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Health Affairs This Week places listeners at the center of health policy’s proverbial water cooler. Join editors from Health Affairs, the leading journal of health policy research, and special guests as they discuss this week’s most pressing health policy news. All in 15 minutes or less.
Hello and welcome to Health Appears This Week. I'm your host Jeff Byers. We're recording on 07/15/2025. Welcome back. We took a couple of weeks off this month for the fourth, and I was out in the mountains, but we are back.
Jeff Byers:This week, health affairs released its second insider trend report. The first one was on artificial intelligence in health care. Hopefully, you caught that. This new report is titled The Health Care Workforce, A Challenge in Sustainability. It provides insights into the key factors surrounding the current and future sustainability of the health care workforce.
Jeff Byers:You can get this report by becoming a Health Affairs Insider member, where you also get access to exclusive virtual events, as well as exclusive newsletters straight to your inbox. One of the things this report touches on, but doesn't dive into deeply, is the current HR regulations affecting all businesses, including providers. So to discuss those regulations, I'm joined today by Ryan Golden, senior reporter at HR Dive. Ryan and I used to work together at Industry Dive. I used to steal HR Dive articles for Healthcare Dive on the reggae.
Jeff Byers:It was beneficial on my end. I think it was beneficial on their end. We might not get to that, but here to talk about HR regulations. Ryan Golden, welcome to the program.
Ryan Golden:Jeff, thanks so much for having me.
Jeff Byers:Ryan, so you are based in Baltimore. Is that right?
Ryan Golden:That's correct. Yeah. Born and raised.
Jeff Byers:Born and raised. So we are a month and a half after after the release of Never Enough by Turnstile. Is the city still talking about it? Is it over? What's what's the party line there?
Ryan Golden:Oh, I'm kidding. Turnstile is the talk of the town. It's it's amazing to see an indie band grow from where they where they started out and now they're on the the national stage. It's it's incredible. I love seeing Baltimore represented, you know, in in in the media, in the popular sphere, and turnstiles is a huge highlight.
Ryan Golden:Love them.
Jeff Byers:Fantastic. Yeah. I saw them at the anthem about a couple years ago. Fantastic show. Absolutely.
Jeff Byers:Glad glad they're doing well. So moving on, you know, from from regional to more, national issues. So looking at HR and you know recent regulations that you track while at HR Dive, know, you give us a top line on what's the biggest changes to employment laws that industries such as healthcare may need to know about?
Ryan Golden:Yeah. Absolutely. And I had three specific ones I wanted to highlight for your your folks at health affairs. The first one is, of course, diversity, equity, and inclusion, otherwise known as DEI. We have seen quite a bit of rollback on DEI initiatives within the last few years, pushback on the cultural level as well as the legal level.
Ryan Golden:Of course, know that the Trump administration has been particularly insistent on cracking down on what it has called a legal DEI. It's put many of the regulatory agencies in charge of workplace law on this subject, including the Equal Employment Opportunity Commission, also known as the EEOC. They have targeted law firms based on their DEI programs and have tried to emphasize to employers that they're very much interested in cracking down on this area. And as a related note, know, this just happened, you know, the employment law sphere, the Supreme Court decision in Ames versus Ohio Department of Youth Services, which deals with so called reverse discrimination where majority group plaintiffs alleged workplace bias. That decision, which was a unanimous decision authored by Justice Ketanji Brown Jackson, was seen as a very landmark one for the workplace.
Ryan Golden:It eliminated some standards that certain courts maintained for majority group plaintiffs to allege workplace bias and the folks who I speak to think this will make it easier for those plaintiffs to bring such claims moving forward. So to the extent that healthcare employers have DEI initiatives in areas like recruiting, hiring, promotion, or even things like employee resource groups, they should be aware of these developments and just be aware of the laser focus that lawmakers and members of the public are placing on DEI. The second one is religious anti discrimination law. So we are seeing quite a bit of claims and things like vaccination requirements. Of course, when COVID happened, we saw a lot of vaccine requirements in healthcare and other industries.
