Proposition B falls short

By Marc D. Smith

In today's uncertain economy, the last thing Missouri residents need is a new state agency that has no oversight of how it spends public money. Proposition B would do just that. Voters should reject this effort.

In promoting Proposition B, its supporters imply that the elderly and disabled could no longer live independently in their homes without its passage. Proposition B does nothing new to improve the quality or accountability of services provided by personal care workers. What Proposition B would do, if approved, is insulate a newly created agency from meaningful oversight of its decisions to spend taxpayer funds.

Proposition B would authorize the Quality Home Care Council to establish the "terms and conditions of employment" for workers hired to provide personal-care services -- housekeeping, bathing and grooming assistance, dressing, meal preparation -- under the state's Medicaid program. However, aside from creating the council, the proposition is void of explicit new protections.

Voters must make an informed decision. Here are our concerns.

The council created by Proposition B would create a list of approved personal-care workers. However, there are no safeguards to prevent the council from inside dealing by providing referrals to some providers and not others. In addition, there is no appeal process for home-health workers who are not on the council's list.

Although taxpayers would fund the council's decisions, the council would act as an independent agency with no state oversight. The council would be accountable only to standards set in Proposition B. The ballot measure contains no defined standards.

Ultimately, the proposition is about "employment" rather than "quality." Buried within the proposition is authorization for personal-care workers to join a labor union and engage in collective bargaining for higher state-funded wages. The proposal seems to be designed to evade the standards of federal labor law. This helps explain the willingness of a national labor union to invest millions to promote Proposition B.

Missourians should expect quality nonmedical personal-care services delivered in a home setting. Proposition B does not increase quality. We urge Missourians to reject the proposal.

Marc D. Smith is president of the Missouri Hospital Association.