Archive for the 'Iowa' Category

Cindy Ramer poses for The Courier with a picture of her and her late husband, Jim Ramer, at her home in Denver on Sept. 4, 2009. (RICK TIBBOTT / Courier Staff Photographer)

Cindy Ramer, a certified nursing assistant in Denver, Iowa,  “lives a precarious existence for one simple reason: for more than 20 years she has not been able to afford quality health care, “ wrote the Waterloo Courier in a profile on Ramer published earlier this month.

Ramer, who declared bankruptcy due to medical debt from her late husband’s illness, lives in constant fear of getting sick.  “I worry about it,” she said. “I hope my health doesn’t get bad.”

Ramer works nights and weekends as a CNA taking care of those whose health requires that they need Ramer’s care.  Yet she goes without health insurance herself because her employer has a difficult time finding health insurance that is affordable for both the employees and employer.

Becky Lohrbach, Ramer’s employer’s benefits manager, explained, “It becomes very difficult to be able to meet the participation requirements that the insurance companies have set up to even have a group plan,” she said.  Many of the workers at Ramer’s agency either use their spouses insurance or are eligible for Medicaid or Medicare.

It is not that Ramer doesn’t want insurance or is unwilling to pay for it. She simple wants to be able to buy insurance that she can afford and that will cover her medical needs.  Until that day arrives, Ramer is dedicated to telling her story and advocating for state and federal reform that works for direct-care workers.

• Read the full article in the Waterloo Courier
• Read Cindy’s post on fighting distortions about health care reform

Allison Lee
National Campaign Manager
HCHCW
alee@phinational.org

Cindy Ramer

My name is Cindy and I am a direct-care worker in Iowa.  I am uninsured because my employer does not offer comprehensive health insurance and any plan on the private market is way out of reach for me.  Due to my late husband’s illness, we had to file medical bankruptcy a few years back and I am still climbing out of that situation.

Health care reform is very close to my heart and I support the current bills before Congress. That is why I get so angry when I see the lies and distortions that those who are opposed to reform are spreading.  We need to fight back with truth and passion about why reform is good for all Americans.

For example, I recently received an email from a friend of mine which was a line by line analysis of the House Bill that she found on the internet.  Based on the “analysis” she was encouraging me to contact my Representative and tell him to not vote for this “TERRIBLE” bill.  This really bothered me because I had recently met my representative, Bruce Braley, who is on the House committee that is working on this bill. I feel he is very sincere about getting a good health care plan in place. I went to his web site which is: www.braley.house.gov and looked at the bill myself and was shocked to find how distorted this so-called “analysis” was.  For example my friend’s email suggested we should be against this bill because:

• On page 30 section 123 it says there will be a government committee that decides what treatments/benefits you get. First of all, it is a council that makes recommendations about the minimum standard of benefits that insurance companies must offer.  I hope that this council exists!  This is a huge undertaking and we need a ccouncil to make sure it is done right.  Right now the insurance companies, decide what treatments and benefits most people get – based on their bottom line benefit.  That surely isn’t fair.
• On page 59 it says that the government will have direct access to our bank accounts for electronic funds transfer.  This is really about electronic payments between insurance companies and providers.  Not about individual citizens. The government will not have access to our individual accounts.

And the list went on and on…Nowhere did it mention all the good that this bill does like:

• Make health insurance affordable for millions of Americans like myself through a public insurance plan and subsidies for those who need it.
• Prohibit insurance companies from denying anyone coverage because they have a pre-existing condition.
• Regulate premiums and other health care costs so they can only be a low percentage of your income

I emailed my friend back that she should take a look at the bill herself by visiting Congressman Braley’s website instead of taking somebody else’s interpretation. We need to fight back with the truth and make sure this time America wins health care reform that will really make a difference.  I encourage you to arm yourself with the facts and be ready to counter-attack the lies and opposition.

You can find more information by visiting here:

Health Insurance Reform Reality Check
AARP Myths vs. Facts

If you receive a similar email to the one my friend sent me,  use this document (pdf) to check the facts and reply.

Let’s do what we can to make health care reform a reality now.  We can’t wait!