Ryan Golden:Employees have filed suits saying that these requirements go against their religious beliefs and they do have protections under federal civil rights law. So we've seen a variety of cases on this subject and that particular area is also subject to a Supreme Court decision regarding religious accommodation requests in Groff v. The Joy where the court said it would lower the bar for plaintiffs to bring Title VII claims based on religious beliefs and accommodations against employers. So the rulings on religious anti discrimination vary from court to court. They're very fact specific and it's hard to really extract a general trend for employers, but it's just important to note that it's out there and that there are many bases at play on those particular cases.
Ryan Golden:And third, finally, you mentioned AI. I think that's important to note that in HR, we're constantly looking at developments in artificial intelligence. Executives are expected to have a perspective and a vision on AI. It's going to look different ultimately for every industry, but in healthcare could affect things like how physicians treat patients and especially how administrative tasks are performed, things like scheduling patient follow ups and management of employee schedules pertinent to this conversation. So expect to see continued interest in AI solutions both inside and outside of HR, as well as healthy skepticism of AI.
Ryan Golden:And in the regulatory space, we're watching a case against an HR vendor by the name of Workday in California, which is about the discriminatory impact potentially of AI in hiring specifically. So yeah, very much an emerging area watching that very closely.
Jeff Byers:Yeah, so that case in Workday, correct me if I'm wrong, that's kind of generally like you upload a resume, then they ask you to do it again and they may use AI to filter you out.
Ryan Golden:Yes. The the employee in that case or the job applicant in that case is alleging that he was screened out of multiple roles due to his age and he's been given class certification in that case. So that could apply to far more plaintiffs than just himself. So it's an ongoing case and I think it's the it's maybe the most significant case we're watching as far as AI intersecting with HR right now.
Jeff Byers:Yeah. It will be fascinating to watch. So thanks for that. I might want to ask you a little bit more about some of those going forward, after we talk about some of the things that are touched on the report, but not too deeply. One of those things is the changes to overtime eligibility criteria.
Jeff Byers:A little bit of a will they won't they kind of situation since, 2016 or so. What's the latest on this criteria? It's a final rule, but maybe it's not?
Ryan Golden:Yeah. It's confusing. Is one of those areas that always changes hands. It's nice to
Jeff Byers:know I'm not alone. Thank you.
Ryan Golden:No. No. You're absolutely not alone, Jeff. It it is a confusing area. It changes whenever the White House changes hands.
Ryan Golden:Most recently, you had the Biden administration attempt to raise the overtime eligibility criteria for US workers. They tried to do it in three steps. There was a July increase, a January 2025 increase, and then they even implemented an automatic increase strategy for 2027 and beyond. Of course, this was held up in the courts. Eventually there were federal judges in Texas that struck down the rule.
Ryan Golden:Currently it's technically still in litigation, but because the Trump administration really hasn't signaled it will litigate on behalf of the Biden rule, it's very, it's pretty much dead in the water according to the folks I speak to. So the latest update on overtime, you know, in 2019, the first Trump administration actually increased the overtime eligibility threshold. It's now hovering around $35,000 a year. And it depends on what duties your workers perform as well as how much they make, whether they're eligible for overtime pay. In healthcare, the rule that you need to pay attention to is the executive administrative professional designation and you know workers may or may not fall under that.
Ryan Golden:There are other exemptions for first responders and other categories, but it's just one of those issues that we continue to watch change on because you know especially given that this rule is still technically up in the air in the courts, but you know, there's not much defense of it from the current administration. It's hard to see. And I just want to note also, you continue to see healthcare systems deal with overtime pay litigation. There was a lawsuit filed in June by nurse managers in Georgia versus Humana, which claimed the company didn't compensate them for overtime pay. It continues to be an issue for not just health care employers, but employers generally just keeping track of hours, keeping track of exemptions, things of that nature.
