Harvard’s shameful stance on insurance for low-income employees

Harvard’s low-income workers deserve affordable health insurance

By Micah Johnson and Sanjay Kishore
STAT, September 30, 2016

There’s an outbreak of a hidden epidemic — unaffordable employer-based health insurance, especially for low-income workers — at Harvard, a place where it should never occur.

As medical students at Harvard, we were deeply troubled to learn that our university was proposing changes to dining workers’ health plans that would make essential health care unaffordable. After months of negotiation, the dining workers’ union voted to authorize a strike, which will launch on Wednesday if a deal is not reached. The campus has rallied around the workers, circulating a petition of support signed by 2,500 students, including us, in advance of federal mediation held earlier this week.

In the dining workers’ fight with Harvard, we see a microcosm of current challenges for health insurance across America.

The affordability of health insurance plans comes down to two factors: premiums and out-of-pocket costs. How affordable are employer plans? A team of Harvard medical students compared the plan Harvard proposed for the dining workers to what would be available on the Massachusetts health exchange.

For a family of three earning $30,000, the Harvard plan requires an employee to contribute a premium of $233 a month, while the health exchange has plans that require no premium at all. Harvard Medical School faculty and the World Health Organization have defined any health spending over 10 percent of annual income as a catastrophic expenditure. The Harvard plan comes perilously close to this with premiums alone. The cherry on top? Harvard’s plan also has higher co-pays than the exchange plans.

It is shocking that these low-income workers would be better off financially if they were not offered employer-sponsored insurance.

This may seem confusing. After all, exchange plans have been lambasted for their soaring costs. But the sobering truth is that the situation is worse among employer-provided plans. A recent Urban Institute study showed that total premiums were lower in exchange plans than in employer-provided plans in more than 80 percent of major US markets. In Boston, the premiums for exchange plans were 35 percent less expensive than employer plans. The gap would likely be even larger for lower-income employees, who would be eligible for more robust subsidies in the exchange plans.

Harvard’s proposal for its dining workers threatens to widen health disparities along lines of race and class. Many of the dining workers are immigrants, over half identify as people of color, and nearly half earn less than $35,000.

Innovation in health care is more likely to happen when big employers, rather than low-income workers, feel the burden of health care costs. Institutions like Harvard hold tremendous untapped power to implement novel programs and pressure health systems to make badly needed reforms.

Not every creative intervention will work. But only by moving beyond the status quo will we learn which new ideas have real benefits. Simply making poor families pay more for essential services like insulin prescriptions and hospital admissions is an unacceptable cop-out.

As physicians in training, we cannot stand by as the world’s richest university forces its most vulnerable employees to choose between dinner and a doctor’s visit. Harvard can do better, and this “better” can have a ripple effect on other unions, other universities, and other workplaces across the nation. Employers like Harvard must pursue real innovation, not simply balance their budgets on the backs of those least able to afford it — and least likely to survive it.

Micah Johnson and Sanjay Kishore are second-year students at Harvard Medical School.


Harvard students freak out as dining hall workers prepare to strike: ‘I don't need to worry about where my food is coming from’

By Meg Wagner
New York Daily News, October 4, 2016

Harvard's dining hall staffers are about to go on strike, much to the dismay of starving, stressed-out students.

"I understand it's for legitimate purposes, but I'm worrying about midterms right now," freshman Sofia Garcia told the Washington Post. "I don't need to worry about where my food is coming from."

It's unclear if students — who pay a whopping $36 a day for unlimited dining hall access — will be refunded for any lost meals.

Union negotiator Michael Kramer said the 750 workers demand "the ability to earn at least $35,000 a year and a health insurance program that does not shift costs onto those who can least afford it."

The university countered that the workers receive "some of the most generous hourly wages and benefits" for food service workers in the region and that it is proposing "modest" health care changes already accepted by thousands of other unionized university workers.



By Don McCanne, M.D.

Creeping deterioration of employer-sponsored health insurance seems to lie in the background as concerns are directed to many other more obvious deficiencies in America’s dysfunctional health care financing system. But creeping deterioration is occurring and the seriousness of it is demonstrated by Harvard - an employer that should be carrying the banner towards comprehensive reform but instead is shamefully joining the trend toward shifting unaffordable health care costs onto its employees, seriously impacting affordability and access especially for its lowest wage employees.

It is gratifying to see that two of Harvard’s medical students, Micah Johnson and Sanjay Kishore, are joining in the effort to publicize the plight of low-income Harvard employees in their stalled negotiations over maintaining essential health benefits.

But Harvard defends itself by saying that the reductions are modest and commonplace, while Johnson and Kishore suggest that we need to experiment with creative intervention. And student Sofia Garcia simply doesn’t want to worry about where her food is coming from during the strike.

We have decades of creative intervention and that has only resulted in the highest costs and the most dysfunctional health care financing system of all industrialized nations.

This problem is much greater than being simply a negotiating point in a labor dispute. Harvard, their students, and everyone else needs to demand enactment of a health care financing system that will make health care affordable and accessible for all of us - a single payer national health program. Harvard’s dining hall staffers might still need to negotiate for decent wages, but at least they would have affordable and accessible health care permanently.