Cindy Ramer
Certified Nursing Assistant
Iowa

Representative Lisa Heddens

Last month, HCHCW and the Iowa CareGivers Association, HCHCW”s partner in Iowa, collaborated on the launch of the first Come Care with Me Day in the state.  Modeled after the Pennsylvania HCHCW program, Iowa State Representative Lisa Heddens visited the Madrid Home, a skilled nursing facility, where she spent a few hours walking in the shoes of several direct-care workers.

Representative Heddens was able to view health care from a hands-on perspective by engaging in the daily activites of the workers and residents of the home.   “I didn’t come here just to watch,” Heddens said in an article in the Ames Tribune. “I came here to work and to get a better appreciation for both the rewards and the challenges of the job.”

Also in the article, Madrid Home President and CEO Keith Kudej said “Come Care With Me” gave his staff members a chance to talk with Heddens “about the important and difficult work they do and the impact they have on the lives of residents and their families.”  Certified nurse aides Jessica Jungck, Michael Dittert, Brenda Haberer, Nicole Udorvich, Sadie Fuson, April Brown and Jessica Pitts participated in the event.  “Most people don’t realize how difficult our jobs are and how close we are to the residents,” Dittert said. “In many cases, we become part of the family.”

Both HCHCW and ICA hope to plan a second Come Care with Me Day in the near future.  “In light of the increasing state and national focus on health and long-term care services, it’s particularly timely (for Iowans to consider) how to pay for them and enhance quality,” John Hale, ICA policy director, said.

Allison Lee
National Campaign Manager
HCHCW
alee@phinational.org

“It is a simple fact.  Access to coverage does not equal access to care,” wrote John Hale, Policy Director for the Iowa CareGivers Association, an HCHCW partner, in a Des Moines Register guest editorial about national health reform.  “Not unless legislation also addresses an emerging crisis: a worker shortage in many parts of the health and long-term care work force.”

The shortage is particularly critical in the long-term care sector where 1 million direct-care workers nationawide are needed over the next decade.

In his editorial, Hale applauds Iowa for leading the nation in establishing comprehensive solutions to addressing the shortages.  A newly created Health and Long-Term Care Advisory Council has been tasked with documenting and addressing both the existing and emerging shortages.

“Iowa is doing it right but it can’t do it alone,” wrote Hale. “Federal action is needed.”

Hale provided a “to do” list for the federal government that included:

• Thoroughly documenting the extent of the problem.  In the case of direct-care workers, state data on the workforce is either in complete or non-existent
• Focus on expanding capacity to train more medical professionals, providing scholarships and loan-repayment, mentoring programs and career ladders
• Enhance Medicaid and Medicare reimbursement rates to allow physicians, nurses and direct-care workers to be compensated appropriately

“The most important thing for the federal government to do is give this looming crisis the sense of urgency it deserves and provide funds to the states to allow them to act,” said Hale.

“The health-care-reform bills being considered in Congress are an opportunity to deal proactively with the health- and long-term-care work force that each of us depends on. It’s an opportunity that Congress and the president should seize.”

Allison Lee
National Campaign Manager
HCHCW
alee@phinational.org

This year the Iowa CareGivers Association (ICA) helped lead a coalition of advocates for expansion of adult coverage as well as the funding of a premium assistance demonstration project for direct-care workers.   While the priority of the legislature for this year was expanding coverage for children, we were able to get specific language included in the health reform bill (SF 389) that new coverage options for adults would be available for purchase by July 1, 2010. Affordable, quality coverage for adults will enable many direct-care workers in Iowa to have health insurance which they currently cannot afford.

In addition, the 2009 General Assembly agreed to fund a demonstration project that will allow a minimum of 250 direct care workers in Iowa to participate in a premium assistance project. The project will assist those workers in paying for coverage that is currently available to them through their employer, but that they do not access due to its cost. The outline for the demonstration project was developed in 2008 by an advisory council that included the Iowa  Caregivers Association, agencies of state government, and long term care employers.

The advocates were also able to secure a number of seats on a reconstituted Legislative Health Care Coverage Commission.  Details about the adult plan will be decided by the members of this Commission.  The ability to serve on and provide technical support to this Commission will enable us to hold the legislature accountable for meeting the July 2010 goal.

John Hale
Policy Director
ICA
hale_john@msn.com

The Iowa legislature adjourned early Sunday morning having made promising advances on health care for direct-care workers  – despite the bleak economic outlook for the state.