Jeff Byers:Yeah. Do you foresee a future where this might be for lack of better term settled where like administrators can know what to do or how to think about this?
Ryan Golden:At the federal level
Jeff Byers:we already hear?
Ryan Golden:Yeah I mean at the federal level it's settled for the time being, right? You know for the next four years we have some sort of guarantee that it's not going to go to the levels that the Biden administration proposed. So that's a bit of ground for employers to look at. Whether we have future changes again, it's one of those issues that just you know when a Democrat is in office, they're very insistent on changing it. Have to recall and maybe you know your readers are familiar with the 2016 Obama overtime rule that was blocked similarly by federal courts.
Ryan Golden:Before that rule, we hadn't seen an overtime threshold increase since I think it was 02/2004. So this used to be an issue that lawmakers came to back pretty infrequently. Now it's a very hot button topic that successive administrations have addressed in some way shape or form. So definitely wouldn't be surprised to see it be addressed again before the next administration comes into power. But it's one of those things that for the time being, there is a bit of clarity going forward.
Jeff Byers:Right. Well, thanks for providing some of that clarity. Another hot button issue is pay transparency, particularly in the wake of the COVID nineteen pandemic. You know, I'm sure prospective employees love this, wanting to know what the pay range is. Some employers have given wild pay ranges like $0 to half a million dollars in in some job descriptions.
Jeff Byers:Don't quote me, or don't quote any particular job description on that. But it looks it looks to be something taken up mostly by states currently. Have we heard about how the transparency is faring in terms of attracting or retaining talent? Like, what's the latest on that?
Ryan Golden:Yeah. That's that's dead on. State and local lawmakers have really taken up this issue, and it's one of those employment law topics we've been tracking for a while where it's just we call it the patchwork, right? There are certain states and jurisdictions where they address this sort of thing in certain states where they don't. And those areas that do address it tend to have a lot of employers, a lot of large employers.
Ryan Golden:Think about places like California, New York, New York City, Pennsylvania, know all up and down the East And West Coast and in the Midwest as well. Pay transparency you know it's something that the research on it is still very new. Will say that whether or not it's a beneficial thing for reducing things like pay gaps, I've seen a lot of literature on it in both directions. I wanted to cite a few statistics. So in 2023, we got a report from SHRM, which if you're not familiar is HR's biggest industry trade group.
Ryan Golden:They found that pay transparency had a positive effect on employers who participated in pay transparency. They saw a boost to attracting skilled applicants and SHRM actually specifically said that 70% of the employers that surveyed that had paid transparency say that doing so led to an increase in applicants. We also had a vendor report in 2023 from Payscale, which said that paid transparency reduced turnover among employers. As far as whether it reduces pay gaps, I found a little bit of mixed as far as I have my own reading of it, my limited reading of the research out there. It's sort of mixed.
Ryan Golden:There has been some reporting that it reduces pay gaps in some instances while it can also have negative effects such as discouraging lower performing employees from asking for higher pay. And that's lower performing in terms of whether they self perceive as lower performing compared to other coworkers or actually lower performing. It discourages them potentially from asking for higher pay when they see how their coworkers, their cohorts are paid. So the research is still very new. I would encourage people to just keep an eye on it.
Ryan Golden:And I mean, or not what the employer's perspective on pay transparency is, it's clear that the states and local jurisdictions are very active on it. We just had a new law passed in Cleveland. So one of the biggest cities in The US Midwest now addressing this topic as well.
Jeff Byers:Yeah. Do you get a sense that this will kinda trickle out even more patchwork, as it becomes more normalized, or is it a yet to be determined kinda thing?
Ryan Golden:Yeah, it's one of those things where federal lawmakers have tried to put forward legislation to address it. Effort has succeeded so far. So you have this as with many employment law topics, you'll find there's just different approaches on a state by state basis and even on a city by city basis. So for now it's very much that patchwork until you have a federal law that provides a little bit more, you know, clarity and security.
