Purple hats and gold thunder sticks carrying the message, "Enough is Enough", filled Albany's West Capitol Park on Thursday as some 5,000 1199SEIU caregivers rallied to protest another round of healthcare budget cuts proposed by New York's Governor David Paterson.

The Governor's proposed $278 million in Medicaid cuts would cause the state to lose a total of $746 million, when federal matching funds are figured in. For every dollar cut in state Medicaid funding, New York loses $2.60 from Washington.

In the past two years, healthcare funding has already been cut six times by the legislature, with a combined loss of over $2.2 billion, resulting in the loss of several hospitals and nursing homes in distressed areas.

Ros Hampton, an LPN and longtime 1199SEIU Delegate in Buffalo, rally inspired the crowd when she asked, "Governor Paterson, is this any way to treat the most vulnerable members of our society that have paid their dues? Our elderly need to be treated like the kings and queens they are, but how can we do that with these outrageous budget cuts?"

Paulette Abrams, an 1199SEIU homecare worker with the Social Concern Homecare Agency, told the rally, "I've been a homecare worker for 19 years and I'm here to tell Governor Paterson that our patients and all of our families cannot survive any more cuts to homecare. Our clients won't be able to get the care they need and we won't be able to pay our bills."

1199SEIU caregivers came to Albany from as far away as the tip of Long Island and up to the Canadian borders of Western and Northern New York. They were joined by hospital and nursing home executives, who understand the devastating impact of these cuts.

Over the past few months, we've been reminding folks that the "the cost of doing nothing is too high." How high, exactly? Glad you asked.

The Robert Wood Johnson Foundation, a nonprofit group working to improve the health and health care of all Americans, decided to look into that. Their recently published report, "The Cost of Failure to Enact Reform: Implications for States," shows the price that states would bear if Congress fails to pass reform.

The report shows that under the worst-case scenario, within 10 years:

• The number of people without insurance would increase by more than 30 percent in 29 states. In every state, the number of uninsured would increase by at least 10 percent.


• Businesses would see their premiums increase - more than doubling in 27 states. Even in the best case scenario, employers in 46 states would see premiums increase by more than 60 percent.


• Every state would see a smaller share of its population getting health care through their job. Half of the states would see the number of people with employer-sponsored insurance fall by more than 10 percent.


• Every state would see spending for Medicaid/Children's Health Insurance Program (CHIP) rise by more than 75 percent.

Of course, that's only the worst case scenario, which may not happen at all. In fact, our health care system could magically cure itself, making reform pointless. While that seems to be what the Republicans are banking on, it's clear to the rest of us that we have a lot of work ahead of us.

HUGE news for home care workers and those they care for. In response to SEIU lawsuit, a U.S. District Court judge issued an injunction Thursday afternoon ordering the state of California to halt a proposed $2 cut in wages for the state's 400,000 home care workers.

The injunction has the effect of stopping pay cuts in all California counties that were planning on passing the state cut through to their home care workers.

The injunction, issued by federal judge Claudia Wilken, was in response to a lawsuit filed by the Service Employees International Union (SEIU), which has 250,000 home care members in California. The lawsuit alleges the wage cut violates the federal Medicaid Law, Americans with Disabilities Act, and Rehabilitation Act.

"This ruling is bringing hope to hundreds of thousands of home care consumers and workers all across the state," said Mary Harms, a home care worker in Contra Costa County. "We had no choice but to ask the court to help us after the governor and legislature let everyone down and put so many people in danger."

The enjoined state budget cuts would have slashed homecare workers' wages to as low as $9.50 an hour. The wage cuts would have forced thousands of homecare providers to leave their employment to seek living-wage jobs, forcing frail seniors and people with disabilities to enter nursing homes or other residential institutions.

