HealthCare.gov, which launched on July 1, allows health care consumers to easily view all of the ways they can obtain insurance.

“For too long, the insurance market has been confusing and hard to navigate,” said HHS secretary Kathleen Sebelius. “HealthCare.gov makes it easy for consumers and small businesses to compare health insurance plans in both the public and the private sector.”

The creation of the website was mandated by the Patient Protection and Affordable Care Act, the wide-ranging health reform legislation President Obama signed in March.

The site also provides links to two other online resources run by HHS: Healthfinder.gov, an inventory of health advice, and Hospital Compare, which allows users to compare the quality of care of hospitals throughout the country.

Customized Information

Users of HealthCare.gov can receive customized information based on their current circumstances.

In addition to having to provide their age and state of residency, users are asked to answer several short questions regarding their health status and the extent to which they are having difficulty paying for insurance.

Once those questions are answered, users are guided to a list of as many as eight possible insurance options, ranging from government programs (such as Medicaid, COBRA, and the Pre-Existing Condition Insurance Plan) to private insurance plans based in their area.

Small businesses can also use the site to find ways to ensure coverage for their employees.

“PHI is working to get the word out to the thousands of uninsured direct-care workers — and their employers — who will benefit from this information,” said PHI government affairs director Carol Regan.

Additional and Upcoming Features

HealthCare.gov also includes a section explaining the new health reform bill, and how it will impact ordinary Americans. It features an interactive timeline showing how and when each new section of the law will be phased in.

Indeed, as health reform continues to be integrated into U.S. law, HealthCare.gov will be updated to reflect those changes.

Starting in October, it will include price estimates for private insurance plans; HHS plans to include performance data on each plan at a later date.

By 2014, when the entire health reform law takes full effect, state-based insurance exchanges will run their own websites allowing consumers to compare insurance plans.

– by Matthew Ozga

Health Reform Facts 3 is the latest in a series of PHI publications that describes how health reform provisions affect eldercare/disability employers and direct-care workers.

Benefits Outlined

The benefits offered to small businesses as a result of the passage of health reform include:

• Tax credits: Depending on how many employees they have, and how much they pay them, small businesses may be entitled to tax credits covering as much as 50 percent of their contributions to employee coverage. Small Business Majority, an organization that advocates for small business employers and employees, has set up a calculator on its website to help employers determine the size of this tax credit.
• Wellness grants: Beginning next year, a $200 million, five-year federal grant program will award grants to employers that have established employee wellness programs. The program is designed to encourage employers to promote physical activity, healthy eating habits, and other wellness-related initiatives among their employees.
• Health insurance exchanges: Each state is required to establish a health insurance exchange that will facilitate the purchase of qualified insurance plans. These exchanges will also each maintain a Small Business Health Options Program (SHOP) to further assist small businesses as they attempt to find benefit plans that best meet their employees’ needs.

Other Health Reform Fact Sheets

PHI’s fact sheet on health reform and small businesses is the third in a series of health reform-related fact sheets. The others are:

• Health Reform Facts 1: Workforce Development and Training Opportunities for Direct-Care Workers, which describes several new workforce commissions, federal training grants, and workforce-development programs affecting direct-care workers.
• Health Reform Facts 2: Pre-Existing Condition Insurance Plan, which explains a program that will allow individuals with pre-existing medical conditions to purchase insurance.

– by Matthew Ozga

The temporary insurance program, entitled the Pre-Existing Condition Insurance Plan (PCIP), is intended to help people who have been unable to obtain health insurance due to pre-existing medical conditions such as diabetes, hypertension, cancer, or injury.

The program will run until January 1, 2014, when the Affordable Care Act is fully enacted.

A provision in the Affordable Care Act provides $5 billion in federal funding to support state PCIPs for the next four years. States can use the funding to subsidize the costs of running their own PCIP and to reduce premiums for participants.

States also have the option of opting out, in which case the federal government will provide a PCIP for the state’s residents. Twenty states have opted out of running their own high-risk pools.

Details of PCIP, including which states are operating their own PCIP or have opted out, are available in Health Reform Facts 2 (pdf), the second fact sheet in PHI Health Care for Health Care Workers‘ series on how health reform affects direct-care workers and their employers.

