The Ins and Outs of Hazard Pay for Healthcare Workers

​Essential health care workers are putting their lives on the line as they treat and attempt to control the spread of COVID-19. This webinar examines the concept of Hazard Pay, defined by the U.S. Department of Labor as “additional pay for performing hazardous duties or physical hardship.” The panel provides a brief overview of current hazard pay proposals, examines the need and impact of hazard pay for low and high wage essential health care workers, and offers an economist perspective and possible approaches.

---

​Essential health care workers are putting their lives on the line as they treat and attempt to control the spread of COVID-19. This webinar examines the concept of Hazard Pay, defined by the U.S. Department of Labor as “additional pay for performing hazardous duties or physical hardship.” Dr. Natalie Kirilichin, an emergency physician, moderates. Panelists include Dr. Michael Strain, Arthur F. Burns Scholar in Political Economy and Director of Economic Policy Studies at the American Enterprise Institute (AEI); Dr. Sarah Nolan, Deputy Policy Director for Healthcare at Service Employees International Union (SEIU); and Ms. Laura Wooster, Associate Executive Director of Public Affairs at the American College of Emergency Physicians (ACEP).
 
SEIU and ACEP are two organizations that traditionally represent low and high wage essential health workers, respectively. Dr. Sarah Nolan describes how SEIU represents one million health care workers, including personal care attendants, nurses, and nursing home workers (3:27). She discusses the challenges facing workers predate the pandemic and includes issues related to low wages, lack of benefits, few opportunities for professional development, and historical exclusion of home care providers—the majority of whom are women of color—from labor protections. These challenges are exacerbated by fewer available jobs or hours as consumers become fearful of workers entering their homes. Dr. Nolan emphasizes that the pandemic has exposed the cracks in our health care system, and pay policy must include long term structural solutions (8:29).
 
Ms. Wooster provides an overview of ACEP, a professional organization representing 40,000 emergency physicians from across the country and the 150 million patients they serve (12:04). She points out that in addition to those practicing in COVID-19 hot spots, resident physicians in training are particularly vulnerable to COVID-19 given their extended contact with patients during 80-hour work weeks. She also explains the counterintuitive downward pressure on front line physician salaries and benefits occurring as a result of curtailed care-seeking behavior leading to lower E.R. volumes and diminished profitability.
 
Dr. Michael Strain explains the importance of clarifying the goals of hazard pay before developing policy (17:22). Hazard pay may be a uniform supplement if intended as a gesture of gratitude; incremental based upon hours worked if intended to mirror potential exposure, or periodic over time to discourage attrition. He believes the purpose of hazard pay has been ill-defined at the Federal level.
 
(19:35) When asked what factors might govern hazard pay eligibility for health care workers, both Dr. Nolan and Ms. Wooster agreed that type and duration of exposure and the availability of PPE should all be considerations. They point out that even with adequate PPE, there are clear points of exposure risk during donning and doffing.
 
Ms. Wooster explains current policy proposals for hazard pay across sectors (22:43). She reflects on how certain private companies like Amazon and Walmart have temporarily increased pay at a flat rate for grocery workers. There are many similar proposals at the state and local levels, but few actual laws. At the Federal level, House and Senate Democrats have recently called for legislation including hazard pay differentials. She cites the following examples: Rep. Torres’ “Dear Colleague” Letter; The “Heroes Fund”; Senator Romney’s “Patriot Pay” proposal, and HEROES Act provisions. Ms. Wooster also emphasizes ACEP’s advocacy efforts to direct hazard pay towards individual workers as opposed to their employers. (29:08).
 
When thinking about the proposed policies, Dr. Strain reiterates the lack of clear goals from these proposals and identifies two approaches depending on the intended outcome of hazard pay. Stemming attrition with an income threshold payment, particularly for low wage workers, or encouraging retention within the profession by way of ongoing hazard payment are possible scenarios (31:10).
 
Dr. Nolan considers the potential limitations of hazard pay (37:07). She explains how short-sighted hazard pay policy may act as a patch but may fail to address the longstanding injustices marginalized health workers like home care workers face. Dr. Nolan suggests retention pay as a longer-term benefit for low wage workers after a finite period of hazard pay.
 
Dr. Strain examines potentially sustainable alternatives to hazard pay (42:34). He emphasizes the importance of programs that support workers with reduced hours, like partial unemployment. Of note, 27 states and D.C. have allowed employees who’s hours have been cut to receive partial unemployment benefits. He believes all states should embrace such a policy. Dr. Strain closes the discussion with how measures of health care worker morbidity and mortality in work settings may also provide objective criteria for hazard pay (45:25).