Without Medicaid Expansion, Home Aides Caring For The Sickest Americans Don’t Have Their Own Insurance

As a home health aide, Rose Ruiz earns about $8 dollars an hour caring for Medicaid patients in Texas. Ruiz cooks, cleans, checks oxygen tanks, and changes diapers for disabled people who need her assistance. “I look at it as taking care of people who need help more than anyone else,” Ruiz explained to Bloomberg News.

But Ruiz doesn’t have any health care herself. She makes about $540 every two weeks, which she says isn’t enough to buy an insurance plan. And she doesn’t get insurance through her employer — typical for home care organizations, which have to negotiate their prices with the government and say they can’t afford to offer their workers health care. Ruiz would have qualified for public insurance under Obamacare’s Medicaid expansion, one of the central tenets of the health reform law that seeks to extend public health insurance to low-income Americans who don’t currently qualify for it. But her lawmakers have refused to expand Medicaid in Texas, leaving Ruiz without any options.

“The politicians don’t know where I’m coming from, they don’t walk in my shoes,” Shantelle Williams, another home aide working in Texas who scrapes by on minimum wage, told Bloomberg in reference to the state lawmakers who rejected Medicaid expansion. “That decision was for them, it wasn’t for me.”

Across the country, other health aides are in similar positions. About 37 percent of home health workers were uninsured in 2009. Thanks to a loophole in labor protection laws, most health aides make less than minimum wage and are often forced to forgo their own medical needs because they can’t afford to address them.


And, as Baby Boomers age, the hospice industry continues to grow. The low-paying home health aide position is currently the fastest-growing job in the country. That’s partly why home care groups are joining other advocates in Texas to fight for state-level Medicaid expansion. As they add more and more employees to their rolls, they worry about the cost of providing health care to people who would have otherwise qualified for public health insurance under Obamacare.

“It is shameful,” Jennie Baird, the president of a trade group that runs the hospice company Angels at Home Inc., said. “With a business with low-income workers like pizza delivery or fast food restaurants, they can pass on their higher rates to customers. But we can’t do that because our rates are set by the federal and state government.”

Home health aides like Ruiz and Williams are part of the approximately 1.5 million low-income people who will go uninsured in Texas because of Gov. Rick Perry’s (R) decision not to expand Medicaid. Some uninsured people in Texas have been seeking medical care across the border in Mexico because they can’t get it in their own state.