[Vision2020] Wal-Mart and the health care burden

[Joan Opyr]

Dear Visionaries:

Here’s another piece of the Wal-Mart equation to consider: the burden 
the store places on state and local governments by not providing health 
care coverage to the store’s workers.

Also, for those of you interested in buying American, I came across the 
following website: http://www.stillmadeintheusa.com.  This is a 
clearinghouse of information about where to buy American-made clothing, 
appliances, boots and shoes, and a host of other products.  The website 
is owned and maintained by one concerned, educated consumer on her own 
time and at her own expense.  It’s well worth checking out.

Oh, and before Jeff Harkins again waxes enthusiastically about the 
positive effects our existing Wal-Mart has had on Tri-State, he might 
want to read Gerard Connelly's letter in today's Daily News.  
Tri-State's owner, it would seem, is not in favor of a Wal-Mart 
Supercenter.  He would prefer that Moscow attract more businesses like 
his own or like Schweitzer Engineering Labs: both offer benefits, pay 
well, respectively, and accord their employees dignity and respect.

Joan Opyr/Auntie Establishment
www.joanopyr.com

From: http://www.goodjobsfirst.org/gjfhealthcaredisclosure.htm

Good Jobs First
1616 P Street NW · Washington, DC 20036
(202) 232-1616 · www.goodjobsfirst.org

updated November 1, 2005
   
DISCLOSURES OF EMPLOYERS WHOSE WORKERS AND THEIR DEPENDENTS ARE USING 
STATE HEALTH INSURANCE PROGRAMS

Since the mid-20th Century, most Americans have obtained health 
insurance through workplace-based coverage. In recent years there has 
been a decline in such coverage. In August 2004 the Center for Studying 
Health System Change released a survey that found the proportion of 
Americans under 65 covered by employer-sponsored insurance had fallen 
from 67.0 percent in 2001 to 63.4 percent in 2003.

The drop in coverage has two main causes: a rise in the number of jobs 
that do not provide coverage at all and growth in the number of workers 
who decline coverage because it is too expensive.

Faced with the unavailability or unaffordability of health coverage on 
the job, growing numbers of lower-income workers are turning to 
taxpayer-funded healthcare programs such as Medicaid and the State 
Children’s Health Insurance Program (SCHIP).

This trend is putting an added burden on programs that are already 
under stress because of fiscal constraints caused by medical inflation 
and federal cutbacks. Many states are curtailing benefits and 
tightening eligibility requirements.

It also raises the issue of whether states are being put in a position 
of subsidizing the cost-cutting measures of private sector employers.

Across the country, policymakers and others concerned about the 
healthcare system are pressing for disclosure of information on those 
employers whose workers (and their dependents) end up in 
taxpayer-funded programs.

The following is a summary of the employer disclosure that has come to 
light so far. It includes one case (Massachusetts) in which the 
information was produced as a result of legislation. The other cases 
involved requests by legislators or reporters. The latter situations 
have sometimes resulted in data that are incomplete or imprecise, which 
suggests that only legislatively mandated, systematic disclosure will 
tell the whole story.

This compilation was originally produced by Good Jobs First as part of 
its preparation of testimony given before the Maryland Senate on an 
employer disclosure bill. That testimony can be found here.

At the end we have added some other items of interest about Wal-Mart 
and public health insurance programs. On October 26, 2005 the New York 
Times reported on an internal Wal-Mart memo that noted that 27 percent 
of the company's workers had dependents receiving taxpayer-funded 
health coverage (and another 19 percent were uninsured).

   If you know of additional cases of employer disclosure, please 
contact Good Jobs First Research Director Philip Mattera at 
pmattera at goodjobsfirst.org


Alabama

In April 2005 the Mobile Register published an article citing data from 
the Alabama Medicaid Agency on companies in the state with employees 
whose children are participating in Medicaid. The newspaper obtained a 
list from the agency of 63 companies whose employees had 100 or more 
children in the program as of mid-March 2005. At the top of the list 
was Wal-Mart, whose employees had 4,700 children in the program. 
Following it were McDonald's (1,931), Hardee's (884) and Burger King 
(861). The data were similar to information obtained from the same 
agency by the Montgomery Advertiser two months earlier. 

