaid expansion under the Affordable Care Act, leaving approximately 78,000 currently uninsured adults, half of whom are women, who would have otherwise qualified, without coverage.
  • Sixty percent of minimum wage earners are women.
  • According to the National Women’s Law Center, the unemployment rate for women in Kansas in 2011 was 6.2 percent, a 2.1 percentage point increase since the recession began in December 2007. 41.7 percent of jobless women workers in Kansas had been looking for work for 27 weeks or more.
  • Women also face a persistent gender wage gap – while women overall make only $0.76 for every dollar a white man makes, African American women make $0.66 to the dollar and Hispanic women only make $0.50 to every dollar.
  • The state has no paid sick leave or family leave policies.
  • Kansas passed a law in 2011 that blocked any clinic or provider that provides abortions from receiving Title X federal family planning funds (federal law already prevents Title X funds from being used for abortion but does allow providers to use other funding sources to pay for such services).

Where do the candidates stand?

Affordable Care Act

Senator Pat Roberts has consistently opposed the Affordable Care Act (ACA) and is a vocal critic who advocates for complete repeal of the law. He was the first to call for the resignation of Kathleen Sebelius, the then-Secretary of Health and Human Services, and supported the federal government shutdown during the debate to defund the ACA. In the past, Roberts has supported federal health care spending, voting for the 2003 Medicare prescription drug benefit and supporting efforts at the federal level to expand access to health care service delivery options in rural areas.

Greg Orman has criticized the ACA as an expansion of a “broken system” and says he would have voted against it if he had been in the Senate, but has said he does not support repealing the entire ACA. He has also said that Governor Brownback made a mistake in not accepting federal money to expand Medicaid in Kansas.

Family Planning

Roberts supported the U.S. Supreme Court ruling in the Hobby Lobby case, saying “Every American has a right to the free exercise of religion guaranteed by the First Amendment to our Constitution.” Roberts voted no on adopting an amendment to the Senate’s 2006 budget that allocated $100 million to increase funding and access to family planning services (including creating and expanding teen pregnancy prevention and education programs).

Orman disagreed with the Hobby Lobby ruling, saying on his website that the case “is a dangerous precedent to set and opens the door to many more court challenges from private employers.” He also says that, “As a man, I’ll never face some of the decisions women have to make. I know the women of Kansas are smart, and I trust them to make their own decisions about their reproductive health.”

Abortion

Kansas has passed a number of restrictions on abortion, including, among other restrictions, a 24-hour waiting period, state-directed counseling, the requirement that an optional rider must be purchased at additional cost for abortion coverage in private insurance, the prohibition of telemedicine for medication abortions, parental consent for a minor, and an ultrasound requirement. Many of these requirements were passed in an omnibus bill in April 2013 and are currently being challenged in two different lawsuits.

Roberts is a staunch abortion rights opponent and has voted a number of times in support of federal restrictions on abortion access, including an amendment prohibiting minors from going across state lines for abortion services, a bill that would make harming a fetus during a violent crime a criminal offense, the 2003 “partial-birth” abortion ban, and the No Taxpayer Funding for Abortion Act. In a recent debate with Orman, Roberts blasted him for suggesting that a debate on abortion was detracting from other important issues. "Get past the rights of the unborn? Get past the guarantee of life for those at the end of life? ... I think that's unconscionable," Roberts said.

Orman has said he supports access to abortion services and that he believes “it’s time for our government to move past this issue and start focusing on other important issues.”

Violence Against Women

Roberts was one of 22 Senators to vote against reauthorizing the Violence Against Women Act (VAWA) in 2013. It was his second time voting against the bill. Many who opposed VAWA considered it an overreach of the federal government to include specific new protections for immigrants, gays, and Native Americans.

Orman's campaign materials and website do not mention violence against women.

Minimum wage and the social safety net

Roberts does not support raising the minimum wage. Roberts also added an amendment, which ultimately did not pass, to the Agriculture Reform, Food, and Jobs Act of 2013 (the Farm Bill) to cut $12 billion in addition to the $4 billion already in the bill that did pass from the SNAP program (also known as food stamps).

Orman supports tying a federal rise in the minimum wage to inflation, and believes that areas with higher costs of living should have a higher minimum wage. He has not said anything publically on food stamps or other social safety net programs.

