Insight, analysis & opinion from Joe Paduda


Good news Friday – protecting workers and an improving economy

Lots of good stuff to start your weekend…

First a California Senate Committee passed a bill to protect workers from heat-related injuries. SB1299 establishes a presumption that:

a heat-related injury that develops within a specified timeframe after working outdoors for an employer in the agriculture industry that fails to comply with heat illness prevention standards, as defined, arose out of and came in the course of employment.

Kudos to the Committee – this type of legislation is sorely needed – and should be promoted enthusiastically by anyone and everyone concerned about protecting workers.

And shame on the California Chamber of Commerce and APCA for their objections. The bill is clearly intended to encourage employers to comply with existing heat-related standards…yet these opponents are quibbling over minor definitional issues when they should be pushing their members hard to do the right thing.

More details on heat injuries here.

Hat tip to Workcompcentral.

Inflation – or not.

Wholesale prices edged up 2/10ths of a percent last month, significantly less than expected.

Reminder – retail price increases are closely related to increasing corporate profits. It is very clear indeed that big food is a major driver of consumer inflation.


Filings for unemployment benefits were also lower than expected, yet more evidence of a very solid jobs market.




What’s driving inflation?

There’s increasing evidence that higher corporate profits are driving inflation.

From the Hill:

Adjusted profits after taxes hit a record high of $2.8 trillion, beating the record of $2.7 trillion in the third quarter of 2022. Profits increased 3.9 percent on the quarter, above expectations of around 3.3 percent. [emphasis added]

This news preceded today’s announcement that inflation ticked up 0.4% in March, a number higher than expected. Annualized the rate is 3.5%, higher than wanted but much lower than this time last year.

Consumer goods prices have gone up much more than other goods and services, with prices for packaged foods and drinks noticeably higher.

So…corporate profits AND consumable prices are increasing, with both higher than expected.

The good news is wages are still trending higher than inflation, despite the profiteering of big corporations. 

What does this mean for you?

Wages are up – which means consumers are holding their own, but increases will affect WC premiums and indemnity expenses.





Consolidation among health systems and hospitals continues apace, and with it comes higher costs, more utilization, and longer disability durations.  Get the details from WCRI’s much-watch webinar on the impact of vertical provider integration on prices, medical utilization and outcomes.

It’s on Thursday May 2 at 2 pm eastern.

You can access the written report (free for members) here.

Another major factor that will greatly affect a state’s health, outcomes and costs is Medicaid expansion. A thorough yet simple discussion of implications of one state’s refusal to expand Medicaid is here.

The benefits of Medicaid expansion are broad, deep, and impactful.

Among the findings

  • A 2020 national study found that expansion was associated with a significant 3.6% decrease in all-cause mortality,
  • Two studies found significant declines in maternal mortality
  • expansion is associated with improvements in access to care and outcomes related to substance use disorder (SUD) as well as other mental health care.
  • hospitals in non-metropolitan areas and small hospitals experienced improved profit margins
  • Analyses find effects of expansion on numerous economic outcomes, including state budget savings, revenue gains, and overall economic growth
  • rural hospitals experienced particularly substantial improvements in financial performance following expansion

KFF on Texas’ uninsured population [note Texas is just one of 10 states yet to expand Medicaid]…

(a) significant proportion of adults in the coverage gap are employed unless they are elderly or disabled. The most common jobs among adults in the coverage gap are construction laborer, cashier, cook, waiter, house cleaner, retail salesperson, and janitor. These workers usually do not have access to employer-based health insurance and cannot afford plans on the federal insurance exchange. [emphasis added]


Most of the non-expansion states:

  • have major problems with rural hospital cutbacks and closures
  • have significantly worse health outcomes
  • have healthcare access challenges

What does this mean for you?

Pay attention to the real drivers of healthcare outcomes and costs – they have more impact on duration and ultimate costs than anything else.



Another April snowstorm here in New Hampshire…weather is getting weirder by the week.

Not to worry  – we are keeping the just-arrived birds well fed!


WOW. This just in from BLS

Total nonfarm payroll employment rose by 303,000 in March, and the unemployment rate changed
little at 3.8 percent, the U.S. Bureau of Labor Statistics reported today. Job gains occurred 
in health care, government, and construction.
March's growth was significantly higher than the average monthly
gain of 231,000 over the prior 12 months.

Payroll company ADP predicted booming private sector job growth with an estimated 184,000 new jobs created last month – a big jump over the forecasted growth of 148,000 jobs.

Construction, financial services, and manufacturing sectors saw significant job growth.

Women’s NCAA tournament

Is breaking every record in sight…ticket prices for the semis are more than twice that for the men’s, viewership is off the charts, and everyone with a pulse knows who Caitlin Clark is.

Gotta love the increasing exposure for women’s sports – this will have incalculable impact on girls for generations to come.

Medicare – is NOT about to go bankrupt.

It is highly likely Medicare funding will be more than sufficient to its pay bills for decades to come. Merril Goozner provides a summary of funding’s vagaries, concluding government policy changes and economic ups and downs bounce around, but nonetheless the Trust Fund survives.

