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Boston Globe
16-07-2025
- Health
- Boston Globe
Some Massachusetts parents face hurdles to access paid medical recovery time after childbirth
'It feels like the standard insurance thing of deny, deny, deny, until the person really fights back and understands their rights,' said Coffey, 36, of Arlington. 'And I just think putting mothers who have recently gone through childbirth through that is really egregious.' Advertisement This isn't what state lawmakers had in mind when they passed the family leave law in 2018, with the idea of making life easier for recent mothers, caretakers of elderly parents, and those recovering from illnesses or injuries. But in allowing companies to opt out of a state-run program and operate their own family leave plans, the law opened the door to insurers and other benefit managers. And that has meant hassles. Get Starting Point A guide through the most important stories of the morning, delivered Monday through Friday. Enter Email Sign Up It's unclear how many people have had similar experiences — neither the state nor companies collect data on aggravation — but Coffey isn't alone. Facebook pages of mothers' groups are filled with similar stories of frustration, futility, and anger. Most of the time, these disputes are resolved by benefits managers. When they're not, employees can appeal to the state. Since 2021, the Department of Family and Medical Leave has received 26 appeals of decisions by insurers and other plan administrators; all but one were resolved in favor of the claimant. Advertisement Coffey, whose daughter is now 18 months, had lined up child care based on her doctor's recommended leave, but suddenly she faced a scramble to come up child care eight weeks sooner. She eventually convinced The Hartford, her employer's family-leave administrator, to approve all the time prescribed by her doctor. But it required weeks of calls, emails, and gathering additional documentation. 'They didn't tell me [about the six-week limit] until after I had given birth,' Coffey said. 'I was so stressed trying to take care of this little baby and trying to understand if my leave was going to be ending.' The Hartford did not respond to requests for comment. The Massachusetts Paid Family Leave law allows employees to take up to 20 weeks of leave for medical recovery after giving birth and 12 weeks to bond with a new child, although total paid leave is capped at 26 weeks. Employees receive up to $1,170.64 per week in 2025. Most of the 272,000 employers covered by the law participate in a state-run program, funded by employee payroll taxes and employer contributions. The law also allows companies to carve out their own plans, which must provide equal or better benefits than the state program and be approved by state Division of Insurance. About 6,000 companies with an estimated 1.2 million employees use approved private plans, according to the state. Advertisement Employees who receive benefits through the state rarely run into the kind of hassles that Coffey encountered. The state generally accepts what health care providers determine is the appropriate length of medical leave, said Bill Alpine, director of the Massachusetts Department of Family and Medical Leave. Erin Coffey playing with her children Charlie, 4, and Natalie Coffey, 18 months. Matthew J. Lee/Globe Staff 'If the medical provider says, for example, this individual needs 12 weeks for medical care after birth,' Alpine said, 'we're not going to question that.' But that's not always the case with private plans. These plans sometimes pay employees on leave more than the state program does, but the plans ultimately are designed to give companies more control over how and how much benefits are paid out, said Jon Hurst, president of the Retailers Association of Massachusetts. 'If you're in a private plan,' Hurst said, 'you can police it better to make sure that there's not abuses going on in the system.' Mike Spinale, a board member at the Massachusetts state council of the Society for Human Resource Management, said some companies might have 'more onerous' claims processes that require more documentation than the state program. 'In the insurance company is a claims adjuster,' Spinale said. 