1. Nearly half (48%) of working New Yorkers do not receive paid sick days, while 44% receive no paid vacation.  A full 39%–or 1.3 million workers in New York City–receive no paid leave (sick or vacation).
   • 66% of low-income workers in New York City lack paid sick leave, with Latinos faring the worst; more than 7 out of 10 Latinos lack paid sick leave.
   • 60% of low-income working moms in New York City lack paid sick leave for themselves and for their children.
2. Availability of paid sick leave is declining across income spectrums.
   • Where 56% of the near-poor had paid sick leave in 2007, only 33% have it in 2009.
   • Where 82% of moderate to high-income workers had it in 2004, only 63% have it in 2009.
3. Workers in unions are more likely to receive paid sick leave; 64% of those in union jobs have paid sick days versus 48% of those in non-union jobs.
4. Workers in small businesses in New York City are the least likely to receive paid sick leave; nearly two-thirds of those in businesses with 10 or fewer employees lack paid sick leave.  The authors underscore that these small businesses hire over 26% of all New Yorkers.
5. Workers in the service sectors, construction and manufacturing are the least likely to receive paid sick leave, with a full 68% of working New Yorkers lacking paid sick leave in the leisure, hospitality, retail and wholesale areas.
6. When no paid sick leave is provided, low-income workers who take time off to care for themselves or a sick child are more likely to be threatened with retaliation in the form of docked pay, job loss, or suspension.
7. The lack of paid sick leave results in public health consequences, including the spread of contagious illnesses, like H1N1, and higher health care costs. Low-income workers without paid sick leave are more likely to go to work sick, and more likely to rely on emergency room visits to tend to routine medical issues. Even when these workers have health insurance coverage, the ER provides care outside of work hours and does not jeopardize job security.
8. Most New Yorkers, across income and political party lines, support the passage of a paid sick law.

For more information on paid sick days, generally, visit our mini-brief and topic page on the matter.

As a mom, I want my children to be bilingual. Why not give them every advantage when they one day enter the job market? But as a working mom, finding the time and making the commitment to teach my children a second language has been more difficult than I expected.

I’ve discovered that other parents are struggling, too. It’s Nia Yasher’s third go round at raising a bilingual child and this time she’s sending her daughter to a Spanish-language school. Yasher, a Cuban-American insurance agent in Miami, who grew up speaking Spanish in her home, has two older daughters who aren’t fluent in both languages. “Teaching our kids Spanish is hard for my generation,” Yasher says.

Today, working parents who grew up speaking Spanish, Creole, Portuguese, Hebrew and other languages have so much else on their plates that raising a bilingual child often becomes complicated, overwhelming and the chore on their to-do list that they let slide. In an era where most families rely on two incomes, working parents may have the desire to teach their children their native tongue, but lack the time and energy required to carry out their good intentions.

The recession is teaching us a lesson: being bilingual — even multilingual — is a huge career advantage and learning it as an adult is challenging. CareerBuilder.com has hundreds of jobs advertised in almost every industry seeking workers who are bilingual. There’s other incentives, too. Bilingualism has also proven to be beneficial for the cognitive development of young children, Jennifer Santiago writes for Babyzone.

As many bilingual parents know, the key to teaching a child a language is consistency. This is where I went wrong. Here in South Florida, where much of the population speaks more than one language, I had my oldest child begin life learning Spanish and English. When she started school, I had her tutored in Spanish. Even though she hears Spanish in the community, I didn’t keep up with it the lessons or practice with her and she has lost her fluency. As a parent who has struggled all my life to become fluent in Spanish, I feel guilty.

It’s that guilt that keeps Roberto Giuffredi of Step by Step Languages in Miami in business. Giuffredi says he’s been surprised by the demand since opening his language school seven years ago. Giuffredi has taught Spanish to about 600 children of Hispanic parents who typically have some Spanish spoken to them at home — just not enough to make them fluent.

Of the 53 million U.S. children between 5 and 17, about 15 percent are bilingual, according to the U.S. census 2008 American Community Survey. Several factors complicate parents’ efforts to raise a bilingual child. They include whether they are the first or second generation in the United States, whether both spouses speak the language, whether extended family are nearby to reinforce the language, whether the desire to assimilate is stronger than the interest in passing a second language on to offspring, and fear of delayed speech skills.

