Hopes for comprehensive healthcare reform in California in the near term crashed and burned in late 2007. Even a special legislative session failed to produce a comprehensive healthcare package.

But-to its credit-the legislature hasn't given up. Recognizing that millions of Californians have no healthcare coverage (including many disabled workers who are no longer covered by group medical), Democrats in the legislature have sponsored a number of bills to ease access to coverage and prevent abuses by health insurers.

Injured workers have a dog in this hunt.

AB 1945 (DeLaTorre) would prevent insurers from retroactively canceling coverage unless they could show that intentional misrepresentations were made in the application for coverage. Over the past few years there have been occasional horrendous stories of insurers yanking coverage from seriously ill folks. This bill would force insurers to face a high standard of proof before rescinding coverage.

SB 1440 (Kuehl) would require health insurers to spend 85% of premium dollar collected on patient care. That's a fine concept, and one the governor has supported as part of his 2007 healthcare proposal.

Other provisions would expand the list of required items to be covered.
AB 1877 (Beall) would require coverage for diagnosable mental illness.
AB 1962 (DeLaTorre) would require maternity care be covered. AB 1198
(Kuehl) would require durable medical equipment (wheelchairs, etc) be covered.

AB 2 (Dymally) would reform the high risk insurance pool, attempting to make insurance more available for high risk individuals.

You can read about these and other healthcare bills in an excellent article on the California Progress Report by Hanh Kim Quach of Healthcare Access California:
http://www.californiaprogressreport.com ... al_25.html

It's not clear what Governor Schwarzenegger will do with these bills.
Schwarzenegger's governorship will be in its sunset phase before we know it, and with that goes his chance of leaving a legacy. Piecemeal reform was clearly not his first choice, but it may be his only option.
If he fails to sign these bills, he may find that he will achieve absolutely nothing in healthcare reform during his tenure.

Given the state's budgetary distress, it's hard to envision comprehensive healthcare being enacted in next year's 2009 legislative session. One hopes the Goverrnor will think twice before rejecting these "piecemeal reforms".

Stay tuned.

Julius Young
www.boxerlaw.com
(you can subscribe to the blog by clicking on the RSS reader button on the right lower column under "Most recent entries")

It was an interesting weekend. Those of us who hadn't previously followed Alaska politics were introduced to Sarah Palin, who has registered the name "Rouge Cou" (translated as "redneck") for a marketing venture.

Rust belt hockey moms, NASCAR dads and Catholic women may be deciding whose fairy tale comes true.

Turns out Palin is the part owner of an Anchorage car wash. Here in California the car wash industry has been the poster-boy for labor law violations. It'll be interesting to see whether that's the case in Alaska or whether Palin ran a "clean" car wash.

But while you were barbecuein' and the media was reeling at the Palin pick, the California legislature was wrappin'.

We may not have a state budget yet. But we have comp legislation on its way to the Governor's desk.

The bill in increase benefits to permanently disabled workers over a 3 year period-SB 1717- passed its last Assembly hurdle. The vote on August 29 was 46-31, with 3 absent or abstaining. The California Senate voted in favor 23-14 back on May 17. To see how the Assembly voted, click here:
http://www.leginfo.ca.gov/pub/07-08/bil ... floor.html

To see the official analysis of SB 1717, click here:
http://www.leginfo.ca.gov/pub/07-08/bil ... floor.html

SB 1717 is now on its way to the Governor, where it faces almost certain veto. Similar bills were rejected in 2006 and 2007. The third time is not likely to be the charm.

Also on its way to the governor is the Migden bill on apportionment discrimination, SB 1115. Here is the official analysis of SB 1115:
http://www.leginfo.ca.gov/pub/07-08/bil ... floor.html

SB 1115 passed out of the Assembly on 8/19, on a 46-31 vote, with 3 absent or abstaining. Here is the Assembly tally:
http://www.leginfo.ca.gov/pub/07-08/bil ... floor.html
And here is the Senate tally:
http://www.leginfo.ca.gov/pub/07-08/bil ... floor.html

I'll be covering any developments as these bills head toward Schwarzenegger's desk.

