Tagged Insuring Your Health

Tax Bill Provision Designed To Spur Paid Family Leave To Lower-Wage Workers

Tucked into the new tax law is a provision that offers companies a tax credit if they provide paid family and medical leave for lower-wage workers.

Many people support a national strategy for paid parental and family leave, especially for workers who are not in management and are less likely to get that benefit on the job. But consultants, scholars and consumer advocates alike say the new tax credit will encourage few companies to take the plunge.

The tax credit, proposed by Sen. Deb Fischer (R-Neb.), is available to companies that offer at least two weeks of paid family or medical leave annually to workers, but two key criteria must be met. The workers must earn less than $72,000 a year and the leave must cover at least 50 percent of their wages.

If contributing at the half-wage level, a company receives a tax credit equal to 12.5 percent of the amount it pays to the worker. The tax credit will increase on a sliding scale if the company pays more than 50 percent of wages. It could go up to a maximum credit of 25 percent of the amount the employer paid for up to 12 weeks of leave.

Payments to full- and part-time workers taking family leave who’ve been employed for at least a year would be eligible for the employer’s tax break. But the program, which is designed to test whether this approach works well, is set to last just two years, ending after 2019.

Aparna Mathur, a resident scholar in economic policy studies at the American Enterprise Institute, says the new tax credit sidesteps a pitfall for Republicans. They are wary of any legislation mandating that employers provide paid leave. The tax credit also is appropriately aimed at lower-wage workers who are most likely to lack access to paid leave, said Mathur, who co-authored a recent report on paid family leave.

But it’s not a big enticement.

“Providing this benefit is a huge cost for employers,” Mathur said. “It’s unlikely that any new companies will jump on board just because they have a 12.5 to 25 percent offset.”

That view is shared by Vicki Shabo, vice president for workplace policies and strategies at the National Partnership for Women & Families, an advocacy group, who said it will primarily benefit workers at companies already offering paid family leave. The new tax credit “just perpetuates the boss lottery,” she added.

Heather Whaling said her 22-person public relations company probably qualifies for the new tax credit, but she doesn’t think it’s the right approach. Whaling, the president of Geben Communication in Columbus, Ohio, already offers paid leave. The company provides up to 10 weeks of paid leave at full pay for new parents. Four employees have taken leave, and by divvying up their work to other team members and hiring freelancers they’ve been able to get by.

“It is an expense, but if you plan and budget carefully it’s not cost-prohibitive,” she said.

The tax credit isn’t big enough to provide a strong incentive to provide paid leave, said Whaling, 37. Besides, “having access to paid family leave shouldn’t be luck of the draw, it should be available to every employee in the country.”

Still, the tax credit may be appealing to companies that have been considering adding a paid family and medical leave benefit, said Rich Fuerstenberg, a senior partner at benefits consultant Mercer.

By defraying some of the cost, the tax credit could help “tip them over” into offering paid leave, he said. But  “I’m not even sure I’d call it the icing on the cake,” Fuerstenberg said. “It’s like the cherry on the icing.”

Only 15 percent of private-sector and state and local government workers had access to paid family and medical leave in 2017, according to the Bureau of Labor Statistics’ National Compensation Survey. Eighty-eight percent had access to unpaid leave, however.

Under the federal Family and Medical Leave Act, employers with 50 or more workers generally must allow eligible employees to take unpaid leave for up to 12 weeks annually for specified reasons. These include the birth or adoption of a child, caring for your own or a family member’s serious health condition, or leave for military caregiving or deployment. An individual’s job is protected during such leaves.

A tax credit that can be claimed at the end of the year is unlikely to encourage small businesses to offer paid family and medical leave, said Erik Rettig, an expert on family leave policies at the Small Business Majority, which advocates for those firms on national policy.

“It isn’t going to help the family business that has to absorb the costs of this employee while they’re gone,” Rettig said.

A better solution, according to Shabo and others, is to provide a paid family leave benefit that’s funded by employer and/or employee payroll contributions. Sen. Kirsten Gillibrand (D-N.Y.) and Rep. Rosa DeLauro (D-Conn.) last year reintroduced such legislation. Their bill would guarantee workers, including those who are self-employed, up to 12 weeks of family and medical leave with as much as two-thirds of their pay.

