Categorized | Health, Family Care, Features, Pushback

Biden Takes Long Step Towards Long Term Care

COVID-19, home health, long term care

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 care, and private long term care insurance products are too expensive and too confusing for most consumers to purchase. 

By Al Norman

FDR thought about doing it 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 another shot at it 2021.

Federally-sponsored health care has been a long-time coming. 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 — all the earlier plans covered very little long term care — mostly in nursing homes.

patient-centered, Social Security, ageist, nursing, COVID, Trump, vaccineBill 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 wanted elderly votes, but produced nothing in return.

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 is best provided by 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 percent 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/hr. 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, and private long term care insurance products are too expensive and too confusing for most consumers to purchase.

Elder champion Claude Pepper, U.S. Senator from Florida, who died at 88 years of age in 1989, once told a group of advocates at a Cambridge, MA rally, “I hope to live long enough to see long term care become part of the Medicare program.” Under the Medicare for All proposal, that integration of long term care into Medicare would have happened.

Claude Pepper never lived to see his dream, but he would be cheering on Pres. Biden for his $400 billion long term care plan. With the number of elders expected to double by 2050, this plan certainly comes at an opportune time. 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 worked as a elderly home care lobbyist in Massachusetts for 38 years. He has been writing this column for the FiftyPlus almost as long.

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