Stay tuned.

Julius Young
www.boxerlaw.com
(you can subscribe to the blog by clicking on the RSS reader button on the lower right column under "Most recent entries")

J.P. Morgan. Savior of Bear Stearns. Now coming to workers' comp.

Huh?

There's a reason why the folks on Wall Street are on Wall Street. They understand how to gin up new financial opportunities.

Credit debit swaps and slice n' dice mortgage pools. Been there. Done that.

Where's there a huge pool of cash ready for the tapping?

Workers' comp. That's where.

What if we could get the float on some of worker indemnity payments? We'll handle the funds-cash deposited by the insurer up front-and invest those monies, all the while making the funds available to the disabled worker.

Voila! Workers' comp debit cards. The worker can use them like cash to pay for a wide range of items or withdraw cash like an ATM. A toll free number would allow workers to check balances. Workers without bank accounts would not be forced into expensive check cashing services.

Advantages? Problems with account holds and missing or late checks would be reduced if not eliminated. Transaction costs for employers and carriers might be lowered.

But like all plastic, there are problems. ATM-like access to cash might facilitate irresponsible financial planning by impulsive injured workers.
And how to pay landlords and utilities? Many of these workers are not folks who do electronic banking.

And with the entire banking system under cloudy skies, involving large banks in new financial products may be a bit much for many to stomach.

I've yet to hear discussion of workers' comp debit cards in California.
I'll leave it to wiser oracles to analyze whether comp debit cards would be permitted under current statutes or whether there would need to be enabling legislation.

But stay tuned.

Julius Young
www.boxerlaw.com
(you can subscribe to the blog by clicking on the RSS reader button on the right lower column under "Most Recent Entries")

Californians like to think of themselves as the ultimate trendsetters. From beach volleyball and skateboards to iPods and iPhones, it tends to happen here first.

But consider Alabama. There's a cutting edge place for you. Hey, it's not Santa Cruz, Venice Beach or Cupertino, but even Tuscaloosa can generate a trend now and then.

The State of Alabama plans to start surcharging obese state workers for part of their healthcare coverage. State workers who aren't fat will continue to get coverage for free. Those who don't meet the weight goal
(a body mass index of under 35 or lack of progress thereto) will be paying $25 per month.

Smokers are already surcharged in Alabama.

Other states have been experimenting with various financial incentives to promote wellness and reward healthy behavior.

It's doubtful that we'll see these kinds of penalties in
California workers' comp. As a statutory scheme, using a stick rather than a carrot will probably never fly politically.

But it would be interesting if an insurer offered incentive programs to disabled workers to help keep them in shape. In an era of rising medical costs, might it be cost effective for an insurer to actually give small financial incentives (slightly higher indemnity payments?)
to workers who met certain performance incentives? Incentives to workers who demonstrated motivation in their treatment regimen or progress dealing with associated problems such as obesity?

Granted, the current prevalence of utilization review and ACOEM guidelines seems to discourage such an approach.
Try being a lawyer fighting for a gym membership or a structured weight loss program for a worker who wants to keep in shape. Sometimes you can win these fights, but it's a battle.

But-thinking outside the box-wouldn't it be cost effective for a large insurer like SCIF to provide some gym or pool facilities or gym discounts where workers could keep in shape under proper supervision?

Silicon Valley companies have long recognized the advantages in this type of approach. In the comp arena it won't be effective for everyone. But getting the worker active is the whole concept behind functional restoration.

The problem is that most injured workers have no workout equipment and no concept of how to get started. Keeping motivated is hard and the risk of reinjury is higher without training. And many workers are afraid to be too active lest they be accused of comp fraud.

This is one concept that Arnold would understand.

Stay tuned.

