Archive for the 'Maine' Category

This report is from Helen Hanson – a direct-care worker in Maine – who has been involved in PHIs Health Care for Health Care Workers campaign and advocating for state action for direct care workers’ insurance since 2005.

Maine is one of thirteen states to receive a federal grant  to help provide health care insurance to part-time, seasonal and direct care workers. Maine received this $8.5million grant from US HHS in the fall of 2009.  

The Governor’s Office of Health Policy and Finance applied for the grant as a way to help Maine’s direct care, part-time, and seasonal workers obtain health care coverage. This grant is being administered by DirigoChoice, the state’s insurance plan to help small businesses and low-income Mainers get health insurance. The second $8.5 million will be awarded if the Dirigo Health Exchange or the Governor’s Office of Health Policy and Finance show that the grant is insuring and working the way it is designed to

 The past few years, Dirigo has been tied in knots because of revenue shortfalls and by a very complicated formula that provided the program’s funding. Even I can’t begin to explain it and I’ve been involved with trying to gain health insurance for Maine’s Direct Care Workers for some time.

That complicated formula is now gone, but  the revenue shortfalls are not. Many individuals are on Dirigo’s waiting list for when more funding becomes available. The way Dirigo was designed to work was to base premiums on a sliding scale based on income. The individual would pay a portion and the rest would be subsidized by the Dirigo program.

Now that Maine has received this grant, Trish Riley from the Governor’s Office of Health Policy and Finance and the staff at Dirigo have put together an advisory group to help guide its implementation.

The Business Advisory Group had one meeting last fall. Direct care workers were not in attendance. The Maine Personal Assistance Services Association (Maine PASA), a worker led advocacy group, pushed to have workers involved in the Advisory Group.

The second meeting was held on February 26, 2010. I am very happy to report that Maine PASA received an invitation from Trish Riley to participate.

I attended this meeting, representing Maine PASA and the Direct Care Alliance. It was a privilege and an honor to be representing Maine’s Direct Care Workforce on the Advisory Group.

The first phase of this grant will be rolled out to employers of direct care, part-time, and seasonal workers, with a target start date of April 1.

Vouchers will be available to workers to help them pay their portion of their employer’s sponsored health insurance. If part-time workers take the insurance, the employer will withhold the employees’ contribution. A voucher will be given to the workers to help pay for their portion of their employer’s health insurance. The voucher is based on federal poverty levels, figured by income and assets the employee has. Based on federal poverty levels, a worker’s contribution may be $400, with the voucher paying $300 of it and the worker paying $100. This would be per month.

The second phase of the grant will be rolled out in July of 2010. This phase is for those who would come into the “individual” plan type of insurance. If your employer, like mine, simply does not offer insurance, you’d be able to obtain coverage this way. I think the basic premise is the same, there will be a voucher available, based upon income and assets that will help individuals purchase insurance through DirigoChoice.

This second Advisory Group meeting discussed definitions; what is part-time, what is a resident of Maine, what is having 50 employees, what is being uninsured. I know it sounds stupid, but clear definitions are needed so that there is no confusion as this starts getting implemented.

There was discussion about plans offering single deductibles of $5,000 or more and if these should be excluded. The business representatives felt this should be allowed for the vouchers because it offers “choice” on the employee’s part.

Those of us against this were opposed because if you’re already make low wages, you’re probably eligible for a voucher to help pay for your insurance. Having a $5,000 deductible, if you’re making low wages, is just an added financial burden if you should need your insurance. It is not having viable coverage. With deductibles that high, and not making a lot of money, you are not apt to see a doctor when you need to, or get those preventative screenings to detect problems early. It is defeating the purpose of having coverage. I agreed; I’ve been there myself.

In the end, the group decided that these high deductible plans would not be covered under the program.

Enrollment for employers is on a first come, first serve basis. Concern was expressed that Maine’s large employers of part-time workers like Hannaford, Walmart, and L.L. Bean would take up the 3,500 or so slots and there would be none left for direct care workers. The direct care advocates expressed great concern over this.

One of the stickiest parts of the discussion was whether employers should be required to contribute to their employee’s coverage and how much. Originally, there was no employer contribution requirement. Trish commented that Dirigo really wanted an employer contribution requirement and that if employers paid in 30% to 35%, the grant would cover its target goal of 3,500 people.

Consumer advocates and some of the business community opposed there being no employer contribution while others in the business community supported no employer contribution.. One representative of a home care agency said that she could not afford a 10% contribution because of possible cuts in state funding. One person felt that employers should contribute at least 5% of what employees are contributing. A consumer advocate suggested that the employer contribution be based on the size of its payroll.

In the end the majority voted to have some sort of an employer contribution.

Trish has expressed concern on many occasions on how to market this plan so that employers of direct care workers would indeed expand coverage so that their workers would sign on.

In the end, it will be very interesting to see who ends up with coverage through this grant. As a worker, and part-time at that, I want to ensure that as many direct care workers get coverage as possibly can. A barrier for workers is the fact that wages are so low. Many workers in nursing home settings don’t enroll in their employer’s coverage because they simply cannot afford their share of the premiums. That is not right either, but again, that’s the way it is.

Workers in home care agencies do not even have the option to deny their employer’s coverage. The employer simply does not offer it to the workers who are day in and day out serving their consumers.

So, it will be very interesting to see how many direct care workers actually gain health care insurance through this grant. My hopes remain high that many will take advantage of this opportunity, either through their employer or individually.

Whenever I talk to workers, I tell them about this opportunity, hoping that they mention it to their managers or employers. I tell them as a means of raising awareness about this opportunity.

For more information contact Allison Lee at alee@phinational.org

Helen Hanson

“I firmly believe: what is good for direct-care workers is good for America,” said Helen Hanson, a Maine direct-care worker who had a guest column on health care reform published recently by the Portland Press Herald.