Of course, grandparents can be helpful. Ana Lopez-Blazquez says as the daughter of Cuban refugees she went out of her way to teach her two children her native Spanish. But her home has three generations under one roof, with grandparents who don’t speak English and reinforced her efforts while she was at work.

Jeannette Kaplun, co-founder and chief content officer of Todobebe.com,  a website for Spanish-speaking parents, says ensuring your child is bilingual requires mom and dad taking a tough stance. “The older they get, the more they prefer to speak back to you in English. They resist and you have to resist, too.”

Kaplun offers advice to working parents who feel overwhelmed: Listen to music in another language, watch Disney movies or cartoons, read books at story time, play games.  “It doesn’t have to be seen as a chore.”

Of course, there’s also Yasher’s approach, the one I’m considering again: outsource it. As Yasher notes, “At least with my daughter taking classes, I know she’s getting the basics.”

• Our latest Topic Page, Single Workers, is live! Thank you to Caroline Ogilvy and Jane Case for compiling and Bella DePaulo for advising. Please let us know what you think!

New, free work-life content online:

• CLASP: New Report Reveals Higher State Poverty Rates Based on Alternative Measure
• National Science Foundation: Minority Students Earned Greater Number of Academic Degrees in Fiscal Year 2006
• Center for Retirement Research at Boston College: The National Retirement Risk Index: After the Crash
• Pew Internet & American Life Project: Social Isolation and New Technology
• Monthly Labor Review: Part-Time Workers: Some Key Differences Between Primary and Secondary Workers
  

Summer vacation season is over and we have definitely moved into fall. As we celebrated National Work and Family Month this October, I wanted to look back to see if workers took vacations this summer, identify the benefits of vacations and discuss the status of vacations in the U.S. Vacations are a critical work-family issue as they provide an opportunity to relax, reconnect with the important people in our lives, and have time to pursue our personal passions.

A poll conducted from August 1-September 11, 2009 on the Sloan Work and Family Research Network website found the following among 74 respondents:

Are you taking vacation time this summer?

Yes, I am taking the time that I desire ….. 23%

Yes, but I am taking less time than I want to ….. 30%

No, I don’t have the money for vacation this year ….. 27%

No, I’m too busy at work ….. 14%

No, I am afraid that it will put my job at risk ….. 7%

So, what does this tell us? Granted, this is a small, rather unscientific sample, but only about a quarter of respondents took the time that they wanted. Another 30% took some time, but wish that they could have taken more. Just under half (48%) did not take vacation time because they didn’t have the money, were too busy, or were afraid that it would put their jobs at risk. Half of the respondents did take some time off, but almost half did not. Should we be concerned?

An interesting article by David Rock in Psychology Today found that if you are a knowledge worker who thinks for work, there are benefits to a break. He reports that time away from a problem allows you to get unstuck from your typical way of viewing situations and promotes new perspectives. Research also finds that we are more effective at solving difficult problems when our minds are less cluttered, which is more likely to occur if we get our heads out of work — for example, by taking a vacation.

A new report by the Families and Work Institute, “The State of Health in the American Workforce,” found a decrease over the past 6 years in the number of employees indicating that their overall health is “excellent” (from 34 to 28%). Co-author Ellen Galinsky says, ” …organizations can promote wellness by monitoring overwork and providing and encouraging employees to take their vacations.” Other indicators of poorer health include more stress, clinical depression, difficulty sleeping, and medical conditions such as high blood pressure and elevated cholesterol. Read more here.

Author Joe Robinson echoes these findings in his book, Work to Live. People who take vacations are less likely to have heart attacks or other illnesses compared to those who don’t take vacations. “But it only starts to work that way when you take at least a two-week block of time,” says Robinson. A long weekend or a few days off doesn’t promote better health; we need a chunk of time off to reap positive health benefits.

Compared to the rest of the world, the U.S. is an outlier around vacation time with 137 countries (including all industrialized nations) mandating a minimum of 4 weeks of paid vacation time. In the U.S., there are no laws requiring employees to have any paid vacation time so employers offer paid vacation time at their discretion. As noted by Julie Weber here on the Work and Family Blog,

“The Center for Economic and Policy Research reports that about one fourth of the U.S. workforce has no paid vacation in the course of their work year. Part-time workers, low-income earners, and workers in small establishments (fewer than 100 workers) are less likely to receive paid vacation and paid holidays, and when they do, these workers receive fewer paid days off.”

