2020 Policy Proposals: Sanders on Long-Term Care

Sen. Sanders on LTC

This April, presidential hopeful Sen. Bernie Sanders (D-VT) introduced the Medicare for All Act of 2019. This sweeping proposal would create a new, universal, single-payer health system. Among other effects, if passed, the bill will dramatically impact how older Coloradans receive long-term care.

Related: Quick Takes on 2020 Policy Proposals

Under the Medicare for All Act of 2019, long-term services and supports (LTSS) provided in the home and community, also known as home and community-based services (HCBS), would be available to all enrollees. LTSS comprise the essential services most of us need as we age.

These services involve everything from dressing or making meals, to more intensive (and expensive) supports provided in nursing homes. Under Sen. Sanders’ plan, the way we pay for HCBS would change, but services provided in facilities like nursing homes would continue to be covered through Medicaid.

Sen. Sanders’ plan to finance long-term care is a solution to a growing problem in Colorado and beyond. Under current systems, we lack a sustainable way to pay for LTSS. Many older adults don’t have enough money to pay out of pocket for long-term care, few private insurance options exist, and state budgets lack the ability to support increased Medicaid caseloads when older adults can’t afford their own acute long-term care needs. Sen. Sanders’ plan — though it still has many large, outstanding unknowns — offers a way to change this system and provide more older adults with the care they need.

Paying for Long-Term Care in Colorado

The current way we pay for long-term care in Colorado isn’t working. Few older adults have access to preventative, private pay options, and are instead forced to spend down their personal assets before receiving the care they need. In addition, its toll on Colorado older adults and their families, this system is contributing to the state’s ballooning Medicaid budget.

Currently, LTSS is paid for through a variety of sources, including:

  • Medicare: Most Coloradans aged 65 and older are enrolled in Medicare. Historically, these plans, regulated by the federal government, have minimal LTSS offerings. New guidelines however, allow Medicare Advantage plans to offer more LTSS services. With time, the number of Coloradans with access to LTSS through Medicare may grow, but as of right now, the percentage remains small.
  • Long-term care insurance: A supplement to Medicare, long-term care insurance offers individuals a way to privately offset the cost of LTSS. For a multitude of reasons — from cost to questions about plans’ financial stability — only about 11 percent of people 65 and older have long-term care insurance.
  • Out of pocket: Those without long-term care insurance must pay for LTSS out of their own pocket. Unfortunately, these services are often expensive. In 2018, the cost of employing a full-time home health aide in Colorado was almost $5,000/month, and a semi-private nursing home room was close to $8,000/month. Exacerbating the high cost of LTSS, research shows individuals increasingly have inadequate personal resources to pay for these essential services.
  • Medicaid: Once individuals exhaust their personal savings, they may become eligible for Medicaid. Responsible for the majority of long-term care, Medicaid offers beneficiaries a variety of LTSS, including adult day, homemaker, transportation, and nursing home services. With a growing number of older Coloradans qualifying for Medicaid, LTSS comprises an increasingly large part of the state budget.

Sanders’ Plan in Colorado

Sen. Sanders’ plan offers a way to change our current LTSS funding model by providing automatic enrollment in a health insurance plan that covers preventative services provided in the home and community. In theory, this plan should prevent older adults from needing to spend down their assets before accessing essential long-term care services.

It should also be noted, however, there are a number of important unanswered questions about Sen. Sanders’ plan — most importantly, its cost, how it’d be paid for, and the effect it’d have on the number and availability of service providers.

The Bell’s Work on Long-Term Care

The Bell recognizes the growing need for sustainable solutions which address the question of how to pay for long-term care. That’s why — in partnership with CCHI, and with a grant from the Next50 Initiative — we’re working with partners to develop a statewide aging policy agenda that includes a focus on how to sustainably fund long-term care services.

With this focus, we’ll be taking steps to create a state that supports older Coloradans’ financial security and allows all of us to age in a way we find meaningful.