Eligibility

In order to be eligible for coverage through PCIP, an individual must meet the following requirements:

• Be a U.S. citizen or legal resident;
• Not have had coverage through a private group or individual health insurance plan, an existing state high-risk pool, COBRA, or a public program like Medicaid for six months prior to applying for coverage; and
• Have a pre-existing condition.

How to Apply

For more information, including full eligibility requirements and application instructions, visit www.pcip.gov.

“I strongly encourage workers to explore their eligibility for this program,” said Carol Regan, national director of the PHI Health Care for Health Care Workers campaign. “This may be an opportunity for some uninsured workers with pre-existing conditions to finally get coverage.”

To receive the Health Reform Fact Sheets as they are released, subscribe to PHI’s Health Care for Health Care Workers email alerts.

– by Deane Beebe

His proposal makes significant improvements in making health care more affordable for low-wage workers, seniors, and state government. In addition, he reiterated his support for the Community Living Assistance Services and Supports (CLASS) Act, which will allow workers to pay into an insurance program for long-term services and supports.

The full proposal is available on the White House website.

New and Revised Policies Proposed

The proposal includes a number of important new or revised policies that would advance the goals of making health care more affordable:

(1) Making coverage more affordable: Compared with the legislation passed by the Senate, the President’s proposal would significantly improve health care affordability for most low-and moderate income families by reducing both premiums and out-of-pocket costs for most families earning less than $44,000. This is critical for direct-care workers because:

• One in every five nursing home workers and more than a third of personal and home care aides lack health coverage.
• In 2008, annual earnings for direct-care workers averaged $17,000 (pdf).
• About 44 percent of direct-care workers live in households earning below 200 percent of the federal poverty level income (pdf).

(2) Reducing the cost of prescription drugs for seniors: The proposal would also make prescription drugs more affordable for seniors by closing the Medicare Prescription Drug Plan’s “donut hole,” which currently leaves some seniors unable to afford the medicines they need to remain healthy.

(3) Regulating excessive insurance rate increases: In addition to adopting the House and Senate ban on insurance companies denying people coverage for pre-existing conditions, the proposal would create federal oversight of excessive rate increases by private insurers.

(4) Increasing federal support for state Medicaid programs: The President’s proposal eliminates a special deal negotiated for Nebraska, and instead increases federal support to states to defray the cost of enrolling people who will be newly eligible for coverage under health reform. The federal government will provide states 100 percent support through 2017, 95 percent support for 2018-2019 and 90 percent support for 2020 and beyond.

This will help hard-pressed states expand coverage to low-income households, including those of direct-care workers. Two in five direct-care workers live in households that receive one or more public benefits (pdf) such as food stamps; Medicaid; and housing, child care, energy, or transportation assistance.

Additional Information

A side-by-side brief prepared by the Pico Network gives a comparison of the status quo, the Republican House plan, and the President’s plan, as well as what will be discussed at today’s Health Care Summit.

If you missed today’s live broadcast of the summit, visit HealthReform.gov.

– by Carol Regan

In some settings — specifically residential care and nursing homes — “almost one third of all workers providing hands-on care to vulnerable adults are uninsured,” the researchers report.

The authors examine rates of uninsurance across three health care settings — ambulatory care, including home health care services; hospitals; and nursing and residential care facilities — using data from the 2004-2006 National Health Interview Survey. The authors find that 31 percent of health service workers in residential care settings and 22 percent of health service workers in ambulatory care settings have no health coverage.

PHI recently reported similar uninsurance rates for direct-care workers, who constitute the vast majority of the occupational group “health service workers.” Based on its analysis of the most recent Current Population Survey insurance data, PHI found that one-third of direct-care workers in home health care services, and nearly half of those who work directly for private households, reported having no health insurance in 2008.

The authors of the AJPH article argue that their findings raise serious public health and policy issues regarding the quality of the U.S. health care workforce. Of particular concern are “workers transmitting undetected infectious disease because they delay seeking care, and transmitting the flu because they do not receive a flu shot.”

