Health Reform Coverage for Asbestos Victims Expands

The Federal health reform medical coverage for asbestos victims is expanding in Libby Montana. The announcement was made by Senator Baucus who sponsored the innovated unified Federal healthcare legislation that is a national pilot program for the treatment of occupational illness and diseases.. 

"Libby Care" is an innovated plan under which the Federal government provides medical care to those who were exposed to asbestos fiber in the geographical area of the Libby asbestos mines. The mines were operated by WR Grace. The program is a pilot plan providing for free coverage to asbestos victims and is administered by Medicare. The pilot program may expand the Federal government's future role  in providing  medical coverage for all occupational exposure claims and thus avoid the litigious and burdened workers' compensation medical treatment system.

Montana's senior U.S. Senator Max Baucus today announced additional asbestos-related health services to be included under the health care coverage he secured for Lincoln County asbestos victims in the Affordable Care Act.

"The people of Libby and Lincoln County suffered a horrendous injustice in the name of greed, and we have a responsibility to help them heal however we can. We secured a Public Health Emergency Declaration in Libby to make sure these folks had access to all the tools they needed. Providing Libby victims with the consistent, reliable, health care they are entitled to under the law is the least we can do to help right this outrageous wrong," Baucus said.

Dr. Brad Black, Medical Director of the Center for Asbestos Related Disease in Libby said, "CARD, our patients, and the Libby community greatly appreciates Senator Baucus' work to secure legislation to provide long-term asbestos health benefits and screening. Medicare benefits, the Medicare Pilot Program for Asbestos Related Disease and ongoing asbestos screening are critical services for the affected population of today and tomorrow."

CARD is a community based non-profit organization established in 2000 that is committed to providing asbestos screening and healthcare related to the Libby asbestos exposure.

"While some in Congress are trying to end Medicare as we know it for Montanans, we strengthened it and improved access to better health care for folks in places like Libby," said U.S. Senator Jon Tester. "Today the people of Libby have better access to the health care services they need and deserve. It's a powerful investment in Montana's people."

The Centers for Medicare and Medicaid Services (CMS) said today the agency would begin covering the additional benefits July 1, 2011 under a permanent pilot program Baucus included in the Affordable Care Act to ensure Libby victims received the full range of services needed to treat asbestos diseases. Benefits cover services not already included under Medicare coverage Libby asbestos victims now receive under the law, including:

• Special home care services;
• Special medical equipment;
• Help with travel to get care;
• Special counseling, for example, help quitting smoking;
• Nutritional supplements; and
• Prescription drugs not covered by Medicare drug plans (Participants in the Pilot Program must be in a Medicare drug plan to receive this benefit.)

According to CMS, individuals participating in the Pilot Program will also be able to work with a nurse case manager to coordinate their health benefits and receive individualized care planning.

Today's news is the third step in Baucus' provisions to secure health care coverage for Libby under the Affordable care Act. In Spring 2010, as part of Baucus' provisions, victims of asbestos exposure in Lincoln County began getting care under Medicare. In March of 2011, Baucus announced a grant program to help Lincoln County health care providers screen for asbestos-related diseases. Before the new program announced today, Libby asbestos victims relied on temporary and uncertain grants programs to receive the additional care they needed.

Individuals can call 1-888-469-9464 to enroll in the pilot by phone or visit the websitewww.noridianmedicare.com/ard beginning June 14.

Earlier this year Baucus was announced as the 2011 Tribute of Hope Award recipient by the Asbestos Disease Awareness Organization (ADAO) for his tireless efforts fighting on behalf of residents of Libby, Lincoln County and Asbestos victims everywhere. In March, the Senate unanimously passed Baucus' resolution to designate the first week of April 2011 as "Asbestos Awareness Week," and call attention to Libby and other victims of asbestos-related disease.

Additional background on Baucus' longstanding efforts to secure declaration of a Public Health Emergency in Libby:

Baucus has been a long-time champion of asbestos awareness in his efforts to declare the mining tragedy in Lincoln County a public health emergency and make sure folks there have access to the clean-up tools and health care they need.

Since news reports first linked widespread deaths and illness to exposure to deadly asbestos fibers at the defunct W.R Grace and Co. mine, Baucus has visited Libby more than 20 times, secured millions for healthcare and cleanup, brought numerous White House cabinet secretaries to the town, helped save the CARD clinic, and has dogged the EPA to keep cleanup efforts moving forward.

