In New York City, Retirees Brace for Switch to Privatized Health Care

Originally published in The Intercept on August 19, 2021. Co-authored with Sam Mellins.
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STARTING IN JANUARY 2022, over a quarter million former New York City government workers and their dependents are set to be shifted off Medicare and on to privatized health insurance. Mayor Bill de Blasio and the Municipal Labor Committee, which represents retired New York City employees, announced the move in mid-July, following several months of scrambled protest from bewildered retirees.

The plan has been cast as a necessary measure to rein in mounting health care costs and reduce strain on the city’s budget. While public sector retirees in New York City are currently insured by Medicare, the federal government’s program for people over 65, the city reimburses them for outpatient care, as well as for a “Medigap” plan that offers additional services. City officials and union leaders have negotiated a deal that they claim will save upward of $600 million by switching to Medicare Advantage, the federally funded privatized health insurance program that launched ostensibly to give consumers more choice and reduce Medicare costs.

For months, union leaders have emphasized that despite distressing stories members may have heard about Medicare Advantage, the new plan will yield affordable care at the same level, if not better, for enrolled retirees and their dependents. But retirees who spoke with The Intercept and New York Focus expressed concerns that their health care will become less accessible over time, and health care experts say their fears are not unwarranted.

Retirees who do not want to switch to privatized insurance will have the option to remain in traditional Medicare, but they will need to pay a monthly premium, currently covered by the city, to access the same level of coverage they receive now. That rate is likely to be around $200 a month, estimates Stu Eber, president of the Council of Municipal Retiree Organizations, a group that advocates for retired city workers.

Eber predicts that this option will be infeasible for many older adults. “There are tens of thousands of people … whose pensions are less than $20,000 a year,” he said. “They can’t afford it; they have no choice. They’re going to be in this Medicare Advantage plan.” The new plan has been awarded to a coalition of Emblem Health and Blue Cross known as “The Alliance.”

Now that the plan has been approved, the city and labor committee are doubling down on their efforts to persuade the public that the switch is good policy and the coverage is nothing to be concerned about.

The city points to rising costs associated with traditional Medicare, which have increased nearly 50 percent over the past six years. To make up for the higher costs, co-pays for those who opt to stay in traditional Medicare will begin in January. A side-by-side comparison of the traditional Medicare option and the Medicare Advantage plan, released by the city, shows competitive rates and benefits between the two in the coming year. Some elements of the Medicare Advantage plan, such as annual maximum out-of-pocket costs and primary care physician visits, actually appear friendlier to beneficiaries.

benefit-comparison-1

“This new plan not only mirrors and improves on the GHI Senior Care Plan [the city’s traditional Medicare option], it also includes aggressive oversight to protect member benefits,” read one update from the United Federation of Teachers, the city’s teachers union. “Most importantly, under this plan, retirees will still have premium-free access to the same providers and hospitals they now use.”

One flyer from the Municipal Labor Committee says that savings will come from “subsidies” the federal government gives to Medicare Advantage programs because Medicare Advantage “relieve[s] it from much of the back-office tasks” associated with traditional Medicare.

But health insurance experts said that explanation doesn’t hold water. Under Medicare Advantage plans, the federal government pays private insurers, whereas under the current model, the federal government pays providers directly for care.

“It’s not that the federal government is paying for something they weren’t paying for before, it just changes the nature of how they pay,” said David Meyers, an assistant professor at the Brown University School of Public Health.

And indeed, when pressed for details, a de Blasio administration spokesperson acknowledged that “it’s a mischaracterization to call it a subsidy.”

In reviewing the cost-benefit comparison literature, Meyers told The Intercept and New York Focus that the proposed Medicare Advantage plan “appears to be somewhat generous as far as plans go.” He pointed to relatively low out-of-pocket maximum costs of $1,470 and supplemental benefits such as meal delivery on returning from a hospital stay. “It’s not obvious that this is a predatory sort of plan,” he said.

Another health policy expert agreed. “The outlook for the first year looks pretty good,” Tricia Neuman, executive director of the Kaiser Family Foundation’s Program on Medicare Policy, told The Intercept and New York Focus.

But concerns remain for retirees trying to figure out if they’re getting a raw financial deal. Some local health advocates, meanwhile, believe that the shift will create new disparities among New York City retirees across race and gender.

