Health Care Lags As Hot-Button Issue

As it turns out - according to this poll conducted by Kaiser Health News - health care is not a key issue battleground voters wish to discuss. Instead, a large number of voters are more interested in dealing with issues regarding our economy and jobs.

Read further in this article below.

background-voters-poll-health careAs the midterm elections approach, health care ranks as the top issue, mentioned more frequently among voters nationwide than among those living in areas with competitive races, a new poll finds.

In areas with competitive congressional or gubernatorial races, the economy and jobs ranked as the top issue for candidates to discuss, with 34 percent of registered voters listing it as No. 1, according to the poll from the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.) Following economics was the conflict with North Korea (23 percent), immigration (22 percent) and health care (21 percent). The competitive areas are 13 states with statewide races and 19 House districts judged as toss-ups by the nonpartisan Cook Political Report.

Nationwide, 29 percent of registered voters ranked health care as the most important issue for electoral discussion — though it was far more important for Democrats than Republicans. Economy and jobs were close behind with 27 percent of voters rating it most important, and then immigration, with 24 percent listing it.

The poll found that nearly half of Americans believed there is still a federal requirement for everyone to obtain health insurance, even though Congress’ tax bill last year repealed the penalties for that requirement in the Affordable Care Act, known as the individual mandate. Only a third of the public was sure that those penalties had been repealed.

Fifty percent of the public expressed a favorable view of the health law, while 42 percent disliked it. Six in 10 people said that since President Donald Trump and the Republicans in Congress have altered the law, they are responsible for any problems. Like other opinions about the law, there was a strong partisan split: Only 38 percent of Republicans thought their party is now responsible, while 77 percent of Democrats thought so. Half of Republicans still listed repealing the health law as a top priority.

There was less of a partisan split over the importance that the president and Congress address the epidemic of prescription painkiller addiction. Among Republicans, 43 percent rated it a top priority; 54 percent of Democrats agreed.

There was no such comity over whether lawmakers should allow people brought illegally to this country by their parents — the so-called Dreamers — to stay in the country legally: 21 percent of Republicans called that a top priority, while 66 percent of Democrats did. And while 43 percent of Republicans said they wanted lawmakers to focus on passing federal funding for a border wall with Mexico, only 5 percent of Democrats and 19 percent of independents did.

The poll was conducted Jan. 16-21 among 1,215 adults. The margin of error was +/-3 percentage points. The poll included 298 people who said they were registered to vote in one of the areas the Cook Report identified as a battleground in the fall elections. The margin of error for results for this group was +/-7 percentage points.

Read the original article.

Rau J. (26 January 2018). "In Battleground Races, Health Care Lags As Hot-Button Issue, Poll Finds" [Web Blog Post]. Retrieved from address

The Future of Health Care in Obama’s Second Term



Although members of the Obama team are now celebrating their election victory, the next four years will not be smooth sailing. Ignoring the campaign rhetoric, there is still much more work to be done in order to reshape our health care system; the effect on academic medical centers and teaching hospitals will be significant.

The political conscience is still being driven by the fear of the fiscal cliff, which dominates most Washington conversations. Both political parties agree that health care is a significant contributor to our present and future deficit and that we have to figure out how to deliver more care at a lower cost. But, they argue about what to call it, who gets credit, and whether the solution is bigger government involvement or a dominant private market?The potential cuts to NIH funding and graduate medical education support do not go away with another four Obama years. We anticipate that the president will reform the tax code and transform how we deliver health care. The latter will be his lasting legacy.

However, in all this chaos, there are opportunities. While we no longer hope for a bipartisan middle ground on health care — and rancor will certainly escalate if President Obama is reelected — to many people, the Affordable Care Act is starting to look like a tangible business opportunity. Every insurer is looking at the 30 million uninsured people who will receive coverage through a mix of subsidized private insurance for middle-class households and expanded Medicaid for low-income people. These new markets could be worth $50 billion to $60 billion in premiums in 2014, and as much as $230 billion annually within seven years. The structure and implementation of these programs present specific challenges for AMCs.


Academic medical centers currently deliver 28 percent of inpatient care for Medicaid recipients and 40 percent of uninsured care in the United States — in only 6 percent of the acute care facilities. We have the Medicaid specialty care market cornered — because no one else will accept these patients. The expansion of Medicaid will create stress in our historical access points: emergency rooms and primary care offices. We will be overwhelmed if we do not dramatically reengineer where we deliver care and rethink who should deliver care for what conditions. We will experience costs that quickly spiral out of control if we just expand our current system.

Obama’s re-election removes the indecision about whether to opt in or opt out for many state governors. Most insurers are betting on the fact that dual eligibles (patients who are disabled or poor enough to qualify for both Medicaid and Medicare) will be moved into the managed Medicaid plans. This will require active care management, better EHRs, geomapping of resource utilization, and a greater understanding of the impact of social determinants of health on this population. It will be interesting to see if the role of the insurer really expands to manage the outcome instead of just the cost.