Funding was approved for a premium assistance demonstration program that would subsidize the cost of employer sponsored health insurance for a small number of direct-care workers.   The details of the program were outlined in a report released earlier this year.

Other issues were also addressed including increasing direct-care worker wages, and restoring funding for the Iowa CareGivers Association.

Congratulations to ICA on their hard work this session.  More detailed coverage of the successes will be in our next edition.

Allison Lee
National Campaign Manager
HCHCW
alee@phinational.org

Cindy Ramer

Last week, Newsweek highlighted the story of Cindy Ramer, a direct-care worker from Iowa, in an article about the high number of American workers who lack health insurance.

Cindy, a long-time certified nursing asssistant (and an active member of the Iowa Caregivers Association and the HCHCW campaign), is currently uninsured after her employer canceled the company’s health insurance plan several years ago.

Instead of seeing a doctor, Cindy now goes to free screenings and health fairs in order to find care.  Cindy, like a lot of uninsured American workers, is willing to pay for health coverage but is unable to find a plan that is affordable and comprehensive.

“I don’t think it’s fair that I’m caring for people and helping them with their health care, and I don’t have adequate, affordable health care of my own,” said Ramer. “I’m not asking for a handout. I’m just asking for something I can afford, and won’t have all these restrictions that they’ll cover this and won’t cover that.”

The article highlighted a recent study by the Robert Wood Johnson Foundation that found that 1 out of 5 American workers are uninsured.  Among direct-care workers that number rises to almost 1 in 3.  Efforts are underway to create a premium assistance program for direct-care workers in order to make employer sponsored health coverage more affordable.

Allison Lee
National Campaign Manager
HCHCW
alee@phinational.org

White House Regional Forum on Health Reform in Iowa

On March 23rd, Des Moines, Iowa hosted the third in a series of Regional White House Forums on Health Reform taking place across the country. The Forum was led by Iowa Governor Chet Culver and Governor Mike Rounds of South Dakota, Nancy-Ann DeParle, Director of the White House Office on Health Reform, and Iowa Senator Tom Harkin. All offered brief comments and responded to questions from the approximately 500 people in attendance.

The Forum brought together diverse groups that have a stake in reforming the health care system and provided an opportunity to offer ideas about bringing down costs and expanding coverage for American families.  Participants included health care professionals, patients, providers, insurers, policy experts, and health care advocates.  Regional forums will also be held in California and North Carolina.

Di Findley (Executive Director) and John Hale (Policy Director) of the Iowa CareGivers Association attended the forum along with ICA member Sally King and ICA Board member Anne Kinzel.  John was able to direct comments to the four panel members about the importance of keeping direct care workers “on the radar” when it came to dealing with both health care coverage and access-to-care issues. Two other members of the audience, including a parent of a child with a disability, followed up John’s comments by talking about the importance of home health and other long term care services and supports.

Senator Harkin was very specific when talking about the need for reform and the timeframe to do so. He indicated that the Congressional and White House expectation was that the Congress would have a draft of health care reform initiatives done be May 22nd, that hearings on the proposals would begin prior to the August recess and that a bill would be ready for the President’s signature prior to the end of 2009.

John Hale
Policy Director
ICA
hale_johnd@msn.com

A recent guest editorial by the Iowa CareGivers Association in the Des Moines Register criticizes the Iowa legislature for its lack of urgency in improving long-term care services.

After decades of stories citing poor quality of care, legislation was passed last year to improve caregiving in the state by providing workers with health care benefits, better compensation, and increased training – all factors that reduce turnover and therefore improve quality of long- term care services. However, the authors question the speed at which the legislature will implement the recommendations –  ”If Iowa’s governor and the Legislature seize the moment and give priority attention to the challenges in the direct-caregiving workforce, the stories on poor quality care in Iowa’s nursing facilities will subside, because fragile Iowans will be better served. If elected leaders choose to continue doing what we’ve been doing for far too many years, the stories will continue, and Iowa’s most fragile residents – and their families – will too often be let down.”

Elected leaders in Iowa have a chance this year to make great strides in improving long-term care for all Iowans.  Let’s hope they do it.

