John O'Connor, VP, Associate Publisher, Editorial Director
John O’Connor

When the big boys in Washington decide to tackle healthcare policy, long-term care rarely gets a seat at the table. Unless it’s at the children’s table.

It’s not so much that this sector is an afterthought in Washington. It’s just that, well, others get to eat first. And by the time the hospitals, docs, insurance companies, drug firms and other major players load up their plates, long-term care operators are lucky if any scraps remain.

So it was more than a little refreshing to hear about two new proposals that would improve health services by actually targeting long-term care. One plan is nuanced and incremental. The other is painted with a wide brush and could be a real game-changer.

Let’s start with some small ball: Sen. Patrick Toomey, (R-PA) is preparing legislation that would let people make tax-free withdrawals from their 401(k ) retirement plan in order to pay for long-term care insurance. Under his measure, a person could remove up to $2,000 of retirement assets annually to cover long-term care insurance premiums and other policy charges. The withdrawals wouldn’t be subject to income tax, and the limit would be indexed for inflation.

If you prefer your coffee a bit stronger, then maybe South Bend, IN, Mayor Pete Buttigieg’s proposal is more to your liking.

Buttigieg, who also happens to be running for president in the crowded Democratic field, last week revealed his Dignity and Security in Retirement plan. The measure would set up a national long-term care benefit, help shore up the much maligned long-term care insurance market, and possibly even encourage more people to work in this sector.

The centerpiece is a benefit program that would give eligible recipients $90 per day that could used to cover the costs of care. Eligible recipients would have to be at least age 65 and require help with at least two activities of daily living.

To help drive up the number of direct care workers, his plan also raises the federal minimum wage to $15 an hour, while also establishing a National Direct Care Workforce Standards Board. This oversight agency would help regulate the industry and set policies for issues such as compensation, training and recruitment.

Does either plan have a snowball’s chance? Who knows? Each still has a lot of explaining to do on the details and cost fronts.

But at the very least, it’s nice to see long-term care back in the conversation. Sure beats the back of the line.

John O’Connor is McKnight’s editorial director.