Thankfully, there has been some recent attention in the U.S. to mandating vacation time. In May of this year, Congressman Alan Grayson (D-FL) introduced the Paid Vacation Act of 2009, which would amend the Fair Labor Standards Act to require that employers provide a minimum of 1 week of paid annual leave to employees at companies with at least 100 employees. Advocates of the bill note that vacations are important for family well-being as well as for improving workplace productivity.

Vacations — who needs them? We all do! What is it going to take to move us from a nation of overworked, unhealthy, stressed out Americans with no time to relax, explore our passions or engage with our families? Of course, we have to start by taking care of ourselves as much as that is realistic given our financial and employment situations these days. We definitely need to prioritize taking vacation time, but this can’t just be an individual responsibility. Supervisors and managers have to support our efforts to take a vacation, so we can return to work as more productive and healthier contributors.

Employers have to support the use — not just the availability — of vacation time. This requires changing the culture of the workplace and moving our thinking from vacation as a burden for the work team and for the organization to an opportunity for employees to recharge so they’ll return to work more creative and engaged.

Marcy Karin is an Associate Clinical Professor of Law and Director of a new Work-Life Policy Unit of the Civil Justice Clinic at the ASU Sandra Day O’Connor College of Law. Her research interests include workplace law, policy, and practice, civil justice and litigation, and women’s legal history. She is also an active member of the national work-life law and policy community. Please note that the views of our guest bloggers do not necessarily reflect the views of the Sloan Work and Family Research Network.

Military families have acute needs for workplace flexibility. Dealing with multiple deployments, war-related disabilities and injuries, frequent moves, geographic isolation from services at bases, transitions back to civilian life, and other service-related needs impact servicemembers and their families in a real way. Military families also struggle with many work-life stresses that all families face. As The Shriver Report: A Woman’s Nation correctly notes, “policies that ease the strains on service members’ families” must be enacted.

Last week, President Obama signed the National Defense Authorization Act for Fiscal Year 2010 (NDAA 2010) into law. The NDAA 2010 includes the Supporting Military Families Act of 2009, which expands the qualifying exigency and military caregiver provisions of the Family and Medical Leave Act (FMLA). President Bush enacted these provisions last year in the first successful attempt to amend the FMLA.

Under the 2008 FMLA expansion, eligible employees are allowed to take up to 12 weeks of job-protected time off for any qualifying exigency arising out of the fact that the spouse, son, daughter, or parent of an employee is on active duty (or has been notified of an impending call to active duty) in the National Guard or Reserves in support of a contingency operation. Department of Labor regulations define a qualifying exigency to include short-notice deployment, military events and related activities, childcare and school activities, financial and legal arrangements, counseling, rest and recuperation, post-deployment activities, and any other service-related activity that the employer and employee agree is a qualifying exigency.

The 2008 law also created military caregiver leave, which allows an eligible employee (spouse, son, daughter, parent, or next of kin of a covered servicemember) to take up to 26 weeks of job-protected time off to care for a wounded servicemember.

The NDAA 2010 expands the scope of who may take time off under the 2008 provisions. Specifically, the new law allows:

• family members of active duty members of the regular Armed Forces to use qualifying exigency leave when the servicemember is deployed to a foreign country. (The 2008 law only applied to family members of the National Guard and Reserves who were called to active duty in support of a contingency operation.);

• federal employees to use qualifying exigency leave. (Only certain federal employees were allowed to use it under the 2008 law.);

• military caregiver leave to be taken for veterans who served within 5 years of the date of medical treatment, recuperation, or therapy. (The 2008 law only applied to servicemembers who were currently in the military.); and

• military caregiver leave for existing or preexisting injuries that are aggravated in the line of duty during active duty service. (The current regulations deny coverage for these injuries.).

The expansions took effect when the President signed the law. Proposed regulations from the Department of Labor and the Office of Personnel Management, which will be drafted in consultation with the Secretaries of Defense and Veterans Affairs, should be issued shortly.

At the bill signing ceremony, President Obama noted that this law “reaffirms our commitment to our brave men and women in uniform and our wounded warriors.” This is just the first of many laws that President Obama will likely sign that reaffirm this commitment and provide military families with access to additional time off and other types of workplace flexibility. We can also expect the President to fulfill his campaign promise to support the needs of all workers as they struggle to find a work-life balance. Stay tuned for more action from the Obama Administration in the months and years to come. In the meantime, employers should revise their FMLA policies to reflect the NDAA 2010, as well as notify employees of these changes.

