Michelle Andrews | KFF Health News (TNS)

Companies have increasingly offered generous fertility benefits to attract and keep top-notch workers. Now, the federal government is getting in on the act. Starting this year, federal employees can choose plans that cover several fertility services, including up to $25,000 annually for in vitro fertilization procedures and up to three artificial insemination cycles each year.

With about 2.1 million civilian employees, the federal government is the nation’s largest employer. Now, just as businesses of every stripe prioritize fertility benefits, in vitro fertilization — a procedure in use for more than 40 years — has become a tricky topic for some anti-abortion Republican members of Congress and even presidential candidates.

It was inevitable that disagreements over IVF among abortion opponents would eventually break into the open, said Mary Ziegler, a legal historian and expert on reproductive health.

“The anti-abortion movement from the 1960s onward has been a fetal personhood movement,” said Ziegler, a law professor at the University of California-Davis. Since the U.S. Supreme Court’s Dobbs decision eliminated the constitutional right to abortion, anti-abortion groups and the Republican Party are grappling with what “fetal personhood” means and how that fits into their position on IVF and other technologies that help people have babies.

The Alabama Supreme Court set the stage for the recent brouhaha with a ruling last month that frozen embryos created through IVF are children under state law. A pair of Democratic senators advanced legislation that would override state laws by establishing a statutory right to access IVF and other such technologies. The bill was blocked on the Senate floor by a Republican opponent.

These events highlight the tough spot in which Republicans find themselves. Many support IVF, and they are keenly aware that it’s extremely popular: 86% of adults in a recent CBS News-YouGov poll said IVF should be legal. The outcry over the Alabama ruling and Republicans’ inability to coalesce around a federal response, however, has exposed fault lines in the party.

Some anti-abortion groups have strenuously objected to measures like that Senate bill, arguing that lawmakers must balance IVF with the responsibility to respect life.

Republicans “are trying to finesse it, which is very hard,” Ziegler said.

About 10% of women and men face fertility problems, according to the National Institute of Child Health and Human Development. IVF, a process in which an egg is fertilized in a laboratory and later implanted in the uterus, is among the most expensive fertility treatments, costing about $20,000 for one round. Even with insurance coverage, the procedure is pricey, but for some people it’s the only way to conceive.

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In recent years, the number of companies offering fertility benefits to employees has grown steadily. In the early 2000s, fewer than a quarter of employers with at least 500 workers covered IVF, according to benefits consultant Mercer’s annual employer survey. In 2023, that figure had roughly doubled, to 45%. Employers typically cap IVF benefits. In 2023, employers had a median lifetime maximum benefit of $20,000 for IVF, according to the Mercer survey.

The federal government’s IVF benefit — paying up to $25,000 a year — is more generous than that of a typical employer. Coverage is available through the popular Blue Cross and Blue Shield Federal Employee Program’s standard option. Altogether, two dozen 2024 health plans for federal workers offer enhanced IVF coverage, with varying benefits and cost sharing, according to the federal Office of Personnel Management, which manages the federal health plans.

“OPM’s mission is to attract and retain the workforce of the future,” said Viet Tran, OPM’s press secretary, in written answers to questions. He noted that surveys have found that federal health benefits have influenced employees’ decisions to stay with the federal government.

Starting this year, plans offered to federal employees are required to offer fertility benefits, according to OPM.

But it’s unclear how the emerging political debate surrounding IVF and other reproductive health issues could affect national benefit and coverage trends.

Last month, after the Alabama Supreme Court ruled that frozen embryos left over following IVF procedures are considered children under state law, the state legislature quickly passed and Republican Gov. Kay Ivey signed a bill that grants immunity to patients and providers who participate in IVF services. During the ensuing dust-up, a coalition of more than a dozen anti-abortion groups signed a letter drawing a clear line in the sand. “Both science and logic have made it clear that embryos must be accorded the same human rights” as other human beings, it read. The Alabama law didn’t address the underlying issue of the “personhood” of the embryos, leaving open the door for further litigation and potential restrictions on IVF in Alabama and other states, some legal analysts say.

