Visa crackdown threatens seasonal help

businesses that just can’t function on a full-time basis, and some might not even open at all,” said Mac Hay, who co-owns Mac’s Seafood on Cape Cod and has organized seasonal businesses to lobby Congress.

At issue are H-2B temporary visas, which are issued for workers holding down seasonal, nonagricultural jobs.

The U.S. caps the number at 66,000 per fiscal year. Some workers return year after year, and Congress has let them do so in the past without being counted toward the limit. No such exception was passed for 2017 at the end of last year, after the presidential election.

Lawmakers on Monday unveiled a government spending bill that would allow the homeland security secretary to increase the number of H-2B visas this fiscal year to almost 130,000.

But there is concern that even if the measure passes, it will take weeks for visas to be processed, meaning many workers probably won’t arrive in time for Memorial Day and maybe not until after the Fourth of July. Many resorts rely heavily on foreigners on H-2B visas to work as housekeepers, cooks, dishwashers and the like, saying they cannot find enough Americans willing to take such jobs.

Each visa typically costs at least $1,000 in government fees, travel and other expenses, paid by employers.

At the Beachmere Inn in Ogunquit, Maine, owner Sarah Mace Diment said she cut back on the number of rooms available during spring vacation week in April because she is short eight housekeepers. None of her visa requests were granted, she said.

Warranties and TRENTON, N.J. — money-back guarantees, long used to entice buyers of products such as hand tools and kitchen gadgets, are now being used to sell something more crucial: pricey new-generation drugs for diseases such as rheumatoid arthritis and cancer.

Deals being negotiated between drugmakers and the insurers who buy medicines now sometimes include extra rebates — or even full refunds — if drugs don’t help patients as expected.

It’s part of an effort driven by insurers and government health programs to align the cost of care with the quality of care, and slow the relentless growth of prescription drug costs.

“We’re spending less money on drugs that are less effective,” said Dr. Michael Sherman, chief medical officer for the not-forprofit insurer Harvard Pilgrim, which has several of these deals and is negotiating more. Sherman says one-fourth of every dollar it spends on patient care goes to prescription drugs.

For the patient, it doesn’t mean a check in the mail if cancer comes back after a round of treatment. But it does mean patients could get a drug that an insurer might otherwise be unwilling to pay for. And insurers, who now can track how patients fare through electronic medical records, will be reducing wasteful spending and making at least a dent in overall health care costs.

The cost of many new drugs now tops $100,000 per year or course of treatment, even though their benefits are unclear or only marginally better than cheaper, older drugs. Buyers of those new drugs, usually insurance companies, are hesitant to pay without assurance the drugs will help patients.

As a result, insurers often restrict access to expensive new drugs. Sometimes that’s achieved by making patients pay more out of their own pockets, or making doctors wade through red tape to get authorization for a patient’s medicine.

Sometimes patients have to try cheaper drugs first, and only when they fail are they allowed to get the pricey new drug.