The ‘frills’ of Biden’s infrastructure plan are real needs

Critics of Joe Biden’s infrastructure bill say the problem is all the frills. A deal is possible “if we leave out the unrelated provisions,” said Sen. John Barrasso (R-Wyo.), the third ranking Republican in the Senate, calling on the President “to leave his liberal wish list behind.”

Actually the White House calls its proposals the “American Jobs Plan” with around 30 percent to 40 percent pure infrastructure — not just roads, bridges, transit and airports, but items like water and sewer upgrades and broadband.

The biggest of the “liberal wish list” is $400 billion for vitally needed home health care or community service workers to provide care for the elderly and people with disabilities. When attacking the Biden plan, Barrasso and others should be asked if they think the current home health care system is adequate; and if not, how much of the Biden plan might they support?

With more than 50 million Americans providing most of the care for their elderly family members or those with disabilities — at considerable financial and emotional stress — these Republican politicians may not wish to respond.

A recent Vox poll, which included the price tag in the question, found overwhelming support for this Biden initiative, including a number of Republicans.

The administration hasn’t spelled out many of the specifics of its plan. Much of it will be through Medicaid, which currently provides better support (and at higher cost) for long term care in nursing homes or other institutions than for home care services.

The COVID-19 crisis, where over 180,000 Americans died in nursing homes, raised new fears about these facilities.

An inadequate supply of workers — there currently is a waiting list of 800,000 for home health care services — means more pressure on family members who have to cut back or drop out of their jobs. For many families taking care of the elderly at home is far preferable to putting them in an institution.

Many with disabilities can work, while living at home, though they may need assistance. (We have a son with disabilities who would not be affected by any of these measures, as he is financially self-sufficient.)

One reason there is such a shortage of workers is the miserable pay. The average compensation for home health care workers is about $13 an hour, according to the Bureau of Labor Statistics. That’s less than the average pay for parking attendants.

Think about that: We pay more to people taking care of our cars than to those caring for our loved ones.

Home health care workers are people of color, immigrants and women. “Women are predominately the caregiving workforce, and they are underpaid and undervalued,” says Sen. Maggie Hassan (D-N.H.). She and fellow Democratic Senators Bob Casey (D-Pa.) and Sherrod Brown (D-Ohio) and Rep. Debbie Dingell (D-Mich.) are the leading congressional proponents of increased assistance for home health care workers. This likely will be joined with the White House proposal.

Since Medicaid is a federal-state program, Democrats may propose that the costs — already picked up mainly by the Feds — would be covered entirely the first several years by the federal government. States would have the option of not participating in any expanded program.

A tragic illustration of this problem is Alzheimer’s. More than 6 million Americans suffer from this dementia, according to the Alzheimer’s Association — and that number is projected to more than double over the next three decades. Over 11 million Americans provide unpaid care for Alzheimer’s patients, most family members, giving an estimated 15.3 billion hours of care valued at $257 billion. Too many of these families face financial and/or emotional bankruptcy.

There are a number of congressional Republicans who support increased funding for Alzheimer’s research. That’s essential. However, given the frightening projections, and no breakthrough in sight, it’s essential to help those families living with this burden today.

Sen. Hassan says she doesn’t “care terribly what we call” this effort — social infrastructure or something else. “I do care that hundreds of thousands of Americans right now are waiting for home and community based care. They want to get that care rather than go to a nursing home, and they can’t get it because we haven’t been funding it.”

Whether a “liberal wish list,” or not, it’s incumbent upon critics to answer what — if anything — they would do about that 800,000 backlog; about paying home health workers below the poverty level; and what to tell those desperate families?

Al Hunt is the former executive editor of Bloomberg News. He previously served as reporter, bureau chief and Washington editor for the Wall Street Journal. For almost a quarter century he wrote a column on politics for The Wall Street Journal, then The International New York Times and Bloomberg View. He hosts Politics War Room with James Carville. Follow him on Twitter @AlHuntDC.