The Senate Republicans’ “Better Care Reconciliation Act,” which would repeal the Affordable Care Act (ACA), would slash resources needed for Medicaid to pay for tax breaks for the wealthy. The homecare workforce, one of the country’s fastest-growing, would be extremely hard hit by the plan. The passage of this bill would not only kill homecare jobs, but make homecare workers sicker, while permanently destabilizing the homecare industry.
The number of homecare workers in the country is conservatively estimated to be two million, and it has been growing by about 7 percent per year. Every day, these workers, who are primarily women, provide critical care for seniors, people who are sick, and persons living with disabilities. Homecare workers meet the needs of seniors who want to stay at home as they get older and people of all ages who have disabilities and want to live independently. The daily assistance of homecare workers makes it possible for millions of people across the country to live in their communities.
Yet instead of investing in this critical industry, the new Senate bill spells disaster for those who provide care and those who need it most. Priscilla Smith, from Fayetteville, North Carolina, has been a homecare worker for seven years. She says she’s most concerned that the people in the facility where she works won’t get the care they need. “Medicaid is what pays for workers like me to provide care,” Smith said. “And many elderly people can’t afford private insurance.”
The bill ends Medicaid expansion and introduces per capita caps and block grants. Combined, these changes spell the end of Medicaid in its current status as a successful, responsive program. For decades, Medicaid has allowed seniors and adults and children living with disabilities to get the homecare they need to live at home and in their communities.
At the same time, the bill includes multiple tax breaks for the wealthy, including retroactive tax breaks for high-income households.
The exact number of people who would lose Medicaid is not yet known due to the furtive and hasty way in which the bill was created, but the nonpartisan Congressional Budget Office has announced that by the year 2026, 22 million people would lose insurance under the bill and cuts to Medicaid would reach $772 billion. The CBO also predicts that few people who lose their Medicaid eligibility would be able to purchase insurance “because of the expense for premiums and the high deductibles” for individual market plans.
Because the ACA expanded healthcare access for many people, it additionally created positive growth in healthcare jobs, from doctors to home health aides. If the ACA is cut, there will be an estimated three million jobs lost by 2021. Between 305,000 and 713,000 homecare workers will lose their jobs if the Senate is allowed to restrict Medicaid through per capita caps alone. This estimate does not account for eventual job losses due to the end of Medicaid expansion.
Currently, most homecare workers subsist on poverty wages of under $12,000 a year, and as a result, have a turnover rate of up to 60 percent a year. As one of the fastest-growing sectors in the country, home care has the potential to provide good, stable jobs with wages that are high enough to support working families. However, the Senate bill sucks Medicaid’s resources dry, limiting any possibility for raising worker wages and locking this majority woman-of-color workforce into perpetual poverty wages.
Most families and individuals must rely on Medicaid-funded services to obtain homecare. However, the average yearly cost of a home health aide is $45,760 — unaffordable for most families. There are not enough homecare workers to meet current needs, let alone the growing needs of the nation’s seniors. The ACA expanded the supply of homecare workers in the United States, primarily by providing Medicaid-funded services to more people who needed homecare. With the Senate’s proposed Medicaid cuts, there won’t be enough funding for lower-income adults and seniors to get help from homecare workers. This means that more people living with disabilities and seniors will be forced into institutional homes, which are far more expensive than in-home care.
Before the Affordable Care Act passed, one in three homecare workers was uninsured. Under the ACA, home care workers’ uninsured rate decreased by 26 percent, in large part due to increased access to Medicaid. With the Senate bill’s massive cuts to the program, homecare workers will lose their affordable coverage, and be forced to work with vulnerable and sick persons, while unable to treat their own illnesses.
Homecare worker Priscilla Smith is making her voice heard through We Dream in Black, a program of the National Domestic Workers Alliance that focuses on improving conditions for African American domestic workers. In the health care fight in Washington, she sees a bigger struggle over economic justice.
“This Senate bill sends a message that our work doesn’t matter. That the lives of aging people don’t matter. But we are the people who help put money into the health care system in the first place.”
Smith’s solution? “We need more people in political office who understand care from the bottom up, because at one point or another, everyone will need care.”