WASHINGTON
(AP) — Sen. Bernie Sanders is raising the stakes of the “Medicare for All”
debate by expanding his proposal to include long-term care, a move that is forcing
other Democratic presidential candidates to take a stand on addressing one of
the biggest gaps in the U.S. health care system.
Medicare for All is unlikely to advance in the GOP-controlled
Senate, but it’s a defining issue in the early days of the Democratic primary
and candidates have pointed to their support of Sanders’ legislation as proof
of their progressive bona fides.
Some moderate Democrats have criticized the cost of such an
expansive proposal and by adding the long-term care provision, Sanders could
further expose that divide.
So far, 2020 candidates Sens. Cory Booker of New Jersey, Kirsten
Gillibrand of New York and Kamala Harris of California say they’ll support
Sanders’ more ambitious bill. Sen. Elizabeth Warren of Massachusetts also backed
the 2017 version of Medicare for All but has not said how long-term care might
affect that.
Sanders’ move, confirmed by his office, follows action by
Medicare for All allies in the House to incorporate a generous long-term care
benefit in their newly introduced legislation. Medicare for All would replace
the current mix of private and government financing for health care with a
system paid for by the government and funded by higher taxes
As with the rest of Medicare for All, supporters aren’t saying
how they would pay for long-term care, which experts estimate could cost
several hundred billion dollars a year. Several independent estimates for the
broader program have ranged from about $25 trillion over 10 years to $36
trillion, although supporters say it would be considerably less.
Still, the general idea of a government long-term care program
has broad backing.
About two-thirds of U.S. adults favor a long-term care program
similar to Medicare, according to an Associated Press-NORC Center for Public
Affairs Research poll last year. That includes 76 percent of Democrats and 56
percent of Republicans.
The attention from Sanders as well as House Medicare for All
leaders Reps. Pramila Jayapal, D-Wash. and Debbie Dingell, D-Mich., comes after
advocates for disabled people lobbied them to step up coverage for long-term
care in the push for a national health care plan.
Many Americans assume that Medicare covers long-term care, but
that’s not the case. Qualifying for public coverage under Medicaid, which
covers low-income people, involves spending down lifetime savings.
Long-term care has “always been the stepchild,” said Marc Cohen,
a gerontology researcher and professor at the University of Massachusetts
Boston. Cohen says he thinks the House plan recently introduced by Jayapal and
Dingell would be “unaffordable,” but says it recognizes a need. “That is really
a positive thing that someone is trying to address it,” he added.
Recent state-level efforts on long-term care have sent mixed
signals. Maine voters last year rejected a referendum that would have provided
home care to all seniors and disabled people regardless of income. But last
month the Washington state House approved a plan creating a limited cash
benefit to offset long-term care costs. The measure, sent to the state Senate,
is financed with a payroll tax on employees.
Only an estimated 7 million to 8 million people have private
long-term care insurance, which is costly and generally requires applicants to
pass a health screening.
In Congress, the new House Medicare for All bill from Jayapal
and Dingell offers the most generous benefit.
People of any age could qualify if illness, injury or age limit
their ability to perform at least one “activity of daily living,” such as
bathing or dressing, or one or more “instrumental activities of daily living,”
such as managing money or taking prescribed medications. There would be no
income or assets tests to qualify, and no copays or deductibles.
The House bill — known as H.R. 1384 — emphasizes home- and
community-based care in the “least restrictive setting.” But it would also pay
for nursing home care. The earlier version of the House bill included a few
mentions of long-term care but did not specify benefits.
“We flip the model on its head,” said Jayapal. “Instead of
saying institutional care is the default we say ... you should be able to be
taken care of at home, in your community.”
In his 2017 bill, Vermont Independent Sanders left the current
low-income Medicaid coverage for long-term care in place. His office says a new
edition to be introduced in coming weeks will include added coverage for home-
and community-based services, available to people of any age as Medicare for
All benefits. Such services can include adult day care, a housekeeper, or home
improvements like grab bars in the shower.
The shift by Sanders and his House counterparts came after
intensive lobbying from disability rights advocates. The groups were a central
part of the coalition that defeated President Donald Trump’s effort to repeal
the Affordable Care Act and restrict federal financing for Medicaid.
The activists realized during that effort that even Medicare for
All came up short on the needs of disabled people, said Nicole Jorwic, policy
director for The Arc, which serves people with intellectual and developmental
disabilities.
“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,”
Jorwic said.
Online:
House Medicare-for-all bill summary - https://tinyurl.com/y26keeur
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