[Editor’s note: This story originally was published by Real Clear Health.]
By Maxford Nelsen
Real Clear Health
Amid the fast-paced congressional talks over President Joe Biden’s budget-busting “Build Back Better Act” (BBBA), the legislation’s massive expansion of federal Medicaid funding for in-home care has thus far received little scrutiny.
Unfortunately, the legislation is cynically engineered to steer potentially billions of Medicaid dollars to labor unions, forcing hundreds of thousands of home care aides into supporting far-left political advocacy and saddling taxpayers with wasteful programs.
Medicaid has long paid for eligible adults with functional disabilities to receive long-term care. Recent decades have seen a shift towards providing such services in the client’s home, a model which minimizes costs and maximizes the client’s independence compared to institutionalized settings.
Beginning in the 1990s, home care aides serving Medicaid clients became the target of union organizing campaigns. Hundreds of thousands of Medicaid-paid caregivers in at least eight states are now unionized, generating about $150 million in dues for unions like SEIU and AFSCME in 2017 alone.
Most of these caregivers are related to their clients. Because they work in homes (often their own), caregivers receive little in the way of traditional workplace representation from their unions, despite paying as much as $1,000 per year in dues.
In 2014, the U.S. Supreme Court ruled in Harris v.