Biden $400 billion care plan would have a caveat: States opt in

Katia Dmitrieva, Alexander Ruoff and Benjamin Penn, Bloomberg News on

Published in Political News

The president supports investing the funds in HCBS, said an administration official, who declined to be identified because the proposal isn’t final. Since the Congress is still working on legislation, the White House hasn’t yet weighed in on the mechanics and many options are still on the table, the official said.

The Biden administration aims to improve the quality of care for the 14 million elderly Americans who will need the services in four decades — double today’s level. The need for in-home care workers, which has already exploded to almost 2.4 million in 2019 from fewer than 1 million 10 years earlier, will only increase.

“It’s incredibly important that the jobs created in home health work are good jobs,” said Heather Boushey, a member of the White House Council of Economic Advisers who focuses on child and elder care.

Most home care is paid through Medicaid via a “fee-for-service” platform. Many workers are contractors, rather than full-time employees, meaning they’re deprived of federal wage protection. The system of training is also fragmented, and career advancement is difficult. This contributes to high turnover and lower job quality.

Creating good-paying union jobs is one of Biden’s selling points for his economic overhaul. Advocacy groups are pushing for measures that go beyond Casey’s legislative draft to achieve that goal, although they are facing resistance and may not be adopted. The general idea among Democrats crafting proposals is to leave it to states to decide how the money should trickle down to workers.

The National Domestic Workers Alliance has floated creating health care “hubs,” where consumers could find care and workers would get trained. This would minimize the need for private agencies that currently do this. The new entities could also handle payroll and lead negotiations for higher wages, something that the Service Employees International Union is pushing for, according to the people.

“There’s the public health benefit, the safety for the care workforce, and the economic stimulus and the overall growth of the economy,” said Haeyoung Yoon, senior policy director at NDWA. “We want everyone to be earning family-sustaining wages and having a real shot at that economic security.”

SEIU, which represents about 740,000 home-care workers and is the lead union in the talks, has proposed to go a step further and let the new entities assume the role of employers, according to two people familiar with the thinking.


SEIU President Mary Kay Henry, in an e-mailed statement, urged Congress to “quickly pass the American Jobs Plan and this bold investment in good, union, living-wage care jobs.” The union didn’t address questions about the structure of the legislation.

Lydia Nakiberu will provide a litmus test for Biden’s in-home care plan.

The 42-year-old mother of three works 12-hour shifts several days a week, bathing, feeding, and administering insulin to an elderly man with dementia in Pepperell, Massachusetts. The money she earns, without benefits or danger pay during the pandemic, makes it difficult for her to pay gas, electricity and mortgage payments on time.

“In our job, we are undervalued, we are underpaid,” said Nakiberu, who’s an NDWA member. “If they raise our wages, that will definitely improve our lives.”

A thorny sticking point in the policy talks has been how to divvy the funds to balance the needs of the workforce and the people they care for.

“That’s what the calculation is right now — how big can we go in order to create an entitlement for these services while also ensuring that the workforce is paid a family-sustaining wage,” said Nicole Jorwic, senior director of public policy at the Arc of the United States, which advocates for people with intellectual and development disabilities. “It has to be a ‘Both, And’, which is what Congress is grappling with.

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