Losing jobs and health access

As Iowa’s unemployment rate climbs towards numbers not seen since the Great Depression of the 1930s, we are shedding health coverage — in the midst of a sustained public health crisis — almost as fast as we are shedding jobs.

One of the cruelest ironies of the COVID-19 unemployment crisis is that, alongside the job losses, many workers and their families are also losing health coverage.

In Iowa, almost two-thirds (64 percent) of the nonelderly population rely on employment-based health insurance. As Iowa’s unemployment rate climbs towards numbers not seen since the Great Depression of the 1930s, we are shedding health coverage — in the midst of a sustained public health crisis — almost as fast as we are shedding jobs.

Even in good times, our crazy patchwork of health coverage — job-based care for most, Medicare for the elderly, Medicaid for low-income families, the ACA “marketplace” for others, and no coverage at all for the rest — is an engine of inequality. The better the job, as a rule, the better the health coverage. And in bad times, that coverage can easily disappear. Our reliance on job-based coverage, as one health policy expert famously put it, is like an umbrella that melts in the rain.

By one estimate (through May 14), about half of the 300,000 Iowans who lost their jobs in the COVID-19 recession also lost their health insurance. And this is a conservative estimate, as it does not count family members who might have relied on the same coverage and it is based only on those who lost their jobs and filed an unemployment claim.

These workers have some options — although the interruption of coverage alone is a frightening prospect in these troubled times. A lucky few might be able to pick up coverage through another family member who remains employed (and insured). Those losing job-based coverage have the “COBRA” option of continuing coverage by paying the full premiums themselves. But this is a costly option (the annual premium for job-based family coverage in Iowa is over $18,000) that few can afford.

Most displaced workers will turn to public programs. Iowa’s Medicaid program offers coverage to adults earning less than 138 percent of the federal poverty level ($16,791 for an individual, $28,888 for a family of three), and Medicaid and CHIP cover children in families with incomes up to 302 percent of the federal poverty level ($65,594 for a family of three). Unemployment benefits count towards this threshold, but the supplemental $600/week in Pandemic Unemployment Compensation (available through the end of July) does not.

Those whose family incomes fall above the Medicaid or CHIP thresholds have the last option of the Affordable Care Act “marketplace” insurance. Iowa’s health insurance exchange is a “federally facilitated” marketplace, which means it cannot allow open enrollment outside the conventional enrollment window in November.

But loss of a job (and job-based insurance) does qualify for off-cycle enrollment, and the premium assistance available for those purchasing at least a bronze plan on the exchange can substantially reduce costs for those with income under three to four times the poverty level. But here again there is a catch: Unemployment benefits count as income in determining both eligibility for ACA assistance and the amount of the assistance.

All this underscores the inequity and inefficiency of our job-based health care system. It is uneven and unreliable. And it fails at its most elemental goal: to protect working Iowans from risks that are beyond their control.

Colin Gordon is senior research consultant for the nonpartisan Iowa Policy Project (IPP) and a professor of history at the University of Iowa. He has led IPP’s State of Working Iowa analyses since 2001, and is author of Dead on Arrival: The Politics of Health Care in Twentieth Century America, and Citizen Brown: Race, Democracy, and Inequality in the St. Louis Suburbs.

Historically high: Jobless claims vs Great Recession

New unemployment claims are trending down, but still rising and in the latest week were still nearly as high as the worst week of the Great Recession.

The pace of new unemployment claims slowed in Iowa to 13,040 for the week ending May 16, but still nearly as high as new claims in the worst week of the Great Recession. Meanwhile, the running total of new claims since mid-March — at 313,150 — is about 18 percent of Iowa’s entire labor force.

On top of that, Iowa has slowly begun to process claims for Pandemic Unemployment Assistance (PUA), the federally funded benefits for those ineligible for regular UI. In the week ending May 9, there were 15,219 Iowans on continuing PUA claims and 4,552 new applications.

The PUA has enormous potential for the self-employed, independent contractors, platform or “gig” workers, and new entrants to the labor force. It pays a weekly benefit of between $200 and $590 (depending on earnings and dependents). Once approved, recipients can received up to 39 weeks of benefits — retroactive to early February and running through December. Receipt of PUA benefits brings with it another $600 month in Pandemic Unemployment Compensation (PUC), the federal top-off that runs through the last week of July.

All of this is funded entirely with federal dollars — making it an important source of economic stimulus for the state as well.

