The Legacy of a Senate Lion: An Ambitious Plan for Long-Term Care

Article excerpt

Throughout the 46 years that Senator Ted Kennedy served in the U.S. Senate, healthcare access and affordability were always at the top of his agenda. He was responsible for the State Children's Health Insurance Program, the Family Medical Leave Act and the Health Insurance Portability and Accountability Act. But despite Senator Kennedy's hefty legislative accomplishments on the healthcare front, it is too soon to be assessing his legacy: It was Kennedy who introduced long-term supports and services (LTSS) into the not-yet-settled healthcare reform debate.

When Congress began its new session this year and made clear that healthcare reform would be at the top of its agenda, aging advocates rightfully insisted mat any comprehensive legislation should address LTSS.

Ten million individuals in America have chronic conditions, and this number is expected to double during die next 30 years. The private cost of care for mese individuals is exorbitant and insurance coverage is relatively uncommon. Many people are forced to either impoverish themselves in order to access Medicaid or rely on the unpaid assistance of family members, whose energy and financial resources are frequently drained in the caregiving process.

Given this scenario, it had to be mat some consideration of how the country will meet this current and prospective challenge would be central to healthcare reform proposals.


True to form, Senator Kennedy gave substantial consideration to this critical issue in his draft version of die health reform bill. While still serving as chairman of the Senate's Health, Education, Labor and Pensions (HELP) Committee, he engineered the committee's approval, in early summer, of the Affordable Health Choices Act, which included his plan to create a new national insurance plan for coverage of community living assistance services and supports (the CLASS program).

The CLASS program would allow an individual with a chronic condition to receive a cash benefit to pay for necessary services and supports. To receive the benefit, the individual must have paid premiums for a total of at least 60 months during his or her lifetime, and at least the 12 consecutive months prior to the request for the benefit. A clinical eligibility standard would be imposed in which the individual would have to establish that he or she is unable to perform not less than two or more tiian three activities of daily living (ADLs) or, due to a cognitive impairment, requires supervision, cueing or hands-on assistance to engage in not less tiian two or more than three ADLs. The agency responsible in each state for conducting disability determinations for purposes of Social Security benefits would be charged with conducting die clinical eligibility assessments.

The cash benefit can be spent on "home modifications, assistive technology, accessible transportation, homemaker services, respite care, personal assistance services and home health aides." The eligible individual must receive at least an "average" of $50 a day, with increases available if there is a higher level of need. Enrollment for all working individuals would be automatic, with die premium collected through a payroll deduction (individuals may drop out). Monthly premium amounts are uncertain, but are currendy projected to be between $50 and $100.


This is an ambitious plan for addressing die country's LTSS needs, but it is difficult to exaggerate die challenges posed by die nation's current and future LTSS needs.

Currently, however, it is not clear that the rest of Congress is feeling similarly ambitious. The House's proposed healtii reform bill, America's Affordable Health Choices Act of 2009, was initially almost bereft of LTSS proposals, although an amendment to the bill, submitted by Congressman Frank Pallone (D-N. …