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Amid Biden’s ambitious extension of long-term care is controversial

WASHINGTON (AP) – President Biden is proposing a major expansion of the government’s role in long-term care, but questions are being raised about the whole idea of ​​its low-income Medicaid program օգտագործման infrastructure bill.

The White House infrastructure package includes $ 400 billion to accelerate the transition from institutional care to home-community services through the federal-state Medicaid program. The financial commitment, about 17% of the $ 2.3 trillion infrastructure offer, leaves no doubt that Biden intends to make his mark on long-term care.

Biden is acting as the nation emerges from an epidemic that has severely damaged older people, particularly nursing home residents. Long-term care has always been a growing problem in an aging society like the United States. The epidemic has made it even more significant.

“The most important thing Biden did was to say, ‘Long-term care is my priority,'” said Howard Gleckman, a pension policy expert at the Urban Inst Institute. “At 30,000 feet, that’s really possible, because the president says so.”

The White House did not write much below that. Biden’s program summary says the money will be used to expand home and community services so that more people can be cared for. The main goal will be to increase wages and benefits for workers, almost all of whom are women, many from minority և immigrant communities. Salary now averages $ 12 an hour. The proposal will also forever validate a Medicaid program that helps people move from nursing homes to their communities.

But Medicaid remains a safety net program, which means that middle-class people can withstand qualifying challenges even if they have staggering long-term care costs. As Biden promotes its funding through Medicaid, it leaves it out to the middle class.

“Biden is a working-class, middle-class boy … he knows that if we focus only on Medicaid, they will not help their key voters if they do not wipe out their assets,” said William Arnone, a non-partisan executive. National Academy of Social Security, which works on policies.

The alternative to Medicaid could be similar to Social Security և Medicare, which does not have income-based tests for benefits, Arnone added. But it will cost much more than Biden suggests spending. People often assume that Medicare covers long-term care, but this is not the case.

Some Republicans have also questioned whether long-term care is included in the infrastructure bill. Senate Minority Leader Mitch McConnell called the White House bill a “liberal wish list”, which is wrong in the subcommittee. As a rebuttal, Biden said infrastructure should include expanded services, not just roads and bridges, as part of what Americans need to “build a little better life, a little bit of breathing.”

According to the Kaiser Family Foundation, Medicaid spends about $ 200 billion a year on all long-term care needs. Reflecting the growing mood that older adults should be able to stay in their homes, more than half of the money goes to home-community care. Biden’s bill will average $ 40 billion a year over 10 years.

About 4 million people receive home-community services, which are more expensive than nursing home care. But it is estimated that 800,000 are on the waiting list for such services. More than 1 million people live in nursing homes.

Policy adviser Brian Blaise, a former Trump White House health adviser, said the Republican flag is a warning that Biden’s plan calls for the protection of medical workers’ union rights.

“Creating more union workers seems to push Democrats back through the unions,” Blaise said.

It makes union officials scatter. “It is simply unacceptable in principle that federal dollars should be paid to pay for poverty-stricken jobs. We have the opportunity to change that,” said Leslie Fran, vice president of the International Union of Employees, which represents many health care workers.

Taking a step back, Republicans generally do not argue over prioritizing home services over nursing homes. “It is partisan to support people who have the right to stay at Medicaid, not enter institutions,” Blaise said. However, weakening the rules of jurisdiction will lead to “escaped costs,” he said.

The cost of the infrastructure project for the Biden Coronavirus Assistance Act is $ 12.7 billion for homes and community services. Sen. Bob Casey, a Democrat from Pennsylvania, played a key role in developing the infrastructure.

“I am going to do everything I can to help middle-class families,” said Casey. “What I’m trying to do is add dollars to Medicaid to serve more people. We owe $ 12.7 billion on the bailout bill, but obviously we need a lot more. ”

Congressional officials say the emerging approach calls for increased federal investment in states’ home-community services while setting key national standards. Such standards may include the type և scope of services provided by States, as well as the mechanism for raising staff salaries. They are also exploring ideas such as creating state registries of qualified caregivers that may be useful to middle-class people who are not eligible for Medicaid.

“There are some issues with long-term care that precede the epidemic, they will be a challenge even after the epidemic,” Casey said. But coronavirus “forces us to deal with problems that we have overlooked for too long in our long-term care system, as well as investing more in long-term care in general.”

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