The first step is making sure the President's budget gets the support it needs from leaders in Congress. His budget makes a huge down-payment on reforming healthcare this year, and toward erasing the disparities that have resulted in unequal care. We need to show our strong and unequivocal support for the Presidents budget. Already, Obama has done more to reform health care than George Bush did in eight years including:

· Covering More Children: Reauthorization of the Children's Health Insurance Program to cover an additional 4 million children

· Preventing Cuts in Medicaid: $87 Billion to prevent Medicaid cuts

· Real Money for Disease Prevention in Underserved Communities: $1 billion for prevention & wellness--much of which will be focused on underserved communities & advocates need to weigh in with HHS to shape this spending

· Research Into Which Treatments Work Best for Minority Communities: $1.1 billion for comparative effectiveness--research into what treatments & procedures work best for which patient groups--this research will be conducted with sensitivity to gender, ethnicity, and minority populations.

· Technology To Collect Health Data For Communities of Color: $20 billion in Health Information Technology investments--Health Information Technoloy should enable the improved collection of patient demographic data to better measure patient outcomes by subpopulations

· Investing in the Healthcare Workforce for Communities of Color: $500 million for health care workforce--much of this investment will go to promote National Health Service Corps, whose physicians, dentists, and nurses serve underserved communities

Obama's proposed budget will go even further to promote equality by:

· Investing $640 Billion In Expanded Coverage To Improve The Delivery System and Contain Costs. It's the first step in vastly reducing the number of uninsured and leveling the health care playing field.

· A New Nurse Home Visitation Program That Targets Families At Risk for Chronic Disease With Early Intervention Programs for New Moms.

· Additional $330 Million in Health Care Workforce - Something Communities Of Color Need, So That We Have The Workforce and Delivery System To Level The Playing Field.

Click here to join the Healthcare Equality Project and show your support for President Obama's budget.

We cannot get our economy back on track without repairing the American health care system. Health care reform is not just a moral imperative, but also an economic necessity. In 2007, the U.S. economy lost as much as $207 billion as a result of the poor health and shorter lifespan of the uninsured.

Skyrocketing health care costs add to families' already overwhelming burden, threatening their health and financial security. We can do better. Solving America's health care crisis will improve quality of care, reduce costs and make businesses more competitive.

The urgent need for reform is more apparent now in Tennessee than ever. In the past eight years, health care premiums for family coverage have risen more than 5 times faster than wages. With 7.9% unemployed, many families are at risk of losing their health coverage. The message is clear: Tennessee's families urgently need Congress to take direct action on health care reform.

Supporting Facts

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• Health Insurance premiums in Tennessee increased by 61.9% from 2000 to 2007, while median earnings only increased a mere 12.1%. The median yearly wage in 2007 for Tennessee was only $25,639, but the average health care premium for a family was $10,606. This means that premiums grew 5.1 times faster than wages.


• In Tennessee, approximately 1,301,000 non-elderly people spent more than 10% of their pre-tax family income on health care costs in 2008. 87% of those people have insurance, but are underinsured. 1,133,000 Tennessee residents with insurance spent more than 10% of their pre-tax income on health care costs, and 333,000 spend more than 25% of their income.


• By 2016, projections show that Tennessee families will have to pay close to $19,400 for health care or over 44 percent of median household income. This would represent a 70 percent increase over 2008 levels.


• In addition, more and more Tennessee residents have been forced into the exorbitantly expensive individual market, as unemployment reaches massive heights. As of December 2008, 241,183 Tennessee residents were unemployed. That reflects a loss of almost 90,000 jobs statewide last year alone, increasing the state unemployment rate by over 2.9 percentage points.


• If the state keeps losing jobs at the rate it did last year, 384,425 people in Tennessee will be unemployed by 2010. 48.35% of insured Tennessee residents depend on their employers for their health insurance. If nothing is done to stem the economic downturn and reform our health care system, 69,259 Tennessee workers will lose their current health coverage, meaning that 28,684 more people will likely enroll in COBRA. That leaves 40,611 people who will have to enroll in Medicaid, fend for themselves on the private market, or become uninsured.


