Tag Archives: health care

Senate Health Care Debate Timeline

As a follow-up to my August 2017 IM column on health care, this details recent actions on Capitol Hill. The House completed its work and passed a repeal and replacement for the Affordable Care Act (ACA) health care bill. The 2017 House American Health Care Act (AHC) was then forwarded to the US Senate for consideration. Upon receipt, the Senate determined that it needed to compile its own proposal. Hence, Senate majority members went into closed session to draft a new proposal.

The Better Care Reconciliation Act of 2017 (BCRA) was introduced as the vehicle used by Senate leadership to start the repeal and replace process. The following timeline provides a sense of Senate action, along with a glimpse at the procedural difficulty encountered after the seven-year attempt to totally eliminate the ACA. Though this process goes back seven years, we begin in 2017 with the 115th Congress, where a single party controls the House, Senate, and White House.

Health Care Timeline

May 4: House passes its version of health care reform, the American Health Care Act of 2017.

May 24: Congressional Budget Office (CBO) reports House bill (American Health Care Act) increases federal deficit by $119 billion; over 10 years 23 million would lose health care.

June 13: President Donald Trump weighs in with Senators at a White House lunch to “make the [House] bill more generous.”

June 22: Senate releases its Better Care Reconciliation Act of 2017.

June 26: CBO reviews draft Senate bill.

June 27: Senate Majority Leader Mitch McConnell delays vote; not enough votes for his Better Care Reconciliation Act (BCRA).

July 13: Republicans present updated version; moderates say new version will hurt those with pre-existing conditions.

July 15: Procedural vote delayed because of Senator McCain’s surgery.

July 17: Senators Mike Lee and Jerry Moran kill the bill by announcing they would vote against it.

July 25: Senator John McCain votes for a motion to proceed.

July 25: Senator Ted Cruz introduces a health care bill amendment to allow insurers to sell low cost health
insurance; bill is rejected by the Senate.

July 27: McConnell announces plans for his Health Care Freedom Act, or as his colleagues call it, “skinny repeal” bill; will not replace the ACA for two years or have a two-year transition period. It is supported by the White House, but Senators oppose the tactic.

July 28: ACA repeal vote takes place, defeated by all Democrats, and Republicans John McCain, Lisa Murkowski, and Susan Collins; bill would leave 16 million more people uninsured than ACA. After the vote, Trump continues to push for a health care resolution, while McConnell insists on moving on to tax reform and the debt ceiling.

July 28: House on August recess while Senate remains in pro forma session with no changes to the Affordable Care Act. (The pro forma session prevents President Trump from making recess appointments.)

For AFM members subject to requirements outlined under ACA, you should know that no additional work on health care has been scheduled. We expect more information after the August recess.

Health Care

Deciphering Health Care

Since the start of the 115th Congress, both the executive and legislative branches of government have been under single party control. The US House of Representatives, under the leadership of Speaker Paul Ryan (R-WI), and the Senate, under the leadership of Majority Leader Mitch McConnell (R-KY), with the backing of the Republican White House, have been fully engaged in repeal and replacement of the Affordable Care Act (ACA).

Once the process began in earnest, principal concerns came from Republicans who believed that the new health care bill should include provisions 1) to provide coverage for people with pre-existing conditions, 2) for those with employer-based health insurance, and 3) for cuts to Planned Parenthood. Democrats flatly rejected the bill saying that, in particular, its Medicaid cutback provisions would hurt too many elderly and poor Americans by eliminating Medicaid expansion eligibility included in the ACA. Democrats also complain the bill may cause unnecessary spikes in premiums for low-income families, older Americans, and those with pre-existing conditions.

The Medicaid Debate

Chief among concerns is the gradual elimination of the ACA Medicaid Expansion Program eligibility written into the new Republican House and Senate Bills. Both the Senate and House bills phase out extra money that the federal government has provided to states under ACA as an incentive to expand eligibility for Medicaid. More importantly, this means that seniors would receive fewer health care benefits under the new Senate and House bills.