The mine near Libby, Montana, was the source of over 70 percent of all vermiculite sold in the U.S. from 1919 to 1990. There was also a deposit of asbestos at that mine, so the vermiculite from Libby was contaminated with asbestos. Vermiculite from Libby was used in the majority of vermiculite insulation in the U.S. and was often sold under the brand name Zonolite.

As far back as 1999, Baucus wrote a letter to then Secretary of Health and Human Services Donna Shalala requesting immediate medical help and assistance to the area. He further lambasted the EPA's decision to not declare a Public Health Emergency, calling it an "outrage." 

In 2008, Baucus released a report detailing a 2002 attempt by the EPA to declare a Public Health Emergency in Libby that was thwarted by the previous Administration's Office of Management and Budget. And on June 17, 2009, due in large part to Baucus' efforts, the EPA declared its first ever public health emergency in Libby, Montana.

After securing the declaration, Baucus fought hard, as a key author of the Affordable Care Act, to make sure the law included a mechanism for residents of Libby and Lincoln County to access the health care they were entitled to as victims of a public health emergency. As a result, Libby residents began receiving coverage under Medicare in Spring 2010.

For over 3 decades the Law Offices of Jon L. Gelman  1.973.696.7900  jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.

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• The Path to Federalization (workers-compensation.blogspot.com)
• The Health Reform Act Charts A New Course for Occupational Health Care (workers-compensation.blogspot.com)
• EPA: Mont. town cleaner but asbestos risks persist (sfgate.com)
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US EPA Reports: Better Planning, Execution and Communication Could Have Reduced the Delays in Completing a Toxicity Assessment of the Libby, Montana, Superfund Site

The US EPA could have done better in handling the asbestos exposure site in Libby Montana according to a report issued yesterday by the US EPA's Inspector General. 

"U.S. Environmental Protection Agency (EPA) action officials did not complete  planned corrective actions under its Libby Action Plan in a timely manner. This occurred because the scope of the work was larger than originally thought; there was no established charter; and there were contracting delays, competing priorities, unanticipated work, and poor communication with stakeholders. Consequently, the Agency has twice revised its estimates for completing actions in response to our December 2006 report. 

"The toxicity assessment is one of two components (an exposure assessment 

being the other) that makes up the health risk assessment for determining 

cleanup levels in Libby. In December 2011, EPA informed us that the health 

risk assessment would be substantially delayed. As a result, the Agency’s final 

determinations that the completed and ongoing cleanup actions are sufficient to 

address the health risks from site contamination have been delayed from 2 to 6 

years, depending on the studies being performed. This is a significant concern, 

considering that the EPA Administrator declared a public-health emergency at 

the Libby site in 2009 and the Agency has spent over $400 million on cleanup. 

Communications about delays in completing Libby Action Plan items, and the 

reasons for those delays, were not always timely or clearly communicated to 

stakeholders; and EPA officials failed to update the Agency’s follow-up system 

or notify the Office of Inspector General (OIG) about known delays until 

planned corrective actions under the Libby Action Plan could not be met.

Click here to read the complete report: Better Planning, Execution and Communication Could Have Reduced the Delays in Completing a Toxicity Assessment of the Libby, Montana, Superfund Site

Better Control Over Asbestos Contaminated Sites Required

Senator Max Baucus (MT)

The recent discovery of the spread of asbestos contamination in Libby MT, which had been declared a Public Health Emergency, is shocking. Asbestos, a known carcinogen, associated with mesothelioma, is reportedly still lingering throughout the community. 

Montana's senior U.S. Senator Max Baucus vowed to find answers regarding reports today of asbestos-contaminated bark and wood chips being sold in Libby, MT and beyond. 

"We've made tremendous strides in the effort to help Libby heal with health care and environmental cleanup. But trust is essential to Libby's ability to heal psychologically and economically. Now it appears EPA's actions may have put that trust in jeopardy, so you can bet I'll be holding EPA's feet to the fire to find out exactly what they knew, when they knew it, and whether action is needed to ensure the safety of folks in Libby and across the country who were exposed to this bark," Baucus said. "The people of Libby have already been poisoned in the name of greed and I won't allow them to be victimized again because of negligence. We need to work together to make sure safety information is complete and transparent so the community can move forward and create jobs with faith in the agencies and processes that are supposed to protect them."

