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Uninsured Day Care Workers At Risk During The Pandemic

MARY LOUISE KELLY, HOST:

Thousands of coronavirus cases have hit day care centers across the country. In addition to the kids, those outbreaks threaten a vulnerable workforce of largely low-paid women. In states that have not expanded Medicaid, child-care workers are often uninsured. As Liz Schlemmer of member station WUNC reports, that is leaving preschool teachers in North Carolina worried.

LIZ SCHLEMMER, BYLINE: Near the end of a long week at the day care center where she works, LeKeshia Liles got a call from home. Her 3-year-old daughter was sick with a fever. In the middle of a pandemic, she imagined the worst.

LEKESHIA LILES: My thought goes there every time a kid is sick, honestly, even at my center. That's my first thought, is Lord Jesus, do they have COVID-19?

SCHLEMMER: Liles rushed home and took her toddler to the doctor.

LILES: But she ended up with an ear infection. Thank God that's all she had.

SCHLEMMER: That moment was a relief. Fortunately, Medicaid paid for her daughter's appointment and medicine. But Liles is not covered and can't afford private health insurance. So she avoids going to the doctor for herself, even with her diabetes and hypertension. She doesn't know what she'd do if she got COVID-19.

LILES: I have no clue. I have a little bit in savings but I'm quite sure not enough to pay for medical bills if I have to be hospitalized.

SCHLEMMER: In her nearly 20 years in child care, Liles has only had health insurance when she was pregnant and covered by Medicaid. Fawn Pattison at the advocacy group NC Child says that's common among child care workers in North Carolina, who on average earn $10.50 an hour. She says about 1 in 5 preschool teachers in the state don't have health coverage.

FAWN PATTISON: A lot of centers will say like oh, well, our staff just get it through their husband if they're married, (laughter) you know? Like, so - and that's not realistic in a workforce.

SCHLEMMER: Cassandra Brooks has been in the child care business for a decade and owns two day care centers. Money is always tight, and she didn't think she could provide health insurance to her employees. Then something horrible happened.

CASSANDRA BROOKS: Unfortunately I lost two staff members due to preventable conditions.

SCHLEMMER: They were both mothers who died at ages 46 and 52 - married and without health insurance. After that, Brooks dug deep to offer discounted health plans to her two dozen employees.

BROOKS: A few people signed up. But out of my staff, only two people have been able to sign up and pay for it for all year, which is really sad.

SCHLEMMER: Child care workforce studies in several states found fewer than half of privately owned businesses offer insurance to employees. Before the Affordable Care Act, about a quarter of child care workers nationwide had no health coverage. That's gotten better in states that expanded Medicaid under the ACA, but North Carolina and a dozen other states have not. Here's Fawn Pattison of NC Child again.

PATTISON: There's all this polling data on, like, early childhood's so important. You know, early childhood education, let's invest in it. But we're not investing in it, and we're definitely not investing in the workforce. They are overwhelmingly women of color living at the poverty line.

SCHLEMMER: It's an old problem exacerbated by the COVID-19 pandemic. So far, the North Carolina Health Department has recorded at least 11 outbreaks at child care centers across the state, including at the one next door to where Liles works.

LILES: Yeah, it is really scary because I'm like, OK, it's really close to home.

SCHLEMMER: She carries that fear home with her every day, hoping she has not brought the virus along with her. For NPR News, I'm Liz Schlemmer in Durham.

(SOUNDBITE OF AXEL BOMAN'S "BARCELONA") Transcript provided by NPR, Copyright NPR.