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Concerns grow over home health care as Democrats debate funding

Lauren Clason, CQ-Roll Call on

Published in News & Features

Democrats are considering reducing the duration of a number of programs in the package as a way to bring down the cost. But Casey expressed hesitation about that idea, citing the need for long-term stability to convince states to make the effort.

“The United States is in the midst of a caregiving crisis and we have a once-in-a-generation opportunity to solve it,” he said in a statement.

A shorter authorization also would put the program at risk of expiring. Congress frequently passes short-term extensions of expiring programs at the last minute, and advocates are constantly working to make sure lawmakers continue to renew funding.

While home health aides count some major groups, such as unions, in their corner, they lack the star power of some lobbying organizations backing other industry players like doctors, hospitals or insurance companies.

“The political coalition behind it may not be as strong as for some of the other priorities,” said Jonathan Oberlander, chair of social medicine at the University of North Carolina-Chapel Hill.

Lower funding jeopardizes the impact the money will have on the program, including what advocates say is the most important factor: raising wages and increasing the workforce. Without better pay and benefits, states will likely struggle to recruit more aides to care for more patients.

“It means we’re likely not going to open up new jobs, because if we don’t at least increase wages, then we’re not going to have the supply of workers we need for those jobs,” Ives-Rublee said. “So that means we can’t do much in terms of getting people off waitlists.”

Lower funding also means less incentive for states to expand. The result could mean fewer states expanding services, or some expanding services without raising wages.


An analysis from the Urban Institute estimated that increasing the federal match rate by 10 percentage points could increase wages by an average of $5,000 per year and create an additional 147,000 jobs. Home health aides currently earn an average of $12 per hour, or $25,000 per year.

Long-term care aides are also disproportionately low-income women of color, meaning an investment in the industry would help deliver on Democrats’ promises of improving equity. Haeyoung Yoon, senior policy director at the National Domestic Workers Alliance, noted that many health aides already worked multiple jobs even before the COVID-19 pandemic hit.

“We want to make sure that we do it in such a way that workers have a real shot of economic security,” she said of expanding the program.

Advocacy groups are keeping up pressure amid whispers of further funding reductions.

More than a dozen organizations, including the Service Employees International Union and the National Domestic Workers Alliance, formed the Care Can’t Wait Coalition in 2020 to push the message. The coalition held a 24-hour vigil last week at the Capitol that featured personal stories of affected workers, family caregivers and patients.

The event follows a rally last month on Capitol Hill that featured Speaker Nancy Pelosi, Senate Majority Leader Charles E. Schumer and a number of other lawmakers promising to get the expansion passed.

Mary Ellen McIntire contributed to this report.

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