Medicaid is in Danger of Being De-Funded

Medicaid is in danger of being slashed. I’m a caregiver whose sister depends on Medicaid. I’m a caregiver who gets paid to be a caregiver because my sister qualifies for Medicaid. If my sister loses Medicaid, she loses very necessary medical and health services, and I lose a huge chunk of my income.

I became a caregiver for my sister around 2002. I’d never even heard the word and never knew that Medicaid would become involved. Taking care of someone is something you did for family. In the Latino culture, we care for each other and help our community however we can. We also don’t get paid for it. We are a collectivist culture. There was never a question about helping my mother to care for my sister. In fact, that’s the reason my ma and sister moved to Seattle.

I’m proud of caregiving, knowing that I’m helping to maintain and improve my sister’s quality of life, something that wouldn’t be happening in a residential care home. And I’m not alone. As difficult as it can be, it’s also very rewarding.

Meanwhile, as I was going through the process of getting hired, I was also working full-time at the University of Washington. I had a good salary and had excellent benefits, so I wasn’t worried about benefits or wage increases as a caregiver.

Despite already having a job, when the union came knocking at my door in 2002, I immediately signed up. I knew that being in a union would protect me in case I ever left the UW. Today, I’m confident the union will continue to fight, all the way to Washington, DC.

Here’s a look off the top of my head of what we get as union members:

• Collective bargaining. The key word here is “collective.” We pay dues to have representation when we negotiate with the state for safety and security
• Medical/dental/vision insurance for ourselves and our dependents
• Free mental health services
• Free and affirming care for trans caregivers and their dependents
• State-funded retirement plan
• Paid training
• Respite care so we can get a break from the mental and physical labor that is caregiving
• Mileage reimbursement
• Annual wage increases
• Free work shoes every year
• Paid holidays and PTO
• Money management resources

Who Pays for Caregivers to Provide Care?

When I started out, I was an independent contractor with the Washington State Department of Social & Health Services. The state paid me directly for care.

In 2022, the state contracted out the hiring and personnel details to a company called Consumer Direct of Washington. They are now my employers. CDWA handles anything to do with hiring and payroll; the union handles everything to do with benefits. However, the union works directly with the state to negotiate our work contract. It’s thanks to the union that we have what we have as union members.

But you may wonder, where does the money come from?

It comes from Medicaid.

Cutting or de-funding Medicaid will cause ripple effects across the country.

Consequences of Medicaid Cuts

My sister is lucky to have three insurances. She has Medicare (because she has a disability), Tricare (she is a military dependent because our father was in the Army) and she has Medicaid (she qualifies due to income and disability).

If you know anything about Medicare, it doesn’t cover 100% of all services. Rebecca has a number of health issues, from a ventricular septal defect (heart) pulmonary arterial hypertension, hypothyroidism, gastroparesis and more. As a consequence of having Down Syndrome, she also has short tooth roots. Not only has she had to have teeth pulled, because with age (she’s 49) her teeth have loosened, but she’s also at risk for infection and periodontal disease.

Last week she spent two nights in the hospital with a massive infection in two molars that have to be removed. This is in addition to a third molar that was supposed to be removed in December. And Medicare doesn’t pay for dental care for people with disabilities. Neither does Tricare. This is where Medicaid kicks in.

And not only does she depend on Medicaid for taking care of her oral health, there are very few dentists who specialize in caring for special needs patients. And of those who do, not all of them may take Medicaid. This is a huge problem outside of the Puget Sound area and Spokane (the state’s second-largest city) because there are no dentists in rural areas or on the reservations. People need to drive miles and possibly spend time overnight to get dental care in many areas of Washington. This costs money and time.

If Rebecca hadn’t been hospitalized and given antibiotics immediately, that infection would have gotten into her blood stream and very likely would have resulted in her death. In fact, a bacterial infection in the bloodstream can kill many of us. Are we looking at a future where patients and their family members are going to hesitate to take our loved ones to the hospital because of the astronomical costs?

Here are some Medicaid benefits Rebecca depends on:

• Medical visits and medication when Medicare and Tricare (she has Tricare from the Department of Defense) don’t pay
• Vision care-eye exams and glasses
• Hearing aids
• Community access-someone to take Rebecca to activities in the general population
• Classes at an adult day center for people with disabilities
• A trained paid caregiver (me)

Many times when we think of Medicaid, we think of poor people using it to pay for doctor visits. But we forget that there are people, like my sister, who depend on it to pay for more than just doctor visits.

Consequences for Caregivers

I get paid to provide care. It’s that simple. If I don’t have this income source, I can’t provide care for my sister the way she needs.

In 2022, I had a temp job that allowed me to work from home. The people I was working for wanted to hire me on a permanent basis, and the extra income would be good, so I accepted.

For the most part, the job was a good one, with great benefits, a retirement plan and a flexible schedule. But as flexible as this job was, I didn’t feel comfortable taking time off to provide needed care for my sister. By this time we were coming out of the pandemic and my mother had aged a lot over the past two years. She needed care too. So I was juggling a job, caregiving, taking care of my kids and helping my ma.

I ended up quitting–for several reasons, but this was one of the biggest ones. It was hard to juggle all of these things. There were times when I needed to be able to drop what I was doing to take someone to urgent care or to the emergency room. It wasn’t fair to my co-workers or my employer that I need to take more time off than others.

