AFTER FOUR WINTERS — NO MORE WAITING, NO MORE 24
Dear Speaker Julie Menin, Members of the New York City Council, Labor Leaders, Fellow Rank & File Unionists, Community Advocates, and All Members of the Public,
WHY THIS LETTER — WHY THIS MOMENT
This letter is written for those who do not yet know about the fight to end 24-hour shifts for Home Health Aides and for those who do, yet insist that now is not the time.
Right now, in New York City, legislation introduced by Council Member Christopher Marte (Intro 303 of 2026 (Int. 0303-2026), the ‘No More 24’ bill—and promised for advancement by Speaker Julie Menin—now requires your immediate support and pressure to move it out of committee and to a full Council vote. The ‘No More 24’ bill would end the practice of forcing one home care worker to cover 24 hours—often paid for only 13—by mandating 12-hour maximum shifts, full hourly pay, and adequate staffing to protect both workers and patients.
And yet—despite years of organizing—it is at risk of delay, dilution, or defeat. Why? Because we are being told: there is no money, the system is not ready, patients may suffer. This letter exists to confront those claims—factually, politically, and morally. Because what happens next depends on what is done now.
A VOICE FROM THE WORKERS — YEARS OF ENDURANCE, BLOOD, SWEAT & TEARS
For four winters and many years before that—they have stood outside City Hall.
Women.
Immigrant women.
Women of color.
Working 24 hours.
Paid for 13.
Sleeping in fragments—if at all.
Waiting through the night for a call, a fall, a cry.
Lifting bodies while their own backs give out.
Feeding others while skipping meals themselves.
Keeping people alive—
while being told their exhaustion is not work.
And still—
they are told: WAIT!
THE CORE LIE — “THERE IS NO MONEY”
NO EXCUSE TO WAIT — THE MONEY IS THERE, IT’S BEING MISDIRECTED
The resistance to ending 24-hour shifts—“No More 24”—is not driven by patient need, but by the financial structure of Medicaid managed care and the insurance companies that control it. Companies such as UnitedHealthcare, Centene Corporation, Elevance Health. In New York Healthfirst, Fidelis Care, and VNS Health for example, receive fixed public Medicaid payments to manage care—and protect their margins by suppressing labor costs.
The 24-hour shift is central to that model: one worker, often paid for just 13 hours, covering an entire day. Ending it requires proper staffing and full pay—which is why it is resisted. But the real choice is not between humane working conditions and patient care. It is whether we continue to prioritize insurer margins, or restructure public funding so care remains at home—safely and with dignity.
We can and must do both. Legislators can immediately tie increased Medicaid reimbursement to safe staffing standards; require that the vast majority of funds go directly to wages and care; cap excessive administrative costs and profit-taking; and guarantee continuity of care so patients are not displaced. A stable, adequately paid workforce is the strongest protection against nursing home placement—not a threat to it.
And there is no need to wait. The state can enact targeted rate adjustments now, mandate that 80–90% of funds go to direct care, impose caps on insurer overhead, and require full transparency and audits. These are not future reforms—they are tools available today. The resources already exist; they must be redirected from profit to care.
To those who say they agree but urge workers to “wait”: workers have already waited—through exhaustion, poverty, and a system built on their sacrifice. Delay is not neutral; it is a decision to continue exploitation.
No More 24 is not a risk to manage—it is a responsibility to meet. And we can meet it now.
Let’s deal in facts.
This is less than 1% of Medicaid spending. So, the issue is not affordability, It is political choice.
THE MEDICAID SYSTEM — A STRUCTURE BUILT ON CONTRADICTION
The current home care system operates through:
Managed Long-Term Care (MLTC) plans
Private insurers administering public Medicaid funds
Fiscal intermediaries and agencies
At every stage: money is filtered, managed, and reduced before it reaches the worker. So, when we are told:
“there isn’t enough money”
we must ask:
enough for whom?
Because there is:
But not enough to pay workers for every hour they work.