Since news reports first linked widespread deaths and illness to exposure to deadly asbestos fibers at the defunct W.R Grace and Co. mine, Baucus has visited Libby more than 20 times, secured millions for healthcare and cleanup, brought numerous White House cabinet secretaries to the town, helped save the CARD clinic, and has dogged the EPA to keep cleanup efforts moving forward. 

As far back as 1999, Baucus wrote a letter to then Secretary of Health and Human Services Donna Shalala requesting immediate medical help and assistance to the area. He further lambasted the EPA's decision to not declare a Public Health Emergency, calling it an "outrage." 

In 2008, Baucus released a report detailing a 2002 attempt by the EPA to declare a Public Health Emergency in Libby that was thwarted by the previous Administration's Office of Management and Budget. And on June 17, 2009, due in large part to Baucus' efforts, the EPA declared its first ever public health emergency in Libby, Montana. 

Earlier this year Baucus was announced as the 2011 Tribute of Hope Award recipient by the Asbestos Disease Awareness Organization (ADAO) for his tireless efforts fighting on behalf of residents of Libby, Lincoln County and Asbestos victims everywhere. In March, the Senate unanimously passed Baucus' resolution to designate the first week of April 2011 as "Asbestos Awareness Week," and call attention to Libby and other victims of asbestos-related disease.

The continued spread of this contamination is yet another reason why the US must finally ban asbestos entirely. 

Related articles

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• Quebec Does the Dirty Deed - Funds Asbestos Production (workers-compensation.blogspot.com)
• Canada Called A Pariah State (workers-compensation.blogspot.com)
• Fallen Asbestos Workers Honored at a Memorial Mass (workers-compensation.blogspot.com)
• EPA: Mont. town cleaner but asbestos risks persist (seattletimes.nwsource.com)
• New danger found in Montana asbestos town (cbsnews.com)

The Health Reform Act Charts a New Course for Occupational Health Care

The occupational healthcare program embodied in the recently enacted legislation has the potential for being the most extensive, effective and innovated system ever enacted for delivering medical care to injured workers. The “Libby Care” provisions, and its envisioned prodigies, will embrace more exposed workers, diseases and geographical locations, than any other program of the past. Potential pilot programs  will now be available to injured workers and their families who have become victims of the failed workers’ compensation occupational disease medical care system.

The legislation initially establishes a program for the identification, monitoring and treatment of those who were exposed to asbestos in Libby Montana where W.R. Grace formerly operated an asbestos (vermiculite) mine producing, among other things, attic insulation. The plant belched thousands of pounds of asbestos fiber into the air of the geographical area daily. Libby Montana has been declared a Federal Superfund Site and the asbestos disease that remains as its legacy has been declared a National Public Health Emergency.

The newly enacted national health care law will have profound effect upon the treatment of occupational disease.  Placed deep within the text of the bill (H.R. 3590), on page 836 (Section 1881A Medical Coverage for Individuals Exposed to Environmental Health Hazards), is the new occupational medical care model, “Libby Care.”  The Manager’s Amendment, embracing the concept of universal occupational health care, inserted in the final moments of the debate, will make all the difference in world to the future of medical care and the handling of work-related illnesses.

What We Learned From History

Historically it is well known that occupational diseases are problematic issues confronting workers’ compensation.They are problematic for all stakeholders in the system. For employers, it is difficult to defend a claim that may occur over a lengthy working period, ie. 280 days per year. Defending occupational disease claims has always been an elusive and a costly goal for employers and insurance carriers. Employees also are confronted with obstacles in obtaining timely medical benefits. Occupational disease claims are universally contested matter and medical care is therefore delayed until the claim is successfully litigated and potentially appealed. This process results in delay and denial of medical care and sometimes death.

In the 1950’s the insurance industry put tag-along verbiage in the statute to modify the 1911 workers’ compensation act to encompass occupational disease claims. This was not a philanthropic gesture, but one rather intended to shield Industry from rapidly spreading silicosis liability in civil actions emerging in the 1950s.

Over time, the failure of the workers’ compensation system to provide adequate medical care to injured workers suffering from occupational illness has given rise to the emergence of several attempted collateral benefit systems by the Federal government. The Black Lung Act-The Federal Coal Mine and Safety Act of 1969 established the Federal Black Lung Trust Fund, which obtained its revenue from the assessment of a percentage tonnage fee imposed on the entire Industry. In October 2000, the Federal government established The Energy Employees Occupational Compensation Program Act that provided a Federal bailout of liability for the monopolistic beryllium industry. The hastily enacted Smallpox Emergency Personnel Protection Act of 2003 (SEPA) shielded pharmaceutical manufacturers from liability.  Following the horrific events of September 11, 2001, the Federal government quickly established The Victims Compensation Fund to compensate the victims and their families through an administrative system.

