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The Supreme Court Rejected 4 People’s Attempt to Blow Up Obamacare

This article, published by Mother Jones, sheds light on the real stories behind the SCOTUS appeal decided on June 25th allowing subsidies under the Affordable Care Act to continue.  – KC

When I saw the white stretch limousine parked out front, I knew I’d found the right place. I walked down the gravel driveway toward the white single-level house with trepidation; the owner’s Facebook page had suggested the possibility of pit bulls. But I was greeted at the door by David King, a garrulous 64-year-old self-employed limo driver who has lent his name to what may be the weightiest case to come before the Supreme Court in years. I’d come unannounced to King’s modest home in Fredericksburg, Virginia, to learn why he’d agreed to headline a legal assault that, if successful, could hobble the Affordable Care Act and result in millions of Americans losing their health insurance.

Asked what he might get out of King v. Burwell, the burly, mustachioed Vietnam vet replied that the only benefit he anticipated was the satisfaction of smashing the signature achievement of the president he loathes. Obamacare, King explains, bilks hardworking taxpayers to support welfare recipients. Those people who might end up without insurance? He didn’t care, because “they’re probably not paying for it anyway.”

Of course, you can’t challenge a law simply because you hate it. Legally, King’s case rests on his claim that he has been personally harmed by the law, specifically its subsidies to help people buy health insurance. He alleges that the subsidies are illegal in states without insurance exchanges and put him in a position where he must get health insurance or pay a penalty.

If five Supreme Court justices buy this argument, the stakes are huge: More than 13 million people could lose their subsidies and about 8 million could lose their health insurancealtogether. Public health experts estimate that nearly 10,000 of them could die every year as a result. Premiums for some plans could skyrocket by as much as 256 percent. The insurance markets in more than 30 states could implode.

The case is the work of the Competitive Enterprise Institute, a libertarian think tank funded by pharmaceutical firms, the Koch brothers, and Google, among others. While the legal logic behind the suit is obtuse (much of it hinges on what one appeals judge called “a tortured, nonsensical” interpretation of two sentences in the law), its goal is simple: As the center’s then-chairman declared in 2010, Obamacare “has to be killed as a matter of political hygiene.”

But first CEI had to recruit real people who could claim they had been harmed by the Affordable Care Act. That led them to King and his three fellow plaintiffs, one man and two women. The four had been largely absent from coverage of the lawsuit, but after the Supreme Court agreed to hear the case this spring, I set out to find out just how Obamacare would hurt them.

King’s situation was typical of what I found. He wouldn’t say whether he currently had health coverage, but he was adamant that he would never take advantage of Obamacare, no matter what. Last year, according to court filings, his income was $39,000. With an Obamacare subsidy, he could have purchased a health plan for as little as $275 a month (or less, if he weren’t a smoker). Without the subsidy, the same plan would cost $648 a month. Most importantly, for purposes of the case, King wasn’t actually required to buy coverage at all: Under the law, he qualifies for a financial hardship exemption because the cost of subsidized insurance is more than 8 percent of his income.

Plaintiff No. 2 was Brenda Levy, a 64-year-old substitute teacher who lives outside of Richmond, Virginia. With her wild, frizzy hair and earthy clothes, Levy looks like an aging hippie. When I met her at her log-cabin-style house, she mentioned that she’d once belonged to the Sierra Club and used to read Mother Jones. Levy insisted she leads “a quiet life,” but she is politically active. She’s donated to conservative causes and has been involved in opposing gay rights. In 2013, she helped organize a rally to protest the Boy Scouts’ plan to admit gay kids.

Surprisingly, she didn’t recall exactly how she had been selected as a plaintiff in the case. “I’m gonna have to ask them how they found me,” she said. When I talked to her in January, more than a year after the case was filed, she’d still never met the lawyers handling it. Asked if she realized that her lawsuit could potentially wipe out health coverage for millions, she looked befuddled. “I don’t want things to be more difficult for people,” she said. “I don’t like the idea of throwing people off their health insurance.” She was under the impression that expanding Medicaid might help anyone who lost their insurance—unaware that Medicaid expansion was actually part of Obamacare, or that the same groups backing her lawsuit have opposed this expansion in her state.

