Voters this week approved a minimum wage hike in four states, funding for a safety net hospital in Arizona, and the so-called "any-willing provider requirement" initiative in South Dakota.
Minimum wage workers in four states will be able to celebrate the New Year with a slightly higher salary—and their employers, including hospitals and healthcare systems, will have to find a way to tighten their belts a bit.
While Tuesday's election results shifted political power in the U.S. Senate to the GOP, voters in Alaska, Arkansas, Nebraska, and South Dakota empowered low-wage earners to receive minimum wage increases (Illinois had a non-binding minimum wage question on its ballot.)
Minimum wage workers often include healthcare support occupations, personal care and service employees, cafeteria workers, administrative support roles and other jobs that can be found in any large hospital.
Population Health and Wealth
"We think having a living wage is tied to everyone's health and well-being," says Liz Jacobs, RN, a spokesperson for National Nurses United. "[Our organization has] long endorsed and worked for a living wage for everyone. We're very concerned about inequality—and it's only getting worse."
A wage hike for healthcare workers—has direct effects on the health of a population, says Jacobs. It affects their ability to purchase medical coverage, to eat healthy foods and afford copays. Additionally, from a management standpoint, paying employees more can lead to higher levels of employee engagement—which can lead to better patient engagement and higher HCAHPS scores.
"I think this will contribute to employees themselves having a better quality of life, and that in turn could improve their morale in their workplace. I've spoken to low-wage workers in hospitals that have health insurance, but have chronic health conditions that they can't get treated because they can't afford the co-pays."
While concerns over layoffs, hiring freezes, and other effects of raising personnel costs are frequently cited by those opposed to an increased minimum wage, Jacobs remains unconcerned and resolute. "The recent elections show the tremendous public support for raising the minimum wage in cities across the country, so I imagine hospitals might try to find another excuse if they want to do hiring freezes or layoffs."
Wanted: Higher Wages
Other labor organizations echo Jacobs' sentiments.
"In deeply conservative states like Nebraska and South Dakota, the economy isn't working for working people and the message from voters was clear: we've got to increase wages," says Mary Kay Henry, president of the SEIU, which represents over 1.2 million healthcare workers, in a statement issued by her office.
Healthcare leadership is still weighing the impact of these new laws, but it does not appear to be a big issue in Alaska. "To date, [the minimum wage increase] has not risen as a significant issue in Alaskan hospitals," says Becky Hultberg, president and CEO at the Alaska State Hospital and Nursing Home Association, where minimum wage will raise from $7.75 per hour to $8.75 per hour on January 1—and then to $9.75 per hour the following year.
State hospital association leadership in Nebraska and Illinois declined to comment on this story; The South Dakota State Hospital Association and the Arkansas Hospital Association were unavailable.
AZ Voters Back $935M for Safety Net Health
By an almost two-to-one margin voters in Maricopa County Arizona approved a $935 million bond issue Tuesday to pay for significant upgrades to the Maricopa Integrated Health System.
MIHS President/CEO Steve Purves says 63% of the voters backed Prop. 480 because they "understand and appreciate the vital mission we have as a safety net system of care."
"We take care of the vulnerable. We also have the second-largest burn center as part of our organization. We do things that nobody else does," Purves says.
"We have a vital and very important teaching mission. We are the second-largest provider of medical residency programs in the state. In fact, we are the state's first sanctioned teaching hospital by American Medical Association back in 1954. People understood that every major metropolitan area and vibrant community needs a healthy public healthcare system. Those things resonated with the voters."
Maricopa voters were not necessarily in a giving mood on Tuesday. For example, 66% of them voted against Prop. 304 to raise state legislators' annual salaries from $24,000 to $35,000.
Purves says the MIHS took great pains to explain to the public what the Prop. 480 money would be used for, and how much the bond would cost for each taxpayer "down to the penny" over its 27-year assessment.
"That way they can put that into context," he says. "For example, for somebody who owns a $100,000 home that would increase their property taxes by $13.74 a year. When you break that down on a monthly basis you begin to see what it costs and what you get. That value proposition in our case resonated overwhelming with our community."
With the new funding, $570 million will be used to upgrade acute-care facilities, including a new Maricopa Medical Center, $225 million will fund new behavioral health facilities, and $138 million will target outpatient facility construction and upgrades, Purves says.
Engaging the public is critical for safety net hospitals and should be part of the job description for senior leadership and oversight boards, he adds.
"Especially hospitals that rely on public tax support have an obligation to communicate regularly and strongly with the community what they are doing with the resources they have been entrusted with," Purves says.
"That is what we have done. If people don't know what you are doing, if they don't know your relevancy, then why would they ever support an increase in their taxes to support your mission if they don't know what your mission is?"
SD Voters OK Network Expansion
In South Dakota, voters passed Initiated Measure 17, which had pitted providers against payers. The measure permits any healthcare provider to join an insurance company's network, as long as the provider agrees to the company's terms and conditions, and works within the company's coverage area.
IM 17, also known as the "any-willing provider requirement" was opposed by insurers, such as Sanford Health Plan, on grounds that it would cause healthcare costs to rise.