Covered California to cut patient costs...

states, along with Massachusetts, New Jersey, Rhode Island, and Vermont, as well as the District of Columbia that have their own health coverage mandate, though not all levy a tax penalty for remaining uninsured.

Among them, California is most aggressively trying to lower health care costs and achieve universal coverage, said Larry Levitt, executive vice president for health policy at KFF.

“Even though they may disagree on the big picture of health care reform and singlepayer, California Democrats have managed to come together and unify around these incremental steps to improve the current system,” Levitt said. “Step by step, they have put in place the pieces to get as close to universal coverage as they possibly can.”

Democratic leaders in the state have faced political blowback for not using the penalty revenue for health care, details first reported by KFF Health News, even though Newsom and other Democrats vowed to spend the money to make health care more affordable in Covered California.

Advocates say the deal represents a win for low- and middle-income people.

“We’re excited that this money is protected for health care, and ultimately is set aside for future affordability assistance,” said Diana Douglas, chief lobbyist with the consumer advocacy group Health Access California. Advocates want the state to tap those health care dollars to get more people covered, such as lowering health care costs for immigrants living in the state without legal permission.

A bill this year by Assembly member Joaquin Arambula, a

Fresno Democrat, would require Covered California to establish a separate health insurance marketplace so that immigrants who lack legal status and earn too much to qualify for Medi-Cal, California’s version of Medicaid, can purchase comprehensive coverage that is nearly identical to plans sold on Covered California. Currently, immigrants without legal residency are not allowed on the exchange. Other states, such as Washington and Colorado, have set up similar online marketplaces.

“We’re working hard to create a system that has equal benefits and affordability assistance for everyone,” Arambula said.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KFF Health News is a national newsroom that produces indepth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism.

Domestic workers are America’s most...

paycheck while their loved ones are safe and secure,” said Biden in a statement announcing the executive orders. “These unsung heroes strengthen our communities and form the backbone of our nation’s economy.”

Low pay, no sick leave

The president noted that domestic workers are among the lowest paid workers in the US economy, and often juggle multiple jobs while struggling to care for their own households.

“Family care givers are especially overstretched,” said Poo July 19, speaking at The Scan Foundation’s first Advancing Health Equity in Aging summit. “Other countries have a social safety net. We use workers to take care of our families, but they are grossly underpaid, have no sick time, and sometimes no days off,” she said.

“We have worked to make childcare and elder care good paying jobs, with access to medical leave and paid time off. The progress has been slow and incremental,” said Poo.

Domestic Workers Bill of Rights

Poo has worked on labor rights issues since 1996, and was the 2014 recipient of a MacArthur Fellowship, also known as a “Genius Grant.”

The NDWA was established in 2007. It achieved its first victory three years later, when the state of New York passed the nation’s first-ever Domestic Workers Bill of Rights.

The new law provided comprehensive employment benefits to domestic workers, including overtime pay, paid vacation, sick time, and health insurance coverage.

The legislation was revised in 2021 to add additional protections including provisions for undocumented workers, who often face wage theft by their employers. In New York, domestic workers are defined as full-time nannies, au pairs, housekeepers, and the caretakers of elderly people.

The value of stories

Poo spoke about the power of hearing directly from people she hoped to impact. “When we first set out to rewrite labor laws in New York, we realized we had to ask domestic workers what they really needed.”

The NDWA set up a conference, reaching out to potential attendees at churches, parks, and other venues. “We listened to each one of them for hours,” she said, noting “there were interpreters in seven languages.”

“Listening to people really helped us win. You have to engage with people who have the most at stake.”

Poo shared her credo: “Listen to learn, not confirm.”

State legislation

10 states have now adopted legislation to protect domestic workers. California passed AB 241 in 2013, granting, in part, overtime pay to domestic workers at one and a half times their regular rate of pay for any hours worked in excess of nine hours in a day or in excess of 45 hours in a week.

Connecticut, Hawaii, Illinois, Massachusetts, Nevada, New Mexico, Oregon, and Virginia also have some version of a Domestic Workers Rights Bill. And three cities have also passed similar legislation: Philadelphia, Chicago, and Seattle. Philadelphia’s law is considered the strictest in the nation, requiring a written contract with a description of duties, along with rest breaks and meal breaks, as well as paid time off.

Disability care

The attempts to establish such legislation have received push-back from organizations supporting differently-abled people. “Raising the minimum wage for personal attendants without raising Medicaid resources meant that many people would lose access to their care providers. People couldn’t afford care,” explained Poo. She stressed the need to expand financial resources to the disabled community.

“So many false choices trap us,” said Poo. “We need to find the emotional truth.”

“Our biggest challenge is making people understand that change is possible,” she said. “I can’t believe how far we’ve come.” (Sunita Sohrabji/Ethnic Media Services)