An op-ed  in today’s Saint Paul Pioneer Press by Kathryn Roberts, president and CEO of Ecumen, and Mary Birchard, executive director of the Minnesota/North Dakota chapter of the Alzheimer’s Association follows:

Americans Need a New Way to Pay for Long-Term Services and Support

Congress last considered transforming the inadequate way we pay for long-term care 20 years ago when the bi-partisan Pepper Commission created its Call for Action for health reform. Nothing happened.

Fast forward to last fall: Authorities filed charges against a Minnesota farmer whose alleged crime was keeping his wife at home with him. She sat in the easy chair, he on the davenport and, when she wandered, as many people with Alzheimer’s do, a wiggling chain attached to her called him to her aid. Authorities faulted his ingenuity, arrested him and made his wife go to a nursing home before finally dropping charges. She returned home.

At least he had a plan. Most of us don’t. So let’s have a televised congressional health care summit and include a good idea – the CLASS Act (Community Living Assistance Services and Supports). In both Senate and House health bills, it would increase personal responsibility; empower more people with affordable services; and slow growth to Medicaid, America’s de facto long-term services insurer.

Someone develops Alzheimer’s every 70 seconds. Nearly 800,000 people nationally had strokes last year – the largest cause of adult disability. We don’t know what’s next. We do know that the overwhelming majority of Americans are uninsured for Alzheimer’s care or other supportive services, leaving most of us vulnerable to a cycle of personal stress and fiscal loss. It’s unacceptable.

People – often in crisis – frequently scramble to find supportive services only to learn they’re not Medicare-covered. After spending into poverty and qualifying for Medicaid, they learn their only choice for shelter and care is most often an institutional government-funded nursing home.
Seventy-three percent of family caregivers work outside the home. Two-thirds have missed work to provide care – a $34 billion business productivity hit. Employee health suffers. A new study of the National Alliance of Caregiving at the University of Pittsburgh shows employee caregivers cost businesses an average of 8 percent in increased health costs or $13 billion annually. Many caregivers stop personal savings. Examples abound of caregiving families, including those of newly returned veterans, impoverishing themselves.

These families are giving us a lot. For example, family care for Alzheimer’s in Minnesota is valued at nearly $2 billion. And every 1 percent decline in family caregiving costs state government $30 million.

The CLASS Act would provide coverage where most have none. Through voluntary payroll deduction, Americans 18-plus would pay premiums – set by the Secretary of Health – building a national risk pool minus pre-existing condition penalties. Upon five years of vesting, someone needing help with daily activities, such as dressing, would receive a cash benefit to self-direct.

This national benefit would be self-funded by premiums and earned interest, not tax dollars. Some have concerns about its solvency; however, legislation mandates solvency for 75 years, and Congressional Budget Office modeling shows it meets this requirement.

Some are concerned the CLASS Act would threaten private insurance. It won’t. Few have private long-term care insurance. A new approach will elevate the need for service and care planning and spur new products, such as supplemental insurance plans – similar to those for Medicare – extending the national benefit. We’ll also see state innovation wrapping around the benefit, slowing growth to Medicaid and strengthening it for those unable to escape poverty.

An average $75 daily benefit for enrollees sounds small. But it would be more than $27,000 annually a person could self-direct. A husband could get respite, paying for a half day of in-home services for his wife with Alzheimer’s. It could provide someone with multiple sclerosis morning assistance to dress and continue working.

People moving into their 70s have more disabilities than our previous generation. Most young people have no insurance for a long-term disability. Policymakers didn’t see this when Medicare and Medicaid were formed in 1965. The CLASS Act does.