Sources: Sean Reilly, "Medicaid Providing Health Care for Kids of 
Working Families," Mobile Register, April 17, 2005 and  John Davis and 
Jannell McGrew, “Health Plans Not Family Friendly,” Montgomery 
Advertiser, February 22, 2005, p.B6.

Arizona

In July 2005 the state Department of Economic Security issued data on 
the largest private employers with workers receiving taxpayer-financed 
medical insurance through the Arizona Health Care Cost Containment 
System. At the top of the list was Wal-Mart, with about 2,700 
workers--or 9.6 percent of its Arizona workforce--participating in the 
program. It was followed by Target, Kroger and regional supermarket 
chain Bashas, each of which had about 5 percent of their workers 
getting state healthcare coverage.

Sources: Howard Fischer, "Wal-Mart 1st in State Aid Enrollees," Arizona 
Daily Star, July 30, 2005 and Amanda J. Crawford, "Nearly Half of Poor 
in AHCCCS Hold Jobs," Arizona Republic, July 30, 2005.

Arkansas

In March 2005 the Department of Human Services, responding to a request 
from the Arkansas Democrat-Gazette and the Arkansas Times, released a 
list of the number of employees at the state's largest employers who 
receive some form of public assistance for themselves or their family, 
mostly Medicaid coverage for their children. The disclosure found  a 
total of 9,698 workers at the top nine employers, by far the largest 
number of which--3,971--were employees of Wal-Mart.

Source: Brian Baskin, "Top 9  Employers in State have 9,698 Getting 
Public Aid," Arkansas Democrat-Gazette, March 17, 2005.

Connecticut

In January 2005, the Office of Legislative Research released a report 
on the employers of participants in the state’s HUSKY health program 
for children of low-income families. The report was prepared at the 
request of several legislators who had been encouraged to seek the 
information by organizations such as Connecticut Voices for Children. 
HUSKY (an acronym for Healthcare for UninSured Kids and Youth) has two 
parts: Part A is traditional Medicaid and Part B is Connecticut’s 
version of the State Children’s Health Insurance Program. For HUSKY A, 
the top employer of workers with children in the plan was Wal-Mart, 
with 824 workers with children in the plan. It was followed by Stop & 
Shop (741), Dunkin' Donuts (530), Laidlaw (460) and McDonald’s (also 
460). The report also looked at employer data for HUSKY A enrollees who 
were also enrolled in HUSKY B. For that group the top employer was Stop 
& Shop with 99 HUSKY A enrollees also participating in HUSKY B, 
followed by Wal-Mart (79), Laidlaw (65), Home Depot (45), Dunkin' 
Donuts (39) and Family Care VNA (also 39). The report counted only 
parents of plan participants, not the total number of their children.

Source: Robin K. Cohen, HUSKY A and B—Enrollment and Employer Data, 
Connecticut Office of Legislative Research Report 2005-R-0017, January 
10, 2005; available online at  www.cga.ct.gov/2005/rpt/2005-R-0017.htm

Florida

In March 2005 the St. Petersburg Times published a summary of data it 
obtained from the Department of Children and Families on the employers 
in the state with the most workers who were enrolled in Medicaid or 
KidCare Insurance (Florida's version of SCHIP). Leading the Medicaid 
list was Wal-Mart with 12,300 employees or their dependents enrolled in 
the program. Wal-Mart also accounted for 1,375 employee children 
enrolled in Kidcare (second only to Miami-Dade County with 1,518). The 
other employers with the most Medicaid enrollees were McDonald's 
(8,100), Publix (7,900), Wendy's (4,100), Winn-Dixie (4,000) and Burger 
King (3,900). Publix ranked third on the KidCare list with 1,250 and 
Winn-Dixie ranked fifth (after Broward County Schools) with 379.