The largest transfer of economic wealth in the United States from Industry to the private sector, other than in the Attorney General’s thirty-eight State tobacco litigation, emanated from asbestos litigation which had its geneses in workers’ compensation.   The late Irving Selikoff, MD’s pioneering efforts in providing expert testimony, based upon his sentinel studies of asbestos workers in Paterson, NJ, created the trigger mechanism for a massive wave of claims for occupational health care. The program never did adequately nor efficiently or expeditiously provide medical care.

The workers’ compensation system did not provide an adequate remedy because of a constellation of reasons, and subsequently, the wave spread to civil litigation out of desperation for adequate benefits. Asbestos litigation has been named, "The Longest Running Tort” in American history. While the Fairness in Asbestos Resolution Act of 2003, failed to be release from committee, the insurance industry tried to stifle the litigation but the effort failed.  Asbestos litigation expanded into  bankruptcy claims that continue unabated and the epidemic of disease continues. The remaining cases in the Federal court system were transferred to Federal Multi District Litigation (MDL 875) and the majority are finally concluding after twenty years of Panel consolidation. Medical benefits were not a direct component of that system. Unfortunately, asbestos is still not banned in the United States and the legacy of disease continues at historic rates.

The Costs

In a study prepared in 2000 by Dr. Steven Markowitz for a book entitled “Cost of Occupational Injuries  and Illnesses”, it was revealed that the direct medical costs attributed to occupation illness by taxpayers, amount to $51.8 Billion dollars per year for the hospital physicians and pharmaceutical expenses. Overall workers’ compensation is covering 27% percent of the cost. This amounts to 3% of the National Gross National Product. The cost is passed on to: employers, insurance carriers, consumers, injured workers and the taxpayer. Medicare, a target of the cost shifting mechanism employer by Industry, continues its “pay and chase” policy in an effort to seek reimbursement under the Medicare Secondary Payer Act. All the stakeholders and the compensation systems have become increasingly bogged down as cost-shifting continues by Industry. The workers' compensation claims process has become stagnant. 

Reportable Data A Questionable Affair

The quantification of occupational illness data has been very problematic as it is based on sources of questionable reliability. The US Bureau of Labor Statistics (BLS) based its collection on employer driven safety reporting, ieNCCI), keeps its data and procedures under wraps.

Both the NY Times and Nebraska Appleseed have reported that there exists underreporting of occupational disease conditions in epic proportions. They report that the elements of fear and intimidation directed to injured workers compound the defense attitude of employers and the insurance industry resulting in a massive underreporting of occupationally related medical conditions.

Increased Hurtles for Compensability

There have been attempts over the years to integrate more claims statutorily into the workers’ compensation system to shield employers from civil action and resultant large liability verdicts. This resulted in a flood of occupational exposure claims into the workers’ compensation arena. An effort in the mid-1980’s, following the asbestos litigation explosion, was by Industry to contain costs and restrict the payment of occupational disease claims even further in the workers’ compensation.

The initial effort was to create higher threshold standards and requirements in the area of mental stress claims. That was quickly followed by efforts to limit orthopedic and neurological carpal tunnel claims.  Restrictive language interpreting what is peculiar to employment further limited all occupational disease claims.

Furthermore, scientific evidence proof requirements became increasingly difficult to surmount. Daubert type arguments emerged by the defense in the nations’ workers’ compensation forums where simplicity of a remedial and efficient benefit delivery program had existed in the past. Where a biological marker was not present, as was in asbestos exposure claims, the establishment of causal relationship was universally challenged.

Pre-existing and co-existing factors soon became other hurtles for injured workers and their families.  Medical histories of orthopedic difficulties such as back conditions soon complicated repetitive motion trauma litigation. Co-existing and pre-existing smoking habits, family genetics and obesity were yet another obstacle to recovery.

Societal Habits Changed

Life and the way we look at work have changed dramatically with the onset of technology. Off-premises work is becoming more and more common with the advent of Internet access and economic globalization. Defining the barriers between work and pleasure has grown to be exceedingly difficult.