A handful of mostly Democratic states — including California, New Jersey, Rhode Island and New York — have similar laws in place, and a program in the District of Columbia and Washington state will begin in 2020.

“We know from states that this approach works for both employees and their bosses,” Shabo said.

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When You Need A Breast Screening, Should You Get A 3-D Mammogram?

When I went to the imaging center for my regular mammogram last year, the woman behind the desk asked me if I’d like to get a “3-D” mammogram instead of the standard test I’d had in the past.

“It’s more accurate,” she said.

What do you say to that? “No, thanks, I’d rather have the test that gets it wrong?” Of course, I agreed.

A growing number of women are likely to face a similar choice in coming years as imaging centers across the country add three-dimensional (3-D) mammography, also called digital breast tomosynthesis, to the two-dimensional (2-D) screening women customarily receive.

What’s not yet clear is whether this newer, more expensive technology is better at catching cancers that are likely to kill. So should it be widely recommended? And who should pick up the extra cost involved?

According to the Food and Drug Administration, there were 3,915 certified mammography imaging facilities that offered digital breast tomosynthesis in January. That’s a sharp increase over the previous January, when the total was 3,011.

Some facilities have switched over entirely to 3-D imaging, but many practices have both, experts said.

“There’s a lot of marketing pressure to offer these new machines,” said Robert Smith, vice president of cancer screening at the American Cancer Society.

Both types of tests use X-ray technology to create images of the breast. The 2-D digital mammograms that most women receive typically provide front and side images, while for the 3-D test the X-ray arcs across the breast, creating multiple images of breast tissue. The experience is the same for women, though, because both scans involve compressing the breast between two plates extending from the machine.

Studies have generally shown that the 3-D test is slightly better at detecting cancers than the 2-D test, and women typically have to return less often to have additional images taken. But the jury is still out on whether the newer technology is any better at identifying the advanced cancers that will become lethal.

“Cancers don’t always progress and kill people,” said Dr. Etta Pisano, chief science officer at the American College of Radiology’s Center for Research and Innovation and a faculty member at Harvard Medical School. Pisano is leading a five-year clinical trial of 165,000 women that will compare the two types of screening tests to evaluate whether the new technology reduces the risk that women will develop life-threatening cancers.

“If tomosynthesis is improving the likelihood of women to survive their breast cancers, they should have fewer cancers that are more likely to kill women over the 4.5 years of screening. Since tomosynthesis caught them early, they’ll never grow up to be bad cancers,” Pisano said.

Overdiagnosis is one of the potential downsides of this technology, said Dr. David Grossman, chair of the U.S. Preventive Services Task Force. The more sensitive test picks up more breast lesions for which the clinical significance is unclear, potentially resulting in women receiving more testing and treatment they don’t need. Some research suggests the biopsy rate is slightly higher with 3-D mammograms.

In addition, some of the mammography systems require both 2-D and 3-D X-rays, which can expose women to twice as much radiation. Other systems are able to generate a 2-D image from the 3-D version with software, eliminating the extra exposure. The 2-D image is important because clusters of calcifications, which may signal breast cancer, might be easier to see on the 2-D image, said Pisano.

Under the Affordable Care Act, most health plans are required to cover preventive services that are recommended by the task force without charging patients anything out-of-pocket. The task force recommends biennial mammograms for women ages 50 to 74, but it says that there’s not enough evidence to recommend 3-D mammograms at this time.

Insurance coverage of 3-D testing has improved in recent years, but it’s not assured. The 3-D test typically costs about $50 more than a 2-D test, according to a 2015 study by Truven Health Analytics that was funded by Hologic, a manufacturer of 3-D mammography systems. Medicare also covers 3-D tests.

A growing number of states require commercial insurers to cover 3-D mammograms, including Arkansas, Texas, Connecticut, Maryland, Illinois and Pennsylvania.

My state of New York also requires coverage, without any out-of-pocket payments. Though I didn’t have to pay it, the explanation of benefits form I got from my insurer said the 3-D portion of the test added $51 to the $157 cost of the mammogram.

“Costs are high for new technologies,” Pisano said. “Maybe they are better, but we need to have evidence before we recommend it for the entire population.”

So if you’re offered a 3-D test, should you get it?

“If the examination is available at no extra cost, the data we have now tells us it has some advantages,” said Smith. On the other hand, “any woman who’s feeling stressed about the extra cost … should feel comfortable getting a regular mammogram,” he said.