“Poor health status and obesity among these workers could result in an increased number of lost workdays caused by illness, contributing to high turnover rates in nursing homes,” add the authors.

They conclude:

Given concerns about infectious diseases, new resistant bacterial strains, and the quality and safety of our health care institutions, it is essential that the people who work directly in these settings receive needed health care services, including recommended immunizations and primary and preventative care.

Many direct-care workers are unable to get basic preventive services and treatment because they lack insurance.

The authors recommend that states include in their Medicaid payment rates a portion targeted directly at financing health insurance coverage for health service workers. PHI has also made this recommendation in several of its studies.

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.

Contact: Deane Beebe
Media Relations Director
dbeebe@PHInational.org
718.928.2033 / 718.812.5586

Experience of Massachusetts Eldercare and Disability Service Providers Suggests Public Options Essential to Health Coverage

New York, NY — Less than one-fifth of Massachusetts direct-care workers — nursing home assistants, home health care aides, and personal care attendants — are enrolled in employer-sponsored health insurance plans, primarily because they are too costly, according to a new study on the impact of Massachusetts health reform on the state’s largest and fastest-growing employment sector.

A new study from PHI, a national nonprofit organization working to strengthen the eldercare and disability services workforce, done in collaboration with Amy Lischko, DSc, assistant professor in the Department of Public Health and Community Medicine at Tufts University School of Medicine, found that most employers in this sector offered employer-based insurance but their direct-care employees did not enroll.

Many workers are caught in a bind. If they are offered employer-sponsored health coverage, direct-care workers, whose wages primarily come from public programs such as Medicare and Medicaid, cannot access Massachusetts’ less-expensive subsidized health insurance programs. As a result, many choose to work part-time and enroll in either MassHealth or Commonwealth Care.

“This disincentive to work undermines state efforts to build a quality, stable direct-care workforce,” says PHI Massachusetts Policy Director Amy Robins. “Direct-care work is among the state’s fastest-growing job sectors, yet full-time workers really can’t afford employer-based insurance.”

Massachusetts employs nearly 100,000 direct-care workers, and direct care is among the top 10 fastest-growing occupations.

“While considering proposals to expand access to health care coverage, 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.

“Congress must create public and publicly subsidized options to ensure that low-wage, direct-care workers have access to quality, affordable health care coverage. It’s the right thing to do and will also help meet the nation’s rapidly growing demand for this critical workforce that provides eldercare and services to people with disabilities,” Regan said.

Nationally, there are currently 3 million direct-care workers. That number is projected to grow to 4 million by 2016, becoming our nation’s single largest occupational group. Direct-care workers lack health coverage at twice the rate of the nation’s general population.

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, reports that eldercare and disability service sector employers use eligibility requirements to limit access to employer-sponsored coverage and to help employees access Commonwealth Care.

Nearly half of all direct-care workers were ineligible for employer-sponsored coverage due to their part-time work status or a waiting period. Nursing home assistants were more likely to be eligible for employer-sponsored insurance coverage — 70 percent — compared with only 39 percent of home care workers. Only 12 percent of home care workers have employer-sponsored insurance coverage.

In Coverage for Caregivers: Lessons from Massachusetts Health Reform, researchers recommend that for Congress to significantly improve access to quality, affordable insurance for direct-care workers and their employers, the following provisions should be included in health reform legislation:

• Support the inclusion of a national, publicly operated health insurance option.
• Allow all eldercare/disability service 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.

More information on the recommended federal and state action steps, as well additional key findings, are included in Coverage for Caregivers: Lessons from Massachusetts Health Reform, Findings from a Survey of Eldercare and Disability Services Employers.

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PHI (www.PHInational.org) works to improve the lives of people who need home and residential care — and the lives of the workers who provide that care. Using our workplace and policy expertise, we help consumers, workers, employers and policymakers improve eldercare and disability services by creating quality direct-care jobs. Our goal is to ensure caring, stable relationships between consumers and workers, so that both may live with dignity, respect, and independence. For more information about PHI PolicyWorks and our Health Care for Health Care Workers campaign, visit: www.PHInational.org/policy and www.coverageiscritical.org.

