Capitol Correspondence - 04.15.19

Aligning on LTSS: Senate Medicare for All Bill Now Incorporates LTSS Language Seen in House

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ANCOR is sharing this highlight from an article by Politico Pro because the concept of Medicare for All is gaining political visibility and traction in the Democratic Party and could be an important policy position in the 2020 Presidential election. ANCOR has been monitoring various Medicare for All proposals and responding to Congressional inquiries about on disability long term services and supports, given that essential supports and services for people with intellectual / developmental disabilities (I/DD) are funded primarily by Medicaid. While ANCOR does not have a position currently on any Medicare for All proposal, we will will continue to monitor this discussion and educate on disability services.

 As written in Politico Pro:

“Medicare for All legislation in the House and Senate does more than cover people. The bills swiftly transform the entire $3.7 trillion health care system, touching on everything from building primary and rural health care capacity to addressing socioeconomic disparities to getting all health care providers to use the same electronic billing format. And they wade into some of the biggest political fights of our era, including abortion, drug prices and immigration.


4. Long-term care is included.

Long-term services and supports — both in institutions like nursing homes and, wherever possible, in home- and community-based settings — would be covered. Medicaid already pays a big share of the cost for low-income people or people who have spent most of their savings on care. But this would be a significant expansion of government health spending, and that expense is why Congress has never been able to come up with a better system for long-term care despite the demand and aging population.

The Congressional Research Service estimated that the cost of long-term care was $366 billion in 2016 — not counting the hours put in by unpaid family caregivers, which is billions of dollars more. The House bill would cover all long-term care; in the Senate version, Medicare for All would cover home- and community-based options, and a remaining portion of Medicaid would finance nursing homes. There are some policies to be worked out here. It’s possible that some form of private long-term care insurance could still have a role for those who get institutional care under Medicaid, a congressional aide said.


12. Some would get free rides to medical appointments.

Low-income and disabled people would get free transportation to medical care — addressing what’s known as a “social determinant of health.” Some government and private health plans already cover some transport for doctors’ appointments, dialysis sessions and the like.

The thinking is that if people get timely care, they are less likely to end up in hospitals — and an ambulance costs a whole lot more than a van or car ride. But this proposal appears broader than current practice — and runs counter to CMS Administrator Seema Verma’s offer for state Medicaid programs to cut some non-emergency transportation services.

13. The two-year wait for Medicare disability coverage would be abolished.

Medicare is usually thought of as health care for people 65 and older, but it also covers younger people with disabilities who meet certain criteria. But even after qualifying for Social Security Disability Insurance, people currently have to wait 24 months for the Medicare coverage to kick in. That would no longer be true under Medicare for All.”