• This year Tennessee faces a $1.4 billion budget shortfall. As of 2007, 29% of all state spending has gone to Medicaid and SCHIP. $7.5 billion went to spending on Medicaid alone.


• As of 2007 there were already 126,186 uninsured children in Tennessee, and more than 714,361 uninsured adults. 276,378 of uninsured adults in Tennessee also live below the Federal Poverty Line. Tennessee's economy lost as much as $3.57 billion because of the poor health and shorter lifespan of the uninsured in 2007. That equates to $4,000 per uninsured Tennessee resident.


• Of the top 10 employers in the state of Tennessee, 3 of them are Healthcare Providers. According to the US Census, 209,949 individuals work in the Heath Care Sector in the state & make an average of $3,886 per month, which accounts for $1.0 billion in wages per month.

The health of the American economy cannot improve without addressing the healthcare crisis. Building on the existing healthcare system, quality, affordable healthcare can be guaranteed to every American. It's the reform truly needed to rebuild Tennessee's economy.

We cannot get our economy back on track without repairing the American health care system. Health care reform is not just a moral imperative, but also an economic necessity. In 2007, the U.S. economy lost as much as $207 billion as a result of the poor health and shorter lifespan of the uninsured. Skyrocketing health care costs add to families' already overwhelming burden, threatening their health and financial security. We can do better. Solving America's health care crisis will improve quality of care, reduce costs and make businesses more competitive. The urgent need for reform is more apparent now in North Dakota than ever. In the past eight years, health care premiums for family coverage have risen more than twice as fast as wages. With 3.5% unemployed, many families are at risk of losing their health coverage. The message is clear: North Dakota's families urgently need Congress to take direct action on health care reform.

Supporting Facts

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• Health Insurance premiums in North Dakota increased by 74.3% from 2000 to 2007, while median earnings only increased a mere 26.4%. The median yearly wage in 2007 for North Dakota was only $24,255, but the average health care premium for a family was $10,674. This means that premiums grew 2.8 times faster than wages.


• In North Dakota, approximately 155,000 non-elderly people spent more than 10% of their pre-tax family income on health care costs in 2008. 89% of those people have insurance, but are underinsured. 138,000 North Dakotans with insurance spent more than 10% of their pre-tax income on health care costs, and 48,000 spent more than 25% of their income.


• By 2016, projections show that North Dakota families will have to pay around $20,000 for health care or over 41 percent of median household income. This would represent an 76 percent increase over 2008 levels.


• In addition, more and more North Dakotans have been forced into the exorbitantly expensive individual market, as unemployment reaches massive heights. As of December 2008, 12,848 North Dakota residents were unemployed. That reflects a loss of over 1,078 jobs statewide last year alone, increasing the state unemployment rate by over .3 percentage points.


• If the state keeps losing jobs at the rate it did last year, 14,025 people in North Dakota will be unemployed by 2010. 66% of insured North Dakotans depend on their employers for their health insurance. If nothing is done to stem the economic downturn and reform our health care system, 630 North Dakota workers will lose their current health coverage, meaning that 235 more people will likely enroll in COBRA. That leaves 395 people who will have to enroll in Medicaid, fend for themselves on the private market, or become uninsured.


• As of 2007, 14% of all state spending has gone to Medicaid and SCHIP. $513 million of North Dakota's budget went to spending on Medicaid alone.


• As of 2007 there were already 14,305 uninsured children in North Dakota, and more than 53,677 uninsured adults. 16,927 of uninsured adults in North Dakota also live below the Federal Poverty Line. North Dakota's economy lost as much as $269 million because of the poor health and shorter lifespan of the uninsured in 2007. That equates $4,400 per uninsured North Dakota resident.


• Of the top 10 employers in the state of North Dakota, 8 of them are Healthcare Providers. According to the US Census, almost 42,000 individuals work in the Heath Care Sector in the state & make an average of $3,264 per month, which accounts for $137 million in wages per month.