More than a third of states have laws on the books that classify fetuses as people at some stage of pregnancy, according to an analysis by Politico.

It’s unclear whether the turmoil surrounding the Alabama case will have long-term repercussions for employee benefits there or in other states.

“If this were something that were to happen in multiple states, employers would have to figure out how to navigate around that,” said Jim Winkler, chief strategy officer of the Business Group on Health, a nonprofit that represents the interests of large employers. At this point, employers will want to keep a watchful eye on the issue but probably not plan any changes, Winkler said.

A Mercer blog post advised businesses with Alabama employees to review health plan policies related to medical travel and leave benefits. Further, “employers should monitor other states that broadly define fetal personhood and restrict reproductive healthcare,” the blog post advised.

The situation is reminiscent of what happened with abortion coverage following the Supreme Court’s Dobbs decision in 2022. As states imposed restrictions on access to abortions, many companies began providing travel expenses for their workers to seek them.

But what happened with abortion may not be a good predictor of what will happen with IVF, said Dorianne Mason, director of health equity at the National Women’s Law Center.

Following the Alabama judge’s ruling, “the legislature in Alabama moved so quickly to respond to the outcry,” Mason said. “When we look at the legislative response to IVF, it’s moving in a markedly different direction on access to care” than has occurred with other types of reproductive care.

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

Tony Leys | (TNS) KFF Health News

GRINNELL, Iowa — A for-profit company has proposed turning a boarded-up former nursing home here into a psychiatric hospital, joining a national trend toward having such hospitals owned by investors instead of by state governments or nonprofit health systems.

The companies see a business opportunity in the shortage of inpatient beds for people with severe mental illness.

The scarcity of inpatient psychiatric care is evident nationwide, especially in rural areas. People in crisis often are held for days or weeks in emergency rooms or jails, then transported far from their hometowns when a bed opens in a distant hospital.

Eight nonprofit Iowa hospitals have shuttered their psychiatric units since 2007, often citing staffing and financial challenges. Iowa closed two of its four mental health institutions in 2015.

The state now ranks last in the nation for access to state-run psychiatric hospitals, according to the Treatment Advocacy Center. The national group, which promotes improving care for people with severe mental illness, recommends states have at least 50 state-run psychiatric beds per 100,000 people. Iowa has just two such beds per 100,000 residents, the group said.

Two out-of-state companies have developed psychiatric hospitals in Iowa in the past four years, and now a third company has obtained a state “certificate of need” to open a 60-bed facility in Grinnell.

Before 2020, Iowa had no privately owned, free-standing psychiatric hospitals. But several national companies specialize in developing such facilities, which treat people in crisis from conditions such as depression, schizophrenia, or bipolar disorder, sometimes compounded by drug or alcohol abuse. One of the companies operating in Iowa, Universal Health Services, says it has mental health facilities in 39 states.

Lisa Dailey, the Treatment Advocacy Center’s executive director, said that for-profit hospitals don’t necessarily provide worse care than nonprofit ones but that they tend to be less transparent and more motivated by money. “Private facilities are private,” she said. “As a result, you may not have a great insight into why they make the decisions that they make.”

Dailey said solid data on privately run mental health hospitals nationwide is scarce. But she has heard for-profit companies have recently set up free-standing psychiatric hospitals in several states, including California. The California Department of Public Health confirmed three such facilities have opened there since 2021, in Aliso Viejo, Madera, and Sacramento.

The latest Iowa psychiatric hospital would be housed in a vacant nursing home on the outskirts of Grinnell, a college town of 9,500 people in a rural region of the state. The project’s developers noted there are no other inpatient mental health facilities in Poweshiek County, where Grinnell is located, or in any of the eight surrounding counties. The nearest inpatient mental health facilities are 55 miles west in Des Moines.

