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It’s sad that it took the demise of the CLASS Act for the media to take notice that the problem the measure was trying to solve, long-term care, is both serious and growing.
But whether or not the CLASS Act comes off the books, the problem it was meant to address remains: A gap in the health care system is swallowing up the savings of a growing number of seniors and increasing pressure on Medicaid, the program that usually pays for long-term care.
And the near-term outlook for improving access to long-term care is bleak.
“CLASS was the one big idea out there, and I don’t think there’s another one waiting in the wings,” said David Certner, legislative policy director for the AARP, which is not good, he said, because “the unmet need is huge.”
About 20 million people, including more than two-thirds of people over age 65, are expected to need long-term care at some point in the coming years, but only 7 million have private insurance to cover it.
The number of people with such insurance has remained roughly flat for at least the past four years, suggesting the limits of the private market’s ability to fill the need.
The CLASS Act, in many respects, was a program that extended the life of Medicaid – and Medicare, in a way. Medicaid, already under threat of cuts from federal budget trimmers, will face increasing burdens from long-term care if the private market sees the opportunity to offload costs. Long-term care insurance simply doesn’t have much of a payoff to private industry. And if that market just collapses, you’re going to have so much unmet need for long-term care that there will be a clamor for the easiest fix, to simply incorporate it into Medicare. And that will take years off of Medicare’s life.
The positives of that outcome would be to consolidate long-term care under one program that can then bring down provider prices. Another way to handle this would be to get everyone into an insurance program for long-term care, so that benefits can be paid out at decent levels without forcing the patient to divest themselves of all their money to qualify for Medicaid coverage. If people are signed up early enough, there would be enough money in the pool to provide those benefits. And if this gets routed through community care rather than Medicaid, it relieves the burden on that program, making the funding crunch less troublesome.
Hey, that sounds like the CLASS Act!
Don’t expect the private market to take care of this one. Met Life just abandoned the long-term care business last year, and I’d expect others to follow. There’s no doubt that there’s a serious gap here, and as the baby boom generation starts requiring long-term care, the political demand from the country will grow. We cannot continue to have a situation where people have to put themselves into bankruptcy to get the care they need. Nobody lays it out in this fashion, but that’s the practical effect of a broken long-term care system.
UPDATE: Sarah Kliff is right that the CLASS Act’s $50-a-day benefit would have been insufficient to deal with the actual costs of intensive long-term care. It comes closer on assisted living. It’s a very serious problem, however, and even the aborted solutions wouldn’t have been full solutions.
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Over a third of the baby boomers are obese, which means that they will need much more long-term care which will have to be paid for, one way or another. MetLife apparently wanted out for this reason, and so will others as noted above.
People who are so grossly overweight that they can hardly walk are not good candidates for insurance programs, and people who do take care of themselves are not eager to pay for others’ irresponsibility.
Warehousing of people in need of LTC has been the norm for many decades in this country. It is cheaper than the alternatives and the inmates (and the treatment they receive) are kept out of public view. In 1977, Claude Pepper chaired the House Select Committee on Aging which put the “industry” under a search light. While changes were made as a result, the situation festers with people suffering due to lack of funding for the alternatives as well as adequate funding (backed up by rigorous enforcement of standards) for best quality care in facilities. With the overwhelming financial crises engulfing the nation and the world, the chances for improving lives of people who have to rely on the larger society for LTC are receding even further. It is shameful and heart-breaking.
good thing we got that public option to begin moving in the right direction
right, obama?
One third of baby boomers are obese? Got a link for that? As opposed to the 1/3rd of children who are obese? http://www.aacap.org/cs/root/facts_for_families/obesity_in_children_and_teens
I love the yoyo Republicans. (You’re on your own) Anyone with half a brain is aware of how the insurance industry works when they sell insurance. It’s called a pool.
When you find one that’s handled a different way, let me know. With the exception of colds, or broken fingers (4) over the years, I’ve never been out of work for more than two days. The same with my wife. We’re both 63.
Of course WE have to pay higher rates for people with low IQs.
Yep, it is still adrift and, like health care in general, likely will be for some time to come. Seems a lot of people are far more interested in revising the tax code so the Kochs and Forbes don’t need to pay so much tax. Sounds like a good idea?
$50 a day is not far from the actual cost or a “Medicaid” nursing home ($18,000). The private nursing homes I had to put relatives into range from $24,000 and up depending on location more than on services provided. There are already few “Medicaid” homes and they all have long waiting lists.
In any case the HCA expanded Medicaid that is the heart of the expanded coverage under HCA is a cost the states can not handle – so the states are rushing to pass laws that limit Medicaid stays in hospitals to 10 days.
HCA rather than single payer with a budget – or at least fixed reimbursement prices for each service as in the Maryland Medicare waiver and the Maryland 3rd part reimbursement price fixing board – was a massive mistake.
But Obama will get votes for his “first universal health bill”.
Average price is more than $70,000 a year. Where did you get your $18,000?
From what I understand, the only reason CLASS ACT failed is because it was underfunded.
Tax everyone more and bring it back.
Mandate everyone buy private long-term care insurance, problem solved./s
I’m personally aware (apart from periodic media coverage related to law suits) of several instances where gross neglect of elderly patients in a particular LTC facility were compounded by relatives attempts to get help from the state agency that is supposed to investigate and advocate for patients who have been mistreated by whatever means used. We found that the agency’s “investigation” by an incompetent volunteer investigator was a mockery of the word and the final whitewash report essentially said the facility’s staff was doing fine and there were no problems. A much more competent volunteer (and friend who was a disabled/retired nurse with quite significant experience on such matters) knew of the specific problems and confronted the agency, which did everything it could to discount her. I appealed to a gerontology professor friend who had sent students to the agency for internships in the past and she refused to consider the possibility that the agency was in cahoots with the facility owner to hid the facts and refuse to be held accountable under the state’s cheap but established oversight vehicle. Neither of the families involved in the matter chose to go to court. While the parents were removed, the facility and it’s owners got off scott free. The reality made me sick and so furious, I resolved never to give my professor friend, for whom I had had great respect during my training, any more credence on such matters.
Just shameful. And what you observed in that one situation is repeated daily throughout this country. You stood up for those patients, though, and not only helped them, but set an example for others to follow.
I know someone who works in a nursing home and he says the cost is 187 to 200 a day.
Those are charges, I believe, and each is pretty standard. The costs are another matter and would depend on thorough-going independent audits to determine. Availability of ’round-the-clock care to people with conditions that make them significantly to highly dependent does not come cheap, but remember two things: 1) most nursing care in LTC facilities is provided by nursing aides and 2) a majority of LTC facilities are proprietary.
This might make you feel a little better. It’s quite a rare occurrence, sad to say.
In 2006 I put my 96 year old Aunt into a nursing home in Urbana Illinois. Initial cost as level one assisted under a 1000 for a room, 6 months later as a level two assisted it went to 1800 with two care visits for shower and cleaning each day and as needed, then 6 months later at a different nursing home as wheel chair but otherwise mentally OK the cost was $3000 a month – and we were on a wait list for a “Medicaid” home that said they ran at about $24,000 (to be taken from value of home sale on death).
I never was shown any $70,000 prices for anything, although round the clock nursing would easily reach that number.
This is a myth that’s mentioned over and over, and I don’t believe it’s been shown to be true. If anything, it’s the opposite. Obese people don’t live as long, and don’t use as much medical care in their lifetimes as thinner peopler.
The legislators do not care. I’m sure they have long-term care insurance.