The health of the American economy cannot improve without addressing the healthcare crisis. Building on the existing healthcare system, quality, affordable healthcare can be guaranteed to every American. It's the reform truly needed to rebuild North Dakota's economy.

We cannot get our economy back on track without repairing the American health care system. Health care reform is not just a moral imperative, but also an economic necessity. In 2007, the U.S. economy lost as much as $207 billion as a result of the poor health and shorter lifespan of the uninsured.

Skyrocketing health care costs add to families' already overwhelming burden, threatening their health and financial security. We can do better. Solving America's health care crisis will improve quality of care, reduce costs and make businesses more competitive.

The urgent need for reform is more apparent now in Iowa than ever. In the past eight years, health care premiums for family coverage have risen almost 4 times faster than wages. With 4.6% unemployed, many families are at risk of losing their health coverage. The message is clear: Iowa's families urgently need Congress to take direct action on health care reform.

Supporting Facts

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• Health Insurance premiums in Iowa increased by 72.6% from 2000 to 2007, while median earnings only increased a mere 18.5%. The median yearly wage in 2007 for Iowa was only $26,247, but the average health care premium for a family was $11,194. This means that premiums grew 3.9 times faster than wages.


• In Iowa, approximately 701,000 non-elderly people spent more than 10% of their pre- tax family income on health care costs in 2008. 91% of those people have insurance, but are underinsured. 638,000 Iowans with insurance spent more than 10% of their pre-tax income on health care costs, and 172,000 spend more than 25% of their income.


• By 2016, projections show that Iowa families will have to pay over $21,000 for health care or over 39 percent of median household income. This would represent a 76 percent increase over 2008 levels.


• In addition, more and more Iowans have been forced into the exorbitantly expensive ndividual market, as unemployment reaches massive heights. As of December 2008, 77,080 Iowa residents were unemployed. That reflects a loss of over 13,100 jobs statewide last year alone, increasing the state unemployment rate by 0.8 percentage points.


• If the state keeps losing jobs at the rate it did last year, 92,989 people in Iowa will be unemployed by 2010. 59% of Iowans depend on their employers for their health insurance. If nothing is done to stem the economic downturn and reform our health care system, 9,126 Iowa workers will lose their current health coverage, meaning that 3,182 more people will likely enroll in COBRA. That leaves 5,944 people who will have to enroll in Medicaid, fend for themselves on the private market, or become uninsured.


• This year Iowa faces a $134 million budget shortfall, and has already depleted its budget stabilization rainy day fund. As a result, the state has instituted a hiring freeze on public employees. As of 2007, 17% of all state spending has gone to Medicaid and SCHIP. $2.6 billion went to spending on Medicaid alone.


• As of 2007 there were already 41,361 uninsured children in Iowa, and 248,817 uninsured adults. 89,178 of uninsured adults in Iowa also live below the Federal Poverty Line. Iowa's economy lost as much as $1.2 billion because of the poor health and shorter lifespan of the uninsured in 2007. That equates $4,335 per uninsured Iowa resident.


• Of the top 10 employers in the state of Iowa, 4 are Healthcare Providers. According to the US Census, 142,870 individuals work in the Heath Care Sector in the state & make an average of $3,256 per month, which accounts for $466 million in wages per month.

The health of the American economy cannot improve without addressing the healthcare crisis. Building on the existing healthcare system, quality, affordable healthcare can be guaranteed to every American. It's the reform truly needed to rebuild Iowa's economy.

We cannot get our economy back on track without repairing the American health care system. Health care reform is not just a moral imperative, but also an economic necessity. In 2007, the U.S. economy lost as much as $207 billion as a result of the poor health and shorter lifespan of the uninsured.

Skyrocketing health care costs add to families' already overwhelming burden, threatening their health and financial security. We can do better. Solving America's health care crisis will improve quality of care, reduce costs and make businesses more competitive.