What is Medicaid (not to be confused with Medicare)? It is a government funded health care program that provides health insurance to people with disabilities, the elderly, low-income seniors, and families with children and pregnant women. It helps pay medical expenses for those who cannot afford comprehensive medical coverage. Medicaid is financed by both federal and state governments. However, each state manages its own Medicaid program and decides its own rules for participation.   

What is Medicaid Expansion? The federal government website Medicaid.gov defines the program as expanded eligibility coverage under ACA for the poorest Americans. ACA created an opportunity for states to provide Medicaid eligibility, effective January 1, 2014, for individuals under 65 years of age with incomes up to 133% of the federal poverty level (FPL). For the first time (under ACA), states could provide Medicaid coverage for low-income adults without children with guaranteed coverage through Medicaid in every state without need for a waiver.

House Deliberations 

After a month of wrangling, the new health care bill was withdrawn from consideration due to moderate and conservative Republicans who threatened not to vote for it until outstanding issues were resolved.

In the House, the Congressional Budget Office (CBO) score was not released until after the bill passed. The eventual nonpartisan score showed that 15-23 million Americans could lose their health care benefits by 2026, more than if Obamacare remained intact. The new American Healthcare Act (HR 1628) passed the House May 4 by a vote of 217 to 213.

After House passage, the bill moved to the Senate. Senators agreed to disagree with significant elements of the House bill and decided to totally rewrite it. As the House moved expeditiously to put a bill in place, the Senate worked behind closed doors with 13 Republican Senators drafting a revised bill. There was major concern over the bill being drafted without a CBO score analyzing its cost. The Senate decided to delay releasing its bill until all the pieces are in place.

Democratic Senators protested because the bill was not subject to committee hearings or debate on the floor. Now, Republican senators who heard from angry constituents at town hall meetings during their recess are carefully considering their options. Meanwhile, political pundits continue to calculate the impact of possible losses of Republican seats if the bill is signed into law without the support of voters.

The Senate bill was recently released with deep cuts to Medicaid and ending the ACA mandates for purchasing insurance, maternity care provisions, emergency services, and mental health treatment.

Now that the July 4 holiday recess has ended, the Senate is moving toward a full vote in the chamber. As of this writing, four Republican Senators will oppose it: Rand Paul (KY), Ted Cruz (TX), Mike Lee (UT), and Ron Johnson (WI). Cruz has introduced his own amendment that is now under consideration. Vice President Mike Pence, President Donald Trump, and Mitch McConnell are negotiating hard with reluctant Senate members to move the bill forward as opposition voices continue to grow from Members like Susan Collins (R-ME). Further complicating forward progress on the vote is the absence of Senator John McCain who recently had eye surgery and will be away from Washington for approximately two weeks. Failure to hold a vote could mean that no bill would pass this year, leaving the ACA as the “law of the land.”

The White House continues to weigh in with uncommitted Republicans suggesting that Trump would like to see the outstanding issues resolved and have a bill in place and ready for his signature before congress takes its August recess. At this writing, less than three weeks before August 1, few members of Congress have hope that an agreement can be reached in time. Some in leadership are beginning to believe that the best chance they have for passage of the Senate bill is to reach out across the aisle and include Democrats in the negotiations. Trump has now suggested that the Senate consider first repealing the ACA and then replacing it. Not all members of Congress support that solution.

health care

Renewed Focus on Arts, Health Care, and Performance Rights

NEA and CPB Funding

In a May 31 communique, AFL-CIO President Richard Trumka released an analysis of the White House’s FY 2018 federal budget. Within the Document entitled, Budget of the US Government: A New Foundation for American Greatness, the White House made several recommendations that cut short the ability of the US Government to invest in arts and culture. Under the section “Other Programs and Agencies Eliminated,” they list the Corporation for Public Broadcasting, the National Endowment for the Arts, and the National Endowment for the Humanities.  

