A Proposal To Revolutionize Caregiving -- And Why Its Funding May Get Cut In Half
Two new articles that tell a bigger story of what's going on in Congress right now
Among the many initiatives Democrats hope to pass this year, as part of the big reconciliation spending bill, is a proposal that could transform life for elderly and disabled Americans and the people who care for them too.
Over the past few days, I wrote two articles on the subject -- one on why the initiative is so important and one on why it might end up with only half the funding that its champions envisioned.
The first article tells the story of Justin Martin, a 25-year-old graduate student at Vanderbilt who I first met about four years ago when I was covering the debate over ACA repeal. Justin has cerebral palsy and, back then, he wanted to warn people that GOP repeal legislation included big cuts to Medicaid, jeopardizing the services and programs that made it possible for him to live on campus, rather than in an institution.
There’s a great video of him here, from that 2017 article, if you’re interested:
In the end, the GOP repeal effort failed. Justin went on to graduate with honors and gain admission to Vanderbilt's prestigious master's program in education, putting him on track to realize his dream of becoming a high school English teacher. With the return of full in-person learning this fall, he was looking forward to joining his classmates in Nashville. But he can't, because he can't find caregivers in Tennessee.
His situation is not unusual. It's a byproduct of a nationwide caregiver shortage that was severe before the pandemic but has gotten worse since. The underlying cause is chronically low pay for caregivers -- which, in turn, is something the new Democratic proposal would address.
Which brings me to the second article, just out this morning.
That Democratic proposal would dramatically increase federal funding for what are formally known as "home and community-based services," or HCBS. President Joe Biden endorsed the idea during his presidential campaign and included it as part of his "Build Back Better" agenda. His budget anticipated including the proposal in the forthcoming reconciliation bill, setting aside $400 billion over ten years. A preliminary, but unpublished CBO estimate that sources shared with HuffPost suggested that allotment was enough to fund the initiative fully.
But there is only so much money in the reconciliation bill and there will be even less if more conservative Democrats like Joe Manchin and Kirsten Sinema get their way. Democratic leaders are making difficult choices over which parts of their agenda to fund fully, which ones to fund partly and which ones not to fund at all. One operative told me the dynamics are a bit like "The Hunger Games."
At the moment, leaders are talking about funding the home care initiative at somewhere between $150 billion and $250 billion — which, obviously, is a lot less than $400 billion. The big worry for advocates is that such a cut would make it difficult to accomplish the initiative's twin goals: making home care services available to everybody who wants and needs them, while simultaneously boosting caregiver pay in order to attract and then retain enough well-qualified workers. As Justin Martin's story demonstrates, both needs are real.
Here's a link to the Justin Martin story:
Here's a link to today's article on the congressional deliberations:
https://www.huffpost.com/entry/caregiving-funding-cut-democrats-house_n_6132d9ade4b04778c0052765
And here's a tweet-storm with a few more reporting details about the internal Democratic deliberations:
Thank you for reading!