Pay Now, Care Later

Posted Jan. 10, 2010, at 6:50 p.m.

No one expects to be unable to feed, dress or bathe themselves. But it happens, and it can happen at any age. One piece of the health care reform proposal could provide a critical safety net that can mean the difference between misery and relative happiness. And the safety net, though overseen by the federal government, won’t cost taxpayers a dime.

The CLASS, or Community Living Assistance Services and Supports, Act, is now part of both the House and Senate health care bills. It would create an insurance pool to provide coverage for anyone who is disabled at any point in life. Disability is defined as the inability to provide oneself with at least two of several essential daily living functions, such as eating, walking, using the toilet, bathing, etc. If someone is disabled, the insurance pool will pay out an average of $75 a day in benefits.

Larry Minnix, president of the Washington-based American Association of Homes and Services for the Aging, explains those benefits might include the services of a nurse for three hours a day. He cites the case of someone who is nearly quadriplegic but still able to work. Such a person needs help getting out of bed, dressed, fed and bathed, but can still be employed.

Those drawing the benefits are almost as likely to be under the age of 60 as over it, he said. Younger people facing disability might have multiple sclerosis, Down syndrome, spinal cord injury or traumatic head injury. Older people may be disabled by a stroke, Parkinson’s disease, Alzheimer’s or diabetes.

“All of these groups are under-insured for their problems,” Mr. Minnix said. “They either become impoverished and go on Medicaid or use charity care.”

Under current law, many people with disabilities end up on Medicaid, and many end up in nursing homes, rather than the alternative most prefer, which is to stay at home. Mr. Minnix said that 70 percent of Medicaid funds go to nursing homes for such cases. The pool would begin “to take the pressure off Medicaid,” he said.

So how would this insurance be paid for? Those who want the coverage would pay $85 to $100 a month in voluntary payroll deductions to fund the insurance pool. Those who are below the poverty level would not pay more than $5 per month. The federal government would manage it, with third-party oversight, just like the highway trust fund and the flood insurance fund, Mr. Minnix said. It’s estimated that 4 to 5 percent would choose to enroll. Subscribers could not draw on the insurance until they pay into for at least five years, and they would have to be employed for three of those five years.

“Being disabled is probably the single biggest personal exposure any of us have and most of us don’t realize it,” he said. And most Americans will face caring for a disabled family member at some point.

The CLASS Act must remain part of the health care reform package, as a self-sustaining option to get people through difficult periods of life.

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