‘No More 24’ Opponents Warn of ‘Care Gap’
“No More 24” opponents rallied outside Council Member Chris Marte district office in Manhattan this week. Photo/Steve Wishnia
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By Steve Wishnia
A quartet of people in wheelchairs, joined by a handful of supporters, protested outside City Councilmember Christopher Marte’s Chinatown district office May 12, saying that Intro 303, his bill to prohibit 24-hour shifts for home-care aides, would lead to patients getting their care cut off.
“I understand the need to change the rules, but 303 is not the answer,” Jose Hernandez, 45, an advocacy and policy associate for the New York Association on Independent Living, told Work-Bites. He says he understands “intimately” the problems workers have doing 24-hour shifts, because he often needed care during the night when he was younger and had a 24-hour aide, but the change “needs to be done in Albany.”
The bill is intended to protect home-care workers from doing grueling overnight shifts where they often get little sleep—and get paid for only 13 of the 24 hours.
Banning 24-hour shifts without increasing Medicaid funding to pay 24 hours of wages, Hernandez says, would lead to agencies dropping clients.
It would create a “care gap,” Nina Bakoyannis, 30, told Work-Bites. “Workers are exploited. It needs to be restructured,” she said. But “Medicaid’s done at the state level.”
The city passing the law on its own means “care will be unfunded,” said Evan Yankey of the Brooklyn Center for Independence of the Disabled (BCID). The 1199SEIU union, which represents a significant share of the city’s home-care workers, estimates the cost of funding full wages at $460 million a year.
“As opponents of this bill continue to point to budget concerns, those of us fighting to end 24-hour workdays are increasingly reminded that similar arguments were used to say stopping child labor, or even slavery, were too expensive.”
Councilmember Marte (D-Manhattan) disagrees vehemently. “As opponents of this bill continue to point to budget concerns, those of us fighting to end 24-hour workdays are increasingly reminded that similar arguments were used to say stopping child labor, or even slavery, were too expensive,” he said in a statement. “The violence that 24-hour shifts inflict on the health and lives of immigrant home-care worker cannot be understated. Women I once rallied beside have since passed away due to health complications from 24-hour shifts.”
Marte agreed earlier this year to postpone the date the bill would go into effect until April 1, 2027, to give more time to obtain state Medicaid funding. But he disputes the idea that ending 24-hour shifts would cause a financial disaster.
“The cost thrown at this issue vacillates—rooted in no data or facts whatsoever,” his statement said. “The organizing of home-care workers has already broadly ended the practice of 24-hour shifts, and we saw no massive fallout. The industry did not collapse, Medicaid funding wasn't drained. My legislation will ensure that the few remaining bad actors, who will use any and every excuse available to them, will finally be forced to end their wage theft and end these brutal working conditions.”
The opposition, however, is eroding the bill’s support. The Legal Aid Society said May 13 that five Councilmembers, including Disability Committee chair Shahana Hanif (D-Brooklyn), had withdrawn as sponsors in the past month. That has reduced the number of cosponsors to 13, plus Public Advocate Jumaane Williams.
Supporters of Intro 303 envision replacing 24-hour shifts with split shifts in which two workers would do 12 hours each. That would be next to impossible under the current system, Yankey told a Disability Committee hearing May 5.
New York State privatized Medicaid home-care management in 2011, turning it over to insurance companies running managed-care programs. Those companies control how many hours of care people get, and then assign their case to nonprofit social-service agencies, who hire the aides, Hernandez explains.
Individuals needing 24-hour care can appeal to the program to have it changed to split shifts, Yankey told the May 5 hearing, but “it is a long process with hundreds of steps.” “It’s not an easy process,” Hernandez says: When he did it, it took a year.
“We need all of us to advocate in Albany,” he says. He adds that he would work with the Ain’t I A Woman Campaign and Youth Against Sweatshops, the Chinatown-based coalition that has been organizing for years to end 24-hour shifts, to “find a solution that protects both the workers and the patients.”
But there is no current legislation in Albany that would fund Medicaid enough to cover split-shift wages. “Given the state budget delays, it isn’t happening this year,” BCID executive director Joe Rappaport told Work-Bites; Gov. Kathy Hochul and the Legislature “have made it clear.” It probably won’t happen in 2027 either, he adds.
Rappaport said one alternative could be the Home Care Savings and Reinvestment Act, a bill sponsored by state Sen. Gustavo Rivera (D-Bronx). Rivera has said it “would restructure the Medicaid Managed Long Term Care program to eliminate the private health-insurance companies that act as middlemen.” When it was first introduced in the 2023-24 session, 1199SEIUprojected that it would save $3 billion a year. The union said those savings could be used to care for more people, improve service quality, and fund higher wages.
The Legislature took no action on the bill in 2024. Rivera reintroduced it in January. “Privatizing health care has not saved the state money. It has not improved care for New Yorkers,” he told a rally in Albany in March. Neither the Senate nor the Assembly has taken any action on it so far, however.