Op-Ed: Washington state’s investment in caregiver health: A model for expanding high-quality, affordable healthcare coverage


Eli Kirshbaum


We all deserve the peace of mind that high-quality, affordable healthcare coverage provides. Ongoing, preventative care is proven to support better health outcomes over time. And it prevents unexpected or emergency care costs from spiraling into catastrophic debt.

Yet too many people – especially those earning low and moderate wages – can’t access the healthcare services they need. This is especially true for Black, Indigenous and People of Color (BIPOC) and immigrants, who are more likely to work in lower-wage jobs.

But it doesn’t have to be this way.

SEIU 775 Benefits Group, in collaboration with our partners, provides high-quality, affordable health coverage and holistic, tailored, wrap-around health benefits to Washington state’s caregivers. This is especially noteworthy because caregivers – mostly women and often women of color – have been historically excluded from many worker benefits other professionals take for granted.

As such, our model can offer a framework for expanding access to comprehensive care and improving health outcomes for more low- and moderate-wage workers.

Partnerships to support high-quality, affordable healthcare coverage

Washington state’s commitment to caregivers’ health and wellness is unique. Our strong labor-management partnership – made up of caregivers’ employers and their union, SEIU 775 – and crucial investments from our state legislature means that no matter their employer, caregivers can count on our health insurance and benefits.

As a result, more than 52,000 caregivers have access to our health and wellness benefits, with nearly 23,000 enrolled on one of SEIU 775 Benefits Group’s health plans. We’re dedicated to keeping costs low and quality high.

As a value-based purchaser of healthcare, our health plan partners Kaiser Permanente and Aetna are incentivized to work with us to achieve better health outcomes for caregivers. For a monthly co-premium of just $25 per month, caregivers can access healthcare with no or low co-pays for a wide array of services.

And this year, we’re excited to add a full dental benefit for caregivers’ children for just $10 per month. With further investments from the state, this dependent coverage could be expanded to ensure caregivers’ children can access full healthcare services.

Data-driven health benefits designed to support caregiver wellness and keep care affordable

As a self-insured healthcare purchaser, we take on the risk for financial gains and losses in our plans. To manage costs, it’s critical we thoroughly understand our caregiver population.

It’s not uncommon to hear from our caregivers that this is the first time they’ve been insured or received workplace health benefits.

And many BIPOC and immigrant caregivers may distrust healthcare systems due to past negative experiences or not receiving culturally appropriate care. These deep structural inequities can lead to a host of unaddressed or undiagnosed health issues and a limited understanding of navigating the complex healthcare system.

For example, compared to the overall population, caregivers experience:

• A higher prevalence of Adverse Childhood Experiences (ACEs).
• Higher rates of anxiety and depression.
• A greater likelihood of being a smoker.
• Notably higher obesity rates, with nearly half of caregivers affected.
• A 4x higher on-the-job injury rate.

“I have asthma, so it’s a constant worry because I need my medicine. The impact on my life from having insurance has been wonderful. I don’t have to worry about how I’m going to pick up my medicine.” – Katherine M., caregiver

This information helps us strategically build benefits and programs that provide caregivers with interventions that minimize the need for expensive operations and procedures and build good health over time, such as:

Making preventive screenings easy: Colon cancer is the second most common cause of cancer-related deaths and is highly preventable if detected early, with people who are obese and who smoke at increased risk. Historically, few caregivers were taking advantage of their health plans’ fully covered colonoscopies, citing difficulty taking time off work. In response, we worked with our providers to send at-home fecal immunochemical tests, or “FIT” kits, to caregivers over age 50, so they can easily send in a stool sample for testing. For the past 3 years, nearly half of eligible caregivers participated, and the 4% with positive tests were contacted for colonoscopies.

Supporting emotional wellness: Caregivers’ high ACE scores and emotional demands put them at greater risk for depression. But they often feel stigma or are daunted seeking support. One benefit we offer, Ginger, provides them with emotional support at their fingertips via a smartphone app. Of those users who screened positive for depression when signing up for Ginger, 76% showed improved symptoms within 6 weeks. This in-the-moment support can help prevent mental health issues from snowballing and nurture greater long-term resilience.

Preventing injury: We’ve also implemented Caregiver Kicks, a program which provides caregivers with a brand-new pair of slip-resistant shoes annually at no cost. A high-quality pair of shoes can be a big out-of-pocket expense. Ensuring caregivers have high-quality footwear significantly minimizes the risk of on-the-job slips, trips or falls.

Encouraging regular doctor visits: Having a relationship with a healthcare provider and seeing them regularly keeps people healthier by ensuring health conditions are monitored and preventive screenings occur. Our annual See Your Doctor for Free marketing campaign targets insured caregivers. It breaks down processes they may be unfamiliar with – such as finding a doctor or scheduling an appointment – and encourages them to choose and visit a primary care doctor.

It’s exciting to design and deliver innovative health benefits to caregivers. But caregivers are just one group of workers doing critical work that supports the functioning of our communities and economy. Far too many care professionals, laborers, gig workers and part-time workers don’t have this kind of access.

In the early 2000’s, Washington’s caregivers were also without health insurance. But partnership, advocacy and investment have ensured access to high-quality, affordable healthcare coverage for caregivers is possible. Roadmaps like ours offer a blueprint for bridging the growing chasm in healthcare access and outcomes between white collar workers and those who work for wages.

It’s up to all of us to build the infrastructure and political will for a stronger, more equitable health care system that truly values the wellbeing of everyone in our communities.

This op-ed was written by Abby Solomon, CEO of SEIU 775 Benefits Group.