'and like any insurance, their goal is to pay as little as possible, unfortunately.' Under the law, the benefit of the doubt is supposed to go to employees seeking the time off. Still, Coffey and other women said the onus fell on them when benefits managers refused to approve the full leave recommended by their doctors. Coffey said she only succeeded after sending an email to the The Hartford citing specific passages of the law, including, 'All presumptions shall be made in favor of the availability of leave and the payment of family and medical leave benefits.' Advertisement When she recounted her ordeal to her new moms Facebook group, more than a dozen women asked for the email she sent to the insurer. Coffey posted a She said she regularly hears from new mothers thanking her for posting the template and requesting help navigating the process. Susan Wilson, a mom who works for a local university, said her employer's leave administrator, Workpartners, would only approve eight weeks for medical recovery after the birth of her twin boys, despite her doctor signing off on 14. After weeks of phone tag and emails, Wilson said she caved to the benefits manager's requests to provide additional medical reasons for the extra weeks of leave. But even after her doctor sent the documentation, Wilson said, the back-and-forth continued until Workpartners finally approved her full claim. Workpartners did not respond to requests for comment. Wilson said she felt frustrated by the experience, especially since paid leave in the US lags far behind many other countries. In Canada, mothers take up to 15 weeks of maternity leave 'It just felt so sad that I had to fight and be made to feel like I was asking for too much when, frankly,' Wilson said, 'I still think that we get so little.' Advertisement Stella Tannenbaum can be reached at
Boston Globe
28-05-2025
- Business
- Boston Globe
Healey, moving to cut red rape and burnish business-friendly chops, unveils dozens of regulatory changes
Advertisement 'What's most important is the mindset, [the] message that we heard,' said Jim Rooney, president of the Greater Boston Chamber of Commerce. 'This administration has that mindset of trying to deal with issues that are burdensome for people in businesses.' The various regulatory amendments followed a Her administration ultimately reviewed 150 sets of regulations. Healey said her administration is ultimately 'cutting down' 38 of them, many of which may appear minor, if not esoteric, to most consumers. One would Advertisement Grocery stores and supermarkets would no longer have to make parts of so-called Healey said the Division of Insurance would also no longer require banks and insurance companies to submit paper copies of filings in many instances. 'We'll save some trees in the process,' Healey said as she fed a prop piece of paper into the whirring shredder. 'It's about making sure that we have the right regulations [and] smart regulations.' Healey isn't the first governor to boast of slashing red tape for businesses. Governor Deval Patrick, a Democrat, boasted in his final year in office in 2014 having led a review of nearly 1,800 regulations, and Months after taking office in 2015, his successor, Charlie Baker ordered a wide-scale review of 'onerous' regulations. The move immediately Jon Hurst, president of the Retailers Association of Massachusetts, said many of Patrick and Baker's efforts ultimately had 'little or nothing to show' for it. Advertisement He said his own members had raised to their administrations concerns about the unit pricing rules or the state's so-called hoisting regulations — think forklifts, Hurst said — without ever seeing action on them. Healey on Wednesday offered changes to the latter, including removing the requirement that hoisting engineering applicants communicate in English. Those moves are encouraging, Hurst said, even if 'these were the easy ones, right?' 'The hard ones are yet to come,' he said, pointing to the potential for tackling escalating health insurance costs for businesses — a shift that could require legislation, is often complicated, and usually 'politically fraught.' 'We're just kind of just hitting the surface at this point,' he said. Healey called Wednesday's announcement a 'first set of cuts and reforms,' though she did not indicate where or what rules her administration would review next. Healey's first term, and her bid next year to remain in office, will likely hinge in part on whether she's met her repeated promise to shed Massachusetts' tax-heavy label and She ran on realizing, and signed, a Advertisement Both Republicans who've announced challenges to Healey — former MBTA executive 'Massachusetts [is] bleeding businesses, private sector jobs and workers,' Holly Robichaud, a Shortsleeve adviser, said in a statement Wednesday. Matt Stout can be reached at
Yahoo
22-05-2025
- Health
- Yahoo
Lawmakers advance proposal to cap insulin costs at $35 per month