In the editorial, Helen shares her personal story of living without affordable, comprehensive coverage.  “To buy a health care plan that would protect us from bankruptcy we paid $3,200 per year, with a $10,000 deductible per family member, Hanson explained.

Hanson, loving her direct-care job, always feared that she would need to leave it to find employment that offered health insurance if she became ill.  Almost 30% of the direct-care workforce faces the same problem.

“That’s why health reform matters so much to direct-care workers – and those they assist,” Hanson wrote. “A health care system that denies care to workers who are providing daily health-related services to millions is a system that needs fundamental change.”

Hanson urged Congress to pass reform that is:

• Accessible to all individuals regardless of their family status, their employment status, or how many hours they work.
• Affordable for workers, their families, and their employers.
• Adequate, with a full range of benefits to protect older workers, those with chronic health conditions, and injured workers.
• And the coverage should be simple, easy to understand and enroll in.
• A public option, along with a regulated insurance exchange, is essential to meet these goals.

Congress reconvenes today and tackling national health care reform continues to be a primary activity.

Allison Lee
National Campaign Manager
HCHCW
alee@phinational.org

In a significant victory for the fight for health care coverage for direct-care workers in Maine, the Governor’s office announced last week that the state has been awarded a grant of $8.5 million to provide expanded coverage to 3,500 Maine residents — including direct-care workers.

The grant from the U.S. Department of Health and Human Services will provide $8.5 million a year for up to five years for the state to expand the Dirigo health program to part-time, seasonal, and direct-care workers.

Starting in 2010, workers employed by firms that offer health insurance and have over 50 employees will be eligible to receive vouchers to make their employer-sponsored insurance more affordable.  The grant also will allow the Dirigo program to develop a special coverage product for workers who are not offered employer-sponsored coverage.

This victory comes after a five year campaign waged by members of the Direct-Care Worker coalition.  In March of this year, Coalition members pulled together a high stakes meeting of key political leaders to discuss the issue of health insurance and direct-care workers. HCHCW participated in the meeting offering examples from other states and raising the possiblity of applying for the DHHS grant.

The participants agreed at the end of the meeting that a solution must be developed and several options were on the table including the ones now funded by the grant.

As a direct-care worker and a leader of the Coaliton, Helen Hanson, was on hand for Secretary Kathleen Sebelius’s announcement of the grant at the University of Maine last week.  “I heard it with my own ears,” she said. “We will finally be able to provide insure to some of Maine’s uninsured direct-care workers.  Today is a significant victory in a very long fight for coverage.  But I will not stop until all of Maine’s direct-care workers have coverage.”

Helen recently wrote an editorial on the need for federal reform in order to help direct-care workers gain affordable, comprehensive coverage.

The Direct-Care Worker Coalition now turns its attention to enrollment and design of the new coverage programs.

Allison Lee
National Campaign Manager
HCHCW
alee@phinational.org

A few weeks ago, a handful of members of the Maine Direct Care Worker Coalition brought together department heads and legislative leaders in an unprecedented meeting to discuss health insurance options for the direct-care workforce.  The meeting was held in the office of the Speaker of the House and was arranged by home-care worker Helen Hanson.  The policymakers in attendance at the meeting were:

• Senator Nancy Sullivan
• Speaker of the House Hannah Pingree
• Senate President Libby Mitchell
• Trish Riley, the director of the Governor’s Office of Health Policy and Finance
• Brenda Harvey, Commissioner of the Department of Health and Human Services
• Mila Kofman, Superintendent of the Maine Bureau of Insurance
• Representative Adam Goode
• Representative Steve Butterfield
• Representative James Campbell 

At the beginning of the meeting, Joyce Gagnon, a long-time worker leader of the Coalition, set the tone of the meeting by describing her plight with cancer and the resulting medical bills that piled up as a result of the lack of insurance being offered through her job.  Mollie Baldwin, the director of Home Care for Maine, was on hand to present the employer perspective on the negative impact the inability to provide health insurance to her workers has on retention.  Ms. Baldwin spoke about the need to increase Medicaid reimbursement rates so that providing health insurance is a financially viable option.

I was fortunate to be asked to attend the meeting to present a new program that went into effect in January in Montana that attempts to solve that program.  The Montana program provides an increase in the Medicaid reimbursement rate for employers who opt to provide a quality health insurance plan to their workers.

The meeting was a first in many ways, but perhaps the most important was that it facilitated a discussion across agencies that must be involved in creating an affordable quality health insurance option for the direct-care workforce.  The decision makers left the meeting with their own “to do” lists that were generated from their discussion with one another.

Having been involved in the Maine efforts for over two years, this meeting  was most positive one held to date and a great accomplishment for the Coalition. It only goes to show what tenacity and dogged determination can accomplish!  Congratulations to Helen and the DCW Coalition.

Allison Lee
National Campaign Manager
HCHCW
alee@phinational.org

We have another small victory in the ongoing battle to gain health care insurance for Maine’s DCWs!

Last Thursday, at the Insurance and Financial Services Committee held a work session for the Direct Care Worker Coalition’s bill for a pilot for health insurance for direct care workers (LD1059). Geoff Green, Deputy Commissioner of the Health and Human Services, spoke in support of our efforts. He said that DHHS is strongly supportive and wants to do a further study into the Montana Plan that provides a Medicaid reimbursement rate increase for employers who provide health insurance to their workers. He said the Department wants to work further with the Center for Medicare Services to figure this out how to do this in Maine. He said the Department is “willing to commit” to this, but told the committee that more time is needed than this legislative session allows.

The committee asked DHHS to come back with specifics on the plan. Green told them that pilots are hard to set up and that he wants to work with stakeholders to design a program but being so early in the process it was hard to say how long the process will take.