So yeah, I depend on this income stream to pay for rent, food, utilities and gas. I depend on my wages to save for emergencies and for retirement. I also depend on the benefits because not only do I have health insurance, but I was able in 2023 to add my kids to my health and dental insurance! That’s a big fucking deal! They’d been on Medicaid for so long, but finally we were able to have private insurance.

Losing this income would cause a financial disaster in my life. And for others, it would be worse. The ripple effects would reach everyone, even people who aren’t caregivers. It would make things worse for the millions of caregivers who aren’t paid, who provide free labor at a rate of $1 trillion annually. Capitalism depends on these caregivers to continue working for free because the alternative is taxing the highest earners in this country to pay their fair share of taxes.

I often talk with María, my eldest child, about how I’m grateful that this provides a source of income, but that I’m definitely not paid a fair wage for the mental and physical labor involved. And I feel like I have it easier than many other caregivers who make the same or less than me. I currently make the most per hour that’s been negotiated because of the number of lifetime hours. At just under $25/hour I’m definitely not making what I should and VERY DEFINITELY not making enough for this to be my only source of income.

Legislation to De-fund Medicaid

Republicans are always trying to find ways to punish poor people for being poor. The welfare reform laws signed by President Bill Clinton didn’t go far enough, so they want to continue this march toward radical punishment.

Although there is surely disagreement among the House and Senate over how much to cut, and there’s been no discussion about whether to cut Medicaid. With Elon Musk on his rampage and accusing every agency of being full of waste, it isn’t surprising that any Republicans not on board with cutting Medicaid are keeping quiet. They used to fear retaliation from trump but the guy with the money has threatened them by funding their primary opponents.

Cutting Medicaid benefits would be devastating to millions of Americans who rely on it to access medical care. I myself used it when I was pregnant with my second child because I was out of work and didn’t have health care coverage. All the years I was a stay-at-home mom, my kids were on Medicaid. They were on Medicaid from the time they were in grade school up until 2023 when, after years of negotiation, the Washington State Legislature and our union came together to add this benefit.

It’s almost like unions help address the problem of health insurance and steady wage increases. Who would have thought?

Letter from a Caregiver

Today caregivers received this email that was sent out to all SEIU 775 members. I’m sharing because it provides a glimpse into the lives of real people.

My name is Nelly and I am a caregiver. Last week, I had the honor of traveling to Washington DC to demand members of Congress protect Medicaid. If you haven’t heard, Congressional leaders have released a budget that would completely devastate Medicaid programs our clients and residents all rely on, in order to pay for tax breaks for the wealthiest few. And we are not waiting to take action. I joined more than 300 SEIU members from across the U.S., including SEIU 775 siblings BJ, Edna, Kim, Essie, and Bryan from Alaska, and Gwen, Diane, and Janie from Washington, in a national Lobby Day because we know any cuts to Medicaid are harmful to our clients, residents, families, and to us as caregivers. We came from across the U.S. because we know our stories make an impact and that it’s important for our lawmakers to hear the impact they have on our lives.

While there, Janie and I were able to catch Washington Congressman Newhouse (CD 4) as he walked by. [Note: Rep. George Newhouse is a Republican from Eastern Washington.] Janie shared her story with him, saying, “I work with an elderly diabetic client who has a lot of health issues. Due to his inabilities, he can’t do simple things like safely manage his own meds. His whole life depends on me. It scares me to think he loses any benefits due to Medicaid cuts because he already doesn’t have what he needs.” 

And it wasn’t just this interaction we had with members of Congress. Edna from Alaska shared, “out in the villages, any appointment we have is at least $165 plane ride each way just to see a doctor. The Elders rely on us out here to take care of each other and we can’t afford to live up here if we lose our hours, and if we can’t do the care all the Elders will have to leave. Our village depends on our Elders – they keep the culture. There’s no room to cut.” 

Also, Gwen from Washington shared about how her mom’s and son’s health are on the line. Her mother needs a lot of support, her health is fragile, it is always an uphill battle to keep her stable. Cuts to Medicaid mean Gwen couldn’t afford to be her caregiver anymore. She’d have to work out of the home and leave her mom alone. 

Every single one of us has a story about how these cuts would hurt our clients, our residents, our families, and our communities. Cutting Medicaid would be devastating on our clients, us as caregivers, and nearly 80 million people who depend on it. Medicaid funds our jobs as healthcare workers who care for our loved ones in nursing homes and in their own homes and communities. Every caregiver in Washington, Montana, and Alaska will be affected by Medicaid cuts.

Call your Members of Congress at this toll-free line – 866-426-2631 – to let them know why we need to protect Medicaid. Also, make sure to share how any cuts to Medicaid will impact you, your family, client/resident here.

In Solidarity,

Nelly Prieto Caregiver, Sunnyside, Washington

We’re in challenging times. We need to build community. In times that challenge us, we need to build community. Being in community and advocating for our most vulnerable strengthens our moral bonds. If you’re looking for something to do because you’re feeling out of sorts, please call your state and congressional representatives at the number Nelly listed above. Tell them that you are an advocate for your community (or tell them about your personal experience with Medicaid) and that you want them to strengthen Medicaid. Tell them it’s not a handout.

In other words, Medicaid not only provides access to just medical care, but also to other services people need to live a quality way of life.