President Obama’s Health Care plan is now in the hands of Congress, who produced House Bill 3200, America’s Affordable Healthy Choices Act of 2009. This bill could improve health care and lower costs for seniors in Assisted Living.
What is CLASS?
The bill would create a voluntary national long-term insurance plan for adults who become functionally disabled. Under this plan (called CLASS for Community Living Assistance and Supports), individuals would pay monthly premiums and be eligible for benefits within 5 years. CLASS prevents insurance companies from denying coverage for pre-existing conditions or charging more based on health status.
CLASS targets the cost of living in an Assisted Living Facility, but it would not cover all costs. Two-thirds of Assisted Living seniors pay for care themselves with help from family or Medicaid. ALFA (Assisted Living Federation of America) calls CLASS a “strong first step towards encouraging personal responsibility in saving for long-term care.”
Current Regulations Have an Assisted Living Gap
ALFA explains that because of costs and coverage, seniors are often moved to a nursing home, which provides more care than they really need or want. Medicare covers only hospitalization and physical therapy, and most private insurers follow suit. But many seniors need help with custodial care–daily activities like bathing, dressing, grooming, toileting and getting around-and state laws often prevent Medicaid from paying for these services. With CLASS, more of these costs would be covered, so that many seniors could stay in Assisted Living. According to ALFA, the median monthly rate for assisted living is $2,350, about two-thirds the cost of skilled nursing facilities.
HR 3200 also ends limits on lifetime benefits and sets minimum standards for core benefits. These include outpatient hospital and clinic services and emergency room visits. HR3200 will not force seniors to give up or switch their current insurance.
New Rules for Skilled Nursing
The bill outlines new rules for skilled nursing homes, requiring them to disclose information about owners, operators, and board members, develop accountability procedures, quality measures, and ethics rules to prevent crime and abuse, and establish systems for formal complaint. Penalties would be imposed for non-compliance. Less clear is whether Assisted Living will be included in these provisions.
The bill proposes tax increases only on those with annual incomes over $350,000. Despite rumors, the government will not pay for reform by pushing seniors toward euthanasia. HR 3200 requires Medicare to reimburse physicians for visits involving end-of-life planning, such as living wills and health care proxies. Eligibility for such reimbursement is limited to once every five years, and New York already has a similar provision.
On September 1, 2009, AARP’s website clarified its support of health care reform that lowers drug costs, eliminates waste, protects seniors’ choice of insurers, and prevents denial of coverage based on pre-existing conditions, or higher costs due to age or gender.
Obama’s health care plan responds to the urgent need to curb health care and insurance costs. According to ALFA, over 50% of Medicaid funding goes to skilled nursing care for older Americans. By 2020, approximately 12.5 million Americans over 65 will need long term care. Find nonpartisan comparisons of current health care reform proposals at http://www.kff.org/healthreform/sidebyside.cfm.
Written by senior housing writer Lisa Logan, Ph.D.