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Supreme Court Ruling Means More Direct-Care Workers Will Have Health Coverage

June 25, 2015

The U.S. Supreme Court upheld on June 25 a key provision of the Affordable Care Act (ACA), ensuring that millions of lower-income people — including many direct-care workers — can keep their subsidized health insurance.

In a statement, PHI President Jodi Sturgeon said that PHI “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.”

The case, King v. Burwell, hinged on whether the ACA could allow people earning less than 400 percent of the federal poverty level (FPL) to access federal tax subsidies to help them buy health coverage on the federally run health insurance exchanges in states that did not set up their own exchange.

The Supreme Court’s majority opinion (pdf) said that the ACA should be interpreted to allow residents of every state to have access to insurance subsidies. 

Chief Justice John Roberts, who wrote the opinion, said that the ACA’s intent is clear:

Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.

The ACA, which was signed into law in 2010, called for each state to create and run its own insurance exchange, but only 16 states (and the District of Columbia) have done so thus far. The U.S. Department of Health and Human Services stepped in to establish federally run marketplaces for residents of the 34 remaining states.

The plaintiffs in King v. Burwell argued that only those people purchasing insurance through state-run exchanges should have access to federal tax subsidies.

Impact on Direct-Care Workforce

An estimated 1.4 million direct-care workers with incomes between 100 percent and 400 percent of FPL live and work in the states affected by the King v. Burwell decision. It is likely that hundreds of thousands of them were able to gain health coverage with the subsidies; the average direct-care worker earns just $17,000 a year, well under 400 percent of the FPL.

“This workforce — mostly female and predominantly women of color — has historically struggled to access affordable health coverage,” Sturgeon said in her statement. “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.”

As long as direct-care jobs continue to pay low wages and offer paltry benefits, the ACA will be the only way for many direct-care workers to afford health coverage. The law must be maintained if the U.S. hopes to build the strong direct-care workforce necessary to meet rising demand for care, Sturgeon stated.

“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,” she concluded. “Access to affordable health coverage is essential to grow the pool of workers willing and able to become paid caregivers.”

— by Matthew Ozga

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