The White House’s March 18 budget release was merely an outline of the budget, which allowed AFM members to organize a Save the NEA campaign, an email campaign to Members of Congress expressing AFM members’ discontent over White House budget cuts to the arts. This successful mobilization program allowed AFM members, family, and friends to send approximately 4,301 emails to members of Congress encouraging them to make adjustments in the congressional appropriations process to recognize the intrinsic value of arts funding. In particular, such funding promotes a vibrant economy that, in turn, generates and contributes significant tax dollars designed to reinvest in local communities. For every dollar contributed by the NEA, the agency generates eight dollars to the community’s financial well-being.

Our work continues with the letter writing campaign in support of the tireless efforts of the House Arts Caucus led by Representative Louise Slaughter (D-NY) and Leonard Lance (R-NJ), along with the Department for Professional Employees of the AFL-CIO, the Congressional Arts Group, and myriad other individual artists and arts organizations across the country. If you have not written a letter to Congress on this vitally important issue, please visit the AFM website (www.afm.org/2017/02/nea) for information.

Health Care

Republicans are looking to complete the repeal and replacement of the Affordable Care Act (ACA), or Obamacare. The new legislation, which passed the House May 4 by a vote of 217 to 213 (with 20 Republicans and all Democrats voting against it), is now under consideration in the Senate. The House bill suffered through interparty squabbling as various Republican caucuses disagreed with certain provisions. There were fears that, if passed, the poorly crafted bill could lead to a Democratic takeover of the House of Representatives.

Among principal concerns from Republicans was the belief that the bill should include provisions for coverage for people with pre-existing conditions, as well as those with employer-based health insurance. After a month of wrangling, the bill was yanked from the floor, with both moderates and conservatives threatening not to vote for the bill until these issues were worked out.  

In the House, the Budget Office (CBO) score was not released until after the bill was passed. It showed that more than 23 million Americans could lose their health care benefits by 2026—more people than if Obamacare remained intact.

After House passage, the bill moved to the Senate where Senators agreed to disagree with the content of the bill and decided to totally rewrite it. As the House moved as quickly as it could to put a bill in place, the Senate worked behind closed doors with 13 Republican Senators drafting a revised bill. There was major concern over the bill being drafted without a CBO score analyzing its costs. The Senate decided to delay releasing its bill until all the pieces are in place. Democrats protested because the bill will apparently not be the subject of committee hearings or debate on the floor. Democrats also complain the bill may cause unnecessary spikes in premiums for low-income families, older Americans, and those with pre-existing conditions.

As of this writing, the Senate is looking to release its bill by June 19, aiming for a full vote in the chamber just prior to the July 4th holiday recess. Many senators are hoping for a revised CBO score before they vote for the bill.

Fair Play Fair Pay Act

The AFM’s work toward a legislative solution to a performance right on AM/FM radio continues. H.R. 1836, the Fair Play Fair Pay Act, which was introduced by Congressman Jerrold Nadler (D-NY) and Marsha Blackburn (R-TN), is a key piece of legislation being spearheaded by the musicFIRST Coalition. First, the bill levels the playing field by having AM/FM radio stations pay performance royalties for music they air. Secondly, it provides real protection for small, local stations (AM/FM stations with annual revenues below $1 million) to pay just $500 a year. Public, college, and other noncommercial stations would pay only $100 a year. Religious radio, talk radio, and those stations with incidental use of music would not pay royalties. The bill also contains language that provides copyright protections for pre-1972 artists who currently do not receive royalties for their works.

The coalition is currently working with House Judiciary Chair Robert Goodlatte (R-VA) and Ranking Member John Conyers (D-MI) to bring the parties together. Nadler, Blackburn, and the musicFIRST Coalition continue to build support of cosponsors for the package. Despite broadcaster efforts to stop the bill, and thanks to the work of an ambitious team of legislative representatives, the bill continues to build bipartisan co-sponsorship.

More importantly, through musicFIRST, the AFM is working to help build a comprehensive music package that includes Copyright Office Reform and HR 1914, the PROMOTE Act offered by Representative Darrell Issa (R-CA), which would provide the right to copyright owners to prohibit the use of sound recordings by broadcasters, unless permission is granted by the copyright owner.

