The fate of the Class Act, which would have established the nation’s first voluntary public long-term care insurance program, was sealed in 2011 when the Obama administration shut it down, essentially calling it unworkable.
As long as the language remained part of the Affordable Care Act, supporters allowed themselves to hope, or perhaps fantasize, that the administration might return to the subject. How to care for an aging population, and who pays for that and how, are questions that won’t go away.
But Congress quietly administered the coup de grâce last month, during the fiscal cliff negotiations. The budget deal stripped the Class Act language from the Affordable Care Act. R.I.P.
In its place — thanks to the intervention of Senator Jay Rockefeller, Democrat of West Virginia — the negotiators created a Commission on Long-Term Care, charged with developing plans for “a comprehensive, coordinated and high-quality system” ensuring long-term care for older adults and people with disabilities.
Its 15 members — three picks each for the president, the Senate majority and minority leaders, and the House speaker and minority leader — face a tight deadline. Within six months, they are supposed to recommend legislative or administrative actions, including actual legislative language. Then bills are to be introduced in both houses of Congress on the very next day they are in session.
Which sounds like urgency, but is it? Even Connie Garner, the longtime Kennedy staff member who directs the advocacy group called Advance Class, was skeptical. “What can you really do in six months?” she said. Actuaries and policy types had been working on the Class plan for 19 months before the plug was pulled. “And so what if you introduce a bill?” she went on. “You can introduce stuff and nothing happens.”
So when Advance Class held its monthly board meeting a few days after the Class Act officially bit the dust, Ms. Garner figured this push for a national long-term care approach was dead, along with her organization. She had prepared a valedictory, praising the group for at least putting the issue on the national agenda.
“But they said, ‘No, we’re going to keep Advance Class going; we’re going to fight the long fight,’ ” she recalled. So on we go.
Discouragingly, the commission has already hit delays: Its members were to be named within 30 days of the budget deal’s enactment, but only the Congressional Democrats have made appointments.
Senator Harry Reid, the majority leader, nominated a veteran health policy scholar, Judy Feder, who is now at the Georgetown University Public Policy Institute; the labor executive Laphonza Butler, who heads California’s United Long-Term Care Workers Union; and Javaid Anwar, a Nevada internist.
Representative Nancy Pelosi, the House minority leader, appointed Bruce Chernof, chief executive of the SCAN Foundation, which promotes quality care for the elderly; Judith Stein, founder of the Center for Medicare Advocacy; and George Vrandenburg, a retired corporate lawyer who has put his philanthropic muscle behind Alzheimer’s causes.
We have heard nothing yet from the White House or the Republican Congressional leadership.
Maybe that barely matters. “I can’t imagine anything coming out of this commission that won’t be totally forgotten a year from now,” said Jesse Slome, executive director of the American Association for Long-Term Care Insurance. “How many commissions have there been?”
Yet one thing that he and the proponents at Advance Class can agree on — maybe the only thing — is that this issue demands attention.
Otherwise, Mr. Slome says, we are stuck with what we have when it comes to older people who might need expensive care for 30 years, and disabled people who might need care for even longer. And what we have, he said, amounts to “a little here, a little there, a little Medicare, a lot of Medicaid, a little long-term care insurance and a lot of unpaid family caregiving.” (I would say very little long-term care insurance, and a vast amount of unpaid family care.)
Discussing the future of Medicare and Medicaid without including long-term care is pointless, Mr. Slome added. Ms. Garner notes that she meets frequently with Republicans and that they never dismiss the issue as unimportant.
Well, there’s a start.
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”
The New Old Age Blog: A New Commission: Time to Cheer or Yawn?
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