The former West Virginia Senator John “Jay” D. Rockefeller IV, who passed away Nov. 6 at the age of 89, chaired the U.S. Bipartisan Commission on Comprehensive Health Care that, in 1990, issued a report recommending federal social insurance for home and community-based care and coverage for nursing home care to ensure that no one in nursing homes became impoverished.
As the Commission’s long-term care recommendations had strong bipartisan support, Rockefeller thought them easier to achieve than broader health care reform, writing in the New England Journal of Medicine that in long-term care, “no entrenched system of private insurance is threatened by government expansion, and providers stand to gain considerably from broader public support.”
Yet nothing came of these recommendations, as Rockefeller noted in a 2002 Senate hearing. He still insisted on reform, stating that “[m]ost people who enter nursing homes can return home and public insurance for a 3-month stay provides the protection to do that.”
The Affordable Care Act of 2010 included a long-term care component called the Community Living Assistance Services and Supports Act, which was to create a long-term care benefit through voluntary payroll deductions, but the Obama Administration abandoned it in 2011 as actuarially unsustainable and it was repealed by the American Taxpayer Relief Act of 2012.
As a gesture to seniors and those with disabilities, that repeal was accompanied by the creation of another bipartisan commission to focus squarely on long-term care. While writing that “[t]he need is great” and “[t]he time to act is now” the U.S. Commission on Long-Term Care was unable to come to any agreement on financing, making its report in 2013 an exercise in futility.
With Democrats having taken control of the next Congress, their stated priorities include restoring enhanced subsidies to those obtaining health insurance under the ACA, as well as reversing cuts made to hospitals and the Medicaid working poor by the federal budget reconciliation law enacted last year. Yet there has been nary a whisper about long-term care.
Through what is called the Federal Medical Assistance Percentage, the ACA requires the federal government to pay 90% of a state’s costs of providing health care to the Medicaid expansion population. However, it pays as little as 50% of a state’s Medicaid long-term care costs, including in New Hampshire. And yet New Hampshire is one of eleven states where those 65-and-older outnumber children.
As Rockefeller recognized 36 years ago, the federal government cannot leave states to their own devices when it comes to funding care for our most fragile, elderly citizens. Idaho, for example, cut Medicaid reimbursement for nursing home care 7% last year in just a 60-day period.
Nor do many Americans have the savings for the extraordinary costs of long-term care. As of federal data in September, only 9% of private sector workers participated in defined benefit pension plans. For those already 65-and-older, data shows the poverty rate is rising and is the highest of any age group in the United States.
Furthermore, very few people have long-term care insurance. In fact, the federal government has suspended the offering altogether for its own employees, attributing the decision “to ongoing volatility in long term care costs and a diminished insurance market…”
The proportion of elderly Americans has grown exponentially since Rockefeller’s report, with no corresponding congressional urgency. Surely a great nation that has spent over $47 billion on its war with Iran can afford to provide more assistance to its aged and infirm citizens. A good step would be to increase the Federal Medical Assistance Percentage for state long-term care Medicaid expenditures.
Our aging society needs more Jay Rockefellers.
Brendan Williams is the president and CEO of the New Hampshire Health Care Association.