Sign Up to Receive PHI Alerts

Statement Regarding the U.S. Supreme Court Decision on King v. Burwell, by PHI President Jodi M. Sturgeon

June 25, 2015

PHI (Paraprofessional Healthcare Institute) is pleased that today the U.S. Supreme Court reaffirmed (6-3) the clear intention of Congress to make affordable health coverage available to all. In King v. Burwell, the Court has stated clearly that individuals buying insurance through a health care market exchange, regardless of which state they live in, are eligible for tax credits if their income falls below 400 percent of the federal poverty level.

We agree wholeheartedly with the majority opinion (pdf), which states: "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them."

This decision ensures that hundreds of thousands of direct-care workers, living in states that have federally run exchanges, will continue to have access to affordable health coverage.

Direct-care workers — nursing assistants, home health aides, and personal care aides — provide vital health care and support services to millions of elders and people with disabilities. This workforce — mostly female and predominantly women of color — has historically struggled to access affordable health coverage. Prior to the expansion of coverage under the ACA, more than one in four direct-care workers — or close to one million workers — had no health coverage.

Direct-care workers, on average, earn about $17,000 per year, putting them just above the poverty level. For these low-wage workers, the cost of insurance is far out of reach without the tax credits that reduce the cost of insurance premiums.

Moreover, because of their low wages and often part-time hours, direct-care workers are less likely than the average American worker to be able to access employer-sponsored coverage. The Supreme Court's decision assures that 1.4 million direct-care workers who live and work in states affected by this decision will continue to have access to affordable coverage even if they are unable to access employer-sponsored insurance.

As our population ages and more people need long-term support, the direct-care workforce will need to grow by 1.5 million workers over the next decade. Access to affordable health coverage is essential to grow the pool of workers willing and able to become paid caregivers.

Today's decision is extraordinarily important to all low-income workers — but it also critical to our system of long-term services and supports, which families across America rely on to ensure the health and safety of their loved ones.

For state-by-state information on health coverage for the direct-care workforce, visit the PHI State Data Center.

— end —

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,, 718-928-2033 (office); 646-285-1039 (cell)

Caring for the Future

Our new policy report takes an extensive look at today's direct care workforce—in five installments.

Workforce Data Center

From wages to employment statistics, find the latest data on the direct care workforce.