Like many Americans, Topeka resident Jocelyn Lyons is interested in the health reform debate underway in Congress.
There’s a section in one of the massive reform bills under consideration that holds particular interest for her. It would authorize a new national insurance program for long-term care services.
Lyons, like millions of Americans, is helping to care for aging loved ones — her 102-year-old grandmother, her 85-year-old father and an 83-year-old stepfather.
For the past seven years Lyons has been preparing meals and doing some light housekeeping for her grandmother, Neva Douglas-Tucker, or “Gran” as she’s known to family members. An attendant provided by a small state program also visits a couple of hours a week to assist with household tasks and to help Douglas-Tucker bathe.
But in recent months Douglas-Tucker’s needs intensified.
“Two months ago, she woke up and couldn’t see,” Lyons said. “Once that happened, we needed to get more help into the house.”
Now, after her nightly dinner with her grandmother, Lyons, a longtime administrator at the Jayhawk Area Agency on Aging, hands off care responsibilities to an overnight attendant. Another service provider comes in the morning to prepare breakfast.
The services cost approximately $2,400 a month. Douglas-Tucker, a domestic worker most of her life with a small Social Security pension, pays what she can. Lyons and one of Douglas-Tucker’s daughters pay the rest.
“That’s just the way I was raised,” Lyons said, when asked whether she felt burdened by her care-giving responsibilities, which also include helping her father, who suffers from glaucoma, and visiting her step father in an Omaha nursing home a few times a month.
A shared problem
Approximately 10 million Americans need some kind of long-term care, according to the American Association of Homes and Services for the Aging, which represents nonprofit nursing homes. That number is expected to grow to 12 million by 2020 as baby boomers age.
“Seventy percent of American families will face this care-giving challenge,” said AAHSA President and CEO Larry Minnix, Jr. at a recent forum in Lawrence sponsored by the organization’s Kansas affiliate and AARP.
Studies cited by the AAHSA found that 78 percent of long-term care services are provided at home by family and friends, at an average annual cost of $5,500.
But taxpayers are also shouldering a substantial portion of the bill through Medicaid. The program primarily created to provide health care services to low-income Americans pays 42 percent of all long-term care costs, about $116.8 billion a year. Lawmakers from both political parties agree that isn’t sustainable.
“We can’t throw enough money at today’s delivery system to make it work,” Minnix said.
A proposed solution
A coalition that includes AAHSA, the Alzheimer’s Association, the Services Employees International Union and the National Council on Aging is lobbying for a new voluntary national insurance program. Everyone, except those who opt out, would pay into a fund through a payroll deduction to qualify to receive cash assistance when they need it to help pay long-term care expenses.
An actuarial study commissioned by AAHSA showed that for an annual premium of about $1,000 a year — approximately $2.87 a day — an individual could receive a lifetime benefit of about $27,000 a year. An annual deduction of about $800 would provide five years of benefits.
Minnix and other advocates of a national insurance trust say that private long-term care insurance can’t solve the problem because it costs too much for many Americans and many of those who apply are denied coverage for health reasons.
A private policy that provides three years of benefits would cost a 40-year-old applicant an average of $1,512 a year in premiums, according to a new report by the Kaiser Commission on Medicaid and the Uninsured. The annual premium for a 50-year-old would be $1,741 while someone who applies at 60 would pay $2,329.
Minnix and other advocates for a government program say it would leave room for private insurers to market wrap-around coverage, similar to the expanded Medicare coverage offered by private companies.
The idea of a government-sponsored long-term insurance program has some support in Congress. U.S. Sen. Ted Kennedy, D-Mass., chairman of the Senate Health, Labor and Pensions Committee, included a plan similar to the one being advocated by AAHSA in his panel’s version of the health reform bill. And Sen. Chris Dodd, D-Conn., who is running the committee while Kennedy receives treatment for a brain tumor, said last week that a review by the nonpartisan Congressional Budget Office showed the proposed program would save the federal government approximately $59 billion over 10 years.
But Republicans on the panel are signaling their opposition to creation of another government program. Sen. Judd Gregg, R-N.H., responding to Dodd last week, said that the long-term care proposal would be a new entitlement that over time would become too costly to sustain.
“You can claim a 10-year savings, I won’t argue with that,” Gregg said. “But over 40 years you’re putting $2 trillion in costs on our children that you’re not paying for.”
Saying that he was committed to producing a “deficit neutral bill,” Dodd said the committee will start work on the long-term care section when it returns July 6 from its holiday recess.
U.S. Sen. Pat Roberts, R-Kan., a member of the HELP Committee, didn’t immediately respond to a request for comment on the long-term care proposal. But Deb Zehr, president and CEO of the Kansas Association for Homes and Services for the Aging, said Roberts didn’t express opposition to it in April during a Washington, D.C. meeting with Kansas advocates.
“It’s not out of the question that he might support it,” Zehr said. “We’re working him very hard. The door hasn’t been closed.”
Zehr and her counterparts across the country are urging people with a stake in the outcome — people like Jocelyn Lyons — to lobby members of Congress when they’re home over the July 4th holiday.
“We have a lot of work to do. A lot of convincing,” she said.
-Jim McLean is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at jmclean@khi.org or at 785-233-5443, ext. 110.