The New York Metro chapter of Physicians for a National Health Program, a national group of health care professionals who support single-payer health insurance, warned that the city’s Medicare Advantage plan will create a bifurcated system: Higher-income, predominantly white retirees will stay on traditional Medicare because they can afford the supplemental Medigap insurance, while lower-income retirees, predominantly people of color, will accept the more restricted Medicare Advantage plan.

Physicians for a National Health Program – NY Metro statement3 pages

The chapter further cautioned that the move to Medicare Advantage could result in gender disparities already demonstrated in worker pay. Among current New York City municipal workers, 58 percent of men earn $70,000 or more, compared to just 36 percent of women. “This disparity in income among retirees is likely to be even greater, since they worked for the city before many of the current measures aimed at decreasing inequalities in the workforce were put in place,” noted Leonard Rodberg, the New York Metro chapter’s research director and a municipal retiree.

These inequities have played out nationally, according to Meyers. “Medigap plans can often be quite expensive, so many lower-income people, who are often minorities, tend to enroll in Medicare Advantage at high rates and Medigap at lower rates,” he said.

Another top concern is whether the costs imposed on retirees would remain similar to traditional Medicare over time or whether the plan might shift more costs on to older adults in years to come.

The present cost-sharing arrangement has been locked in through 2026, a spokesperson for the de Blasio administration told The Intercept and New York Focus. But uncertainties surrounding federal funding of Medicare Advantage and less stringent pricing regulations than exist in traditional Medicare mean that the post-2026 future is less certain.

“This arrangement assumes that Medicare will continue to provide favorable payment to Medicare Advantage plans that enable them to provide extra benefits,” said Neuman. “That may continue into the future, but it may not.”

Many retirees are also concerned about the plan’s requirement that enrollees obtain permission from insurance companies before accessing certain recommended procedures. A significant portion of the savings achieved by most Medicare Advantage plans hinges on such preapprovals.

“Gatekeepers are never a good thing,” Eber said. “They stand between you and getting the medical assistance and tests that you need, when you need them.”

A spokesperson for the de Blasio administration said that services requiring such pre-authorization would include inpatient hospital admissions, skilled nursing facility admissions, rehabilitation services, complex radiology, prosthetics and orthotics, and transplants.

“To wait around for somebody to say, ‘Yes, you can have an MRI; yes, you can go to physical therapy; no, I don’t think you need this test or that test’ — I’m not interested,” said Jane Roeder, a retired city administrator.

Some retirees may even be receiving misinformation from their own union leadership regarding which services will require authorization under the new plan. A United Federation of Teachers spokesperson told The Intercept and New York Focus that the new Medicare Advantage plan “will have to adhere by the same ‘prior authorization’ requirements as [traditional] Medicare.”

But other than for “durable” medical equipment (such as walkers or oxygen tanks), prosthetics, and certain physician-administered drugs, traditional Medicare very rarely requires preapprovals.“

Diane Archer, president of Just Care, an informational site that offers health and financial tips to older people, said suggesting that retirees will get the same health care fundamentally obscures the differences between the two programs. “They may offer the same benefits, but the way Medicare Advantage plans ‘save money’ is by covering fewer services,” she said. “What few people understand is that ‘same benefits’ is very different from ‘same health care.’”

On top of pre-authorization, Medicare Advantage plans tend to come with more restrictive networks than traditional Medicare, which offers access to the vast majority of physicians nationally. “While the plan is PPO and claims to have a very large network, PPO plans can still guide you to specific providers,” said Meyers. “I can’t say if the plan will have a robust network in the NY area- if it does, it might be fine, but one of the largest benefits of [traditional Medicare] is that there are really no network restrictions.”

The city and union leadership argue that retirees need not worry. According to an FAQ published by the city’s Office of Labor Relations, 640,000 out of 850,000 Medicare providers nationally are contractually obligated to accept their new Medicare Advantage plan.

A de Blasio administration spokesperson dismissed concerns regarding whether the remaining 210,000 will accept the plan, noting that those providers will be compensated at the same rates that Medicare pays. In the case of recalcitrant providers, a call center will assist retirees in getting payments to relevant physicians, the spokesperson said.

According to the FAQ, as a last resort, retirees can pay their providers and submit the claims to the health insurance companies for reimbursement.

Notably, the city is touting the fact that Hospital for Special Surgery and the Memorial Sloan Kettering Cancer Center — two top-tier local hospitals that typically do not accept Medicare Advantage — have agreed to participate in their plan. But there is no binding legal obligation yet, a de Blasio spokesperson confirmed, though the administration expects to finalize an agreement with the hospitals before January. “Both facilities have agreed to continue to see our Medicare Advantage members on an out-of-network basis while negotiations are underway,” the spokesperson added.

