PDF The Building Trades were well represented at the Health Care for America NOW rally on Thursday, June 25, 2009.
IBEW members at the Health Care for America NOW rally on Thursday, June 25th.
The International Brotherhood of Electrical Workers (IBEW) brightened the audience with their yellow shirts everywhere. The Bricklayers and Allied Trades (BAT) cemented their presence with bright orange shirts. Laborers International Union (LIUNA) carried their brown and yellow shirts well. Plumbers & Pipefitters Local 5 from Washington DC gathered around their prominently placed banner. I hope to hear from others that I missed.
The Building Trades have not always been in front of the charge for health care reform. And in some ways there issues offer both insight into how health care has changed and guidance for how it could change.
The unionized building trades provide their members benefits exclusively through multi-employer benefit trust funds. This vehicle is ideally suited for those industries where employment in often seasonal or temporary: the construction industry, the needle trades, the retail food industry, trucking and others.
What do multi-employer funds teach us?
They offer guidance on continuity of coverage. By maintaining eligibility from employer to employer, workers and their families don’t experience the disruptions of coverage that others who change employment experience. The value of this should not be underestimated.
This blog has often criticized those who offer “delivery system reform’ as the number one priority. I maintain that the patient delivery system needs to be fixed first. Only when everyone has coverage, and they understand how that coverage works, can we begin to be successful with chronic condition management, or medical homes, or patient centered care, or any of the other popular delivery system reform buzz terms that are out there.
If a patient is involved an a chronic condition management program, and loses their insurance or changes to an insurance with different rules, any gains achieved may be lost with the transition.
Multi-employer plans offer examples of how that can work.
Multi-employer plans point the way on portability.
Congress faces the challenge of paying for coverage for the uninsured. Most of those uninsured are working poor, people who earn too much to qualify for Medicaid. Yet multi-employer are also set up to provide coverage between periods of employment.
Employers pay into the fund while the employee is working and the fund provides benefits when the member is not. They protect their members from periods of unemployment that might result from either the local economic situation, or the members own disability status.
When I started as an apprentice with UA Local 520 in Harrisburg, PA many years ago, eligibility for benefits was established after three days and those three days established eligibility for six months. Cost pressures have eroded the level of protection, but not the principle behind them. It is not hard to see that this is not a model that is sustainable in isolation in the long run.
A key phrase in that last sentence is “in isolation”.
Recent economic events have shown us that corporations who take on a degree of social responsibility by providing health benefits or retirement benefits are at a competitive disadvantage in today’s economy.
That’s why the Building Trades were out in force on Thursday, demanding health care reform.
They want to stop the race to the bottom that they saw in the airline industry, the steel industry and is threatening the auto industry.
Multiemployer plans can no longer afford the kind of generous eligibility that my local offered thirty years ago. Today cost pressures and competitive pressures threaten the very principles of continuity and portability that make the multi-employer plans so valuable to their members.
What can policy makers learn from multi-employer plans?
Require that all employers pay a uniform rate for health care per employee. That can be based on hours worked or a percentage of income or amount paid for contract employees.
A portion of that amount should be used to provide transitional benefits for people who have lost their jobs.
Allow people to carry the same insurance from employer to employer.
If health care reform does not improve on the current system’s ability to guarantee continuity of coverage and portability of coverage, it will have failed the American public and confounded much needed efforts for delivery system reform.
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