But the rollout of the PUA has been slow. Initial applicants were summarily rejected by Iowa Workforce Development and the first payments did not trickle out until almost two months after the program was put in place. And the number of new and continuing PUA claims in Iowa (just under 20,000) as of this morning is very low given the number of Iowans that could benefit from this program (taken together, those reporting some form of self-employment income and new entrants probably account for about 20 percent of the labor force). Under normal conditions, Iowa pays unemployment claims to only about 41 percent of the unemployed. The PUA could and should extend that coverage dramatically.

Colin Gordon is senior research consultant for the Iowa Policy Project and a professor of history at the University of Iowa.

Faster infection pace, fewer limits

Despite problems with testing, we are able to know where there have been major increases in identified cases.

A number of Iowa counties are seeing a surge in coronavirus cases, even as the Governor continues to reopen the Iowa economy and further relax social distancing requirements.

In Wapello County, cases soared from 10 on April 28 to 306 two weeks later. Over that same time period, Crawford County saw an increase from 21 to 207, and Sioux County from 8 to 103. Yet instead of reinstituting social distancing in those hot spots, the Governor has expanded her relaxation of requirements on businesses from 77 counties to all counties statewide.

Given the problems and delays with testing, and the lack of widespread testing, it is difficult to know just how many Iowans are actually infected with the coronavirus, and whether there are other emerging hotspots that remain unidentified. But we do know where there have been major increases in identified cases. For the most recent two-week period, the table below shows the 16 counties with the highest number of new cases per 100,000 population over the past two weeks (through May 12).

When adjusted for population, we see that many rural counties are experiencing more rapid growth than urban centers, many of which (Linn, Johnson, Scott) did not even make this list. Half the counties on the list (indicated by shading) are among the 77 counties where restrictions were first relaxed on May 1.

Most of those eight counties we identified last week as likely hot spots based on the growth in cases up to that point. New additions to the list are Monroe and Osceola, where the total number of cases is not large, but where we may be seeing the beginning of a surge. Six of the eight shaded counties saw their case count more than double in the past week.

It is easiest to see which counties have grown the fastest if we compare the cases per 100,000 population and how this number changed since the county first hit 50 cases. The counties are compared on the basis of when the surge began in their county. Wapello and Crawford have been growing at much the same rate as Woodbury, notably one of the top counties in the entire country in terms of the size and rate of the coronavirus surge.

 

 

 

 

 

 

 

Peter Fisher is research director for the nonpartisan Iowa Policy Project in Iowa City.

Another 25K Iowans file unemployment claims

At a moment when going back to work poses grave public health risks, it is in our best interests to be generous in determining eligibility for benefits.

In the week ending May 2, another 24,693 Iowans applied for unemployment insurance. That brings the total new claims for unemployment insurance, over the last seven weeks, to 285,741.

Iowa’s insured unemployment rate (the share of the labor force receiving unemployment benefits, which does not include this week’s new claims) is now 11 percent. Since mid-March almost 1 in 5 Iowa workers (more than 18 percent of the non-farm labor force) have filed an unemployment claim.

This total does not include those who have dropped out of the labor force. It does not include those unable to access our overwhelmed unemployment insurance application system.

And it does not include those discouraged from even applying by Iowa Workforce Development’s chilling “get back to work” directive. The outcry against that directive — so clearly at odds with both Iowa law and the unemployment crisis at hand — has forced IWD to soften its tone. The “FAQ” for workers on IWD’s website now acknowledges that unsafe working conditions, and the failure of employers to provide adequate protection, constitute valid reasons for leaving a job and claiming benefits.

As the jobs crisis deepens, we need to remember that unemployment insurance is intended as a safety net, as a means of sustaining incomes through periods of both personal misfortune and broader economic troubles.

We are at a moment when going back to work poses grave public health risks, and when the federal government has stepped up to cover most of the costs. Under these conditions, it is in our best interests to be generous in the determination of eligibility for benefits — and to let Iowa workers displaced by this crisis make the right decision for themselves, for their families, and for their communities.

Colin Gordon is senior reearch consultant for the Iowa Policy Project, and a professor of history at the University of Iowa.

Demanding a healthy way to go back to work

The state’s “back to work” directive sends the wrong public health message at exactly the wrong time. And in clear defiance of Iowa and federal standards, it puts economic and physical security of workers at unnecessary risk.

