When is a $2.3 trillion infrastructure bill not really about infrastructure? How about when $400 billion would go to expand Medicaid payments for home healthcare, with much of that padding the rolls of the Service Employees International Union (SEIU)? That not-so-little detail is one of the line items the media don’t want to cover in President Biden’s latest spending blowout. Allow us to fill the information gap.
State Medicaid programs spend about $40 billion on nursing homes and $76 billion on in-home and personal care annually. Most states have been shifting more long-term care to homes because it is less expensive. Many elderly also prefer to stay in their homes, which is understandable when their health allows it.
Mr. Biden wants to spend $400 billion to expand Medicaid in-home and “community-based” care (e.g., adult day care), increasing annual spending by 50%. The fine print of his proposal says his home-care plan would “create good middle-class jobs with a free and fair choice to join a union . . . and the ability to collectively bargain.” This is where the SEIU comes in. The union has been able to exploit Medicaid home-care programs to expand its membership with help from state Democratic lawmakers.
Many home-care workers are family members or hired by families. But since Medicaid pays for home care, Democratic states have deemed them public employees and designated the SEIU as their exclusive representative for collective bargaining. The union then bargains with the same politicians the union supports in elections to deduct member dues automatically from home-worker Medicaid payments.
The Supreme Court in Harris v. Quinn (2014) ruled that these employees who don’t belong to the union can’t be required to pay fees for representing them in collective bargaining. Democratic states and the SEIU, however, have made it hard for caregivers to opt out of the union. Last September the SEIU, Healthcare Illinois and Indiana settled a lawsuit brought by an Illinois home-care worker who said the union kept deducting dues from her Medicaid payments despite two requests to stop. After her second request, SEIU officials told her she needed to provide—get this—a photo ID.