Here’s the best part, the Committee voted unanimously to carry over LD 1059 until the next session.  We did it!

I say this is a small victory because never before has DHHS even offered to look into this for Maine’s direct care workers. Everyone who has worked on this a lot longer than I have has told me that this is the closest we’ve ever gotten. To have gained that commitment from DHHS is a big deal.
I know that we still have a long way to go before insurance is actually implemented, but every small victory counts. This is a hill we’ve been climbing for a while now, we are one more step closer to the top.
The Direct Care Worker Coalition’s next steps are to keep DHHS on task, and try to get more providers on board.

Again, I am willing to do what I can to keep this moving. I hear from so many workers that health insurance is important to them, they need it.
This is great news.

Helen Hanson
Direct-Care Worker and Coalition Leader
China, Maine

Last week, the Maine Direct Care Worker Coalition was successful in getting a bill introduced for a pilot program for health care coverage for direct care workers.  The bill was sponsored by Senator Nancy Sullivan, co-chair of the Insurance and Financial Services Committee.  Senator Sullivan became a champion for direct care worker issues after a strong hearing on a bill (pdf) addressing health care for DCWs heard by the committee last year.  The bill echoed the recent recommendation of the Bureau of Insurance.

The bill as introduced reads:

An Act to Enhance Health Care for Direct Care Workers

This bill would establish a pilot project with a $500,000 limit (up to discussion) that will be available to providers of MaineCare Services to enhance or add health insurance for their health care workers.  The funding will come from MaineCare.  There will be a simple process by which providers may apply for this limited project.

The legislation will be amended with details later in the legislative session.

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

The Maine Bureau of Insurance recently issued its long awaited report Health Insurance Coverage for Maine’s Direct Care Workers  (pdf) and recommends the development of a pilot program to cover a segment of the direct-care workforce.  The report was the work of a working group convened over the summer by the Superintendent of Insurance at the direction of the Insurance and Financial Services Committee.  Several direct care workers, providers and advocates participated in the group. 

The recommended pilot program that “would allow several large home- and community-based direct-care service providers to receive an enhanced State reimbursement directed toward paying for coverage within DirigoChoice.” Specifically:

• The Legislature could direct enhanced General Fund or MaineCare reimbursements specifically to pay solely for coverage through DirigoChoice. Participating employers would be required to demonstrate that the enhanced payments were used in this manner.  
• The Dirigo Health Agency would open large group enrollment strictly to the home- and community-based direct-care service providers receiving the enhanced reimbursements.  
• Home- and community-based direct-care providers with 50 or more DCWs eligible for coverage could apply to participate in the pilot. Participation would be voluntary. The maximum number of participating firms would be based on the amount of available funding.  
• The pilot would provide an opportunity to examine the extent to which employees take up coverage, the level of benefits and premium best suited to the DCW workforce, and the impact providing coverage has on workforce retention.

“Given the state’s economic situation, a universal health insurance plan for the state’s entire direct-care workforce is not feasible.  However, starting with a pilot project may be the best strategy under the current climate to move things forward,” said Allison Lee, National Campaign Manager for HCHCW. The report concludes that “although there are no easy solutions given budgetary constraints and challenges, it is certain that absent effective interventions to provide health coverage to DCWs, the need for DCWs in Maine will outpace the supply.”  The report now goes to the State Legislature.

• Helen Hanson, a direct care worker in Maine, gives her account of the working group and report process

Allison Lee
National Campaign Manager
HCHCW
alee@phinational.org

I hear it all the time when I talk to co-workers.  “We need health insurance,” they always say to me. The drawback is the funding. With Maine’s budget the way it is, I honestly will be very surprised to see if the Legislature follows Ms. Kofman’s recommendation on the pilot.  But I am hopeful.

The Bureau of Insurance report on options for providing health insurance to Maine’s direct care workers is finally complete and recommends that a pilot program be developed for covering direct care workers in our state. Having been involved in the process of producing the report, I think the recommendation of a pilot is great as it would be a way to show employers and policy makers that health insurance is important to this workforce.

The report was a result of action taken by the Insurance and Financial Services Committee on the Direct Care Worker Coalition’s bill during the 2008 session. I was involved in both advocating for the bill and contributing to the report, because I feel it is a grave injustice to us direct care workers and the kind of work we do that we cannot get health insurance through our work.

The bill was to expand Dirigo, Maine’s health insurance program for small businesses and individuals, to let more direct care workers participate by allowing employers with more than 50 employees enroll and by subsidizing individuals with their premium costs. When the bill was going before Insurance and Financial Services, I presented testimony, explaining to the committee that the work I do is important and rewarding in other ways than monetary.

When the committee voted “Ought not to Pass” on the bill because of Maine’s bleak budgetary problems, it felt like just another hurdle to overcome. When I heard Senator Nancy Sullivan make the recommendation to further look into insuring direct care workers, it was like music to my ears. At first, I was not sure that I had heard her correctly. I still look at that recommendation as a small victory, it was another chance to educate policy makers as to the important work we do and the little compensation we receive.  I wrote a letter to Senator Sullivan, thanking her for the recommendation and telling her that I wanted to sit in on the work group.  A few weeks later, I received a phone call from Superintendent Mila Kofman, asking me to sit on the work group. I was very pleased that she asked me. Again, another chance to let a direct care worker talk to policy makers and educate them a bit!

The work group convened over the summer. We talked about the direct care workforce and the problems we face; i.e., low wages, no benefits, no paid time off. We looked into various types of Maine’s insurance codes to see which ones may benefit direct care workers. It was soon obvious that the workforce would need some sort of subsidy to help pay for health insurance and that the Medicaid reimbursement rates were too low to allow employers to offer health insurance to their workers. It also became apparent that DirigoChoice is probably the best option to gaining health insurance for direct care workers because Dirigo was designed to insure low-income folks and help with a subsidy to pay premiums.

