It is an oddity of American health care: Many nursing homes and home care agencies do not provide health insurance to their workers. Most home health agencies bills Medicaid or Medicare for their services and because they do not have the ability to increase prices despite the increased cost of providing their services, they pay wages so low that employees cannot afford the coverage that is offered.
The numbers are stark. Among workers who provide hands-on care to people living at home, one in three is uninsured.
The new health care law is supposed to fix the problem by guaranteeing access to affordable coverage for all. But many home care agencies, alarmed at the cost of providing health insurance to hundreds of thousands of health care workers, have started a lobbying effort seeking some kind of exemption or special treatment.
Mark Parkinson, president of the American Health Care Association, the largest trade group for nursing homes , says the problem is that reimbursement rates for Medicaid and Medicare, set by government agencies, do not pay them enough to offer their employees medical coverage. “We do not have much ability to increase prices because we are so dependent on Medicaid and Medicare” for revenue, he said.
Mr. Parkinson acknowledged that when nursing homes and home health agencies do offer health insurance to employees, the benefits are often limited. The coverage “is probably not up to what will be required” by the federal law, he said.
Medicaid covers about two-thirds of nursing home and home health patients. States set Medicaid rates, and many states, facing severe budget problems, have reduced their payment rates
William A. Dombi, vice president of the National Association for Home Care, said the new law would impose “huge costs” on some of his members, who provide medical and social services to people living at home. In its legislative agenda for 2011, the association recommends that Congress “exempt home care providers from the employer responsibilities” or require Medicaid and Medicare to help defray the costs.
Starting in 2014, the law will require employers with 50 or more full-time employees to offer affordable coverage or risk paying a penalty. For a midsize home health agency, that penalty could easily exceed $200,000 a year. Health care executives are urging Congress and the Obama administration to spare them from the penalties.
Vanessa Valerio, 25, a certified nursing assistant who earns $10 an hour at Lakeview Christian Home in Carlsbad, N.M., said she was uninsured because she could not afford the coverage offered by her employer.
The chief executive of the Lakeview nursing home, Joanna D. Knox, said the company used to pay the entire premium for employees. It now requires workers to pay $25 of the $585 monthly premium for individual coverage.
“When we started charging $25 a month,” Ms. Knox said, “many employees dropped coverage.” Of the home’s 200 employees, only 87 have elected it, she said, adding, “I don’t know how we could possibly absorb the additional cost of providing coverage for the other employees.”
Charlene A. Harrington, a professor at the School of Nursing at the University of California, San Francisco, said it would be a mistake for Congress or the administration to relieve nursing homes of the obligation to provide coverage to employees.
“It’s scandalous to have nursing home employees taking care of people when they themselves lack coverage and go without care,” Ms. Harrington said. “If employees have health insurance, they are more likely to be treated for illnesses, less likely to pass on infections to nursing home residents and more likely to get early treatment for occupational injuries.”
The rate of injuries in nursing homes is about twice the rate for all occupations, according to the Labor Department. Back injuries are common among those who lift patients and help them get in and out of bed. Home health aides routinely help lift their patient and also help them get in and out of bed and are not immune to such work-related injuries.
Since the law was signed 14 months ago, the focus of lobbying has shifted. A tumultuous battle over the future of the health care system has given way to more concentrated efforts to undo or rewrite particular provisions.
Mr. Parkinson, a former Democratic governor of Kansas who is now the top Washington lobbyist for nursing homes, is pushing several ideas.
One option would give nursing homes and home health agenices more time to comply with the requirement to offer coverage. Another proposal, according to a list of options prepared by lobbyists for the industry, would waive or reduce the penalties for nursing homes “placed in financial distress as a result of the new mandates and fines.” Alternatively, Mr. Parkinson said, Congress could allow nursing homes and home health agencies to take tax deductions for the penalties, which under the 2010 law are nondeductible.
Home care agencies, which are even less likely than nursing homes to offer coverage to employees, are also seeking an exemption or financial assistance, contending that they would otherwise have to increase charges to their clients, older Americans and people with disabilities.
William A. Dombi, vice president of the National Association for Home Care, said the new law would impose “huge costs” on some of his members, who provide medical and social services to people living at home. In its legislative agenda for 2011, the association recommends that Congress “exempt home care providers from the employer responsibilities” or require Medicaid and Medicare to help defray the costs.
Debbie D. Gantz, administrator of the Sunset Estates nursing home in Purcell, Okla., south of Oklahoma City, said Sunset Estates did not offer health insurance to its employees.
“If I could afford to pay for it, I would,” Ms. Gantz said. “We are a small home. We are not part of a chain. We could not provide health insurance to our employees and still be able to pay all our bills and make the payroll.”
The Paraprofessional Healthcare Institute, a nonprofit group that studies the industry, says that 26 percent of front-line workers in nursing homes and 37 percent of those employed by home care agencies are uninsured.
Under the new law, coverage is deemed unaffordable if an employee’s share of the premium exceeds 9.5 percent of his or her household income. That could often be the case for nursing assistants, who provide the bulk of direct care in nursing homes, for wages that typically range from $10 to $12 an hour. In such cases, employers would be subject to penalties.
Supporters of the law say several provisions will help low-wage workers who are uninsured or have bare-bones coverage. The law will expand Medicaid to cover people under 65 with income less than 133 percent of the federal poverty level, and it will offer subsidies to make insurance more affordable to those with incomes from 133 percent to 400 percent of the poverty level ($24,645 to $74,120 a year for a family of three).
“This assistance could significantly increase coverage among direct-care workers because 80 percent of them have income less than 400 percent of the poverty level,” said Dorie K. Seavey, director of policy research at the Paraprofessional Healthcare Institute.
This article by Robert Pear appeared in the May 15, 2011 publication of the New York Times