THE CPC POSITION — AND ITS CONTRADICTION
Provider organizations like the Chinese-American Planning Council (CPC) argue:
reimbursement rates are too low
the system cannot sustain reform
ending 24-hour shifts without funding will destabilize care
Let’s take that seriously. Because what it reveals is this - the current system only functions if workers are exploited. That is the contradiction. If reimbursement is too low to support humane work then the system must be changed—not preserved, Anything else says continue exploitation until further notice.
THE LEGAL AID SOCIETY ARGUMENT — CAUTION THAT BECOMES DELAY
The Legal Aid Society has helped expose wage theft in this system. In the context of policy discussions, another perspective emerges: "If sufficient funding and a well-managed transition are not provided, discontinuing 24-hour shifts may result in patients being moved into institutional care." This sounds reasonable. But what does it actually do? It says: exploitation must continue, until the state decides to fund care. It creates a moral trap: workers endure abuse — or patients suffer. That is not neutrality. That is austerity logic. And it stands in contradiction to Legal Aid’s own litigation: which has shown that workers are already functionally working 24 hours without real rest. If the system is already violating labor standards— why is the solution caution rather than correction?
WHAT IF THE MONEY ISN’T THERE?” — ANSWERING THE HARDEST QUESTION
Let us take the argument seriously. We are told: If we end 24-hour shifts now—before full funding is secured, patients could be pushed into nursing homes. This is not a trivial concern. No one wants to see patients displaced. No one wants institutionalization. But the conclusion being drawn from that concern is wrong.
THE CORE REBUTTAL — WAITING MAKES THE RISK WORSE, NOT BETTER
The argument to “wait until funding is fully in place” assumes that the current system is stable and protects patients. It is not. The current system is already: burning out workers driving aides out of the workforce; creating gaps in care; forcing patients into hospitals or nursing homes when coverage collapses. So, the real choice is not: act now and risk disruption vs. wait and preserve stability. The truth is: waiting is the disruption—just slower, hidden, and already happening. Ending 24-hour shifts is not the threat to home care—it is what makes home care viable.
What actually keeps your mother out of a nursing home? Not a system built on exhaustion, but one where: workers are paid fully; shifts are sustainable; staffing is stable.
WHY CHANGE DOES NOT COME AFTER FUNDING — IT FORCES FUNDING
Legal Aid’s position assumes: first secure full funding then change the system. But historically, that is not how change happens. In labor, civil rights, and social policy: change comes first—then funding and structure are forced to follow. If you wait for perfect funding: insurers keep extracting; agencies keep operating the same way; legislators feel no urgency. But when you mandate the change: the system must adjust; funding must be found; priorities must shift. That is how the eight-hour day was won. That is how labor standards were enforced. You don’t wait for a just system to exist, you force it into existence.
THE REAL PROBLEM WITH THE LEGAL AID POSITION
The Legal Aid concern is real—but its conclusion leads to a trap: It says: protect patients now, fix the system later but in practice, that becomes preserve the current system indefinitely because “later” never comes. Funding is always incomplete. Budgets are always constrained. There is always another reason to delay. So what sounds like caution becomes a mechanism that locks in exploitation
If a system can only keep patients at home by forcing workers to work 24 hours, then the system is already failing both—and waiting only deepens that failure.
WHY WORKERS AND PATIENTS ARE NOT IN CONFLICT
The “what about my mother?” argument is powerful—and it deserves a real answer. Here it is: Your mother is safest at home only if there is a stable worker there to care for her.
FIRST — THE REAL CAUSE OF THAT RISK
If patients are at risk of being pushed into nursing homes, it is not because workers are demanding humane conditions. It is because: the state has underfunded home care while allowing a system built on exploitation to stand in its place. That is the cause. Not the workers. Not the reform.
SECOND — THIS ARGUMENT LOCKS IN EXPLOITATION
If we accept this logic, what are we really saying? That: workers must continue 24-hour shifts until the state chooses to fund care properly. In other words: exploitation becomes a condition for stability. That is a dangerous precedent. Because it means any unjust system can be preserved simply by pointing to the harm its removal might cause— without addressing why that harm exists.