Levy claimed Obamacare gives the government control over Americans’ medical treatment and had caused insurance premiums to rise. She told me her monthly premiums, purchased outside the exchange, were more than $1,500, which she attributed to health woes, including two hip replacements and two craniotomies. “I’ve had some holes drilled in my head,” she quipped. Levy hadn’t checked out the plans she qualifies for under Obamacare, but an affidavit filed by the government in King v. Burwell indicates that she could have purchased a low-cost plan on the federal exchange for $149 a month.

Tracking down the third plaintiff wasn’t so easy. The home address 56-year-old Rose Luck had provided in legal filings turned out to be an extended-stay motel on a commercial strip in Petersburg, Virginia. When I finally reached her by phone, Luck hung up on me. Contacted via Facebook, she responded, “Please leave me alone.” But social media and public records provide a snapshot of her life. On her Facebook page, she has called Obama the “anti-Christ” and voiced her belief that he came to power because “he got his Muslim people to vote for him.” She has warned that Obamacare will cost people $77,000 a year.

Since the late 1990s, Luck and her husband have faced legal judgments for nearly $5,000 in unpaid medical bills, something that typically happens to people with inadequate or no insurance. (The judgments have since been paid off.) Luck’s Facebook page also made clear that she had experienced serious health problems, raising questions about her insistence that she would prefer to go uninsured or buy high-deductible catastrophic coverage. According to government filings, the cheapest plan available to her on the exchange would cost $333 per month. And like King, she is eligible for a hardship waiver.

The final plaintiff was Doug Hurst, another Virginian in his early 60s. According to bankruptcy filings, Hurst and his wife had more than $8,500 in out-of-pocket medical expenses in 2009. His insurance premiums in 2010 were $655 a month. Under Obamacare, Hurst could have purchased a bronze health plan for $62 a month. I never spoke with him, but I reached his wife, Pam, on the phone. She declined to talk about the case or her family’s experiences with the health care system. (In 2009, her 37-year-old daughter died following a long struggle with schizoaffective disorder.) She told me angrily, “I’m very well aware of my situation. You are not. You are not aware of extenuating circumstances. I don’t have to justify my life, the loss of my child, which included the loss of a business, to anyone, do you understand?”

The weakness of the King plaintiffs’ individual claims of injury—particularly given the fact that Obamacare would likely help, not hurt, them—suggests that it wasn’t easy to find people to join CEI’s lawsuit. When I mentioned this to Michael Carvin, the plaintiffs’ lead lawyer, he bristled. “Linda Brown was the only plaintiff in Brown v. Board of Education,” he retorted, invoking the Supreme Court case that led to school desegregation. “Does that suggest there weren’t a lot of people who supported her point of view?” (In fact, Linda Brown’s father was one of 13 original plaintiffs in that case, which was filed as a class action.)

During the oral arguments before the Supreme Court in March, Justice Ruth Bader Ginsburg quizzed Carvin about whether his clients actually had the legal standing to bring the case. “At least one plaintiff has to have a concrete stake in these questions,” she said. “They can’t put them as ideological questions.” Carvin responded that the lower courts had accepted his clients’ qualifications. Ginsburg wasn’t deterred from probing further. “The court has an obligation to look into it on its own,” she said.

Judge OKs settlements in World Trade Center cleanup

Today’s post was shared by Workers Compensation and comes from www.businessinsurance.com

World Trade Center Cleanup

(Reuters) — A federal judge has approved $53.8 million in settlements for 82 unionized cleanup workers who claimed they were made ill by exposure to toxic dust near the World Trade Center site, court papers showed.

The workers were among roughly 1,000 to seek compensation in federal court in Manhattan for alleged injuries stemming from their cleanup work at more than 100 privately owned buildings in downtown Manhattan.

While a few hundred other workers have also settled, the settlements approved on Tuesday night by U.S. District Judge Alvin Hellerstein in Manhattan offers a new window into the payouts, which typically have not been made public.

Payouts to the 82 workers will average $656,119, and range from $25,000 to $1.45 million. They reflect such factors as injury severity, lost earnings, age and smoking history. One worker still has claims against two related defendants.

Most litigation stemming from the Sept. 11, 2001, attacks has been completed. Judge Hellerstein has handled much of that litigation.