Read the rest of this series here.

Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn.

Shulie Eisen is an independent reproductive health care consultant. Follow her on Twitter @shulieeisen.

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Dramatic Differences on Abortion and Family Planning in North Carolina

Nov 3, 2014Andrea FlynnMolly Williams

While North Carolina's Senate candidates agree on some issues, their views diverge dramatically on reproductive health care. Read the other state-by-state analyses in this series here.

While North Carolina's Senate candidates agree on some issues, their views diverge dramatically on reproductive health care. Read the other state-by-state analyses in this series here.

North Carolina Senator Kay Hagan (D) and Speaker of the North Carolina House Thom Tillis (R) are in a neck-and-neck race for that state’s Senate seat, and all eyes are watching to see where women voters place their bets. A number of polls show Hagan with a slight lead over Tillis, but women voters – who turned out at higher rates than men in the last two elections – could certainly make a winner of either candidate on Tuesday. According to The New York Times, “Like other important Senate elections this year, the North Carolina race could ultimately be decided by the size of Ms. Hagan’s margin among women.” Tomorrow's election will determine who fills a critical Senate seat, and that will influence a host of issues impacting women and families at the state and national level.

Where do women in North Carolina stand?

  • Seventeen percent of North Carolina’s women (18.9 percent of black women and 38.8 percent of Latina women) are uninsured. One in ten women receive health care coverage through Medicaid.
  • There has been a decrease in the teen pregnancy rate in North Carolina from 76.1 percent in 2000 to 49.7 percent in 2010.
  • North Carolina does not have paid sick leave or paid parental leave.
  • According to the National Women’s Law Center, women who work full-time in minimum wage jobs (paying $7.25 per hour) earn just $14,500 a year, leaving them more than $4,000 below the federal poverty line for a mother with two children.
  • 17 percent of women in North Carolina live in poverty, including more than a third (34 percent) of black families and 39 percent of Hispanic families with children, and 36 percent of families headed by single mothers.
  • If North Carolina began to increase the minimum wage to $10.10 per hour this year, by 2016 approximately 578,000 women would get a raise. A jump to $10.10 an hour would increase annual full-time earnings by $5,700 to $20,200, which would pull a family of three out of poverty. That increase would also create or support about 3,700 new jobs in the state and generate over $1 billion in additional economic activity.
  • Affordable childcare is hard to come by in North Carolina, and average costs run more than $9,000 a year for infants and nearly $8,000 a year for toddlers.
  • There is a significant gender wage gap in North Carolina, with women working full-time year-round paid only 82 cents for every dollar paid to their male counterparts. Compared to white men, Black women make only 64 cents, and Latina women only 54 cents, on the dollar.

Where do the candidates stand?

Affordable Care Act

In 2013, Tillis led the North Carolina general assembly’s rejection of Medicaid expansion, claiming participating in one of the key pillars of the ACA would hurt taxpayers in his state. However, on the campaign trail he has warmed up to expansion, recently saying he thinks it might make sense for the state to participate in expansion “once the state has better control of the financing of the program.”

Hagan delivered a key vote in support of the Affordable Care Act and has advocated for the state’s expansion of Medicaid, citing the 500,000 individuals who would gain coverage.

Family Planning

Tillis supported a law that took state funding away from Planned Parenthood. Of the Supreme Court’s Hobby Lobby decision – which allowed employers to deny insurance coverage for contraceptive methods they believe violate their religious beliefs – Tillis said, “The American people are the clear winners.” But he then argued that birth control pills should simply be made available over the counter so that more women could have access to them, a move criticized by health advocates who argued that was simply a way to shift costs away from employers and insurance companies and onto women.

Hagan co-sponsored and voted for the “Not My Boss’ Business” bill, which would have reinstated the ACA’s contraceptive mandate. She said, “Employers who make their employees pay out-of-pocket for contraceptives just aren't imposing their personal beliefs… They're also making it much more difficult for women to access important, potentially lifesaving medical prescriptions and medical treatment.”

