NYC home care workers are waging a fight against the 24-hour workday. Care workers, who are disproportionately comprised of immigrant women of color, have decried these 24-hour shifts as racist and sexist. Proponents of the Intro 303 bill, also known as the No More 24 Act, have argued that the greed of insurance companies and the inadequacy of New York’s for-profit healthcare system have left care workers grievously overworked and underpaid. Mayor Zohran Mamdani and City Council Speaker Julie Menin have been notably targeted for criticism by the bill’s supporters.
On April 16th a group of home care workers initiated a hunger strike, which came to an end six days later following Menin’s agreement to promptly introduce a vote on the bill. According to Washington Square News, the mayor “repeatedly pushed to water down its language at the advice of the Legal Aid Society, which raised concerns that it would come into conflict with state law.” Mamdani publicly called for the end of 24-hour shifts back in December 2024 when he was still an obscure mayoral candidate.
Mamdani has reportedly been seeking to alter the language of the bill in order to make the 24-hour workday voluntary rather than illegal. Critics have responded that a 24-hour shift is inherently exploitative and inhumane, and that a disproportionate number of workers who enter into it do so out of coercion. While acknowledging these facts, the Legal Aid Society and other experts have argued that the bill fails to account for how home care is funded and authorized, as 24-hour care services are governed by New York State Medicaid and not by New York City. For many activists, this explanation is insufficient. At a rally outside City Hall in late April, a representative of the International Women’s Alliance US declared that “migrant women…are targeted for their supposed submissiveness and willingness to work in some of the worst conditions…employers abuse documentation status, sexist and racist stereotypes, and kiss up to politicians in order to maintain this systemic abuse.” Mamdani and Menin, critics claim, are aware that 24-hour shifts encourage violence towards vulnerable workers, but choose to turn a blind eye regardless.
Proponents of Intro 303 have argued that, in addition to the dangers care workers face as members of vulnerable minority groups, they are also victims of ruthless economic exploitation. Dr. Steve Auerbach, a vocal supporter of the legislation, stated that “it is absurd and obscene that an employer is allowed to control where an employed person’s body is located for a 24 hour shift but then only pays for 13 hours.” This absurdity, he claimed, is made possible by the double-dealing of insurance companies and healthcare providers: while patients are being assured that they will receive 24-hour round-the-clock care, workers are told that they are only performing 13 hours’ worth of salaried labor and must be paid accordingly. “It is simply a self-contradictory lie to say they have 11 hours off, but then also require them to be present for 24 hours to provide care” Auerbach argued, while also claiming that the most effective, long-term solution to exploitation and non-transparency is the passage of the New York Health Act (S3425/A1466), which would enact a statewide single-payer health care system.
Auerbach has not been the only figure to promote the New York Health Act in the context of No More 24. Hannah Keziah Agustin of Sojourners has claimed that “because insurance companies like UnitedHealthcare and New York Healthfirst receive fixed public Medicaid payments to manage care, they make a profit by hiring only one worker for an entire shift.” Radio Host Mimi Rosenberg has similarly insisted that resistance to 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.” For many workers closely involved with this fight, the passage of Intro 303 is a necessary step on the road to making universal, single-payer health care a reality for all New Yorkers. A representative for the workers on hunger strike promised that May Day would bring “a big protest to demand that Mayor Mamdani supports the No More 24 Act, fights for universal healthcare, and stops displacement [of minority and working-class residents].” The protest that took place on May 1st featured appearances from care workers, political organizers, union members, council members, and assemblymembers.
It is not yet clear if and how city funds will be made available to enforce Intro 303. On Tuesday Mamdani released the budget for the 2027 fiscal year after a protracted standoff between City Hall and Albany. The resolution to this budget crisis comes after Mamdani’s proposed “last resort” property tax increase was shot down by the City Council, while Governor Kathy Hochul remains steadfast in her opposition to a proposed income tax (1% on incomes over $1 million, 3% on corporations). Hochul had insisted previously that the state would not put forth the $460 million to fund the legislation. However, the just-announced $4 billion in state support raises the question of whether or not Hochul has changed her tune.