Allison Lee
HCHCW National Campaign Manager
alee@phinational.org

State Seal of Iowa

A report (pdf) by the Iowa Department of Health and Human Services and the Division of Insurance outlines a demonstration project that would provide health insurance for up to 250 direct care workers through a voluntary employer-sponsored plan.  The report was a directive of HF 2539, a health insurance reform bill passed during the 2008 legislative session.

Report recommendations include:

• eligibility requirements for both workers and employers
• coverage and cost parameters, and
• criteria for measuring success

Employee contributions would be limited to 2.5% of gross family income and employers would be required to contribute at least 50% of the cost of an employee’s single plan.  The remainder would be subsidized by the state.

The goal of the project, as stated in the report, is to determine whether the availability of affordable health care coverage helps to stabilize the direct care workforce and improve quality of care.  However, there was acknowledgment that the size of the project which is limited to 250 workers may not be large enough to adequately evaluate whether the goal of the project is met.

The recommendations of the report must now be introduced in legislation and passed in both the House and the Senate.

Allison Lee
National Campaign Manager
Health Care for Health Care Workers
alee@phinational.org

Issues facing direct-care workers were highlighted at a recent “Healthcare in the Heartland” forum in Des Moines, Iowa. The event, sponsored by the University of Iowa and the Iowa Department of Public Health, focused on the implementation status of numerous provisions of House File 2539, the Health Care Reform Act, passed by the Iowa General Assembly in 2008.
 
Several provisions in HF 2539 focused on direct care workers. A panel, which included John Hale, Policy Director of the Iowa CareGivers Association and Diane Frerichs, a Certified Nurse Aide from Estherville, Iowa discussed the emerging crisis in the direct care workforce and the activities underway to address their training, certification, wages and health care benefits.
 
The event was attended by 250 health care insurers and providers, elected leaders, representatives of state government agencies, citizen advocates and others interested in health care reform initiatives. United States Senator Tom Harkin, the featured speaker, spoke at length about the prospect for health care reform in an Obama Administration, and of his work with Senator Ted Kennedy to insure consideration of reform initiatives in 2009.
 
John Hale offered this comment on the day: “This forum provided us with an opportunity to discuss direct care worker issues on the same level and with the same seriousness as other health care issues. Having Diane speak from the heart about the work she does, and why she does it, brought a powerful human element to the day. Our hope is that attendees left thinking differently about direct care workers and the work they do, and recognizing the need to continue the efforts begun in Iowa to insure that direct care workers are well paid, adequately benefitted and receiving excellent initial and ongoing training.”

John Hale
Policy Director
Iowa CareGivers Association
hale_johnd@msn.com

The emerging crisis in the health and long term care workforce was up for discussion on August 20, when members of the Iowa Legislature and the Iowa Congressional delegation held a Healthcare Roundtable in Des Moines. The focus of the roundtable was coordinating state and federal efforts to expanding health care coverage.

I was there along with Di Findley of the Iowa CareGivers Association (ICA), Iowa’s HCHCW partner, to talk to the elected officials about the health coverage needs of direct-care workers. We also talked about the need to give attention to the crisis in the direct-care workforce. As a result of the conversations, ICA has scheduled follow-up meetings with several elected leaders in attendance.

Other topics disucssed include ERISA rules, Medicaid and Medicare reimbursement levels, S-Chip expansion, the need for federal electronic medical record standards, approaches to cost containment, medical homes, and chronic disease management.

John Hale
Policy Director, Iowa CareGivers Association
hale_johnd@msn.com

On August 16, members of the Health Care for America Now (HCAN) Coalition met with Iowa Senator Tom Harkin, sharing their concerns and stories about uninsured Iowans. They also talked about the struggles faced by both direct-care workers and the people they serve as a result of inadequate or no insurance. 

That’s me in the back row of the photo right behind the senator, along with other members of the coalition, as he signs HCAN’s Which Side Are You On? pledge.

Senator Harkin supports the establishment of a comprehensive national health care plan. He mentioned two ways that goal might be achieved:

1. Give all Americans the option to enroll in the Federal Employee Benefit Pool (the same insurance he has), with the rationale that enrolling more would lower the cost to individual members; or
2. Expand Medicare to cover all Americans. It would be much more difficult to get Congress to pass the second, he noted.

The senator explained that Congress has the authority to set up a board, much like the federal reserve board, to set up and regulate the new health care system.  He believes that kind of non-partisan process will be required to get past some of the hurdles a comprehensive health care plan would have to cross in Washington. 