The glitch in the whole thing is the state of Maine’s budget. Deficits are looming again. Maine has to have a balanced budget, so cuts have to be made in order to achieve that. With revenues falling short, there isn’t much left over to fund this project. MaineCare continues to be hit with budget cuts. It is a challenge to find the funding for this. Dirigo is currently closed to individuals who require subsidies. Again, budget problems are the cause. However, I plan to work hard to educate the legislature that Maine’s direct care workers need this pilot program.  I hope we can be successful.

Helen Hanson
Direct Care Worker
China, Maine

A testimonial by Eunice Spooner, a home care consumer in Sidney, Maine:

My name is Eunice Spooner, I’m a member of First Congregational Church in Waterville, and I live in Sidney. I was a school teacher until a car crash left me a quadriplegic and confined to a wheelchair over 20 years ago. Since then, I have had many blessings in my life – wonderful family, friends, and caregivers, the chance to be a deacon at church, a volunteer at the Atwood Elementary School, and a member of the SAD #47 School Board. Still, the fact is that I cannot get through my day without a lot of assistance throughout the day, from getting up, doing light housework, driving to appointments, going me to bed and even using the bathroom.

Through the Home Based Care program administered by Alpha-One, I am eligible for 30 hours of daytime home care a week, and 7 hours of nighttime care. I am responsible for finding, hiring, and training the workers to take care of me. After a co-payment I do qualify for some assistance but cannot offer health insurance or other benefits, which makes it quite a challenge to find and keep qualified, professional caregivers. After several months of searching, I was lucky to find some highly dedicated women who take wonderful care of me.

Still, it breaks my heart to see the challenges they face to stay in this field – working long hours at second jobs and forgoing needed medical care because they can’t get insurance. I appreciate their sacrifice, but I know that at any moment they could experience a setback that would require them to look for work with better pay and benefits. This is a constant worry to me, because I know how difficult it would be to replace them.

To be able to offer my home care workers health insurance would make such a huge difference. The challenge to find and retain good applicants, who provide the best care and make it possible to live at home as opposed to a more expensive nursing home, would be greatly lessened for me and many others.

Mostly, though, it would give me peace of mind to know that the people who go above and beyond to take care of me every day, can also care for themselves now and care will be there when they need it. The school teacher in me knows that is only fair.

Last Wednesday, the summer working group heard presentations on four models for health care coverage, three for members of a specific workforce and one for employees of small businesses. It also heard an argument for tailoring a health care plan to address obstacles encountered by all low-wage workers, not just one particular workforce.

Coverage models

The first model concerned the Maine State Chamber Purchasing Alliance. As explained by Dana Connors, the president of Maine’s State Chamber of Commerce, the principal features of the model include:

• It is available to small businesses with 2-50 employees
• It creates seven different plans for employers to offer
• It received a Bureau of Insurance (BOI) waiver to reduce required employee participation rate from 75% to 60%
• A wellness discount of 2% of premiums is available to businesses whose employees participate in special health programs

This set-up is apparently useful for some 480 Maine businesses insuring some 3200 folks, but its rates are similar to “community rating” rates available in the general market, so it doesn’t help much with affordability. Mollie Baldwin, the CEO of Home Care for Maine, also noted that this kind of system does nothing for larger employers and their workers.

The second model presented was that of the Maine Bar Association. Here, a group of businesses has pulled themselves together to form a risk pool. Because these lawyers felt they were likely to be healthier than the general community, they sought to make use of BOI rules allowing them to be rated separately from the community rating system.

For a while, this brought down premium costs. However, when several employees became severely ill and ran up high costs, insurers significantly boosted the association’s premium costs at time of renewal. With that, several large employers withdrew from the association, decreasing the size of the pool significantly, so premiums went up again.

This option would not be particularly attractive in any event for long-term care employers, since direct-care workers tend to be older and more injury-prone than the general population.

Both of these models fail to address the basic underlying issue: cost. A 2% wellness discount is good, but it won’t make up the difference between high premium costs and low wages for direct-care workers.

Toward the end of the meeting, Elise Scala and I presented brief overviews of experiences from other states, both of which are highlighted in Coverage Models from the States (pdf).  I went first and talked about Montana and Rhode Island.

In Montana, recent legislation singled out direct-care workers for special attention. The state will increase Medicaid payments to home care agencies that make affordable coverage available to their employees. The details are still under discussion, but the plan is supposed to go online in January 2009. Several summer meeting participants voiced interest in this model, which transfers a very large portion of the subsidy costs to the federal government through the Medicaid matching dollar program (in Maine, the feds provide 66% of all funding for Medicaid expenditures). The group plans to discuss this further at the next meeting.

In Rhode Island, the state singled out child care providers as eligible to join a state health insurance program. Depending on income, the state requires these workers to contribute between $61 and $130 a month. As in Montana, the program is subsidized through Medicaid, transferring a significant portion of the cost to the federal government.

Elise spoke briefly about models that focus not on individual groups of workers but on the obstacles that prevent direct-care workers from acquiring coverage. Tailoring programs to these common obstacles and thus making them accessible to all low-income workers, she said, would probably reduce political opposition – and ultimately increase coverage for direct-care workers.

Talking strategy

After the general BOI meeting, a small group from the Direct Care Worker Coalition spent an hour in a wide-ranging talk with Mila Kofman and Judy Ward, the Superintendent and Deputy Superintendent of Insurance. Both Mila and Judy listened carefully to our concerns and seemed genuinely interested in helping us find ways to move our agenda forward.

