David Ward
Send us your questions: We figure you have plenty of thoughts and questions about this issue, so we published this update in this blog and our Direct Care News newsletter in late October, and we’ll keep updating it until a health care reform bill is passed or vetoed. If you have any questions about health care reform and how it would affect direct care worker and the people they assist, please send them to me at dward@directcarealliance.org. And if you just want to tell us what you think about this issue, please leave a comment below.
Everybody has heard a lot about health care reform, but with so many conflicting opinions about the impact that it will have on our health care system, it has been very difficult to make sense of it. The health care reform bills in the House and Senate range from about 1,000 to 1,500 pages, giving supporters and naysayers lots of material to applaud and oppose.
Why does America need health care reform?
Our health care system is broken. According to a recent Gallup poll, approximately 16% of Americans — about 46 million people – are currently without health insurance. Millions more have insurance but do not receive necessary services because of high deductibles and co-pays. Even for those of us who are happy with our health insurance coverage, insurance premiums are rising faster than wages, so many people will be priced out of their policies if something doesn’t change.
Why do direct care workers need health care reform?
Approximately 30% of direct care workers lack health insurance – nearly twice the uninsurance rate of the population as a whole. There are many reasons for that sky-high rate. Some direct care workers are hired directly by the people they assist, who cannot offer health insurance or worker’s compensation. Others work for small businesses that can’t afford to subsidize high group insurance rates. Home care workers at agencies that offer insurance often can’t book enough hours to qualify for the company plan, since employers often manage costs in part by offering insurance only to full-time employees. And a lot of people just can’t afford the premiums and copays.
Being without insurance obviously puts direct care workers and their families at financial and medical risk. It also hurts the people who depend on direct care to do daily activities and maintain their health and independence, since the shortage of affordable insurance is a key factor in the high turnover rates that plague the profession. The high cost of insurance is also a problem for the people who employ direct care workers, since they must either bear the brunt of the costs or worry about losing good candidates because they cannot offer this basic benefit.
What’s happening now with health care reform?
Five Congressional committees have introduced and passed health care reform bills: Senate Finance, Senate HELP, House Ways and Means, House Education and Labor, and House Energy and Commerce. The Senate Finance and Senate HELP committees are in the process of merging their bills into one to will be voted on by the entire Senate. The three House committees are undergoing the same process.
Update: On Saturday night, November 7, the House passed its bill, HR 3962, or the Affordable Health Care for America Act
If the Senate also passes a health care reform bill, those two bills will be merged and voted on by Congress.
There are many similarities between the current bills but also some differences. The most controversial is the so-called “public option.” The DCA supports a public option because we think that it will help keep private insurance companies honest by offering competitive policies that ensure consumer choice at affordable rates.
What does the DCA like about the bills?
Many people agree that we need health care reform but do not support the reform bills under consideration in Congress. The DCA supports the bills because they will make health insurance more accessible and affordable for all Americans – including direct care workers.
We don’t like everything about them, but we do like the fact that they would eliminate several of the common barriers to insurance. All of them would:
- Make it illegal for insurance companies to deny coverage based on preexisting conditions;
- Limit the costs that can be passed on to patients, creating a sliding scale based on annual income; and
- Limit the ability of insurance companies to deny coverage based on criteria such as age, gender, and occupation.
These three requirements will help ensure that health care is more affordable and accessible for all Americans, so we’re delighted that they were included in all five versions of the health care reform bill.
Additional Resources
The DCA’s Direct Care Worker Principles for Health Care Reform (PDF)
The PHI Health Care for Health Care Workers Health Care Reform Resource Center
A PHI chart comparing the bills as of October 27, 2009 (PDF)
Testimonials about the need for better health care coverage from direct care workers Don Krutsinger, Cindy Ramer, Helen Hanson, and Ray Erickson.
Health care reform advocates make progress in Maine and Virginia
Economist Candace Howes on what the research tells us about how health care coverage boosts retention rates among direct care workers
David Ward
Director of Policy and Planning
Direct Care Alliance
This is a great posting. Thank you for sharing this information-
The healthcare reform passed by the house will mean at least a $2 per hour pay cut to my direct care workers. The 8% payroll penalty I will have to pay will be more than my salary and the company profits combined and not enough to pay for health care for 1/3 of my staff. The 28% employee pay and 38% for their family is not affordable to my employees even if I could subsidize health insurance! They wouldn’t pay $50 per month when we did try offering insurance. This legislation does not help direct care workers!
Direct care employees are very difficult to find. Competition, at least in my area, means the highest wages possible for workers. Our average wage for home care workers is $10.50 per hour. Many already have insurance through a government program or spouse. My workers want the pay rates.
A more critical issue to attracting more qualified dedicated workers is addressing the lack of respect afforded home care aides by consumers and the public at large about the value of this profession, addressing the instability in work hours caused by cancelations (for whatever reason) or consumer requests and weeding out the workers that do not show respect for their consumers and co-workers by not being willing to work as a team and often resign with no notice causing more hardship for consumers and those quality workers who are left to cover.
Thank you for your thoughts about this issue. While I can’t speak to the impact that health care reform legislation will have on your agency, the unfortunate reality of any comprehensive health care legislation is that there could be undesired outcomes.
The DCA’s view is that health care reform will largely benefit the 46 million uninsured Americans and millions of more Americans who are underinsured or at risk of losing their coverage. Given that a large segment of the direct care workforce fall into these categories, the DCA has been strong advocates for this legislation.
Moreover, the DCA supports wage increases for the direct care workforce and we have not encountered any analysis of the legislation that finds the outcome that you are expecting to be widespread.
