Better, Smarter, Healthier: Health Care Payment Learning and Action Network kick off to advance value and quality in health care.

Women outnumber men in the nursing profession by more than 10 to 1. But men still earn more, a new study finds.

The report in this week’s Journal of the American Medical Association found that even after controlling for age, race, marital status and children in the home, males in nursing out-earned females by nearly $7,700 per year in outpatient settings and nearly $3,900 in hospitals.

Even as men flowed into nursing over the past decades, the pay gap did not narrow over the years studied: 1988 to 2013.

According to the Census Bureau, men made up about 9 percent of registered nurses in 2011, roughly a three-fold increase from 1970. And even though men were not permitted in nursing programs at some schools until the 1980s, they have overall earned more, just as in society at large.

The biggest disparity was for nurse anesthetists, with men earning $17, 290 more.

Ulrike Muench of the University of California-San Francisco, the study’s lead author, said in an interview that the data do not suggest why men earn more, although “some have suggested men have better negotiating skills” and are able to start out earning higher salaries.

Jennifer Stewart, who oversees nursing and other workforce issues at the health research group The Advisory Board, agrees that’s one possibility. “Also maybe some gender discrimination,” she adds.

But most people who study nursing trends say this is a difficult problem to sort out.

For example, says Stewart, because men have joined the profession more recently, women tend to be more senior nurses. But as such, they get to work preferred day shifts, even though night and weekend shifts tend to pay more.

Peter McMenamin, a health economist at the American Nurses Association, says that while ANA policy “is that there should be pay equity,” he’s not convinced the problem is as large as the study suggests. For one thing, he says, with so many women compared to men in the study, the numbers for women “are much more precise.”

But no one questions the overall finding that men out-earn women. And that is “dismaying,” says McMenamin. “We would like any differentials in pay to be based on skills and experience and not on gender,” he said.

The study analyzed data from the National Sample Survey of Registered Nurses (which ended in 2008) as well as from the Census Bureau’s American Community Survey for years 2001-2013.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

This tax season, for the first time since the health law passed five years ago, consumers are facing its financial consequences. Whether they owe a penalty for not having health insurance or have to reconcile how much they got in premium tax credits against their incomes, many people have to contend with new tax forms and calculations. Experts say the worst may be yet to come.

When Christa Avampato, 39, bought a silver plan on the New York health insurance exchange last year, she was surprised and pleased to learn that she qualified for a $177 premium tax credit that is available to people with incomes between 100 and 400 percent of the federal poverty level. The tax credit, which was sent directly to her insurer every month, reduced the monthly payment for her $400 plan to $223.

A big check from a client at the end of last year pushed the self-employed consultant and content creator’s income higher than she had estimated. When she filed her income taxes earlier this month she got the bad news: She must repay $750 of the tax credit she’d received.

Avampato paid the bill out of her savings. Since her higher income meant she also owed more money on her federal and state income taxes, repaying the tax credit was “just rubbing salt in the wound,” Avampato says. But she’s not complaining. The tax credit made her coverage much more affordable. Going forward, she says she’ll just keep in mind that repayment is a possibility.

It’s hard to hit the income estimate on the nose, and changes in family status can also throw off the annual household income estimate on which the premium tax credit amount is based.

Like Avampato, half of people who received premium tax credits would have to repay some portion of the amount, according to estimates by The Kaiser Family Foundation. Forty-five percent would get a refund, according to the KFF analysis. The average repayment and the average refund would both be a little under $800. (KHN is an editorially independent program of the foundation.)

Tax preparer H&R Block has also looked at the issue. It reported that 52 percent of people who enrolled in coverage on the exchanges had to repay an average of $530 in premium tax credits, according to an analysis of the first six weeks of returns filed through tax preparer. About a third of marketplace enrollees got a tax credit refund of $365 on average, according to H&R Block.

