Toward national long-term care insurance

By Will Parry

The late Senator Edward Kennedy recognized the need for an insurance program that would provide services and supports for those Americans, millions in number, who become functionally disabled.

Kennedy directed his staff to work on the issue. The result was legislation that became the CLASS Act – for “Community Living Assistance Services and Supports.”

When President Obama signed the Patient Protection and Affordable Care Act into law on March 23, 2010, the CLASS program was established as a national, voluntary insurance program for the purchase of long-term services and supports.

As the name indicates, the intent of the legislation is to enable persons with disabilities to live out their lives in their own homes, or in another community setting, rather than in a nursing home.

The program would be open to any working adult who makes voluntary premium payments every month for at least five years.

Eligible adults would receive a cash benefit of no less than $50 a day. The actual daily amount would depend on the degree of impairment or disability. The money could be used to purchase non-medical services and supports – in-home care, for example – needed to maintain residence in the community.

The program would be financed entirely by premiums paid voluntarily by those persons who elected to enroll. The law specifically prohibits any taxpayer subsidy.

Unfortunately, the voluntary nature of enrollment has sidetracked the program in its present form. Healthy individuals would be unlikely to enroll. Those who elected to pay the monthly premiums would be persons most likely to incur a major and costly long-term disability.

Either mandatory enrollment by all working adults or a substantial tax subsidy would solve the funding problem. Kathleen Sebelius, secretary of Health and Human Services, says the law clearly gives her the authority to make the necessary changes without Congressional intervention.

Republicans are seeking repeal of the CLASS Act in pursuit of their goal of destroying the Affordable Care Act piece by piece.

Senior and disability advocates are calling on Congress to place the program on hold while workable funding mechanisms are explored. The program is urgently needed now. As the population ages, the need for the program will explode.

The White House opposes repeal. Obama’s 2012 budget seeks $93.5 million for a vast “information and education” campaign with the goal of having 7.7 million people in the program by 2015.

More than 50 senior and disability rights groups, unions and other advocacy organizations have sent a joint letter to House and Senate leaders calling on them not to repeal the legislation.

“We urge continued dialogue and development of a viable path forward,” the groups wrote. Their letter states that 70 percent of persons older than 65 will need long-term care services, which are not covered by Medicare.

Modest as it is, CLASS provides a framework for a universal insurance program that could protect every American against being impoverished by the costs of long-term care. It could stand alongside Social Security and Medicare as one of the nation’s hallmark social programs.

Senator Kennedy’s foresight has placed affordable, community-based long-term care on the national agenda. Clearing away the obstacles to implementation of the CLASS Act would make his vision a reality.