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.
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."