The Leaflet: The End of Dues-Skimming Could Finally Be Near

Published July 27, 2018

The Centers for Medicare and Medicaid Services (CMS) may soon end the controversial practice of union dues-skimming. On July 10, CMS issued a notice that it would accept public comments about a proposed rule ending states’ ability to divert, or “skim,” Medicaid payments from independent care providers to third-party entities, such as public unions. Although unions have been deducting agency fees from Medicaid payments since 1992, the Obama administration issued a rule in 2014 codifying the practice. Many claimed the Obama rule violated Section 1902 (a)(32) of the Social Security Act, which prohibits states from directing Medicaid payments to anyone but providers.

The review of the Obama-era rule is timely considering that public-sector unions received nearly $1.5 billion of taxpayer-funded Medicaid payments from 2000 to 2017. For years, public-sector unions have fought to increase their membership by reclassifying independent caregivers as pseudo-state employees so that they could be governed under public collective bargaining laws.

Independent caregivers, also known as in-home caregivers, provide much needed attention and assistance to low-income, elderly, and disabled individuals. Often, these caregivers are related to the person for whom they are providing care, such as a frail mother or physically disabled child. Many are paid directly by the state to care for Medicaid clients and are thus considered independent contractors.

Public-sector unions have lobbied state legislatures, cajoled sympathetic governors, and passed deceptive ballot measures to force independent caregivers to become union members. From there, unions were easily able to certify themselves as the official exclusive bargaining agent of the state’s in-home caregivers. In Illinois, no election was held for SEIU to represent caregivers; the union simply collected authorization cards from caregivers and remitted them to the state as proof of majority support.

In Harris v. Quinn (2014), the U.S. Supreme Court sided with in-home caretaker Pam Harris, and ruled that unions cannot forcibly take agency fees from home care providers. Unfortunately, this ruling was not enough to completely halt dues-skimming. The infrastructure authorizing their unionization still exists in 11 states (California, Connecticut, Illinois, Maryland, Massachusetts, Minnesota, Missouri, New Jersey, Oregon, Vermont, and Washington). Moreover, in these states, unions continue to make it difficult for independent caregivers to opt out of membership. For example, in California and Oregon, caregivers have a 10-day window to decline union membership.

In the case of Medicaid, there is a fixed pie of funds for providers. One more dollar diverted to unions is one less dollar paid to care providers. If an individual caregiver wishes to join a union, he or she can do so and arrange to pay for dues on his or her own. Caregivers who do not want to join a union should be extended the same freedom of association without having to pay agency fees. Given that a significant portion of dues and agency fees fund unions’ political activity, this is a violation of the First Amendment rights of caregivers.

State legislators who believe in freedom of speech and freedom of association should submit comments to CMS stating their opposition to the practice of union dues-skimming. Comments can be submitted online until the end of the comment period, August 13, 2018. Legislators can contact The Heartland Institute if they need assistance in writing a comment or finding state-specific research.

 

What We’re Working On

Budget & Tax
South Dakota Should Not Increase Regressive Tobacco Taxes
In this Research & Commentary, State Government Relations Manager Lindsey Stroud argues against a ballot initiative to increase cigarette and tobacco taxes in the Mount Rushmore State. Besides fostering black markets and disproportionately impacting lower-income individuals, revenues from cigarette taxes continue to fall and should never be relied on to fund government programs. Stroud wrote, “Although sin taxes usually create short-term revenue increases, they very frequently generate lower funds in the long term.” 

Health Care
Fixing Skyrocketing Health Care Costs (Guest: Charlie Katebi and Thurston Powers)
On this episode of the Heartland Daily Podcast, Health Care News Managing Editor Sarah Lee interviews Charlie Katebi of The Heartland Institute and Thurston Powers, policy analyst at the American Legislative Exchange Council, on the rising costs facing the states. Katebi and Powers also cover which options are available to employees and states to help assuage the growing expenses related to employer-provided health insurance.

Education
Latest Bullying Data in Maryland Underscores the Need for Child Safety Accounts
In this Research & Commentary, Policy Analyst Tim Benson analyzes a report from the Maryland State Department of Education that shows incidents of bullying in state public schools increased by almost 33 percent from the 2015–16 school year to the 2016–17 school year. The data show there were 6,091 incidents of bullying reported across the state during the past school year, an increase of 1,386 reported instances over 2015–16. Benson argues these numbers underscore the need for Maryland to adopt Heartland’s Child Safety Account program, which would allow families to remove their children from unsafe schools.

Energy & Environment
Time to Reject EPA and Tom Steyer (Guest: Daniel Turner)
In this edition of the Heartland Daily Podcast, Heartland Senior Fellow H. Sterling Burnett is joined by Daniel Turner, founder and executive director of Power the Future, to discuss how billionaire Tom Steyer self-interestedly promotes renewable energy mandates that will line his pockets while hurting the poor by raising their energy bills. They also discuss how the Environmental Protection Agency (EPA) wastes billions of dollars in resources on unnecessary regulations and ignores actual environmental hazards. They argue that states are more apt to protect human health and the environment than the EPA and out-of-touch billionaires such as Steyer.

From Our Free-Market Friends
Oklahoma Professors Push Back Against Campus Groupthink, Identity Politics
Staci Elder Hensley of the Oklahoma Council of Public Affairs examines the censorship of alternative viewpoints on college campuses. The censorship and disdain for freedom of speech come from both students and professors, Hensley argues. Hensley also discusses a recent Wisconsin Supreme Court decision that is “being hailed as a blow against suppression of diverse viewpoints on college campuses,” placing emphasis on the fact that the First Amendment protection of freedom of speech also applies on college campuses. “Fear of retaliation for questioning left-leaning ideology is very real,” wrote Hensley.

 

Click here to subscribe to The Leaflet, the weekly government relations e-newsletter.