WASHINGTON ? It is an oddity of U.S. health care: Many nursing homes and home care agencies do not provide health insurance to their workers, or 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 nursing home residents, one in four has no health insurance. Among those who provide care to people living at home, one in three is uninsured.
Almost all nursing homes in Idaho offer health care ?as an option, but very few of the front-line caregivers can afford it,? said Robert Vande Merwe, executive director of the Idaho Health Care Association. ?And hardly any employers, anywhere, pay 100 percent of the premium.?
The new health care law is supposed to guarantee access to affordable coverage for all. But many nursing homes and home care agencies, alarmed at the cost of providing health insurance to hundreds of thousands of low-wage 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.
Parkinson acknowledged that when nursing homes do offer health insurance to employees, the benefits often are 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 residents. States set Medicaid rates, and many states, facing severe budget problems, have reduced payments for nursing homes.
There are about 80 nursing homes in Idaho. They rely on Medicare and Medicaid for about 80 percent of their funding, Vande Merwe said.
A recent survey by the financial security company Genworth Financial Inc., found nursing home and home-care costs in Idaho are inflating faster than in the U.S. overall. The median hourly rate for in-home health care is $18 in Idaho, after increasing at twice the national rate over the past six years. For a private room in a nursing home, the median cost is $77,927 per year, about $180 more than the national rate, the survey found. That cost has grown 6.1 percent in Idaho over the past six years, compared to 4.4 percent nationally.
Starting in 2014, the law will require employers with 50 or more full-time employees to offer affordable coverage or risk paying a penalty. Almost all of the nursing homes in Idaho fit in that category.
For a midsize nursing home, that penalty could easily exceed $200,000 a year. Nursing home 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,? 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,? 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.
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.
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.
Vande Merwe said the law?s mandate on coverage ?certainly will be an issue? in Idaho when it kicks in less than three years from now. Any exemptions would have to come from Congress, not the state Legislature, he said.
?You have a choice to pay for more caregivers, or pay higher wages and benefits (to) fewer caregivers,? Vande Merwe said. ?And we desperately need more caregivers.?
Statesman reporter Audrey Dutton contributed to this report.
Source: http://www.idahostatesman.com/2011/05/19/1654331/nursing-homes-seek-reprieve-from.html
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