Mila, coming from a federal background, was focused on federal options we might explore, including possible increases to Medicaid’s SCHIP program, which she felt might be used to increase Medicaid funding and ultimately reimbursement rates. She also mentioned a new initiative co-sponsored by Sen. Durbin and Sen. Snowe, the SHOP Act, which would allow small businesses to band together in a larger risk pool in order to obtain lower premiums. The SHOP Act would provide employers with significant tax credits if they cover their employees. It probably isn’t an immediate or complete solution for direct-care workers, but it may help some employers overcome the financial barrier to providing affordable coverage.

Mila and Judy both expressed an interest in scheduling a longer meeting to delve more deeply into the obstacles to coverage, the complicated interactions between reimbursements and coverage, unemployment insurance and injury rates. We expressed a desire to hear more about their thoughts on state-level policy and/or code-related options on which the Direct Care Worker Coalition might focus its future efforts.

Though no immediate solutions emerged from this meeting, I think it is fair to say that it was quite productive and moved the Direct Care Worker Coalition very much into the thoughts of both of the BOI’s top administrators.

At the next meeting, I believe the plan may be to have more open discussion of the solutions presented to date, and perhaps some discussion of Dirigo. Judy also hopes to begin discussing the kinds of recommendations the group will want to see included in the final report.

Kurt Wise
Financial Analyst
Maine Center for Economic Policy
kwise@mecep.org

Previous coverage of the summer work group: first meeting |  second meeting

At its last meeting, the Direct Care Worker Coalition (DCWC) expressed a desire to return its discussion with the state’s Bureau of Insurance (BOI) to specifics. The goal is to build a better understanding of why this workforce deserves special consideration — and of the challenges the BOI group has to grapple with.

Following up on those wishes, Elise Scala took the initiative to build an agenda, in conjunction with Bureau of Insurance staff, for presentations to the BOI on the direct-care workforce. 

Using the full two hours of the latest summer BOI meeting, members of the DCWC presented information on:

• the composition and importance of the direct-care workforce
• the results of various surveys
• the obstacles faced by direct-care workers in obtaining health insurance
• the testimonials of specific providers, consumers, and workers.

At the next meeting, which will be held on Wednesday, July 30th, from 9-11 at the BOI in Gardiner, Elise Scala and I have been asked to give a brief presentation on the experiences of three other states: Iowa, Montana, and Rhode Island. We’ll talk about how those states were willing to identify direct-care workers — or, in Rhode Island, a similar group, child care workers – as a special class of workers in order to respond to their unique needs.

In addition, BOI staff plan to present information on the insurance code.  

We hope that the insurance experts gathered around the table can then begin to formulate some specific suggestions as to how Maine might address the health coverage needs of the direct-care workers.

Kurt Wise
kwise@mecep.org
Fiscal Policy Analyst
Maine Center for Economic Policy

A testimonial by Helen Hanson, a home care worker in Maine.

I am Helen Hanson, a direct-care worker with Home Care for Maine. I have been working at my home care job for five years. I help keep elderly folk living in their homes. I help them with grocery shopping, taking them to medical appointments, to the bank, getting errands done. I help them keep their homes clean and tidy. I also help them with personal care like bathing and dressing.

They look forward to my visits every week. I look forward to seeing them too. I enjoy their company and I enjoy this job.

As a direct-care worker, I do not make tons of money. There’s no paid sick time, paid vacations, or paid holidays. Most important, there’s no health insurance.

When I took this job, I had health care coverage through my husband. Circumstances changed, and we now buy our own catastrophic coverage. It doesn’t pay much and is very expensive — $300 per month, with a $10,000 annual deductible per family member. The way I see it, we won’t lose our home if one of us should become very sick. We won’t have to file bankruptcy to pay our medical bills.

I’ve lived with the threat of cancer all my life.

I am now 43, just a bit older than my mom was when she died of breast cancer. Since November 2007, I have had three abdominal ultrasounds and my annual mammogram – all screenings to detect cancer. The cost of these screenings plus the doctors’ consultations and visits is over $3,000. All of this is out-of-pocket cost to me.

I am very healthy and grateful that I’m so far cancer free. If one of my doctors should tell me that I have cancer, I will have to leave this job in search of one with health insurance. That would mean that the three consumers I have would be out of a worker until another worker could be found – if one would be found at all.

If I was in the position I’m in now back when I took this job, I would not have been able to take it. What keeps me at it is the fact that I’m helping someone in need. There’s something to be said for that. I enjoy what I do a lot. It is more than cleaning for someone; it is the satisfaction of knowing I’m making a difference for them.

But Maine’s direct-care workers need health insurance. Our disabled and elderly folk rely on the quality care that direct-care workers provide. As the number of folks needing assistance increases, where are the workers coming from? Right now, people needing assistance are on waiting lists.

Why is there a shortage of workers? Why is there such a turnover in workers? Low pay and no health care insurance are part of the answer.

If better wages and health insurance were in the picture, maybe direct-care workers would or could afford to stay at their jobs. Maybe younger people looking into the health care field would think about direct care as an opportunity.

It is hard on low wages to pay for the things you need, such as oil to heat your home, food to feed your family, and routine check-ups and yearly medical exams to help keep you healthy.

I know there’s a lot of work ahead in order to obtain health insurance for direct-care workers. I come before you today in an effort to educate you on this very important issue.

Thank you for listening to my story.

Helen has shared her story many times, including testifying in front of Maine’s Insurance and Financial Services Committee in support of LD 1687 this past winter.  She is also an active member of the workgroup convened this summer by the Maine Superintendent of Insurance to address health care coverage for direct-care workers.

Helen is also president of Local 771 of the Maine State Employees Association’s direct-care worker union, representing 1,700 fellow direct-care workers.

The blog she maintainsfor the union has a strong focus on healthcare for health care workers.

