Home health workers’ ‘skim’ union will hurt the most vulnerable
President BidenJoe Biden France (and Britain) set to join quadruple election denier overthrown by Idaho Secretary of State Under Biden, US could fall even further behind in the Arctic MORE promised to be the most pro-union president in history. And he is faithful to this commitment, but to the detriment of the seriously ill and disabled.
Biden’s Department of Health and Human Services (DHS) has proposed a new rule that would allow unions to skim contributions from home health care workers. Under the proposed rule, DHS would allow the diversion of Medicaid payments to third parties, including unions. Although this may seem trivial, it is quite the opposite. In effect, this rule would re-authorize what is known as “premium skim”, a scheme that has benefited unions at the expense of vulnerable Medicaid beneficiaries and their caregivers.
In 2011, the Mackinac Center was the first organization to discover the reorientation of Medicaid payments towards labor organizations. In Michigan, the local affiliate of the Service Employees International Union (SEIU) admitted it could get “dues” from home health care providers and worked with the state to forcefully unionize them. First, the SEIU press the state created an agency known as the Michigan Quality Community Care Council that would serve as the putative employer of home health care providers in Michigan. The SEIU then negotiated with this “employer” to organize these workers. All of this happened even though less than 20 percent of affected home health care providers voted for the union. Many did not even know that an election to organize had taken place.
As a result, a portion of Medicaid payments intended to cover the costs of home care providers – often family members of the critically ill or disabled – has been redirected to SEIU. By 2012, the SEIU had successfully skimmed over $ 34 million in Michigan alone. After the adoption of reforms prohibiting the skimming of contributions (and later reaffirmed in a ballot proposal), home care providers have overwhelmingly demonstrated that they do not want to be unionized. In less than a year, the membership of SEIU Healthcare Michigan has plummeted 80 percent. In other words, when given the choice to join a union, only 20% of claimants decided it was worth it.
The consequences of premium skimming are worsening nationwide. From 2000 to 2017, unions successfully hijacked around $ 1.4 billion in Medicaid payments.
These payments are hardly justified. Although DHS claims that allowing these diversionary payments would benefit caregivers through better training and education, it has presented no evidence to support this claim. Existing evidence suggests that such arguments are without merit.
The position is also logically inconsistent. If unions had training opportunities that would benefit home care providers, nothing would prevent them from offering such training for a fee. Providers could then decide to spend the funds they receive from Medicaid to improve their skills by attending these training sessions. This arrangement would comply with both the law and market incentives. Instead, DHS opted for an arrangement that favors coercion and potential fraud.
The practical consequences of allowing premium skimming cannot be underestimated. The providers whose payments would be misappropriated are often family members of the critically ill or disabled. Without this care, the sick and disabled would be forced to be placed in an institution, probably at the expense of taxpayers. These family members sacrifice their time and energy and are compensated slightly mainly through Medicaid payments.
Despite this, some unions have used skimmed dues to divert payments while offering little or no tangible benefit to Medicaid providers or recipients. But in this situation, unions have little to offer either side, since home care providers are not employed by an outside agency, but rather by their patients. They work either from their own home or from the homes of their sick or disabled relatives. They manage their own working conditions and schedules, according to the needs of their patient. Trade unions play no representative role in these areas – the traditional goal of collective bargaining.
DHS should not reinstate dues by administrative decree. This would reduce the funds available to help the sick and disabled, increasing the shortage of home health workers and divert Medicaid payments from their destination. Funds paid to caregivers should be used to support their efforts on behalf of the sick and disabled, and not for privileged political causes.
Steve Delie is Director of Labor Policy at Mackinac Center for Public Policy in Midland, Michigan.