Junk fees..

Cost Americans billions as big finance companies hoover dollars out of our pockets.

Good news – efforts to drastically reduce credit card payment late fees got a big boost when a financial industry challenge to those limits was moved to a court much more likely to protect consumers.

Medicare drug prices

About 60 million folks are covered by Medicare – including your author.

Government action is helping reduce drug costs…the cost of insulin for diabetics on Medicare is limited to $35 per month, a huge drop…

From PBS…

The three major manufacturers we’re talking about, Sanofi, Novo Nordisk, and Eli Lilly, who cap their co-pays at $35, make up more than 90 percent of the insulin market. And the Medicare provisions in the Inflation Reduction Act mean that now about 1.7 million Medicare beneficiaries stand to benefit from that $35 monthly co-pay cap on their insulin. [emphasis added]

But wait…there’s more!

  • prescription costs of certain drugs for Medicare recipients is going to be capped at $3,300 annually.
  • In September the new list prices of 10 major drugs are going to be made public. That was made possible by the Inflation Reduction Act’s provision allowing Medicare to negotiate drug prices with manufacturers. Those prices go into effect in 2026
  • The annual cap on prescription costs will drop to $2,000.

The net – Medicare recipients will save big bucks.



For those I caught with my April Fool’s post…I hope you took it in the spirit in which it was intended…

Okay, back to reality (oh no….)

Hospital closures and cutbacks

Another hospital in a non-Medicaid expansion state is closing its ER and shuttering its inpatient care facility. The facility was acquired by a competitor a mile away a few years back…if this goes like most acquisitions folks around Anniston Alabama will likely have poorer outcomes and pay higher prices…

Ignore the corporate happy speak from the owners…this is the same stuff every exec that buys a rival hospital says.

Oh, and here’s research showing the link between Medicaid expansion and hospital closures.

Consolidators are doing just fine…the CEO of CHS just “earned” $8.3 million in pay and perks.

Obamacare…aka the ACA.

Remember way back when folks got all worked up about the ACA, how it was going to kill off old folks, destroy the “best healthcare system in the world”, cost millions of jobs and bankrupt thousands of small employers…and lots of people hated it?

News flash – Americans like it.  A lot.

That’s because:

  • Pre-existing conditions are covered.
  • Kids can be covered under the parent(s)’ insurance till they are 26.
  • 45 million Americans get insurance thru Obamacare and/or benefit from its provisions.
  • Provisions ensure adequate benefits for mental health, emergency care, maternity and child care and seven other key healthcare needs.
  • People who actually had Obamacare plans realized it saved lives.

Oh, and since people with health insurance are healthier than those without, if they’re hurt on the job, they recover faster and employers don’t have to pay to treat co-morbidities. 

We’re going to dive deep into the ACA in a coming week…stay tuned for more facts.

Change Healthcare cyber attack

It isn’t over. Owner United Healthcare recently stated patient data had been stolen by hackers.

This is a much bigger story – with much wider implications – than many think.

What does this mean for you?

More stuff affects you and your business than you may think. 


They lied to you.

A really scary study was just published…one that shows just how deadly healthcare misinformation is.

Not “can be”, but is.

Remember those politicians promoting hydroxychloroquine as a cure for COVID – AFTER studies showed it had little to no benefit – and was dangerous?

Well, they have blood on their hands.

A very well done meta-analysis (rigorous review of all available research studies)  estimated there were 16,990 hydroxychloroquine related deaths in hospitalized patients in six countries.

One of the studies, known as the RECOVERY trial, showed a significant increase in cardiac mortality among patients receiving hydroxychloroquine (HCQ). 

The study published in PubMed this February is here.

Two things.

First, anyone willfully lying – or passing along someone else’s lies – to people terrified of a deadly disease has much to apologize for. Would these people tell friends and family to eat rat poison?

Drive drunk?

Inject fentanyl?

Of course not – yet by pushing HCQ misinformation out to friends and family, they did much the same thing.

Second, in a case before the Supreme Court, some politicians are trying to argue that spreading misinformation – like “hydroxychloroquine cures COVID” is “protected free speech.”

What utter BS. Again, is it okay to tell kids – “hey, vaping is good for you!”… or “Sure, unprotected sex is fine!” or “No car seat needed – just carry your baby sister in your lap!”

Tobacco companies and the opioid business are just two examples of industries forced to pay billions for publishing lies.


As noted in yesterday’s post, thousands of us are dying from preventable causes…that’s really, really bad…what’s much worse is politicians legitimizing deadly disinformation. 

What does this mean for you?

Spreading deadly misinformation is NOT “free speech”. It is a cynical and disgusting abuse of power.





Good news, Friday!

Here it is, spring at last.

Well…not here in central New Hampshire where we’re going to get somewhere from 21″ of snow to…3-6″.  Gotta love the northeast in “spring”!

Income vs Inflation

Things continue to improve with worker income increases outpacing inflation.