The Indiana-based company proposing the hospital, Hickory Recovery Network, primarily runs addiction treatment centers in Indiana. But it opened psychiatric hospitals in Ohio and Texas in 2023 and 2024, and it told Iowa regulators it could open the Grinnell hospital by August.

An affiliated company ran the facility as a nursing home, called the Grinnell Health Care Center, until 2022, according to a Hickory Recovery Network filing with Iowa regulators.

Medicare rated the nursing home’s overall quality at just two out of five stars. And in 2020, the facility was suspended indefinitely from Iowa’s Medicaid program because of billing issues, state records show.

Officials from Hickory Recovery Network responded only briefly to KFF Health News inquiries, including about how the former Iowa nursing home’s spotty record could affect the proposed psychiatric hospital.

In a short telephone interview in February, Melissa Durkin, the company’s chief operating officer, declined to say who owns Hickory Recovery Network.

Durkin denied in the interview that her organization was associated with the company that ran the defunct and troubled Grinnell nursing home.

However, Hickory Recovery’s application for a certificate of need refers to the nursing home operator as “Hickory’s affiliated company.” In testimony before Iowa regulators, Durkin made a similar reference as she expressed confidence her organization could find sufficient staff to reopen the facility as a psychiatric hospital. “We have a history with that building. We operated a nursing home there before,” she said at the video-recorded hearing.

Durkin said in the interview that company leaders had not decided for sure to redevelop the vacant Iowa nursing home into a psychiatric hospital, although they twice went through the complicated process of applying for a state “certificate of need” for the project. The first attempt was stymied in 2023 by a tie vote of the board that considers such permits, which are a major hurdle for large health care projects. The second application was approved by a unanimous vote after a hearing on Jan. 25.

Keri Lyn Powers, a Hickory executive, told regulators the company planned to spend $1.5 million to remodel the building. The main changes would include making rooms safe for people who might be suicidal, she said.

The company predicted in its application that 90% of the hospital’s patient revenues would come from Medicare or Medicaid, public programs for seniors or people who have low incomes or disabilities. It doesn’t mention that the nursing home was suspended from Iowa’s Medicaid program, which covers about half of the state’s nursing home residents.

A for-profit company has proposed remodeling a vacant nursing home building in Grinnell, Iowa, into a 60-bed psychiatric hospital. If the project moves forward, it would become the third privately owned stand-alone psychiatric hospital to open in the state since 2020. (Tony Leys/KFF Health News/TNS)

Iowa authorities suspended the Grinnell Health Care Center nursing home in 2020 for failing to repay nearly $25,000 in overpayments from Medicaid, state records show. When the nursing home closed in 2022, its former medical director told the local newspaper part of the reason for its demise was its inability to collect Medicaid reimbursements. Iowa administrators recently notified the owners that the former nursing home owed $284,676 to Medicaid. A state spokesperson said in March that neither amount had been repaid.

The proposal to reopen the building as a psychiatric hospital won support from patient advocates, Grinnell’s nonprofit community hospital, and the regional mental health coordinator.

The only opposition at the state hearing came from Kevin Pettit, leader of one of Iowa’s two other private free-standing psychiatric hospitals. Pettit is chief executive officer of Clive Behavioral Health Hospital, a 100-bed facility in suburban Des Moines that opened in 2021. Pettit told regulators he supports expanding mental health services, but he predicted the proposed Grinnell facility would struggle to hire qualified employees.

He said despite strong demand for care, many Iowa psychiatric facilities are limiting admissions. “The beds exist, but they’re not actually open, … because we’re dealing with staffing issues throughout the state,” Pettit testified.

Overall, Iowa has 901 licensed inpatient mental health beds, including in psychiatric units at community hospitals, in free-standing psychiatric hospitals, and in the two remaining state mental health institutes, according to the Iowa Department of Health and Human Services. But as of January, just 738 of those beds were staffed and being used.

