(Illustration via Pixabay by Gerd Altmann)

For the last year, health care workers across Massachusetts have been sounding the alarm. Since Congress passed the “One Big Beautiful Bill Act” last summer, we have warned that the legislation’s enormous cuts to Medicaid would create a seismic crisis for our state’s health care infrastructure. We’re beginning to feel the initial impact of that massive disruption.

Starting next year, Massachusetts is projected to lose as much as $3.5 billion in annual federal aid as cuts to Medicaid are fully phased in. Faced with rising health care costs and that looming loss of substantial federal aid, the Healey administration is proposing $100 million in cuts to the state’s personal care attendant program in the governor’s 2027 budget proposal. This is a preview of the pain that awaits our entire health care system.

Personal care attendants provide the essential labor that allows seniors and people with disabilities to live with dignity in their own homes. Over 50,000 people in Massachusetts rely on PCAs for the basic activities of daily living, including bathing, dressing, eating, toileting, and meal preparation. The PCA workforce is majority women, people of color, and immigrants.

By allowing residents to stay in their homes, PCAs prevent the need for more expensive medical interventions, such as long-term nursing home placements or frequent, avoidable emergency room visits.

As Massachusetts’s population ages and more residents choose to live independently, the cost of the PCA program, which is 50 percent federally funded, has grown. Yet rather than investing in this cost-saving model, the governor’s budget proposes an enormous cut, which will result in less care.

Reducing services for seniors and people with disabilities is a short-sighted strategy that will cost us all more down the road. When home care is stripped away, the burden does not disappear; it shifts to families who must put their careers on hold to take on unpaid caregiving, or to other state programs like higher-cost congregate care settings or emergency room beds.

Cuts to home care are merely a precursor to the devastation that will follow as Medicaid cuts reach our hospitals, community health centers, and nursing homes.

In the face of rising costs, the governor’s proposal to level-fund health care provider rates in her FY 2027 budget represents a further reduction in care. That reduction would fall on hospitals and community health centers that are already facing unfilled staff vacancies, resulting in mandated overtime and temporary department closures.

And as difficult as the current budget process is looking, we know that next year will be far worse.

At 1199SEIU, we know Massachusetts must do more to control health care costs. Our members are not just health care providers; we are patients who often receive care in the same facilities where we work. We feel the sting of rising costs as much as any other worker in the state.

Our PCA members do not receive health insurance through their work and often must rely on the state Medicaid program, MassHealth, or the Health Connector. Meanwhile, our members in hospitals, health centers, and nursing homes are facing significant increases in their own health care costs.

From tackling pharmaceutical pricing and addressing price variation between providers to reducing administrative complexity, we can reduce costs in a way that improves the quality of the care our patients receive. What we can’t do is balance the budget on the backs of seniors, people with disabilities, and Medicaid recipients, which disproportionately impacts women and people of color. We cannot reduce costs by cutting essential services, or by paying health care workers poverty wages.

Since the federal government is no longer a reliable partner, Massachusetts must be aggressive in raising the revenue necessary to protect our care. That starts with opting out of the Trump corporate tax cuts.

Right now, Massachusetts is set to automatically adopt these tax breaks into our state tax code, a move that would drain $463 million from state revenues this year and nearly another $1 billion over the next five years. These tax breaks largely reward massive corporations for investments they’ve already made in other states; they do next to nothing for our state’s economy. We should join the many states that have rejected Trump’s corporate tax cuts.

We should also tap a portion of the state’s $8 billion “rainy day” fund. If $3.5 billion in federal cuts isn’t a “rainy day,” what is?

Withdrawing a modest 15 percent of that fund would generate $1.2 billion to help us weather this immediate storm. And by joining most neighboring states in passing corporate fair share legislation to combat the offshore tax dodging of billionaire global corporations like Amazon and Walmart, we could raise an additional $400 million annually.

Massachusetts cannot afford to allow the canary in the coal mine of home care to succumb to these cuts, signaling the eventual collapse of our entire health care system from the looming cuts of up to $3.5 billion. We must chart a different course by raising new revenue from the big corporations whose massive tax cuts were paid for by Trump’s Medicaid cuts.

We must tackle the true drivers of health care costs, like pharmaceutical pricing and price variation. And we must keep the needs of Massachusetts patients at the center of our policymaking.

By investing in home care now, Massachusetts can save money in the long run, and, most importantly, ensure that our most vulnerable neighbors can continue to live with independence. That’s a model for getting through this crisis with the health care system Massachusetts deserves.

Cari Medina is the executive vice president for Massachusetts of 1199SEIU United Healthcare Workers East, which represents over 85,000 health care workers throughout Massachusetts.