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

While the first BOI meeting was largely a round of introductions and a broad overview of the work ahead, at this last meeting BOI staff delved into the nitty-gritty of the Maine Insurance Code. The point of this exercise was to see if there was already an existing model/structure that would allow the Direct Care workforce to organize some kind of insurance purchasing pool or entity that could acquire coverage through the private markets (or form their own, independent insurance pool that essentially would act as an insurance company specifically for Maine’s direct-care workers (DCWs).

Staff presented the seven organizational structures for group purchasing permitted under Maine law. A lot of it was fairly technical, but the folks assembled at the BOI meeting were able to identify several models on which BOI staff will do more research and report back to the group. I believe these models included “Trustee Groups” and “Labor Union Groups” (and possibly “Small Group Health Plans”). Unfortunately, most of the seven permitted structures have specific rules that would make it difficult for DCWs to use them as models for organizing a purchasing group (for example: a) policies can’t be sold to individuals who are not directly employed by an employer, or b) the organization must be formed for purposes other than purchasing insurance and must be in existence for more than two years prior to initiating the purchase/provision of insurance, etc).

Learning more about these models may lead us to a permitted structure that holds special promise for DCWs. As a number of people have noted, however, it is not only a matter of organizing DCWs into a legally permissible purchasing group. A significant hurdle exists in identifying ways to make coverage economically feasible, regardless of the structure under which DCWs are organized. Under any circumstances, a little more information on these models will be instructive and will help us understand the regulatory environment to which we currently must conform. It may also help us understand how those regulations impede the provision of coverage to DCWs and thereby allow us to work with BOI andlegislators to alter that system so it better serves the needs of DCWs.

As it now stands, at the next BOI meeting (Monday, July 14th, 10-12 at BOI).  Stay tuned.

Kurt Wise
Fiscal Policy Analyst
Maine Center for Economic Policy
kwise@mecep.org

On June 17, the first meeting of the summer working group organized by Maine Superintendent of Insurance Mila Kofman was convened.  The working group was established to look into how affordable health coverage can be made available to all of Maine’s direct-care workforce.

The first meeting was a useful start. A somewhat formal set of introductory remarks set out the scope and intent of the summer’s discussions. The meeting was attended by several members of the Direct Care Worker Coalition (DCWC), including Helen Hanson, Joyce Gagnon, Mollie Baldwin, and me. There were also representatives from Harvard Pilgrim, the Maine State Chamber of Commerce, MaineCare/DHHS, Dirigo Health, and  the Governor’s Office (Karynlee Harrington and Trish Riley), as well as five or six members of the Bureau of Insurance (BOI) staff.

Senator Sullivan of the Insurance and Financial Services Committee and Representative Campbell of the Health and Human Services Committee also attended, both speaking at length and in strong support of direct-care workers and the need to find a real solution to the question of affordable coverage.

The  overarching goals of the working group – as defined by the superintendent and the legislators – appear very promising. The superintendent made clear her own longstanding interest in and work on these issues, as well as repeatedly clarifying that the goal of the group was to find a way to provide truly affordable coverage to direct-care workers and their families.  She insisted that all options were on the table for discussion. 

Despite early attempts by some participants to immediately begin looking at the obstacles to coverage – particularly those related to funding sources for subsidizing costs – the superintendent insisted that the group’s first several meetings must focus entirely on educating ourselves and discussing various models and possible solutions before any attempts to torpedo solutions due to cost concerns.

Senator Sullivan stated that she was not interested in market reforms. She also said she expects not only a report by October 1st but “bipartisan legislation” to be drafted from the report for consideration in the next legislative session.

I believe that this is enormously positive. It seems like the superintendent, the deputy superintendent (Judith Shaw, who will be heading up this effort for the BOI), and various well-positioned legislators are all taking this very seriously. The superintendent has made her staff available to do research between meetings, and has already expressed interest in having Health Care for Health Care Workers staff talk to the group about models from other states.

Everywhere I look I see reason for us to be hopeful, and to take this effort seriously. Summer is a hard time to get people together (and to want to really dig into the nitty-gritty details of various coverage models and relevant political strategizing), but I recommend we put all possible effort into this endeavor . This seems like a very good opportunity for the DCWC and one that we would do well to use to our best advantage.

The next meeting is scheduled for Tuesday, July 1 at 10 a.m. at the Bureau of Insurance in Gardiner.

Kurt Wise

kwise@mecep.org

Fiscal Policy Analyst

Maine Center for Economic Policy

The departure of Lisa Pohlmann from the Maine Center for Economic Policy has left the Maine HCHCW campaign with a new leader. Kurt Wise, who recently joined MECEP as its fiscal policy analyst, is the new facilitator of the Maine Direct Care Worker Coalition and co-leader – along with Barbara Asnes of Maine PASA – of the Maine HCHCW campaign.

“The HCHCW campaign is grateful to Lisa for her passion, policy acumen, and effective leadership,” said Allison Lee, national campaign manager for HCHCW. Pohlmann was instrumental in raising the awareness of the direct-care workforce among legislators and administrators, helping to move the state toward implementing policies to improve the quality of direct-care jobs. She left MECEP on January 14, after 13 years of service, to become deputy director of the Natural Resource Council of Maine.

After being kept alive with the help of Maine PASA (see below), LD 1687 was considered by the Health and Human Services (HHS) Committee on October 30. Committee members voiced considerable support for improving compensation for direct-care workers, but the state’s revenue situation remains gloomy, with significant revenue shortfalls forecast for 2008.

As a result, the Direct Care Worker Coalition recommended removing the MaineCare demonstration program, which was not likely to be recommended for funding, and asking the Insurance and Financial Services (IFS) Committee to conduct a hearing on the Dirigo Health proposals in the bill next session. These proposals also require funding subsidies for low-income direct-care workers, but they may be considered as part of the larger debate on continuing Dirigo Health funding.