For more stories about the flexibility needs of military families, listen to the remarks of Dr. Shelley MacDermid Wadsworth, Kelly Hruska, Sheila Casey, and Patricia Kempthorne at this 2008 Workplace Flexibility 2010 briefing.

We connect with millions of people across the globe, yet we have trouble sitting down to share a meal with those we love. We’re often so busy being “productive” that we wind up racing right past the important moments in life.

I’m thinking about time because I just wrote one of my “Balancing Acts” columns in the Globe on the declining health of the American worker. Our experience of time is a key to understanding how we can gain a better quality of life, with deeper human connections.

The new report by the Families and Work Institute shows that too many of us are fat, sick, sleepless and inactive. Just 28 percent of U.S. workers say their health is excellent, down from 34 percent six years ago. Workers in poor health are less likely to be loyal, engaged and satisfied with their jobs, the findings show.

Why are we so unhealthy? Certainly, many of us don’t exercise or eat right, and at the heart of these poor habits is often a time drought. About 60 percent feel they don’t have time for themselves, and an equal number report a lack of time for a partner or spouse. Chillingly, 75 percent report not having enough time with their children.

Moreover, those who most often don’t have enough time for the important people in their lives report poorer health – more depression, higher stress, more minor health problems. Nearly half of people who often or very often don’t have time for family and friends show signs of depression, compared with a third of those who sometimes feel this kind of time famine.

Vacations boost health, too. People with paid vacation time are less depressed and stressed than those without any paid holidays. The longer the vacation taken, the more likely a worker is to show few minor health problems. Still, 40 percent of workers don’t take all their vacation time, and the longest vacation taken on average in 2008 was nine days.

I believe that as a result of the mechanization of the Industrial and Digital Ages, we now pattern ourselves after our machinery. We seem to believe that we can be 24/7 beings, who interact in snippets and tweets, measuring our worth quantitatively. This collective adoration of the machine changes our experience of time, and squeezes the serendipity, mystery, and poetry out of our lives. And it just might be killing us, too.

• October issue of the Network News: Kate Lister on Telework
• New Policy Brief: The Impact of the Recession on Work and Family
• Updated Policy Brief on: Part Time Work
• Who’s Who in Work and Family: Bella DePaulo, PhD

National Work and Family Month at the Huffington Post:

• California: An Example of State Action on Workplace Flexibility
  by David Gray, Director of the Workforce and Family Program, New America Foundation
• Workplace Flexibility and People with Disabilities
  by Robin Shaffert, Senior Director of Corporate Social Responsibility of the AAPD
• Vacations—Who Needs Them?
  by Judi Casey, Principal Investigator and Director, The Sloan Work and Family Research Network
• Some States Respond to Recession with Work-Family Policies
  by Julie Schwartz Weber, Policy Specialist, The Sloan Work and Family Research Network

How Health Care Costs Affect Businesses:

Since most people get their health insurance through their jobs, employers are saddled with most of the burden of rising health care costs and insurance premiums. As employees’ shares of the cost of insurance increase, it is easy to ignore the financial expenses employers are absorbing on their employees’ behalf.

• Health insurance expenses are the fastest growing cost components for employers.
• In 2008, employer health insurance premiums increased by 5%, twice the rate of inflation.
• Employer-sponsored health insurance premiums have been rising four times faster than workers’ earnings since 1999.
• This increase places corresponding downward pressure on salary increases, new hiring, and capital investment.
• For small businesses, health insurance premiums have increased 12% annually. Rapidly rising health insurance premiums are the main reason cited by small firms for not offering coverage.
• Surging health care costs slow the rate of job growth, contributing to a recessionary economy) and making it more expensive for companies to add new workers.
• The high cost of health care for businesses also suppresses wage growth for current workers by increasing total compensation costs.
• As health care costs rise as a percentage of operations expenses, corporate operating margins are reduced, which limits the capacity of companies to grow through investment in research, plant and equipment.
• High medical insurance costs place American firms at a disadvantage in world markets where they compete against companies with much lower health care costs in the nations where they operate.

Health Care For Profit

In America, health care is not considered a right, but a privilege to be earned. And as a privilege, a lot of money is made by providing it.

