Politics. America just wants to have fun.
It seems that, and the jobs report Friday perhaps drives it home, receding disease is not enough to get people up and out, especially with enhanced unemployment benefits in their pocket. Meanwhile, slowing rates of vaccinations in the face of an audacious – we would argue nearly impossible in the near term - goal of 70% of the U.S. immunized by July 4 has the White House reconsidering some of its buzz-kill COVID public health policies.
Federal guidance such as mandatory mask-wearing at sleep-over camp for children and prohibitions on gatherings for vaccinated people have left some in the scientific community scratching their heads. The always level-headed former Food and Drug Administration Commissioner Scott Gottlieb has become increasingly vocal in the last week, citing the reduced incentives for vaccination the longer these policies stay in place.
COVID-19 czar Jeff Zients and NIAID chief Anthony Fauci hit the Sunday shows and signaled new guidance may be forthcoming on mask wearing and the like. Whether inspired by Gottlieb’s conclusions or the jobs report, it would be nice if the Memorial Day picnics were sans mask.
Policy. As the pandemic-induced child care crisis lingers, the question of women returning to the health care workforce appears now to be less question of “when?” and more “if?,” especially on the lower rungs of the pay and work environment scales. As women make up the overwhelming majority of health care workers, the implications are significant.
Jobs data released Friday indicates a small decline in health care employment. We hasten to add that the ADP report showed an increase of 76k jobs so the BLS data may be getting a little “August” effect early. Most health care providers are very busy and short-staffed leaving little time to complete the survey.
The BLS report also updated female and state level employment in the Health Care and Social Assistance industry category for March. As schools have reopened and life started to normalize, women have been returning to the health care workforce. However, they are being more selective.
Women are employed at near pre-pandemic levels in the most desirable and highest paid area of health care, ambulatory services – physicians’ offices, outpatient care centers, etc. – while nursing facilities and psychiatric and substance abuse facilities have 12% and 5% fewer women employed than in January 2020.
In some cases, being selective includes not returning to health care at all. Florida, where schools have been opened since last fall and most COVID-19-related behavior modification has been self-imposed has about 4% few health care and social assistance workers than in January 2020. California, which has the highest number of shuttered school districts, has 2.4% fewer health care worker and social assistance workers.
There are a variety of factors in play. Nurses in Florida may have hit the travel nurse bid (AMN). Nursing homes, which experienced high mortality during COVID, have become less desirable places for care. Unemployment insurance and stimulus checks have reduced the urgency for some to get back to work.
Most certainly, another factor must be the near permanency remote K-12 learning has acquired in a number of states, forcing women out of the workforce to oversee zoom class or into other fields more accommodating of current conditions.
Survey data released by the U.S. Department of Education last week suggests little progress is being made in offering in-person instruction. A similar release in January indicated about 42% of fourth and eighth grade students were offered in-person instruction. In March the figure rose to 50%. The South and the Midwest states offer in person learning to 69% and 61% of the same students, respectively, while the Northeast and the West offer it to 32% and a dismal 18%, respectively.
For the laggards, there appears to be no end in sight. The American Rescue Plan Act poured about $130 billion on school districts, to be spent over the next 3 ½ years. Such an infusion of capital means that the loss of education funding from state and federal sources due to student attrition, will be meaningless.
Time marches on, adjustments are made. The less skilled and credentialed find other work or different schedules, almost guaranteeing the future of health care will look different from the past as it becomes more difficult to staff certain areas of health care.
Power. The amnestic muscle memory of federal regulation of workplace standards has been slowly moving toward an Emergency Temporary Standard in response to COVID-19. As the record of scheduled meetings with the Office of Management and Budget can attest, worker groups and representatives from industries as diverse as roadbuilding and meatpacking have awoken from their own stupor to pre-emptively challenge the Biden administration proposal to establish standards to prevent and mitigate the spread of infectious diseases.
As you would expect, on the one hand, representatives of workers like the United Food and Commercial Workers union are requesting staggered schedules, reduced capacity, flexible leave policies and loads of testing. On the other hand, industry representatives are pointing out the obvious; they have been managing the problem for over a year and would like to continue to do so without federal intervention.
Someone is sure to be disappointed.
If we know anything about the Biden administration, it is that they have consistently followed through on pledges and promises made during the campaign. Since last summer Biden has promised new workplace standards that include testing, PPE and contact tracing. So, there is little reason to think industry will be able to affect the outcome, regardless of how many charts they show of reduced disease spread and mortality.
For Biden, the pandemic is a little bit beside the point, an excuse really to get everybody used to a regulatory environment that imposes high standards on the workplace environment.
Have a great rest of your weekend and don’t forget to call your mother.
Emily Evans
Managing Director – Health Policy
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