Menin has recently faced opposition from DC 37 (New York’s largest public sector union), the Legal Aid Society, and various disability rights activists, complicating the passage of Intro 303. Some have expressed fears that passing the bill would jeopardize the 24-hour live-in support that they require for health and security. The bill, they argue, would only strip them of essential care without introducing a workable substitute. “Supporters of the bill often claim that agencies can simply switch to split shifts,” wrote Julia Yepez-Macbeth, a disabled Puerto Rican immigrant who resides in Flatbush. “That is not true. Agencies cannot legally make that change unless insurance plans authorize it. Right now, they do not.” Other disabled activists have voiced strong disagreement with this assessment, which has been echoed by other disability rights groups like Legal Aid. One disabled supporter of Intro 303 claimed that these groups only look at the problem “through insurance companies, who make decisions about what disabled people need and deserve through legal categories disconnected from life.” They added that Intro 303, by splitting 24-hour care into two 12-hour shifts, would provide needed relief and dignity for both care givers and recipients.
In certain cases, both supporters and detractors of Intro 303 agree that insurance companies play too large a role in dictating the lengths of individual workers’ shifts. This is another major reason why some of the bill’s more progressive supporters see it as a crucial stepping stone towards a single-payer healthcare system, which would strip private insurers of their outsized ability to dictate such policies. “Health care for all New Yorkers will save billions of dollars,” according to a coalition of New York religious leaders, who described private insurance and real estate moguls as being “in collusion with our city government.” Going beyond criticism of New York’s for-profit healthcare services, several supporters of Intro 303 have directly criticized the entire system of free-market capitalism. “We must allow space for the super exploited immigrants to raise the consciousness of the working class, to agitate from below, around the violence of our insurance regime that we ourselves are committed to resisting as socialists” wrote Bisma Punjani of NYC-DSA. Scott Henstrand of the United Federation of Teachers’ Retirees Chapter and co-founder of The Labor Solidarity Project gave a speech in support of Intro 303 in which he paraphrased Warren Buffett. When asked in 2006 if class warfare existed, Buffett replied in the affirmative: the wealthy are waging it, and they’re winning.
The Ain’t I A Woman? campaign and its allies plan to rally this Friday to mark the intended passage of the bill. While the council was expected to vote on Intro 303 around this time, as of this writing, the legislation remains laid over in committee. “If there is no action on this bill by May 15” said Christopher Marte, “I will be with these workers on the ground, and taking whatever action we need to take to make sure that they put this bill to a vote.” The staff of D@W remains in touch with representatives of the No More 24 movement and will continue to monitor the situation as it progresses.
Isaiah Blum is a Graduate of the New School, teacher, and contributor with Democracy @ Work. he writes about economics, politics, history, culture and more. Follow him on Instagram @blumbergznews.
That situation looks like the kind of conundrum with which Citizens-Deliberative-Committees have a proven track record,and now that AI can get them all up to speed on these complex issues, more likely to provide realistic solutions.
I have programs that simulate the community and have done a sanity cross check with another AI for this output pasted here:
Why the "No More 24" Home Care Fight is a Manufactured Civil War—And How a Citizens' Assembly Would Fix It
What happens when you bring a random, representative microcosm of everyday New Yorkers together, give them the unvarnished facts on the city’s home care crisis, and ask them to find a solution?
They don't pick a side in the political theater. They rewrite the script.
Right now, New York City Hall is locked in a bitter, heartbreaking stalemate over Intro 303 (the "No More 24 Act")—a bill aiming to ban grueling 24-hour work shifts for home health aides. On one side, exhausted, predominantly immigrant women of color are fighting to end an exploitative system where they are paid for only 13 hours of a 24-hour shift. On the other side, disability rights advocates and major labor unions (like DC 37) warn that passing the bill without guaranteed state funding will collapse the care system, leaving 13,000 disabled New Yorkers stranded.
Our simulated citizens' assembly came to a "striking" conclusion: Workers and patients are not natural adversaries.
This conflict was manufactured by the structure of Medicaid Managed Care. Private insurers profit heavily by paying for a single 24-hour live-in shift rather than two 12-hour split shifts, pocketing the margins while forcing the true costs onto the broken bodies of workers and the anxiety of families.