Abortion

Tillis is endorsed by one of the country’s leading anti-choice organizations, National Right to Life. He supports the bill introduced by Senator Lindsey Graham that would make abortions after 20 weeks illegal. In 2009, he co-sponsored a state bill that would require doctors to provide pre-abortion counseling that warned of risks such as breast cancer, even though all major American medical associations say there is no link between abortion and breast cancer. In 2011, Tillis championed a mandatory ultrasound bill and during primary season he said he was supportive of “personhood” measures, as long as they made exceptions for rape, incest, and when a women’s life was in danger.

Hagan has been endorsed by NARAL Pro-Choice America and Planned Parenthood. I am a strong supporter of a woman’s right to choose …I would like to see abortions be safe, legal, and rare. These decisions are best made privately by a woman in consultation with her doctor.” Hagan also supports the Women’s Health Protection Act, a bill that would prevent states from applying regulations to reproductive health care providers that do not also apply to other low-risk medical procedures. 

Violence Against Women

Tillis has praised the Violence Against Women Act, saying it has been “instrumental in raising awareness about domestic violence and has provided women with vital support services…I will never hesitate … to ensure that partisan politics doesn’t get in the way of effective and commonsense legislation to protect victims of domestic violence and abuse”

Hagan also supported the Violence Against Women Act in Congress and worked to include a provision that encourages health care providers to improve identification and response methods to domestic violence.

Pay Equity

In his position as House Speaker Tillis blocked a paycheck fairness act in the state legislature, arguing that while he opposes workplace discrimination, the proposed legislation was redundant given the pre-existing federal regulations. Tillis says he supports equal pay for equal work, but believes “current law is sufficient to ensure it.” Tillis denounced calls for new legislation as “campaign gimmicks.”

Hagan voted to pass Lilly Ledbetter Fair Pay Act in 2009, a law meant to restore protections against pay discrimination on the basis of sex, race, national origin, age, religion, or disability. She also supports the Paycheck Fairness Act, which strengthens the 1938 Equal Pay protections against sex-based wage discrimination.

Minimum Wage

Tillis is on record as saying the North Carolina General Assembly should not raise the minimum wage, citing concerns that cost increases would lead to job losses. He has also said he opposes federal minimum wage legislation because decisions should be left up to state legislators. “Kay Hagan wants to create a minimum wage economy…What I want to do is create jobs that make minimum wage irrelevant.”

Hagan favors incrementally increasing the federal minimum wage of $7.25 an hour to $10.10 an hour.

Read the rest of this series here.

Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn.

Molly Williams is a senior at the University of North Carolina at Chapel Hill studying public policy and sociology.  

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How Will Georgia Voters Turnout for Equal Pay?

Oct 31, 2014Andrea FlynnKameel MirKathleen Wilson

The Georgia senate candidates' most interesting records on equal pay are in business, and they're worth close attention. Read the other state-by-state analyses in this series here.

The Georgia senate candidates' most interesting records on equal pay are in business, and they're worth close attention. Read the other state-by-state analyses in this series here.

Early observers pegged the Georgia midterm senate race as one to watch, and they’ve been spot on so far. Democratic challenger Michelle Nunn and Republican contender David Perdue – legacies of two of Georgia’s most established political families who both happen to be from the tiny town of Perry – have been polling neck and neck for the past few weeks. At this point, many project the election in November will result in a January runoff.

Currently Nunn is polling at 45 percent, three points behind Perdue’s 48 percent, and her lead among women voters is down from 13 points to two. Even though Georgia has historically ranked low on female voter turnout, it is likely women voters will determine the outcome of the race. And for good reason: the winner will influence a number of issues that impact the lives of women, particularly women of color, both at the state and national level.

Where do Women in Georgia Stand?

