As debt-talks smolder in Washington, a聽proposal by the bipartisan “Gang of Six” senators聽to cut health program spending and increase revenue has scored a lot of attention. Among the proposal’s key health program tenets is the repeal of the Community Living Assistance Services and Supports Act, the , that is part of last year’s health care law.
Home health worker April Quinn brushes Holly Hawthorne's hair to make sure there are no knots in it from laying in bed in this photo from early 2011. Hawthorne, 32, is in the Medicaid managed long care program. (Photo by Joshua Anderson)
The CLASS Act is a voluntary, long-term care insurance program in which聽working Americans who join would generally have premiums withheld from their paychecks. After they have contributed for five years, they would be eligible for a cash benefit if they became disabled and suffered from at least two limitations in daily activities, such as eating, bathing and dressing. Some critics are worried that the CLASS Act would become a , but advocates say the program would provide assistance to people who need long-term care but can’t afford it.
At , Judy Feder, Harriet Komisar and Paul Van de Water write about why CLASS should be preserved. “On the help side, CLASS addresses a huge hole in our social safety net: neither private insurance nor Medicare protects people against the risk of needing extensive and long-term help with fundamental tasks of daily living like eating, bathing or getting dressed,” they write, adding, “On the deficit side, CLASS actually helps the budget in the coming decade because CLASS will collect premiums well before it will be obligated to pay benefits. Over the long term, the Secretary of Health and Human Services is required to design benefits and set premiums to assure that the program covers its costs 鈥 a standard CBO judged that CLASS can satisfy over the next 75 years.”
But Harold Pollack, at the blog wonders if this is the death-knell for the CLASS Act. “Given Kent Conrad and Max Baucus’s dislike of CLASS, I’m not all that surprised by this outcome … ,” he writes. “In a different political moment, CLASS would have greater chance of survival. Our current polarized environment prevents us from performing reasonable technical fixes when challenges to complicated proposed programs become known.”
writes that repeal would be a “big deal.聽This is the little-discussed but hotly disputed new long-term care insurance benefit in the Affordable Care Act. Spending hawks are concerned the cost of this benefit will explode in the long run. Repeal is a big deal fiscally, as a health policy matter, and politically.”
Howard Gleckman, at his blog, says the move could mean a return to the old way of paying for long-term care, Medicaid. “While CLASS is deeply flawed, it is an opportunity to transform long-term care from the means-tested Medicaid program to an insurance-based system. If CLASS is repealed, that opportunity will be lost, and millions of Americans will find themselves with only a shrinking Medicaid benefit to support them in frail old age or if they become disabled聽at a younger age.”
At , Don Taylor looks for the best way to insure long-term care. He outlines six policy “big picture” points. “If ever there were a risk that called out for social insurance (broad spreading of premium in return for broad coverage) it is LTC. The policy answer is risk pooling and the private market has failed to do it.”
At blog, Peter Suderman doesn’t lament the prospect of the loss of the聽CLASS Act. In fact, Suderman also calls out a proposed Health and Human Services strategic branding strategy for the CLASS Act. “The Community Living Assistance Service and Supports (CLASS) Act is a long-term care insurance program and quasi-entitlement attached (to) the last year鈥檚 health care overhaul despite the fact that every reputable analyst deemed it unworkable and unsustainable. 鈥 Obama鈥檚 own fiscal commission last year recommended shuttering the program completely. And one of the best parts about the Gang of Six bipartisan budget compromise released yesterday is that it follows suit by closing CLASS for good. The administration doesn鈥檛 need a ‘strategic brand’ for CLASS. It needs a stop work order.”
At blog, Alison Acosta Fraser writes about “What’s wrong with the Gang of Six Plan?” and talks the CLASS Act: “Repealing the聽CLASS Act 鈥 the new entitlement to long-term care for the elderly 鈥 is a great idea.聽 But repeal is likely to happen with or without the Gang鈥檚 plan.聽 Everyone agrees the entitlement鈥檚 Ponzi Scheme financing is doomed to fail, making elimination the only viable option.”
