Nursing homes seeking reprieve from health care law

WASHINGTON — It is an oddity of U.S. health care: Many nursing homes and home care agencies do not provide health insurance to their workers, or they pay wages so low that employees cannot afford the coverage that is offered.

The numbers are stark. Among workers who provide hands-on care to nursing home residents, one in four has no health insurance. Among those who provide care to people living at home, one in three is uninsured.

The new health care law is supposed to fix the problem by guaranteeing access to affordable coverage for all. But many nursing homes and home care agencies, alarmed at the cost of providing health insurance to hundreds of thousands of low-wage workers, are seeking some kind of exemption or special treatment that would relieve them of the obligation or help them with the expense.

Mark Parkinson, president of the American Health Care Association, the largest trade group for nursing homes, says the problem is that reimbursement rates for Medicaid and Medicare, set by government agencies, do not pay them enough to offer their employees medical coverage. "We do not have much ability to increase prices because we are so dependent on Medicaid and Medicare" for revenue, he said.

Parkinson acknowledged that when nursing homes do offer health insurance to employees, the benefits are often limited. The coverage "is probably not up to what will be required" by the federal law, he said.

Medicaid covers about two-thirds of nursing home residents. States set Medicaid rates, and many states, facing severe budget problems, have reduced payments for nursing homes.

Starting in 2014, the law will require employers with 50 or more full-time employees to offer affordable coverage or risk paying a penalty. For a midsize nursing home, that penalty could easily exceed $200,000 a year. Nursing home executives are urging Congress and the Obama administration to spare them from the penalties.

Vanessa Valerio, 25, a certified nursing assistant who earns $10 an hour at Lakeview Christian Home in Carlsbad, N.M., said she was uninsured because she could not afford the coverage offered by her employer.

The chief executive of the Lakeview nursing home, Joanna D. Knox, said the company used to pay the entire premium for employees. It now requires workers to pay $25 of the $585 monthly premium for individual coverage.

"When we started charging $25 a month," Knox said, "many employees dropped coverage." Of the home's 200 employees, only 87 have elected it, she said, adding, "I don't know how we could possibly absorb the additional cost of providing coverage for the other employees."