A unique approach to in-home care involves a new tax, which riles critics

ELLSWORTH — On Nov. 6, Maine voters will decide whether to support a ballot initiative — Question 1 — aimed at enabling elderly or disabled citizens to receive free care in their homes.

The measure would create a state-run, taxpayer-funded Universal Home Care program to provide free services to anyone needing long-term care. If it passes, the program would be one of the first of its kind in the United States.

Supporters of the proposal say it would ease the burden on those caring for a relative, allow the state’s aging population to stay in their homes, boost pay for homecare workers and cover gaps in care left by other federal programs such as Medicare and Medicaid.

Medicare covers short-term homecare in the event of illness or injury but does not cover long-term home care and Medicaid is subject to strict income limits, meaning residents often have to burn through savings before becoming eligible.

Opponents say the tax required to fund the program would make the state unattractive to higher earners, result in waiting lists for care, exacerbate the shortage of homecare workers and violate federal privacy laws.

The program would be funded by a 3.8 percent tax on wage and non-wage income above the threshold of wages subject to Social Security taxes, which is $124,800 in 2018.

Mainers for Home Care, the group that proposed the referendum, says the 3.8 percent tax would apply to individuals — not families — and raise around $310 million per year. Employers would pay 1.9 percent of the wage tax and earners would cover the other 1.9 percent. Non-wage income such as alimony, self-employment and unemployment compensation, rental income and money made from the sale of investments also would be subject to the full 3.8 percent tax.

While Mainers for Home Care insists the tax would apply only to individuals, the language of the question approved by Secretary of State Matt Dunlap reads that the tax would be on “individuals and families.”

That means a married couple filing jointly with income over the $124,800 threshold “could” be subject to the tax, according to a memo from the Maine Office of the Attorney General.

The nonprofit Maine Center for Economic Policy, which presents Question 1 in a favorable light on its web page, reported in September that if the tax were applied to individuals it would hit just over 3 percent of earners in the state.

The “[LePage] administration has said they might interpret it differently” than was intended, said Mike Tipping, communications director for Mainers for Home Care. Tipping said the group would work to clarify the intent if the measure passes but that he did not believe it would be necessary.

But David Clough, director of the Maine Chapter of the National Federation of Independent Businesses, said the state already has trouble attracting physicians and other high earners and that this would compound the problem.

Tipping pushed back.

“The real migration right now is young people out of Maine,” he said. “This would create good-paying jobs that are mostly worked by young people in rural Maine.”

Newell Augur, chairman of No On 1/Stop the Scam and a lobbyist with the Maine Home Care & Hospice Alliance, which opposes the referendum, said the lack of an income threshold or residency requirement to qualify might result in wealthy residents receiving services before those with “little or no income” and would result in “benefits tourism.”

Tipping rejected the notion that residents from out of state would travel to Maine to receive care.

“You have to be living in a home to get it,” Tipping said. “It’s not the kind of thing that is a concern.”

Tipping said the allocation “would be based on need,” with services available to “those who most need the help” with activities of daily living, such as getting out of bed, eating a meal or bathing.

The Maine State Chamber of Commerce and the Maine Hospital Association oppose the referendum. Clough acknowledged that the reason was in part because of a new payroll tax.

“Hospitals would have to pay 1.9 percent payroll tax,” Clough said. “That is a very substantial amount.”

The money would be distributed by a nine-member board, initially appointed by elected state officials. Subsequent board members would be chosen by providers and recipients of home care.

Homecare workers would have the option to join a union, which opponents have seized on as part of a push “to create a privatized shadow government whose true purpose is to impose labor regulations on homecare agencies,” according to a statement made to the Portland Press Herald.

Augur said the referendum also would result in a program with little state oversight. Supporters compare the board to the Maine Potato Board, which operates in a similar fashion.

The task of caring for an aging family member falls almost exclusively to women and people of color. Nine out of ten homecare workers are women, average age 45, making around $14,000 per year, and wages have decreased since 2005.

Both opponents and supporters agree the state is reaching a crisis point in its long-term care system.

“Everyone acknowledges that we’re facing a crisis here,” Tipping said. “We’re an old state and we’re getting older. We don’t have the support people need. Are we going to do something about that or are we going to default to the status quo?”

“This ought to be done through the existing infrastructure that we have,” Augur said. “No one else in the country has even discussed something like this.”

Supporters of the Universal Home Care initiative have raised nearly $1 million so far, according to the Maine Ethics Commission, with around half of the money coming from out-of-state sources.

Opponents have raised just shy of $120,000, with 90 percent of the cash from in-state sources.

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