All the major Democratic presidential hopefuls have proposed significant plans to support those receiving long-term supports and services and their families. While this amount of attention to long-term care is unprecedented, the candidates are taking three broadly different approaches to the problem: tax credits; universal government-funded coverage; and public long-term care insurance against catastrophic costs.
Most also support higher pay for direct care workers, paid family leave for caregivers, and more funding for Older Americans Act programs. But their most ambitious—and divergent—ideas address long-term care financing.
Two candidates, former vice president Joe Biden and Sen. Amy Klobuchar (D-MN), support new tax credits. Two others, senators Bernie Sanders (I-VT) and Elizabeth Warren (D-MA), would roll long-term care into their Medicare for All plans, including it as part of the broad new government health benefit. And one, former mayor Pete Buttigieg, favors a universal public long-term care insurance program for those with catastrophic needs.
I’ll analyze these ideas in more detail in a separate blog but, for now, here are brief descriptions of their plans:
Joe Biden: Biden’s plan is among the most modest of the candidates. His major initiative is a $5,000 non-refundable tax credit for family caregivers. He says it is based on an AARP plan to allow caregivers a credit for up to 30 percent of documented expenses above $2,000. The credit would phase out for couples with income of $150,000 or singles who make $75,000.There is a bipartisan bill in Congress called the Credit for Caring Act based on this idea.
Biden also would increase Social Security benefits for the very old, and increase federal funding for caregiver respite.
Pete Buttigieg: Unlike other Democrats, Buttigieg has proposed a new public long-term care insurance program aimed at covering true catastrophic needs. While he has offered only limited specifics, it appears his plan would require people to finance their own care for a period of time based on their income. Government would then provide coverage of $90 per day for as long as someone needed a high level of care.
He’d encourage people to self-finance their initial long-term care costs by simplifying and standardizing private long-term care insurance policies, creating an online marketplace (similar to Medicare Supplement (Medigap) insurance), and encouraging employers to offer private long-term care insurance, including as an opt-out benefit.
He’d also expand eligibility for Medicaid long-term supports and services by liberalizing financial requirements for enrollment, and he’d make home and community-based care more available. He also promises to raise wages and benefits for direct care workers.
Amy Klobuchar. The Minnesota senator has raised the issue of long-term care needs in at least two debates. Most recently, on Jan. 14, she said this, “What should we do about long-term care, the elephant that doesn’t even fit in this room? We need to make it easier for people to get long-term care insurance. We need to make it easier for them to pay for their premiums.”
She’s proposing a broad package, including at least three new tax benefits:
- A new 20 percent tax credit to offset the premium costs of qualified long-term care insurance.
- Incentives for employers to automatically enroll workers in long-term care insurance, unless the employees opt out.
- New federal rules to make it easier for carriers to sell long-term care riders to life insurance.
- A $6,000 tax credit to reimburse family caregiving expenses, as well as family leave for those assisting parents and spouses.
- A separate (unspecified) refundable tax credit for those receiving care to help offset qualifying long-term care costs, such as nursing facility care, home care, assistive technologies, respite care, and home modifications.
- Higher wages and better working conditions for paid aides.
The rest of Klobuchar’s plan focuses almost entirely on older adults with dementia, especially Alzheimer’s disease. For example, she promises to expand Medicare services to include Alzheimer’s. She does not say how, or whether this would include personal care or other supports and services. It appears that these new Medicare benefits would be available only to those with dementia but not other age-related diseases.
She’d also increase government funding for research into a cure for Alzheimer’s as well as other chronic conditions and for a program that provides “dementia training for public sector workers who interact with seniors.”
Bernie Sanders: He’d include government-funded home and community based long-term care as part of his Medicare for All plan. While this seems extremely expansive, he has not described any details: Would government funding be unlimited? What level of impairment would trigger the benefit? Would there be some waiting period before benefits are paid? He does not say.
Elizabeth Warren: While Warren currently differs from Sanders in how she’d phase in Medicare for All, she still supports Sanders’s basic bill, including the public home care benefit. But, like Sanders, her plan is little more than a brief phrase of support. It includes no explanation of how benefits would be triggered or who would be covered.
Of other candidates, Andrew Yang has no specific agenda for frail older adults and their caregivers. His proposal to give every American adult $12,000 in a universal basic income plan (UBI) would put cash in the pockets of all, including seniors, that could help pay for long-term care costs. But he does not say whether people with disabilities would continue to receive current government benefits as well as the UBI. And when his website describes his ideas for people with disabilities, it largely ignores older adults.
Former New York Mayor Michael Bloomberg, a late entrant in the campaign, has not yet proposed a long-term care plan though he reportedly is working on one.