According to court papers, the latest settlement covers members of Laborers International Union of North America Local 78, which represents asbestos, lead and hazardous waste handlers in New York City, Long Island and New Jersey.

They claimed to suffer respiratory and digestive diseases, psychological injuries and cancer after the defendant building owners and contractors failed to provide equipment to keep them from inhaling toxic dust in about 71 buildings near Ground…

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Spokane Card Dealer Charged with Theft in Disability Scam

A card dealer who claimed he was too injured to work has been charged with stealing workers’ compensation benefits after he was caught working at casinos in Spokane.

Victor O. Arredondo, 58, is scheduled to be arraigned Monday, June 15, in Spokane County Superior Court on a felony count of first-degree theft. The Spokane man is accused of stealing more than $27,000 in wage-replacement checks and vocational rehabilitation services from the Washington State Department of Labor & Industries (L&I).

The Washington Attorney General’s office filed the charges based on an L&I investigation.

Arredondo claimed he injured his lower back in May 2013 while working as a card dealer at a Spokane casino. L&I opened a claim for Arredondo, and two doctors and a nurse practitioner certified he should receive wage-replacement payments. He received the workers’ comp benefits from June 2013 through March 2014.

An L&I investigation, however, later found that Arredondo continued to work as a card dealer for nearly the entire eight months he was collecting workers’ comp benefits. Instead of working where he was injured, he was hired for separate stints at two other casinos in Spokane.

Arredondo’s medical providers told L&I that if he had told them he was working, they would not have certified him to receive the state benefits, charging papers said.

Investigators were alerted to the case by cross-matching L&I data with those of other state agencies.

“This case serves as a warning to people who fake or exaggerate workers’ comp injuries. Odds are, we’ll track you down,” said Elizabeth Smith, who directs L&I’s Fraud Prevention & Labor Standards. “We have safeguards in place to detect fraud, and protect the workers’ comp system for truly injured workers.”

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BMX Bike Racer Defrauded State, Must Pay Back $14,000

A Port Orchard, WA man who was caught on video racing BMX bikes while claiming he was too injured to work pleaded guilty to stealing more than $14,000 in disability benefits.

 

Tony T. Perry Sr., 52, pleaded guilty to two counts of third-degree theft, a gross misdemeanor, in Thurston County Superior Court. Judge Anne Hirsch sentenced Perry to 364 days in jail, but suspended all but 15 days if he obeys the law for two years. She is allowing him to serve the 15 days in electronic home monitoring, according to the Washington Attorney General’s office, which prosecuted the case.

 

Judge Hirsch also ordered Perry to repay the Washington State Department of Labor & Industries (L&I) $14,422. That was how much Perry received in workers’ compensation wage-replacement checks from January 2012 to August 2013 while misrepresenting his physical abilities.

 

Perry paid the full amount. The money will be returned to the state workers’ compensation fund, which helps employees recover from workplace injuries.

 

“It’s outrageous when people try to scam the workers’ comp system so boldly. When they steal from us they’re stealing from you,” said Elizabeth Smith, assistant director of L&I Fraud Prevention & Labor Standards. “A tip from the public helped us get to the bottom of this. We appreciate it, and encourage people to tell us when they’re aware of workers’ comp fraud.”

 

BMX racing is an off-road, physically demanding bicycle competition typically held on dirt race courses with hills requiring riders to jump in the air.

 

Racing throughout the Pacific Northwest

 

The criminal case resulted from an L&I investigation. Investigators found that Perry began racing BMX bicycles as an amateur in January 2012, eventually competing throughout the Pacific Northwest and Nevada.

 

The case investigator videotaped Perry competing in two races, and found numerous Facebook posts about Perry’s racing activities, charging papers said. In a post about a May 2012 race, Perry described how he crashed and injured his ribs ­− but told L&I he hurt himself at home that day due to a fall caused by his injured knee.

 

After receiving a summary of L&I’s investigative findings in March 2014, Perry’s physician told L&I he would have ended Perry’s wage-replacement payments as of January 2012 had he known about his physical abilities.

 

Perry had been receiving workers’ comp benefits based on knee and other injuries he sustained when lifting a heavy box while working in grounds maintenance.