THIRD — THERE ARE ALWAYS TRANSITION SOLUTIONS
This is not an all-or-nothing choice. If the concern is real, then the solution is not delay—it is immediate transitional funding and planning, such as:
phased implementation with guaranteed reimbursement increases
emergency Medicaid allocations for high-need cases
rapid hiring initiatives to expand the workforce
prioritizing the most extreme 24-hour cases first
The government manages complex transitions all the time—when it chooses to. The question is not capacity. It is commitment.
FOURTH — THE COST OF DELAY IS NOT NEUTRAL; IT DEMANDS WORKERS’ BLOOD, SWEAT, AND TEARS
Every day we delay:
This is not a stable system we are preserving. It is an ongoing harm we are extending.
FIFTH — HISTORY TELLS US THIS ARGUMENT IS ALWAYS USED
We have heard this before:
Ending child labor would hurt families — In the early 1900s, textile mill owners and lawmakers argued that banning child labor would deprive poor families of needed income; Southern states in particular fought federal laws, and the Supreme Court even struck down early child labor protections in cases like Hammer v. Dagenhart.
Shorter hours would destroy industry — Employers fiercely opposed the eight-hour day, claiming it would collapse productivity; yet after mass strikes and organizing—including the struggle commemorated by the Haymarket Affair—the eight-hour standard became foundational to modern labor law.
Civil rights would disrupt society — Segregationists argued that ending racial segregation would bring chaos and economic harm; these claims were used to resist decisions like Brown v. Board of Education and to oppose the Civil Rights Act of 1964.
Each time, the warning was: change too quickly, and harm will follow. And each time, that warning was used to delay justice. So the choice is not protect patients or protect workers - the real choice is:
THE PRINCIPLE THAT MUST GUIDE US
We do not solve one injustice by continuing another. We do not protect patients
by exploiting caregivers. And we do not accept a system that only works because someone is being overworked, underpaid, and exhausted.
THE ANSWER
If the money is not there—then it must be put there immediately. Because the alternative is not stability. It is the continuation of harm. The fear being raised is real. But the conclusion being drawn is wrong. The answer is not to wait. The answer is to act—with urgency, with resources, and with political will to ensure that neither workers nor patients are forced to bear the cost of a broken system.
THE 1199 POSITION — LABOR FROM COMPROMISE TO CORRECTION
1199 SEIU has long stood as a pillar of healthcare unionism and a defender of workers’ rights. That history matters—and it is precisely why this moment matters. When 1199 initially raised concerns about ending 24-hour shifts—arguing that workers relied on overtime— limiting hours may reduce income it reflected a broader reality: a system so broken that survival depends on exhaustion.
But that is not a solution. It is the problem. To its credit, 1199 has moved. And that shift reflects what workers themselves have made clear: no one should have to work 24 hours to survive. Let’s be clear what that means: workers must destroy their bodies to survive. That is not a labor victory. That is a concession. The labor movement was not built on: “work more to earn more”. It was built on: shorter hours, full pay, and dignity. The lesson here is not to fault the union—but to recognize the pressure of a system that pushes even worker organizations toward compromise and to affirm that the path forward is clear: not accommodation to exploitation, but transformation of the conditions that make it seem necessary.
THIS IS HOW LIBERAL AUSTERITY OPERATES
Not through open opposition—but through language like:
This is how injustice survives.
Through delay.
Through caution.
Through managed concern.
THE FALSE DIVIDE — WORKERS VS PATIENTS
We are told: “If 24-hour shifts end, patients will suffer.” This is the most dangerous argument of all. It pits workers against the elderly and disabled. But both are victims of the same system.