You can join Senator Harkin in signing your support for the HCAN pledge.

HCAN Iowa is comprised of the following organizations:

ACORN
AFSCME Council 61
Alliance for Global Justice
American Medical Student Association Des Moines University Chapter
American Medical Student Association University of Iowa Chapter
Child and Family Policy Center
Communication Workers of America
Iowa CareGivers Association
Every Child Matters Iowa
Iowa Citizen Action Network
Iowa Citizens for Community Improvement
Iowa Community Action Association
Iowa Conference of the United Methodist Church
Iowa for Health Care
Iowa Federation of Labor AFL-CIO
Iowa Planned Parenthood Affiliate League
Progressive Action for the Common Good
Progressive Coalition of Central Iowa
MoveOn.org
Service Employees International Union
Visiting Nurse Services Polk County
Working Families Win

Di Findley
Director, Iowa CareGivers Association
Di.FIndley@iowacaregivers.org

On August 11, the Iowa Choice Health Care Coverage Advisory Council, which is charged with designing a comprehensive plan to cover all children and adults in the state without health care coverage, held its first meeting. The council was created by health care reform legislation passed by the 2008 Iowa Legislature and signed into law by Governor Chet Culver in May. The legislation calls for new plans to be available for purchase as of January 1, 2010.

At the first meeting, the coucil discussed the challenges of coming up with definitions and parameters of adequacy and affordability, potential ways to administer the plans, and key issues such as who is eligible for coverage and whether or not coverage should be mandatory. The council also requested data on the various health plans that currently exist in Iowa and the associated costs. The Council will meet every two weeks.

The Advisory Council includes:

• two former Iowa Governors
• four members of the Iowa General Assembly
• consumers
• employers
• representatives of organized labor and the insurance industry

The Iowa CareGivers Association, HCHCW’s Iowa partner, is not a formal member of the Advisory Council, but it will play an active role in its work. 

John Hale
Policy Director, Iowa CareGivers Association
hale_johnd@msn.com

Health Care for America Now, a national grassroots campaign seeking to win affordable, quality health care for all Americans, launched on July 8 with events across the country. PHI’s Health Care for Health Care Workers campaign recently joined the new campaign.

In three key HCHCW states, HCHCW staff and partners participated in launch events, seizing the opportunity to focus attention on the health care needs of direct-care workers:

• Pennsylvania. HCHCW Community Organizer Simone Baer spoke about the thousands of direct-care workers caring for the state’s most vulnerable citizens who lack health care coverage of their own. The event was covered by the Pittsburgh Post Gazette.
• Iowa. Iowa’s HCHCW partner, the Iowa CareGivers Association, participated in the launch on the steps of the state capitol. The ICA is one of 18 initial members of a growing campaign in Iowa that is working to assure that the next President and Congress pass legislation guaranteeing quality, affordable health care for all. ”As a key battleground state in the Presidential election, Iowa will be a focal point for debate over the respective candidates’ plans to reform the health care system,” said ICA Policy Director John Hale. “The ICA and direct-care workers will be involved in those debates, and will insure that the candidates recognize the unique needs of direct-care workers in getting and keeping adequate and affordable health care coverage.”
• Maine. Helen Hanson, a direct-care worker from China, Maine, represented the Maine Direct-Care Worker Coalition, a HCHCW partner, at the launch event on the steps of her state’s capitol. Helen spoke of her struggle with health care bills after routine tests that were not covered by her catastrophic coverage plan.  Another HCHCW partner, the Maine Center for Ecomomic Policy, also participated in the launch event, which was covered by the Portland Press Herald.

Things will be heating up as the Presidential campaign moves toward November. Visit the Health Care for America Now website to find out how you can get involved.

Allison Lee, HCHCW National Campaign Manager
alee@phinational.org

On May 13, Iowa Governor Chet Culver (pictured) signed HF 2539, a new law that will have a dramatic and lasting impact on the direct-care workforce. The bill, whose intent is to “progress toward achievement of the goal that all Iowans have health care coverage,” includes several clauses specific to direct-care workers.

