Child-Care Workers Protest Changes in Health Insurance

By The Providence Journal, R.I.



Dec. 21--PROVIDENCE -- Home-based child-care providers accused the governor and General Assembly of "trying to kill" them with changes that make some providers ineligible for reduced-rate health insurance.



Those strong words belong to Grace Brown, a child-care provider from Providence who lost her health insurance due to the new rules.



"Believe me, one of us here is going to die because we don't have the proper health coverage," Brown said at a demonstration outside the State House last night.



About 50 people donned hats, scarves and mittens to join in the procession. Headed by a sign proclaiming, "Medical coverage should be a human right, not a privilege," they marched around the ice-glazed plaza along Smith Street, chanting, "Restore health! Restore hope!"



The child-care workers are angry over a $1.2-million cost-cutting move the state's overwhelmingly Democratic lawmakers made this year at Republican Governor Carcieri's request. What is at stake is eligibility for reduced-cost health insurance, at rates that range, depending on income, from $61 to $130 a month for family coverage.



The lawmakers changed the rules in three ways: They raised from $1,800 to $7,800 the minimum a worker would have to earn every six months from taking care of eligible children to qualify for state-subsidized health care. Where before home-based child-care workers could qualify for the low-cost health care by taking in only one child, they now have to take in at least two every 26 weeks. And the lawmakers adopted an earnings cap that limits eligibility to child-care workers making less than 350 percent of the Federal Poverty Level which, today, means less than $56,315 annually for a family of three, for example.



The demonstration's organizers said the cutoff applies to household income, so it would include a spouse's income, even though only the child-care provider and his or her minor children -- not spouses -- qualify for the subsidized health insurance. (The demonstration was organized by District 1199 of the Service Employees International Union, the same union that's championing child-care workers' right to unionize.)



But looked at another way, the child-care workers can still have significantly higher household incomes than anyone outside their ranks and would be allowed to have and still qualify for some form of state-funded health-care coverage. Eligibility for the state's RIte Care eligiblity is capped, for example, at 185 percent of the Federal Poverty Level, which for a family of three -- whether a two-parent family or a single parent with two children -- is capped at $29,767 a year.



Norma Tetrault, a child-care provider from Pawtucket, said she was sick a few weeks ago, and had to beg her doctor to see her because she'd lost her insurance. The doctor agreed to charge her just $35, and gave her medication from his office supply, she said.



"What kind of child care do you think I'm providing when I'm sick like that, coughing all over the place, and I can't even get to a doctor?" Tetrault asked rhetorically.



Taking a more lighthearted tone, the demonstrators sang Christmas-song spoofs: "Health Care for All," to the tune of "Joy to the World" (sample lyrics: "Health care for all Rhode Island's kids and those who care for them. Let every heart in the State House listen to our song. . ."), and "Budget Night," to the tune of "Silent Night" ("Round yon State House, politicians making deals and cruel decisions, cut our health care to pieces...")



Last night, the demonstrators clearly sought to draw attention to their cause as the 2006 session's opening looms. "I am here tonight because I have hope, and I have faith, and I believe that the General Assembly will restore our health care," said Monica Marshall, a daycare provider from Providence.



According to the printed program for the demonstration, Marshall works an average of 14 hours a day, and devotes "most of her earnings" to child-care expenses. Marshall said she is diabetic, and can no longer afford to take her medication three times a day, as recommended. She also went without a flu shot this year because she lost her health coverage, she said.



Before the new rules took effect at the beginning of October, a total of 976 people -- including 581 home-care providers and 458 of their dependents -- were eligible for the state subsidized health-care coverage, according to the state Department of Human Services.



After the new rules went into effect, only 393 of the 518 child-care workers reapplied and only 251 of them were deemed eligible. The other 142 who applied were rejected as ineligible for a variety of reasons: six are no longer working as child-care providers; 68 exceeded the income cap by an average of $1,000 a month; another 41 did not meet the new earnings threshold; and 27 failed to provide all the required information, including documentation of their income.



In their own tally of the toll taken by the new law, the union organizers also count the 116 who did not reapply for the state-paid health coverage -- and 9 others who declined it -- after the new rules took effect.