Figure 1

PHI’s analysis of the 2009 Current Population Survey data on health insurance coverage shows that an alarming number of direct-care workers lack health insurance.

Overall, more than one in four direct-care workers (26.1 percent) — over 800,000 individuals in total — reported no health coverage in 2008, according to the analysis (pdf). This compares to an uninsurance rate of 17.3 percent for the general U.S. population under age 65.

The rate of uninsurance was highest for personal and home care aides, over one-third of whom (34.5 percent) did not have health insurance in 2008. (see Figure 1)

Health coverage is particularly problematic for direct-care workers working in home and community-based settings. One-third of direct-care workers employed by home health care agencies reported no health coverage, as did nearly half (44.5 percent) of direct-care workers directly employed by private households. (see Figure 2)

Figure 2

In contrast, only 12.7 percent of direct-care staff in hospitals reported no coverage. And in nursing and residential care facilities, about one in five aides (21.8 percent) reported having no health coverage.

The relatively high uninsurance rate of direct-care workers in home and community-based settings is largely due to the fact that employer-sponsored insurance (ESI) is less likely to be available in these settings. For example, while 81.2 percent of hospital aides report having ESI, only 38.1 percent of aides working for home health care services were covered by their employers. In nursing and residential care facilities, nearly 60 percent of direct-care workers reported having ESI in 2008. (see Figure 3)

ESI tends to be less available in home and community-settings for several reasons. For example, home care agencies do not always offer coverage, or only offer it to full-time workers. Additionally, while home care agencies may offer coverage, the premiums and co-pays make the insurance unaffordable for direct-care staff. The median wage for Personal and Home Care Aides in 2008 was only $9.22.

Figure 3

Policymakers must pay particular attention to the inadequacy of ESI in home and community-based settings. Jobs in this sector are expected to grow faster (pdf) than nearly all other jobs in the economy over the next decade, and they are among the jobs expected to produce the greatest number of new positions. Research studies show that health insurance is critical to effective recruitment and retention (pdf).

“These new estimates,” says Carol Regan, PHI’s government affairs and Health Care for Health Care Workers campaign director, “demonstrate the critical lack of health coverage for this essential part of our country’s health care workforce. And they underscore the need for national health reform that lays the groundwork for affordable, accessible coverage.”