Nursing homes in nearly all 50 states are looking into their future with uncertainty, as Medicare and Medicaid cuts seem certain. Further, skilled nursing facilities are required to comply with the Affordable Care Act, which mandates that employers with 50 or more employees provide health insurance or pay a shared responsibility fee. According to a White House brief, 96 percent of all employers with more than 50 employees already provide ample coverage. Many nursing homes, however, do not offer health insurance to hourly employees. 
The New York Times recently reported on the growing concern of many nursing homes and home care agencies who are petitioning for exclusion from the new law. Twenty-five percent of nursing facility staff and 33 percent of home care workers are uninsured. Low wage-earners who work for organizations that do offer coverage often can’t afford premiums.
Mark Parkinson, president of the American Health Care Association, is active in lobbying efforts to exclude nursing homes and home care providers from the requirement. According to Parkinson, Medicare and Medicaid reimbursement rates are too low to allow health providers to cover the cost of insurance for workers. Potential cuts to these reimbursement rates only further complicate the issue. Skilled nursing facilities who opt out of providing coverage will face a penalty, which The Times estimates could exceed $200,000 per year for a mid-size facility.
Charlene A. Harrington, professor at the School of Nursing at the University of California in San Francisco, has a different take on the situation. She feels that nursing homes and other healthcare providers should not be exempt from the requirements, pointing out that direct care workers with adequate health care coverage are more likely to be treated for illness and, therefore, less likely to pass dangerous infections to residents.
Parkinson has suggested a number of alternative solutions, such as exempting only those organizations who enter financial distress as a result of compliance or allowing penalties to be used as a tax write-off.
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