Senate Bill Maintains Direct-Care Worker Provisions

Posted on01 December 2009

Matt Ozga - PHInational.org

Following months of intense negotiations and extensive input from stakeholders, Senate Majority Leader Harry Reid (D, NV) and other Democratic leaders presented the blended Senate health insurance reform bill on November 18.

The new legislation, the Patient Protection and Affordable Care Act, would extend coverage to 94 percent of Americans.

PHI’s side-by-side chart (pdf) provides an update of the new Senate bill and compares the House and Senate provisions.

Some of the most significant provisions of the bill include a public insurance option that gives states the choice to opt out, an excise tax on high-cost insurance plans offered by employers, and a Medicare payroll tax on people with high-incomes (individuals with annual incomes above $200,000 and couples above $250,000).

There are also many provisions — some related to health coverage, others to long-term care services — that could have significant impact on direct-care workers. The major changes since the Senate Finance and HELP committees released their proposals this summer include:

• Expansion of mandatory Medicaid coverage to include all non-elderly Americans with income below 133 percent of the federal poverty level (FPL), which is $24,352 for a family of three. (While affordability premium credits for individuals between 150 and 400 percent FPL have been scaled back, out-of-pocket spending has been capped to protect individuals’ level of cost sharing at each income tier.) With median annual wages of $17,000, many direct-care workers would gain affordable comprehensive coverage through Medicaid.
• Inclusion of the CLASS Act — a new, voluntary, public long-term care insurance program to purchase community-living assistance services and support for individuals with functional limitations.
• Advancing the establishment of core training competencies for personal care attendants through three-year demonstrations in six states.

Preliminary Congressional Budget Office (CBO) estimates of the blended bill project a cost of $848 billion, a figure that would reduce the federal deficit by about $130 billion over the next 10 years.

The next step is floor consideration, where the entire Senate will debate and vote on the bill. Debate began earlier this week.

Delays in CBO analyses have led to increasing speculation that work on health reform could continue into the beginning of next year.