But to some retirees, the assumption seems risky.

“How many hospitals are there in this country that don’t accept any Medicare Advantage plan? Why all of a sudden will they accept this one plan?” asked Eber, who noted that he represents retirees living all over the country. “We don’t share the confidence that the city and the Municipal Labor Council have. We hope they’re right, but the proof will be in the pudding come January.”

A spokesperson from Memorial Sloan Kettering declined to comment. Tracy Hickenbottom, a spokesperson for Hospital for Special Surgery, said, “We work with patients, payers and community leaders to demonstrate value and best serve as many people as possible. This enables us to offer acceptance of most major insurance plans for Hospital services, including several Medicare Advantage plans.”

NEW YORK MUNICIPAL retirees are not alone in wondering what an increased push toward Medicare Advantage means for them. As of this year, 42 percent of all Medicare beneficiaries are enrolled in Medicare Advantage plans, up from 24 percent a decade earlier. The Congressional Budget Office projects that share could hit 50 percent by 2026.

“Retiree health benefits have become a significant expense, and employers are looking for ways to meet their obligation and cut costs, which makes Medicare Advantage quite appealing at the moment,” said Neuman.

Despite so many people now on the privatized plans, researchers say they do not have a strong grasp of what kind of health care beneficiaries are actually receiving, especially those who are sickest or have the most complex needs.

This past spring, in an annual federally mandated analysis on Medicare, the Medicare Payment Advisory Commission wrote that “the current state of quality reporting in [Medicare Advantage] is such that the Commission can no longer provide an accurate description of the quality of care.”

The plans are also taking a toll on federal coffers, due to overpayments and disenrollments in the final year of life, among other factors. “There is no question that Medicare Advantage is unsustainable in the long term,” said Archer. “It’s driving up Part B premiums, eroding the Medicare trust fund, and costing taxpayers tens of billions a year more than traditional Medicare.”

While support for Medicare Advantage in Congress has been strong and bipartisan for some time, Politico reported on August 3 that some lawmakers and outside groups are pushing “some form of cuts” to the program as a potential source of savings in the budget reconciliation bill. Politically, it may also be easier for the federal government to reduce reimbursements to health insurance companies than to the providers it pays directly through traditional Medicare.

If federal support for Medicare Advantage decreases, costs may rise for city-insured retirees like Josephine Malaysz, who worked for decades as a nurse in the city’s public and private hospitals. Malaysz, whose husband is also a city-insured retiree, views the shift to Medicare Advantage as a poor measure of gratitude for the couple’s long careers in public health.

“My husband worked over 30 years as a paramedic — sometimes he would work 80 hours a week. He loved his job,” she said. “And when I was in the city hospitals, I gave my all to my patients.”

“We gave ourselves to the city, and now you’re retired, and here we go,” she added. “It’s just not respectful.”

You Don’t Have to Tell Your Employer About a Serious Diagnosis—But You Still Might Want To

Originally published in GQ on August 31, 2020.
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On Friday, Actor Chadwick Boseman died of colon cancer at age 43. From an announcement posted to his Instagram, the public learned the star had originally received the diagnosis in 2016, and that he had filmed many of his best-loved films while undergoing chemotherapy and surgeries to fight the disease.

The news came as a shock not only to the general public, but even to directors, producers and colleagues he had worked closely with over the last four years. Sarah Halley Finn, the veteran casting director who picked Boseman to play T’Challa in Black Panther, told Vulture she had no idea the actor had cancer as the blockbuster was filmed in 2017. And in a tribute on Saturday, Spike Lee said it never crossed his mind while on set with Boseman. “I never, ever suspected that anything was wrong,” said the director of Da 5 Bloods. “No one knew he was going through treatment.”

The decision of whether to disclose a serious diagnosis like cancer to an employer is frequently a fraught one. Under federal law, no one is required to tell their employer as long as they assume they can reasonably do the work required, but disclosure is necessary to trigger the protections of the Americans with Disabilities Act, the main federal statute protecting cancer patients in the workplace.

Even if workers disclose, employers are limited in what they can ask about the cancer and must keep any medical information they learn confidential. Reasonable workplace accommodations for cancer patients include leaving for doctor’s appointments, time off to recover from treatment, and periodic breaks during the work day.