Iowans want to get back to work. But — much more importantly — they want to get back to work under conditions that protect their health and safety, and the health and safety of their families and communities.

Over the past few weeks, we have questioned both the metrics and the lack of transparency behind the state’s decision — virtually alone among its peers — to stop short of a “shelter in place” order. Those concerns are now magnified by announcement this week that Governor is lifting social distancing measures in 77 of Iowa’s 99 counties — this despite the fact that the caseload in Iowa continues to grow, that two of Iowa’s metros (Sioux Falls and Waterloo-Cedar Falls) are currently among the worst “hot spots” in the entire country, and that a sudden influx in social interactions, as the Iowa Medical Society warned earlier this week, “is all but certain to cause a spike in new COVID-19 patients and potentially overwhelm our health care system.”

Even more troubling is the clear evidence that public health policy is being driven by largely economic concerns. At the same moment as the Governor’s office announced the relaxation of restrictions, Iowa Workforce Development (IWD) chimed in with a chilling directive for unemployed Iowans — warning not only that “Iowans who refuse to return to work without good reason when recalled will lose eligibility to unemployment benefits,” but that those who continued to draw benefits in defiance of this directive faced “serious consequences for fraud, including fines, confinement and ineligibility for future unemployment benefits.” IWD even created a webform where employers are encouraged to “report employees who refuse to return to work without good reason or who quit their jobs.”

The IWD directive goes on to list a narrow range of “good cause” reasons for remaining unemployed — including a positive COVID test (for the worker or a member of her or his household), and the loss of child care or transportation to work because of COVID-19.

This directive — and the message it sends to working Iowans — is bad public health policy in a state where the most severe COVID outbreaks have occurred at workplaces. But, just as importantly, it offers a fundamentally flawed misreading of both Iowa law and the terms of the federal Families First and CARES Acts.

Iowa Code (871-Chapter 24.26 [96]) is crystal clear on this point, and offers a much broader set of conditions and options. A person who leaves a job due to “unsafe working conditions” or “intolerable or detrimental working conditions” cannot be considered to have voluntarily quit the position, which would make the worker ineligible for unemployment benefits. The determination of what is “unsafe” or “intolerable” depends upon both the workplace and the worker. A reasonable standard of safety, under these conditions, might be the guidance offered by the Centers for Disease Control or the Occupational Health and Safety Administration for best practices — regarding social distancing and protective equipment — for workplaces. Yet, while IWD is directed to discourage claims and applications, there is no accompanying expectation that such safety guidelines are mandatory in Iowa workplaces.

Federal law offers the same basic assurance. For workers collecting regular UI, the federal “prevailing conditions of work” provision prohibits a state from denying UI to a worker who refuses work if the “the wages, hours, or other conditions of the work offered are substantially less favorable to the individual than those prevailing for similar work in the locality.” This provision covers “work rules, including health and safety rules” and situations where there has been a change in the existing conditions of work. According to the legislative history of the provision, it “requires a liberal construction in order to carry out the Congressional intent and the public policy embodied therein,” and the “the claimant should be given the benefit of the doubt.”

In turn, IWD’s directive flies in the face of the federal programs (and money) designed to both prop up Iowa’s unemployment system through the crisis and offer a more generous approach to eligibility. The Families First Act (passed in mid-March) offered emergency grants to states (including Iowa) for the administration of unemployment under the condition that states streamline their application process and “demonstrate policies to increase access to unemployment compensation.” The Act also requires a report, due at this time next year, detailing how progress on increased access.

The CARES Act (passed in late March) established three new unemployment programs: Pandemic Unemployment Assistance (PUA) for those workers (self-employed, gig workers) not conventionally eligible for unemployment insurance; Pandemic Unemployment Compensation (PUC), which adds $600 per week (through the end of July) to all unemployment claims paid under either regular UI or the PUA; and Pandemic Emergency Unemployment Compensation (PEUC), a 13-week extension of state UI benefits.

The programs extended the logic of the Families First Act: States were expected to be expansive and generous in their approach to eligibility for unemployment insurance, making it both possible and economically-feasible for workers to shelter in place and avoid the risks posed in many settings by continued employment. Importantly, the CARES Act attached a list of COVID-related conditions (similar to that in the IWD directive) to the PUA program, but not to the expansion or extension of regular UI benefits.