  • Georgia’s current poverty rate of almost 20 percent is 50 percent higher than it was in 2000. Among black and Latina women, the rate is even higher: 33 and 36 percent, respectively. Forty percent of families led by single mothers are in poverty.
  • Georgia has the fifth largest uninsured population in the country.  Thirty percent of women in Georgia – 20 percent of white women, 29.4 percent of African-American women, and 53.1 percent of Hispanic women – have no health coverage.
  • If Georgia were to participate in Medicaid expansion under the Affordable Care Act (ACA), nearly 350,000 women would become insured. Expansion would generate the development of 70,343 jobs statewide in the next decade, would bring $33 billion of new federal funding into the state, and stimulate $1.8 billion in new state revenue.
  • More women in Georgia die of pregnancy-related causes than women in all but two other states. The state’s maternal mortality rate (MMR) – the number of women who die for every 100,000 births – has more than doubled since 2004 and is now 35.5 (a shocking 63.8 for black women and 24.6 for white women). That is almost twice the national MMR of 18.5.
  • Georgia has the highest unemployment rate in the United States, at 7.9 percent. It also has the highest unemployment gap between men and women, with 1.5 percent more women unemployed than men.
  • Georgia women who do work receive only 76.4 cents to the dollar compared to their male counterparts. The minimum wage in Georgia is $5.15 per hour, the lowest in the country, though workers are paid the higher federal minimum wage of  $7.25 per hour. Women are particularly affected by low minimum wages, comprising two-thirds of all minimum wage workers. More than 75 percent of these women are age 20 or older, and, if they are single with children, a full-time minimum wage job will not provide enough income to keep them above the poverty line.

Where Do the Candidates Stand? 

Health Care

Perdue’s campaign platform seeks to repeal the ACA and “replace it with a solution that works to lower costs and put patients in control of their health care decisions.” He believes the health law is harmful to small businesses and argues that its repeal will help strengthen the economy.

Nunn states that she supports the ACA and adopting Medicaid expansion in Georgia, and she did not support the 2013 government shutdown, which was driven by GOP opposition to many of the law’s key provisions, such as mandatory coverage of contraceptives. Nunn’s emphasis has been on fixing, not eliminating the ACA. She has proposed adding a more affordable tier of coverage and extending the tax credit for small businesses. “Here in Georgia--because we did not accept Medicaid expansion--a number of our rural hospitals are now having cuts that are really problematic. So I am running as someone who wants to fix the things that are broken in the health care system and build upon the things that are good, including ensuring that people who have preexisting conditions have access to health care, that kids up to age 26 have the opportunity to be covered by their parents.”

Abortion

Perdue is anti-choice and opposes same-sex marriage. Perdue has been quoted saying, “I believe that we should promote a culture that values life and protects the innocent, especially the unborn. Being pro-life and believing in the sanctity of marriage are my deeply held personal convictions. I will not waver in defending them if I have the privilege of serving you in the U.S Senate.” In September, Perdue was endorsed by the Susan B. Anthony List Candidate Fund, a nationwide anti-choice group.

Socially, Nunn walks an understated yet relatively liberal line. She believes that abortion should not be severely limited. She has drawn attention for touting her “Safe, Legal, and Rare” abortion policy, which is a relatively conservative stance for an Emily’s List-endorsed candidate. “On the issue of abortion, Nunn said that she believes abortions should be ‘safe, legal and rare’ and that women should be ultimately able to make this very difficult personal decision in concert with their doctor and their family." She believes employers should be able to withhold contraceptive coverage from employees.

Economic Security

Perdue promises to pursue job creation policies that will “grow our economy, plain and simple.” During his tenure as CEO of Dollar General, Perdue created nearly 2,000 stores and 20,000 new jobs, although he has been criticized for his outsourcing of thousands of jobs in an attempt to cut manufacturing and labor costs.

Perdue has not yet taken a stance on raising the minimum wage or on the Paycheck Fairness Act, a bill that would help close the pay gap between men and women. However, while Perdue was CEO, over 2,100 female employees launched complaints against Dollar General for practicing wage discrimination. The Equal Employment Opportunity Commission found that female store managers at Dollar General “were discriminated against” and “generally were paid less than similarly situated male managers performing duties requiring equal skill, effort, and responsibility.” His critics fear this may lead to Perdue’s support of policies that are economically unfavorable to women, if voted into office.

Michelle Nunn describes herself as a “pro-business moderate and defense hawk who wants to cut deals and get things done.” Nunn is CEO and President of Points of Light, which is the largest organization in the country committed to volunteer service. Under her tenure last year, Points of Light facilitated 260,000 projects that delivered 30 million hours of labor, amounting to $635 million.

Nunn says she supports raising the minimum wage, and that she wants to lower the corporate tax rate and eliminate tax breaks for companies that close factories and ship jobs overseas. She has been a proponent of equal pay legislation, and her campaign website reads, “People should get paid for the work the do – not who they are. Equal pay is respect for hard work, and every minute we let go by without it hurts Georgia families.”