Health Care Open Enrollment

Don’t Miss Health Care Open Enrollment Now Through January 2017

Did you know that an unexpected trip to the hospital could cost you and your family more than $2,000 a day? The hefty price tag does not even include prescription drugs or medical procedures, which easily can add up to tens of thousands of dollars. Medical bills are the leading cause of all bankruptcies in the US. Health insurance can protect you from an unexpected financial hit due to accident or illness.

Not only that, as of 2014, you are required to have health insurance or pay a tax penalty. The period to shop for and switch coverage for next year, November 1-January 31, 2017, has just begun. Even if you already have coverage, you might want to re-evaluate your current plan.

Reasons to re-evaluate your current plan:

• It costs too much.

• It does not provide the coverage I (or my family) need.

• Your current health insurance company does not pay medical bills quickly and efficiently.

• Your current health insurance company does not provide good customer support.

• You do not have dental or vision coverage.

Plans fall into four categories, from lowest cost/least coverage to highest cost/most coverage they are: bronze, silver, gold, and platinum. Coverage also varies based on category, provider, and geographic area. If you feel confused when it comes to comparing plans, you are not alone. That’s one of the reasons the Working American Health Care (www.workingamericahealthcare.org) was launched.

AFM members and their families are eligible to shop for a plan through Working America Health Care. In partnership with Working America and Union Plus, AFL-CIO affiliate Working America Health Care connects union members to quality health insurance. The plans available through the marketplace include important consumer protections that meet or exceed coverage requirements to avoid the tax penalty. Unbiased, licensed professionals at Working America Health Care can help you:

• Figure out if you qualify for financial help in paying for a plan.

• Identify plans available to you in your geographic area.

• Evaluate plans to find the best fit (cost versus coverage) for you and your family.

Once signed up with a plan, you can access additional vision and dental discount programs. (Call 1-877-570-4845 or visit: workingamericahealthcare.org/why-working-america/dental-and-vision-coverage).

In addition, Working America Health Care Advocates (available 24/7) can help you coordinate medical care, locate the right providers, explain conditions and treatment, resolve claims, and answer coverage questions. Best of all, these advocates will help you understand your coverage and protect you from being wrongly charged or over-charged.

Transparent Agreement

Transparent Agreement Shows Pride for Musicians

Transparent Agreement

AFM Local 47 (Los Angeles, CA) musicians, union officials, and JLC Western Region Executive Director Leslie Gersicoff leaflet outside a Transparent shoot March 29. The show’s producers recently agreed to sign an AFM agreement to cover its musicians. (Photo by Linda A. Rapka)

The AFM and Local 47 announced that an agreement has been reached with the producers of Amazon original series Transparent to cover musicians working on the show under a union contract.

Producers at Picrow swiftly agreed to sign on to the AFM television and new media agreement after musicians from the Los Angeles musicians union spoke out publicly late last month asking where was the pride for musicians, pointing out the unequal treatment of musicians who were not covered under a labor contract unlike all the actors, writers, directors, crew and other workers. 

The new contract covers the employment of professional musicians, arrangers, copyists, leaders, conductors, and sideline musicians, guaranteeing they will receive fair wages, benefits, health care, pension, and other union protections.

“We thank Transparent producers at Picrow for stepping up to treat musicians as equal workers,” says AFM Local 47 President John Acosta. “Musicians contribute as much to a production as all other workers, and we are happy that those working on the series will receive fair treatment, dignity and respect in the workplace.”

Are You Getting the Most from Health Care Reform?

It’s been five years since Congress passed health care reform, but many people are still missing out on possible savings, like lower premiums and out-of-pocket costs, just because they don’t know about them. The Center for Medicare and Medicaid Services (www.cms.gov) and www.healthcare.gov are two websites that can provide detailed information on how you can save on health insurance. The chart below can be used as a general guide.

Are you thinking about getting coverage, but finding yourself overwhelmed by all your options? Visit the Working America Health Care (WorkingAmericaHealthCare.org/AFM) website, or call 1-855-589-4253, to get personalized, unbiased support before, during, and after plan enrollment. As a member of the AFM, you can have a complimentary personal health advocate answer questions about coverage, help you understand your benefits, recommend doctors, help negotiate medical bills, and much more.