The urgent need for reform is more apparent now in Florida than ever. In the past eight years, health care premiums for family coverage have risen more than three times faster than wages. With 8.1% unemployed, many families are at risk of losing their health coverage. The message is clear: Florida's families urgently need Congress to take direct action on health care reform.

Supporting Facts

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• Health Insurance premiums in Florida increased by 72.0% from 2000 to 2007, while median earnings only increased a mere 20.2%. The median yearly wage in 2007 for Florida was only $27,353, but the average health care premium for a family was $11,720. This means that premiums grew 3.6 times faster than wages.


• In Florida, approximately 3,873,000 non-elderly people spent more than 10% of their pre-tax family income on health care costs in 2008. 79.7% of those people have insurance, but are underinsured. 3,087,000 Florida residents with insurance spent more than 10% of their pre-tax income on health care costs, and 883,000 spend more than 25% of their income.


• By 2016, projections show that Florida families will have to pay close to $22,400 for health care or over 43 percent of median household income. This would represent a 76 percent increase over 2008 levels.


• In addition, more and more Florida residents have been forced into the exorbitantly expensive individual market, as unemployment reaches massive heights. As of December 2008, 751.753 Florida residents were unemployed. That reflects a loss of over 336,000 jobs statewide last year alone, increasing the state unemployment rate by over 1 percentage point.


• If the state keeps losing jobs at the rate it did last year, 1,360,143 people in Florida will be unemployed by 2010. 46.38% of insured Florida residents depend on their employers for their health insurance. If nothing is done to stem the economic downturn and reform our health care system, 282,168 Florida workers will lose their current health coverage, meaning that 121,678 more people will likely enroll in COBRA. That leaves 160,490 people who will have to enroll in Medicaid, fend for themselves on the private market, or become uninsured.


• This year Florida faces a $5.7 billion budget shortfall, and as a result, the state government has implemented a hiring freeze on state employees. As of 2007, 20% of all state spending has gone to Medicaid and SCHIP. $14.6 billion went to spending on Medicaid alone.


• As of 2007 there were already 843,006 uninsured children in Florida, and more than 2,840,918 uninsured adults. 1,190,935 of uninsured adults in Florida also live below the Federal Poverty Line. Florida's economy lost as much as $14.55 billion because of the poor health and shorter lifespan of the uninsured in 2007. That equates $4,000 per uninsured Florida resident.


• Of the top 10 employers in the state of Florida, 4 of them are Healthcare Providers. According to the US Census, 814,904 individuals work in the Heath Care Sector in the state & make an average of $3,876 per month, which accounts for about $3.2 billion in wages per month.

The health of the American economy cannot improve without addressing the healthcare crisis. Building on the existing healthcare system, quality, affordable healthcare can be guaranteed to every American. It's the reform truly needed to rebuild Florida's economy.

We cannot get our economy back on track without repairing the American health care system. Health care reform is not just a moral imperative, but also an economic necessity. In 2007, the U.S. economy lost as much as $207 billion as a result of the poor health and shorter lifespan of the uninsured.

Skyrocketing health care costs add to families' already overwhelming burden, threatening their health and financial security. We can do better. Solving America's health care crisis will improve quality of care, reduce costs and make businesses more competitive.

The urgent need for reform is more apparent now in California than ever. In the past eight years, health care premiums for family coverage have risen 5 times faster than wages. 9.3% unemployed, many families are at risk of losing their health coverage. The message is clear: California's families urgently need Congress to take direct action on health care reform.

Supporting Facts

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• Health Insurance premiums in California increased by 95.8% from 2000 to 2007, while median earnings only increased a mere 19.3%. The median yearly wage in 2007 for California was only $30,702, but the average health care premium for a family was $12,194. This means that premiums grew 5.0 times faster than wages.


