Top Senator Wants Democrats United on Expanding Home Health Care


June 24, 2021 10:47 am

  • Democrat finds no Republicans to support home health investment
  • Legislation looks to fulfill Biden’s pledge to spend big in Medicaid

A top senator is trying to unify Democrats in supporting a massive investment in home- and community-based health-care services, but faces slim margins in both chambers of Congress.

Sen. Bob Casey (D-Pa.) Thursday unveiled his plan to make what he calls a “historic investment” in Medicaid home- and community-based services. The goal is to cut down the waitlists for such services for the elderly and disabled, as well as improve pay for home-care workers.

“We can’t just say we’re going to expand Medicaid to get rid of the waiting list—but we’re still going to have the same $12-an-hour-workforce,” Casey said in an interview. “We want that balance.”

Casey said he’s found no support from Republicans for the plan, and hopes to pass the measure as part of a larger jobs and infrastructure package with only Democratic votes in the Senate.

That means Casey will need to unify Democrats behind his plan in a 50-50 split chamber. Already 40 Senate Democrats have signed onto the legislation.

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Price Tag

Casey told reporters Thursday that the main obstacles are likely the price tag and finding ways to pay for it. The plan would authorize $100 billion for state grants, but the final cost may wind up much higher, depending on how many states elect to participate.

Helping Casey’s effort: unions and domestic workers groups that often align with Democrats are backing the proposal, saying it’s an essential start to better pay and benefits for home-care workers.

“So many years we’ve been pushing on this, with no traction,” Ai-jen Poo, executive director of the National Domestic Workers Alliance, said.

The U.S. overall spent $379 billion in 2018 for long-term services and support—which are used to help seniors and people with disabilities with tasks such as preparing meals, bathing, dressing, and managing medication or mobility, according to figures from the Kaiser Family Foundation. Medicaid paid for more than half of the total, which includes nursing home and home health services.

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Long Waitlist

Demand for home health services is already high: almost 820,000 people in the U.S., most with intellectual or developmental disabilities, are on waiting lists to get home- or community-based care.

Home health aides and personal care aides represent the sixth-fastest growing occupation in the country, according to Labor Department data, and get paid about $12.15 per hour, or $25,280 per year.

In many areas those earnings aren’t enough: Most home health aides qualify for federal help such as food assistance and Medicaid, according to research from PHI, a nonprofit that focuses on direct care workers.

Casey said injecting Medicaid programs with as much as $400 billion over eight years might not solve all these problems, but will go a long way to bolstering the industry.

“I’m certain of one thing: if we don’t make this investment now these waiting lists will grow exponentially,” Casey said.