The House of Representatives approved a $1.2 trillion infrastructure bill over the weekend but stopped short of voting on the Build Back Better (BBB) Act.
The Build Back Better Act would, among other things, expand Medicaid funding to care for adults with disabilities, but with strings attached.
“Nobody knows at the moment how much additional funding would be made available for Medicaid home and community-based services,” said Maxford Nelsen, director of labor policy for the Freedom Foundation, a think tank.
“The general estimates appear to be several hundred billion dollars that overall would be made available to states across the board for expanding these home and community-based services,” said Nelson.
Texas is among the states that will be required to change their Home and Community-Based Services (HCBS) programs before receiving federal funding under the Build Back Better Act, according to the Freedom Foundation.
“For a state like Texas, that doesn’t already have a unionized home care workforce, it would find itself having to make some decisions,” Nelsen told Dallas Express.
The Freedom Foundation is alleging that under the BBB Act, Texans would have to agree to the strings that are attached to that federal funding and whether to open the door for a union to organize the workforce and require the caregivers to pay union dues.
“Within the context of home care to adults with functional disabilities, the main piece that we’re concerned with is how the legislation would incentivize states to unionize home care workers and to require them to pay union dues as a condition of employment,” Nelsen said. “We think that is a violation of their personal freedoms and it’s also a massive windfall for very politically influential special interest groups.”
The Freedom Foundation is further alleging the BBB Act could steer billions of dollars in Medicaid funds to unions, such as the Service Employees International Union (SEIU) and the American Federation of State, County, and Municipal Employees, through HCBS.
“The federal government already regulates how Medicaid funds can be used at the state and local level,” said Nelsen. “This is the federal government adding more parameters, adding more requirements, and adding more restrictions in a way that would serve a large, special interest group that favors the current administration and the current majorities in Congress.”
The Service Employees International Union and the American Federation of State, County, and Municipal Employees are unions representing home care aides.
“There are a lot of other components of the Build Back Better Act that are creating brand new programs that would be precedential like that Medicaid would probably become permanent and very hard to unwind, and that would continually grow in costs and a decline in efficiency over time,” said Nelsen. “When it comes to Medicaid, we’ve already established the precedent that the federal government can regulate the program and do what it wants.”
The practice is already standardized in Democratic states such as Washington. The result has been that the unions allegedly representing these home care providers rival teachers’ unions in money and power.
“What I object to is diverting some of that money in structuring the programs in such a way that two or 3% of every Medicaid dollar that goes out, winds up in a private, special interest groups’ treasury,” Nelsen added. “It’s objectionable to allow private interests to hijack Medicaid for their own enrichment.”
