The Recorder – My Turn: Biden’s long step towards long-term care | #insurance | #seniors | #elderly
Back in the early 1980s, I recall meeting U.S. Sen. Claude Pepper of Florida, the elderly rights champion, at a rally of advocates in Cambridge. Pepper told the crowd: “I hope to live long enough to see long-term care become part of the Medicare Program.” Pepper died in 1989 — and his dream has still not come true 32 years later.
Federally sponsored health care has been a long time coming. Franklin Roosevelt thought about national health care in 1935. Harry Truman proposed it in 1945. Dwight Eisenhower signed a small program in 1960. JFK proposed his own version in 1961. LBJ took a big bite of it in 1965. Now Joe Biden wants to take a serious shot at expanding long-term care in 2021.
When Roosevelt was lobbying Congress for a national health plan, his first priority was passage of an old age, retirement and disability program. FDR’s Committee on Economic Security “intensely studied” nationalized health care, but private health associations said the White House was secretly trying to impose a “socialist conspiracy” of government health insurance on the nation. Roosevelt dropped the idea to improve his chances of getting Social Security adopted.
Harry Truman was called “the real daddy of Medicare” by Lyndon Johnson. Truman tried three times during his presidency to get a federally funded health insurance program, but Congress wouldn’t have it.
Dwight Eisenhower signed a program of “medical indigency” for the elderly, called Kerr-Mills. Kennedy had Medicare on his short list of legislative priorities, but never lived to see it. Johnson got Medicare across the line in 1965, George W. Bush added prescription drugs to Medicare in 2003.
Of all of these presidential lobbyists, only LBJ was able to get Medicaid passed. But these plans covered very little long-term care — mostly in nursing homes.
Bill Clinton expanded eligibility for Medicaid long-term care, allowing community long-term care programs to expand. In 1999, the U.S. Supreme Court’s Olmstead decision ruled that segregation of people with disabilities in nursing homes is a form of unlawful discrimination. Obama’s Affordable Care Act did not centrally change long-term care, and Donald Trump’s “America First” did nothing to advance elderly long term care.
Now Joe Biden’s has offered a proposal to spend $400 billion over eight years on home and community-based services, a major part of his $2 trillion American Jobs Plan “infrastructure.”
Biden is targeting help with home and community-based services, like a visiting nurse, physical and occupational therapy, as well as personal care attendants and homemakers for help with non-medical activities of daily living, like eating, bathing dressing, and walking, or assistance with cooking, grocery shopping, and transportation. Home repairs, durable medical equipment like wheelchairs or oxygen tanks, are also part of home care supports package.
Medicare was never designed to pay for long-term care. It covers some short-term care in nursing facilities but long-term care in the community falls to the Medicaid program — which only serves people with very low incomes, and almost no assets. Over the past decade or more, Medicaid spending for long-term care has been “rebalanced” from mostly nursing home care to 57% community care today.
Biden’s plan doesn’t detail how the $400 billion in additional funding would be spent, but it does promise that homemakers and personal care attendants who do the work would be paid “a long-overdue raise, stronger benefits, and an opportunity to organize or join a union.” These workers today are making, on average, around $12/hour. They are predominately a workforce of minority women. The fact that Biden has even noticed these workers is a policy advance we certainly did not see in previous administrations.
While expanding Medicaid community long-term care is long overdue, the fact remains that millions of elderly and disabled middle-class Americans are still without Medicare coverage for long-term care. Private long-term care insurance products are too expensive and too confusing for most consumers to purchase.
Claude Pepper would be cheering on President Biden for his $400 billion long term care plan. American infrastructure is much more than roads and bridges. Allowing every citizen to live in the most integrated setting is part of our infrastructure. With the number of elders expected to double by 2050, this plan gets us started down the long road. Readers should contact their Congressional representatives and senators and urge them to “support the President’s American Jobs Plan for enhancing elderly long-term care.”
Al Norman, a Greenfield resident, worked as a home care lobbyist in Massachusetts for 38 years. He helped write the Massachusetts statutes regarding elderly home care infrastructure.