That Boseman kept his private life under wraps does not mean he never sought any accommodations to deal with his illness in the workplace, and he was potentially able to negotiate well beyond the legal minimum. “Given that it’s Hollywood, I could imagine a contract that [Boseman] enters into with a studio setting out his specific needs and binding anyone to secrecy,” said Sasha Samberg-Champion, a civil rights attorney who specializes in disability law. “If you have that kind of stature and a sophisticated agent you could work those things out. And the employer might not even be allowed to know why you need certain things.”

Gordon Firemark, a Los-Angeles based entertainment lawyer, told GQ that it’s “pretty typical” for an actor’s agent or manager to negotiate special accommodations for their clients like private dressing rooms, separate facilities, transportation or special foods. “If an actor of his stature is starring in a movie and he can’t be there because he had a chemo session, they’ll often just schedule around them, and that could be kept very quiet,” said Firemark.

For many workers who may have less negotiating power, having cancer in the workplace, even with the protections of the A.D.A., can be extremely difficult. To start with, the 30-year-old law does not protect independent contractors or those who work in businesses with fewer than 15 employees. But even employees covered by the law can still face discrimination, as some courts have ruled that extended periods of leave for cancer treatment can be legitimate grounds for termination.

Ann Hodges, a University of Virginia law professor and co-founder of CancerLINC, a nonprofit that helps cancer patients and their families navigate legal issues, said employers are often more willing to accommodate people working in higher-wage jobs.

“Sometimes it’s because they’re just not as easy to replace, or they may have more power in the organization,” she said. “Often those patients also have jobs that can more easily be done remotely.” According to the Economic Policy Institute, higher-wage workers are six times as likely to be able to work from home compared to lower-wage workers.

Hodges, a cancer survivor herself, points out that many Americans also lose their health insurance if they lose their jobs—a problem in the best of times, and an acute crisis for someone in treatment for cancer.

As a member of SAG-AFTRA, the union for film and television actors, Boseman would have had access to the union’s vaunted healthcare plans. But David White, the national executive director of SAG-AFTRA, noted that even these plans have been under strain—they’re “not immune” from the larger issues plaguing America’s healthcare system. Earlier this month, in light of projected deficits in the tens of millions of dollars, the entertainment union announced it would have to tighten eligibility requirements and raise premiums going forward. More than 17,000 people have signed a petition in protest.

“It’s a constant struggle to make sure that we are maximizing access for people like Chadwick and for people who can only dream of having Chadwick’s level of success,” White said.

Why the Dichotomy Between Racial and Economic Justice is A False One

Originally published in The American Prospect‘s Tapped blog on July 21, 2015.
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Yesterday, Vox’s Dara Lind published a post analyzing what this past weekend’s protests at Netroots Nation tell us about splits within the progressive movement. I personally don’t think Bernie Sanders handled the Black Lives Matter demonstrators very well, and I imagine his advisers had several serious conversations with him following the conference about how to better approach these voters going forward. He’s a politician—I’m pretty confident he’ll figure out how to campaign more effectively.

It’s the media analysis I’m more worried about.

Lind writes:

There is a legitimate disconnect between the way Sanders (and many of the economic progressives who support him) see the world, and the way many racial justice progressives see the world. To Bernie Sanders, as I’ve written, racial inequality is a symptom—but economic inequality is the disease. That’s why his responses to unrest in Ferguson and Baltimore have included specific calls for police accountability, but have focused on improving economic opportunity for young African Americans. Sanders presents fixing unemployment as the systemic solution to the problem.

Many racial justice advocates don’t see it that way. They see racism as its own systemic problem that has to be addressed on its own terms. They feel that it’s important to acknowledge the effects of economic inequality on people of color, but that racial inequality isn’t merely a symptom of economic inequality. And, most importantly, they feel that “pivoting” to economic issues can be a way for white progressives to present their agenda as the progressive agenda and shove black progressives, and the issues that matter most to them, to the sidelines.

We must push back against this false dichotomy of “racial justice progressives” and “economic progressives.” I think it’s a harmful way to frame what’s going on, and it suggests that we can have racial justice without economic justice, and that economic justice can come about without tackling racism. Neither is true, at all.

Racial justice amounts to far more than dismantling our racist criminal justice system and reining in police brutality. Affordable housing, public education, and quality health care are all issues that impact individuals directly based on class and race. Drawing imaginary lines between them just doesn’t work.