The IWD’s “Back to Work” directive is bad public policy. On public health grounds, it sends exactly the wrong message at exactly the wrong time. And, in clear defiance of Iowa and federal standards for unemployment insurance eligibility, it puts the economic security and physical health of Iowa workers at dire and unnecessary risk. The Governor and Iowa Workforce Development should reverse course and protect our workers and their families.

Colin Gordon, senior research consultant for the Iowa Policy Project, is a professor of history at the University of Iowa.

Iowa unemployment claims keep rising

New unemployment claims continued to climb in the week ending April 11. Nationally, 5,245,000 workers filed new claims, bring the total to 22,634,000 new claims since March 21 (when the first COVID-19 layoffs starting hitting the books). As this week’s release concludes glumly: “This marks the highest level of seasonally adjusted insured unemployment in the history of the seasonally adjusted series.” In Iowa, we added 46,356 new claims, for a four-week total of 207,468.

We can now also begin to see the impact on national and state unemployment rates. The weekly claims data allows us to calculate the “insured unemployment rate” or the share of the labor force receiving unemployment benefits. In Iowa, the insured unemployment rate rose to 10.2 percent for the week ending April 4.

200416-IA_insured_unemployed

It is important to point out that this represents a fraction of the actual unemployment rate, which is the share of the labor force unemployed but looking for work (in Iowa, only about 40 percent of unemployed workers receive unemployment benefits).

The rates of insured unemployed in the states for the week ending April 4 range from 3.8 percent in South Dakota to 17.8 percent in Rhode Island. For a conservative estimate of the actual unemployment rates by state, double these numbers. Those estimates — putting most states in the range from 20 to 30 percent — are steeper than the unemployment rates of the Great Depression.

Colin Gordon is a professor of history at the University of Iowa and senior research consultant at the nonpartisan Iowa Policy Project.

 

Governor’s metrics still raise questions

Iowa’s social distancing policy appears to be hostage to an unexplained and backward-looking indicator for hospitalizations.

(UPDATED, APRIL 16)

The latest “metrics” from the Governor’s office once again raise serious questions. A few days ago it seemed clear that two or three of the state’s six regions would very soon reach the magic number 10, at which point shelter-in-place is considered justified by the Governor and the Iowa Department of Public Health, according to their guidelines. Instead, as of April 15, regions 1 and 6 remained stuck at 8 and 9, respectively, and region 5 had fallen to 8. Why? Because the hospitalization rate score, which by deduction must have been at 3 for all 6 regions just a week ago, was suddenly downgraded to 1 in two regions, and 2 in two others.

Today, April 16, things changed again. Lo and behold, Region 6 made it to 10. And in fact the Governor followed through with something akin to shelter in place, with most kinds of gatherings limited to families, not groups of 10 or fewer. No additional business closures were announced, however. Meanwhile, Region 5 jumped two points with new outbreaks at two more nursing homes, but then lost a point because the hospitalization score apparently was lowered again, without any explanation. So it remains at 9, even though it is maxed out on all criteria except hospitalizations.

No explanation of the hospitalization score has been forthcoming beyond the vague definition in the “Guidance” memo unearthed by Zachary Smith of the Iowa City Press-Citizen last week. That memo defines it thus: “Percent of identified cases requiring hospitalization.” Is the numerator the cumulative total of all cases in Iowa that required hospitalization at some point, or just cases in the last 14 days, or just current hospitalizations as of the most recent day? Is the numerator cumulative cases, cases in the last 14 days, or something else? We don’t know, and no hospitalization rate by this measure has been reported even statewide, nor does the newly launched dashboard contain any hospitalization data at the county or regional level.

Total cases of COVID-19 continue to rise, as do current hospitalizations. So in the face of a rising number of Iowans currently with a severe enough case of the virus to be hospitalized, why does the hospitalization score decline, lessening the supposed need for shelter in place? Why is the percent relevant in the first place? Surely the total number of persons hospitalized for the virus is the single most important indicator, since it signifies not only the number of Iowans seriously affected by the virus, but the potential strain on hospital resources.

A forecast of this number is the crucial indicator in the widely known forecasting models by epidemiologists at the University of Washington and elsewhere. But in Iowa, we still do not have a forecast, and social distancing policy appears now to be hostage to an unexplained and backward-looking indicator. If that percentage continues to be low, or to fall, despite daily increases in cases, deaths, and hospitalizations, we may not see another region get to the magic number of 10.

Peter Fisher is research director for the nonpartisan Iowa Policy Project in Iowa City.

pfisher@iowapolicyproject.org