Extending Health Plan to Caregivers Is Key First Step

Los Angeles County is poised, at last, to right a long-standing wrong in the way that it has treated some of its most important but least compensated caregivers.

For several decades, the California In-Home Supportive Services program has provided health care and personal assistance to one of the most vulnerable and dependent client populations imaginable: the roughly 230,000 residents who through age, infirmity or disability are unable to care for themselves, but through the grace of their program workers, are still able to live independently in their own home.

These workers, who until very recently earned only the minimum wage with no benefits or guaranteed time off, have--by avoiding the heavy costs of hospitalization or institutionalization--saved California millions of dollars more than the state has spent to fund the program.

The added benefits of allowing these clients to live in relative independence, dignity and privacy, of course, cannot even be quantified. Some 72,000, or nearly a third, of the state’s total IHSS work force reside in Los Angeles County.

Several years ago, the Board of Supervisors at last began the incremental process of improving their situation. First, the board established the self-governing Personal Assistance Services Council, creating a legal “employer of record” with whom these traditionally independent workers could bargain collectively.

Having fought for and won their right to unionize, the IHSS workers were then able to negotiate a modest wage hike. Since that time, for more than a year, the board and the council have been struggling to secure for them the most fundamental benefit a worker in any field can hope to receive: a health plan that they can call their own.

It has been a bitter irony that these workers--many of them elderly or otherwise in particular need of health services--who provide life-saving health care to others had yet to be given an opportunity to receive a stable and guaranteed level of health care themselves. Today, that has finally begun to change.

In recent weeks, the board, after months of impassioned debate and heart-rending testimonials, has agreed to furnish IHSS workers providing care for at least 112 hours a month with eligibility in the county’s 15-year-old Community Health Plan, offering a range of services within the county’s extensive network of clinics, comprehensive health centers, hospitals and community-based nonprofit health care partners.

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While the details remain to be hammered out between the council and the IHSS workers, several things about this arrangement are already known:

* The Community Health Plan is financially sound and, in fact, the more IHSS workers who enroll, the more financially sound it becomes since we project that state reimbursements will outstrip the anticipated costs.

Our estimates show, for example, that covering 2,555 workers nets $1.4 million in additional revenues, while enrolling 7,799 workers nets $3.9 million for the county’s health plan.

* Designating the plan as the IHSS health-coverage provider will buttress a plan serving 124,000 members that has proven its value over 15 years, compared to the relatively untested alternative serving only 6,000 members for only the past two years.

* Administrative overhead costs of the Community Health Plan will be substantially less--at an estimated 12%, less than half those incurred by the suggested alternative--thus releasing more money to be programmed into direct services benefiting plan members.

* Adding the IHSS work force to the plan’s member mix offers a natural alignment with the unionized work force in the county’s health-care system. This synergy offers additional incentives to maintain high-quality medical services, retain health-care clients within county facilities, and strengthen alliances to win more support and resources for the county health system.

Make no mistake: This is evolution, not revolution. Los Angeles County is still home to nearly 3 million uninsured residents, fully a third of all those under the age of 65, a number that has remained dismayingly constant for nearly a decade. As a county, we will not and cannot ever insure them all. As a society, we have every duty to try.

With this important first step, we have done what we should. We will continue to do what we can. And we must always strive to do even better.