People are working harder and longer. More chronic conditions are prevalent in older workers. Disease increases with age and results in more total disability claims.

Occupational Medical Costs

The compensability of occupational claims is much more difficult to sustain in court. In recent studies over 99.9% of occupational deaths and 93.8% of the medical costs of occupational disease were held to be non-compensable. Over 50% of the lifetime medical costs are incurred during the last year of one’s life.

The Legacy of The Libby Montana Gold Rush

In 1881 gold miners discovered vermiculite, a form of asbestos in Libby, Montana. In 1920 The Zonolite Company was established and began to commercially mine vermiculite. W.R. Grace bought the mining operations in 1963. In 1990 the mine was closed and production ended.

For decades W.R. Grace belched over 5,000 pounds of asbestos into the air in and around Libby on a daily basis. The residents who worked at the plant and their families and household contacts were exposed to asbestos fiber.  Mineworkers brought home the asbestos on their clothing. The unknowing inhabitants and their families  used the asbestos to fill their gardens, their driveways, the high school track, the little league field and in their attics for insulation.

The US Environmental Protection Agency (EPA) visited Libby in 1999 and investigated the incidence of disease and the contamination of the site. The EPA declared Libby a Superfund site in October 2002 and a physical clean-up began of the geographical area. The question of who would pay for the medical care of Libby remained an unknown.

A Manager’s Amendment

Senator Max Baucus (D-MT), Chair of the Senate Finance Committee, utilizing a mechanism known as “A Manager’s Amendment,” at the last moment, modified the Senate’s version of the Health Care Reform Bill. The Patient Protection and Affordable Care Act passed the Senate, ultimate cleared the House and was signed into law by President Obama on March 23, 2010. Section 10323, Medicare Coverage for Individuals Exposed to Environmental Health Hazards, 2009 Cong US HR 3590, 111^th Congress, 1^st Session (December 31, 2009).

Senator Bacus said,  “This provision is important because it will provide vital medical services to American who—through no fault of their own—have suffered horrible effects from their exposure to deadly poisons. It will provide vital medical services we owe these Americans under our commitment in the Superfund Act.”  The amendment initially provides for screening and medical care to residents of the Libby Montana asbestos contaminated site that was owned and operated by W.R. Grace. It essentially provides for universal health care.

“Libby Care” Is The New Occupational Medical Care Model Legislation

The Libby site qualified for the medical program because the hazardous asbestos contaminated site in Libby was deemed to be “a public health emergency” on June 17, 2009 as defined by the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). While there are 1700 designated Superfund sites, Libby is the first site in the history of the program that has been designated as “a public health emergency.” The program may be expanded in adopted to other communities at the discretion of the Secretary of of the Department of Health and Human Services (HHS). 

The plan authorizes a grant for initial medical screening purposes. The screening would determine if a medical condition is present that is attributable to the environmental exposure. It allows those individuals with a diagnosed medical condition due to the environmental exposure at the site to get Medicare services. The Secretary of the Department of HHS may establish additional pilot programs to provide additional medical care appropriate for the residents of contaminated communities so designated. The delivery of Medicare medical benefits will be directed to those “who have suffered horrible effects from their exposure to deadly poisons.”

The purpose of the legislation is  “…. to furnish such comprehensive, coordinated and cost-effective care to individuals…..” p2224 l3-1. It mandates the furnishing of “Flexible Benefits and Services,” for items, benefits or services NOT covered or authorized by the Act. It further authorizes the institution of “Innovative Reimbursement Methodologies,” for reimbursement subject to offsets for individuals “eligible to receive public or private plan benefits or legal agreement.” p2226 ll8-11. The Secretary of HHS will maintain “waiver authority.”

Charting A New Course

After a century of struggle, the United States now embarks upon a new course for occupational medical care. The law charts a new path for the delivery of  occupational disease medical benefits on a timely basis. It will permit researchers an avenue for the collection of epidemiological data so that the workplace can be made safer. All will benefit. The innovative legislation provides for a long awaited and much needed initiative to provide an efficient, responsive and coordinated treatment plan and preventive health program that hopefully will expand and will vastly improve occupational health care.

To read more about health care and workers' compensation click here.

Our Journey Forward on Occupational Medical Care

President Barack Obama

On Tuesday, the American people expressed its support for a unified medical care program that will embrace all aspects of life, including industrial accidents and diseases.  They validated, as did the Supreme Court, the coverage afforded those who have suffered from industrial pollution such as the deadly asbestos exposures that occurred in Libby Montana (“Libby Care”).

