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. 


“AI-djusters” are becoming a reality.

It’s happening sooner than expected…a new entrant into the workers’ comp insurance business (following other P&C lines by companies including Omnius) is pursuing regulatory approval for and licensure of an “AIdjuster”.

Notably this goes far beyond current thinking, described in a recent Risk and Insurance piece as:

By reducing administrative workloads, AI can give claims adjusters more time to spend with injured workers.

This is replacing adjusters with technology, technology that will:

  • interact (both verbally and electronically) with providers, injured workers, and employers;
  • constantly evaluate those interactions to identify red flags or barriers to progress;
  • better estimate future costs, duration, reserves, and return to functionality;
  • leverage provider data to identify potential abuse or overuse;
  • constantly update the worker’s profile and compare it to job requirements (from past job to transitional jobs to potential new employment)

There’s a raft of complications with one of the most obvious being state requirements for human licensure. I spoke with the company’s Chief Claims Officer, Aprille Pfuehle PhD. Dr Pfuehle noted:

There’s a raft of complications with one of the most obvious being state requirements for human licensure. This can easily be addressed by having a human adjuster “oversee” the AIdjuster’s work…We are also working on logic to insert a human adjuster into claims issues based on our algorithm’s determination that a human intervention is optimal…

While it seems pretty sudden, reality is many industry stakeholders have been working towards this for some time.

But…Color me skeptical...there is so much nuance to the job, experience is critical, human interaction essential, and empathy critical…that and AI is still awfully new, risky, and more than a bit weird.

Yet…the factors driving the “AIdjuster” may outweigh those needs. When I asked how they were expecting widespread adoption, Dr. Pfuehle seemed quite confident, alluding to the staffing challenges facing insurers and TPAs;

  • an aging workforce;
  • lack of training;
  • a talent war accelerating turnover;
  • lots of other opportunities for potential new hires;
  • a difficult, trying, and sometimes quite frustrating work environment; and
  • increasing labor costs while premiums are shrinking.

Pfuehle also opined that the P&C industry’s chronic under-investment in IT all-but ensured their venture would succeed, stating:

They just don’t have the financial or talent resources to do what has to be done (building AI capabilities)…our solution eliminates the need for massive investment with an uncertain result, while allowing insurers to greatly improve their financials by eliminating much of their administrative costs...

The implications are broad indeed; In conversations with claim execs,  the adjuster shortage is one of the factors driving insurers to outsource claims to TPAs…lack of training is another major obstacle, rising labor costs yet another and both contribute to a lack of consistency in claims handling.

That and WC profits are desperately needed to fund losses in most other lines...and thus can’t be invested in tech.

What does this mean for you?

What’s fantasy today is reality tomorrow.


Good news…Friday!

First, it’s…Friday – reason enough to celebrate!

Second, the baseball season opened this week…although my beloved White Sox lost to Detroit, the Sox had very good pitching and defense. Yeah, they won’t be good this year but at least they’ll catch the ball…

Third, women’s NCAA hoops has been really fun. Watching Caitlin Clark – wow. That plus how much she inspires girls is making for the best championship in forever.

Fourth, the US economy is doing very well, with new data showing production increased more last month than previously reported, AND

business and household income jumped almost 5% in the last quarter of 2023 while core inflation dropped…

From Barron’s

Finally, in another win for consumers the Biden Administration’s effort to force a cap of $8 on late fees for credit card payments is making progress. That would be a big help for those who miss a deadline…the AVERAGE late fee is $30.

From Accountable USA

CFPB identified late fees as “the most significant fee assessed to cardholders in both dollar amount and frequency” and a major contributor to the more than $1 trillion in outstanding credit card debt in 2022.

What does this mean for you?

Things are getting better. Well, not including the White Sox’ chances of a winning season…


Two big things

Aren’t getting near enough coverage from industry media.

We’re talking about the battle over prior authorizations (PA) and the Change Healthcare cyber attack.

Both have major implications for healthcare and workers’ comp; I’ll very briefly summarize both here and we’ll dive in next week.

Prior Auth.

PAs are used by healthcare payers to evaluate medical procedures, drugs, facility services and treatments before approving them. There’s been a major effort by the AMA and others to restrict the use of PAs, claiming PAs are all about increasing insurer profits, harming patients, delaying care, and leading to the end of civilization.

Well, maybe not the last, but pretty close.

PAs were instituted decades ago because some treatments/services/procedures/ hospital stays appeared to be unnecessary.

Several states appear ready to restrict the use of PAs or otherwise limit their use, add requirements and tighter time limits. 

Needless to say, there’s a lot of claims and counter-claims out there, some pretty strident with language intended to inflame.

Net – keep a close eye on this…it’s an election year and pols may well lean into the PA fight…likely on the side of physicians.

Change cyber attack.

I posted on this a few days ago…Change, which is part of UnitedHealthcare’s Optum subsidiary, suffered a major cyberattack a few weeks ago, one that has crippled a huge chunk of payer-provider electronic communications.

From WebMD

Change Healthcare, part of Optum and owned by UnitedHealth Group, processes about half of medical claims in the U.S. for about 900,000 doctors, 118,000 dentists, 33,000 pharmacies, 5,500 hospitals, and 600 laboratories…

Much of the system is (reportedly) back up and running, but the fallout  – severe cash crunches for small practices, delays in PA transmissions, confusion on what’s covered and what isn’t – continues to make life miserable for office staffs, providers, insurers and banking entities. 

Net – expect the Feds to dive deep into this, assess impacts, require much studier cyber protections and regulatory controls/monitoring of healthcare’s electronic information exchanges.

note – Change was an HSA consulting client prior to it’s acquisition by Optum.



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.





The Pro-Life solution to the US health crisis

There’s a health crisis in the US – more people are dying younger, most from preventable diseases.

The good news is this is fixable. Sure there are any number of causes –

  • the opioid epidemic continues to destroy lives,
  • more kids are killed by firearms than anything else;
  • cancers associated with pollution are a major killer in some states;

all of which require thoughtful and very well-executed policy changes…which will take a lot of time, during which many more of us will die.

Like any complex problem the first task is to determine where the problem is. Thanks to the CDC, we know.

The lightest shaded states have the lowest life expectancy…

And the deepest red indicates states have the longest life expectancy.

8 of the States with the two lowest life expectancies have not expanded access to Medicaid…

And all of the States with the highest life expectancy HAVE expanded Medicaid.

Healthier people – kids, moms, grandparents, the disabled – live longer, more productive lives. And people with access to healthcare are far healthier than those without.

What does this mean for you?

If you are pro-life, the solution is blindingly obvious.


Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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