Health economists are criticizing the Biden administration for withholding crucial details about an ambitious proposal to invest $400 billion in reforming the home caregiving industry, a move they say erodes public confidence that the massive funding package will be spent wisely.
The Biden administration included the proposal in the $2 trillion American Jobs Plan, an infrastructure package that aims to repair thousands of bridges and roads, expand high-speed broadband, and fund development of new clean energy technology to combat climate change. The $400 billion initiative is meant to make home-care services for the elderly and disabled more accessible as well as boost wages and provide health benefits for “underpaid and undervalued” home-care providers.
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The administration has not disclosed further details about how the funding will be allocated, explaining in the written proposal that President Joe Biden’s goal is to “expand access to home and community-based services” under Medicaid that would “support well-paying caregiving jobs that include benefits and the ability to collectively bargain.”
“No specific details have yet been released so far on how the money will be spent, which does not create confidence that it will be spent effectively, rather than just inflating the cost of care or crowding out family provision,” said Chris Pope, an expert in Medicare and Medicaid spending at the Manhattan Institute. “The best way to be sure to fail to hit a target is to not have a specific target.”
The home-care industry is among the fastest-growing sectors in the U.S. economy, according to the Department of Labor, which predicts the occupation will grow 34% by 2029. Still, about 1 in 4 home-care aides live below the poverty line. Home-care workers make an average hourly wage of about $12.15 and typically lack health benefits. But for many seniors and disabled adults, home-care services are essential to avoid moving into nursing homes.
Home-care aides assist elderly and disabled people with daily tasks such as preparing meals and cleaning, as well as medical assistance such as help with organizing and taking their prescription medications, checking blood pressure and vital signs, and tending to wounds.
“Maybe [the spending is] justified, but the amount of material that was provided in the briefing material just doesn’t give you enough information to know the basis upon which the number has been established,” William Hoagland, a health economist at the Bipartisan Policy Center, told the Washington Examiner.
PHI, a public health policy group that advocates for workers in the home healthcare sector, reported that 1 in 4 home-care workers lives below the federal poverty line.
“In the material that was distributed was a discussion about the low pay for the caregivers particularly … It confused me as a numbers person as to whether that $400 billion included increasing the minimum wage for those individuals out there that are in the caregiving business,” Hoagland said.
Biden’s plan also includes a paucity of information about his goals for making high-quality home care more affordable for seniors. Government health plans through Medicare, an insurance program for seniors over 65, only cover a fraction of the cost for home care. Medicare plans only cover “intermittent care,” or care provided for fewer than eight hours per day and less than seven days per week.
Medicaid, a government insurance program that offers health coverage to the poor and disabled, covers certain home-care services carried out by trained medical professionals, but not those nonmedical services such as housekeeping tasks and companionship. Those not covered by government-backed health plans or whose private plans do not extend to elder care have to pay out of pocket.
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“High-quality care is offered by people who are compensated, have benefits, are trained … that impacts patient outcomes,” said Rani Snyder, a public health expert at the elder care advocacy group John A. Hartford Foundation.
White House press secretary Jen Psaki told reporters on Thursday that Biden “will be speaking more in the coming weeks about how we can do more to help our caregivers.”