Here is the blueprint our assembly designed to break the gridlock—protecting vulnerable patients, honoring workers, and forcing the financial burden back onto the corporate entities that profit from the status quo.
The 7-Point Blueprint for a Real Compromise
1. Pass Intro 303—With a Funded 18-Month Transition
Do not pass the bill as an immediate, unfunded mandate that forces providers to choose between violating city law or abandoning patients. We recommend passing Intro 303 but delaying its full enforcement for 18 months, giving the city and state a defined runway to adjust care infrastructure.
2. Close the Consent Carve-Out
The current draft allows an "opt-in" for excess hours. In low-wage healthcare, "consent" is easily coerced. We recommend closing this loophole, allowing narrow 24-hour exceptions only under strict, independent third-party labor advocate oversight, with a hard phase-out by 2028.
3. Honor Existing Union Contracts (With a Cap)
To prevent the immediate destabilization of hard-fought healthcare benefits, existing Collective Bargaining Agreements (CBAs) must be honored—but only for a maximum of two years. No new or renewed contracts may include 24-hour provisions.
4. Force the City to Lobby Albany Within 60 Days
Because home care is governed by state-administered Medicaid, the Mayor must legally petition Albany within 60 days for explicit split-shift authorization and funding restructuring, accompanied by mandatory, public quarterly progress reports.
5. Establish an Emergency Patient Continuity Fund
No care recipient should lose their independent living status during this transition. A city-backed emergency fund must be established to bridge any immediate gaps in coverage while split-shift authorizations are processed.
6. Proactive Enforcement at the DCWP
The Department of Consumer and Worker Protection cannot rely on a "complaint-driven" model, which relies on vulnerable workers sticking their necks out. The city must fund a dedicated enforcement unit to run proactive payroll audits on home care agencies.
7. Fast-Track the New York Health Act
Ultimately, tinkering with Medicaid guidelines is a band-aid. The assembly recognized that the New York Health Act (universal single-payer healthcare) is the true structural fix that completely removes the profit motive from human survival.
Follow the Money: The Fairness Breakdown
When opponents ask, "How do we pay for this?", the subtext is usually an assumption that taxpayers or families will be squeezed. According to union estimates, splitting these grueling 24-hour shifts into humane 12-hour rotations will cost roughly $460 million annually.
Our assembly mapped out exactly where that money belongs, and why it is fundamentally fair:
Private Insurers (MLTCs) Must Absorb the Hit: Insurers currently receive a flat monthly fee ("capitation rate") from the government per patient. They maximize profit by authorizing cheap 24-hour live-in shifts (paying for 13 hours) instead of authorizing more expensive split shifts. Renegotiating these state contracts to reflect actual labor hours isn't punitive—it's corrective.
The State & Federal System Siphons Hidden Costs: Opponents call the $460 million cost "new spending." The assembly points out that this cost already exists—it’s just paid invisibly through workers’ chronic spinal injuries, stress fractures, early medical retirements, and mental health crises. Moving the money to the front end keeps workers healthy, dramatically reducing costly workforce churn.
Zero Cost to Patients: Under this framework, vulnerable seniors and disabled individuals pay $0 more out-of-pocket, and regular taxpayers face no new local tax hikes. The cost lands square on the balance sheets of the insurers who extracted profit from the system in the first place.
The Assembly's Core Takeaway: You pay in proportion to how much you benefited from the status quo. Insurers benefited most. They pay most.
Self-check synopsis:
Why This Will Do Well on Substack
It's Unpredictable: It refuses to fall into the standard "Pro-Worker vs. Pro-Disability Rights" trap that standard media outlets are lazily reporting.
It Uses a Framing People Trust: Framing the solutions through a simulated "Sortition/Citizens' Assembly" shifts the tone from partisan bickering to civic problem-solving.
It Offers Math and Specificity: Breaking down the $460 million cost and the "13-hour pay rule" exposes the structural villain (MLTC insurance margins) rather than blaming local non-profits or patients.
Recommendation: Ship it. It provides an elegant, highly educated off-ramp to a political disaster happening in New York right now.