Union “dues” by home health workers will hurt the most vulnerable


President BidenJoe BidenFrance (and the UK) should join the Quad-polling resistors put down by the Idaho Secretary of State Under Biden, the US could fall further behind in the Arctic MORE promised to become the most union-friendly president in history. And he is faithful to this obligation, but at the expense of the seriously ill and the disabled.

Biden’s Department of Health and Welfare (DHS) proposed a new rule that would allow unions to siphon off contributions from home care workers. Under the proposed rule, the DHS would allow Medicaid payments to be diverted to third parties, including unions. This may seem harmless, but it is everything else. In fact, this rule would re-authorize what is known as “dues skim,” a system that unions benefited from at the expense of vulnerable Medicaid recipients and their caregivers.

In 2011, the Mackinac Center was the first to discover the diversion of Medicaid payments to labor organizations. In Michigan, the local affiliate of the Service Employees International Union (SEIU) recognized that it could receive “fees” from home health care providers and worked with the state to compulsorily unionize them. First, the SEIU lobbied the state to create an agency called the Michigan Quality Community Care Council to serve as the alleged employer of Michigan home health care providers. The SEIU then negotiated with this “employer” to unionize these workers. All of this happened even though less than 20 percent of the home nurses affected voted for the union. Many did not even know that a union election had taken place.

As a result, some Medicaid payments have been diverted to the SEIU to cover home health care costs – often for family members of seriously ill or disabled people. By 2012, the SEIU had successfully skimmed over $ 34 million in Michigan alone. After reforms were passed banning dues (and later reinforced in an electoral proposal), home nurses overwhelmingly demonstrated that they did not want to be unionized. In less than a year, SEIU Healthcare Michigan’s membership dropped 80 percent. In other words, only 20 percent of vendors thought it would be worthwhile to have a choice of union membership.

The consequences of toll recovery are getting worse at the national level. From 2000 to 2017, unions successfully diverted around $ 1.4 billion in Medicaid payments.

These payments can hardly be justified. Although DHS claims that allowing these diversion payments would benefit nurses through better education and training, it has provided no evidence to support this claim. What evidence exists suggests that such arguments are unfounded.

The position is also logically inconsistent. If unions had training opportunities that would benefit general practitioners, nothing prevents them from offering such training for a fee. Providers could then decide whether to use the funds they receive from Medicaid to improve their skills by attending these training courses. This regulation would be compatible with both the law and the market incentives. Instead, the DHS has opted for a regulation that encourages coercion and possible fraud.

The practical consequences of allowing fee skimmings should not be underestimated. The service providers from whom payments would be diverted are often the family members of the seriously ill or severely disabled. Without this care, the sick and disabled would be forced into an institution, probably at higher taxpayers’ expense. These family members sacrifice their time and energy and are easily compensated, mostly through Medicaid payments.

Even so, some unions have used levies to reroute payments while providing few, if any, tangible benefits to providers or Medicaid recipients. But in this situation the unions have little to offer either party, as the home nurses are not employed by an outside agency, but by their patients. They either work at home or with their sick and disabled relatives. They manage their working conditions and working hours themselves, based on the needs of their patients. Unions do not play a representative role in these areas – the traditional purpose of collective bargaining.

DHS should not restore toll recovery through administrative fiat. This would reduce the resources available to the sick and disabled, exacerbate the shortage of home care workers, and divert Medicaid payments from their intended purpose. Funds paid to carers should be used to support their efforts to care for the sick and disabled, not for favored political ends.

Steve Delie is Labor Policy Director at the Mackinac Center for Public Policy in Midland, Michigan.

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