Health Insurance Lingo


When people try to explain how the Marketplace health insurance under the Affordable Care Act (ACA) works, it may sound like a foreign language. Here is a glossary of some key health insurance words to help you better understand the jargon:

Network: the facilities, providers, and suppliers your health insurer has contracted with to provide health care services. Through your insurance provider you should be able to find out which providers are “in-network,” sometimes called “preferred-providers” or “participating providers.” It may be more expensive to see an “out-of-network” provider. (These networks do change, so check with your provider each time you make an appointment to find out how much you will need to pay.)

Deductible: the amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services, subject to the deductible. The deductible may not apply to all services.

Co-insurance: your share of the costs of a covered health care service, calculated as a percentage of the allowed amount for the service. You pay co-insurance, plus any deductibles you owe. For example, if the health insurance plan’s allowed amount for an office visit is $100, you’ve met your deductible, and your co-insurance payment is 20%, you would pay $20. The health insurance or plan pays the rest of the allowed amount.

Co-payment or co-pay: an amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or prescription drug. A co-payment is usually a set amount, rather than a percentage. For example, you might pay $10 towards a doctor’s visit, lab work, or prescription.

Premium: the amount that must be paid for your health insurance or plan. It is paid monthly, quarterly, or yearly, and is separate from your deductible, your co-payment, or your co-insurance. If you don’t pay your premium, you may lose your coverage.

Out-of-pocket maximum: the most you pay during a policy period (usually one year) before your health insurance or plan pays 100% for covered essential health benefits. This limit includes deductibles, co-insurance, co-payments, or similar charges, and any other expenditure for a qualified medical expense. This limit does not include premiums or spending for nonessential health benefits.

Explanation of benefits (or EOB): a summary of health care charges that your health plan sends you after you see a provider or get a service. It is a record of the health care you, or individuals covered on your policy, received and how much your provider is charging your health plan. If you have to pay more for your care, your provider will send you a separate bill.

Health Insurance Checklist

health care


With more than 10,000 options through the Affordable Care Act (ACA) Marketplaces, it’s critical to know what you want from your health insurance to get the most value for your family. Here’s a list of items you will want to consider.

  • Does the plan provide coverage for pre-existing conditions, maternity care, mental health services, prescription drugs,  and dental and vision care?
  • Does the plan have long waiting periods?
  • Does the plan provide other support and wellness services for its members?
  • How much will the plan cost each year, including the premium, deductible, co-payments and/or co-insurance, and out-of-pocket maximum? What is the lifetime limit on coverage?
  • How large is the plan’s network and how close are you to the plan’s doctors and hospitals?
  • Does the plan have a clear arrangement for specialist referrals?
  • How does the plan’s disputed claims appeal process work?

Even if you’re already insured, it’s still a good idea to shop around with the Working America Health Care program.

How to Take Care of Your Eyes

EDITOR’S NOTE: The following article is a result of research conducted across a number of health-related Web sites. The AFM does not endorse any specific remedy for eye problems and urges members to consult a medical practitioner before deciding on a course of action.

Eye problems are an often-overlooked health issue for professional musicians. The effort eyes make to read sheet music or follow the conductor while peering around an instrument can lead to a number of common, but treatable, complaints.

Unfortunately, opticians aren’t always sensitive to the specific concerns musicians have with their eyes. For instance, a one-size-fits-all approach to correcting vision may not work when there are so many different tasks eyes perform in an average day. A musician who logs off the computer, drives to work, performs for an evening, then goes home to watch the “Late Show with David Letterman” on TV, before reading in bed, ideally might need different glasses for each task. Fortunately, opticians who are used to treating increasingly widespread computer-related eye disorders suggest their advice can also help working musicians.

