Medicaid Officials Target Home Health Aides’ Union Dues

By Shefali Luthra, who covers consumer issues in health care. Her work has appeared in news outlets such as The Washington Post, CNN Health and Originally published at Kaiser Health News

Medicaid home care aides — hourly workers who help the elderly and disabled with daily tasks like eating, getting dressed and bathing — are emerging as the latest target in the ongoing power struggle between conservatives and organized labor.

About half a million of these workers belong to the Service Employees International Union, a public-sector union that represents almost 1.9 million workers in the United States and Canada. The union is an influential donor to liberal politicians and boasted strong ties to the Obama administration.

A proposed rule from the federal Centers for Medicare & Medicaid Services would prohibit home health aides paid directly by Medicaid from having their union dues automatically deducted from their paychecks, though it doesn’t name the fees explicitly.

Blocking these direct Medicaid payments means the workers — especially those who don’t work in a single, centralized office, or don’t have a credit card or a bank account — are far less likely to pay dues, diminishing the union’s potential influence.

CMS’ language affects only “individual providers” — that is, those who aren’t employed by the private, for-profit agencies that dominate this industry. Individual providers, who are technically state employees, are far more likely to be unionized.

The directive, which would overturn an Obama administration policy put in place to ease the collection of union dues and pay for other fees, such as health benefits, could take effect by the end of this year. A month-long comment period, ending Monday, has attracted more than 3,300 responses.

“This is just another way to make life more difficult for public-sector unions,” said Jake Rosenfeld, an associate professor of sociology at Washington University in St. Louis, who studies unions and their influence.

The proposed rule comes on the heels of June’s landmark Supreme Court ruling, in which a 5-4 majority held that public-sector workers don’t have to pay unions for the cost of collective bargaining, calling it a violation of their free speech.

That decision expanded on the Supreme Court’s 2014 ruling in Harris v. Quinn, in which the high court found that home care workers must explicitly state their desire to be in a union before the organization can collect dues. But because these workers are not attached to a single office or meeting point, organizing them into a collective unit poses a distinct challenge; collecting membership dues, even more so.

As union membership has waned in other sectors, organized labor has doubled down on home care, lobbying liberal governors to declare thousands of workers as state employees, rendering them eligible to organize and engage in collective bargaining.

The median annual salary for home health aides in 2017 was $23,100, with about 67 percent turnover in 2017. The federal Bureau for Labor Statistics projects that demand for home care will increase by as much as 41 percent from 2016 to 2026, as more Americans age.

Both SEIU and the National Employment Law Project, an advocacy group, said that, if the rule takes effect, they expect to file a lawsuit seeking to reverse the decision. And a spokesperson for California Attorney General Xavier Becerra, who has frequently clashed with the White House, said the state will “take any action necessary” to blunt its impact.

In states where home care workers are unionized, the group can have the state withhold membership fees from their paycheck and transfer them directly to the union. Workers must actively choose to join the union.

In California, where most home care workers don’t work for private agencies, about 250,000 belong to the state SEIU chapter.

“They’ll effectively lose their voice on the job and their ability to advocate,” said Laphonza Butler, president of SEIU Local 2015, the California branch of the union.

Beyond California, home care aides have unionized in states including Connecticut, Massachusetts, Minnesota, Illinois, Oregon, Vermont and Washington.

The government is arguing that federal law does not allow states to divert Medicaid dollars to pay for a home care worker’s other benefits, such as health care or job training.

“The law provides that Medicaid providers must be paid directly and cannot have part of their payments diverted to third parties outside of a few very specific exceptions,” said Tim Hill, acting director for CMS’ Center for Medicaid and CHIP Services, in a statement.

Supporters of the rule, such as the National Federation of Independent Businesses, argue it stops powerful unions from using taxpayer dollars to pad their lobbying budget.

But it’s a controversial take. Critics said CMS’ argument inappropriately casts workers’ paychecks as government property, instead of as their own money. And they said it leaves vulnerable workers — arguably, the backbone of elderly care — unable to fend for themselves.

“When a state pays a worker, and the worker pays the union, it’s the worker’s money going into the union,” said Benjamin Sachs, a professor at Harvard Law School who studies labor law. “CMS doesn’t have the authority to decide.”

Some conservatives suggested that limiting union membership is less about home care policy and more about curtailing a powerful liberal lobbying force.

“There have been steps taken in underlying law and practice to provide extra favors to public sector unions. They are as much political bodies as they are representatives,” argued Thomas Miller, a resident fellow at the conservative American Enterprise Institute.

But labor advocates warned the consequences could be steep, and not just for home care workers.

Surveys from the National Employment Law Project suggest that unionized home care workers stay in their jobs longer when represented by unions, partially because they can negotiate better pay and benefits. Higher pay also makes the job more appealing, especially as need grows.

