Challenges Faced by Home Care Workers in Securing Health Insurance Benefits
Over three million people in the United States work as home and personal caregivers, yet many face obstacles in securing affordable health insurance due to low wages and changes to tax credits. Joyce Rena Bumbray-Graves, a home care worker in Woodbridge, Virginia, cares for her adopted sister Leah and great-niece Lisa, both requiring extensive medical assistance. She receives compensation for her caregiving through Virginia's Medicaid program.
Following the expiration of enhanced Affordable Care Act (ACA) tax credits on December 31, 2025, Bumbray-Graves saw her health insurance premium surge from $544 to over $1,300 per month. This financial strain led her to relinquish her coverage, despite her vital role as a healthcare provider. “I work in health care and I can’t afford health insurance,” she stated during her testimony before the House Budget Committee.
The Financial Strain on Home Care Aides
Home health and personal care aides, including approximately 3.2 million workers, are crucial in enabling elderly and disabled individuals to live at home rather than in nursing facilities. Despite a median hourly wage of $16.77, many workers do not receive pay for travel time between clients and rarely achieve a full 40-hour work week. Consequently, their median annual wage is around $22,000, with over half lacking employer-provided health insurance.
Leslie Frane, executive vice president of the Service Employees International Union (SEIU), describes the situation as a 'triple blow' involving the loss of ACA subsidies, potential Medicaid cuts affecting caregiving service programs, and reduced client care benefits. This creates a significant burden on home care workers who provide essential services but struggle to afford basic healthcare for themselves.
Potential Coverage Losses and Advocates' Response
The Congressional Budget Office estimates that the expiration of enhanced ACA credits and possible Medicaid cuts could leave approximately 20 million individuals without coverage. The KFF anticipates a significant increase in marketplace premium payments, potentially causing millions to lose coverage in the coming year.
Efforts for systemic change continue, exemplified by SEIU Virginia 512’s advocacy for collective bargaining rights for home care workers at the state level. This legislative push underscores the critical nature of caregivers' work and the need for improved working conditions and benefits. Frane highlights the moral imperative to recognize and fairly compensate these workers, predominantly people of color, historically excluded from basic labor protections.
As Bumbray-Graves continues her caregiving role without health insurance, she exemplifies the broader challenges faced by many in this vital industry. Advocates persist in calling for policy reforms to ensure those providing indispensable care receive accessible health coverage and fair compensation.