Julius Young
www.boxerlaw.com (you can subscribe to the blog by clicking on the RSS reader button on the lower right column under "most recent entries")

The public's attention is not exactly on workers' comp as the summer winds down. The Olympics, the impending vice-presidential picks and McCain's apparent pull ahead, the financial teeter-totter of Fannie Mae and Freddie Mac, the spectre of a restless Russia... is it John Edward's baby? .There's a lot on the public mind.

You, dear reader, perhaps live in a quiet corner of the state with gated communities and manicured lawns. But here in Oakland the public's mind is on a spate of brazen restaurant robberies. Young hooded thugs in baggy pants barging into restaurants-even in upscale, trendy areas-and holding up diners and staff at gunpoint (there's a comp case for ya!)

Restaurants installing countersecurity measures. Some owners locking doors and considering doing racial profiling before inviting customers into the premises. A lethargic mayor who blames thuggery on lack of hope for young men without economic opportunities.

Sometimes its not hard to image society devolving into shocking lawlessness.

Workers' comp is a backwater.

Last week's announcement that the WCIRB may recommend as much as a 20% increase in comp premiums received some press coverage. But the story dropped out of sight quickly, causing few ripples.

At the WCAB district offices today, a collective sigh of relief. The Governor's plan to reduce state employees to minimum wage pay has been put off til a September hearing. Board employees I've talked to this summer have been dispirited.....concerned over the pay issue and
unenthused over what they've seen of EAMS so far.

Meanwhile, the California legislature grinds towards the finish of this term. Carole Migden's anti-discrimination in apportionment bill cleared its last legislative hurdle yesterday and heads to the Governor.

Here's a link to the roll call vote tally in the California Assembly:
http://info.sen.ca.gov/pub/07-08/bill/s ... floor.html

You'll notice the vote is along party lines. The California Republican party is reliably in the service of California business interests.

Never mind that Migden's bill, SB 1115 codifies basic tenets of fairness that are a consensus in our society. Discrimination is not in vogue.

In coming posts I'll be looking at SB 1115 in more depth.

Stay tuned.

Julius Young
www.boxerlaw.com

Not UR'd.

The Governor, that is.

The Governor found time to go have a quick knee arthroscopy while the legislature was in full food fight mode over the budget over the budget.
Since the torn ligament was non-industrial, there was no need to wade through ACOEM review under UR.

Turns out the Governor has had quite a bit of surgery. 1997 heart surgery. 2003 rotator cuff surgery. 2006 femur surgery.

If he has a work injury while in office, looks like there may be grounds for apportionment.

One would hope this gives him perspective on the travails of injured workers. Of course, if the Governor wants surgery it's a just do it mentality. Workers, on the other hand, sometimes must run a gauntlet before getting the requisite approvals.

Stay tuned.

This week I'll be providing analysis on the recent rate increase recommendation filed by the California WCIRB. The proposal-known as a rate filing-was unveiled last Friday.

Julius Young
www.boxerlaw.com
(you can subscribe to the blog by clicking on the lower right hand column RSS reader button found under "most recent entries")

The WCIRB has just announced that it plans to recommend to Insurance Commissioner Poizner a 16% increase in workers' comp rates effective 1/1/09. The actual "filing"
(a recommendation with the Department of Insurance) will be coming in the next few days.

The Insurance Commissioner can accept or reject the WCIRB
recommendation. The WCIRB recommendation applies to "pure
premium rates"; these essentially set the tone for California workers' comp pricing but are not binding on California comp insurers.

California employers won't be welcoming this news.

The WCIRB recommendation apparently reflects concerns about rising costs, particularly medical treatment costs.
A WCIRB news release claims that the increase breaks down as follows:
10.8% for increasing medical treatment costs
2.8% for increasing loss adjustment expenses
1.8% "due to the annual adjustment to the experience
rating of balance correction factor"

The small PD rating schedule revision currently under consideration would add another 3.7%.

The WCIRB release notes that even with the increase, premiums would be down 60% from the pre-2004 reform level.