Jeff Byers:So much like pay transparency was buzzy coming out of COVID-nineteen, also remote work was a big, big topic because it was kinda necessary in 2020 and 2021, and now you kinda see some return to work efforts. Have you seen from an HR, you know, retention and attracting talent perspective, have you seen any trends from remote or hybrid work that have bared out any interesting results that you could share?
Ryan Golden:Yeah. I mean, this is of course a hot button topic and it's hard for me to think of a specific statistic, but I will say one thing that we consistently find looking at surveys of job candidates is that they value flexibility. Flexibility continues to be something and flexibility that can encompass you know full time remote work, it can also encompass a hybrid work you know part time in office, part time at home or somewhere else. Even like flexibility in hours, like maybe you have a schedule that you can choose a certain number of hours per week or you can work a certain time frame in a given week compared to a different day where you work a different timeframe. Those kinds of options have tremendous sway among job candidates and of course it's become more in vogue for employers to return to office or RTO as we call it.
Ryan Golden:You see more and more employers doing that. Would say it's fairly mainstream. We had a transition period in COVID from like, I'm going say '22 to '24 where employers were in the middle in large part on this, but I think we fully swung in the direction of RTO since then, at least for most large companies, right? And that has affected employee relations, it's affected talent, but I think the constant drumbeat I hear from analysts and HR folks is that flexibility is still valued. So even if you have an RT requirement you know, letting people come to the office a certain amount of days and also work from home a certain amount of days per week is still very valued as is the things like you know being able to have flexibility in scheduling and shift changes and things like that.
Jeff Byers:Yeah. And another hot topic is non compete agreements. You see this in the health care provider space and in health tech space a lot, or in the start up world as well, which includes a lot of health tech start ups. There was a final rule, kinda barring these non compete agreements, but it looks like it's working its way through the courts, and non competes are permissible in the meantime. What can you tell us about this?
Ryan Golden:Yeah. That's right. You're referring to the Federal Trade Commission FTC ban on non compete agreements with some limited exceptions. This was under the Biden administration in 2024. They allowed some exceptions for certain senior executives and they sort of outlined what that looks like.
Ryan Golden:It was a very shot. Would say it was kind of surprising for us in the HR space to see that happen. However, it was effectively tied. It was struck down by a federal judge months before its September 2024 deadline. It never took effect and it's still tied up in the courts.
Ryan Golden:We're not quite sure where that rule goes from here. We have quite a bit of bipartisan there's been some interesting if you look out at the accounts that are available in news websites, can see that there are politicians and there are influencers on both sides of the aisle who sort of look at non compete bands positively, think that they're a bottleneck on competition. You also have quite a bit consensus in the business community that you know these kinds of agreements are valued because they help protect things like trade secrets, customer bases. You know there's quite a bit of variety and perspective there compared to some of these other topics. So as far as where let's say the Trump administration goes on this, think it's really yet to be seen.
Ryan Golden:We haven't really seen the administration firmly say where they're going to stand on this. But what I can say is that in the meantime, the states have moved forward in implementing non compete bans. So I wanted to call a few out examples that specifically affect the healthcare industry. So a law firm that we file, Whitler Mendelson, they've reported that several states have enacted these kinds of agreements specifically affecting physicians and other practitioners this year. Oregon passed a law in June which voids non competes which involve workers with certain medical license.
Ryan Golden:And in Texas there are time and geographic based limitations according to regulations there on non competes for a physician. So I hate to be repetitive, but you know this is very much something where the states have taken the lead for the time being while the FTC rule is sort of held up in the courts.
Jeff Byers:Is there a specific definition of the term trade secrets yet?