This dramatic success flows from years of work on the part of Di Findley, the founder and executive director of the Iowa CareGivers Association, as well as extensive advocacy efforts by direct-care workers and their supporters. Lots of seeds have been planted over the years. This year, we had the opportunity to see them grow and bear fruit.

Being part of the Health Care for Health Care Workers campaign was also of great importance to the legislative effort. The activities of HCHCW – the research that’s been done, the publications that have been prepared, the ideas that we gained, and the help that was provided — were critical to our work.

Another factor in these legislative successes was the creation of the Iowa Healthcare for All Coalition (pdf), a coalition of 24 organizations that worked collaboratively to get the legislation crafted, debated, and passed. The member groups represent a myriad of interests, including direct-care workers, organized labor, AARP, and organizations representing kids, community action entities, the faith community, farmers, social workers, nurses, public health, and working families. 

The coalition allowed the voices of direct care workers to be echoed and strengthened by voices representing a host of other interests and perspectives. It was this collective voice that gave the interests of direct-care workers a greater presence and greater power at the Iowa Capitol. This was truly a team effort.

Key facts about HF 2539:

• Its initial priority is to cover all children eligible for Medicaid or an expanded Children’s Health Insurance program;
• It commits to creating comprehensive and affordable health care plans for uninsured adults, to be available for purchase by January 1, 2010;
• It requires the Department of Public Health to expand efforts to insure that a well-qualified and stable health and long term care workforce exists (initial report and  plan due by January 1, 2010);
• It creates a Direct Care Worker Advisory Council (that includes direct care  workers) to continue work on education and certification issues  (recommendations due by November 30, 2008);
• It establishes a Direct Care Worker Compensation Committee to develop recommendations to increase direct care worker wages and other forms of  compensation (recommendations due by December 12, 2008);
• It instructs the Department of Human Services to create and publish an ongoing report that measures direct care worker turnover in nursing facilities (first report due by December 1, 2008); and
• It directs the Department of Human Services to design a premium assistance demonstration project to provide health care coverage for up to 250 direct care  workers and their dependents (design due by December 15, 2008.)

Timeline of ICA and HCHCW activity to win health care reform

• Materials used in the campaign
  • Iowa Fact Sheet (pdf)
  • Touched By A Caregiver Day Materials (pdf)

John Hale
Policy Director
Iowa Caregivers Association (Iowa’s Health Care for Health Care Workers partner)
hale_johnd@msn.com

Members of the Iowa CareGivers Association (ICA) lobbied their legislators on January 29, talking about the need for better pay, better benefits, and better training and education for Iowa’s direct-care workers.

The caregivers also asked their legislators about their personal experiences with caregiving, as part of a push by the ICA to collect and publish stories of legislators and others who have been, in the words of the ICA’s theme for 2008, “touched by a caregiver.”

“The value of that is, it forces legislators to think completely differently about direct-care workers,” says ICA Policy Director John Hale. “When they start to think about direct-care workers in terms of their own lives, it becomes real, not just one of the hundreds of issues they have to deal with every day. It becomes more of a priority.”

“Invest in the nursing-facility work force, those who provide the care and have the most influence on the results produced. Hire the best people, train them and treat them well. Reward them with a livable wage and great benefits. Involve them in planning and decision-making. Have enough staff on board to ensure that the safety and well-being of residents can be assured. Acknowledge the good work being done,” urges an op-ed in today’s Des Moines Register. John Hale, the policy director of the Iowa CareGivers Association and the point person for the PHI Health Care for Health Care Workers campaign in Iowa, co-authored the piece with ICA Executive Director Di Findley. The two wrote in response to an expose on the quality of care in Iowa’s nursing homes.

“One of the more troubling aspects of the reporting to date has been the information pertaining to the million-dollar chief-executive salaries, $400-per-hour director fees and the off-shore, for-profit insurance companies used by the not-for-profit sector,” wrote Hale. “It’s particularly troubling when contrasted with the $10.77 average hourly wage of the certified nursing assistants who provide most of the hands-on nursing-home care. A quarter of these caregivers have no health-insurance coverage.”

The Iowa caucus may be over, but Iowa’s nursing assistants haven’t stopped asking the presidential candidates to acknowledge the importance of direct-care workers – and to offer them better health care coverage and other supports.