Even without seeing the actual filing, its clear that medical costs continue to be THE big driver in workers' comp costs. Despite somewhat Draconian treatment guidelines and utilization review, medical and pharmacy costs continue to spiral. New medical technologies and more expensive medications may be a component of the problem. It's a scenario not unlike that seen in the healthcare system in general.

Insurers have been feasting on large profits in California workers' comp since 2004. Loss ratios have been at historically low levels for most of the last 4 years. But most observers have expected margins to tighten somewhat tighten somewhat.

The scenario that may be emerging is one where benefit levels for disabled workers are low but costs for employers are rising. If that's the scenario, they system is not "fixed", but rather in need of another overhaul.

Stay tuned.

Julius Young
www.boxerlaw.com

Think back a few years.

Many in the press and public believed that California workers' comp was rife with worker fraud. The vision was fed by the occasional arrest shown on the 10 o'clock news. Or the story that doctor and attorney mills were feeding on each other, treating workers up the yin yang, ordering every expensive test possible. Billboards plastered over some major metropolitan areas didn't help the perception.

But the perception has changed.

Now there's still focus on employee fraud, but increasing concern about employer fraud.

Marc Lifsher's recent piece in the Los Angeles Times is a good summary of recent efforts to focus on employer fraud. Lifsher's piece is viewable here:
http://www.latimes.com/business/la-fi-c ... 3850.story

My earlier blog piece on the issue was "Its the Employer Fraud, Stupid".
That post is viewable here:
http://workerscompzone.com/index.php?en ... 818-110358

Employer comp fraud is costing honest California employers and insurers huge amounts of money.

There's a good chance your local car wash, dry cleaner and your favorite ethnic restaurant aren't covering their employees. It's that bad.

Until the legislature increases penalties for failing to maintain insurance,
enforcement raids seem to be key. But given the how endemic this problem appears to be (along with widespread other labor law violations), the state has a monumental task in educating employers, many of whom are ethnic minorities.

Stay tuned.

Julius Young
www.boxerlaw.com




I

Strange brew-what's inside of you may kill ya. Strange brew. Strange brew.

I'm sitting here pondering the fate of AB 515, a bill currently under consideration in the California legislature that would regulate worker chemical exposures.

I can hear the guitar riffs now. Strange brew, strange brew, strange brew-

Eric Clapton, Jack Bruce, Ginger Baker. Cream, one of the British pop super groups. Lotsa wailing guitars.

OK. Alright. You caught me. I'm taking artistic license. Perhaps Cream wasn't singing about toxic sludge, carcinogenic emissions, or workplace exposures. For them, it was strange brew-kill what's inside of you.

But it got me thinking about strange toxic brews that thousands of California workers are exposed to at work. Who sets standards for acceptable exposures? Is the seven -member California Occupational Safety and Health Standards Board adopting standards tough enough to protect California workers?

AB 515 would require the Board to set long term exposure limits in addition to standards limiting short term exposures.

As many as 44 chemicals on the Prop 65 list as cancer-causers are not subject to any standards for worker exposure.

The result? The public receives general Prop 65 warnings of the presence of cancer causing substances, but workers dealing with the substances day in and day out have little or no protection from the effects of long term exposure. Many of these workers will find themselves on workers' compensation years later, their health in shambles.

The availability of a Material Data Safety Sheet doesn't protect workers from long term exposures.

I know. One of my favorite clients died recently of a form of brain cancer, a cancer quite likely linked to his years of service at a Bay Area oil refinery. I visited him at the Walnut Creek skilled nursing facility where-barely able to sit straight in a chair-he gave a two hour deposition detailing his exposures to a long list of chemicals for over 20 years. At the end, he slumped over, barely able to speak. About a month later he was gone.

It's a debate which is playing out under slightly different circumstances on the Potomac. For background on the Bush administration's attempt to change the standard for measuring worklife exposures, check out the post I did earlier this week. Bush appointees are clearly intent on pushing through the agenda of oil and chemical industry lobbyists.