“Being a Woman is Not a Pre-Existing Condition” was launched on October 20 to mobilize women to tell their Congress members that health reform legislation must eradicate the disparities women face in health insurance coverage.

A centerpiece of the national campaign is a report called Still Nowhere to Turn: Insurance Companies Treat Women Like a Pre-Existing Condition (pdf). The report highlights the facts about gender discrimination in private health care coverage. For example:

• Ninety-five percent of the most popular health insurance plans charge women more than men for the same individual coverage;
• In every state but Montana, insurance companies can charge businesses with 50+ employees more for group coverage of their female employees;
• Women age 25 are charged up to 84 percent more than 25-year-old men for individual plans, even when these plans exclude maternity coverage; and
• More than 60 percent of the best-selling plans charge 40-year-old female non-smokers more than male smokers of the same age.

PHI, along with 20 other national organizations, sent a letter to President Obama last month urging him to use health care reform to eliminate such gender disparities.

“Long-term care employers cannot find affordable health coverage policies for their employees — an overwhelming majority whom are women,” said Steven Dawson, PHI president. “That’s one key factor that contributes to direct-care workers being less likely than other American workers to have employer-sponsored coverage.”

Only about half of direct-care workers have employer-sponsored health insurance. Nearly one-third of all direct-care workers in the United States lack health coverage.

Other elements of the National Women’s Law Center’s campaign include advertising, a video, events, and a website with information and tools to help women contact their Congress members.

More than 20 national organizations, including the YWCA USA, the National Organization for Women, and PHI, expressed dismay after the president neglected to mention putting an end to age and gender discrimination in health insurance in his joint address to Congress in September.

In a letter to the president (pdf) dated September 15, the organizations state that:

. . . we hope this is not an indication of a departure from your previous commitment to eliminate discrimination, and that it does not signal a willingness to compromise, resulting in discrimination being written into this important federal legislation.

Obama went on record in late July in support of eliminating gender and age discrimination in health insurance.

The advocates commended the president for supporting a public health insurance option, which they say would benefit women whose coverage does not work for them and women who don’t yet have insurance because of the lack of affordable options.

The letter states that:

• Many women over age 40 cannot find affordable coverage, not even high-deductible plans with coverage riders.
• With rising unemployment, women are losing employer-sponsored coverage, and lost income puts COBRA coverage out of reach.
• Many women work in hourly wage and part-time positions earning less than their male counterparts, so they lack a cushion to get them through hard times.

“Many direct-care workers will continue to go uninsured or pay higher premiums if health reform legislation does not include a provision to end gender and age discrimination,” said Carol Regan, PHI Director of Government Affairs and the National Director of the Health Care for Health Care Workers Initiative. “Long-term care employers cannot get affordable health coverage policies for their employees, the majority of whom are women — and often older.”

According to a PHI fact sheet (pdf):

• 88 percent of direct-care workers are women;
• The average age of all direct-care workers is 41, while the average age of direct-care workers who are self-employed or working directly for private households is 49; and
• 43 percent of direct-care workers did not work full-time hours throughout 2007.

“If you look at the data,” says Carol Regan, PHI Government Affairs Director, “you can see the critical role that public programs like Medicare, Medicaid, and veterans’ insurance have been playing for millions of American families.

“It’s more important than ever to achieve health reform that will offer secure coverage for those currently with insurance as well as the growing numbers of unemployed and uninsured.”

The census report also shows that the number of uninsured children has fallen to its lowest level in twenty years, thanks, in part, to the effectiveness of public programs that provide coverage for children like Medicaid and the Children’s Health Insurance Program (CHIP).

Jocelyn Guyer of the Center for Children and Families at Georgetown University — and the author of a report examining how states are providing health coverage to children — says that while this data is encouraging, “the health and wellbeing of children… can also be dramatically affected by the health of their parents and the financial stability of their families.”

To continue the positive momentum for children, says Guyer, “Congress should quickly pass meaningful health reform legislation.”

Analysts expect the next round of data in 2010 to show still higher poverty rates and more Americans going without insurance.