Going forward it is imperative that a universal medical program be established to provide medical treatment for  all work-related occupational injuries and exposures. The delay and denial of medical benefits to those who suffer from industrial illness must be cured.

“America has never been about what can be done for us. It’s about what can be done by us, together, through the hard and frustrating but necessary work of self-government. That's the principle we were founded on.”

— President Barack Obama, November 7, 2012

....

Jon L.Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson).  

Read more about Universal Medical Care – The “Libby Care” Prototype
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The Saga of Asbestos in LIbby Montana

The plight of the workers of Libby Montana may have been highlighted by efforts of Senator Harry Reid in the recent Senate Health Care Reform legislation, but it goes historically much deeper. While the hazardous of asbestos may have been studied for over a hundred years, it wasn't until a newspaper article 1999 did horrors of Libby become nationally recognized.

A a recent lecture Aubrey Miller, M.D. spoke on the plight of Libby and its people. An environmental epidemiologist and a captain in the U.S. Public Health Service board-certified in occupational medicine, Miller currently serves as the chief medical officer in the U.S. Food and Drug Administration (FDA) Office of the Commissioner's Office of Counterterrorism and Emerging Threats. Previously, he worked for the U.S. Environmental Protection Agency (EPA) and for the U.S. Department of Health and Human Services (DHHS) as a regional health administrator, coordinating multi-agency emergency responses, such as the Libby situation.

"It's the worst site in EPA history in terms of human health......Even though asbestos has been studied for 100 years," he added, "the science and regulations were developed from worker studies for workplace settings and thus were not very useful for environmental situations and non-worker exposures."

Eddy Ball, a reporter covering the Miller's lecture to a capacity audience concluded, "Politics and financial interests further complicate the regulation of such environmental hazards as Libby's. For instance, there was ample evidence accruing for many years that environmental asbestos contamination was hazardous and that the Libby situation was 'a predictable surprise.' Based on his experiences Miller is convinced that 'there must be other Libbys occurring under our noses' in the U.S. Miller stated we need to challenge dogma and preconceptions about environmental exposures and who is at risk in order to identify disease and provide honest and useful solutions for our communities."

Click here to read more about asbestos and Libby, Montana.

Path to Federalization: A National Workers Compensation System--US Supreme Court Validates

United States Supreme Court has taken a giant leap forward to facilitate the Federalization of the entire nation's workers' compensation system. By it's recent decision, upholding the mandate for insurance care under the Affordable Health Care for America Act (ACA) 2009, it has set the precedent to federalize the nation's fragmented and chaotic workers' compensation medical delivery system.

John G. Roberts Jr.,
Chief Justice US Supreme Court

Validating Mechanism
In a 5 to 4 ruling, Chief Justice Roberts validated the individual mandate as a permissible exercise of congressional power under the Taxing Clause of the US Constitution. Under 26 U.S.C. Section 5000A. The law requires that: (a) an individual must maintain minimum essential coverage for each month beginning after 2012; and (b) if there is a failure to maintain minimum essential coverage, a "penalty" is imposed "on the taxpayer" of $695 per year or 2.5% of family income, whichever is greater. The penalty "shall be assessed and collected in the same manner as taxes."

The Chief Justice, writing for himself, stated, "Every reasonable construction must be resorted to in order to save a statute from unconstitutionality." If it is "fairly possible" to interpret the statute as merely imposing a tax on those who've failed to purchase insurance. Writing for the majority, the Chief Justice stated, that the penalty is not a tax for anti-injunction act purposes. The Court, he wrote, needs to look beyond the label when assessing the constitutionality. For constitutional purposes Justice Roberts reasoned that the penalty may be considered as a tax when: it is not so high that there is no choice; and it is not limited to willful violations; and the penalty is collected by the IRS through normal means.

Constitution of the
United States

The Court indicated that the assessment is not really a "penalty." "Taxes that seek to influence conduct are nothing new," the Chief Justice wrote. He reasoned for the Court that there are no negative legal consequences to not buying health insurance, because beyond requiring a payment to IRS, Congress anticipated that some 4 million people would pay the penalty, and Congress did not treat them as "outlaws."