That, many experts argued, means patients also benefit.

“We can be putting more money into making these good quality jobs. The shortages and turnover we are facing —it is not rocket science what is causing that,” said Caitlin Connolly, who runs the National Employment Law Project’s campaign to increase home care wages. “If we made these quality jobs, we would be able to ensure that people had access to quality care.”

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  1. Eureka Springs

    Of course I agree people should be able to do whatever they want with their pay. With such low compensation and high turnover in this field I could not imagine wanting or being able to contribute so much as a wooden nickel to a union. If I worked for the union I couldn’t image asking such poor people for money. SEIU so often seems like it preys on the poor rather than working without apology for a living wage (considerably more than 15.00).

    1. Darius

      People who work in union shops make a lot more money. I suppose that’s your real problem with unions. It ruins the neoliberal hellscape.

    2. That Guy

      Well, I worked in the union busting, right to work state of Colorado. Our CNA’s in the hospital only got about 15-18 dollars an hour. A pittance for what they did and how hard they worked. I bet all of them would have jumped on a union and gladly paid dues if they averaged in the low 20’s. It would have benefited the RN’s and all other staff to as wages were pushed up. As it stands now the only people in the hospital that get raises that exceed inflation have titles like CEO….

    3. Lord Koos

      People voluntarily join these unions because it gives them some negotiating power. I guess you’re not a believer in workers’ rights.

  2. Darius

    Dues deduction is foundational. You can’t have a union without it. The National Federation of Codependent Businesses is fully aware of this. The union would spend a lot of time dunning its members for dues every month. I’m a core activist in my shop and I’d even forget to pay monthly dues.

    I’m in a free rider state. We spend so much time convincing people to be members we don’t have time to actually represent them. Hounding people for dues would be another body blow. That’s a feature of this, not a bug.

    1. DHG

      I have had it with all this BS. This all needs to stop or there are going to be major backlashes against the ones pushing all this.

  3. Lupemax

    Just to share:

    another helpful video on what’s really happening out there. It’s about 10 minutes

    You also really should watch the documentary on William Binney:
    “A Good American” for more infor on him. It’s on netflix or from the library.

    I must admit Senator Schumer was right when he said this about Trump. “When you take on the intelligence agencies, they have six ways to sunday to getback at you.” It’s at the 40 second mark.

    As Binney says above – the NSA etc. are tracking American citizens probably as much as if not more than they are foreigners… – all of which is what he was fired for after 30 years at the NSA just before the Iraq war, for warning that this was a very dangerous path. And it is one Eisenhower warned about when he left office.

    and it’s happening. And it’s frightening.

  4. Merf56

    My sister has stage 4 terminal colon cancer. She has a home health aide who is one of the hardest working people kindest I have met recently. She is a dues paying union member despite her low pay and has worked in this capacity for 20+ years. She does all kinds of above and beyond for my sister – she grabs my sister’s mail on the way in, paints her nails to cheer her up, holds her hand quietly if she is crying over a particularly bad day and so very much more as well as doing her regular duties. She has to hide these extras from her boss because she is not supposed to take the time to do them. She also works privately on weekends for clients who ask her to.
    These people are saints in my book. It is depressing and exhausting work and so ill compensated it disgusts me. Sure there are bad apples but that is everywhere in every field. Even the halls of the White House.
    Unions need to exist in this field as much as any but they really need to step up and force higher wages. My sister’s aide feels strongly that her union protects her well job security wise but is failing her on the wage front. She has not exited the field because she sees it as a calling …

  5. Darius

    Keeping home health aides from organizing is obviously critical for the neoliberal order. Organized healthcare workers would be a powerful force to raise up all working people. This cannot be allowed.

  6. sharonsj

    The elderly and sick in rural areas have an even greater need for assistance. Our elected officials don’t give a damn now and haven’t before. I remember standing on the supermarket line a few years ago and hearing an aide say that if the price of gasoline hit the $4 mark, she would have to quit because the cost of travel would exceed what she earned. I also have an elderly friend, with no family, who got a hip replacement and the state was supposed to send an aide to help him at home. No one showed up. When he phoned, he was told there wasn’t enough money available to send the aide. If he didn’t have another friend nearby willing to come, he would have died in his padded chair.

  7. Paul Harvey 0swald

    By this logic Raytheon, et al, would not be able to pay dues to, say, the National Defense Industrial Association?

  8. Unna

    Care Aide or Health Care Assistant positions in BC interior Canada: Wages starting from $20.46 – $23.93 / hr. Full union benefits, retirement pension, maternity leave. Did I say union??? This is a tough job and the people who do this work deserve every dollar plus good benefits. And the people who live here deserve this assistance when they need it. Health care is not a business, it’s a human right.

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