From USAToday:

the average salary in the U.S. has grown by 5.4%, there was a gain of 3.2% in the Consumer Price Index for All Urban Consumers. This indicates that the average income increase is also an increase in people’s real income — taking into account their spending power.

Workers have seen steady increases in earnings over the last two years…

Two other items of note:

  • Black unemployment fell beneath 5 percent for the first time in history this last April.
  • There are 6 million more jobs today than in December 2019.


The CHIPS Act – bipartisan legislation that funded development of domestic computer chip research and manufacturing – is creating tens of thousands of new jobs, many in Ohio, Arizona and Nevada.

And that’s just the start.

Today, a total of zero computer chips are manufactured here…in less than 6 years, 20% of the world’s most advanced chips by 2030 will be made in the USA.

That is great news indeed for workers, families, national defense, and our position in the world as the leading innovator of next-gen technology.

Kudos to politicians on both sides of the aisle.  


One of the issues with healthcare research is studies, findings, and interpretation thereof may not factor in differences between male and female conditions, treatments, reactions to those conditions and treatments, long-term complications, and diseases and medical issues specific to either sex.

To address these disparities, The Administration announced a “new NIH-wide effort that will direct key investments of $200 million in Fiscal Year 2025 to fund new, interdisciplinary women’s health research…”

As more than half of Americans are female, this is very welcome news.

What does this mean for you?

We are getting wealthier and healthier.



Deconstructing Comp Pod!

Friends and colleagues Yvonne Guibert and Rafael Gonzalez went waaaay out on a limb and asked me to do another podcast.

I was all over the place, but Yvonne and Rafe were kind enough – and smart enough to rein me in when I diverged away from what was supposed to be the focus – impact of economics and the upcoming election on workers’ comp.

A deep dive into the economy started things off – how the House of Representatives affects physician reimbursement – and how that affects workers’ comp.

and how Medicaid dis-enrollment affects workers’ comp.

and how wage increases have outpaced inflation.

Listen on!


WCRI – the heat is on.

Kudos to WCRI – it is the first workers’ comp research organization to give center stage to the impact of climate change – primarily heat – on workers’ comp claims.

Dr David Bonauto of Washington’s Labor & Industry (state WC fund) led a session on Washington’s analysis of climate change’s affects on workers. A few quick takeaways…

There have been three studies re Heat Related Illness (HRI) in WA based on 16 years of data.  There were only about 850 accepted HRI claims out of 1.7 million…but the hidden impacts of heat are just beginning to be understood.

  • Heat increases absorption of chemicals thru the skin and potentially increases toxicity, a major concern for ag workers working with insecticides and fertilizers
  • Heat and wildfire smoke increases cardiovascular disease; it appears the mechanism is chronic inflammation.
  • Excessive heat leads to “incredibly diminished productivity”
  • There is a much higher [67%] risk of injury when temperatures are above 82-86 degrees compared to a baseline of 76 degrees.
  • The most vulnerable industry?   Public administration…my guess is this is driven by first responders and fire fighters.

thanks to MTI America’s Nikki Jackson for the slide pic

WA L&I isn’t the only organization doing credible research – WCRI research found 14% more claims occurred at times of high heat – think of these as indirectly related injuries. Falls off ladders are an example.  Great to see WCRI dig into this, although it would have been even better if we had this information several years ago.

The second employer session provided much-needed perspective from executives dating with the fallout from climate change.

Joann Moynihan from Travelers said the industry needs to broaden this dicsussion…it’s not heat claims specifically, but heat-related claims…Ms Moynihan’s words to the effect of “this is an indication of where the. industry is headed” should be a wake-up call to stakeholders who are mostly sleepwalking through massive changes to the work environment. 

Chrissy Lynch of the Massachusetts AFL/CIO described how workers in Mass are now dealing with forest fires…”we never thought we would”…that and it “doesn’t really snow here any more…we are trying to figure things out on the fly.

What does this mean for you.

Wake the *&^%** up. 


Good news Friday!…jobs and pay are both up!

275,000 new jobs last month – VERY good news indeed!

Since the beginning of 2021, over 10 million jobs have been created.

Yesterday’s jobs report showed strong employment growth across multiple industries;


Over the last 3+ years, 800,000 manufacturing jobs have been created..

Along with big job increases, wages are up too.

Last month average hourly earnings rose to $34.57 – a 4.3% increase YoY. (that’s about $69,000 a year)

From USAToday:

“Since the spring of last year, pay increases have outpaced inflation, giving consumers more purchasing power.”

What does this mean for you?

More jobs + higher wages = more payroll + more consumers buying more stuff.

Note – thanks very much to several folks at WCRI who thanked me for doing the Good News Friday posts – I appreciate you.

J.  – thanks for sharing that even though we may have different political views, you appreciate the posts.

Have a most excellent weekend!



© Joe Paduda 2024. We encourage links to any material on this page. Fair use excerpts of material written by Joe Paduda may be used with attribution to Joe Paduda, Managed Care Matters.

Note: Some material on this page may be excerpted from other sources. In such cases, copyright is retained by the respective authors of those sources.