The report from the nonpartisan, nonprofit group found a shift from manufacturing to service jobs and from long-term to short-term employment has left fewer Americans uninsured, and the recession has intensified those trends.

“Employer-provided health insurance has become more rare and more expensive, leaving the economically weakest workers to fend for themselves,” said Noga O’Connor, an IPP research associate and co-author of the report.

The IPP estimated 40 percent of the labor force is now “non-standard,” meaning part-time, temporary, on-call and contract workers. Those workers are less likely to have health insurance, the report found.

Another 2009 report from the Bureau of Labor Statistics found the number of involuntary part-time workers rose from 4.2 million in 2005 to 9.3 million in 2009.

“This has serious implications for policy makers as they consider implementation or changes in the health reform law,” O’Connor said.

The report also found a relationship between the race, age and income of workers, and whether they are “non-standard” workers or have insurance.

“Older, better-educated and better-earning individuals are significantly more likely to be insured and to be standard workers,” the report reads. “We also found a significant race effect — when comparing Black, Hispanic and White workers, Hispanic workers are significantly less likely to be insured and to be standard workers.”

The report also found health insurance is related to job turnover. Workers without coverage are about twice as likely to change their job, and more than seven times as likely to lose their job.

Andrew Cannon of the IPP said the report shows the rapid increase in health costs is only one reason for the steady erosion of employer-sponsored insurance.

“A big reason also is simply that movement of people into jobs that are not likely to offer insurance,” Cannon said.

The report was funded by the U.S. Department of Labor.

Massachusetts topped the list of states with the lowest number of uninsured at 5.3 percent. In 2006, the state instituted a mandate requiring residents to carry health insurance. Vermont has the second lowest uninsured rate at 9.2 percent. Vermont recently enacted the nation’s first single-payer health care system.

Rounding out the top 10 were Connecticut, Hawaii, Pennsylvania, Wisconsin, Maryland, New Jersey and Delaware.

Despite the strong showing in the state-based rankings, Minnesota’s rate of uninsured has climbed over the last few years from 8.7 percent in 2009.

Minnesota also placed third in 2010 and 2009, according to Gallup. The Midwest and Northeast have historically had low uninsured rates.

The bottom ten were all southern states, except for California and Alaska. Texas had the highest percent of uninsured with 27.4 percent followed by Mississippi, Alaska, Florida, Oklahoma, California, Louisiana, Arkansas, North Carolina and Georgia. Texas has consistently led the nation in having the highest percentage of its population without health insurance in the Gallup survey.

On the day Obama signed the health care bill into law — March 23, 2010 — Liberty University, represented by its partner institution Liberty Counsel, filed a lawsuit (PDF) against Timothy Geithner, secretary of the U.S. Treasury Department; Kathleen Sebelius, Health and Human Services secretary; Hilda L. Solis; Labor Department secretary; and U.S. Attorney General Eric H. Holder, Jr., for allegedly violating constitutional rights by implementing individual and employer mandates. After failing in district court, Liberty University has appealed (PDF) the case.

Listen to Mathew D. Staver, founder of Liberty Counsel and dean of Liberty University School of Law, argue before a three-judge panel.

Oral arguments for Liberty University, Inc. v. Timothy Geithner:

Also on March 23, 2010, Virginia Attorney General Kenneth T. Cuccinelli sued Sebelius, challenging the health care act’s individual mandate. On Tuesday, Cuccinelli also appealed to the panel. Both Cuccinelli and Liberty hope their cases will reach the U.S. Supreme Court by year’s end.

Listen to oral arguments for Commonwealth of Virginia, Ex Rel. Kenneth T. Cuccinelli, II v. Kathleen Sebelius:

“Today we took Step Two in a three-step process,” said Cuccinelli in a news conference following the arguments. “As Judge Motz noted, the legal questions raised today are questions that will be answered in another court in another time.”

Cuccinelli offered an overview of the Commonwealth of Virginia’s case during the news conference:

Virginia has argued that the mandate that every person must buy government-approved health insurance violates the Constitution. Using the Constitution’s Commerce Clause to force people to buy a product goes beyond Congress’s power. This is why I have said all along that this is about liberty, not health care. The insurance mandate penalizes people for not engaging in commerce. In other words, you can get fined for doing nothing.

Virginia has also argued that the penalty the government wants to charge if you do not buy health insurance is not a tax. The government cannot start calling the penalty a tax to try to make it legal under Congress’s taxing authority. Congress and the president passed it as a penalty, not a tax; it works as a penalty, not as a tax.