 

South Carolina considers workers comp opt-out system

Today’s post was shared by Workers Compensation and comes from www.businessinsurance.com

Rep. David Hiott South Carolina

Photo by AP Republican South Carolina Rep. David Hiott.

South Carolina legislators have introduced a bill that would allow employers to create alternative benefit plans for injured workers rather than providing traditional workers compensation insurance coverage for employees.

South Carolina is the fourth state to weigh opt-out legislation. The Texas nonsubscription system was established more than 100 years ago, Oklahoma passed opt-out legislation in 2013, and a Tennessee opt-out bill is on hold until 2016.

The legislation, introduced Tuesday, also called the South Carolina Injury Benefit Plan Alternative, states that minimum benefit requirements must be “interpreted and applied in a manner so that the benefit plan is comparable to” the South Carolina workers compensation law.

Republican South Carolina Rep. David Hiott, who introduced the bill, said in a statement that “markets operate best and participants receive the most benefit possible when competition exists … The (bill) will also require high benefits levels, which is a win for hardworking South Carolina workers.”

According to the bill, total disability benefits must be at least 75% of a worker’s average weekly wage and no less than $75 per week. Workers eligible for temporary partial disability benefits will receive at least 75% of the difference between their pre- and post-injury average weekly wages. And death benefits are to be paid when death results from an accident or within two…

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My Concern With Oklahoma Opt Out in One Word – Transparency

Today’s post was shared by WC CompNewsNetwork and comes from www.workerscompensation.com

"Those who do not understand their history are doomed to repeat it”

I will admit to being in unfamiliar territory here. As a conservative businessman who normally identifies with employer challenges and issues, I find myself on the opposite side of the aisle from many in the growing debate over Opt Out from traditional workers’ compensation in this nation. However, my concerns are what they are, and they center around one very simple concept: There is a tremendous lack of transparency in the actual claims management process of companies who have opted out and are now handling workplace injuries under their own “private label” systems.

It is that lack of transparency that threatens not just employees within those programs, but the employers themselves as well as the communities in which they operate. I believe all are at increased risks that are either unappreciated or unrecognized by many.

I must clarify a few points. First and foremost, I absolutely understand an employer’s desire to escape the workers’ compensation system as it exists today. It is on many levels an expensive, bloated, burdensome and inefficient system that sometimes fails to meet the desired results, particularly where permanent injury or impairment is concerned. I also believe that most people are decent and honest, and at a high level view employers want to do the right thing for both company and crew. However, I would also posit that employers have long forgotten…

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Health Hazards in Nail Salons

Today’s post was shared by US Labor Department and comes from www.osha.gov

Nail salons are mostly small businesses that employ or contract with trained professionals to provide clients with nail services including, but not limited to, nail filing and polishing, artificial nail application, and other hand- and foot-care treatments.

The more than 375,000 nail technicians working in salons across the United States face possible health hazards every day. The hazards include exposure to chemicals from glues, polishes, removers, and other salon products; muscle strains from awkward positions or repetitive motions; and risk of infection from contact with client skin, nails, or blood.

Information on nail salon hazards and preventing illness and injury is also available for workers in OSHA’s publication "Stay Healthy and Safe While Giving Manicures and Pedicures: A Guide for Nail Salon Workers" (PDF* | EPUB** | MOBI**)

This publication is also available in:

A flier and wallet card including information on worker rights and health effects are available from the US Department of Labor’s OSHA and Wage and Hour Division.

This web page gives important information about these hazards and the steps that nail salon workers and employers can take to prevent injuries and illnesses.

Nail polishes, glues, and other products used in nail salons may contain the following chemicals, among others:

  • Toluene
  • Formaldehyde
  • Dibutyl Phthalate
  • Methacrylate compounds

Without taking the correct safety precautions each day, these chemicals can cause breathing…

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Roofing Contractor’s Willful Disregard of Fall Prevention Standards Leads to Death of Worker Who Fell Through Skylight

Today’s post was shared by WC CompNewsNetwork and comes from www.workerscompensation.com

Jacksonville, FL (WorkersCompensation.com) – Skylights are a useful way to allow sunlight into a room or other space, but without safety guards or covers, they can expose rooftop workers to catastrophic falls, serious injury and death.

