Pramila Jayapal

Stepchild of Health Care Now Getting Overdue Attention

People are living longer and the population of older adults is growing, but long-term care remains a stepchild in debates over health care. That is beginning to change as presidential candidates offer options for expanding long-term benefits for older adults and people with disabilities. With only a small percentage of older adults who have private long-term care insurance, the challenge and costs of expanded benefits are daunting.

People are living longer and the population of older adults is growing, but long-term care remains a stepchild in debates over health care. That is beginning to change as presidential candidates offer options for expanding long-term benefits for older adults and people with disabilities. With only a small percentage of older adults who have private long-term care insurance, the challenge and costs of expanded benefits are daunting.

Long-term care has been the missing link in health care reform debates, but that is changing as 2020 Democratic presidential candidates offer options for addressing the arguably biggest gap in the US health care system.

The Medicare-for-All plan introduced by Vermont Senator Bernie Sanders and supported by several Democratic presidential candidates adds long-term care benefits to Medicare. Independent estimates place the cost for expanded benefits at $25 trillion over 10 years.

A House version of Medicare-for-All, cosponsored by Washington Congresswoman Pramila Jayapal and Michigan Congresswoman Debbie Dingell, which emphasizes policies that allow older adults to remain in their homes. "Instead of saying institutional care is the default, we say you should be able to get care at home, in your community," Jayapal says.

New Jersey Senator Cory Booker recently unveiled a proposal to expand eligibility for long-term care services for older adults and disabled persons under Medicaid. Roughly 20 percent of Medicaid spending goes toward long-term care. About 65 percent of nursing home residents are supported primarily by Medicaid.

Minnesota Senator Amy Klobuchar has a “Plan for Seniors” that seeks to expand long-term care facilities, add hearing, vision and dental care to Medicare and support training for long-term caregivers. Klobuchar wants to bolster Social Security by lifting the payroll tax from the current $133,000 income cutoff to wages up to $250,000. 

Political dialogue about long-term care has been sparked by data showing projected growth in the number of older adults in the US population. By 2035, there are expected to be 78 million people 65 years and older compared to 76.7 million people under the age of 18. As few as 8 million Americans have some form of private long-term care insurance. There also has been a strong push by disabled Americans to strengthen long-term care.

Older Americans make up one of the most consistent voting blocs and they tend to be more conservative than younger voters. Democrats sniff an opportunity to eat into a bedrock conservative cohort by advancing long-term care initiatives.

AGE+,  a new nonprofit, has formed to address long-term care issues holistically in Oregon with an emphasis on aging in place and addressing equity for underserved older adults in rural areas and minority communities.

AGE+, a new nonprofit, has formed to address long-term care issues holistically in Oregon with an emphasis on aging in place and addressing equity for underserved older adults in rural areas and minority communities.

Providing long-term care benefits under Medicare or Medicaid will be expensive. The dimensions of the problem go beyond money. There aren’t enough long-term care beds available, there are too few single-story homes where disabled and older adults could age in place and there is already a shortage of trained caregivers. Add to that isolation that can occur, especially in rural areas, and inequities in available long-term care options. Low pay is a barrier to recruiting more caregivers.

Gerontology researched Marc Cohen describes long-term care as the stepchild in the broader health care reform discussion. Nicole Jorwic, policy director for The Arc that serves people with disabilities, says, “If you don't include long-term supports and services, it cannot be considered a bill that is for all people because it leaves out huge portions of the population, including people with disabilities and aging Americans."

 


Northwest Congressional Delegation Employs Twitter, Too

President Donald Trump communicates to his political base via Twitter and so do many Members of Congress, including the Pacific Northwest delegation. Issues they tweet about range from orca protection, affordable housing, drug interdiction, family separation at the border and reproductive rights.

President Donald Trump communicates to his political base via Twitter and so do many Members of Congress, including the Pacific Northwest delegation. Issues they tweet about range from orca protection, affordable housing, drug interdiction, family separation at the border and reproductive rights.

