"Slow train": States examines public health insurance extended

"Slow train": States examines public health insurance extended

For most of us, long-term care insurance is prohibitively expensive. The health insurance provided by the employer does not cover daily and long-term care. Medicare only supports short-term stays in a retirement home or a limited number of home care services.

90% of Americans do not have long term care insurance - even though half of those 65 and over will need it at some point. Without this, seniors can go bankrupt by paying for help with their lives, nursing home care or home health care.

"This is a slow-moving train car," said Howard Gleckman, a researcher at the Urban-Brookings Tax Policy Center at the Urban Institute, a non-partisan think-tank based in Washington, DC

"It's a slow-moving train wreck," said Howard Gleckman, a researcher at the Urban-Brookings Tax Policy Center at the Urban Institute, a non-partisan think tank based in Washington, DC

"At a precise moment, we will have a catastrophe."

States are beginning to realize this.

This summer, Washington State created the first public long-term care insurance plan, which will be funded by payroll taxes.

In 2017, Hawaii started giving up to $ 70 a day to working residents while taking care of older family members at home. Hawaii pays for the program, Kupuna Caregivers, out of its total budget.

the nation estimates that 154,000 residents are the unpaid caregivers of older members of the family. Kupuna Caregivers is helping 134 Hawaiians pay for transportation, adult day care, personal care and home meals.

Kupuna Care, another Hawaii program, provides services to older people who need help with their day-to-day activities. This year, legislators passed a series of elder care bills, adding $ 11.2 million to the $ 9.7 million budgeted to the state.

A handful of other states, including Arizona, California, Michigan, and Minnesota, are also exploring long-term care options in public for people who might otherwise have to spend their assets to qualify for Medicaid.

And measures have also been taken at the federal level. In May, US Representative Frank Pallone, a Democrat from New Jersey, released a proposal to create a Medicare Long Term Care Allowance. The proposal would create a public benefit within Medicare, regardless of income.

These changes come as Americans have fewer children and live longer - in many cases, live longer with chronic diseases such as dementia. Fewer children means fewer family caregivers. Many people are not saving enough to pay for long-term care, and the supply of paid caregivers is declining.

Long-term care is expensive. In Washington State, the nursing home costs an average of $ 70,000 to $ 80,000, and at the national level, the cost of a private room is $ 90,000.

Statistics from the US Department of Health and Human Services show that hiring a home medical aide for about $ 20 an hour, which is a quick price for day and night care.

Meanwhile, the price of long-term insurance is often out of reach. A couple in their late sixties can expect to pay up to $ 5,600 a year, according to the American Long Term Care Insurance Association.

Nevertheless, it is possible to save money and have coverage for long-term care, said Jesse Slome, executive director of the group. The majority of people will not need long-term care, he said. A long-term insurance policy covering two years of care would cost less than $ 200 per thirty days.

Medicaid still offers coverage for long-term care, but only after families have paid all their resources to benefit. And even this less than ideal solution puts financial pressure on states.

"We are testing the price explosion of Medicaid as baby boomers get older," said Washington State Representative Laurie Jinkins, the Democratic sponsor of the state's measure.

"It was impossible for our budget to maintain it."

Democrats have included in the Federal Affordable Care Act a publicly administered program of assistance to persons in difficulty and support for community life (CLASS), which would have provided benefits of up to $ 50 a day for home care. The law did not specify the cost of premiums, but students and people living below the poverty line would have paid $ 5 a month.

Health and Social Services Secretary Kathleen Sebelius, however, withdrew the plan after concluding that it was not financially viable. By law, participation was to be voluntary and federal officials feared that the number of registrants was not sufficient.

According to Slome, this does not bode well for a national long-term care solution.

"Will the upper middle class and wealthy people have solutions at their disposal? Yes. Is everyone going? Probably not, said Slome. "Be nice to your children because you may be moving into a spare room."

Elaine Ryan, Vice President of Advocacy and Strategic Integration of States at AARP, said it was essential for states to act.

"We need to find ways to help this middle-class family," Ryan said. "Imagine that you spend your life trying to accumulate wealth, then trying to get rid of it for the last three years of your life to get Medicaid."

States Explore Options

Minnesota is considering two private sector options to solve the problem. One would be to require insurers' supplemental insurance policies to include long-term care. This approach would cost recipients about $ 8 a month and would be limited to home care, according to Lynn Blewett, director of the University of Minnesota's Healthcare Access Data Center.

The alternative would be to allow the sale of term life insurance policies converted into long-term care products once the beneficiary has reached retirement age. Fred Andersen, chief actuary for the Minnesota Ministry of Commerce, said it could appeal to middle-income parents who are looking for financial protection for their grandchildren when they are in their thirties or forties, but who are giving great value to the protection of long-term care. they are 65 years old.

In October, Michigan officials will begin to study what the state can do to help residents pay for long-term care. Illinois legislators have also commissioned a study this year to calculate the number of seniors who may need long-term care. the possible financial impact on their families; the availability of informal caregivers and the tax implications of a publicly administered long-term care program.

In April, the Arizona Senate passed a bill to create a pilot program that provides grants of up to $ 1,000 per year for family caregivers who care for family members. disabled at home. The program would be funded from a $ 1.5 million per year fund included in the state budget. The measure is making its way into the House. (A proposed caregiver tax credit has failed in the Senate.)

And in California, where the over-65 population is expected to almost double to 8.6 million over the next decade, lawmakers recently approved a $ 1 million study to assess the cost of different long-term care plans.Washington's plan

According to Mary Clogston, a senior policy analyst with Washington House's Democratic Caucus, more than 77,000 people in Washington State use Medicaid for long-term care at an annual cost of $ 2.1 billion.

The population eligible for Medicaid long term care insurance is expected to increase by 91% by 2040, said Clogston. Currently, spending on long-term care accounts for 6% of the state's Medicaid budget, she said.

To address this problem, the new Washington State-administered plan will pay a cumulative benefit of up to $ 36,500 to help people pay for home care (provided by a professional or family member) , a house arrest or a retirement home. It will be financed by a wage tax of 0.58% for all workers. (The self-employed may choose to participate.) But the state will not begin payroll deductions until 2022 and the benefits will not start until 2025.

"People hear that and think it's not a lot," Jinkins said. But she said the plan was based on what the average Washingtonian needs.

"Some people will need a lot more," she said. "And others will need a lot less."

Eligible residents must be 18 years of age and have paid either three-year bonuses in the last six years, or a total of 10 years of bonuses, including at least five, without interruption.

Critics, however, question the long-term feasibility of the program because participation is not mandatory for everyone - people with other long-term insurance may choose not to participate. And some Conservatives say that it creates bad incentives.

"This is another program in which you give money to the government, which will then decide if you are qualified to recover it," said Charles Silver, associate researcher at the Cato Institute, a Washington-based libertarian think tank. "We are creating more programs that deter people from doing the right thing - save for your past life."

And the new taxes can be very difficult to sell in other states: many years ago, legislators in Hawaii considered but ultimately rejected a long-term care plan funded by payroll taxes.

Last year, Maine voters overwhelmingly rejected a vote initiative that would have raised income taxes by 3.8% to fund a long-term care plan. And this year, in Washington State, Republican co-sponsors of the Washington measure have withdrawn their support for concerns about costs to taxpayers.

"There must be winners and losers," Republican State Representative Drew Stokesbary said in February at the Washington House Credits Committee debate over the long-term care bill. "We do not draw money from nothing."