The St. Petersburg Times story also took note of the fact that several 
of the companies with the most employees and dependents enrolled in 
public health insurance programs were also recipients of substantial 
amounts of economic development incentives such as tax abatements.   

The St. Petersburg Times numbers were significantly higher than 
comparable data cited in a  December 2004 published by the Tallahassee 
Democrat.  That story, also based on data from the Department of 
Children and Families, reported that the company with the most 
employees participating in Medicaid was McDonald’s, with 1,792 claims 
filed. The other top private-sector employers on its list were Publix 
(1,579), Winn-Dixie (1,108), Burger King (830) and Wal-Mart (756). The 
article noted that the data supplied by the state referred to the 
number of claims rather than the number of beneficiaries, which it said 
was likely to be much higher. This might explain the discrepancy.

Sources:

Sydney P. Freedberg and Connie Humburg, "Lured Employers Now Tax 
Medicaid," St. Petersburg Times, March 25, 2005 plus a spreadsheet with 
additional data provided by the authors to Good Jobs First.

Rocky Scott, “50,000 Workers Qualify for Medicaid: Some Say Companies 
Taking Advantage,” Tallahassee Democrat, December 19, 2004, p.1 
According to a private communication with the author, the headline was 
incorrect and should have referred to 50,000 employers.

Georgia

In February 2004, the Atlanta Journal-Constitution reported the 
contents of an internal memo prepared by the Department of Community 
Health in 2002 that contained a list of the employers whose workers had 
the most dependents enrolled in the state’s PeachCare for Kids health 
insurance program for low-income working families. At the top of the 
list was Wal-Mart, whose employees in Georgia had 10,261 children in 
PeachCare. Far behind in second place was Publix with 734, followed by 
Shaw Industries (669), Mohawk Industries (657) and Cagle’s Keystone 
Foods (463). 

Source: Andy Miller, Wal-Mart Stands Out on Rolls of PeachCare,” 
Atlanta Journal-Constitution, February 27, 2004, p.1B.
   
Iowa

In March 2005, the Associated Press bureau in Des Moines reported that 
it had obtained a list of the Iowa employers with the largest number of 
workers participating in Medicaid. The list, prepared by the state 
Department of Human Services, listed Wal-Mart first with 845 employees. 
It was followed by Tyson Fresh Meats (388), Casey's General Stores 
(371), Hy-Vee Inc. (361) and Access Direct Telemarketing (217).

Source: Ryan Foley, "IA Medicaid Employers," Associated Press, March 4, 
2005 and "Top Ten Employers with Workers on Medicaid," Associated 
Press, March 4, 2005.
   
Maine

In June 2005 the Institute for Local Self-Reliance obtained data from 
the Maine Department of Health and Human Services on companies with 
workers enrolled in Medicaid and other public assistance programs (data 
on dependents was not available). At the top of the list was Wal-Mart, 
with 751 workers receiving benefits. It was followed by supermarket 
chain Hannaford with 527 and LL Bean with 170.

Source: Press release issued June 28, 2005 by the Institute for Local 
Self-Reliance; available online at 
http://www.newrules.org/retail/news_slug.php?slugid=311

Massachusetts

In 2004, the legislature included in the 2005 budget a requirement that 
the state compile a list of employers with workers or their dependents 
participating in public healthcare programs. The requirement applied to 
employers with 50 or more employees using programs such as MassHealth 
and the Uncompensated Care Pool (UCP). On February 1, 2005 the Division 
of Health Care Finance and Policy issued the first report required by 
the law.  The report identified 138 employers that met the 50-employee 
threshhold. At the top of the list was Dunkin' Donuts, with 1,923 
employees participating in UCP and 982 participants in MassHealth. 
Others at the top of the list were Stop & Shop (1,352 & 788), Wal-Mart 
(1,258 & 823), McDonald’s (1,125 & 600) and UNICCO  Service Corp. (743 
& 339).