[...]

If we cross this constitutional line with health care now – where the government can force us to buy a private product and say it is for our own good – then we will have given the government the power to force us to buy other private products, such as cars, gym memberships, or even asparagus. The government’s power to intrude on our lives for our own good will be virtually unlimited.

[...]

You heard about standing today. The federal government thinks it can tell the states to disregard their own laws – like it is doing with Arizona, but then also says the states do not have the same right to challenge federal laws in court. That is not how our system of government is set up. The founders set it up so the states were a check on potentially overreaching federal authority.

I have said all along that this lawsuit is not about health care. It is about liberty. At the same time, I understand that people want more affordable health care, and I sympathize with people who honestly cannot afford it. As a state senator, that was a problem I tried to address by trying to pass a law to allow our citizens to buy better or cheaper plans in other states. But as someone who has sworn to uphold the law, I cannot endorse taking away the rights of all so that government can provide health care to some.

When a ruling will be issued from the Fourth Circuit Court of Appeals is unknown. All three judges were appointed by Presidents Bill Clinton or Barack Obama. The panels are chosen randomly.

Partner institution Liberty Counsel, a nonprofit law firm that traditionally defends right-wing causes, is representing the university and two private individuals, Michele Waddell and Joanne V. Merrill, in the lawsuit (PDF), which was first filed by Liberty Counsel on March 23, 2010, the same day President Obama signed the health care bill into law. The federal suit, first filed in the U.S. District Court for the Western District of Virginia, challenges both the individual and employer mandates and centers around the complaint that the faith-based university could not refuse insurance companies that cover abortion or other health care services the university considers objectionable. Liberty Counsel argued that the new health care law violates the university’s rights as a religious institution but lost the case.

Liberty Counsel has since appealed in the U.S. Court of Appeals for the Fourth Circuit, and on Tuesday at 9:30 a.m. the oral argument in the appeal will be heard at the U.S. Court of Appeals for the Fourth Circuit in Richmond, Va., to be followed by a press conference.

In a press statement released Monday, Liberty Counsel said it expects a ruling to be decided by the end of the year at the case will likely move on to the Supreme Court.

“I am looking forward to the argument tomorrow,” said Mathew D. Staver, founder of Liberty Counsel and dean of Liberty University School of Law, in the statement. ”This massive health insurance law goes beyond the outer limits of the Constitution. It is a big step toward a centralized government. The stakes riding on this lawsuit are high. This case goes beyond health insurance and is more about the role of the federal government to control private decisions and burden the free enterprise system.”

Specifically, plaintiffs are suing U.S. Treasury Department secretary Timothy Geithner, Health and Human Services secretary Kathleen Sebelius, Labor Department secretary Hilda L. Solis and U.S. Attorney General Eric H. Holder Jr., and claiming that certain provisions of the health care act violate the following constitutional amendments in the Bill of Rights:

• First Amendment: “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.”
• Fifth Amendment: “No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a grand jury, except in cases arising in the land or naval forces, or in the militia, when in actual service in time of war or public danger; nor shall any person be subject for the same offense to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation.”
• 10th Amendment: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people.”

Liberty Counsel has also argued that the university should be exempt from the health care act under the Religious Freedom Restoration Act of 1993 (which was struck down by the Supreme Court in 1997). In February, the American Civil Liberties Union filed a friend-of-the-court brief, arguing that religious beliefs should not dictate access to health care service for others.

This lawsuit represents the first challenge to the health care law to be argued at the appellate level.

A separate suit, which will be heard in the same court following Staver’s testimony, Commonwealth of Virginia, et al. v. Kathleen Sebelius, challenges the individual mandate in the health care act  but not the employer mandate.

Senate Bill 1414, introduced by Republican Sen. Stephen R. Wise, says that if an individual or group health insurance policy is purchased in whole or in part with any state or federal funds, the insurance company is prohibited from covering abortion. The law includes “coverage” to mean if any tax credit or cost-sharing credit is applied toward the health insurance policy.

Exceptions are made if the abortion is deemed necessary (and certified in writing by a physician) to save the life of the mother or if the pregnancy is the result of rape or incest.

Health insurance policies can still provide separate coverage for an abortion, so long as no state or federal funds are directly or indirectly used.

A similar bill in the House is scheduled for a committee vote on Wednesday.

