Labor Organizer: Medicaid Cuts Could Devastate the Nursing Home Workforce
In the wake of the passage on May 22 of the 2026 budget bill by the U.S. House of Representatives, leaders of diverse organizations and alliances have been raising concerns over the $715 billion in proposed cuts to the Medicaid program. Not only do they fear tens of millions of individuals being stripped of their Medicaid-provided health insurance; many believe that the cuts will lead hospitals medical groups, nursing homes, and other healthcare organizations to have to lay off large numbers of workers.
Among those concerned is Arnulfo De La Cruz, president of SEIU Local 2015, which, as its website explains, is “the largest union in California, representing more than half a million long-term care workers (home care, skilled nursing facility, and assisted living center workers) throughout the state. We are also the largest long-term care union in the U.S. and the largest local union in SEIU,” the website explains.
De La Cruz spoke recently with Healthcare Innovation Editor-in-Chief Mark Hagland about his concerns regarding what might happen if the House budget bill is approved in some version of its current form by the Senate. Below are excerpts from that interview.
Numerous concerns are being expressed now across U.S. healthcare, regarding the House budget bill that has passed. How do you see the situation?
SEIU Local 2015 represents about a half-million long-term care workers in California; the bulk are home care workers who provide in-home supported services (IHSS); 25,000 members are working in nursing homes. And a few in private-pay home care. They provide care for seniors in their homes, and for children with disabilities.
We have a care crisis. It’s simple math: the demand for home care exceeds the number of providers of care available. Care work is poverty work; many work a little bit above minimum wage, so it’s difficult to attract a skilled workforce. So any cut to Medicaid, called MediCal here in California, goes against everything we’re committed to. So we’ll go backwards. And then on top of that, immigrant labor is an essential piece of the care infrastructure here in California. That amounts to a double whammy that will make Californians sicker. And there will be a crisis that will bring people into emergency departments.
Most members of the public are not aware of the issues you’re speaking to here, then, correct?
That’s absolutely correct. The Congressional Budget Office, a nonpartisan body, has been very clear that this proposal adds to the deficit, and removes millions of people from their healthcare. And many working people depend on Medicaid; and I don’t think Californians buy the talking points; this is clearly a tax cut for the rich that will be given to millionaires and billionaires. They’re trying to cut a program that’s been a bedrock for generations, and they’re looking to destroy it and give the savings to rich people. I do think perhaps that more people will realize what’s happening when they begin to lose their healthcare. Our union members are very aware, but yes, that’s a point about the general public.
And as we prepare for the midterm election, there will be horrible consequences for this administration and their party; Americans will make them pay at the ballot box next November. Here in California, Republican Congressman David Valadao—over three-quarters of his constituents are Medicaid recipients. I don’t know how he could look constituents in the eye. I think that people are upset; I think people are going to unleash their fury on representatives who voted for this legislation. I think that people will start to understand that, and it will backfire on the Republicans in Congress.
What should hospital, health system, and nursing home leaders know?
We have a coalition of hospital leadership, nursing home leadership, and healthcare unions, all of whom are educating the public on the funding of Medicaid. So what those leaders should know is that those cuts will be devastating to providers in California and across the country. And I’ve spoken to many employers; there is serious concern about the impact, on some of the employers, on their ability to continue to provide services primarily funded by Medicaid, which is the case for many hospitals and nursing homes. Also, this proposed budget puts tremendous pressure on states like California; it punishes states that provide care to undocumented residents; and that’s on top of a $14B deficit here in California. We may see hospitals and nursing homes close. We’re going to see consumers of home care not able to find caregivers because they no longer qualify. That’s what I’d like them to know.
What kinds of decisions will hospital and nursing home leaders have to make?
They’ll have to decide what they’re able to fund, and what their capacity is, given these budgetary restraints. We’ve been fighting for more resources in California; we have an aging population. We’ve been focusing on access to long-term care. And there’s been no conversation about increasing access to care in the healthcare system; this has all been about cuts. And so they’ll have to make tough decisions around where they can provide care. And those are really, really tough decisions that we should not have to make in 2025. California’s the fourth-largest economy in the world; but I put the responsibility squarely on this administration and on legislators, whose policies will make America sicker, not healthier.