In a letter to the editor in the January 25 Des Moines Register, CNA Lin Salasberry and 10 colleagues refer to the letter they wrote in late December to presidential candidate Mike Huckabee, expressing “frustration and concern” about a comment he made about direct-care work on Larry King Live. They reiterate the points made in that letter, including “how low pay, lack of affordable health benefits and lack of respect contribute to a high level of turnover, and how that revolving door of workers leads to less care and less quality of care for Iowans.” The Huckabee campaign acknowledged receipt of the original letter, but no response has been received. “We hope that Huckabee and other candidates understand that there are more than 3 million professional caregivers in America who are concerned about his words and failure to respond,” the follow-up letter says.

In a commentary on the January 25 letter posted on the healthcare08 website, health care journalist Craig Stoltz noted: “The healthcare debate is often centered on more easily identified constituencies: the uninsured, doctors, insurance companies. But the millions of people who are working on the front lines of healthcare are rarely considered.

“Can caregivers earn a place at the table of healthcare reform?” Stoltz asked.

After Presidential candidate Mike Huckabee referred to nursing assistant work as “emptying a bedpan” during a discussion of criminal background checks, the ICA sent Governor Huckabee a letter objecting to that characterization. “We wonder whether you know how difficult it is to get talented people to enter and stay in this profession,” the letter asks. “Do you know that 25% of certified nurse aides in Iowa have no health insurance? Do you know how we struggle to make ends meet because of low pay? Do you know that turnover in many of these jobs is running over 70% annually? Do you know that ‘being looked down upon’ and not being respected is a big factor in people leaving the occupation?”

The ICA also sent the letter to the news media and all the other candidates then blanketing Iowa in the lead-up to the January 3 caucuses. Several media outlets picked up the story, including TV news stations KCCI and WHO in Des Moines.

“Having been a nurse aide in the past, I have emptied many bedpans, and quite frankly I believe it to be one of the most compassionate acts of caring that one can do!” said ICA Executive Director Di Findley in a January 2 email about the letter. “And while I realize that we may all say things off the cuff, this truly is an opportunity for us to educate the candidates and others.”

Findley also called on fellow advocates to contact Huckabee’s campaign headquarters and “ask him to publicly respond to our request for an apology to the three million direct care workers in the country.”

Cindy Ramer, a nursing assistant and powerful advocate for affordable health insurance, is a member of the Iowa CareGivers Association (ICA), which is spearheading the Iowa Health Care for Health Care Workers campaign. She has testified in many venues about her experience of having been bankrupted by medical costs.The September 26 hearing was hosted by former Governors Tom Vilsack and Terry Branstad.

Cindy Ramer
Public Hearing on Health Care Reform hosted by Governor Branstad and Governor Vilsack
September 26, 2007

Good evening Governor Branstad and Governor Vilsack and thank you for the opportunity to talk with you this evening.

At your first public meeting in Council Bluffs, you were given a packet of information by Kealy Andersen, a Certified Nurse Assistant from Shenandoah. Contained in that packet was a DVD featuring the stories of three direct care workers (wmv).

I am one of those workers. My name is Cindy Ramer, a CNA from Denver, Iowa. I, like Kealy, serve on the Leadership Council of the Iowa CareGivers Association, and I am proud to represent them here this evening.

I have told my story on numerous occasions over the past 2 years. Each time it becomes a little easier for me to tell it. While it gets easier, the story never gets better. It always ends the same way, with a result that is very sad, very difficult, and very unacceptable.

The short version of the story is this:

Several years ago my husband was working for a small construction company and I in direct care, we did not have health coverage at that time. My husband was diagnosed with diabetes which subsequently affected his heart. He went through surgery. The cost forced us to file bankruptcy. On November 6, 2005, he suffered a massive heart attack and passed away. Since then, I have had to deal with the loss of my life partner and the debts left behind by his illness and death.

Due to the medical debts I carry, I cannot see my family physician until I can at least pay off the smaller bills owed for my own health care needs.

I am a Baby Boomer fast approaching retirement age, who needs some answers on solving these problems. The thing I want to stress to you is this…this should never happen in Iowa. Whether it’s me as a direct care worker, or anyone else, NONE of us should be put in a position where we go without adequate and affordable health care, where we are forced to file bankruptcy due to medical debt, and where we are treated as a second class citizen and actually denied the opportunity for necessary medical care.