Sources: The requirement can be found in Section 304 of Chapter 149 of 
the Acts of 2004; available online at 
www.mass.gov/legis/05budget/outside_sections.htm .The report is online 
at
www.mass.gov/Eeohhs2/docs/dhcfp/pdf/50+_ees_ph_assist.pdf and the 
accompanying spreadsheet at   
www.mass.gov/Eeohhs2/docs/dhcfp/pdf/50+_ees_ph_assist_ss.pdf

Montana

In June 2005 the Great Falls Tribune examined records for the state's 
CHIP program and found that the private employer with the largest 
number of workers with dependents receiving the health insurance was 
Wal-Mart. Its 193 employees using CHIP represented about 4 percent of 
the company's workforce in the state. Other companies high on the list 
were McDonald's, Pizza Hut, NAPA Auto Parts and Subway.

Source: Mike Dennison, "State Insurance for Kids Going to Employees You 
Might Not Expect," Great Falls Tribune, June 26, 2005, p.16A.

Nebraska

In October 2005 the Nebraska Health and Human Services System reported 
that an estimated 9,369 workers and an unknown number of their 
dependents were receiving benefits through the state's Medicaid 
program. Leading the list was Wal-Mart with 654 workers and Tyson with 
548.

Source: Paul Hammel, "Thousands with Jobs are on Medicaid Rolls," Omaha 
World-Herald, October 19, 2005.

New Hampshire

In May 2005 the Associated Press reported that it had obtained a report 
from the state Department of Health and Human Services on those 
employers in New Hampshire with the most workers (or their dependents) 
enrolled in Medicaid or the Healthy Kids Silver program. The employer 
at the top of the list in both categories was Wal-Mart, which had 487 
of its 8,500 workers in the state getting subsidized coverage. Also 
high on the list were the state government, Dunkin' Donuts, the 
supermarket chain Shaw's, Concord Hospital, nursing-home operator 
Genesis and the U.S. Postal Service.

Source: Norma Love, "State, Retail Workers High on List of Needing 
Health-care Subsidy," Associated Press, May 12, 2005. 

New Jersey

In August 2005 New Jersey Policy Perspective (NJPP) issued a report 
that for the first time disclosed which employers have the largest 
number of workers or dependents participating in the state's SCHIP 
program known as NJ FamilyCare. NJPP, which had to pay to get the state 
to reprogram the database of FamilyCare participants to retrieve the 
information, found there were about 50 employers that accounted for 100 
or more program participants. The employer with the most was Wal-Mart, 
with a total of 589 adults and children. It was followed by Home Dept 
(335), the supermarket chain Pathmark (329) and Target (302).

Source: Mary E. Forsberg, ATTENTION SHOPPERS: You Pay the Health 
Insurance Bills for Some of New Jersey's Largest Employers, New Jersey 
Policy Perspective, August 2005; available online at 
http://www.njpp.org/rpt_familycare.html

Tennessee

In January 2005, state officials released the results of a survey, 
undertaken at the request of the Chattanooga Times Free Press, of which 
companies had employees who were enrolled in TennCare, the state’s 
health plan for the poor, uninsured and disabled. Ranking first was 
Wal-Mart, with 9,617 employees on TennCare, nearly 25 percent of the 
company’s entire workforce in the state. Trailing Wal-Mart among the 
top five were four temp agencies: Randstad Staffing Services USA 
(6,389), Adecco USA Inc. (4,205), Staffmark East LLC (3,818) and Real 
Time Staffing Services (3,783). The survey found that the top 20 
employers of TennCare recipients accounted for more than 68,000 
participants in the program, or about six percent of total enrollment.