The real divide is not: workers vs patients. It is: workers and patients vs a system that underfunds care and protects profit
THIS SYSTEM IS NOT NEUTRAL — IT IS BUILT ON RACIALIZED, GENDERED LABOR
Let us be clear the system of 24 hour work shifts is not simply a funding problem or a policy oversight. It is a system built on who is expected to endure. Home care workers in New York are overwhelmingly: women; immigrant women; women of color. That is not incidental. That is the foundation of the system. Because care work in this country has always been assigned—economically and politically—to those whose labor is seen as less valuable and more expendable. From slavery, where Black women were forced to care for others’ families while their own were torn apart, to domestic workers excluded from New Deal labor protections, to today’s home health aides— the same logic persists: care work done by women of color is underpaid, invisible, and expected to absorb suffering.
That logic is now embedded in policy. A system that allows: 24 hours of labor for 13 hours of pay is not an accident. It is a system that assumes: these workers can work beyond human limits; their exhaustion does not count; their time is not fully theirs.
And when they speak out, what are they told? Wait. The system is not ready. There is no money. But those words land differently depending on who is hearing them.
Because when immigrant women of color are told to wait, what is really being said is: your labor can be stretched further, your suffering can continue longer, your rights can come later. That is what makes this not only economic injustice—but structural racism and gender oppression working together.
And it is precisely why this moment demands not on caution— but correction. This workforce is:
And what is demanded of them?
24-hour labor
broken sleep
partial pay
silent endurance
RACIALIZED EXPLOITATION — NAME IT CLEARLY
This is not incidental. It reflects a long history: where care work—done by women of color— is undervalued, invisible, and exploited. This is not just class - It is structural racism.
WE HAVE HEARD “WAIT” BEFORE — AND WE KNOW WHERE IT LEADS
Martin Luther King Jr. warned those who say: “Wait for a more convenient season.” Workers did not wait. They forced change. To those who say—not now—we have heard this before workers were told the 8-hour day was too much, too soon, too expensive. They were told that industry could not survive shorter hours. And yet workers struck—by the tens of thousands—in Chicago and across the country. They did not wait. They forced the system to change.
Black domestic workers and farmworkers were told during the New Deal
that labor protections were not politically possible for them. That their rights would have to come later. “Later” meant decades. That was not compromise. That was exclusion.
In Memphis, in 1968, sanitation workers—Black men risking their lives for poverty wages—were told the city had no money. That it was not the right time. They struck anyway. And with the support of Dr. Martin Luther King Jr., they won recognition, dignity, and better wages. They carried signs that read: I AM A MAN. They did not wait to be treated as one.
Farmworkers in California were told higher wages would destroy agriculture - that the economy could not absorb it. And Dolores Huerta did not accept that lie. They organized, they struck, they boycotted—and they won.
Even public sector workers—told they could not strike, that budgets were fixed—
walked out anyway. Postal workers in 1970 shut down the mail system. They forced the government to raise wages and recognize their rights.
The pattern is unmistakable. Workers are always told:
there is no money
the system is not ready
now is not the time
And too often, these words come not only from opponents— but from those who claim to stand with workers. But history teaches us something simple and undeniable. Workers have never won justice by waiting. They have only won by refusing to. And that is the choice before us now.
AUSTERITY IS NOT AN ACCIDENT — IT IS HOW THE SYSTEM WORKS
What we are confronting is not simply a bad policy choice. It is a system that functions by design. Austerity—the claim that “there is no money,” that resources are limited, that workers must wait—is not a temporary condition. It is structural. It is how this system organizes priorities. Because under capitalism, especially in essential services like care:
And the easiest place to extract those savings is from those with the least power. In this case: immigrant women of color doing the most intimate and necessary labor—care work.
So, austerity is not neutral. It is selective. There is always money: for administrative layers; for insurers and managed care plans; for corporate subsidies; for policing and enforcement but when it comes to the workers who sustain life itself—suddenly: there is no money. That is not scarcity. That is allocation. And allocation reflects power. This is why the system depends on: extending hours instead of hiring more workers; underpaying labor instead of restructuring funding; normalizing exhaustion instead of recognizing care as essential infrastructure. It is cheaper—within this system—to stretch a worker for 24 hours than to hire two workers for 12. That is the brutal arithmetic of austerity.