Pettit’s facility is run by Pennsylvania-based Universal Health Services in partnership with MercyOne, a hospital system based in the Des Moines area.

In an interview, Pettit said his hospital only has enough staff to use about half of its beds. He said it’s especially difficult to recruit nurses and therapists, even in an urban area with a relatively robust labor supply.

State inspectors have cited problems at the Clive facility, including four times declaring that deficiencies put patients’ safety in “immediate jeopardy.” Those issues included insufficient staff to properly monitor patients and insufficient safeguards to prevent access to items patients could use to choke or cut themselves.

Pettit said such citations are not unusual in the tightly regulated industry. He said the organization is committed to patient safety. “We value the review by our regulatory entities during the survey process and view any finding as an opportunity for continuous improvement of our operations,” he wrote in an email.

Iowa’s other privately owned psychiatric hospital, Eagle View Behavioral Health in Bettendorf, also has been cited by state inspectors. The 72-bed hospital was purchased in 2022 by Summit BHC from Strategic Behavioral Health, which opened the facility in 2020. Both companies are based in Tennessee.

State inspectors have cited the Bettendorf facility twice for issues posing “immediate jeopardy” to patient safety. In 2023, inspectors cited the facility for insufficient supervision of patients, “resulting in inappropriate sexual activity” between adult and adolescent patients. In 2021, the facility was cited for insufficient safety checks to prevent suicide attempts and sexual misconduct.

Eagle View officials did not respond to requests for comment.

Advocates for Iowa patients have supported the development of free-standing psychiatric hospitals.

Leslie Carpenter of Iowa City, whose adult son has been hospitalized repeatedly for severe mental illness, spoke in favor of the Grinnell facility’s application for a certificate of need.

In an interview afterward, Carpenter said she was optimistic the new facility could find enough staff to help address Iowa’s critical shortage of inpatient psychiatric care.

She said she would keep a close eye on how the new facility fares. “I think if a company were willing to come in and do the job well, it could be a game changer.”

___

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

Edouard Julien is slumping no more.

After struggling through a rough stretch to start this season, Julien snapped out of it in a big way on Wednesday afternoon at Target Field, almost singlehandedly powering the Twins to a 3-2 victory over the Los Angeles Dodgers. He finished 3 for 4 in the game with a pair of solo home runs. He also scored a run on a base knock by Byron Buxton.

The production from Julien started right off the bat as he squared up a fastball from Bobby Miller for a leadoff home run. That helped the Twins tie the score after they fell behind the Dodgers in the top of the first inning at Target Field.

The next time he stepped to the plate in the third inning, Julien pulled the ball for a single, advanced into scoring position on a hit by Carlos Correa, then came around to score on a hit by Buxton. That sequence helped the Twins snap an 0 for 33 drought with runners in scoring position.

After the Dodgers got a solo home run from Max Muncy in the fourth inning to tie the game, Julien came through for the Twins once again, this time against lefty reliever Alex Vesia. The handedness was important considering Julien rarely gets a chance to face lefties given his splits. He took advantage of this opportunity with another solo home run in the fifth inning to push the Twins in front for good.

It looked like the Dodgers might pull even in the seventh inning when Freddie Freeman roped a line drive into the right field corner. That sent Shohei Ohtani racing around the base paths for what looked like the tying run. Even as Correa field the cutoff throw from Alex Kirilloff it seemed like Ohtani was bound to score with relative ease.

Then came a perfect 92 mph relay throw from Correa to Christian Vasquez to nail Ohtani out at home plate. That proved to be a pivotal play for the Twins, with Kody Funderburk getting the win, and Steven Okert getting the save.

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By Rosalie Murphy | NerdWallet

When Kaustubh Deo, president of Washington-based Blooma Tree Experts, bought the company from its retiring owner, he inherited a weekly payroll system and quickly learned to appreciate shorter pay periods.