Seniors and people with disabilities who receive health care through Medicare* might have an additional service covered in the near future: testing for sexually transmitted diseases such syphilis, gonorrhea and hepatitis B, according to a Reuters report. Centers for Medicare and Medicaid Services (CMS) is due to decide on the measure within the next nine to 12 months.

Government-funded health insurance already covers HIV testing, but now CMS is looking into paying for additional STD exams, in an effort to promote preventative care and reduce the amount spent on costly treatments for people who do become infected.

CMS spokesperson Don McLeod said that under the Affordable Care Act, Medicare has to cover what other private insurers cover if the government deems these procedures appropriate and necessary. Cost of the increased coverage is never factored into CMS’ determination, he said.

“Somebody else has to worry about how to pay for it.”

The tests up for consideration -– chlamydia, gonorrhea, hepatitis B and syphilis -– target people considered to be high risk for these diseases: women, pregnant women and people with disabilities.

The Centers for Disease Control and Prevention estimates:

• Approximately 1.2 million chlamydial infections were reported in 2008, though the disease is frequently under-reported because many people don’t know they have chlamydia and do not seek testing. In women, untreated infections can increase the risk of HIV, cause pelvic inflammatory disease, and lead to infertility or pregnancies outside the uterus.
• More than 700,000 Americans contract new gonorrheal infections each year, but only about half of these infections are reported to the CDC. A pregnant women with gonorrhea can give birth to a baby who is blind or has a life-threatening blood infection.
• In 2007, there were an estimated 43,000 new hepatitis B virus infections in the U.S., and an estimated 800,000 to 1.4 million Americans have chronic hepatitis B.
• More than 36,000 cases of syphilis were reported in 2006. Reported cases of congenital syphilis in newborns increased from 339 in 2005 to 349 in 2006. Pregnant women with syphilis are at greater risk at giving birth to stillborns. Rates have increased in men every year between 2000 and 2006 from 2.6 to 5.7 percent. In 2006, 64 percent of reported syphilis cases were among men who have sex with men.

According to Reuters, since 2009 CMS has had the power to add coverage for preventive services; currently Medicare covers pap smears and pelvic exams and tests for colorectal cancer and diabetes.

Furthering preventative care, the Department of Health and Human Services announced Thursday that it will allocate $100 million to states that offer incentives to Medicaid beneficiaries who adopt healthy habits, as part of the Affordable Care Act. For instance, a state could establish a set of goals -– such as quitting smoking or losing weight -– and people who meet those goals could be offered direct cash incentives, gift cards, reduced Medicaid program fees or even services not normally available through Medicaid.

“With the right incentives, we believe that people can change their behaviors and stop smoking or lose weight,” said CMS Administrator Dr. Donald Berwick, in a press release. “Not only can preventive programs help to improve individuals’ health, by keeping people healthy we can also lower the nation’s overall health care costs.”

The Centers for Medicare & Medicaid Services is now inviting proposals from states to compete for grant awards for this legislatively mandated Medicaid Incentives for Prevention of Chronic Diseases Program. The program will target behaviors that cause some of the most critical chronic conditions Americans face: smoking (kills 430,000 people a year, according to HHS), obesity, heart disease, and diabetes. States’ notices of intent are due April 4; applications are due May 2.

Seniors and people with disabilities who receive health care through Medicare* might have an additional service covered in the near future: testing for sexually transmitted diseases such syphilis, gonorrhea and hepatitis B, according to a Reuters report. Centers for Medicare and Medicaid Services (CMS) is due to decide on the measure within the next nine to 12 months.

*Earlier we stated that additional STD coverage could be extended to Medicare and Medicaid beneficiaries, but only Medicare beneficiaries would be affected.

NPR, however, presents a less optimistic take on what the next few years of health care is America could look like:

[Jamie] Court, the consumer advocate, says he’s happy the law now says policies can’t be rescinded unless companies can prove that a policyholder lied on his or her application, but that until 2014, when the requirement for everyone to have insurance kicks in, he’s still worried that rescissions could continue.

“It’s a great thing, but it’s not a panacea,” he said. “Words in a bill don’t mean enough to insurance companies until they’re backed up by a lot of big verdicts or the wrath of a regulator.”

What kind of lies can prompt an insurer to rescind a patient’s insurance? One example in the NPR story has a patient losing her insurance because the height she reported on her application was an inch off her measured height and her weight five pounds different.