And when advocates, providers, or even unions repeat: “we must be realistic” ;“the funding is not there”; “the system cannot absorb this change yet” they are, whether intentionally or not, reinforcing the logic of that system. Because austerity is not simply about budgets. It is about disciplining expectations. It teaches workers to accept less. To demand less.
To wait. But history shows nothing about this system changes on its own. It changes when workers refuse to accept its limits.
THE REAL QUESTION
So, the question is not: Can the system afford to end 24-hour shifts? The question is: Why is the system structured so that it cannot function without exploitation? And once we ask that— the answer is no longer delay. The answer is transformation.
No More 24 is not a risk to manage—it is a responsibility to meet, and we can meet it now. There is no false Sophie’s choice here between protecting workers and protecting patients. That trap only serves those who profit from a broken system—pitting one essential part of care against another so nothing changes. In truth, a stable, fully paid, adequately staffed workforce is what keeps patients safely at home and strengthens care. The solutions already exist: immediate Medicaid reallocation, cuts to MLTC and insurance profit margins, greater administrative transparency, progressive revenue measures such as a Stock Transfer Tax, and, more broadly, passage of the New York Health Act in Albany to move us toward a healthcare system driven by care rather than corporate extraction. And we must reject the politics of incrementalism that tell us justice must come in small, delayed steps—because that logic has always been used to preserve exploitation, not end it. We do not protect patients by exploiting caregivers, and we do not defend justice by postponing it. The issue is not resources. It is political will.
CONCLUSION — NO MORE DELAY, NO MORE 24
The resistance to ending 24-hour shifts—“No More 24”—is not about patient need, but about a system structured to protect insurer margins over human care. Yet we do not have to choose between workers and patients. That is a false and dangerous divide that keeps this system intact. In truth, a stable, adequately paid, and fully staffed workforce is the strongest protection against institutionalization—not a threat to it.
The tools to act are already in our hands. Legislators can immediately tie Medicaid reimbursement to safe staffing standards, require that the vast majority of funds go directly to wages and care, cap excessive administrative costs and profit-taking, mandate transparency, and guarantee continuity so patients are not displaced. There is no need to wait. The resources already exist—they must be redirected from profit to care.
To those who say they agree but urge workers to “wait”: workers have already waited—through exhaustion, poverty, and a system built on their sacrifice. Delay is not neutral; it is how exploitation continues. We reject the politics of delay, the false choices, and the incrementalism that preserves injustice.
Solutions are not hypothetical—they are concrete and available now: passage of the New York Health Act (S3425/A1466) in Albany, reallocation within Medicaid, cutting MLTC and insurance profit margins, achieving administrative savings under a single-payer model, and generating revenue through measures such as a Stock Transfer Tax. The issue is not resources. It is political will. We do not balance budgets on workers’ backs. We do not preserve systems by preserving exploitation. We do not accept delay as justice.
We demand:
Passage of Intro 0303-2026 (“No More 24”)
Full funding and immediate implementation
Regulation of insurer and MLTC profit extraction
Advancement of the New York Health Act (S3425/A1466)
If you agree—act.
Sign this letter.
Write your own.
Call your City Council members and State legislators.
Demand passage of No More 24.
Bring resolutions to your union to support No More 24.
Challenge leadership that repeats austerity arguments.
Speak out—in hearings, rallies, and every public forum.
The workers have already done their part. For years—through exhaustion, pain, and invisibility—they have carried this system. The question now is not whether they will continue. The question is: Will we continue to ask them to? Or will we finally say—
Enough. No more waiting. No more 24-hour shifts. Pass the law. Fund care. Respect the workers who make life possible
No More 24 is not a risk to manage—it is a responsibility to meet. And we can meet it now.
THE DEMAND — ACT NOW
In solidarity,
Mimi Rosenberg
ALAA Local 2325 (UAW)
Producer/Host, Building Bridges & Equal Rights & Justice radio productions