While certain taxes are prohibited under the U.S. Constitution, the penalty under the Affordable Health Care for America Act 2009 is not barred. The Court reasoned that the Constitution states, "No Capitation, or other direct, Tax shall be laid, unless in Proportion of the Census or Enumeration herein before directed to be taken." The majority of the Court held that a tax on "going without health insurance" does not fall within any recognized category of direct tax since it is triggered by certain specific circumstances.


The US Supreme Court previously validated compulsory workers' compensation programs. Compulsory compensation systems have been held not to be an arbitrary classification contrary to the equal protection clause of the United States Constitution, 14th Amendment.  The state-enacted systems were created for the protection of the lives, health and safety of the employees.  The systems provide payment of compensation through a state mandated system for injuries to employees or for the death of employees resulting from injuries related to work, regardless of fault.  The compensation systems are held as a simple, inexpensive and expeditious method of providing recovery to employees who are injured in a highly organized and modern industrial employment environment.  New York Central Railroad Company v. White, 243 U.S. 188, 37 S.Ct. 247, 61 L.Ed. 667 (1917). See also, Lower Vein Coal Co. v. Industrial Board of Indiana, 255 U.S. 144, 41 S.Ct. 252, 65 L.Ed. 555 (1921) and In re Asbestos Litigation, 829 F.2d 1233 (3d Cir.1987), cert. denied 485 U.S. 1029, 108 S.Ct. 1586, 99 L.Ed.2d 901 (1988).

Medical Delivery & Fees
Generally, the ACA provides a much needed national structure for the regulation, delivery, and enforcement of medical coverage. The ACA contains significant fraud and abuse provisions. In 2010 the law significantly expanded the government's authority to prosecute Faults Claims Act (FCA) cases. In 2011-2012 the ACA triggers increased provider screening, oversight and reporting. The ACA also establishes the Independent Payment Advisory Board to evaluate fee schedules and expands the scope of Medicaid and CHIP payments. 


Unlike most State compensation systems that presently struggle with both expeditious medical delivery as well the value and responsibility of medical care, the ACA provides a uniform system and expeditious system. The fragmented network of complex, dilatory and inconsistent results in the State programs have been described recently by national experts as "irrational" and "unjust."  They characterize the present compensation programs as "....dizzying and frustrating in its complexity, and apparent irrationality,"  and  they conclude that "a substantial proportion of persons with work-related disabilities do not receive workers' compensation benefits," and in need of a better format. 

Non-Traditional Revenue Stream
In addition to the widely publicized tax for non-compliance, the ACA contains several other innovative revenue provisions that will provide additional funding from collateral sources without burdening al employers globally. In 2010 an indoor tanning service tax was implemented. In 2011 annual fee was instituted on pharmaceutical companies as well as  an increased penalty for early withdrawal from health savings accounts. In 2013 the following provisions go into effect: the Medicare payroll tax will increase for high-income individuals, an excise tax on medical device manufacturers, limits on Flexible Spending Accounts, and the elimination of the deduction for Employer Part D subsidy. In 2014 there will be an annual fee on health insurance plans. In 2018 there will be an excise tax and high-cost plans commonly referred to as the "Cadillac tax."

"Libby Care"--Universal Care 

Center for Asbestos Related Disease
Libby, MT.

A provision of the Act, that has already been implemented, provides for the treatment of medical conditions, including asbestosis & mesothelioma, arising out the Libby, Montana asbestos contamination. The industrially caused   catastrophe in Libby has resulted in widespread illness and death. The ACA provides medical attention to those exposed to occupational toxins. The Center for Asbestos Related Disease is now operating in Libby, MT. The “Libby Care” provisions, and its envisioned prodigies, will embrace more exposed workers, diseases and geographical locations, than any other program of the past. This type of program, minimally, needs to be expanded to include all occupational illness nationally.

The Future: Universal Health Care

Landmarks on the Path to Federalization

It is very doubtful that ACA repeal legislation, to be offered by the Republicans in the House will pass Congress, nor will the President sign it.. There may be some technical and substantive revisions to the ACA in the next Congress. If there is a mixed political government after the next election,  the ACA will be implemented and go forward as the law of the land.


History reveals that a series of efforts have been made by the Federal government  to federalize medical care for industrial accidents and illnesses. Those efforts demonstrate a commitment to bring the nation ever closer to a universal care medical program incorporating the entire patchwork of workers' compensation medical delivery systems. The US Supreme Court has accelerated the nation down that promising path.
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Jon L.Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). 

