The recent federal government announcement that employer
responsibility for providing health insurance to their employees under the
Affordable Care Act (aka “Obamacare”) will be delayed for at least another year
is not good news for backstretch workers.
In most of the US, grooms and hotwalkers – the lowest-paid
workers on the racetrack – have no health care coverage at all. If they’re
injured on the job, they get workers’ compensation payments – and may or may
not have a job to come back to when they’ve recovered. And in some states,
jockeys and exercise riders who are injured on the track are covered under
separate workers comp. pools, like New York’s Jockey Injury Compensation Fund,
paid for with a combination of trainer per-stall charges and a percentage of
owners’ purse winnings.
But, apart from those job-related injuries, backstretch
workers are pretty much on their own when it comes to health care. And, if they
have spouses and children, their families are out in the cold as well. With
weekly salaries of perhaps $300 to $500, hotwalkers and grooms can’t afford
health insurance on their own, and they generally earn just too much to qualify
for Medicaid. And few trainers provide health coverage for all their workers.
In at least two states, California and New York, there’s a
comprehensive effort to provide at least the basics of a health care system for
backstretch workers.
On the West Coast, the California Thoroughbred Horsemen’s
Foundation (“CTHF”), founded by trainer Noble Threewitt, operates full-time
clinics at Santa Anita and Golden Gate Fields, and also provides once-a week or
thereabouts mobile clinics during race meetings at Del Mar, Hollywood,
Pleasanton and San Luis Rey Downs. In addition, the CTHF provides assistance
with referrals to specialists for injuries or illness that are beyond the scope
of the clinics and pays some, though by no means all, of backstretch workers’
hospital costs.
The CTHF is funded by the proceeds of unclaimed pari-mutuel
tickets (a declining funding source in the age of internet wagering), and by
contributions from the tracks and from the Thoroughbred Owners of California.
It recently received a $200,000 anonymous donation, brokered by trainer John
Sadler.
Back on the East Coast, the Backstretch Employee Service Team
(“BEST”) operates clinics at Belmont and, in-season, at Saratoga. Like CTHF, BEST
has a plan for paying backstretch workers’ costs for specialist referrals,
medical tests and, within limits, hospital visits. BEST is funded principally
by contributions from the New York Racing Association (“NYRA”) and the New York
Thoroughbred Horsemen’s Association (“NYTHA”), representing owners and trainers
who race at NYRA tracks. BEST also receives significant support from a variety
of government grants and from John Hendrickson and Marylou Whitney. You can
read more about BEST here, here and here.
Both California and New York also offer at least some dental
care to backstretch workers, in California directly through CTHF and at NYRA
tracks through NYTHA and the donation-financed dental clinic at Saratoga.
[Disclosure: I’m a member of the Boards of Directors of both
NYTHA and BEST and am involved in BEST’s efforts to adjust its programs to the
requirements of the Affordable Care Act.]
Because so few racetracks around the country offer any
access to health care for backstretch workers, and because working on the track
is still something of a gypsy life, with trainers moving their horses from
track to track and state to state, workers sometimes save up their medical
needs until they’re somewhere that does offer treatment. So, when trainers ship
in to Saratoga from, say, Kentucky, or when barns return to Belmont from a
winter in Florida, it’s common to see workers lining up at the BEST clinic with
a year’s, or a lifetime’s, worth of medical problems. There’s probably less of
that in California, just because it’s farther from other major-league racing
venues, but in New York it’s a big issue. And it's still unclear how Medicaid or insurance coverage under the Affordable Care Act will work for people who move from state to state.
Under the Affordable Care Act, employers with more than 50
full-time workers will eventually have to offer health insurance. That’s the
requirement that was just postponed for a year. But, in any event, there aren’t
all that many trainers in the US who have more than 50 employees. Most stables
are a lot smaller than that, so their workers wouldn’t have the option of
employer-provided health care anyway.
Apart from employer coverage, the Affordable Care Act makes
a number of changes that are still scheduled to take effect January 1, 2014,
and that will have a big impact on the backstretch.