• In 2007, health-related companies in the Fortune 1000 earned nearly $71 billion.
• The medical establishment (hospitals, pharmaceutical companies, health insurers, medical device manufacturers, etc.) spend nearly $6 billion per year on advertising.
• Pharmaceuticals and medical equipment ranked third and fourth, respectively, in terms of profits as a share of revenue.
• From 2000-2007, the annual profits of America’s top 15 health-insurance companies increased from $3.5 billion to $15 billion.
• The 50 largest nonprofit hospitals or hospital systems made a combined net income (profit) of $4.27 billion in 2006, nearly eight times more than five years earlier.

Facts About Medical Malpractice:

Much has been made of the effect of medical malpractice jury awards, settlements, and rising premiums on the cost and quality of health care. However, there is little evidence establishing conclusive links. Meanwhile, medical malpractice premiums continue to increase at a rate that puts economic pressure on practitioners. The question is, does this influence outcomes?

• A new Dartmouth study suggests that medical malpractice jury awards and settlements are not responsible for raising insurance premiums or health care costs.
• The GAO recently found that access to care was generally not impacted by increasing cost of medical malpractice lawsuits.
• The GAO concluded that liability laws have positive effects on doctors’ behavior, and are frequently the only means by which the consumer can hold the medical establishment accountable.
• The Congressional Budget Office estimated that malpractice costs account for less than 2% of the national health spending.
• There is little research to support anecdotal reports that rising malpractice costs contribute to defensive medicine creating barriers to care and reduced quality of service.

With so much information circulating about heath care in America, it’s easy to lose sight of the forest for the trees. It’s difficult to navigate these thick woods of interested party rhetoric to gain a true understanding of the system, its strengths and its weaknesses, but only then can we make a proper evaluation of the best possible changes.

The information contained in this blog was obtained from the following sources:

Beider, P. & Hagen, S. (2004). Limiting tort liability for medical malpractice. Retrieved from the Congressional Budget Office web site: http://www.cbo.gov/doc.cfm?index=4968&type=0

Henry J. Kaiser Family Foundation. (2007). Health care costs, a primer: Key information on health care costs and their impacts. Retrieved from: http://www.kff.org/insurance/upload/7670.pdf

Henry J. Kaiser Family Foundation. (2008). Employee health benefits: 2008 annual survey. Retrieved from: http://www.kff.org/insurance/7672/index.cfm.

Henry J. Kaiser Family Foundation, (2005). Background brief: Medical malpractice policy. Retrieved from: http:/www.kaiseredu.org/topics_im.asp?id+226&imID+1&parented+59

National Coalition on Health Care. (2009). Facts about health care: Economic costs fact sheets. Retrieved from: http://www.nchc.org/facts/economic.shtml

Rowland, D. & Hoffman, C. (2009). Health care and the middle class: More costs and less coverage. Retrieved from he Henry J. Kaiser Family Foundation web site: http://www.kff.org/healthreform/upload/7951.pdf

Most of us moms and dads have known intuitively that getting the flexibility we need at work makes us loyal to our employers. Let us leave early on Fridays and we’ll work even harder the rest of the week. Now a new report shows that businesses benefit financially from helping their employees achieve work-life balance.

New research by Morgan Redwood, an expert in talent development, reveals that businesses that help staff achieve a good work-life balance enjoyed net earnings per employee of 23 percent more per year than the average for those who don’t. The Morgan Redwood researchers, who surveyed 100 businesses in the United Kingdom, believe this boost in the bottom line is because better work-life balance reduces absenteeism, improves well-being, and increases productivity.

Janice Haddon, managing director of Morgan Redwood, says when companies weigh their management options, they now will have some real numbers to use to make their decisions. She calls the ability to put an actual value on work/life balance “a breakthrough moment,” adding, “Work/life balance is not a “nice to have” when we’re in a boom time. It can have a fundamental impact on the corporate performance at all times.”

What’s more, the report found that in high-performing companies, there was a recognition that the success of the business depended on the success of workers. If a manager goes out of his way to accommodate an employee, the employee will redouble their work efforts later on, the Morgan Redwood study shows.

Will employers embrace these findings? Will they realize that women and men are struggling to manage heavier workloads and negotiate family schedules and responsibilities?

This week, another interesting report surfaced, a nationwide U.S. survey released in conjunction with research on status of women by Maria Shriver and the Center for American Progress. The survey shows that men and women are concerned about what’s happening to families when everybody’s at work. Both genders said that they would like more help with these challenges. The recession seems to have pushed the challenges to new levels, with some parents working two part time jobs to make ends meet.