We strongly agree that the lack of respect sometimes extended to direct care workers needs to be addressed – and that this issue can be reciprocal. We believe that improving working conditions for direct care workers will strengthen the respect shared among workers and consumers as well as a create stable and thriving workforce.
David,
Any “analaysis” of the impact of the proposed legislation is not specific to direct care worker types of work but to all employment in general. The assumption that all direct care workers work under the same situations is also misleading. The variety of types of work, places of work and consumers served make, in my opinion, this legislation devistating for them. We are not WalMart or an accounting company.
DCWs would be better served if congress would address the health care issues affecting our country piece meal. Start by reforming the issues everyone agrees on such as outlawing denial of coverage for pre-exhisting conditions, regionalization of rates so smaller employers could get decent rates for their employees and industries such as DCWs would not be penalized for having women workers, tort reform (1% is a huge amount of money)… See how those changes work before putting business out of business by such steep penalties, don’t put individuals in jail when they chose to feed their family and pay rent before buying insurance.
As for rate increases, that would be wonderful but what about all of those middle class individuals who privately pay for services? Where would they be with $30 per hour fees to pay DCWs what a nurse makes and to provide health coverage to employees who chose to work only 10 hours per week? I suppose our DCWs could get work in skilled nursing facilities but wait–we cut their funding to pay for health care reform! Come visit my world. See how home care works before making a judgement that any reform is better than no reform and that we should take a bullet for the cause.
I would like to know more about the concerns of the health insurance companies and the response to those concerns from those who generally support the health care reform bills?
Hi Bridget:
These are great questions that warrant long responses but I will try to be brief:
The greatest concern of the health insurance companies is a government takeover of health insurance that would eliminate, or significantly reduce, the role of private health insurance companies in our health care system. A good example of expanding the government’s role in providing health benefits would be to extend Medicare coverage to everyone. This can also be described as a “single payer system.” Health insurance companies are concerned that the public option is an effort by some proponents of reform to move our nation towards that kind of system. While some proponents of a public option would prefer a single payer system, others who support it hope that the public option will challenge insurance companies to reduce their overhead and offer comprehensive plans at affordable rates.
Other major concerns that insurance companies have is that the regulations proposed in the health care reform bill – such as eliminating preexisting condition clauses and limiting costs that can be passed onto patients – will negatively affect their profitability as well as their ability to remain in business. While it is possible that some insurance companies will not be able to continue operating with these new regulations in place, proponents of health care reform have decided that the alternative – millions of un- and underinsured Americans and millions of more who have been bankrupted by our current system – is far worse.
Thanks for your question.
Happy Thanksgiving Everyone!
Thank you David. This is a great source to be educated about the healthcare reform.
I would like to know two things:
1. It seems like the Senate needs necessarily 60% to pass the bill with Public Option. If after the vote, they don’t get 60% what will be happened to the bill?
2. We know the benifits of health care reform. You did take a lot in your posting. Beside of the cost, what are the inconveniences and detriments of this health care reform for Americans and particularly for the DCW?
Hi Timothy:
Very good questions. The legislative process is pretty confusing. I copied Health Care For America Now’s explanation of the process to answer your first question:
1. After all amendments have been considered by the Senate, the final bill will be put to a vote. The Senate bill will face a cloture motion requiring 60 Senators to pass. That motion is procedural and Senators will be under pressure to proceed along party lines. After cloture, the Senate can pass a bill with a simple, fair majority of 50 votes. For more information about the process please go to http://healthcareforamericanow.org/site/content/steps_to_win/.
2. Some people might find the penalties for not having health insurance to be inconvenient but low-income families will receive subsidies to make health insurance more affordable. Lori Michaels also posted messages expressing that health care reform will reduce wages for some direct care workers as well as put some providers out of business. The DCA does not agree with this assessment but I recommend that you read our exchange above. As the bill stands now, the majority of direct care workers who lack or have inadequate health insurance will find health care reform to improve these issues that are common for direct care workers.
Thanks,
David
I strongly support health care reform. I am one of thsoe who is insured but rations their healthcare due to copays and out of pocket expenses.
I would like to know more about the penalty that would be invoked for lack of health care coverage.
One concern is that for those of us who do not qualify for low income assistance but live from paycheck to paycheck narrowly avoiding financial disaster assessing a financial burden for not being able to pay one more bill, or going into bankruptcy due to not being able to pay bills due to paying for the health insurance.
How would coverage be tracked, who would ‘police’ that, how much will all that tracking cost?
Hi Julie:
This a great question and I believe that the issues you raise will be scrutinized throughout the Senate debate on health care reform over the next couple of weeks. In terms enforcing the penalties for not carrying insurance, my understanding is that the mandate will be enforced by requiring individuals to provide proof of insurance when filing their federal tax returns. At the same time, subsidies that work on a sliding scale will be available to individual and families with incomes up to 400% of the federal poverty level, or $88,000 per year for a family of four. Also, deductibles, co-pays, premiums, and other expenses will be capped at a percentage of your income (between 1.5% and 11%, depending on how much you make).
I cannot say that ALL low people will not face any additional financial burden if the health care reform bill currently being debated by the senate is passed. However, the Congressional Budget Office – a nonpartisan evaluator of the impact that legislation will have – has found that the current bill will make health care reform more affordable for the vast majority of low- and middle-income Americans.
It is important to remember that this bill is undergoing a process of revision. Given that health care is essential to our well-being and economic security, I encourage everyone to ask their representatives to ensure that health insurance is affordable and available to everyone.
I hope this answers your questions.
Best,
David
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