Health Exchanges:

The implementation of the exchanges poses challenges for states, because they are supposed to be self-sustaining by 2015. Their ability to achieve this comes down to demographics and the size of their insured pool. Small high-risk pools will need to be intensively managed (like the District of Columbia), in contrast to larger populations that can be more loosely managed as they develop state-wide infrastructure. For academic medicine, the exchanges will present specific challenges. Our services could be subject to higher deductibles, copays and even co-insurance if the exchanges choose to tier providers according to cost. As a result, our care could be inaccessible to many patients without means.

There has also been very little discussion about how to transition graduate medical education support into the exchange market. Currently Medicare, Medicaid, and other insurers support the educational mission through explicit or implicit support. Supporting the training of the health care workforce has been considered a public good that increases access and quality for patients. Medicare Advantage programs use a “carve out” to preserve this support, but this option has not yet been part of the exchange discussions.

Physician Shortages:

The Center for Workforce Studies at the AAMC estimates that the nation will face significant physician shortages by 2020. As the newly insured begin to seek care in 2014, and as we anticipate these shortages, one must wonder who will care for these patients? By 2017, the number of physician retirees will be close to the number of new medical school graduates. While medical schools as a whole have been expanding the number of students they admit, there may not be enough residency positions to accommodate them. The Obama team can ignore the growing physician shortage — but at their peril. Unfortunately, we also continue to debate within specialty societies about who should provide the services, rather than talking about how we can deliver care as a team more efficiently. Use of interprofessional teams holds great promise for improving the efficiency of the physician workforce, and we anticipate that the administration will continue to support innovative reforms in health care delivery.

Health care reform will continue to move forward, imperfect as it may be. I have great hopes for bipartisan solutions, but I won’t hold my breath. The really hard work is not over; it has just begun.

Countdown to Healthcare


By Mark Roberts

America is just a few short days away from the election of a new presidential term, and the stakes have never been higher.

On one side is the juggernaut of the Federal government headed up by the incumbent Barack Obama, and on the other side is the locomotive traveling at breakneck speed toward the final depot, with engineer former Massachusetts Gov. Mitt Romney at the throttle. On Tuesday, Nov. 6, the nation will have either a new face in the White House come next January, or the same one inhabiting 1600 Pennsylvania Avenue for the last four years will just go back to the office for another term.

On the block is health care and either the demise or further propagation of the Patient Protection and Affordable Care Act. Both candidates have strong views about this landmark legislation, and both the Democrats and the Republicans have their own reasons why they love it or hate it. The PPACA has no middle ground, and it is fast becoming more entrenched into the fabric of the economy, both businesses and consumers, states and federal government agencies, and the health care environment. And health care is the focal point of much of the political landscape in this election year.

According to LifeHealthPro, health insurance channel editor Allison Bell reports that “the two candidates engage in platform-to-platform combat over the future of commercial insurance, Medicare and Medicaid.”

There are 6 key differences on health care between the two:

1. Commercial health insurance system change. President Obama says PPACA already is improving health care access for millions of Americans and ending insurance abuses by letting young adults stay on their parents’ coverage up till age 26; forbidding health insurers from imposing lifetime benefits caps; limiting insurers’ ability to impose annual benefits caps; requiring insurers to pay for checkups, vaccinations and other preventive care without imposing out-of-pocket costs on the patients; and requiring that plans that spend more than a certain percentage of revenue on administrative costs send their customers rebates.

Gov. Romney says he would return responsibility for regulating local insurance markets and providing care for the poor, the uninsured and the chronically ill to the states, and his administration would limit moves to apply federal standards and requirements to private insurers, he says. The Republican candidate says he would encourage use of health insurance exchanges, and that he would promote the use of high-risk pools, reinsurance and risk adjustment mechanisms to help people with chronic health problems who cannot qualify to buy conventional health insurance. Also, he would work to “prevent discrimination against individuals with pre-existing conditions who maintain continuous coverage” and “facilitate [health information technology] interoperability.”

2. Women’s health and abortion. The Obama team has worked to link the fate of PPACA to the fate of PPACA provisions that require most health plans to include benefits for contraceptive services in the package of basic preventive services that must be covered without imposing out-of-pocket costs on the patients; many insurance plans are beginning to fully cover birth control without co-pays or deductibles as part of women’s preventive care.

The Romney campaign website does not mention abortion or birth control in its discussion of health issues. The Republican Party, in its platform, says the following about federal health care policy and abortion: “Through Obamacare, the current administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life.”

3. Medicare. The PPACA, according to the Obama campaign, already has made important changes in Medicare, such as requiring basic Medicare to impose a package of basic preventive services without imposing out-of-pocket costs on the patients, and reducing the size of the Medicare Part D prescription drug plan “doughnut hole” — the gap between the point at which routine prescription coverage ends and catastrophic coverage begins.