I’m not frustrated with the coverage because, as Lind suggests, I just want to defend Sanders. I am frustrated because attempts to separate economic issues—whether it’s jobs, or retirement savings, or health care, or prisons, or loans, or taxes—from racial justice, is a deeply troubling way to lead a national conversation about racism.

With New Protections Tied Up in the Courts, Home Health Care Workers Aren’t Waiting Around

Originally published in The American Prospect on April 3rd, 2015.
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Almost two years after the Obama administration extended historic labor protections to the nation’s 1.79 million home healthcare workers, those new rights remain in limbo. In September 2013, the Department of Labor (DOL) announced plans to amend a longstanding regulation that has excluded them from earning the federal minimum wage, overtime pay, and compensation for travel on the job. For home healthcare workers in the United States—a group that is nearly 90 percent female—this move marked a significant step towards setting a floor of decent labor standards.

But the rule-change, which was set to go into effect on January 1st, now faces a challenge in federal court, and critics say state legislators are using the ongoing litigation as an excuse to avoid implementing the new protections. At the same time, given that most home healthcare workers are paid through Medicaid and Medicare—two underfunded public programs—many also worry that states will respond to the rule-change by curtailing consumers’ access to quality care. Activists across the country are working to pressure their lawmakers to reckon with these new standards and avoid potential calamity.

Four decades ago, Congress decided that home healthcare workers should be classified more like babysitters who provide “companionship,” rather than as workers entitled to basic protections. Nursing home employees, by contrast, are fully covered under the Fair Labor Standards Act (FLSA), despite performing many of the same tasks. As home healthcare has ballooned in recent years, these occupational distinctions have become harder to justify.

According to the Bureau of Labor Statistics, the U.S. will need one million new home healthcare workers by 2022. But the work is draining, the pay is paltry, and turnover is high. When adjusted for inflation, home healthcare workers’ average hourly wages have declined by nearly 6 percent since 2004. In 2013, the average earnings of home healthcare workers totaled just $18,598. 2013 was also the year that the Obama administration decided it was well past time to update FLSA’s policy. Because the DOL has the authority to amend federal regulations, it was able to enact this change without seeking Congress’s approval.

Though the new DOL rule-change would most directly benefit home healthcare workers, it carries implications for all domestic workers, including nannies and housekeepers. “By improving the conditions and protections in one area, you’re broadly boosting the sense that this is dignified work,” says Elly Kugler, an attorney with the National Domestic Workers Alliance, (NDWA) a group representing domestic workers in the United States.

Whether that change will actually be implemented is another question. Last year three industry groups filed a lawsuit against the DOL rule-change, insisting that it would have a “destabilizing impact” on home healthcare and hurt millions of elderly individuals. On December 22, 2014, a D.C. district judge vacated the rule for third-party employers, arguing that the executive branch cannot make such a regulatory change. A few weeks later, the same judge also vacated FLSA’s revised definition of “companionship services.” The DOL filed a challenge in appeals court, and arguments will be heard later this spring. Some suspect this may ultimately make its way to the Supreme Court.

Then, on March 20th, Labor Secretary Tom Perez sent a letter out to all 50 governors, urging them to focus on budgeting the minimum wage and overtime protections now, “to ensure that [they] will prepared if the Department prevails” in appeals court. Across the country, activists are also pressuring their representatives to focus on these issues. Yet many lawmakers are using the litigation as an excuse to avoid reckoning with the thorny budgetary questions. This means workers may not see minimum wage, overtime, and travel pay increases anytime soon.

“In Georgia, we’re seeing that our lawmakers are not talking about these issues,” says Tamieka Atkins, who leads Atlanta’s chapter of NDWA. “They have the attitude that we’re not going to move on this until the lawsuit comes down.” In response, Atkins’ group launched a campaign to lobby lawmakers and health agency commissioners in advance of their next legislative session. They also started a petition—“Governor Deal: All Eyes Are On Georgia”—asking for gubernatorial support towards minimum wage and overtime.

Activists in Texas are also applying pressure to their leaders. In January, domestic workers launched a home healthcare campaign, bringing together consumer groups, disability rights organizations, and labor unions. The following month—for the first time ever—domestic workers traveled to Austin to share their personal stories and lobby state legislators. “It was a really great opportunity because we agitated on different levels,” says Mitzi Ordonez, a domestic worker organizer at the Fe Y Justicia Worker Center in Houston.What we found is that many of the lawmakers just didn’t know about these [DOL] changes.”

