The Affordable Care Act includes an “employer mandate” that penalizes employers for not providing health insurance for their “full-time” workers. This legislation imposes a $2,000 penalty for each full-time employee who does not get health insurance from the employer of a business that employs 50 or more full-time equivalent employees and at least one of the employees qualifies for a federal subsidy to purchase health insurance. However, a full-time worker is defined in the law as an employee who works just 30 hours a week and not the widely recognized standard 40-hour work week.
It is important for readers to understand that many home care agencies are fully funded by the government. This reimbursement, which has not been increased in some cases in more than 10 years, means that there essentially is nowhere to “shift” the cost of the mandate. Home care agencies that are unable to provide health insurance or absorb the ACA penalties will need to restrict their employees to no more than 29 hours per week to ensure their workers are considered part-time under the ACA. This would weaken patient access to care and reduce wages and working hours of home care staff, many of whom are already struggling.
The majority of direct care and home care workers do not receive employee health insurance because home care agencies have three problems that are fairly unique: reliance on government program, such as Medicaid, that won’t cover the increased costs of providing health insurance; consumers of private pay home care who are often elderly and disabled with low, fixed incomes; and a home care workforce with widely varying work hours.
Current reimbursement levels in Medicaid along with the barriers to price increases in private pay home care put continued access to care in severe jeopardy. The only business option available to home care companies in these circumstances is to limit the working hours of caregiving staff to less than 30 per week. This will likely lead to increased turnover and lower overall wages, while still not providing health insurance to the workers.
Home care employers do not have the ability to control pricing for their services like most other employers that are affected by the employer responsibility provisions in the health care reform legislation. In addition, Maine’s Medicaid programs historically have not increased provider payment rates sufficiently to cover the increases in provider costs.
Home care agencies in Maine are innovative job creators that provide much-needed compassionate, high-quality care to elderly and disabled individuals in their homes and communities. Home care agencies are an essential part of the network of services that our growing population of elderly and persons with disabilities rely on. The last thing we need is an obstacle to helping them grow and create much-needed jobs. Simple, common-sense solutions are often the best answers to complex problems. As far as most people are concerned, 40 hours a week equates with full-time employment.
Vicki Purgavie is the executive director of the Home Care & Hospice Alliance of Maine, which represents providers of home care and hospice services throughout the state of Maine.