For the average worker who has lost her job since May 31, the cost of COBRA has tripled. (Flickr, Steve Rhodes)

In the first week of July, Andie Davis’ husband, who worked in manufacturing, lost his job, as hundreds of thousands of Michiganders have since the onset of the recession. Soon after, he started collecting unemployment insurance benefits that might last the family of four as long as 99 weeks. Davis hopes that the benefits will keep the family afloat — the mortgage paid, school lunches made, the electricity on — without forcing her to tap into the family’s savings.

[Economy1] But to keep the family financially stable while both she and her husband look for work, she has decided to forgo health insurance. The Davis family looked at how much COBRA would cost them, thinking the government would help pay for it. Had her husband lost his job just six weeks earlier, Washington would have footed about two-thirds of the premium bill. But since Davis’ husband lost his job after May 31, the young couple is on their own.

The change has gone little-noticed, both by the press and by the laid-off persons impacted by it. But a popular stimulus provision, the federal subsidy of COBRA benefits, expired for newly unemployed workers as of the first day of June. That means, for the average worker who has lost her job since May 31, the cost of COBRA has tripled.

COBRA — a provision created in the Consolidated Omnibus Budget Reconciliation Act of 1985 — gives workers the option of buying into their old health-care plan when they lose their job. Before the recession, COBRA let workers who lost their job through no fault of their own pay the entire health-care premium plus a two-percent administrative fee to keep coverage, about $8,800 per year for the average enrollee. (Generally, COBRA lasted 18 months.)  As part of the American Recovery and Reinvestment Act, or the 2009 stimulus, Congress subsidized this coverage, given the massive number and economic hardship of laid-off workers. The subsidy paid for 65 percent of health-care premiums for up to 15 months, meaning an average enrollee paid less than $3,000 a year.

For the Davises, under COBRA, coverage might have been a manageable $400 a month. When Davis looked into enrolling her husband and herself, she found it would cost more than $1,100 a month — leaving the family just a few hundred dollars for the mortgage, utilities, gas and food. She sought information on other private plans, but considered all of them too expensive. For now, the Davises are purchasing barebones coverage that will help pay hospital bills in case they are in an accident.

She rationalizes: “Me and the husband, we’re young enough that we can go without visits to the dentist and the [gynecologist] for a year,” and she argues, “I just do not see how it would be worth paying that much money for coverage, when we’re looking at a lot of other problems.” She argues that if the choice is between routine care and paying the electric bill, she will choose the latter. In the meantime, she is praying that her husband’s asthma does not flare up in the fall and hoping that they find jobs soon.

The Davises are one of hundreds of thousands of families doing the same. According to a study of 200 very large employers by Hewitt Associates, the COBRA provision doubled the proportion of laid-off workers enrolling in the program. In the fall of 2008, before the subsidy, about 19 percent of laid-off employees enrolled in COBRA. During the first six months of the subsidy, 38 percent of laid-off workers chose to. Now, with the subsidy’s end, enrollment rates are plummeting.

“Enrollment rates will likely decline over time as workers can’t, or aren’t willing to, afford the high premiums associated with COBRA coverage,” Hewitt’s Karen Frost said in a statement. “It’s possible these laid off workers are simply seeking coverage with a new employer or through their spouse’s employer. Unfortunately, it’s also likely that some are just foregoing health insurance altogether.” The National Employment Law Project estimates that 144,000 individuals and families per month have lost out on the subsidy.

It wasn’t supposed to be this way, but the extension of the COBRA subsidy became caught up in the tax extenders bill — also known as the jobs bill or H.R. 4213 — a large package of popular stimulus provisions that eventually died at the hands of a Republican filibuster. Senate Democrats managed to move unemployment insurance benefits, but few other portions of the popular bill made it through a Senate allergic to deficit spending.

The COBRA subsidy is highly popular: Hart Research found that 70 percent of Americans support extending it.  And many on the Hill fought to keep it in the tax extenders bill or to push it through other provisions. “Millions of Americans have been hard hit by the recession and lost their jobs through no fault of their own,” Sen. Robert Casey (D-Pa.) argued. “If Congress turns its back on them, they will have an even more difficult time making ends meet. With no premium assistance, COBRA health care benefits would consume 75 percent of the monthly unemployment payment for a Pennsylvania family.”

