The Paraprofessional Healthcare Institute (PHI), in collaboration with Amy Lischko of the Department of Public health and Community Medicine at Tufts University School of Medicine, released findings from a survey of eldercare and disability services employers.
The study, Coverage for Caregivers: Lessons from Massachusetts Health Reform, examines the impact of Massachusetts health care reform on the eldercare/disability services sector and its primary workforce of direct-care workers. The sector is notable for two reasons: (1) its employment core depends on a workforce who nationally lack health coverage at twice the rate of the general population; and (2) because employers in this industry sector often provide services under publicly funded long-term care programs, their finances are often very sensitive to public payment policies.
The study offers the following conclusions:
- Employer-sponsored insurance (ESI) is either not available or not affordable for most direct-care workers.
- The eligibility requirement for ESI in Massachusetts’ home care sector, in particular, is unsustainable.
- Combined with the significant disparity between premium costs in home care agencies compared with nursing facilities, home care jobs operate at a competitive disadvantage with respect to workers being able to access and afford ESI.
- A strong, responsive public insurance system is essential to the eldercare/disabilities workforce. Reform measures appear to have strengthened subsidized options for employers and direct-care staff.
- While the reach of publicly subsidized insurance programs has increased since the reform law was enacted, a significant proportion of employers and workers in the eldercare/disabilities sector still appear to fall between the cracks. This lack of seamless access to the public system creates incentives for “perverse” employment outcomes for both employers and their direct-care staff.
This report has implications for two critical policy areas—health reform and workforce development. The findings of this report support the need for both federal and state action. While Massachusetts health reform has increased health care access for thousands of previously uninsured residents, a robust implementation process requires constant monitoring and policy improvement to continue to increase access for those who are falling through the cracks.
– Jaspreet Chowdhary