“If you give somebody a raise, they feel that [increase] like three days after you tell them about it,” Deo says. And payroll errors can be corrected faster, too: “It’s one thing if it’s to wait two weeks or four weeks for that to get resolved, but if it’s next week, employees aren’t that worried about it.”

The bulk (63%) of American workers are paid biweekly or twice a month, according to a February 2023 U.S. Bureau of Labor Statistics survey. But around 27% of workers said they were paid weekly. And technologies like earned wage access are giving more workers the option to draw on their wages between paydays.

For employees, less time between paychecks can increase feelings of financial security, says Karen Burke, a knowledge advisor at the Society for Human Resource Management.

Here are two ways small-business owners can start paying employees more frequently.

1. Shorter pay periods

Weekly payroll is already the norm in many industries. In the same BLS survey, nearly two-thirds of construction workers said they were paid weekly.

It’s common in landscaping, too, Deo says. He found that weekly pay was necessary to compete with other employers, some of whom pay daily rates, occasionally in cash.

If [workers] are comparing getting paid cash daily to getting paid every two weeks, the math starts to get harder,” Deo says.

Similarly, Burke explains, a $100 deduction from a weekly check may seem smaller than a $200 deduction from a biweekly one.

“It’s the same thing, but it’s all semantics. It’s how the employees see it,” Burke says. “They can manage their cash flow better.”

To manage payroll, Deo runs each pay cycle through his payroll software, so taxes and benefit contributions are deducted from each paycheck just as they would be with any payroll schedule.

If you want to pursue more frequent pay, “take time out to pick out the right software,” Burke says. Look for a plan that includes unlimited payroll runs.

If you employ a large number of casual, event-based or short-term workers, a more frequent payroll schedule may also work better for your HR department.

“It’s very efficient for the payroll administrator,” Burke says. “Let’s just do it, get it over with, and we don’t have to worry about running payroll every two weeks and wondering who worked and trying to track those hours worked.”

But for businesses that primarily have salaried employees or more than a few dozen employees, Burke says biweekly payroll is probably the less burdensome option.

2. Earned wage access as an employee benefit

Larger retailers like Amazon, Walmart and Target offer some of their employees earned wage access, a company benefit that lets workers access pay they’ve earned before their paycheck is issued.

Employer-provided EWA platforms integrate with your payroll system. An employee can request a payout of some of the wages for hours they’ve already worked, and the EWA service can transfer funds to them. When the next payroll cycle runs, the worker’s paycheck will be smaller by the amount that was already paid out.

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Standard ACH transfers from EWA providers to employees may be free, depending on the platform; getting funds instantly costs a few dollars more. Employers may choose to cover EWA platform fees as part of the benefit.

In 2023, the Financial Health Network found that employees generally used EWA to cover unexpected bills. In general, they preferred it to more expensive options like payday loans or overdrafting on a bank account, or to more socially complex options like borrowing from family or friends.

“For workers that make a living wage, this can be a really good, effective, short-term liquidity solution,” says Matt Bahl, vice president and workplace market lead at the Financial Health Network.

In fact, 79% of workers said they’d consider switching jobs to have access to EWA, according to a 2019 survey commissioned by Visa.

Bahl cautions that EWA isn’t a silver bullet for employees’ financial challenges, however.

“If people are not making enough money to pay their bills at their current income — no matter the schedule, you cannot fintech your way out of that problem,” Bahl says.

The industry is evolving quickly: Several states have implemented EWA regulations, and in late 2023, the Consumer Financial Protection Bureau announced plans to issue guidance on EWA and “income-based advance” products.

If you’re considering offering EWA, see whether one of your existing benefits providers already offers the option — many do.

And there’s a chance your employees are already familiar with a consumer-facing EWA app or the idea of on-demand pay via gig work.

“We have a group of workers in this country who have grown accustomed to receiving pay daily,” Bahl says. EWA “could be a path in which to do that.”

 

The article To Retain Workers, Consider Paying Them More Often originally appeared on NerdWallet.