He offered an amendment to keep the subsidy within the jobs packages, and along with Sen. Sherrod Brown (D-Ohio) has offered it as a standalone bill. The Extend COBRA Premium Assistance Program Act of 2010 provides a six-month subsidy for workers laid off between May 31 and Nov. 30. The provision is entirely deficit-neutral, eliminating a tax break on annuity trusts as a pay-for. (The bill is one of many that would extend COBRA. On the House side, Rep. Susan Davis (D-Calif.), for instance, introduced a bill doing so until relevant portions of Obama’s health care bill come into effect in 2014.)

Casey and Brown’s bill is popular — cosigned by Democratic Senators John Kerry (Mass.), Carl Levin (Mich.),  Sheldon Whitehouse (R.I.), Debbie Stabenow (Mich.), Patrick Leahy (Vt.), Christopher Dodd (Ct.), Al Franken (Minn.), Roland Burris (Il.) and Daniel Akaka (Hi.) and supported by a slew of others. But it is caught in committee, and its likelihood of passage any time soon is small.

That means that the popular provision is likely dead, and for families like the Davises, health care coverage will remain an unaffordable luxury.

Needless to say, being so sick as to be unable to work six days a month seems a real hurdle to job-seeking.

1. More people than expected lost their jobs last week
New Labor Department statistics show that an additional 31,000 people signed up for unemployment benefits last week. That means that in the last four weeks, nearly half a million more Americans joined their 8.4 million fellow citizens as victims of the recession that’s supposedly over. And those numbers don’t even reflect the 100,000 jobs economists think the massive snowstorms may have cost the economy in February.

2. Even though the economy sucks and interest rates are low, inflation is creeping up
Although the Fed has been keeping interest rates low and, what with massive unemployment, no one can afford to buy that much anyway, the inflation and wholesale rates went up twice as much as economists expected. So, not that Americans have money to spend — which is the only reason that inflation isn’t even higher — but companies are already chomping at the bit to raise their prices and improve their profit margins. For those Americans whose budgets are already stretched to the breaking point, inflation just means the necessities that they are buying may soon cost noticeably more.

3. Rich people paid way less in taxes than you last year
Just in time for tax season comes the news that even as many Americans struggled to keep their jobs and many struggled to pay their tax obligations once they lost their jobs, the rich got to keep more of their not-so-hard-earned money than anyone. The 400 households with the most income in 2007 paid an effective tax rate of 20 percent, due to Bush’s tax cut on capital gains (the profit earned from buying something that you later sell for more money). That effective rate is less than the regular tax rate paid by someone making $34,000 a year in 2009. Naturally, the capital gains tax cut remained in effect in 2009 and, with the wealthy barely facing any unemployment and continuing to earn money hand over fist, their tax bills aren’t likely to be any higher come April 15. Meanwhile, the Republicans who cut the taxes that allowed the super-wealthy to pay an effective tax rate of 20 percent are complaining about the deficit created by Obama’s 2010 budget and stimulus programs designed to improve the economy and get people back to work.

4. Your health insurance premiums are going up — way up
A new report issued by the Department of Health and Human Services notes that insurance companies are raising premiums for 2010 at rates of up to 56 percent in some places. While Congress was considering health care reform last year that would have regulated the industry more stringently, rate increases remained low for what appears now to have been public relations reasons. But now that any comprehensive reforms are off the table and what’s left seems increasing unlikely to pass regardless, insurance companies plan to make up for their mediocre profit increases last year with a gangbuster year in 2010. In the meantime, the 10 percent of Americans who are unemployed (and many more who are underemployed) seem likely to add to the ranks of the country’s 47 million uninsured — unless health care does pass, in which case they’ll be required to buy the increasingly unaffordable health insurance pedaled by this nation’s bloodsucking insurance companies.

5. The foreclosure crisis isn’t over, and the mortgage modification isn’t really working
The mortgage crisis that spurred so many foreclosures might be over, but the foreclosure crisis is not. Economists expect a surge in foreclosures and short sales this year, and the government’s supposed hedge against such eventualities — its $75 billion mortgage modification program — isn’t helping except “at the margins.” Almost 300,000 more homeowners became eligible for permanent mortgage modifications in December and January, but only about half of those homeowners were offered them — and 500,000 are about to be bounced because of supposed paperwork problems, which is the major reason banks have found to exclude homeowners from participating since the program’s inception. In fact, the newest figures show that only about 20 percent of the 4 million eligible homeowners have gotten permanent modifications to date. But that warning may come too late for many homeowners: The deadline for fixing the paperwork they might not have even known was considered incomplete was January 31.