A special committee created by the Legislature is looking for ways to provide health coverage to workers who take care of elderly and disabled in their homes or in institutions – jobs that largely are paid for by Medicaid, but either don’t offer health insurance or pay enough to allow workers to buy it.
The original proposal, that never made it to the floor for a vote this year, was to enroll the workers in DirigoChoice, the state subsidized health insurance plan. But that plan is facing its own financial difficulties and enrollment is closed for now.
The Insurance and Financial Services Committee voted instead to ask the state’s Bureau of Insurance to look at ways of making sure the more than 22,000 direct care workers in the state have insurance and how to pay for it. The bureau has created the Direct-Care Workforce Health Coverage Working Group to help with the task; the group is meeting this summer.
Funding will no doubt involve taxpayer dollars – either through a direct health insurance subsidy or by raising Medicaid payments to the institutions and agencies that employ direct-care workers so the employers can offer insurance.
The rate of uninsured ranges from a high of 34 percent for some home-based workers to 16 percent for those working in nursing homes and residential care facilities, according to a survey of some of the larger health care providers.
The number of uninsured workers correlates to low-wages. Median wages in the direct care industry range from $8.58 for home-based workers to just over $10 for those working in long-term care institutions.
Outgoing Senate President Beth Edmonds sponsored the legislation that would have put direct care workers in Dirigo, but said health insurance is just part of the problem. The overriding issue is making sure they earn a decent wage, she said.
“I just want to make sure that we, as a state, keep trying to figure out how to raise the income of these people,” Edmonds said. “One, it’s the right thing to do and two, it’s a very important piece of the workforce that we need to make sure is stable and surviving.”
Advocates argue that if wages and benefits aren’t increased, the state will not have enough workers to take care of Mainers in their homes as they age. The state has the highest median age in the country. By 2030 it is projected Maine will have 26.5 percent of its population age 65 or older, putting it second only behind Florida.
Mila Kofman, the state’s new superintendent of insurance, said her goal is “getting every single long-term care worker and their families insured.
“I’m not taking anything off the table,” Kofman said, including DirigoChoice as an option for coverage. She agreed public funds most likely will be part of the proposed solution.
“I think it’s realistic to say that for moderate-income wage earners, current prices of private coverage make it very difficult to buy purely private coverage,” Kofman said.
That would leave a public program or a public/private blend like DirigoChoice.
The bureau is due to report back to the Legislature by Oct. 1, and any proposal would require legislative approval.
Rep. Jonathan McKane, R-Newcastle, who serves on the Insurance and Financial Services Committee, voted against creating the bureau study, saying direct-care workers don’t need to be singled out.
“We all need health insurance and direct care workers are, of course, important. But, we need to make insurance affordable for everyone, not just certain groups. The government is kind of choosing the winners and losers,” he said.
The Maine State Employees Association and its national parent, the Service Employees International Union (SEIU), have gotten involved, organizing the Maine Direct Care Workers Union to lobby for pay increases and insurance coverage.
Union spokesman MaryAnne Turowski serves on the health coverage working group and said the issue is inequity.
“Our concern is, these are health care workers delivering health care services, often with public dollars, and they don’t have health care themselves,” Turowski said.
The SEIU, with its local affiliates, is targeting lower-income service providers nationwide as part of its organizing efforts. Not only have they organized direct-care workers, but last year they organized home-based child-care providers – the majority of whom have state-funded care contracts. The Legislature earlier this year voted to recognize the new child care union as a bargaining unit.
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