“Our hope is that the conversation that has been focused on how to pay for long-term-care services will expand into a conversation about the availability of long-term-care services. If it does not, we may be spending a great deal of time trying to find better ways to pay for services that won’t exist,” writes John Hale, policy director of the Iowa CareGivers Association (ICA), in today’s issue of the Des Moines Register.

In his opinion piece, Hale calls on Iowa residents to “work together on how to make jobs in long-term-care good jobs.” The long-term care system may collapse, he warns, if workers are not paid better, offered retirement plans, and provided affordable health insurance.

The ICA is spearheading the HCHCW campaign’s efforts in Iowa.

“It is simply wrong that so many people who provide care for others do not get care themselves because they do not have any health insurance or because the insurance they do have fails to meet their needs,” direct-care worker Kealy Andersen, a member of the Iowa CareGivers Association, told a group of special commissioners studying health care in Iowa. “The work we do is among the most important in society. We deserve good health coverage.”

A story in today’s SW Iowa News describes testimony from Andersen and others at a Council Bluffs public hearing held by the Legislative Commission on Affordable Health Care Plans for Small Businesses and Families. The commission was created by the Iowa Legislature to make recommendations on how to improve health care access and affordability to all Iowans. Its final report is due to lawmakers next year.

“The quality of care provided to our family members, friends and neighbors in health and long term care settings directly relates to the stability of the workforce,” Andersen told the commissioners. “If we have a revolving door of people entering and leaving the field – in large part due to the lack of adequate and affordable health care benefits – the quality of care provided will never be what we want it to be.”

The following testimony was given by certified nursing assistant Cindy R. at a press conference held at the Iowa state capitol. She added the postscript ten months later, after her husband passed away.

Good morning all! I’m a direct-care worker and a member of the Iowa Caregiver’s Advisory Council. I have come here this morning to educate and be educated, so that we can all work together to improve the health care system for the direct-care workers and those that they assist or care for.

One of the issues we are working to change is health benefits for direct-care workers. That’s why I’m here to tell you my story.

About seven years ago my husband found out he was diabetic. He works for a small construction company that offered no insurance benefits at that time and our incomes did not amount to enough that we could afford to buy coverage on our own, so we continued to be without.

Then about four years ago my husband had a heart attack and ended up having to have a stent put in an artery to his heart. The subsequent hospital bills amounted to $33,000. We struggled to find a way to pay this debt, but what made it even more difficult was the fact that my husband now needed to take more medications also, which all told amounted to about $300 a month.

We ended up filing bankruptcy. After this happened, I decided that I needed to take out some major medical coverage through my employer to cover me and my husband. I would have to pay over $400 per month for a plan that would not even cover him for the first year because of his pre-existing conditions. We could not afford this, so I joined the plan for just myself.

About one year later our employer tells us that they can no longer afford to carry this coverage for us, but would offer a supplemental plan that at least would cover some doctor visits and the like. I myself did not have any claims this past year, but many of my co-workers did and had a difficult time getting their bills paid. Our employer cancelled this plan at the end of the year and we have been given the choice to join a new supplemental plan, which they hope will have better coverage. We shall see, but it still does not cover our major medical needs if we have to have a serious stay in the hospital.

My whole point is, it’s unfair that my fellow direct-care workers and I should have to go through this to have good affordable health coverage for ourselves and our families, just because we like the job we do: giving good care to others who need it. We must find an answer to this problem in order to keep the good staff we have caring for those who need it, and also to make our profession more desirable for others who would like to come into doing direct care. This is a big issue because the need for good and caring staff is going to continue to increase as the “baby boomer” generation starts requiring care themselves.

Thank you for listening to my story. I hope you will join us in trying to solve this problem.

Postscript:

When my husband died I was left with over $13,000 worth of bills. I don’t know how I’ll pay those bills. I’m trying to work with the hospital here and I’m not sure how I’ll do it. I may qualify for financial assistance but I’ll still have to pay a portion of the debt.

It’s hard enough dealing with this and going from two incomes that weren’t great to one income. I’ve got a long road ahead of me, and I’m trying to hang onto my home. My youngest son still lives here and is helping me, but it’s a struggle.

My main goal since getting involved with Iowa CareGivers has been to help other direct-care staff. It’s not right that health care workers don’t have better coverage than that.