First, at least in participating states, which include New
York and California, there will be a significant expansion of Medicaid, so a
number of backstretch workers who now make a little too much to qualify will
become eligible for this state-run and federally funded program. Eligibility
will now extend to workers making up to 133% of the federal poverty level of income.
For 2013, those eligibility limits are $15,282 for a single individual and
$31,322 for a family of four.
Second, for those who earn too much to be eligible for
Medicaid, the “individual mandate” of the Affordable Care Act will apply, and
those folks will be required to obtain health insurance coverage through the
“exchanges” that are being set up in participating (read Democratic) states;
workers in states where Republicans have blocked implementation of the law will
be able to go on a national exchange to find coverage.
The cost of that coverage will be limited to somewhere around 3-4% of gross
income for most backstretch workers, depending on their earnings, with
tax-credit subsidies available to offset a portion of the premium costs. Even so, it’s safe
to predict that many backstretch folks will decide that $60-80 a month (their
premium cost after subsidies) is just one expense too many and will decide to
forego signing up for coverage and instead take their chances with the
imposition of penalties when or if they file their tax returns.
Third, the Affordable Care Act provides no coverage for
undocumented non-US citizens or residents and in fact makes it illegal for them
to obtain health coverage through the exchanges. That undocumented group makes
up a significant share of the backstretch workforce, though no one knows
exactly how big a share.
And finally, the Affordable Care Act requires that any
health insurance plan, whether offered through the exchanges or by an employer,
meet certain minimum standards, including the scope of its coverage and its
dollar limits. Unless waivers are granted, that may mean that so-called
“mini-med” plans like those now offered by fast-food and retail employers, with
low dollar limits and many coverage restrictions, will not be permitted. But,
in any event, a “mini-med” plan offered through the CTHF or BEST would not
relieve individual backstretch workers of the obligation to sign up for their
own health insurance through the exchanges.
So what does all this mean for backstretch workers, and for
CTHF and BEST? For certain, the coming into force of the Affordable Care Act
won’t eliminate the need for these workers to have some help in getting decent
health care. Even for those who qualify for Medicaid or who decide to obtain
insurance through the exchanges, there will be co-payments, deductibles and
incidental costs that, on the typically low salaries paid at the track, they
won’t be able to afford. And for those without a legal immigration status,
there won’t be anything at all.
So, at a minimum, backstretch workers will still need access to on-track clinics like those operated by BEST and CTHF, and even, to the extent the clinic sponsors can afford it, to an expanded range
of services, including more medical tests and more
specialist services.
And backstretch workers will need education to help them take advantage of
the expanded care available under the Affordable Care Act, to enroll in Medicaid, for those eligible, and to navigate the online insurance
exchanges that are being set up.
Beyond that, there will be economic gaps that need filling in under the Affordable Care Act, to pay premiums, co-payments and
deductibles and, especially, to find mechanisms to ensure that undocumented
workers, who are ineligible for Medicaid and for exchange-provided insurance,
have some kind of safety net that goes beyond showing up at the nearest
hospital emergency room.
Because New York and California already have strong organizations -- BEST and CTHF -- providing backstretch health care, there's a good chance that these gaps will indeed be filled in a timely fashion. But things are less sanguine in those states without on-track health programs and where political leaders are actively opposing implementation of the Affordable Care Act. One can only hope that all the stakeholders in the industry will join together to take advantage of the opportunities offered by the Affordable Care Act and to continue to meet the needs of the largely invisible folks who work on the backstretch every day to keep the game going.
Because New York and California already have strong organizations -- BEST and CTHF -- providing backstretch health care, there's a good chance that these gaps will indeed be filled in a timely fashion. But things are less sanguine in those states without on-track health programs and where political leaders are actively opposing implementation of the Affordable Care Act. One can only hope that all the stakeholders in the industry will join together to take advantage of the opportunities offered by the Affordable Care Act and to continue to meet the needs of the largely invisible folks who work on the backstretch every day to keep the game going.