The report’s contributors also suggest nothing will change until men push for more family-friendly workplace policies that will benefit both genders. If men aren’t emboldened by their own struggles to balance work and family, there’s certainly some new ammunition in their arsenal—the bottom line.

Ultimately, the high cost of health care is borne by families, both working and nonworking. Rising costs and inefficiencies are passed on to the consumer.

Health insurance for workers:

• Nearly three out of four middle-income families are insured through their employers – coverage that is jeopardized by rising unemployment during the recession.
• The recession will cause an estimated 7 million Americans to lose their health insurance coverage.  If unemployment rises to 10% (as many predict), an additional 6 million will lose their health insurance.
• The annual health insurance premium for a family of four is $12,700 per family, an increase of 78% since 2001.
• Health insurance premiums increased 119%, with the employees share increasing 117%, between 1999 and 2008, compared to cumulative inflation of 44% and wage growth of 29% during the same period.

What about uninsured workers?

• Over 8 in 10 uninsured people come from working families.
• On average, the uninsured are 9-10 times more likely to forego medical care because of cost and twice as likely to have medical debt.
• Among all personal bankruptcy filings, the average medical debt was $12,000.  Sixty-eight percent of those people had medical insurance, and 50% of all personal bankruptcy filings were partly the result of medical expenses.
• From January to March 2009, 44.9 million persons of all ages (14.9%) were uninsured at the time of interview, 57.7 million (19.2%) had been uninsured for at least part of the year prior to interview, and 32.1 million (10.7%) had been uninsured for more than a year at the time of interview.
• Thirty-six percent of families living below the poverty line are uninsured.  Thirty-four percent of Hispanic Americans, 21% of Black Americans, and 13% of White Americans are uninsured.
• Eleven million uninsured people come from the middle class, accounting for a quarter of the nation’s non-elderly uninsured.

Facts about the quality of care we receive:

• Although nearly $2.4 trillion per year is spent on medical care, many people receive less care than they need, more care than they need, or the wrong kind of care.
• Patients fail to receive needed services 46% of the time.
• Patients received services they did not need 11% of the time.
• Patients received recommended preventative care and screenings 49% of the time.

• Total national costs of preventable adverse medical events are estimated to be $35 billion per year.
• There are over 250,000 hospital-acquired pneumonia cases and 23,000 related deaths every year.
• One third of US patients reported a medical, medication or laboratory error in the past two years.

Next week:  PART III: Health Care and American Businesses

The information contained in this blog was obtained from the following sources:

Cohen, R., & Martinez, M., (2009). Health insurance coverage: Early release of estimates from the national health interview survey, January - March 2009.  Retrieved from the Center for Disease Control web site: http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur200909.htm

Goldman, D., & McGlynn, E. (2005).  U.S. health care facts about cost, access, and quality. Retrieved from the RAND corporation web site: http://www.rand.org/pubs/corporate_pubs/2005/RAND_CP484.1.pdf

Henry J. Kaiser Family Foundation (2008).  Employee health benefits: 2008 annual survey, September 2008. Retrived from: http://www.kff.org/insurance/7672/index.cfm.

Himmelstein, D. U., Warren, E., Thorne, D. and Woolhandler, S. J. (2008). Illness and injury as contributors to bankruptcy. Retrieved from: http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.63/DC1

McGlynn, E., Asch, S., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., & Kerr, E. (2003).  The quality of health care delivered to adults in the United States.  New England Journal of  Medicine, 348(26), 2681-2683.

National Center for Health Statistics. (2007).  Health, United States, 2007: with chartbook on trends in the health of Americans, 2007.  Retrieved from the U.S. Department of Health and Human Services web site: http://www.cdc.gov/nchs/data/hus/hus07.pdf

Rowland, D., & Hoffman, C., (2005). The impact of health insurance coverage on health disparities in the United States: Human development report. Retrieved from the United Nations Development Programme web site:  http://hdr.undp.org/en/reports/global/hdr2005/papers/hdr2005_rowland_diane_and_catherine_hoffman_34.pdf

Rowland, D., & Hoffman, C. (2009).  Health care and the middle class: More costs and less coverage.  Retrieved from The Henry J. Kaiser Family Foundation web site: http://www.kff.org/healthreform/upload/7951.pdf

Next week:  PART III: How the American Health Care System Affects American Businesses