Ryan Golden:Yeah. I mean, I would probably defer to an attorney on that one, but Okay. You know, yeah, like the non compete as a concept, right, is to protect from competition with a competitor right. So the main thrust of that kind of agreement is it's a restrictive covenant and the goal is to protect the customer base, to protect the business. There are other forms of restrictive covenants that employers can look to in the meantime, things like NDAs, non solicitation agreements.
Ryan Golden:There are things like garden leave, which is a arrangement where you pay someone to not work for anywhere else you know or work for a competitor for a certain amount of time after they leave the business. And there are some wrinkles in garden leave that you may want to consider legally looking at, you know, depending on where what regulations are in your specific little geographic area, but there are other options besides non competes is the point. And there are many motivations to pursue non competes, I think. But yeah, that's that's I guess the answer to the question is it varies depending on who you talk to.
Jeff Byers:So as we wrap up, are there any other major federal or state HR rules, that you feel our listeners should know about?
Ryan Golden:Yeah. Absolutely. I just wanted to call out again the artificial intelligence and the hiring process part of it. I think it's relatively new. We do have a handful of states.
Ryan Golden:We have a tracker on this on our website. We have a few states and cities that have implemented laws that specifically regulate AI and hiring. The most notable ones are probably New York City and Colorado. Colorado is fairly extensive. There are requirements around notifying applicants about using AI, disclosing what the AI is used for, what it does, and there are even certifications.
Ryan Golden:So there are requirements. I think New York City has a requirement that you have to actually recertify the system with the city government. And I would check my tracker on that just to be sure. But yeah, it's something that's emerging and we're actually watching in California. They are developing regulations around this and I believe a few pieces of legislation around AI and hiring.
Ryan Golden:California, just for those who aren't aware, is sort of seen as a bellwether for employment law. So if California passes something, it's very likely that other states will move forward and do something similar. And given that California is where many of these AI companies are based, it's super, it's double impactful because it directly impacts some of the biggest players in the AI space in general. So that's something to keep in mind.
Jeff Byers:Yeah. And that website is hrdive.com. Ryan Golden from HR Dive. Thanks again for joining us today on Health Affairs This Week. Is there anything, just as we wrap up one final time, that you wanna promote while you're here?
Ryan Golden:Yeah. And thanks so much for the opportunity, Jeff. If you have an HR professional at your practice or organization who's struggling to keep up with all this, hey, we get it. We've got them covered at HR Dive. Our content is free to readers.
Ryan Golden:We don't have paywalls. We cover news, general tricks. We've got daily and weekly newsletters. So the daily issues, they cover general news and talent specific trends, so recruiting, that kind of thing. The weekly issues cover compliance, training, DNI and compensation and benefits.
Ryan Golden:So I highly recommend the weekly newsletters for those who want snapshots of specific topics. The daily ones are more of a broad based overview. And I also wanted to highlight in October, October 8, we have a free live virtual event coming up at HR Dive on open enrollment planning. So open enrollment interfaces with healthcare quite a bit. If you have, if you manage employees or manage employee benefits plans or you interact with employers, health plans that may interest some of your listeners.
Ryan Golden:And one of our reporters actually, Ginger Chris, she'll be hosting a panel at that event on the unsustainable health care cost increases we've been seeing in The US. I know that's a hot topic and she'll be specifically talking about what strategies employers are using to address that. So that may be of interest. Yeah. And Jeff, you called out the website hrdive.com.
Ryan Golden:We're also on social media, X, Facebook and most prominently on LinkedIn where we not only do we post our stories, we also have a discussion group for HR professionals who are interested in talking about, you know, professional issues, you know, different trends they're seeing. We we see a lot of different variety from our folks on LinkedIn.
Jeff Byers:Well, great. Thanks for sharing that information. We'll post links to HR Dive and hopefully the event in the show notes for this episode. Ryan Golden, thanks again for joining me today on Health Fairs This Week. And to you, the listener, if you enjoyed this episode, please send it to, the recruiter in your life.
Jeff Byers:Thanks again, and we'll see you next week.