The so-called “gig economy” — best exemplified by ride-sharing companies like Uber and Lyft — has brought political attention to the plight of workers who are hired as independent contractors rather than employees. As independent contractors, these workers typically have no ability to engage in collective bargaining, often receive little or no benefits, and have limited workplace protections. The attention they are receiving might end up helping therapists and counselors who take insurance — or who would, if the pay and benefits were better. It could also help clients by improving accessibility of care.
As any therapist who serves on an insurance panel can tell you, the limitations of such work are frustrating. Generally speaking, you cannot discuss the fees you get with other therapists. And since most therapists each run individual businesses who are competing with one another, you can’t collectively bargain with the insurance company. (A group practice may contract as a unit with insurance providers, but even then, group practices tend to be made up of just a few therapists out of the hundreds or thousands on each insurer’s network.) And as many therapists on both sides of the fence can tell you, low reimbursement rates from insurance providers and managed care companies discourage many therapists from participating in insurance networks. That limits the number of providers available to clients in need of services.
New laws focused on the gig economy may wind up helping therapists by changing how collective bargaining works. Seattle went so far as to attempt a law specifically allowing Uber and Lyft drivers (as well as drivers for local taxi companies, who are also typically independent contractors) to seek union representation. A California lawmaker proposed the “1099 Self-Organizing Act,” which would allow independent contractors for companies like Uber and Lyft to organize for the purposes of collective bargaining if a certain percentage of the contractors chose to do so. While such laws are sure to face legal challenges, they at least demonstrate a new awareness among policymakers that independent contractors are vulnerable in ways that employees are not.
CliniciansUnited in Massachusetts
And that brings us to Massachusetts, where therapists have had the most success moving policymakers on the concerns specific to our field related to collective bargaining. Last year, the state group CliniciansUnited commissioned a survey of private practitioners asking for their experiences working with insurers and managed care companies. The findings of that survey are presented in this report (or you can just go here for the executive summary, or here if you prefer these things in video form.) Suffice to say they are depressing.
Armed with the findings from that report, state Senator David Wolf championed Senate Bill 649, which declared the power imbalance between insurers and clinicians to have resulted in a “market failure that threatens the availability of high quality, cost effective behavioral health, substance use disorder and mental health services.” The bill would have specifically exempted mental health and substance abuse treatment providers from state antitrust law, allowing them to collectively bargain with insurers and managed care companies.
The bill does not appear to have advanced past its first hearing last June. But the market problems in mental health aren’t going anywhere. The supposedly-expanded availability of care brought on by the Affordable Care Act will prove only to be an illusion if companies are unable or unwilling to pay what it would take to expand their provider networks. CliniciansUnited’s work shows that legislators can be convinced that the problems of independent contractors are not limited to drivers. Indeed, as their survey demonstrated, the overuse of independent contractors who cannot collectively bargain risks creating a market where mental health care is not available for many of those who have insurance that — at least in theory — should cover it.