Nevada could become the 27th state to cap the out-of-pocket cost of insulin for people on private insurance plans. (Photo Illustration by) Tens of thousands of Nevadans could pay less each month for insulin if lawmakers approve a proposed out-of-pocket cap on commercial insurance plans, according to the state Division of Insurance. Assembly Bill 555, sponsored by Speaker Steve Yeager, would prohibit private insurance companies from charging people more than $35 for a 30-day supply of a prescription insulin drug. The Senate and Assembly committees on commerce and labor in a joint meeting heard the bill Wednesday and immediately advanced it. Currently, no such cap on out-of-pocket insulin costs exists for private insurance companies, resulting in 'outrageous and unpredictable' prices for many Nevadans, according to Yeager. The Las Vegas Democrat told the committee he has heard of people paying up to $500 per month for insulin. Adam Plain from the Nevada Division of Insurance estimated there could be 70,000 Nevadans who have diabetes and are on private insurance plans regulated by the state. Private insurance makes up 18.6% of health care plans in the state, he said. Just under 11% of the adult population in the state has diagnosed diabetes, according to the American Diabetes Association. More broadly, the association estimated that nearly 270,000 people in Nevada have been diagnosed diabetic and an additional 70,000 have it but haven't been diagnosed. Twenty-six states, as well as the District of Columbia, have capped out-of-pocket insulin costs for commercial insurance plans, according to the association. Caps range from $25 in Connecticut to $100 bucks in Alabama and Delaware for a 30-day supply. With AB 555, Nevada policy would align with President Joe Biden's Inflation Reduction Act, which established a $35 out-of-pocket insulin cost cap for people on Medicare. Yeager referenced research finding that the number of fulfilled insulin prescriptions rose after the cap provision went into effect, suggesting that fewer people are skipping or rationing their medications because of their high costs. Yeager called his legislation a 'partial answer' and acknowledged it would not help uninsured cash payers. The legislation also does not affect health care plans offered by public employers. During the hearing, Republican state Sen. John Ellison of Elko commented that President Donald Trump recently said he would lower the cost of all prescriptions. 'I thought that was so amazing,' Ellison added. Trump signed an executive order on May 12 aimed at lowering drug prices by pressuring pharmaceutical companies to align their U.S. pricing models with those in similarly wealthy countries. It has been panned by Democrats as unserious. Yeager did not comment on the executive order but said he generally 'would be all for' any federal action that goes beyond what he is proposing at the state level. At the same time, 'there is no reason' Nevada shouldn't do what it can while it can, he argued. AB 555 will provide financial relief to Nevadans feeling the effects of 'disastrous economic policies at the national level,' he'd said at an earlier point in the hearing, an obvious dig at Trump. 'It is incumbent on us at the state level to find solutions for them.' Groups supporting AB 555 include the Nevada State Medical Association, Nevada Women's Lobby, Retail Association of Nevada, and Battle Born Progress. The bill's only public opposition came from Americans for Prosperity, which believes the bill would interfere with 'the natural price mechanisms of the market' and comes with the risk of 'creating a cascade of unintended consequences.' The Nevada Association of Health Plans has taken a neutral position on the bill, but lobbyist Shelly Capurro said some of its 11 members had concerns about unintended consequences. After the hearing, during the meeting's general public comment period, Plain, the insurance regulation liaison for the state, addressed lawmakers as a private individual with diabetes. He thanked them for taking on the subject. He said that with the 'pretty good insurance' he gets as a state employee he pays $320 for a 90-day supply of insulin and three other medications, pen needles, and glucose monitoring. 'The list price for those four meds is $4,000 for a 90-day supply,' he added. Another Nevadan, Lisa Lynn Chapman, testified that when she first started taking insulin for her Type-2 diabetes, her needles and insulin were free. Then, her employer changed insurance and 'suddenly, my two different insulins cost $60 each, and my needles were $35 a month.' The cost, she added, was difficult to absorb. High costs are not what the three men who discovered and secured the patent rights for insulin wanted, Yeager told the joint committee in his closing. One of them, Frederick Banting, is famously quoted as saying, 'Insulin does not belong to me. It belongs to the world.' They sold their patents for $1 each to the University of Toronto in 1923. 'Somehow we are here in the year 2025 and people are paying $500 a month for something that was assigned patent rights for a dollar over a hundred years ago,' said Yeager. 'To me that is not and never will be acceptable.'
