Lobbyists’ fight for Health-Law Exemptions should prompt real reform

(From New America Media)

By Paul Kleyman

According to the front-page New York Times article last Monday, “Nursing Homes Seek Exemptions From Health Law,” the nation’s major nursing home and home care associations are crying poor on behalf of their small-business owners who will be run out of business if they have to start covering their $10-$12 an hour employees under health care reform.

Veteran health policy reporter Robert Pear wrote, “Starting in 2014, the law will require employers with 50 or more full-time employees to offer affordable coverage or risk paying a penalty… Nursing home executives are urging Congress and the Obama administration to spare them from the penalties.”

Some are grating on Pear’s example of employees at a nursing home who dropped their health care coverage when the home they work for told them to pay a $25/month share. Pear doesn’t indicate how common the resistance is, but it doesn’t surprise me.

These are workers at the bottom of the heap, many of them immigrants and middle aged or older women.

Although $25 might seem little more than lunch money to New York Times readers like myself, it’s a bag of groceries at the discount grocery to often ill-trained, underpaid direct-care workers with few job prospects.

So there’s unstated issue No. 1: Who exactly is caring for your mom or dad?

Today, it’s probably someone so devalued and distrustful of the American system that he or she not only can’t afford a seemingly small premium, but also doesn’t trust any move to take money out of his/her meager paycheck. And many have significant challenges themselves in navigating the American health care system.

Pear quotes Charlene A. Harrington of the School of Nursing at the University of California, San Francisco, and one of the leading voices for humane and effective care of elders for the past quarter century. She told Pear that Congress or the administration should not relieve nursing homes of the obligation to provide coverage to employees.

Harrington stated, “It’s scandalous to have nursing home employees taking care of people when they themselves lack coverage and go without care… If employees have health insurance, they are more likely to be treated for illnesses, less likely to pass on infections to nursing home residents and more likely to get early treatment for occupational injuries.”

Yes, on the job injuries, especially back injuries, are very high in this group, so why are these long-term care companies trying to stick premiums on policies they admit (in Pear’s article) frequently offer only limited coverage?

The real crisis has nothing to do with whining health care lobbyists. They are doing zilch to meet the looming lack of qualified health care workers for our aging nation. (See the landmark 2008 Institute of Medicine report “Retooling for an Aging America: Building the Health Care Workforce”.)

Regarding direct care workers, key issues related to what these nursing and personal care aides endure is encompassed by the Caring Across Generations campaign, a project of the National Domestic Workers Alliance. It calls on Congress to pass legislation that would:

1) Create 3 million jobs in direct care over five years;
2) Establish a career ladder to train and certify domestic workers and other workers as direct care workers (“career ladder” is jargon for job advancement and stability);
3) List a new visa category to provide a path to legalization and citizenship for these domestic workers—you know, the kind of people anti-immigrant Tea Party types put in charge of caring for their family elders);
4) Set labor standards for direct care and domestic workers, and eliminate existing exclusions in the labor law to ensure that the jobs created are quality jobs;
5) Give a tax credit to families paying for the cost of direct care for their loved ones.

Unstated issue No. 2: The Health Industry Can’t Afford Itself

The big fat issue here is a health industry crying poor because it can’t afford the system which it itself helps keep too costly and inefficient in the first place. This story is an argument for effective national health care — nothing more nor less.

Look, if these industries — the American Health Care Association (AHCA), serving mostly for-profit nursing homes, and National Home Care Association are pleading poverty because so many are small or medium business, isn’t that a powerful argument for going to a more affordable and effective health care system? (See the two letters in Monday May 16’s New York Times editorial section.)

Meanwhile, costs need to be controlled. That will take a President and national leadership being Osama-decisive in the health care Situation Room. So far, though, the health care lobby has our fearless leaders quaking, as usual, in their campaign boots instead of sending in the American health equivalent of Seal Team 6 to deal with the Greed Lobby.

Governor’s and ex-Governors need to stand up for decency, not pathetic budget arguments, too — including some Democrats like former Kansas Governor Mark Parkinson, the for-profit nursing home lobbyist Pear quotes in his article.

The key here is that once again, an industry that fought for limited regulation to maximize its profits is crying poor by hiding behind its employees’ and holding up small-business operators like human shields to keep the big employers from paying more. (I don’t know how many private equity firms now own nursing home or home care chains, but the Times did a pretty good expose on this about three years ago.)

A well-regulated health care system with prudent cost controls — sounds like a win-win for everyone, even nursing home and home care operators. And it’s one offered worldwide by socialist and capitalist nations alike, in single payer — and multi-payer examples, some involving companies. But that’s all about money.

Here’s the bottom line: Affordable, quality care — it’s your mother, stupid!