This article originally appeared in Next Avenue. Read it there.
There’s an old political slogan: “As Maine goes, so goes the nation.” Well, if that’s true, and if Maine residents approve a long-term care ballot initiative on Election Day, families across America may get help paying for vital home care and home care workers may get higher wages and better benefits.
The “Universal Home Care” ballot initiative, the first of its kind in the United States, would provide home-based assistance to “people with disabilities and senior citizens,” regardless of income. Roughly 27,000 people would likely be eligible; Forbes’ Howard Gleckman estimates that if all 27,000 were eligible, the program would pay for an average of 10 to 15 hours of care a week. (The closest state equivalent is the new Kapuna Caregivers Program in Hawaii, providing family caregivers with up to $70 a day.)
The free home care in Maine would be funded by a new 3.8 percent tax on individuals and families with income over the amount currently subject to Social Security taxes: $128,000. Currently, the median cost of full-time home care in Maine is over $59,000 a year, more than the total earnings of the typical household in the state.
Why Maine Is Ground Zero for Home Care
“Maine — the oldest state in the nation where home care is also the least affordable — is really Ground Zero for care, showing where our aging nation is headed,” said Sarita Gupta, co-director of Caring Across Generations, a national campaign to transform the long-term care system in America and proponent of the ballot initiative. Gupta’s also a 2016 Next Avenue Influencer in Aging.
Gupta said the proposal “offers a generation-defining opportunity to create the sustainable, dignified care system that all of us will someday need, while making the care economy work for everyone.”
In an August 2018 Suffolk University poll of Maine residents, 51 percent supported the initiative, 34 percent opposed it and 14 percent were undecided. “We feel great about how it’s going,” said Kevin Simowitz, political director of Caring Across Generations, who has been driving the campaign.
Opposition to the Universal Home Care Initiative
But the universal home care proposal is facing stiff opposition by some powerful people and groups. All four gubernatorial candidates oppose it, as do the Home Care & Hospice Alliance of Maine, the Maine Hospital Association and the Maine State Chamber of Commerce. Reasons include the tax increase on some Maine residents and concerns about patient privacy.
“We need to put the patient first. The Maine People’s Alliance has concocted a program that will violate patient privacy,” Newell Augur, chairman of the Stop the Scam campaign, a coalition of business groups against the initiative, told me. “The proposal is a wolf in sheep’s clothing.” Augur has previously said approval of the ballot initiative “would be a disaster for our state economy.” Ben Gilman, campaign chairman for No on Question 1 and general counsel for the Maine Chamber of Commerce, said any passage of the proposal “is probably going to hurt the elderly in the long run.”
Simowitz said he and other proponents “are not terribly surprised to find that elected officials and those running for office are not supportive of this ballot initiative. In some ways, it’s a little bit of a challenge to the inaction we’ve seen by elected officials for a long time.”
He concedes that if Universal Home Care passes, “it will be a challenge to the way business as usual is conducted” for home care in Maine. That’s because the initiative would create a universal home care trust fund board that would manage the new system and make decisions about who could receive how much care.
What Would Happen If the Ballot Initiative Passes
The road to fruition wouldn’t be an easy one, either.
Even if the initiative passes, the Maine legislature would need to approve it and the politicians could — and likely would — make adjustments. And the trust fund board would need to work out the implementation details.
There might also not be enough in new tax revenues to provide all the home care Maine residents want. By one estimate, the new tax would bring in around $310 million a year from about 60,000 Maine households.
“If the need or demand exceeds what can be provided, the board would figure this out, meeting the highest level of need first,” said Simowitz.
Proponents of the initiative hope that passage would lead home-care workers to earn more and get better training. But the proposal doesn’t require a specific wage that families would need to pay. That’s because “wage disparities around Maine are significant,” said Simowitz.
The ballot initiative could, however, fund workforce development and training initiatives and says it would “ensure improvements in wages, benefits and working conditions” of caregivers. Also, Simowitz said, it would make sure at least 77 percent of money paid to a home-care agency gets to care workers.
If Universal Home Care passes on November 6, Simowitz said, “we hope other states will follow.” That kind of thing has happened before. Maine was the first state with a marriage equality initiative and the first to pass Medicaid expansion, in 2017.