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The Supreme Court Would Prefer People With Disabilities Receive Care from Disgruntled, Low-Wage, High-Turnover Workers
Health Care

The Supreme Court Would Prefer People With Disabilities Receive Care from Disgruntled, Low-Wage, High-Turnover Workers

By Photo: John Moore/Getty Images News

By a 54 decision, the usual conservative Supreme Court majority today struck a blow against public-sector unions by ruling for the petitioners in a case called Harris v. Quinn.  Most of the press coverage focuses on the worrisome implications for collective bargaining. I have little to add in that conversation, significant as it surely is. But I am sorry to see this decision for some more specific reasons, as well.

This particular case unfolds outside my door, in Chicago. Pamela Harris is a direct care worker who sued the state of Illinois over the way it handles collective bargaining arrangements and union dues. My family has used the type of services provided through the Illinois Home Services Program under dispute. My brother-in-law Vincentwho lives with intellectual disabilities and some related health challenges caused by something called fragile X syndromereceives services every day from unionized direct care workers, in his group home and in his workshop.

With its decision in Harris, the Supreme Court has torpedoed a practical and equitable partnership. People with disabilities could receive the in-home personal assistance they need. The men and women who perform this important work could receive a fair day’s wage for the work they do. Now that arrangementand the well-being of both groupsis in jeopardy.

Some background on the case: In 2003, the governor of Illinois declared that direct care workers were public employees, because they received much of their pay directly from the state, through its Medicaid program. This made it possible for them to unionize and to engage in collective bargaining with the state of Illinois, which they did by electing to have the Service Employees International Union represent them. The state negotiates with SEIU over what to pay workers, much as it would for any other set of public employees. Home health care workers can choose whether or not to join the union. But even those workers who opt not to join must pay an administrative fee, since they benefit from the higher pay that SEIU negotiates on their behalf. Or at least that’s how it was before Harris and some other workers filed a lawsuit, claiming the obligation was unfair, and the Supreme Court sided with her.

Put aside, for the moment, the debate over union dues and fees. There’s no question that these collective bargaining arrangements are importantor that they’ve made a huge difference. And here’s why they are especially important here. Illinois has traditionally ranked near the very bottom in national rankings of disability services. Not coincidentally, Illinois has also been subject to nine-figure lawsuits and consent decrees that reflect our troubled history of over-reliance on state institutions in the care of people with disabilities.

Illinois, like most other states, has a history of shamefully under-paying men and women who provide home- and community-based care.  In 2012, the national median wage of personal care aides had declined to $9.57 per hour. Ironically, direct care workers are also extremely likely to be uninsured. According to materials from the Care Campaign, an advocacy group for direct care workers, the average direct-support wage in Illinois is $9.35 per hour.

Governor Pat Quinn, to his great credit, is trying to address both of the above concerns. Rectifying them requires intricate compromises among many stakeholders. The state has an interest in high-quality, economical services that meet its legal obligations to individuals with disabilities. Direct care workers require minimally decent wages to support themselves and their families.

Individuals with disabilities and their families have a big stake in this, too. Theywerequire a stable and motivated group of direct care workers to perform important and difficult work. The alternative is to receive services from a disgruntled, low-wage, high-turnover group of workers who are unlikely to provide competent and humane care. We consumers know first-hand why these issues are important. We know our great human debt to the men and women we trust so intimately to support people we love.

Direct care work will never pay particularly well. Yet the partnership under dispute provided a fair and practical mechanism through which workers could bargain for decent wages and working conditions. It’s noteworthy that many of the nation’s most prominent disability rights advocacy organizations signed an amicus brief supporting the state of Illinois in this lawsuit. Most are now very disappointed.

Now that this partnership has been overturned by the Supreme Court, our state, direct care workers, and individuals with disabilities face a difficult choice. Direct caregivers can simply be hired and supervised as traditional public employees. This would deprive individuals with disabilities of the ability to select, supervise, and hire their own caregivers.  We can also shift a cumbersome management burden onto people with disabilities and their families, while depriving direct care workers of the collective bargaining mechanisms they seek. Neither option seems particularly fair or practical for anyone involved.

I lack the expertise to judge the broader ramifications of this case or its legal niceties. I do know that it disserved the people my family and so many others trust every day to care for our loved ones. It disserved us, too.

Harold Pollack is the Helen Ross Professor of Social Service Administration at the University of Chicago. 

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