• In California, approximately 6,555,000 non-elderly people spent more than 10% of their pre-tax family income on health care costs in 2008. 77.25% of those people have insurance, but are underinsured. 5,064,000 Californians with insurance spent more than 10% of their pre-tax income on health care costs, and 1,321,000 spend more than 25% of their income.


• By 2016, projections show that California families will have to pay close to $25,500 for health care or over 41 percent of median household income. This would represent a 90.3 percent increase over 2008 levels.


• In addition, more and more Californians have been forced into the exorbitantly expensive individual market, as unemployment reaches massive heights. As of December 2008, 1,731,800 California residents were unemployed. That reflects a loss of over 652,000 jobs statewide last year alone, increasing the state unemployment rate by over 3 percentage points.


• If the state keeps losing jobs at the rate it did last year, 2,778,504 people in California will be unemployed by 2010. 48.35% of insured Californians depend on their employers for their health insurance. If nothing is done to stem the economic downturn and reform our health care system, 506,110 California workers will lose their current health coverage.


• While 209,349 people will likely enroll in COBRA, which lets workers who lose their jobs continue their health benefits at their own expense, the high cost of COBRA will force an estimated 296,761 people to enroll in Medicaid, fend for themselves on the private market, or become uninsured.


• This year California faces a $35.9 billion budget shortfall. As a result, the state has already proposed cuts that will cause more than 429,000 adults to lose health coverage. As of 2007, 19% of all state spending has gone to Medicaid and SCHIP. $35.4 billion went to spending on Medicaid alone.


• As of 2007 there were already 1,232,218 uninsured children in California, and more than 5,360,938 uninsured adults. 1,780,823 of uninsured adults in California also live below the Federal Poverty Line. California's economy lost as much as $32 billion because of the poor health and shorter lifespan of the uninsured in 2007. That equates $4,900 per uninsured California resident.


• Of the top 10 employers in the state of California, 1 of them is a Healthcare Provider. According to the US Census, 1,172,614 individuals work in the Heath Care Sector in the state & make an average of $4,320.26 per month, which accounts for $5.06 billion in wages per month.

The health of the American economy cannot improve without addressing the healthcare crisis. Building on the existing healthcare system, quality, affordable healthcare can be guaranteed to every American. It's the reform truly needed to rebuild California's economy.

Cross-posted from the National Journal's health care blog. The Journal posed this question:

Would it really do much good to extend the length of COBRA health insurance coverage as part of an economic stimulus package? Would people really sign up? Does COBRA ever really work well?

Yes, make COBRA easier to get and easier to use. People are losing their jobs and losing their coverage, so there's no time to waste. With unemployment at a 16-year high, expect the ranks of the uninsured to swell, putting more strain on state programs that help those in need. COBRA - if made to work - can literally be a lifeline.

Part of the problem with COBRA is that many workers don't qualify as it is - if their employers don't offer coverage in the first place or if their employers go out of business.

What's more, COBRA is unaffordable even to those who are eligible, as the Families USA report makes clear. People who are unemployed are often barely able to pay their mortgages, much less the full cost of a health care premium. Even 20% of the premium would be a financial strain on most unemployed workers, given that the cost of an individual premium is more than $4,000 and family coverage exceeds $12,000.

The solution:

- Allow workers who don't have access to COBRA the opportunity to enroll in Medicaid with a small premium contribution - no more than 5% of their income.

- Provide COBRA-eligible workers with a subsidy or tax credit that covers 80% of the premium.

- Expand the time period for COBRA eligibility - currently 18 months in most cases - to 36 months, given the severe economic downturn. Older workers in particular may have the hardest time finding another job.

Rising unemployment is making our health care crisis even worse, highlighting the need for comprehensive reform. We can't get the economy back on track without fixing health care, and workers can't get back to work if they're sick or have lost their homes due to medical debt. Let's fix COBRA now, so the downturn doesn't push more families into financial ruin.