Read the rest of this series, to be published over the course of Thursday, October 30 and Friday, October 31, here.

Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn.

Kameel Mir is a fourth year student of international affairs, English, and Arabic, writer, campus feminist, and policy researcher at the University of Georgia.

Kathleen Wilson is an advocate for gender equality, and a student at the University of Georgia, where she studies Economics and International Affairs. 

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Uneven Records on Health Care for Florida's Candidates

Oct 31, 2014Andrea FlynnAriel Smilowitz

Florida's voters must choose between two candidates who were once members of the same party, which complicates their records. Read the other state-by-state analyses in this series here.

Florida's voters must choose between two candidates who were once members of the same party, which complicates their records. Read the other state-by-state analyses in this series here.

Florida’s gubernatorial race is one of the highest-profile elections in the country this year, with incumbent Rick Scott (R) running against former Florida governor – and former Republican – Charlie Crist (D). The race has been incredibly close, with most recent projections showing Scott just a single point ahead of Crist. Women voters could certainly turn the tide for either candidate. Women make up approximately 50 percent of Florida’s population and their needs and concerns – and consequently their vote – play an integral role in determining not only the upcoming gubernatorial election, but also the well-being and prosperity of Florida’s overall population. But the question remains: where do women in Florida truly stand, and what does the future of women’s rights look like for the state?

Where Do Women in Florida Stand?

  • Nearly one in five women in Florida do not have health insurance. According to the Alliance for a Just Society's recently released report card on women’s health, Florida ranks 47 out of 50 states in terms of women’s health coverage.
  • In 2011, 21 percent of women between the ages of 15 and 44 were living in a county without an abortion provider.
  • As of 2012, over one million women between the ages of 13 and 44 were in need of publicly funded contraceptive services and supplies, but only 21 percent of this need was met.
  • The poverty rate for women is 16.4 percent, and significantly higher for women of color: 26.4 percent for black women, and 21.6 percent for Hispanic women. The poverty rate among female-headed households is 40 percent.
  • Women represent nearly two-thirds of minimum wage workers. Raising the minimum wage would increase earnings for more than 500,000 women workers in the state. And raising the wage to $10.10 an hour would reduce food stamps enrollment by as many as 195,813 individuals.
  • The Florida Department of Law Enforcement reported that the rate of forcible rape has increased from 2012 by 1.7 percent. Today, 1 in 6 women in Florida have been raped at some point in their lives.

Where Do the Candidates Stand?

Affordable Care Act/Medicaid Expansion

Although Crist currently embraces the Affordable Care Act (ACA), over time he has vacillated on President Obama’s signature health law. During his 2010 senate campaign he promised to repeal the law, then later said he wanted to modify it, and now he claims to completely support it. During a 2010 debate with his opponent Marco Rubio, Crist said that he thought we needed to “go ahead and repeal this thing.” Yet during an interview with CNN this past March, Crist said he thought “it’s been great,” and that Scott should have implemented Obamacare’s Medicaid expansion.

Scott does not support the ACA. “Our health care system needs to be improved – there is no doubt, but we cannot say that Obamacare is the answer.” He has also called Obamacare a “bad law that just seems to be getting worse.” Scott initially opposed Medicaid expansion, but then changed his mind in 2013. He has supported the idea of expanding Medicaid, but has not advanced the issue, claiming that he is only committed to expanding the program in the first three years, during which time the federal government foots the entire bill. Beyond that, the state would be responsible for no more than ten percent of the cost.

Family Planning

Crist has been endorsed by Planned Parenthood, has come out in support of family planning access, and recently spoke out against the Supreme Court’s Hobby Lobby decision. “Today’s Supreme Court decision inserts an employer into a decision that women should be able to make without interference. And it will make healthcare more expensive and less available for Florida women.”

Scott was supportive of the Hobby Lobby ruling, stating the Supreme Court “upheld our freedom of religion.” His feelings about this ruling are characteristic of his previous positions on the issue. In 2011, Scott signed into law “a landmark Medicaid overhaul” allowing Medicaid providers to opt out of providing family planning services, including birth control, on “moral or religious grounds.”