President Trump communicates directly with his base via Twitter. So do Members of Congress. Here is a sampler of recent Pacific Northwest congressional member tweets, reflecting the breadth of issues they track and attempt to impact:

  • Oregon Congressman Earl Blumenauer (@repblumenauer) tweeted his support for the 21 young people challenging the Trump administration in court to protect the environment in light of climate change. “Anyone who is still a climate denier or thinks there’s no hope in saving our planet should read about the Juliana v. U.S. case,” the Portland Democrat said. The Ninth Circuit Court of Appeals is hearing the case this week to decide whether to allow it to go to trial. Two previous court rulings okayed moving ahead.

  • Oregon Congressman Peter DeFazio (@RepPeterDeFazio), who chairs the House Transportation and Infrastructure Committee, said investing in the Coast Guard will result in more drug interdiction than spending billions of dollars on a border wall. "An investment in assets for the Coast Guard – both personnel and equipment – would be a heck of a lot better than a static wall that people can go around, under or through," the Oregon Democrat said at a congressional hearing. DeFazio’s comment was posted on Twitter by OPB political writer Jeff Mapes. 

  • Washington Senator Patty Murray (@PattyMurray) tweeted in response to news reports of botched family reunifications art at the US-Mexican border that resulted in long delays and children stuck in vans. “First cages, now vans. This is truly shameful and I will keep fighting to make sure President Trump and his administration are held accountable for this abuse.”

  • Oregon Senator Jeff Merkley (@SenJeffMerkley) tweeted, “It’s time for Congress to pass the bipartisan Uyghur Human Rights Policy Act, and the Trump administration to stop ignoring the ethnic cleansing of China’s Muslim community. The US needs to sanction the officials responsible for these heinous abuses.” 

  • Oregon Congresswoman Suzanne Bonamici (@RepBonamici) is using her Twitter feed this week to promote #WorldOceansDay and the need to protect oceanic resources. She is co-chair of the House Oceans Caucus and her congressional district includes the North Oregon Coast. 

  • Washington Congressman Denny Heck (@RepDennyHeck) noted a resolution he introduced to declare June National Orca Protection Month. “There is cause for hope this year,” Heck tweeted. “But hope alone won’t save the Southern Resident killer whales.” 

  • Oregon Congressman Greg Walden (@repgregwalden) marked the celebration of life for Bob Maxwell, 98, a US Army combat solder in World War II who was awarded the Medal of Honor for his heroism in France. Maxwell, who lived in Bend, grew up as a Quaker, but declined classification as a conscientious objector when he was drafted in 1941. He participated in the Allied military campaign in North Africa and was part of the invasion force in Salerno, which earned him a Silver Star. Walden tweeted, “He will forever be cherished in the country that he sacrificed so much to protect, and in the hearts of everyone he interacted with, especially the community in central Oregon.” 

  • Washington Congresswoman Pramila Jayapal (@RepJayapal) tweeted, “Today, I became the FIRST South Asian American woman to preside over the US House of Representatives. Beyond proud to serve in the most diverse Congress in our nation’s history and to hold the gavel today.”

  • Washington Congresswoman Cathy McMorris Rodgers (@cathymcmorris) tweeted, “Socialism and human rights do not co-exist.” Her comment came in a story about Rodgers servings as one of two elected lawmakers representing Congress at the United Nations.

  • Oregon Senator Ron Wyden (@RonWyden) tweeted, “Housing is a right, not a privilege. But right now, some families face an impossible choice of paying rent and buying food. The affordable housing crisis in my home state and others demands action to ensure every American has a roof over their head. #OurHomesOurVoices.” His tweet coincided with National Housing Week of Action from May 30-June 5.

  • Washington Senator Maria Cantwell (@SenatorCantwell) used her Twitter feed to announce cosponsoring the Women’s Health Protection Act, which she said, “guarantees a woman’s right to choose nationwide, free from medically-unnecessary restrictions that interfere with a patient’s individual choice or the provider-patient relationship. #StopTheBans

  • Washington Congressman Kim Schrier (@DrKimSchrier) tweeted, “So-called heartbeat bills have no basis in science, and are a cruel attempt to control women’s bodies. I’m proud to stand with @DrLeanaWen and @PPFA to #stopthebans.” Schrier is a pediatrician and was elected to Congress from a suburban Washington House district in 2018.