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When You Need A Breast Screening, Should You Get A 3-D Mammogram?

When I went to the imaging center for my regular mammogram last year, the woman behind the desk asked me if I’d like to get a “3-D” mammogram instead of the standard test I’d had in the past.

“It’s more accurate,” she said.

What do you say to that? “No, thanks, I’d rather have the test that gets it wrong?” Of course, I agreed.

A growing number of women are likely to face a similar choice in coming years as imaging centers across the country add three-dimensional (3-D) mammography, also called digital breast tomosynthesis, to the two-dimensional (2-D) screening women customarily receive.

What’s not yet clear is whether this newer, more expensive technology is better at catching cancers that are likely to kill. So should it be widely recommended? And who should pick up the extra cost involved?

According to the Food and Drug Administration, there were 3,915 certified mammography imaging facilities that offered digital breast tomosynthesis in January. That’s a sharp increase over the previous January, when the total was 3,011.

Some facilities have switched over entirely to 3-D imaging, but many practices have both, experts said.

“There’s a lot of marketing pressure to offer these new machines,” said Robert Smith, vice president of cancer screening at the American Cancer Society.

Both types of tests use X-ray technology to create images of the breast. The 2-D digital mammograms that most women receive typically provide front and side images, while for the 3-D test the X-ray arcs across the breast, creating multiple images of breast tissue. The experience is the same for women, though, because both scans involve compressing the breast between two plates extending from the machine.

Studies have generally shown that the 3-D test is slightly better at detecting cancers than the 2-D test, and women typically have to return less often to have additional images taken. But the jury is still out on whether the newer technology is any better at identifying the advanced cancers that will become lethal.

“Cancers don’t always progress and kill people,” said Dr. Etta Pisano, chief science officer at the American College of Radiology’s Center for Research and Innovation and a faculty member at Harvard Medical School. Pisano is leading a five-year clinical trial of 165,000 women that will compare the two types of screening tests to evaluate whether the new technology reduces the risk that women will develop life-threatening cancers.

“If tomosynthesis is improving the likelihood of women to survive their breast cancers, they should have fewer cancers that are more likely to kill women over the 4.5 years of screening. Since tomosynthesis caught them early, they’ll never grow up to be bad cancers,” Pisano said.

Overdiagnosis is one of the potential downsides of this technology, said Dr. David Grossman, chair of the U.S. Preventive Services Task Force. The more sensitive test picks up more breast lesions for which the clinical significance is unclear, potentially resulting in women receiving more testing and treatment they don’t need. Some research suggests the biopsy rate is slightly higher with 3-D mammograms.

In addition, some of the mammography systems require both 2-D and 3-D X-rays, which can expose women to twice as much radiation. Other systems are able to generate a 2-D image from the 3-D version with software, eliminating the extra exposure. The 2-D image is important because clusters of calcifications, which may signal breast cancer, might be easier to see on the 2-D image, said Pisano.

Under the Affordable Care Act, most health plans are required to cover preventive services that are recommended by the task force without charging patients anything out-of-pocket. The task force recommends biennial mammograms for women ages 50 to 74, but it says that there’s not enough evidence to recommend 3-D mammograms at this time.

Insurance coverage of 3-D testing has improved in recent years, but it’s not assured. The 3-D test typically costs about $50 more than a 2-D test, according to a 2015 study by Truven Health Analytics that was funded by Hologic, a manufacturer of 3-D mammography systems. Medicare also covers 3-D tests.

A growing number of states require commercial insurers to cover 3-D mammograms, including Arkansas, Texas, Connecticut, Maryland, Illinois and Pennsylvania.

My state of New York also requires coverage, without any out-of-pocket payments. Though I didn’t have to pay it, the explanation of benefits form I got from my insurer said the 3-D portion of the test added $51 to the $157 cost of the mammogram.

“Costs are high for new technologies,” Pisano said. “Maybe they are better, but we need to have evidence before we recommend it for the entire population.”

So if you’re offered a 3-D test, should you get it?

“If the examination is available at no extra cost, the data we have now tells us it has some advantages,” said Smith. On the other hand, “any woman who’s feeling stressed about the extra cost … should feel comfortable getting a regular mammogram,” he said.

Related Topics

Health Industry Insurance Insuring Your Health Public Health