The amount that people have to repay is capped based on their income. Still, someone earning 200 percent of the poverty level ($22,980) could owe several hundred dollars, says Karen Pollitz, a senior fellow at the Kaiser Family Foundation. People whose income tops 400 percent of poverty ($45,960 for an individual) have to pay the entire premium tax credit back.

Experts say the message for taxpayers is clear: if your income or family status changes, go back to the marketplace now and as necessary throughout the year to adjust them so you can minimize repayment issues when your 2015 taxes are due.

Many people are learning about what the health law requires and how it affects them for the first time when they come in to file their taxes, says Tara Straw, a health policy analyst at the Center on Budget and Policy Priorities. For the past 10 years, Straw has managed a Volunteer Income Tax Assistance site in the District of Columbia as part of an Internal Revenue Service program that provides free tax preparation services for lower income people.

Some of the recently initiated owe a penalty for not having health insurance. For 2014, the penalty is the greater of $95 or 1 percent of income. The H&R Block analysis found that the average penalty people paid for not having insurance was $172. Consumers who learn they owe a penalty when they file their 2014 taxes can qualify for a special enrollment period to buy 2015 coverage if they haven’t already done so.  That would protect them against a penalty on their next return.

People may be able to avoid the penalty by qualifying for an exemption. Tax preparers rely on software to help them complete people’s returns, including the forms used to reconcile premium tax credits and pay the penalty for not having insurance or apply for an exemption from the requirement. For the most part, the software is up to the task, Straw says, but it comes up short with some of the more complicated calculations.

Case in point: applying for the exemption from the health insurance requirement because coverage is unaffordable. Under the health law, if the minimum amount people would have to pay for employer coverage or a bronze level health plan is more than 8 percent of household income they don’t have to buy insurance. That situation is likely to be one of the most common reasons for claiming an exemption.

But to figure out whether someone qualifies, the software would have to incorporate details such as the cost of the second lowest cost silver plan (to calculate how much someone could receive in premium tax credits) and the lowest cost bronze plan in someone’s area. The software can’t do that, so tax preparers must complete the information by hand.

“That one in particular has been vexing,” says Straw.

The gnarliest filing challenges may yet come from people with complicated situations, such as those who had errors in the IRS form 1095A that reported how much they received in premium tax credits, experts say.

Take the example of a couple with a 20-year-old son living at home who bought a family policy on the exchange. If midway through the year the son gets a job and is no longer his parents’ dependent, the family’s premium tax credit calculation will be off. The family needs to work together to figure out the optimal way to divide the credit already received between the two tax returns. The goal is to maximize the benefit to the family and minimize any tax credit repayment they may face.

“A lot of tax software is just not designed for that kind of trial and error,” says Straw.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Bone Marrow Transplant Drive: Donors Needed!

What: A bone marrow transplant drive

Where: Alaska Native Medical Center hospital in the main lobby in front of the gift shop

When: April 8-9 from 10 AM to 6 PM

For every dollar spent on treating depression, almost five dollars is spent on the treatment and workplace costs of related medical conditions like back and chest pain, sleep disorders and migraines – placing a greater financial burden on businesses and the health care system, according to new research measuring the economic impact of depression.

“The fact that they’re finding such greater costs with all these different [related conditions] underscores how the fragmented system is not helpful for our economy because people with mental illness are not getting the rounded health care they need,” said Lynn Bufka, assistant executive director of practice research and policy at the American Psychological Association, who was not affiliated with the study.

Among the study’s findings was that the total cost to the U.S. economy of major depressive disorder – a condition that results in having persistent depressive episodes – rose from $173.2 billion in 2005 to $210 billion in 2010, a 21.5 percent increase. About half of that is for direct treatment and suicide-related services, but the rest is workplace costs. The rise is partially accounted for by the increase in population, but also because depression is being diagnosed and treated more often. The incidence of major depressive disorder rose during this time period from 6.4 percent of the population to 6.8 percent.

In addition, some of this growth might have been caused by the nation’s 2008 economic downturn and tight job market, factors that combined to make it harder for those suffering from depression to retain their jobs and even more difficult for those with this condition who are job seekers to find work, according to Paul Greenberg, a study author and director of health economics at the Analysis Group, a consulting firm in Boston.

