Having taken control of the U.S. House, Democrats are reportedly still searching for a cohesive agenda on the issue that voters most favored them on – healthcare. Simply opposing any further undermining of the Affordable Care Act, or attacks upon funding for Medicaid and Medicare, is not a proactive agenda, however essential such opposition is for many vulnerable citizens. And even protecting those with pre-existing conditions is raising questions of strategy, proof of how complicated health care is.
There is a way Democrats could capitalize upon the enthusiasm of many in their base for “Medicare for All.” They could join together with Republicans and make Medicare responsible for what so many errantly believe it to already be – long-term care. A 2017 poll showed 57% of Americans planned on relying upon Medicare for their long-term care needs, despite the unlikelihood of that care being covered.
No substantive federal effort has been made to address our aging future since the Community Living Assistance Services and Supports Act was included within the 2010 ACA, then abandoned the next year as “financially unsustainable” by the Obama Administration. Both parties joined together to repeal it as part of the so-called American Taxpayer Relief Act of 2012. In the alternative, a Commission on Long-Term Care was created.
Predictably, the Commission’s 2013 report to Congress noted, “The Commission did not agree on a financing approach, and, therefore, makes no recommendation.” One idea considered, and not agreed to, was creating a long-term care benefit within Medicare.
This was not the first time a bipartisan commission had recommended such a thing. In September 1990, the “Pepper Commission,” or Bipartisan Commission on Comprehensive Health Care, made its own report to Congress that looked holistically at health care reform needs and included long-term care. It recommended “social insurance for home and community-based care and for the first three months of nursing home care, for all Americans.” Under such a system, “People who need nursing home care for short periods would have their resources preserved intact to return home.” Recognizing the “urgent needs of the currently disabled and their families” the Commission recommended “that the plan be put into place a step at a time over a four-year period.”
Yet, here we are, 28 years later discussing a single-payer “Medicare for All” approach, without any reference whatsoever to long-term care. It is long past time that we refocus Medicare on better serving the comprehensive health care needs of the elderly population it was originally intended to serve. The 2017 poll referenced earlier showed a large shift in public opinion in favor of having Medicare cover long-term care – significantly, “Seventy percent of older Americans say they favor a government-administered long-term care insurance program, up from 53 percent who said so a year ago.”
Since that poll, even red state voters (in Idaho, Nebraska and Utah) have opted into Medicaid expansion for the working poor, where the federal government covers no less than 90% of the cost. Yet “traditional” Medicaid – that which funds most nursing home care and a great deal of home-and-community-based services – suffers from federal participation rates of as low as 50%.
It is well past time we prepared for the coming age wave by ensuring the solvency of long-term care, and that can best be done through bold new federal action the public is sure to support.
Brendan W. Williams, M.A., J.D. is the president and CEO of theNew Hampshire Health Care Association.