Governor Romney wants to modernize entitlement programs and guarantee their vitality for future generations.

“Instead of paying providers directly for medical services, the government’s role will be to help future seniors pay for an insurance option that provides coverage at least as good as today’s Medicare, and to offer traditional Medicare as one of the insurance options that seniors can choose,” he says. “With insurers competing against each other to provide the best value to customers, efficiency and quality will improve and costs will decline. Seniors will be allowed to keep the savings from less expensive options or choose to pay more for costlier plans.” Medicare would stay the same for retirees and near retirees. Younger workers would get a fixed amount that they could use to buy either traditional Medicare coverage or private plan coverage, and they would have to make up the difference out of their own pockets if they wanted to buy more expensive coverage.

4. Medicaid. President Obama says of Medicaid—the program for poor people and for eligible nursing home patients—mainly that he believes Romney would cut federal Medicaid funding.

Governor Romney says he would replace the current Medicaid funding formula with a “block grant” program that would provide each state with a set amount of cash that it could use as it wished. He says he would “limit federal standards and requirements” for Medicaid as well as for private insurance.

5. Tort reform. President Obama says nothing in his comments aimed at voters about tort reform”—the idea of controlling health care costs by reducing what doctors and other providers spend to protect themselves against lawsuits.

Romney says he would promote free health insurance markets by capping non-economic damages in medical malpractice lawsuits.

6. Health accounts. The president says nothing on his campaign website about health savings accounts or health reimbursement arrangements on his websites.

Candidate Romney states he would “unshackle HSAs by allowing funds to be used for insurance premiums.” Although he has vowed to streamline the tax code, he also mentioned he would “end tax discrimination against the individual purchase of insurance” and encourage independent entities to rate health plans. Plus, he also has talked about wanting to let health insurance companies sell coverage across state lines.

Regardless of the discussion over health care between now and the election, one thing is for sure. There is going to be a winner and a loser. The debate over Obamacare can ramp up the rhetoric about how good or bad the PPACA is, and the electorate certainly gets energized when it is up for discussion.

Who is telling the truth? We’ll see come Nov. 6. Now, here is your obligation—exercise your inalienable right to vote. If you don’t and you find yourself on the losing side the next day, don’t blame the politicians.

Politics in the Workplace: HR's Guide to the Election Season

Source: Hireology


There’s no question that the closer we get to the election, the more difficult it becomes for a worker to distance themselves from politics. Whether they’re listening to the news on their way to work or standing in the office kitchen waiting for their leftovers to heat up, political talk seems to permeate upon every part of our day.

But should we really be talking politics at the office? What if an employee requests time off to go vote? Do you have to let them? Don’t worry, Hireology has you covered.

Hireology’s Do’s & Don’ts of Politics in the Workplace

What is proper etiquette when it comes to discussing politics in the office? We’re the experts, and as a rule of thumb, tread lightly; you don’t want to cause any tension amongst co-workers. By following these do’s and don’ts, your company and your company culture will resist the conflicts of election season.


Make sure employees are aware of any guidelines that prohibit bringing campaign materials into the office. If that includes restrictions on wearing political clothing, setting your desktop screen to a picture of your preferred candidate or sending out emails in support of a candidate, make sure they know that as well. Send out a reminder email about theses guidelines and recommend that all employees err on the side of caution when it comes to deciding what to bring to the office.


If political talk does arise, encourage everyone to play nice and not take any politically charged comments personally. It’s best to avoid conflict and think of the discussion (or debate) as just a conversation. By keeping political conversations friendly, the office culture will not suffer.

When conversations do turn heated, encourage employees to walk away. There’s nothing wrong with using a little white lie such as “I have to run an errand” or “I have to make a phone call” as long as it gets you out of a tense situation. But as Lynze Wardle Lenio shares in her blog post on the Daily Muse, agreeing to disagree is the best solution. By doing so, no one walks away with hard (or hurt) feelings.


Allow your employees to leave the office to vote on Election Day. Not only is it a common courtesy, in many places it’s the law to give employees paid time off in order to vote. Business Management Daily has a list of voting laws by state. If you’re unsure of the law in your state, check the list at the following link just to be safe.


Even if you’re not at work, it’s still important to think before you speak. Don’t rant on Facebook about why you hate candidate X if you’re Facebook friends with your co-workers. Chances are good that not everyone feels the same as you, and you don’t want anyone walking up to you the next day calling you out for your political beliefs.


Discussing any heated issues at the office, even with co-workers who have the same views, is a bad idea and should be avoided at all costs. You don’t want others overhearing your conversation and then complaining to HR (unless you are HR, then things get messy...). Views on heated topics typically stem from religious or moral beliefs and bringing up such topics can easily strike a nerve with people. Plus, you can get into serious legal trouble if someone feels that they were attacked for their religious beliefs.


