August 13, 2018
The MacIver Institute, in comments submitted to the federal government, is urging the federal Centers for Medicare and Medicaid Services (CMS) to reform regulations that allow public sector unions to skim dues payments from home caregivers. This “dues skim” scheme diverts some $200 million each year from Medicaid into union coffers.
CMS took action after pressure from Wisconsin Sen. Ron Johnson. In July the agency proposed new regulatory language – revising Obama-era regulations that created the loophole – to prevent unions from siphoning dues from Medicaid payments intended for low-income, disabled, and otherwise vulnerable Americans.
The public is invited to submit comments of their own. To submit comments, click here.
MacIver’s comments submitted to CMS follow:
The John K. MacIver Institute for Public Policy strongly supports the proposal to remove the regulatory exception at 447.10(g)(4) to prohibit personal care and child care dues skimming from Medicaid and related funds. This dues skim is a practice that is indefensible from both a statutory and moral viewpoint.
Under the statutes, a state is allowed to reassign portions of a provider’s payment to third parties for benefits such as health insurance, skills training, and other benefits customary for employees. However, we agree with the agency’s concern that § 447.10(g)(4) is overly broad, and has been taken advantage of by unions to benefit and enrich themselves at the expense of home caregivers and those in their care, a violation of the statutes that prohibit even voluntary re-assignment of funds.
In 11 states, unions have used this loophole to extract funds from home caregivers, money that the unions use to advance their political agendas and conduct “training” that serves as recruitment and indoctrination sessions. Unions do this by convincing legislatures in these states to classify home caregivers, many of whom are looking after loved ones in their own homes, as government employees.
These home caregivers are considered public employees simply because they receive support through the taxpayer-funded Medicaid program, and unions have organized them through dubious elections. Where the practice of dues skimming occurs, unions siphon off dues directly from caregivers’ Medicaid payments before those funds even reach the patient they are intended to help. It is estimated that this practice diverts $200 million in Medicaid funds each year from the purpose Congress intended it for, instead depositing the money into union coffers, violating Medicaid’s integrity and threatening its long-term stability.
This means that, while unions have more money to push their agenda, patients in need have fewer resources available to make their lives better and pay for much-needed care. It’s especially concerning considering the fact that some caregivers are unaware they even belong to a union and are unlikely to see many, if any, benefits in return for the money deducted from their checks.
In 2011, Wisconsin put a stop to this scheme. The 2011 Wisconsin Act 10 did away with the Wisconsin Quality Home Care Authority that was laying the groundwork for care providers to be represented by SEIU Healthcare Wisconsin. Today, “Wisconsin has the best health care quality in the country,” the Wisconsin State Journal reported last year.
The dues skimming practice robs taxpayer money from already imperiled programs. In 2011, the Journal noted “Wisconsin’s Medicaid programs, which cover 1.2 million people, or one in five residents, face a $214 million shortfall this fiscal year and a $1.8 billion deficit over the next two years.” Outlawing the union dues skim was one step toward addressing the fiscal challenges of these programs by making sure the funds spent on the programs go to the purpose the programs were meant for.
Despite the examples of states like Wisconsin, some still permit the skimming of Medicaid money by unions. It falls to the federal government to correct this with a permanent fix for the dues skim to protect our country’s most vulnerable people. Closing this loophole will ensure home healthcare providers can focus on serving their patients, not fighting off unwanted union membership. Fortunately for the hundreds of thousands of in-home caregivers across the country, CMS is now considering that solution.
Most people would agree that requiring a mother to pay union dues just so she can look after her disabled son is ludicrous, yet that’s exactly what dues-skimming does.
The hundreds of thousands of caregivers across the country should not be subjected to unwanted union membership that brings them little benefit when they’re working out of their own homes, often caring for relatives.
Medicaid patients deserve the best care possible, but our most vulnerable will continue to suffer so long as unions take this money set aside for care and use it for their own selfish political purposes.
Statutes clearly outline which payment reassignments are permissible, and diversion of funds to unions is not among them. The regulatory provision in 447.10(g)(4) grants permissions that Congress has foreclosed, allowing this immoral dues skim to continue. We strongly support the timely removal of this provision and unequivocal regulatory language that expressly asserts that states must immediately stop reassigning home care workers’ Medicaid payments to unions.