A typical complaint of professional musicians is eyestrain. Its cause is similar to that which leads to the same diagnosis in computer users. The eyes just aren’t meant to repetitively scan the small text of a music score or computer screen at a distance of two or three feet for long periods of time. Close focusing and repetitive scanning can even lead to a condition called “spasms of accommodation.” This is when the eyes’ overworked muscles spasm and are no longer able to adjust when a musician looks at something far away. Everything distant becomes blurry because the muscles have lost the ability to focus. Another more serious consequence of eyestrain is ocular migraine, a condition believed to be caused by a spasm of blood vessels brought on by eyestrain and which leads to visual disturbances. Opticians consider eyestrain a form of repetitive stress injury, which takes time to develop and a long time to treat.

Two other eye problems that commonly affect musicians were identified in a study conducted by Dr. Paul Alan Harris and published in a 1988 edition of The Journal of the American Optometric Association. Harris studied orchestra members in situ and found that peculiar working conditions led to diagnoses of astigmatism (abnormal curvature of the lens) and anisometropia (a large difference between the refractive power of the two eyes). Specifically, different vision problems arose depending on which instrument was played and where a musician sat. For instance, Harris found that a bass clarinetist, who habitually tilted his head back to play and looked left to view sheet music and conductor, had a significantly astigmatic right eye.

Whether you wear corrective lenses or not, there are several actions that can be taken to reduce the risk of eye trouble:

  • Wear the correct lenses to play. A pianist’s glasses that are good for reading books might not be suitable for reading a score. She’ll have to have another pair to read the music; if not, she’ll probably find herself leaning forward in order to get the notes in focus. Modern lenses have been developed that can help musicians. Three of these are “progressive bifocal” lenses, “trifocal” lenses, and “variable focus lenses,” sometimes called “computer glasses.” The days when only grandpa wore bifocals might be over; opticians are prescribing these multi-task lenses even for young children these days.
  • Lubricate your eyes. One trick to avoid eye problems is also very simple: blink! Concentrating on a score during a recital might mean a musician forgets to blink, and when the cornea dries out, eyes can start to ache. Musicians who wear contact lenses are prone to dry eyes, especially if seated close to air conditioning ducts in an orchestra pit, so they should either make liberal use of artificial tears, or wear their glasses when performing in the pit.
  • Adjust the music stand correctly. The top of your sheet music should ideally be at or just below eye level to avoid straining. If the stand must be below eye level, it is better to lower the eyes than tilt the head. Avoid eye problems caused by neck rotation by placing the stand directly in front of you. Also, if you have a choice between wearing glasses or contact lenses, the latter might be preferable as they allow for better peripheral vision which in turn can reduce the need for neck movement.
  • Find an optician who understands. A musician’s eyes are arguably as important as his or her hands. If you think you have work-related eye trouble, find an optician who is sensitive to this issue or who works with other musicians. One professional musician suggests going as far as to bring your instrument, music stand, clip light, and sheet music (preferably a complex score with lots of minute instructions) to the clinic so the optician can get to know your working conditions and individual needs.

Tips for Saving Money on Health Care in 2015

While the Affordable Care Act (ACA) has given more Americans access to health insurance, many of the plans come with high deductibles. The percentage of insured workers who face a deductible of $1,000 or more grew from 6% in 2006 to 32% in 2014. Today, consumers need to approach medical care as they do other purchases—shopping for both quality and price. Unfortunately, our health care system is not set up for easy comparison shopping. Here are some tips for saving money on health care in 2015.

Check Your Bills and Statements

Know your insurance policy and what it covers before you need to use it. Read the fine print to find out about preapprovals, emergency room visits, copays for doctor visits, and coinsurance for procedures, as well as “wellness” benefits like preventative care screening, gym membership, and weight loss programs.

Always ask for itemized bills and check them, as well as insurance company statements for errors. Was the same procedure covered for one member of your family and not another? Was it covered last time and not this time? Don’t be shy about asking your doctor’s billing office to resubmit a bill to your insurance company for an item you believe should have been covered.

The same goes for calling the insurance company to question why certain items were not covered. Even those with the best insurance policies often get bills for procedures that should be covered. A mistake in coding can mean a difference of hundreds of dollars.

Prescription Medications

Check prescription medications to see if any of them have gone off patent. For medications that are off patent there may be cheaper generic equivalents. Consult your prescribing physician before switching. When a doctor prescribes a new drug, ask if there are less expensive alternatives.