Sources: John Commins, Dave Flessner and Ashley M. Heher, “On the Job 
and on TennCare,” Chattanooga Times Free Press, January 20, 2005, p.A1. 
Also: Rebecca Ferrar, “Big Companies Have a Large Number of Workers in 
Program,” Knoxville News-Sentinel, January 30, 2005, p.C1.

Texas

The Center for Public Policy Priorities, a non-partisan research center 
based in Austin, has obtained data on the 20 employers in the state 
with the largest number of employees whose dependents participate in 
the Children's Health Insurance Program. (Employer data for Medicaid 
are not available.) The data for February 2005 show Wal-Mart at the top 
of the list, with 2,333 employee families in CHIP, with an estimated 
4,363 individual children enrolled. Many of the other employers on the 
list are school districts (led by Houston with 712 families). The 
University of Texas System ranked third with 475 families. Among the 
other private-sector employers on the list are the department-store 
chain Dillard's (sixth with 284 families) and McDonald's (13th with 238 
families). The full list for both March 2004 and February 2005 is here.

Source: Data obtained by the Center for Public Policy Priorities < 
www.cppp.org > and provided to Good Jobs First 

Vermont

In April 2005 the Vermont Guardian reported that it had obtained data 
from the state's Department for Children and Families on families 
enrolled in Medicaid that had someone employed by a large company or a 
government agency. The state government itself was said to account for 
largest number of such employees with 481. Among the private-sector 
companies with the most workers using Medicaid were Price Chopper 
(443), McDonald's (290), Hannaford (288) and Wal-Mart (286). Among 
industry groups, grocery stores accounted for the largest number at 
1,036.

Source: Kathryn Casa, "Employees at Vermont's Top Companies Enrolled in 
Medicaid Health Plans," Vermont Guardian, April 18, 2005. Some of the 
numbers cited above came from a copy of the data prepared for Casa that 
was provided to Good Jobs First by the Department for Children and 
Families.

Washington

In February 2003, the state Health Care Authority gave the Associated 
Press a list of the ten employers whose workers appeared most 
frequently on the rolls of the state’s Basic Health Plan, which 
provides coverage for low-income families. At the top of the list was 
Wal-Mart, with 341 workers participating in the plan. It was followed 
by Catholic Community Services (265), Del Monte (253), Snokist (218) 
and Express Personnel (191). In February 2004 the Seattle Times 
reported that 281 Wal-Mart workers were enrolled in Basic Health as of 
March 2003. 

Sources: Rebecca Cook (Associated Press writer), “Legislature: Bill Has 
Employers Pay Share of Health Care,” The Columbian (Vancouver, WA), 
February 28, 2003, p.C2; Andrew Garber, “Enrollments in State’s Health 
Plan Questioned,” Seattle Times, February 3, 2004.

West Virginia

In December 2004, the Bureau for Children and Families, acting at the 
request of the Charleston Sunday Gazette-Mail, released data on the 
employers of parents of children enrolled in the State Children’s 
Health Insurance Program. Leading the list was Wal-Mart, with 452 
workers whose children participated in the plan. This group represented 
about 4 percent of the company’s employees in the state. Next on the 
list were the tree-cutting company Asplundh (146), McDonald’s (100), 
Respite Care (97) and the U.S. Postal Service (94).

Source: John Heys and Paul Wilson, “Wal-Mart Culture: Wal-Mart Tops 
State CHIP List,” Charleston Sunday Gazette-Mail, December 26, 2004, 
p.1A.

