COVID-19 outbreaks are springing up at a handful of childcare centers across North Carolina, threatening a vulnerable workforce of women who are largely low-paid and often uninsured.
Near the end of a long week at the daycare center where she works as an assistant director, LeKeshia Liles got a call from home that her 3-year-old daughter was sick with a fever. The news instantly sparked fear.
"My thought goes there every time a kid is sick, honestly, even at my center," Liles said. "My first thought is 'Lord Jesus, do they have COVID-19?'"
Liles rushed home and took her feverish toddler to the doctor's office.
"She ended up with an ear infection," Liles said with a sigh. "Thank God that's all she had."
That moment was a relief. But every day, Liles says she's afraid for her students, whose noses she wipes and diapers she changes. She's afraid for her co-workers, her family and herself.
Medicaid paid for her daughter's appointment and medicine. But Liles is not covered by Medicaid and can't afford private health insurance, so she avoids going to the doctor for herself. Instead, she goes to a county health department to get inexpensive care for her diabetes and hypertension. Liles doesn't know what she'd do if she got COVID-19.
"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 had to be hospitalized," Liles said.
Roughly 1 in 5 Childcare Workers Go Without Health Insurance
In her nearly 20 years as a childcare worker, Liles has only had health insurance when she was pregnant and covered by Medicaid.
Fawn Pattison at the advocacy group NC Child said that's common among childcare workers.
"We have interviewed ourselves quite a few childcare teachers around the state who earn $10.50 an hour on average. That's not a living wage," Pattison said. "Of course, then we have this large percentage of uninsured folks."
About 1 in 5 childcare workers in North Carolina do not have health coverage, according to 2015 survey data collected by the North Carolina Child Care Services Association.
"A lot of centers will say, 'Oh, well, our staff just get it through their husband if they're married,' you know. And that's not realistic for the workforce," Pattison said.
The Worst Case Scenario
Cassandra Brooks has been in the childcare business for 10 years. She runs daycare centers in Clayton and Garner.
With tight profit margins, she didn't feel like she could offer health insurance to her employees. Then something horrible happened.
"I unfortunately lost two staff members due to preventable conditions," Brooks said.
Her two employees were both mothers, who died at ages 46 and 52 — married and without health insurance. After that, Brooks dug deep to offer health plans to her 20-some employees.
"We were able to get 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," Brooks said.
"We hear this from childcare center owners all the time," Pattison said. "'I got a plan. No one could afford it, we got rid of it.'"
Medicaid Expansion Could Provide Health Coverage To Many Childcare Workers
NC Child advocates for another solution: Medicaid expansion. Many uninsured childcare workers fall into the Medicaid coverage gap, meaning they earn too much for Medicaid now, but would be eligible if North Carolina joined the 38 other states that have expanded Medicaid under the Affordable Care Act.
Pattison says polling data show broad public support for investment in early childhood education.
"But we're not investing in it, and we're definitely not investing in the workforce," Pattison said. "They are overwhelmingly women, women of color, living at the poverty line."
It's an old problem, exacerbated by the COVID-19 pandemic.
So far, the state health department has recorded ten COVID-19 outbreaks at childcare centers across North Carolina, with 77 cases total. Liles says there's an outbreak at the childcare center next door to where she works.
"So it is really scary," Liles said. "You know, it's really close to home."
Liles carries that fear home every day. She keeps her own children from hugging her when she walks in the door, at least until she showers and changes her clothes.
Liles said she gets hopeful whenever Medicaid expansion comes up in the news, but with the last state budget deadlocked over the issue, she isn't optimistic. She just hopes everyone shows a little more appreciation for the women in her career.