In a tale all too typical of Albany, Gov. Kathy Hochul a year or so ago was pushing to rein in out-of-control state Medicaid spending on home health aides, only to since switch sides with an eye on her re-election run next year.
Now Medicaid outlays are set to soar at least 17% in the next budget, while the aide ranks are soaring and indeed are by far the single largest job category in all New York.
A new Empire Center analysis of US Bureau of Labor Statistics data shows that the Empire State home-health-aide workforce grew by 57,000 from 2023 to May 2024, for a total of 623,000.
That’s far above the per-capita level of other states and outnumbers New York’s No. 2. job category, retail sales, by nearly three to one.
This year, Hochul’s initial budget proposed a 17% rise in Medicaid spending (some of it buried in other categories); the Legislature will almost certainly add to that somehow, since the health-care-worker unions — above all, 1199 — are a ginormous lobbying power.
This, when state Medicaid spending has seen double-digit growth and a surge in enrollment despite a falling poverty rate.
And when New York’s overall health-care workforce grew from 1.15 million workers pre-pandemic (2019) to 1.40 million in 2024.
Hochul had hoped to rein in the home-aide ranks by centralizing hiring in her Consumer Directed Personal Assistance Program, but that’s since morphed into a mass unionization drive after an administrative maneuver that opened the door for 1199 to sign up the aides as members (even as the firm tapped to run the centralized hiring has itself been a subject of controversy).
Meanwhile, Hochul’s team also allowed New Yorkers without employer-sponsored health benefits to qualify for home-care-aide subsidies under the state Essential Plan, another big boost for 1199.
To be fair, the unions aren’t the only special interest to push ever-higher health spending: The state’s hospitals are a lobbying monster in their own right, and a host of nonprofit insurers and other intermediaries regularly spin off huge payouts to the private interests that control them in various state-approved “restructurings.”
Of course, since Medicaid is a joint state-federal program, New York’s vast outlays (and those of other ill-governed states like California and Illinois) will soon face some tough love from Washington; cuts in payments to the Empire State will hit the $10 billion range — not that anyone now negotiating the new state budget cares to plan on it.
Hochul and all the other Dems who rely on the political support that uncontrolled health spending buys will scream about Republicans’ “savagery” when the time comes, and most likely “temporarily” hike a host of New York taxes to balance the books.
Voters, consider yourselves on notice.