Atop a warehouse on Powers Avenue in Jacksonville, roofer John W. Miles III crashed through a skylight without an adequate safety cage and plunged more than 24 feet to the ground below. He was admitted to an area hospital in critical condition and later died of his injuries.

Skylight with protective system installed

U.S. Department of Labor Occupational Safety and Health Administration inspectors responded to the scene to investigate. They found Pinnacle Roofing Contractors Inc., Miles’ employer, had failed to install protective cages over the skylights and cited the Jacksonville-based company for two willful and two serious violations. OSHA has proposed that the company be placed in the Severe Violator Enforcement Program.

"While some skylights on the warehouse roof had safeguards installed, workers were not protected from fall hazards sufficiently. If Pinnacle Roofing had been more diligent, John Miles would be with us today," said Brian Sturtecky, OSHA’s area director in Jacksonville.

OSHA issued two willful citations to the company for allowing employees to work at heights greater than 6 feet without guardrails or fall protection and for not installing protective systems on the skylights. Two serious citations were issued for failing to ensure the edge of the roof was…

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Death on the Job Annual Report from AFL-CIO Informative, Useful

Today’s post comes from guest author Rod Rehm, from Rehm, Bennett & Moore.

The AFL-CIO’s annual report about “the state of safety and health protections for America’s workers” has been written about in a previous year on this blog. The recently released 2015 version focuses in an in-depth manner on data from 2013 and includes around 200 pages of text, tables, details and information, along with a bit of jargon.

The report is extremely informative, and Nebraska and Iowa’s numbers will be examined in more detail in future blog posts, as these are states where the firm’s attorneys are licensed.

The report can also feel overwhelming once a person processes through the fact the each numeral on each chart represents the death of one person due to the workplace. There is also a ripple effect, as each person represented here had loved ones who both cared about and relied on that person. And for many involved, their lives changed drastically when their loved one died.

I appreciate the work, funding, thoughtfulness and effort put into compiling and analyzing the data, which includes a methodology section at the end of the report.

Here’s some sobering information from the summary.

“In 2013, 4,585 workers were killed on the job in the United States, and an estimated 50,000 died from occupational diseases, resulting in a loss of 150 workers each day from hazardous working conditions.

“Nearly 3.8 million work-related injuries and illnesses were reported, but many injuries are not reported. The true toll is likely two to three times greater, or 7.6 million to 11.4 million injuries each year.”

States with the highest fatality rate in the nation include a couple of relative neighbors: North Dakota and Wyoming. West Virginia, Alaska and New Mexico round out the top five. Lowest state fatality rates in 2013 were Hawaii, Washington, Connecticut and Massachusetts (tied) and New York and Rhode Island (tied).

Please contact an experienced workers’ compensation lawyer if you or a loved one is hurt on the job or has questions about job safety.

Exploding Exclusive Remedy

Today’s post was shared by Jon L Gelman and comes from daviddepaolo.blogspot.com

What’s better than exclusive remedy in workers’ compensation?

Let’s be honest, if you’re an employer, not much.

Sure, one may quibble about the cost of acquiring the status of exclusive remedy, but when the claim hits the file, and the exposure is revealed, there is nothing quite as warming to Business as the doctrine that provides the basic guidance to workers’ compensation.

We’ve all seen the reports this past year (more to follow) about the erosion of benefits to injured workers, and some legal challenges. Some are offended, some are circumspect – most don’t know what to think.

The context of the challenges to exclusive remedy protection is that the balance that represented the Grand Bargain is no longer in the center, and that reform after reform in the various state systems has deteriorated benefits to the point that there is no longer a reasonable compromise.

That’s the argument being played out in Nevada in the face of legislation recently introduced that would reshape one of the cheapest work comp states into, perhaps, an even cheaper state. Nevada ranked 46th out of 50 in Oregon’s most recent cost survey.

Assembly Bill 229, introduced by the Assembly Committee on Commerce and Labor, seeks more than a dozen changes to Nevada’s workers’ compensation law, including when an employer can terminate benefits, changing from the 5th edition AMA Guides to the 6th, and the time for filing a claim from 90 days to 30.

Other changes proposed by the bill would:

  • Expand the prohibition…

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Published by Causey Law Firm