A new study examines the impact of Massachusetts health reform on direct-care workers.

Conducted by PHI in collaboration with Amy Lischko, DSc, of the Department of Public Health and Community Medicine at Tufts University School of Medicine, the study (pdf) found that most employers in the eldercare/disability services sector offered employer-based insurance. However, less than one-fifth of Massachusetts direct-care workers enrolled in those insurance plans, primarily because they were too costly.

Many direct-care workers are caught in a bind. If they are offered employer-sponsored health coverage, they cannot access Massachusetts’ less-expensive subsidized health insurance programs. As a result, many choose to work part-time and enroll in the state’s subsidized plans.

“This disincentive to work undermines state efforts to build a quality, stable direct-care workforce,” said PHI Massachusetts Policy Director Amy Robins.

Employers in the eldercare/disability services sector use eligibility requirements to limit access to employer-sponsored coverage and to help employees access Commonwealth Care, according to the study, which is entitled Coverage for Caregivers: Lessons from Massachusetts Health Reform (pdf).

The study has implications for national health reform. Nationally, direct-care workers lack health coverage at twice the rate of the nation’s general population.

The researchers recommend that for Congress to significantly improve access to quality, affordable insurance for direct-care workers and their employers, health reform legislation should:

• Support the inclusion of a national, publicly operated health insurance option.
• Allow all eldercare/disability services employers access to the proposed insurance “exchanges” or “gateways” regardless of size.
• Ensure adequate federal subsidies to low- and moderate-income workers and their families.
• Expand Medicaid to include all individuals earning up to at least 133 percent of the federal poverty level.

“Congress must heed what we learned from the Massachusetts model: it has done nothing to lower the cost of employer-sponsored health coverage, making it prohibitive for low-wage, direct-care workers and their employers,” said Carol Regan, author of the report and PHI government affairs director.

Coverage for Caregivers: Lessons from Massachusetts Health Reform, based on a survey of nursing home and home care providers conducted three years after Massachusetts legislated health reform, includes more information on the federal recommendations, as well as action steps for Massachusetts policymakers and additional key findings.