The CLASS Story Pits the Angel We Don't Know against the Devil We Do

Article excerpt

CLASS is voluntary, optional, self-sufficient, and could save Medicaid-so let's try it.

Long-term care is an issue most families will face, yet conversations with loved ones about access to it-and paying for it-are all too rare. The affordability of this type of care can be one of the most significant financial hurdles of family life, and a growing body of research shows that increasing numbers of Americans are unprepared should they require long-term care.

For years long-term care was a political anathema that was largely ignored, that is unless elected officials were forced to access the system for themselves or on behalf of family members. Then politicians on both sides of the aisle would often admit that there were growing problems, but they rarely ventured beyond hand-wringing to explore solutions. The cause did, however, have its champions who fought long and hard to include long-termcare reform in the Patient Protection and Affordable Care Act (ACA)-most notably in the form of the Community Living Assistance and Supportive Services program, or CLASS.

Today, as legislators wrestle over the implementation of the new law, long-term care is at the forefront of the debate. The CLASS program represents a landmark piece of legislation, yet it is filled with paradoxes that make its story quite remarkable.

CLASS: A Brief History

Political veterans of health policy will remember how the 1990 Pepper Commission concluded that long-term care was an insurable set of circumstances, and that addressing it should be a priority. But the issue too often remained on the back burner because the assumption was that national health policy should address healthcare reform first, and then tackle long-term care.

So, long-term care was left to the private long-term-care insurance market and Medicaid. Those who could afford private long-term-care insurance and survive the underwriting process had a measure of comfort. Those at poverty level, and those willing to transfer assets or spend down to poverty status had Medicaid. Most middle-class Americans have had to turn to their families to patch together services and pay for them out-of-pocket. This expense often costs thousands of dollars annually for 10-plus million people in any given year, and that number is growing. Medicaid demand is growing exponentially-the devil known all too well.

In addition, Medicaid long-term care is biased toward nursing homes. Though important and necessary, most people do not want or need a nursing home: the vast majority of long-term care is provided in family homes.

Enter CLASS, now at the center of controversy in healthcare reform because of these four questions: Who needs CLASS? What is the potential long-term impact of CLASS? Why do some people want to kill it? What are its unknowns?

Who needs CLASS?

The matter-of-fact answer to this first question is: Every American family. Disabling conditions are indiscriminate of age, socioeconomic status, living venue, background, or genetics. There is the 21-year-old who took that dangerous dive during beach week and is now a paraplegic, or the returning war veteran who is a double amputee. There is the successful lawyer, born with muscular dystrophy and working full time but who could face problems in bathing and dressing in the future. There is the 80-year-old with Alzheimer's Disease who lives with her daughter and family. We know these people. They are us. The U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, through a speech delivered February 7, 2011, at the Kaiser Family Foundation, tells the following story of Michael:

Fourteen months ago, when he was 42, Michael was diagnosed with multiple sclerosis. Since then, he has lost movement in his legs and left arm. His neck muscles have weakened . . . he has lost ability to control his bladder. Michael can live independently, as he strongly prefers to do, because he has part-time personal care assistance to help with daily tasks . …

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