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Long-Term Care Program Debuts In New Health Law

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Long-Term Care Program Debuts In New Health Law

Long-Term Care Program Debuts In New Health Law

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MARY LOUISE KELLY, Host:

The new health care law expands more than just medical care. It also creates the first ever federal insurance plan to help Americans with long term care needs, pay for them. NPR's Julie Rovner reports.

JULIE ROVNER: Most people don't realize how expensive long term care is until they need it. And most people will need it.

NORA SUPER: We find that, you know, the vast majority of people need long term care assistance as they get older, but they don't save for it.

ROVNER: Nora Super is head of federal relations for the senior groups AARP. She says most people don't realize until it's too late, that they're not covered for things like the everyday help people need as they age. Things like dressing, bathing, and eating and preparing meals.

SUPER: Medicare does not cover any long-term care needs. Now, Medicaid does but only for people that spend down or, in other words, don't have the resources to cover their nursing home needs or their long terms care needs.

ROVNER: Which brings us to the new law known as the CLASS Act. It was one of the last legislative efforts of the late Senator Edward Kennedy. Judy Feder is a long time expert on long time care. She says the measure is a major achievement.

JUDY FEDER: The CLASS Act is a phenomenal change in the landscape on long-term care because it establishes a federal long-term care insurance program.

ROVNER: Feder, a senior fellow at the Center for American Progress and professor at Georgetown University explains how the new law would work.

FEDER: The concept is that people start paying in when they're working and after they've contributed for a period of five years, they become eligible for a benefit should they become impaired and need help.

ROVNER: And the program isn't just for the elderly, she says, but for anyone of any age who could become disabled.

FEDER: Bad things happen to anybody. I'm sure we all have friends or know of cases where a family has a disabled child, a pregnancy has difficulties, or a teenager has a diving accident.

ROVNER: But Al Schmitz, a principal with the health care consulting firm, Milliman, says for those trying to avoid a nursing home, it can make a real difference.

AL SCHMITZ: You know, $50 a day, somebody getting $1,500 a month, that can still, you know, help with getting some home care, getting people some community assistance that really provides a - it's still a significant benefit in my mind.

ROVNER: And how will you sign up? Well, the program is voluntary, but if your employer decides to offer it, you'll be automatically enrolled unless you opt out. Schmitz agrees that's a good way to get people to participate. But he's worried about something else.

SCHMITZ: The concern is whether they're going to be able to attract employers to get them to offer this plan.

ROVNER: Employers might not want to take on the paperwork hassle. Schmitz says that leads him to another worry, whether the premiums and benefits will match up. Under the law, the new program has to raise enough money in premiums to cover all the benefits. It will be up to the Department of Health and Human Services to set those final levels.

SCHMITZ: If the final premiums that are determined end up being too high, that has the potential to, you know, scare away healthy individuals and really only attract those who are less healthy.

ROVNER: In other words, those most likely to need the care, which wouldn't create a large enough pool of healthy people to cover the benefits. But Judy Feder said she's confident that won't happen. She says the Congressional Budget Office estimated that the program would pay for itself over the next 75 years, and it based that estimate on participation rates for private long-term care insurance which only enrolls about five percent of the population.

FEDER: And I think that that's conservative, because with a federally blessed, federally advertised program, there is a likelihood of higher participation rates from the get-go - which is what you need to make sure that healthy people are signing up.

ROVNER: Julie Rovner, NPR News, Washington.

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