Key members off the IFS committee have expressed their support for the bill, and several HHS committee members have agreed to testify before the IFS committee in favor of the Dirigo revisions. The Direct Care Worker Coalition is now planning its advocacy work with the IFS committee and other members of the legislature when they convene in January.

An initiative launched last fall by Maine PASA to raise legislators’ awareness of direct-care workers and to get direct-care workers involved in helping to shape the state’s legislative agenda appears to have helped keep alive LD 1687, a bill that would extend health insurance to more Maine workers.

Joyce Gagnon, who spearheaded the effort, called other Maine PASA members and asked if they’d be willing to call or write to their legislators. “We asked to talk to them about the specific kind of work they did and the skills they used to do it, because there are so many kinds of direct-care workers out there. We asked them to talk about health insurance: did they have it? We asked them to talk about what effect not having it – or having it – had.” They also asked for support of the bills then in session that would help direct-care workers, which included LD 1687.

The effort, says Gagnon, raised awareness of direct-care workers and their issues among legislators who often had not know exactly what they did or how many there were. “It brought an awareness that here are a group of people that are working under very extreme conditions. It also brought an awareness that PASA itself was standing up and saying, hey, you got to do something. And it brought PASA members an awareness that legislators would listen to them and they could get something done.”

Roy Gedat, the executive director of Maine PASA when the initiative was launched, agrees. Talking to legislators after the calls were made was a different experience than it had been before, he says. “When we went to the legislature this session, they already knew about us. They were very receptive to what we had to say.”

Maine PASA plans to continue the initiative indefinitely as new bills and opportunities emerge, and as new people are elected to office. “I think it was a great start and we need to continue doing more,” says Barbara Asnes, Maine PASA’s new executive director. “I don’t think most legislators have a clear idea of what it means to be a DCW. They hear multiple stories; they believe what they believe. And I think we’re in an excellent position to make it clear from the workers’ point of view.”

One of the thing the organization plans to ask legislators next term, Asne says, is “to consider, even if they can’t do full-fledged [family] health care, to allow some kind of funding or subsidies so people can at least get individual coverage.”

In another indication of Maine’s heightened awareness of the direct-care worker crisis, a recent Kennebec Journal Morning Sentinel article about an awards ceremony for exceptional caregivers focused largely on the need for better pay and benefits for direct-care workers.

The article, which ran in the August 16 issue, quotes state long-term care ombudsman Brenda Gallant on the poor pay and benefits typically available to workers. “Here we have caregivers who oftentimes can’t get care themselves,” she says. “They don’t have health insurance.” Lisa Pohlmann of the Maine Center for Economic Policy and the Maine Health Care for Health Care Workers campaign echoes Gallant’s comments. “We’re taking care of the elderly on the backs of low-income women,” she says.

LD 1687, An Act to Increase Health Care Coverage for Front-line Workers in Long-term Care, was still alive when the Maine legislature wrapped up its 2007 session. The bill, which would create a pilot program to increase health care access for direct care workers, has been carried over to the session that convenes in January 2008. Meanwhile, a legislative committee of House and Senate members will study Maine’s Dirigo Health insurance program over the summer in hopes of arriving at an agreement and a means to provide additional funding to continue the program’s growth.

The Maine Direct Care Worker Coalition worked hard to promote both bills and to ensure that they meet the needs of direct-care workers. The coalition is regrouping this summer to consider various study mandates regarding this workforce from the session and to develop strategies for moving its proposals forward in January.

The coalition’s campaign began in 2006, with the passage of a study bill to look at direct-care worker wages, health care options, and an expanded worker registry. Its March 2007 report (pdf) was favorably received by the legislature’s Health and Human Services Committee, which called it “just the kind of information we need.”

The reception to LD 1687 was positive as well, but legislators decided against adding new costs to the already strained MaineCare budget to fund it. However, there may be opportunities for new spending in the supplemental budget passed next year.

Coalition members also had productive meetings with the legislature’s Insurance and Financial Services Committee, resulting in a proposal for a pilot project within Dirigo to address the needs of low-wage part-time workers, with direct-care workers specifically named as a target group. However, the legislature adjourned without taking action on Dirigo Health because consensus could not be reached on certain contentious issues and no action was taken to commit the funding needed to continue to grow the program. In addition, the spiraling costs of health insurance in the individual market, where almost half of Dirigo members are covered, limits the coalition’s ability to press for coverage of new direct-care workers who need the discounts provided to low-income beneficiaries.

The legislature also passed several other bills to strengthen the state’s direct-care workforce this year. Actions included:

• Raising reimbursement rates to increase wages for homemakers;
•  Mandating a planning process for the first phase of expanding the CNA registry; and
• Making direct care workers who are hired by for-profit, third party employers eligible for minimum wage and overtime.

–By Lisa Pohlmann, associate director of the Maine Center for Economic Policy and facilitator of the Maine Direct Care Worker Coalition.

After long deliberations, members of Maine’s Health and Human Services Committee voted to carry forward LD 1687, a Health Care for Health Care Workers bill, into the 2008 legislative session. They also voted to send the provisions of the bill to the Insurance and Financial Services Committee for consideration with a strong recommendation that the IFS committee look closely at the bill’s proposals and report back to the HHS in January 2008 with ideas on helping the direct-care workforce. The Health Care for Health Care Workers campaign considers the outcome to be a positive development.

Leaders and members of the Health Care for Health Care Workers initiative in Maine are focusing media attention on the need for better health coverage for direct-care workers.

