Pointed Debate Over Triple-Digit Premium Hikes For Some Brigham Part-Timers

Last week, we posted this story about impending triple-digit hikes in the health insurance premiums that hundreds of part-timers at Brigham and Women's Hospital pay. It prompted cogent comments both on CommonHealth and off the record, in written comments beneath the post and to me verbally.  I highlight a few of them here. And I'd sum up the debate as between those who put cost-cutting first and those who say cost-cutting on health insurance should not begin with part-timers. Responses welcome!

This came in an email today from a non-Brigham full-timer who's highly attuned to health costs:

1) Even with these increases, the part-timers will pay less than I do for a family plan and I have what I consider to be good insurance. So for half the time they get a better benefit. Meanwhile, the state is leaning towards eliminating coverage for 23,000 legal immigrants in February. Who's really suffering?
2) BWH is arguably one of the most expensive hospitals in the world (US is most expensive country, MA is most expensive state and BWH is one of the top 3 highest paid hospitals here.) If a percent of their inflated charges are overly generous benefits, then we must critique those benefits, not support them.

Another comment along similar lines, from the Comments section:
$6,500 is a bargain for a family plan! When you do the math, it sounds to me like the part-time employees are the hospital are going from a great deal to a good deal. Hard to feel sorry for them when they are among the highest paid hospital workers in the city.

One more on this: The truth is our part time work force is very important, but at the end of the day, this change is just one of the things the hospital is doing to cut cost. You can’t fault the Brigham for being “high cost” and then get mad when they look for ways to bring cost down, especially when it’s correcting an inequity. Just my 2 cents.

And a hard-hitting response:
"Correcting an inequity?" As in it is okay for full time employees to continue to feast on 90% coverage, while telling part-timers to suck it up not based on hours worked (which are often more than they are paid for) but based on hours paid for? You should appreciate that "equity" is in the eye of the beholder. Why not provide benefits based on how much profit your job earns for the hospital? Wouldn't that be "fair?"
Sure, an employer can offer whatever pay/benefits it wants, and the employee is free to accept or reject, but the employee has a right to expect the hospital to stick to the deal they had when hired. A change in benefits of this magnitude is a pay cut, Period.

Now some interesting new territory from the Comments section today, an employee writing that Brigham and Women's is not just raising its part-timers' premiums, it's "cost-shifting" — that is, encouraging employees to get their health insurance elsewhere:

Here is the main issue: Brigham and Women's Hospital, which played an important role in crafting Massachusetts' "shared-responsibility" model of health reform, is cost-shifting to other employers and to the state. At the same time it slashed part-time employees health benefits, it increased the incentive for employees to find insurance elsewhere. In 2011, the hospital will pay an ADDITIONAL $2400 to a full-time employee who either goes uninsured or finds coverage elsewhere. In other words, the hospital is paying off employees to drop Brigham-sponsored insurance in favor of any other plan. But a part-time employee who has no other place to buy insurance for her family must PAY $5000 ADDITIONAL for the same insurance they had last year (and about $7000 ADDITIONAL in 2012). For employees who don't happen to have $5000 - $7000 extra in their family budget to buy that insurance, becoming uninsured is the only option. Cost-shifting to other employers and to the state - that is Brigham and Women's version of "shared responsibility."

By the way, they ought to do another employee survey now that 2,000 part-time employees - about 20% of the workforce - feels incredibly undervalued and unmotivated.

Who's affected?? Just a note on this:
One commenter to me pointed out that most of the part-timers affected are nurses who earn good salaries, often more than $50 an hour. Yet another at the bottom of the post counters that "Do you realize that this affects more than just the nurses? Lower paid employees such as nursing assistants, house keepers, etc....will also see this hike."

And finally, this written comment from a Brigham neighbor at Simmons:
Healthcare coverage issues are not limited to BWH. I work nearby at Simmons College; I am full-time and earn approximately $40,000/year. This means that I take home $2,000/month (after taxes). My health and dental insurance comes to almost $200/month - fully 10% of my after-tax earnings. Note that it's fairly basic coverage and only for me, not a spouse or a family.

While this is hard for me to manage, what really blows my mind is that the rates are not based on your earnings - they're flat rates. This means that I pay the same for insurance as someone who makes twice what I earn, and also the same as someone who makes half of what I earn. It's simply ridiculous to ask someone who makes $20,000/year to pay the same as someone who makes $80,000.

Health insurance in America should be a source of national shame. No one should have to make the choice between paying rent and paying for health insurance. No one should have to choose a job based on health insurance. No one should be without health insurance, period.

This program aired on December 14, 2010. The audio for this program is not available.

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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