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PRESS RELEASE: Statement from PHI President Steven L. Dawson on the Supreme Court Affirming the Affordable Care Act, June 28, 2012

June 28, 2012

Law Provides Affordable Coverage for 900,000 Direct-Care Workers, Strengthens Aging and Health Services for All

  Today, the Supreme Court upheld the Affordable Care Act (ACA), which extends health coverage to 32 million uninsured Americans. PHI applauds this decision, which confirms that health care is a right and a shared responsibility for all Americans.

Affirmed by this decision, we are especially pleased that 900,000 direct-care workers will finally have access to affordable health coverage. This is great news for America's elders and people living with disabilities.

These workers — more than a quarter of whom have no coverage today — provide care to millions of individuals who need assistance with daily intimate tasks such as dressing, bathing, toileting, preparing and eating meals, and taking medications. They are the foundation of our long-term care system: the individuals who make it possible for elders and people with disabilities to live where they choose, with respect and dignity. These are the workers who give peace of mind to millions of American families while they care for their loved ones.

Providing coverage for direct-care workers is essential to meeting the needs of an aging population. Affordable health coverage for all will make it easier to recruit a stable, well-trained, compassionate workforce to provide these services.

Direct-care workers will attain affordable coverage through two distinct mechanisms under the Affordable Care Act:

  • More than 350,000, who live in households with incomes below 138 percent of poverty, will be eligible for Medicaid coverage under the federal expansion. Though the Court ruled that states cannot lose all their federal Medicaid matching dollars for not expanding Medicaid coverage, we believe strongly that states will choose to participate in this unprecedented effort to ensure that all low-income Americans have access to health care. In the long run, a healthy population is more productive and less costly to our nation.
  • More than a half-million direct-care workers who cannot afford employer-based coverage will now be able to buy insurance through state-based market exchanges with premiums made affordable through government subsidies linked to income.

Consider the situation of Cindy Ramer, a 62-year-old CNA from Iowa. Ramer has struggled with affording health coverage for years. Her family was bankrupted by the high costs of medical care for her husband, who had diabetes and heart disease. Nonetheless, today she cannot afford insurance for herself.

"The coverage offered by my employer is so limited that when I had an accident and went to the emergency room for stiches, the policy covered only 10 percent of the costs," Ramer said. "I decided at that point the premiums were not worth paying, but I worry every day about what would happen if I got sick."

Ramer applauds today's decision. "When the Iowa exchange opens in 2014," she notes, "I will be able to shop for a policy that will be affordable and meet my needs. I won't have to wait for Medicare."

For direct-care workers — a predominately female (88 percent) and older (median age, 44) workforce — access to health coverage is critical. These workers are the foundation for keeping our most vulnerable elders and people with disabilities healthy and out of hospitals, yet they often struggle with chronic illnesses such as diabetes themselves. They also rank number one in days away from work due to occupational injuries.

The implementation of the Affordable Care Act will finally provide these crucial health care workers with the security of knowing that they can get the medical care they need to stay healthy and support both their families and their clients.

For more information on direct-care workers and health care coverage, see PHI FACTS 4 — Health Care Coverage for Direct-Care Workers: 2009 Data Update (pdf).

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PHI, the Paraprofessional Healthcare Institute (, works to transform eldercare and disability services, fostering dignity, respect, and independence -– for all who receive care, and all who provide it. The nation's leading authority on the direct-care workforce, PHI promotes quality direct-care jobs as the foundation for quality care.

Deane Beebe

PHI Media Relations Director


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