在 ServiceModel 客户端配置部分中，找不到引用协定“TranslatorService.LanguageService”的默认终结点元素。这可能是因为未找到应用程序的配置文件，或者是因为客户端元素中找不到与此协定匹配的终结点元素。
The numbers are stark. Among workers who provide hands-on care to nursing home residents, one in four has no health insurance. Among those who provide care to people living at home, one in three is uninsured.
The new health care law is supposed to fix the problem by guaranteeing access to affordable coverage for all. But many nursing homes and home care agencies, alarmed at the cost of providing health insurance to hundreds of thousands of health care workers, have started a lobbying effort seeking some kind of exemption or special treatment.
Mark Parkinson, president of the American Health Care Association, the largest trade group for nursing homes, says the problem is that reimbursement rates for Medicaid and Medicare, set by government agencies, do not pay them enough to offer their employees medical coverage. “We do not have much ability to increase prices because we are so dependent on Medicaid and Medicare” for revenue, he said.
Mr. Parkinson acknowledged that when nursing homes do offer health insurance to employees, the benefits are often limited. The coverage “is probably not up to what will be required” by the federal law, he said.
Medicaid covers about two-thirds of nursing home residents. States set Medicaid rates, and many states, facing severe budget problems, have reduced payments for nursing homes.
Starting in 2014, the law will require employers with 50 or more full-time employees to offer affordable coverage or risk paying a penalty. For a midsize nursing home, that penalty could easily exceed $200,000 a year. Nursing home executives are urging Congress and the Obama administration to spare them from the penalties.
Vanessa Valerio, 25, a certified nursing assistant who earns $10 an hour at Lakeview Christian Home in Carlsbad, N.M., said she was uninsured because she could not afford the coverage offered by her employer.
The chief executive of the Lakeview nursing home, Joanna D. Knox, said the company used to pay the entire premium for employees. It now requires workers to pay $25 of the $585 monthly premium for individual coverage.
“When we started charging $25 a month,” Ms. Knox said, “many employees dropped coverage.” Of the home’s 200 employees, only 87 have elected it, she said, adding, “I don’t know how we could possibly absorb the additional cost of providing coverage for the other employees.”
Charlene A. Harrington, a professor at the School of Nursing at the University of California, San Francisco, said it would be a mistake for Congress or the administration to relieve nursing homes of the obligation to provide coverage to employees.
“It’s scandalous to have nursing home employees taking care of people when they themselves lack coverage and go without care,” Ms. Harrington said. “If employees have health insurance, they are more likely to be treated for illnesses, less likely to pass on infections to nursing home residents and more likely to get early treatment for occupational injuries.”
The rate of injuries in nursing homes is about twice the rate for all occupations, according to the Labor Department. Back injuries are common among those who lift patients and help them get in and out of bed.
Since the law was signed 14 months ago, the focus of lobbying has shifted. A tumultuous battle over the future of the health care system has given way to more concentrated efforts to undo or rewrite particular provisions.
Mr. Parkinson, a former Democratic governor of Kansas who is now the top Washington lobbyist for nursing homes, is pushing several ideas.
One option would give nursing homes more time to comply with the requirement to offer coverage. Another proposal, according to a list of options prepared by lobbyists for the industry, would waive or reduce the penalties for nursing homes “placed in financial distress as a result of the new mandates and fines.” Alternatively, Mr. Parkinson said, Congress could allow nursing homes to take tax deductions for the penalties, which under the 2010 law are nondeductible.
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