An editorial by Joyce Gagnon of the Maine Personal Assistant Service Association (Maine PASA) cites facts from Direct Care Workforce: Wages, Health Coverage, and a Worker Registry, to explain the importance of the state’s direct-care workers. Gagnon urges support for several pending bills which would increase direct-care workers’ wages or benefits. Her editorial was published in the April 27 Bangor Daily News.

A May 3 article in the Morning Sentinel outlines Maine’s growing care gap, describing direct-care workers as the people “who keep the direct-care industry — more than 22,000 people who provide hands-on health assistance to the elderly, adults and children with disabilities — from collapsing.” One key to stabilizing the workforce, notes staff writer Colin Kickey, is providing health insurance. “If you look around at who is going to be going to be taking care of you as you age or should you become disabled, you will find there are not enough people do that work,” says Senate President Beth Edmonds, the sponsor of LD 1687, “and the ones that are there are dedicated, loyal folks who given the wage structure, and given the lack of health insurance, can’t persist in these jobs.”

And in an article in the May 6 Kennebec Journal, Hickey writes about the work the Kennebec Valley Organization is doing to promote LD 1687 and other initiatives to support direct-care workers.

The Health Care for Health Care Workers team in Maine was featured in “State of the State,” a weekly television show on Maine policy issues. The show was hosted by HCHCW leader, Lisa Pohlmann, associate director of the Maine Center for Economic Policy (MECEP) and facilitator of the Maine Direct Care Worker Coalition. Guests on the show were: State Senate President Beth Edmonds, the lead sponsor of legislation to provide direct-care workers access to health benefits; Susan Rovillard, a direct-care employee; and Roy Gedat, the executive director of Maine Personal Assistance Services Association (PASA).

Guests described the ongoing problem of finding and keeping frontline workers in nursing homes, residential care, and home care. They discussed several legislative initiatives aimed at improving recruitment and retention, such as LD 1687, the health insurance bill. The show, titled “Proposals for a More Stable Direct Care Workforce” can be heard in audio format on the MECEP website.

A testimonial by Joan D., a home care agency owner in Maine:

I know that providing health insurance would help me retain workers. One of my full-time aides who needed coverage prompted my search for insurance by letting me know she would have to seek employment elsewhere if I was unable to offer it in the near future.

The instability of hours is the biggest challenge for direct care workers: if I don’t have work for them, I can’t afford to pay their health insurance. What we really need in this industry is to make health benefits portable, so they can move with them as they move from agency to agency.

A testimonial from Tina, a home care worker in Maine:

My name is Tina, and I provide home based care for Eunice from 10 at night until 7 in the morning. Then, from 8 in the morning to 1 in the afternoon I go to my other job at a developmental disability agency in town.

I’m married, with two grown daughters – one in the Army, and one in Connecticut. I had a lot of experience caring for developmentally disabled people in agency settings, and I have taken care of family members at home, but this is the first time I’ve done professional home care. I just saw Eunice’s ad in the paper, answered it, and we really hit it off.

Eunice is unique – just wonderful, and a good employer. She’s independent, and does a lot for herself, but there are certain things she just can’t do, and I enjoy helping her. I’m glad to help her stay in her own home, and not have to go to a nursing home.

I’ve been interested in caring for others from a very young age. In school, when somebody was getting picked on, I would stick up for her. I guess I’ve always been a bit of a mother hen!

Recently, though, I’ve had to worry about myself, too. There’s a history of diabetes in women in my family, and lately I’ve been having all the signs – unquenchable thirst, frequent bathroom breaks, dizziness, and sleeplessness. My mother gave me a monitor for my sugar levels and I’ve tested as high as 420 – you can go into a coma at 500. Eunice called the diabetes clinic for me, and they told me to go to the ER. But I can’t afford to do that.

I took my second job because I thought I could get health insurance, but you need to work 26 hours a week to be eligible and they will only give me 25. For $400 a month I got added onto my husband’s plan, but the deductible is $2,500, so I still can’t afford to get the care and medications I need to take care of this. I’m between a rock and a hard place here.

I heard there may be a full time opening at the other agency that would have health insurance. I’m tired now. I can only imagine how I’m going to feel working two full time jobs. I’d like to make it work – I don’t want to give up working for Eunice, because she relies on me, and I have a conscience. But I also don’t want to end up in a coma, or dead. If I don’t take care of myself, I’m no good to anybody.

A testimonial from Iya’Negra L., a certified nursing assistant in Maine:

I am a certified nurse aide who has worked in several different nursing homes. In 2004, I had health insurance coverage for six months, which covered my three girls and me. It cost $174 per pay period, but this became too expensive for me. After rent and all of the other basic household expenses I wasn’t making ends meet. So I dropped the health insurance.

A week later I was kicked in the abdomen by an Alzheimer’s resident. I started having complications from the kick. I had constant bleeding and intense pain, and I was getting sick at work. A doctor told me I had fast-growing fibroid tumors. He said I needed surgery immediately and that it would cost $15,000, but I had no way to pay.

My employer said there was nothing they could do because I dropped my health insurance. I applied for Medicaid but was told that I didn’t qualify because I was a working person. I was ineligible for any type of medical assistance, so I didn’t have the surgery at that time. This led to a series of difficult health problems, which kept me away from work for many weeks and put a huge strain on my family.

Maine State Senate President Beth Edmonds introduced legislation to increase access to health care for direct-care workers. The bill, LD 1687, expands the definition of businesses eligible for DirigoChoice, the state’s health care program, to include state-funded long-term care providers that have more than 50 employees.The bill makes DirigoChoice coverage available to home care workers who work part-time and are not eligible for Medicaid or employer-sponsored health insurance. It also establishes a demonstration program to increase health insurance coverage among direct-care workers at agencies that get funding from Medicaid or other state long-term care programs.

PHI’s Health Care for Health Care Workers campaign is working closely with the Maine Coalition to pass LD 1687 this session.