Meanwhile, the study also examined how depression plays out in the workplace.

Mental health experts and economists have long known that someone’s depression can have a significant cost on the workplace, Greenberg said.

For example, the study found that the average worker who had major depression disorder lost the productivity of about 32 workdays a year due to what’s known as “presenteeism.” That is a term for when an employee is at work but not completing daily tasks and responsibilities.

Experts say that, though this loss in productivity highlights the economic toll mental health issues have on the work place, small and medium-sized employers may not have the knowledge or tools to improve the situation.

“While employers suspect depression will lead to greater absenteeism, I’m not sure they know how to judge what effect it’s having on their business,” said Paul Gionfriddo, president of Mental Health America, an advocacy group. “It’s really hard for businesses that are small to medium that account for so much employment to say, ‘this is why this guy is less productive and here’s what I can do about it.’”

Greenberg said, though, that changes in health coverage may alter this landscape. For example, more people gaining health care coverage through the health law and other efforts to integrate mental and medical care could provide more care for people with depression and lessen the workplace burden.

Robert Roca, chairwoman of the American Psychiatric Association’s council on geriatric psychiatry, says the gradual integration of mental health care into primary care means more people may be diagnosed early and treated. “The ACA sets the stage for this kind of integration effort, and I’m optimistic that we’ll see benefit down the road,” said Roca, who was not affiliated with this study.

The research was published in the February edition of the Journal of Clinical Psychiatry and used data from adults 18 to 64 diagnosed with major depressive disorder in 2005 or 2010 from an OptumHealth claims database and from the National Survey on Drug Use and Health.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

HHS seeks to develop improved anthrax vaccine

There has been much hand wringing over the health law requirement that large employers this year offer insurance to workers who put in 30 or more hours a week or face penalties for not doing so. The new rules would cost employers a bundle, some fretted, as part-timers clamored for company coverage previously unavailable to them. Others worried that employers would cut workers’ hours to get under the cap.

A new study found that so far there’s little cause for concern: Average enrollment in company plans was essentially unchanged between 2014 and 2015 at 74 percent of all workers.

The survey of nearly 600 employers by benefits consultant Mercer found that in 2015 the average percentage of employees who were eligible for coverage increased 1 point to 88 percent, but it was offset by a drop in the enrollment of eligible workers of 1 point on average, to 83 percent.

Part of the explanation for the stable results stems from the fact that most employers were already in compliance, says Beth Umland, Mercer’s director of research for health and benefits.

In 2014, employees had to work 25 hours a week on average to be offered health insurance, according to Mercer. That figure has edged up since 2011, when it was 23 hours weekly, but is still well below the law’s 30-hour threshold.

Still, while the expansion in eligibility wasn’t a big change for many employers, “if you were impacted you were really impacted,” says Tracy Watts, Mercer’s national leader for health care reform.

Food and lodging companies were most affected by the new rules, with the average percentage of workers who were eligible for coverage increasing from 57 to 60 percent. Other industry sectors that felt the change included health care, where per diem nurses and other professionals take on short-term assignments, and higher education, which employs many part-time adjunct professors, says Watts.

But most employers aren’t changing their practices to discourage health plan enrollment, the survey found. Seventy-three percent said they had no plans to change, while 16 percent said they ensured that newly hired part-timers work fewer than 30 hours weekly, and 19 percent said they reduced the hours of employees who consistently or occasionally worked more than 30 hours a week.

Even though the health law aims to encourage employers to offer coverage by imposing fines on those who don’t do so, not all take advantage of the offer. Workers might not sign up because they have other options under the health law. Low-income workers may be eligible for Medicaid in states that have expanded coverage to adults with incomes up to 138 percent of the federal poverty level. Young people can stay on their parents’ plan until they turn 26 under the health law, and many people continue to get coverage through their spouses.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

HHS announces proposed rules to support the path to nationwide interoperability