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The Trump-Backed Reconciliation Bill Is Sacrificing Our Care Workers for Billionaires’ Tax Cuts
Last night, the Senate Finance Committee released its proposed cuts to Medicaid—deeper and more devastating than the draconian cuts to Medicaid House Republicans passed last month. The Trump-endorsed reconciliation bill would rob at least 16 million people of their health care and incalculably devastate our collective ability to take care of ourselves and each other. These are the largest cuts to Medicaid ever, all to fund new tax cuts for the ultra-wealthy.
Long-term care, such as support with managing medications or help with eating and bathing, is what many of us need to navigate our lives with disability or chronic conditions. It is also the care we provide or secure for our loved ones who are disabled, or for our aging parents. Medicaid is the backbone: it helps millions of people both provide and receive long-term care.
Republican leaders have claimed that they are “protecting” or excluding people with disabilities from being impacted by the reconciliation bill’s cuts because they are merely addressing “fraud, waste, and abuse”—but they are lying. Any additional requirements that subject people to more paperwork or inspection, or make people ineligible for health care when they lose a job, will result in people losing coverage—we’ve seen that before, and we will see it happen again.
And the Medicaid cuts in the House-passed bill, as well as the Senate Finance Committee proposal from Republican leadership, would not only deeply harm those in need of care. These cuts would also harm family caregivers and the direct care workers (like home health aides and nursing assistants) who provide long-term care to millions of aging people and people with disabilities in multiple settings, including our homes and communities. This will make it impossible to provide care to the people with disabilities and older adults who rely on their critical support—enriching billionaires at our expense.
Direct care workers need access to Medicaid to do their essential work—but Republican leadership’s plan will oust them from their jobs and take away their health care with sweeping Medicaid cuts and anti-immigrant policies.
Since Medicaid is the primary source of funding for long-term care, Medicaid is largely how direct care workers get paid. And that pay is extremely low.
Direct care workers make between $16-18 an hour, and between $33,000 and $38,000 annually when working full time. Home care workers, who are 46% of the direct care workforce, have a median annual income of just $21,889, making it one of the lowest-paying jobs in our economy. As a result, 27% of women direct care workers under 65 years old rely on Medicaid coverage themselves. Without Medicaid coverage, many direct care workers will not be able to take care of their own health—but the massive funding cuts and administrative hurdles imposed by the House-passed bill puts that coverage at risk.
This risk is exacerbated by the myriad ways the House-passed legislation targets immigrants and their families, as nearly one out of three (27%) direct care workers are immigrants—and in some states, immigrants make up half of the direct care workforce. The proposed law would make it even harder for immigrants to access Medicaid or other health care programs, subjecting them to more red tape and discouraging even eligible immigrants from getting covered. If states provide undocumented people with health coverage out of their own state budgets (i.e. not federal dollars), the proposed law will still take away Medicaid money from all the state’s Medicaid users, reducing funding by 10 percent. And once again, the Senate Finance Committee proposal is even more threatening: the Senate Finance proposal bars even more lawfully present immigrants from Medicaid, including refugees.
Medicaid cuts will harm direct care workers twice over. Legislation to slash Medicaid could jeopardize their Medicaid-funded jobs, resulting in decreased wages and/or eliminated jobs, as agencies might be forced to close—and Medicaid cuts will also rob direct care workers of their own health care. That means fewer direct care workers will be able to provide quality care to the millions of older adults and people living with disabilities who deserve to live with dignity.
Ultimately, Medicaid cuts will harm us all, from direct care workers to the people they care for and the people seeking care for their loved ones. All of us, that is, except the billionaires who will get more tax cuts they don’t need. Instead of robbing us of our health care to pay for tax cuts for the wealthiest people and corporations, policymakers should be raising their taxes so we can invest in Medicaid and the other supports we need to ensure that everyone can give and receive care.
