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Trumpcare and Home Care Workers

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The Senate has released its new deathcare bill and it looks pretty much equally horrible to the previous draft. I’m sure Scott will have more on it and I’m no healthcare wonk so I’m not going to try. But I do want to highlight this Sarah Jaffe piece on how it will affect home care workers.

The Obama administration was a high point for the rights of home care workers, many of whom were still locked out of basic labor protections. In 2013, the labor department extended federal minimum wage and overtime protections to them. Elly Kugler, who leads federal policy work at the National Domestic Workers Alliance, says it was meaningful because it recognized them as workers, and afforded them additional pay. Wages for home care have been largely stagnant, hovering just above $10 an hour on average.

Low wages had often driven people out of the field who otherwise found the work meaningful, Kugler notes. “Though many of our members care deeply for the work they do … they had to go and work in other kinds of jobs. Meaning fast food, other sectors, making a little bit more money.”

“I think one of the interesting things about home care is that it forces all these different worlds to connect,” Kugler adds. “The world of state funded home care and and healthcare and also worker rights and disability rights and senior rights and racial justice – all these different worlds are connected in home care.”

Nowhere is that more clear than in the Affordable Care Act (ACA), also known as Obamacare, now under fire from the Trump administration and a Republican Congress.

The expansion of Medicaid, which took effect in 2014, meant more funding for home care and more jobs for care workers. The bill also expanded healthcare for the workers themselves – Barrett had never had chicken pox as a child, and when she contracted it as an adult from a client with shingles, it aggravated her asthma.

“Before the Affordable Care Act passed, one in three home care workers was uninsured,” says Josephine Kalipeni, director of policy and partnerships at Caring Across Generations. After its passage, that rate dropped by 26%.

Because of the general forward trajectory, Kugler says, the Obama years had meant that the movement for care workers had gained more public traction with bigger issues, such as immigrants’ rights (many home care workers are immigrants like Barrett), racial justice, and the value of women’s work. Home care workers had joined the Fight for $15, initiated in part by the Service Employees International Union, which represents tens of thousands of home care workers around the country.

Workers who liked their care jobs, like Barrett, could begin to think about their work as a career.

And then came Trump.

Those priorities are clearly demonstrated in the Republican plan to “repeal and replace” the ACA, currently moving through the Senate. Estimates compiled by the National Domestic Workers Alliance range from 1.8m to 3 million jobs lost in just a few years if “Trumpcare” passes; between 305,000 and 713,000 of those will be home care workers.

The latest version of the bill to be scored by the Congressional Budget Office predicts that 22 million people would lose their health insurance by 2026 if the bill were passed as is. Premiums would spike for elderly people like Barrett’s clients, as Medicaid spending would be slashed by $772bn over 10 years. Changes to Medicaid could include a “per capita cap”, or a limit to how much the federal government pays states per enrollee in the program.

“It is basically saying, ‘Your state can only get so sick. You can only have so much of a disability and then you are just going to have to pay,’” Kugler says. These cuts, Kalipeni notes, will fall squarely on the shoulders of women – the women of color and immigrant women who do the paid home care work, the women who still do most of the unpaid care work that will pick up the slack when the budgets for paid care are cut.

Until such cuts directly affect people’s lives, she says, people often don’t realize the importance of these systems – and by then it is frequently too late.

The whole piece is outstanding, providing some history of home care work and exploring how workers are trying to fight for greater dignity. I will only add that jobs such as home care (and day care and K-12 teaching and others) are absolutely essential for living with basic dignity and yet we don’t provide those workers any dignity at all, or are actively taking it away in the case of K-12 teachers. Home care is pretty tough work. Anyone who has dealt with elderly relatives knows what is coming in no so distant future for them. Don’t we want the people taking care of us when we are old to have decent health care and to make enough money they can be proud of their job and presumably then do a better job at it? We should. And yet as a society we very much do not. Trumpcare would only make their lives worse. And that will eventually mean making our own lives worse.

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