More on improving the medical delivery system

Workers' Compensation: National Experts Call Workers ...

Jun 14, 2012

Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally .

http://workers-compensation.blogspot.com/

The World Trade Center Health Program Expands The Path to

Dec 23, 2010

Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally ...

http://workers-compensation.blogspot.com/

Workers' Compensation: Agenda Announced for Public Meeting on ...

Feb 15, 2011

In December 2010 US Congress passed and President Obama signed, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program.

http://workers-compensation.blogspot.com/

Designing the New Federal Workers Compensation Program

Jul 05, 2010

The trend toward Federalization of workers' compensation benefits took a giant step forward by recent Presidential action creating the British Petroleum Oil Compensation Fund. While the details remain vague, the broad and ...

http://workers-compensation.blogspot.com/

Workers' Compensation: Synchronizing Federal Care for Oil Spill ...

Jul 13, 2010

As The Path To Federalization expands, this debate will expand. A recent study by the Center for American Progress addresses these concerns. "Health threats from the oil spill may linger unseen, perhaps for more than a ...

http://workers-compensation.blogspot.com/

Workers' Compensation: A Nuclear Workers' Compensation Disaster

Mar 16, 2011

Historically The Federal government's role has been to rise to the occasion and walk further down a path to federalization. On a smaller scale than the potential consequences of the Japanesse debacle, the US was first in line ...

http://workers-compensation.blogspot.com/

Workers' Compensation: Vermont Universal Health Care to Embrace ...

Mar 05, 2011

Nationally, advocates to improve the delivery of medical benefits to injured workers have urged federalization of the medical delivery system into a single payer approach through universal health care. ... Compensation Claim Draws Major Public Attention (workers-compensation.blogspot.com); Vermont Governor Sets Out to Lead U.S. to True Universal Coverage (huffingtonpost.com); The World Trade Center Health Program Expands The Path to Federalization ...

http://workers-compensation.blogspot.com/

Workers' Compensation: Libby Care Launches - Center for Asbestos ...

Apr 03, 2010

The recent health care reform legislation provided for the Libby Care which will provide universal medical care for victims of asbestos related disease. The plan is a pilot program for occupational disease medical care fully ...

http://workers-compensation.blogspot.com/

Workers' Compensation: Libby Care Program Begins Enrollment ...

May 19, 2010

The “Libby Care” provisions, and its envisioned prodigies, will embrace more exposed workers, diseases and geographical locations, than any other program of the past. Potential pilot programs will now be available to ...

http://workers-compensation.blogspot.com/

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EPA Declares Asbestos in Libby Montana is a Public Health Emergency

An historic first occurred today with the announcement by the US EPA that the asbestos in Libby, Montana constituted a Public Health Emergency. The EPA stated, "Over the past years, hundreds of asbestos-related disease cases have been documented in this small community, which covers the towns of Libby and Troy. "

"This is the first time EPA has made a determination under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) that conditions at a site constitute a public health emergency. This determination recognizes the serious impact to the public health from the contamination at Libby and underscores the need for further action and health care for area residents who have been or may be exposed to asbestos. Investigations performed by the Agency for Toxic Substance and Disease Registry have found the incidence of occurrence of asbestosis, a lung condition, in the Libby area staggeringly higher than the national average for the period from 1979-1998. EPA is working closely with the Department of Health and Human Services, which is making available a short-term grant to provide needed asbestos-related medical care to Libby and Troy residents. "

Libby Care Launches - Center for Asbestos Related Disease Ground Breaking

The recent health care reform legislation provided for the Libby Care which will provide universal medical care for victims of asbestos related disease. The plan is a pilot program for occupational disease medical care fully funded under the Medicare program.


This week Senator Max Baucus, instrumental in crafting and enacting he program, participated in the ground breaking for ceremony for the expansion of the Center for Asbestos Related Disease (CARD).

“Today was a great day for CARD and the people of Libby,” Baucus said at the groundbreaking. “We’re all in this together, and it’s really through team work that we’re able to get this expansion done. It’s also great day because now the people of Libby will get the health care they need and deserve.”

Baucus said that the EPA designation, along with the new legislation, “has triggered over $300 million [in health aid for Libby] over the next 10 years. This is going to be bigger and better than the aid that was given to victims of 9/11.”

Click here to read more about Libby Care.

Click here to read about asbestos litigation.