Many pharmacies extend special offers on certain prescription drugs. Shop around for the best discounts. Search web pharmacies and mail order pharmacies for even deeper discounts. Check the website GoodRX.com, which gives price comparisons based on your location.

Live Healthy

Probably the best way to be proactive about health care savings is to be proactive about your health. Eat well, exercise, and steer clear of unhealthy habits like smoking and excessive drinking. According to the Center for Disease Control and Prevention (CDC) it costs 18% more to insure a smoker. Medical costs for people who are obese are also significantly higher.

Many insurance companies now offer good health incentives to clients to maintain or improve their healthy lifestyles. Sometimes they will provide a percentage off the cost of gym membership or weight loss programs.

Preventive care is another key to keeping health care costs down over time. Annual checkups give your doctor an opportunity to recommend screenings, provide medical advice, and identify health concerns before they become major issues. By law, ACA-compliant insurance plans offer a number of screenings with no copays. When possible, also take advantage of free screenings provided at health fairs.

Shop Around and Plan Ahead

If you need to see a doctor after hours, don’t visit an ER unless the condition is truly life-threatening. Consider an urgent care center or convenience-care clinic. You can save hundreds of dollars for relatively minor issues like stitches for minor cuts, a sprained ankle, or routine x-rays. Investigate the facilities near you before you need them so you can make the right choice when you do.

Items like flu shots, physicals, and cholesterol and blood tests may be cheaper at walk-in retail clinics. Blood can sometimes be drawn at a clinical laboratory service. Instead of paying for 20 sessions of physical therapy, pay for one and learn exercises to do at home. Get copies of all your medical test results and records. Bringing them to consultations can cut the number of tests and office visits required.

Be sure to compare prices. Don’t be afraid to ask about prices and discounts for cash payment and express the fact that cost is a concern to you. Ask a lot of questions: Is this test really necessary? Are there less expensive alternatives to this treatment? Is it possible to wait and see if the issue resolves before ordering an expensive test?

Nailing down a price is difficult because there are multiple players involved in most procedures. One clinic’s fee may include the surgeon, anesthesiologist, and facility, while another may bill separately for each. Find out the specifics, make sure they’re all part of your insurance plan, and then compare prices.

Reassess Your Coverage

Hold onto all of your out of pocket health care receipts for the entire year. This includes all medications, deductibles, eyeglasses, and dental care. If you are the primary caregiver for an older relative keep receipts for those expenses as well. A tax preparer or accountant can advise you on possible deductions.

As the year winds to a close and the next open season arrives, it’s time to examine how your insurance policy is working for you. The coverage you selected last year may no longer be the best option. Information online can be incomplete or outdated, so call the your doctors to make sure they’re still participating in plans you’re considering.

Could the Working America Concept Work for Musicians?

One of the fastest growing organizations in the country is Working America (www.workingamerica.org). It mobilizes working people 365 days a year, contacting them at home to talk about jobs, health care, politics, and items that working families confront daily. The AFL-CIO initiated Working America to target nonunion working people. These are people who do not have the benefit of collective agreements.

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Healthy Families Act Would Let Workers Earn Sick Time

In February, Senator Patty Murray (D-WA) and Representative Rosa DeLauro (D-CN) introduced the Healthy Families Act to give workers the opportunity to earn up to seven paid sick days. More than 43 million American workers currently earn no sick time and have to make a choice between losing wages and staying home if they or a family member are ill.

According to the AFL-CIO website, more than four in 10 private-sector workers and 81% of low-wage workers do not have paid sick days. A 2014 study by the Institute for Women’s Policy Research shows that Latinos and those who make less than $20,000 a year are the workers least likely to have paid sick days. Even worse is the fact that many of the workers without sick days are food preparation or service workers, despite health department recommendations that these workers not go to work sick.

There is growing momentum across the country to pass paid family leave and paid sick days legislation. Twenty jurisdictions nationwide now have paid sick day laws in place. Philadelphia is the most recent city to pass legislation.