Abortion

When Crist was governor in 2010, he vetoed an ultrasound bill similar to the bill that Scott signed into law in 2011, claiming the bill was “almost mean-spirited.” Throughout his political career, dating back to his days as a state legislator, Crist has claimed that he is personally pro-life, but that he also believes in respecting the right of women to make decisions with their doctors. When Crist was running for the Senate for the first time in 1998, he stated that he believed abortion was a decision that “a woman should make and have the right to make after consulting with her family, her physician, and her clergy, but not the government.” Nonetheless, Crist’s stances on particular abortion laws have varied, ranging from supporting a bill requiring a waiting period for minors to rejecting the overturning of Roe vs. Wade.

Scott’s record on abortion has been consistent. In 2011, he signed four abortion-related bills, one of which mandated women to receive an ultrasound before undergoing the procedure. Earlier this year, Scott signed into law a new bill that completely redefined when women are legally able to obtain an abortion. Today, abortions in Florida are illegal at whatever point a woman’s doctor determines the fetus is viable. The current law does make an exception when a woman’s life or physical health is in danger, but makes no exception for mental health concerns.

Violence Against Women

Crist has long record of supporting domestic violence protection and prevention efforts. As Attorney General, he established the Cut Out Domestic Violence Program and as governor he signed several bills strengthening penalties for those who commit domestic violence and increasing protective injunctions in domestic and sexual violence cases.

Two years ago, Scott vetoed $1.5 million in funding for 30 rape crisis centers, money that state lawmakers had allotted to meet the increased demand for victim services. According to one of Scott’s spokespersons, “this new funding … would have been duplicative, since, as a state, [Florida] already fund[s] sexual violence programs. There was no information suggesting any needs in this area weren’t already being met.”

Pay Equity

During the gubernatorial debates over the past few weeks, Crist has supported raising the minimum wage from $7.93 an hour to $10.10 an hour. “You deserve a governor who will fight for you, fight for a minimum wage increase,” Crist said during a debate in October.

Scott opposed raising the minimum wage and signed a bill in 2013 that prevents local cities and counties from passing their own higher wages and implementing benefits like paid sick leave.

 

Read the rest of this series, to be published over the course of Thursday, October 30 and Friday, October 31, here.

Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn.

Ariel Smilowitz is a senior at Cornell University majoring in Government and the Northeast Regional Policy Coordinator for the Roosevelt Institute Campus Network. She is from Aventura, Florida.

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Still Fighting for Insurance Coverage in Wisconsin

Oct 30, 2014Andrea FlynnShulie Eisen

In the Wisconsin gubernatorial election, Medicaid coverage for 120,000 people hangs in the balance. Read the other state-by-state analyses in this series here.

In the Wisconsin gubernatorial election, Medicaid coverage for 120,000 people hangs in the balance. Read the other state-by-state analyses in this series here.

In the upcoming Wisconsin Governor’s election, which may very well turn on women’s votes, Governor Scott Walker (R) and Mary Burke (D) are vying to show women that they have their best interests in mind. Recent polls show the candidates tied statewide, but with women favoring Burke by as many as 14 points and Walker favored by men by as many as 28 points. The two candidates stand in stark contrast on a number of issues vital to women and families.

Where do women in Wisconsin stand?

  • The poverty rate among women in Wisconsin is 14.4 percent, but rates among women of color are dramatically higher: 41 percent for African American women and 31.4 percent for Hispanic women.
  • One in five Wisconsin women work in low-wage jobs, and women are over twice as likely as men to hold a low-wage job.
  • Women in Wisconsin on average earn only 75 cents for every dollar a man makes, two cents less than the national average.
  • Many women and poor families with children that are eligible are not receiving state support such as food stamps and, as in most states, childcare options are few and expensive.
  • Over one in ten women (11 percent) in Wisconsin are uninsured, with 18 percent of African American women and 29 percent of Hispanic women lacking coverage. 
  • The state has no paid sick leave or family leave policies.

Where do the candidates stand?