Here in California, AB 515 sits in a precarious political balance. A similar bill was withdrawn last year. Forces opposing AB 515 include the California Chamber of Commerce and California Manufacturers and Technology Association, groups behind the SB 899 workers' comp reform. These are groups who have a virtual hotline to the Governor's office.

Assemblywoman Sally Lieber (D-Mountain View) has lined up a labor and environmental coalition behind the bill. But it will be yeoman's work to keep the coalition from fracturing since some labor groups have concerns about the effect on jobs in the industries they serve.
It's common for groups to sign on or sign off of major bills like this depending on how they see their interests being affected.

Environmental groups have a big stake in this bill and are are likely to continue the push each year until this bill gets done.

Seeking a legacy of environmental progress, Schwarzenegger might sign the bill? It's not clear.

Want to see an example of why the bill is needed? Look at the investigative series by Susan Sward in the San Francisco Chronicle.
Sward detailed the effects of cancer causing chemicals on workers at a Mojave Desert chemical plant, Searles Valley Minerals:
http://www.sfgate.com/cgi-bin/article.c ... amp;hw=sus

Strange and ugly brew.

Stay tuned.

Julius Young
http://www.boxerlaw.com/news.html
(you can subscribe to the blog by clicking on the RSS reader button on the lower right hand column under "Most Recent Entries")

My car keys are on a digital clock that counts down the days, hours and minutes til the end of the Bush Presidency.

This hapless POTUS failed to press a war that needed to be won decisively against the Taliban and Qaeda (Afghanistan) and put us in a war that didn't need to be fought (Iraq). Trillions poorer, while we're nation building in Iraq, we're ever closer to the day when we'll see a nuclear bomb in the hands of Islamists in Pakistan or Iran. Don't get me started. The "war" will not be ending soon, though the focus may be shifting.

But enough of the soapbox. Meanwhile, at home, worker rights have been under attack.

The latest example? Bush appointees are rushing to redefine "working life". It's a concept that has immense consequences for worker safety regulation of on the job toxins.

As of last week, the official proposal had not been publicly announced, but the proposal had been obtained by the Washington Post. The revised regulation would allow business additional rounds of challenges to risk assessments involving chemicals and toxins.

What's the beef over "working life"?

Current regulations assume an average 45 year work life (age 20 to age 65). It's that worklife span that is used to measure the health effects of toxic chemicals on workers.

Bush regulators want to dump the 45 year assumption on the theory that most workers nowadays will not stay at one employer for that long.
The proposal would focus on how long workers actually remain on the job. But that's a difficult concept to measure, and the science behind the changes assumptions may be shaky.

The change has been pushed by industry-friendly conservative think-tanks. For example, the Hudson Institute's Diana Furchgott-Roth did a piece on the issue in the New York Sun. To be fair and present a range of viewpoints, here is Furchgott-Roth's justification for the rule change:
http://www.nysun.com/opinion/battlegrou ... nt=6530008

Congressional committees will be looking at the issue closely. Among those concerned are Ted Kennedy and the Bay Area's George Miller (D-Martinez), whose district includes many workers toiling in chemical plants and oil refineries.

Adding to the concern over the proposed rule is the fact that Bush Administration Labor Secretary Elaine Chao was less than forthcoming about the proposed rule. Public notice of regulatory changes were not filed, and the item only surfaced on the Office of Management and Budget's website (OMB), which indicated it was reviewing the proposal.

This lends credence to the charge that Bush will attempt to give big chemical and manufacturing companies a final present as his administration exits stage right.

Stay tuned. I'll continue to cover the issue.

For those who want to become more involved in workplace safety issues, I'd recommend checking out the website of www.worksafe.org

Julius Young
www.boxerlaw. com
(you can subscribe to the blog by clicking on the RSS reader button on the lower right hand column under "Most Recent Entries")