Poll: Nearly 50% of Home Care Providers to Cut Staff

A controversial Affordable Care Act provision could be pressuring a notable proportion of home health providers to shed workers, suggest findings from a recent Home Health Care News poll.

Nearly half of respondents to the poll (48%) said they will reduce staff due to the ACA’s so-called “employer mandate,” while fewer said they will not cut staff (35%) or are undecided (17%).

Under the mandate, companies with 50 to 99 full-time employees (FTEs) will have to provide affordable insurance coverage to those workers starting in 2016, or face fines. And companies with 100 or more FTEs will have to provide the coverage to 95% of workers, up from 70% currently.


The employer mandate originally was set to take effect in 2014, but the Obama administration delayed implementation, in part due to pressure from business owners who said it would impose a burden and that they needed more time to prepare. Implementation is now set for Jan. 1, 2016.

There is some debate about what the large-scale impact of the employer mandate will be, because most U.S. employers have fewer than 50 people on the payroll. However, large employers with 100 or more workers account for a vast proportion of the overall workforce, at about 70%.

And home care industry advocacy groups, such as the National Association for Home Care & Hospice, have long warned that the mandate could have widespread repercussions on providers. A 2013 NAHC study found that 90% of private pay home care providers do not offer insurance to personal care aides.


In fact, the Internal Revenue Service specifically name-checked home care in a final rule on the mandate issued in 2014, saying that the industry is not exempt from its requirements.

One especially contentious aspect of the mandate is that it defines a full-time employee as someone who works 30 hours or more a week. Critics say that the definition should be changed to the more commonly accepted 40 hours. But even with the lower threshold, employers could seek to control insurance-related costs reducing workers’ hours in lieu of cutting staff.

The HHCN poll gathered answers from 40 respondents between May 29 and June 8. 

Written by Tim Mullaney

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