The long-term care industry is one of the largest employers in the United States, yet its direct care workers are woefully underinsured, according to a new analysis.

 

The analysis by PHI, a national nonprofit advocating for the direct care workforce in home and residential settings, found that in 2009 almost 1 million, or 28 percent, of direct care workers were without insurance.

Nearly 20 percent received coverage through Medicaid or another public program, according to the analysis. Forty-seven percent had employer-sponsored coverage (68 percent of U.S. workers generally have employer-sponsored coverage).

 

The analysis also found that more than 900,000 direct care workers lived in households under 133 percent of the federal poverty level – earning $14,000 a year or less for a single person. Forty percent of those workers were uninsured, 30 percent were on some form of public insurance and another 30 percent had private insurance.

 

“This is a very underinsured workplace,” said Carol Regan, director of government affairs at PHI and co-author of the analysis.

 

Many direct care workers are employed by small businesses that don’t have employer-sponsored insurance programs, are employed part-time or are employed as contractors.

 

Because so many are employed part-time by agencies and earn an average of $9.47 an hour, many agencies advise their employees to work fewer hours than are required to meet their insurance eligibility requirements, said Lisa Gurgone, executive director of the Massachusetts Council for Home Care Aides Services.

 

“It’s not because they don’t want to provide health insurance to their workers,” she said. “It’s just that they realize that the health insurance they offer is $400, $500 a month and the Mass. Connector Program (state health insurance program) is $80 a month. For them to make ends meet it’s better off that they don’t work the number of hours to qualify for the agency (insurance).”

 

New rules under the Patient Protection and Affordable Care Act will provide aid to direct care workers, Regan said, by opening up eligibility to Medicaid and providing opportunities to small businesses.

Under PPACA, all families and individuals with incomes up to 133 percent of poverty will qualify for Medicaid.

 

“That’s going to be huge,” Regan said.

 

In 2014, PPACA will establish exchanges for which those who don’t have access to employer-sponsored insurance can qualify. Some of these exchanges offer subsidies for those living between 133 percent and 400 percent of poverty. Eighty percent of the direct care workforce has incomes at less than 400 percent of poverty, Regan said.

 

Those exchanges, said Hayley Meadvin, press secretary at the U.S. Small Business Administration, will provide better healthcare options to small businesses. One of the benefits of the exchanges, she said, is that small businesses can pool their risk together to access more affordable plans.

 

With a workforce that is considered high-risk due, in part, to the high incidence of workplace injury, spreading out risk with other types of companies would be an important benefit to small long-term care companies.