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Health aide with elderly patient
Millions of working poor, more than 4 million, will continue to be shut out of affordable health insurance and health care, even after Obamacare kicks in in six months. Those millions work in the 19 states where Republican governors or legislators refuse to accept federal funding to expand Medicaid. Ironically, many of these people work for the state, and are health-care workers. Like these women in Texas:
Rose Ruiz collects $8 an hour cooking, cleaning, checking the oxygen tanks and changing the diapers for a 67-year-old diabetic confined to a studio apartment on the south side of Austin,Texas.

Ruiz, a home health aide to Medicaid patients, has no medical insurance herself. Her best shot at getting access to doctors and medicines for her own needs was through President Barack Obama’s expansion of the federal-state Medicaid programs. [...]

“The politicians don’t know where I’m coming from, they don’t walk in my shoes,” said Shantelle Williams, a home aide who makes the U.S. minimum wage of $7.25 an hour tending to patients just south of Dallas. “That decision was for them, it wasn’t for me.”

The irony for these workers is that the wages companies pay for home health aides are guided by Medicaid, averaging just less than $10 an hour nationally, said William A. Dombi, vice president for law at the National Association for Home Care and Hospice. That precludes their employers from paying much beyond minimum wage.

Many of the employers are like Ruiz's, the Austin non-profit Helping the Aging, Needy and Disabled Inc. This isn't an organization that can afford to provide health insurance for its employees—health care aides. They make too much to qualify for traditional Medicaid, and they don't make enough to qualify for subsidies to buy insurance on the new exchanges. Those exchanges weren't designed to take the working poor, because Medicaid expansion was supposed to take them in. The Supreme Court wrecked that, too.

As of now, there isn't a plan to close the gap. And there's probably not going to be one, because the Republican House of Representatives won't allow anything to pass that would make Obamacare work better. It would be as bad as the status quo, except that it's worse because now the non-profits employing home health aides potentially face paying a penalty for not being able to insure their employees.

We're a long way away from having the nation's health care system reformed.

Originally posted to Joan McCarter on Tue Jun 25, 2013 at 04:07 PM PDT.

Also republished by Daily Kos and Daily Kos Labor.

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