Republican Legislation Would Devastate Home Care

If Medicaid is cut, as proposed in the bills, between 305,000 and 713,000 home care workers will lose their jobs.
07/13/2017 02:40 pm ET Updated Jul 13, 2017

If you’re like most Americans, three things are true: you occasionally confuse Medicaid with Medicare, you assume that Medicare covers long-term care, and you will need in-home care at some point in your life.

Sadly, congressional Republicans have proposed legislation that will harm millions of people and decimate home care services. Today’s updated version of the Senate bill is no different. Among the many flaws of the health care bills is the fact that they would severely cut Medicaid funding by capping the amount of money the federal government will contribute to state programs.

Medicaid, not Medicare, pays for long-term care, including home care. With home care services, instead of moving into a nursing home, older adults and people with disabilities can have a caregiver come to their home to assist with bathing, moving from a bed to a wheelchair, eating, going to the restroom, cooking, getting exercise, or many of the other daily activities that allow people to remain independent at home. Medicaid allows for people to be active members of their community and to live at home which, understandably, most people prefer. And, if an eligible individual elects to receive care from a nursing home, that is also covered by Medicaid.

As the primary payer of long-term services and supports, Medicaid also funds caregiving jobs. If Medicaid is cut, as proposed in the bills, between 305,000 and 713,000 home care workers will lose their jobs. This is a huge portion of the two-million-plus workforce, and we don’t have enough home care workers to meet current, never mind future, demand. We need to attract more than 600,000 additional home care workers by 2024. Losing workers will only exacerbate existing vacancies and put a greater strain on unpaid family members. And cutting Medicaid funding will impede the ability to increase wages and improve working conditions—changes sorely needed to attract and retain these essential workers, who earn on average only $10.09 an hour.

Lawmakers are trying to shrink federal investments just as more investments are needed. In less than 13 years, 20 percent of our population with be 65 or older. By 2050 the number of adults over 85 years is expected to reach 19 million, a 200 percent increase from 2015. This great achievement of people living longer will mean that most people will outlive their resources and the ability to pay out-of-pocket for home care or nursing home care. When they do, most Americans will rely on Medicaid.

Since the Affordable Care Act, 500,000 direct care workers gained insurance coverage. Almost half of home care worker households rely on Medicaid to provide insurance coverage. Additionally, as more individuals were covered through Medicaid expansion, more people who needed home care services were able to get them. The House and Senate legislation will end Medicaid expansion, cutting benefits and jobs—all while increasing consumers’ out-of-pocket costs.

Medicaid, which is highly efficient and covers people at a lower cost than private insurance, works so well because there is a federal match. That means that for every dollar a state invests in Medicaid, the federal government reimburses by at least 50 percent, and depending on the state’s per capita income, as much as 74 percent. The House and Senate bills will change the amount the federal government will reimburse, meaning that in just the first 10 years, states will lose at least $772 billion in federal dollars and will either need to increase their state budgets or cut spending on their existing Medicaid programs, which are already lean. Within four years of the legislation going into effect, states would need to increase Medicaid funding by at least one-third.

Our current Medicaid program generates economic activity benefiting states, including jobs, income and state tax revenues, and purchases to local businesses. The ripple effect of this legislation is bound to impact us all, with the only winners being the healthcare industry and wealthiest Americans. We must keep up the fight against this shameful legislation and tell our senators and representative that efforts to repeal the Affordable Care Act will harm us all. That the House and Senate bills will have a devastating impact on home care is just one reason to oppose them.

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