Wisconsin

In May 2005 the Milwaukee Journal Sentinel reported on new data from 
the state Department of Health and Family Services about Wisconsin 
employers with the largest number of employees (or their dependents) 
participating in BadgerCare, the state's health insurance program for 
low-income working families. At the top of the list was Wal-Mart, which 
had 809 employees enrolled (1,252 employees and their dependents 
combined). The Department projected the annual cost to the state of 
those enrollees at $2.7 million. Other employers on the list of the top 
ten were the non-profit healthcare provider Aurora (187 employees; 321 
employees and dependents), home improvement chain Menard (126; 217), 
McDonald's (131; 200), Manpower (127; 181), Lands' End (100; 179); 
Kmart (102; 164) and Walgreen (101; 146). The top ten employers were 
said to cost the state a total of $6.4 million. 

In October 2005 Wisconsin Citizen Action published a report estimating 
that large corporations, led by Wal-Mart, were costing the state $46 
million a year because of the participation of their employees in 
public medical assistance programs.

Sources: Stacy Forster, "Big Companies Fill BadgerCare Rolls," 
Milwaukee Journal Sentinel, May 24, 2005 
<http://www.jsonline.com/news/state/may05/328286.asp>; Anita Weier, 
“Wal-Mart Workers Need State Health Aid,” The Capital Times , November 
4, 2004, p.1A; Washington Citizen Action Fund, Rolling Back Benefits, 
Rolling Forward Costs, October 2005.

ADDITIONAL ITEMS OF INTEREST ABOUT WAL-MART
AND PUBLIC HEALTH INSURANCE PROGRAMS

Allegations that the company’s pharmacies shortchanged recipients of 
Medicaid and other federal healthcare programs

In June 2004, the U.S. Department of Justice announced that Wal-Mart 
had agreed to pay $2,866,904 to settle allegations that the company had 
submitted false prescription claims to federal health insurance 
programs such as Medicaid. The company’s pharmacies were alleged to 
have dispensed partial or “short” prescriptions due to insufficient 
stock, while it billed the government programs for the full quantities. 
The settlement amount in the case, which began as a whistleblower 
complaint, was to be divided up among the federal government, the 
District of Columbia, the states participating in the suit and a 
whistleblower. The company also agreed to enter into a Corporate 
Integrity Agreement with the Office of the Inspector General of the 
Department of Health and Human Services.

Source: A Justice Department press release about the settlement can be 
found online at:
www.usdoj.gov/opa/pr/2004/June/04_civ_446.htm

Dispute with Arkansas over payments for filling Medicaid prescriptions

In 2000 the administration of Arkansas Gov. Mike Huckabee sought to cut 
the state’s healthcare costs by reducing payments to large chain stores 
such as Wal-Mart for filling prescriptions for Medicaid participants. 
The rates for small pharmacies were to be left untouched, to avoid 
driving them out of business. The state argued that the reductions were 
in line with the discounts that the chain pharmacies gave to HMOs.

Wal-Mart, the largest handler of Medicaid prescriptions in the state, 
protested the move and brought suit in federal court, claiming the 
policy violated the equal protection clause of the 14th Amendment. 
According to press reports, the company also quietly asked its 
employees to call the governor’s office to complain about the two-tier 
prescription reimbursement plan. The cost to the company of the change 
was reported to be about $1 million a year. In June 2000 a federal 
judge in Little Rock ruled in favor of Wal-Mart and Walgreens, which 
had also joined the suit.

Source: Rob Moritz and Doug Thompson, “Wal-Mart Asks Employees to Lobby 
Huckabee,” Arkansas Democrat-Gazette, May 5, 2000, p. A1.

  Promotion of SCHIP to customers

Wal-Mart has from time to time launched campaigns to inform its 
customers about the availability of taxpayer-financed health insurance 
for low-income working families. For example, in February  2001 the 
company joined with the American Academy of Pediatrics and the Pampers 
Parenting Institute to launch an campaign called Babies First. As part 
of the month-long initiative, Wal-Mart agreed to put displays in its 
stores containing brochures and application forms for SCHIP programs.

Source: “American Academy of Pediatrics, Wal-Mart, Pampers Parenting 
Institute Team Up to Reduce the Number of Uninsured Children,” PR 
Newswire, February 28, 2001.
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