CHARLESTON, W.Va. - West Virginia lawmakers have voted to set up a state insurance exchange, part of implementing the health-care reform law passed by Congress last year. But one public health and medical researcher reports that even if the exchange eases the financial impact of medical crises on families, it won't eliminate them.

David Himmelstein, who has researched medical-related bankruptcies for the past decade, says those bankruptcies went up substantially between 2002 and 2007, even before the Great Recession hit. Himmelstein, a professor of public health at City University in New York and an associate professor of medicine at Harvard Medical School, says the vast majority of those bankruptcies involved people who had some level of insurance.

"Most people who are driven into bankruptcy by illness and medical bills actually have coverage, but it's such inadequate coverage that it doesn't keep them from financial ruin. They're facing huge premiums and copayments and deductibles - and things that aren't covered by their insurance."

Last year's reforms probably will help but won't eliminate the problem, Himmelstein says. In a report released earlier this month, Himmelstein and his fellow researchers looked at Massachusetts in 2009, three years after it had passed a state health-reform law that served as a model for the national law.

"What Massachusetts did was to give people really inadequate coverage. It traded uninsurance for underinsurance. That really didn't work. When people were seriously ill, they ended up with such huge medical bills that they really didn't have coverage that could keep them out of the bankruptcy court."

The report suggests that substantial improvement in coverage and better disability insurance would better protect families. It points to Canada's model, where national health insurance provides universal, first-dollar coverage.

The national medical-bankruptcy study is online at http://bit.ly/AAsE0. The Massachusetts medical-bankruptcy study is at http://bit.ly/fiygJT.


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Nevada U.S. Rep. Steven Horsford - D-Las Vegas - has introduced legislation that would aim to eliminate the subminimum wage for tipped workers across the country, and also eliminate federal taxes on tips - a proposal both presidential nominees have said they would support.

It isn't the first such proposal in Congress.

Horsford noted that a disproportionate number of tipped workers across the country are women and people of color, whom he described as making "poverty wages."

He told his fellow House members the Tipped Income Protection and Support Act is about economic justice, and recognizing that service workers are "the backbone" of the U.S. economy.

"So, to my colleagues on both sides of the aisle, we cannot delay this action any longer," said Horsford. "We must act to ensure that every worker, regardless of their job, can earn a fair wage and keep more of what they earn."

Critics of the idea point out that many tipped employees don't make enough to pay income taxes, so eliminating taxes on tips wouldn't affect them.

The minimum cash wage for tipped workers in the U.S. is just over $2 an hour. Nevada has already abolished the subminimum wage for tipped workers, who now make at least $12 an hour.

Relying on customers to pay the bulk of tipped workers' wages exposes these workers to "tremendous instability of income," according to the Economic Policy Institute.

Across the country, the Institute also found poverty rates for tipped workers are more than twice as high as for non-tipped workers. Horsford called that unacceptable.

"No one should have to depend on the whims of a good tip - which is not a guarantee," said Horsford, "in order to make ends meet."

Horsford said his plan, unlike other Republican-led initiatives which would solely exempt tips from federal taxes, would go a step further and eliminate the federal subminimum wage - which he called "the crux of the problem."




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A new federal proposal to protect workers from extreme heat is being hailed as a potential lifesaver by labor advocates, even as Florida faces backlash over its heat safety rollbacks.

The proposed OSHA regulation is open for public comment until Dec. 30. It could bring long-awaited protections to millions of workers exposed to dangerous temperatures.

Micki Siegel de Hernández, national deputy director of occupational safety and health for the Communications Workers of America, said Florida recorded more than 200 heat-related worker deaths between 2010 and 2020 and she is baffled by a controversial law Gov. Ron DeSantis signed in April to block local municipalities from enacting protections for workers.

"That bill also prohibits any kind of training or posting of information. It's insane," Siegel de Hernández asserted. "It's disgusting and insane, and also blames workers in the event that they do suffer from some kind of heat-related illness."

DeSantis had sidestepped criticism of the bill by saying it did not come from him. Under the proposed OSHA rule, employers would be required to implement heat illness prevention plans, including access to water, rest breaks and shaded areas.

Siegel de Hernández noted many of Florida's workers, especially those in outdoor industries like construction and agriculture, are at risk of heat exhaustion and heat stroke.

"All of these things are preventable and without a standard, workers will continue to die," Siegel de Hernández contended. "We need to get something passed as quickly as possible."

The OSHA rule would mark the first federal legal protections for indoor and outdoor workers exposed to extreme heat. If approved, it could go into effect as early as next year.

The National Institute for Occupational Safety and Health has recommended heat safety standards since the 1970s. But this is the first time the U.S. government has proposed comprehensive heat safety regulations applicable to most industries.


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A new study showed as Texas has emerged as a national leader in wind turbine and solar energy installations, clean energy workers often face dangerous working conditions and unequal pay.

The report from a pair of advocacy groups found few Texas job sites are unionized and workers often receive low pay and lack access to benefits like health insurance, workers' compensation and retirement plans.

Bo Delp, executive director of the Texas Climate Jobs Project, said with unions on the rise in Texas and elsewhere, clean energy job sites need to give workers a voice in determining their working conditions.

"We know unionized workplaces have fewer accidents and have less income and racial inequality," Delp pointed out. "One of the things that's needed is for policymakers and for employers to lean in to that support for collective bargaining that we're seeing across the country."

The report was produced by the Texas Climate Jobs Project and the Cornell University Climate Jobs Institute. The U.S. Bureau of Labor Statistics said while union membership is on the rise in Texas, it remains one of the least unionized states. As a so-called "right to work" state, Texans do not have to join a union to get a job.

The report found work-related injuries are common on industrial-scale work sites, including those where solar panels and wind turbines are installed.

Avalon Hoek Spaans, assistant research director for the Climate Jobs Institute at Cornell University and the study's co-author, said the research showed there were often few work rules designed to prevent injuries on job sites.

"One in four workers have experienced work-related injuries on a clean energy Texas worksite and almost half of all workers surveyed have suffered a heat-related illness," Hoek Spaans reported. "Forty-eight percent of our sample had experienced a heat-related illness, 26% an injury, and 7% saw a fatality."

The study also found rampant racial inequality on job sites, with Black workers making an average of $8,500 a year less than white workers, Spanish speakers made $5,900 less and women made $2,700 less. Workers also said employers often refuse to pay overtime.