It can be hard be avoid discussing politics in the workplace, but it’s imperative to refrain from bringing up politics in an interview. Not only can it hurt the candidate experience; but if that candidate takes to the Internet to share their horror story of your political talk during the interview, it could cause major damage to your company image.

Discussing Politics in the Office

The Wall Street Journal found that employers typically take one of three approaches to dealing with political discus- sions in the office: Ignoring, discouraging or embracing. The approach you implement within the company should be based on the best interest of the entire team, not just a handful of director-level employees.


Are there just a handful of employees who make it their life’s goal to sway others into believing their values and beliefs are superior? Perhaps it would be best to simply ignore them anytime politics are brought up.


Do you have a relatively confrontational team who are so set in their ways that they refuse to accept any beliefs or ideas other than their own? Send out a friendly reminder that talking politics should be done outside of working hours (and even then it’s iffy).


What if you have an office full of open-minded people who enjoy working alongside each other? Make like Boston-based clothing company Karmaloop and embrace it! A friendly discussion never hurt anyone; plus, it’s a great way to nurture company culture!

By looking at the team as a whole, you can make the best decision as to whether or not any guidelines need to be put in place. Just remember to not let your own political beliefs get in the way when setting guidelines about political talk in the office.

Illegal Interview Questions - The “Election Season” Edition

Everyone knows not to talk about the “Big Three” at work (money, politics, and religion) but what about when the only thing the media are talking about 24/7 is politics? Does that make it OK inside a job interview? Maybe it’s just an accident and it slips out, or maybe hiring managers around the country are taking advan- tage of the political season by casually inquiring about a job candidate’s views during an interview.

Either way, it’s totally illegal and unethical. Need to check yourself? Here are the most common sneaky political and totally illegal interview questions asked in an job interview:

1. “So, are you voting next week?”

Ahh... a sneaky starting question that usually leads to a heated political discussion. What a way to con your candidates into blurting out something they will instantly regret so you can mentally ding* them on the spot. It’s definitely not OK to move them on to the next interviewing phase if their views reflect your own. (Just because they support a certain candidate doesn’t mean they are going to make a great Sales Manager.)

*ding or dinging is a word used by Hireologists to describe the action of turning down a candidate or physically pressing the thumbs down button in Hireology to take an unqualified candidate out of the running.

2. “Are you involved in any political organizations?”

Ooh tricky one! The candidate could think that you want to hear their involvement and participation in extra curricular activities and give you the full run down of their campaign work. But really, you just want to hear what political party they represent so you can choose to hire them or not. To avoid a potential lawsuit or the candidate making a stink on social media, don’t ask anything about political affiliations.

3. “How do you feel about Obamacare?”

This is one of the hottest issues of the election. It’s also a much debated and heated topic in health care. If you are hiring for a health care position, the candidate might not find this question sketchy and give you their full honest answer. Don’t be an unethical hiring manager and avoid any election issues in interviews.

4. “Will your religious beliefs affect your vote?”

Ouch. This is a double “Big Three” fail. There is no possible way this question can turn out to be legal and it’s down-right wrong for you to ask. Avoid any questions relating to religion in a job interview, no matter what.

5. “Who do you think won the debate last night?”

This question is pretty innocent. The candidate doesn’t have to choose a side and they can be pretty unbiased here. However this kind of small talk question usually leads to a full blown discussion where a candidate can reveal their political side. Not something you want to dive into. Avoid any questions about debates, they get people way too heated.

Talking politics in interviews is just a lawsuit waiting to happen. Don’t risk your job or your company trying to figure out if your candidate wants to, “Believe in America” or move “Forward.” Instead, focus on what traits will make them the right person for the job, even after November 6. As Tammy Gooler Loeb, a career and executive coach in the Boston area said in The Ladder’s blog, “when it comes to your personal politics, it’s best to save that for the voting booth.”We couldn’t agree more.

Does Your State Have Voting Leave Laws?

It’s a well-known fact that federal law protects citizens’ right to vote; however, there is no federal law that mandates employers give employees a specific amount of time off to do so. Many states have taken care of this and instated their own laws. Some states require employees to give reasonable notice of absence to the employer. Also, many state laws require employees to use their available time outside of work hours to cast their votes if there is sufficient time before or after work to get to local polls.

Does your state have time off for voting laws?  Find out if you get time off at


Keeping a calm office during the election is going to be hard work but don’t let that affect the culture and environment you have worked hard to create. Speaking of politics and elections, keep this quote by President John F. Kennedy in mind throughout the election:

“I am certain that after the dust of centuries has passed over our cities, we, too, will be remembered not for victories or defeats in battle or in politics, but for our contribution to the human spirit.”

About Hireology

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