Long-Term Care

On October 14, the Obama administration halted implementation of the new federal long-term care insurance program – the Community Living Assistance Services and Supports (CLASS) initiative, which had been tucked into health care reform legislation. It is disappointing, but not surprising that the administration was unable to design a financially self-sustaining, voluntary long-term care insurance program. The unusual legislative journey of the Patient Protection and Affordable Care Act, which had no House-Senate conference to clean up the bill, left CLASS with statutory limits that proved unworkable. Without mandatory participation or some other way of achieving near universal participation, the program did not stand a chance.

The piece was written in August 2011 

Now is the summer of our blasted dissent,
With our eyes cast upward at the debt ceiling,
And no one seems even remotely content.
Will this fallout leave us fiscally reeling?

Into this bloodless, ever-present, hot fray,
Come bright-eyed, eager interns ready to learn.
They are told for social insurance to pray,
For nothing it will give and take all we earn.

Unemployment is in federal error,
The Class Act has been passed but still needs a fix,
Medicare is causing the old to terror,
Social Security’s done by ‘thirty-six.

But UI’s computers will be updated,
A tweak here, one there, and the Class Act will roll,
By healthcare reform, Medicare is sated,
Though Social Security still has a toll.

Each summer, NASI’s Somers Aging and Long-Term Care Research Internship program selects 5-7 graduate students to spend 12 weeks receiving high-quality training in policy research skills on challenging issues facing the diverse aging population of the United States.

The Co-chairs of the President’s Commission presented a number of policy proposals aimed primarily at reducing the growth spending on Medicare and Medicaid. Given the size of the two programs, some of these changes may impact health care spending patterns in the private economy, but many will simply shift costs to other payers. Few, if any, proposals would address the underlying growing demand for services triggered by an aging population and a long term care system that relies on private savings.

The United States is going to try something new – a social insurance approach to the problem of paying for long-term services and supports. As more and more of the 76 million baby boomers move into their 60s and beyond, there will be a growing population of people who need help with the activities of daily living (using the toilet, dressing, bathing, eating, getting in and out of bed, walking around in the house or apartment). To date, this has been a private responsibility, with individuals and families providing care or paying for it out of their own funds. The government gets involved only if you go into a nursing home and “spend down,” using all your money until you have just $2,000. Then you qualify for Medicaid, the government’s health program for the poor.