Most of the coverage also discussed the implications of what happened to the act for other parts of the health reform law. So what does it mean for the rest of health reform? Probably not much, unless Republicans use it as ammo in their drive to repeal the entire health law after the next election. What does it mean for the future of long-term care in this country? Probably a lot. The country is back to square one in figuring out how to pay for long-term care. While it may not be surprising that most media outlets told essentially the same story (they usually do when these kinds of announcements are made), it was surprising that there was scarcely a nod to the problem the act had been meant to address, the need to pay for long-term care. The way it works now is that families either pay out-of-pocket or, when they run out of money, they turn to Medicaid and “spend down,” using most of their income and assets on care until they sink low enough to qualify for Medicaid assistance.
A PBS NewsHour blog post touched on the future problem of paying for care. In a Q and A with Susan Dentzer, former NewsHour health correspondent and now editor of Health Affairs, Dentzer responded that she didn’t believe that scrapping the CLASS Act had necessarily killed the idea, adding “I wouldn’t say people should hold their breath that we’re going to get something like this up and running anytime soon.” She suggested that “we might see some creativity in terms of building a market for private long-term care insurance. But one is hard-pressed to see what that might be.”
That might be the case, especially since long-term care insurance is exempt from the rules governing health insurance under the reform law. For example, sellers can turn people away who have health conditions that are likely to send them to a nursing home. It seems that another battle would have to be fought over this issue, and that’s not likely. The Los Angeles Times did note that Sebelius said about fifteen million elderly Americans will need some kind of long-term care and few have insurance. That means most Americans will rely on Medicaid “putting further strain on state and federal budgets”—an important dot to connect as Congress considers significant cuts to Medicaid.
There’s another irony in the CLASS Act’s demise. For most of the year, public discourse has touted the fact that people are living longer and that it’s okay for them to wait longer to receive Social Security and Medicare benefits. The downside to living longer is that it’s likely many will need in-home assistance. But the media, taking their cues from the politicians and the think tanks driving the narrative, have yet to make this connection. This part of the “living longer equation” has barely been mentioned.