Affordable Care Act

Under Governor Walker’s leadership, Wisconsin set up a state-based exchange but has not participated in Medicaid expansion, leaving over 500,000 low-income individuals without health coverage. If those individuals lived in any of the four neighboring states they would be covered under Medicaid. In 2013 he made changes to Wisconsin’s existing Medicaid structure that resulted in more than 60,000 people getting kicked out of the program. Technically, many of those individuals qualified for subsidies to purchase private insurance through the exchange, but it appears that the majority (61 percent, or about 38,000 people) did not do so, though they could have purchased a plan not on sold on the exchange, obtained employer-sponsored coverage, or gotten on a spouse’s plan. According to a recent report by The White House Council of Economic Advisers, Medicaid expansion in Wisconsin would mean coverage for an additional 120,000 people by 2016. The majority of Wisconsin’s voters (59 percent) say they’d like the state to accept federal funding to support Medicaid expansion.

Burke says one of the first three pieces of legislation she would prioritize in her first 100 days in office would be accepting federal funding for Medicaid expansion.

Reproductive Health

Walker identifies as “100 percent pro-life” and has received a zero rating from NARAL Pro-Choice America. In 2013 he signed a law that would require women seeking abortions to get ultrasounds and require abortion providers to have admitting privileges as a hospital within 30 miles (though the law is currently blocked). In 2012, he indicated support for a complete ban on abortion and the adoption of a personhood amendment in the state constitution, and in 2010 he stated his complete opposition to abortion, even in cases of rape or incest. From 2011 to 2013 Walker cut more than $1 million in funding for Planned Parenthood, leading to the closure of five clinics. In 2011, Walker attempted, unsuccessfully, to repeal the state’s Contraceptive Equity Law, which requires insurance companies to cover birth control. Walker also eliminated the state’s comprehensive sex education program and replaced it with an abstinence-based curriculum.

Burke is endorsed by Planned Parenthood. She “strongly supports a woman’s freedom to make her own health care decisions in consultation with her doctor and in accordance with her faith.”  She believes the restrictions supported by Walker are simply a “road block” that prevent women from making their own healthcare decisions, and that “women should have the ability to make their own decision when it comes to decisions that concern their own bodies.” She has promised to veto a 20-week abortion ban if one arrived on her desk.

Fair and equal pay

Wisconsin law requires the minimum wage to be a living wage, defined as one that is “sufficient” and enables workers to have “reasonable comfort, reasonable physical well-being, decency, and moral well-being.” Labor groups in the state have argued that the current wage – $7.25 an hour – does not meet that standard, and one group recently announced that it is suing Governor Walker to demand an increase. Sixty-one percent of likely Wisconsin voters favor increasing the minimum wage, a move that would increase the incomes of 333,000 women in the state.

In 2012, Walker supported the repeal of a law that made it easier for victims of wage discrimination to take their cases to court. He is against increasing the minimum wage and recently accused those who are in support of it as being  “involved in a ‘political grandstanding stunt’ to make ‘a cheap headline.’” He has said that he wants to focus on creating new jobs that pay better, not raising the wage of current jobs. In 2011, Walker received national attention for his support of a bill that dismantled the rights of public sector unions, a move that was a key motivator of the recall election he successfully fought off in 2012.

Burke is in favor of gradually raising the minimum wage to $10.10 an hour over the next three years. “People working full-time should be able to support themselves without having to rely on government assistance. At $7.25 an hour, that's just unrealistic.” Burke also says one of the first three pieces of legislation she would introduce and make a priority in the first 100 days in office is raising the minimum wage. She has also come out in opposition to Walker’s attack on unions, saying it was more than an attempt to address budget concerns, and was really “about undercutting our unions and taking away what I believe should be their right to collectively bargain." In addition to her stance on the minimum wage, Burke was applauded by First Lady Michelle Obama, who recently campaigned for her in the state, for being a leader who would fight for pay equity.

Social Safety Net

Walker believes that safety net benefits serve as incentives that prevent people from working. As such, he has supported drug testing for unemployment benefits and food stamps. In September he said, “My belief is that we shouldn’t be paying for them to sit on the couch, watching TV or playing Xbox.”

Burke is generally supportive of safety net programs such as unemployment insurance. “Making sure that people can access unemployment insurance while looking for work, bridging the gap between jobs, is important to ensuring economic stability.”

Read the rest of this series, to be published over the course of Thursday, October 30 and Friday, October 31, here.

Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn.

Shulie Eisen is an independent reproductive health care consultant. Follow her on Twitter @shulieeisen.

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