Missouri is among the states that will be required to change their Home and Community-Based Services programs before receiving federal funding under the Build Back Better (BBB) Act, according to the Freedom Foundation.
If approved, the legislation would expand Medicaid funding to care for adults with disabilities but with strings attached.
“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,” said Maxford Nelsen, director of labor policy for the Freedom Foundation. “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 alleging that the BBB Act could steer billions of dollars in Medicaid funds to unions, such as the Service Employees International Union and the American Federation of State, County, and Municipal Employees, through home and community-based services (HCBS).
“For a state like Missouri, that doesn't already have a unionized home care workforce, it would find itself having to make some decisions,” Nelsen told the St. Louis Record. “If the state wants to avail itself of the additional federal funds that the BBB Act would make available for Medicaid, it would have to agree to the strings that are attached to that federal funding. It would have to consider whether to open the door for a union to come in and organize the workforce and require the caregivers to pay union dues.”
The Service Employees International Union and the American Federation of State, County, and Municipal Employees are unions that represent home care aides.
“The legislation does say you have to come up with a plan to increase training,” Nelsen said. “You'd have to come up with a plan to increase wages on a regular basis, and you have to do all of this in consultation with home care workers and their representatives, which is code for labor unions."
The House of Representatives approved a $1.2 trillion infrastructure bill on Friday but stopped short of voting on the BBB Act.
“The House is still trying to scramble to get the votes pulled together for it,” Nelsen added. “Nobody knows how much the bill would cost yet. Procedurally, there's a group of a dozen or so moderate Democrats that are insisting that they wait until the Congressional Budget Office comes out with its formal analysis of how much the bill would cost before holding a vote and the Congressional Budget Office has not done that yet. There's a lot of people pushing for quick action but it only takes a couple of people at the moment to slow things down.”