Compared to Texas and Georgia, some states have made greater progress towards implementing the new labor protections. California, which already pays its home healthcare workers minimum wage, allocated new funds for overtime pay in its 2014-2015 budget, and was prepared to pay workers more at the start of 2015. But after learning about the federal lawsuit, California Governor Jerry Brown decided to postpone the overtime pay, even though there is nothing legally obligating him to do so. Frustrated activists have launched a campaign in protest; they organized meetings with state legislators, held rallies and candle light vigils, and even set up a“Justice for Homecare Tribunal”—a mock trial against the state. “The best thing for us to do is to not rest on our laurels,” says Doug Moore, the executive director of the United Domestic Workers of America. “The governor wants this to go through the courts, but we will use pressure to change his position.” Moore says that if the DOL rule-change is upheld in appeals court, they will then move to demand retroactive overtime pay back to January 1st.

Yet for some states that have reckoned with the rule-change, the results haven’t always been encouraging. “What we have been seeing, unfortunately, is that you can equally comply with FLSA by paying overtime and travel time, or by setting caps on the number of working hours,” says Alison Barkoff, the Director of Advocacy at the Bazelon Center for Mental Health Law. This scenario is playing out in states like Arkansas, which is looking to cap homecare workers to just 40 hours per week, and to limit each worker to just one customer per day. In effect, this would enable states to avoid paying workers overtime and travel costs. But such measures will hurt employees who make their living by piecing together multiple part-time jobs. It may also impact consumers who need more than 40 hours of care, or who may have a harder time finding someone willing to work for just a few hours per day.

Some hope that the Americans With Disabilities Act (ADA) and the Olmstead v. L.C. Supreme Court case, both of which protect disabled individuals from discrimination and unjustified segregation, will help consumers fight back against cuts to healthcare services. “The ADA and Olmstead provide important protections to consumers, but they won’t completely prevent a state from implementing restrictive policies,” Barkoff explains. “The laws do not prohibit a state from capping worker hours, so long as the state has a process for exempting individual consumers who will be seriously harmed. Most consumers will have to shift the way their care is provided.”

Meanwhile, labor activists maintain that their interests are not at odds with those of healthcare consumers, because quality care depends on creating sustainable working conditions. Many in the disability community have also signed amicus briefs in support of extending minimum wage, travel time, and overtime protections to home healthcare workers. “I think it’s important to know that there isn’t just one disability rights community,” says Sarah Leberstein, an attorney with the National Employment Law Project. “Many groups are very supportive, but they’re also really concerned about states taking it seriously and implementing the rules in a thoughtful way that doesn’t result in cuts to services.”

Even if upheld, the DOL rule-change may be hard to enforce. In New York City—a place that has instituted a progressive domestic workers’ bill of rights and a paid sick leave policy—activists have learned first-hand how enforcing these types of laws can be quite challenging.

“It’s really hard to be reliant on a complaint-driven process where workers have to come forth, but still fear retaliation,” says Irene Jor, a New York organizer with NDWA. Many domestic workers are also isolated in private homes, without much regular interaction with other workers who might provide them with moral support to raise grievances. Even once complaints are filed, not all are likely to be dealt with. “The Department of Labor, both on the federal and state level, is incredibly underfunded and does not have enough investigators,” says Leberstein. “So often they can’t simply respond quick enough, and they can’t do targeted enforcement.”

Nevertheless, if the DOL rule-change were upheld, it would be an important achievement. Some businesses would certainly have to adjust their operations to accommodate the new labor protections, but supporters of the rule-change insist that the industry’s opposition is overblown. According to national surveys, less than 10 percent of home healthcare workers even report working more than 40 hours a week. “We’ve also got many examples of big home care agencies that have figured out ways to pay workers properly, and still provide good care,” says Leberstein, who points out that many organizations already operate in states that require minimum wage and overtime protections. “So they’ve either figured out a way to do it and still earn profits, or they’re admitting to violating the laws in their state.”

Asking the public to pick between providing quality care and treating workers fairly is ultimately a false choice wrought through a political culture of austerity. States could avoid this by increasing funds towards Medicare and Medicaid, which would help ensure that the disabled and elderly can access the high-quality and flexible care without compromising national labor standards and worker dignity.

Though the future of the law is still unknown, one thing is clear. This is an issue that cannot be put on hold—thousands of health homecare workers live in poverty and 10,000 more baby boomers turn 65 every single day.