David Grabowski, Ph.D.,
professor of healthcare policy
at Harvard Medical School

Contrary to what one might assume due to the increasing appearance of long-term care benefits in Medicare-for-all proposals put forth or supported by national politicians and presidential candidates, long-term care generally has been viewed as a controversial or untouchable issue in political campaigns, and that position may or may not change soon, a health policy expert tells McKnight’s Senior Living.

Sen. Bernie Sanders (I-VT), a candidate for president as a Democrat, recently said he will be adding coverage for long-term services and supports to his previously introduced Medicare-for-all bill, a move that reportedly has the support of at least three Senate colleagues who also are presidential candidates: Sens. Cory Booker (D-NJ), Kirsten Gillibrand (D-NY) and Kamala Harris (D-CA).

The announcement comes after the introduction of the Medicare for All Act of 2019 (H.R. 1384) in late February by Rep. Pramila Jayapal (D-WA). Under the bill, which has 106 co-sponsors, all U.S. residents would be entitled to long-term services and supports if illness, injury or age limit their ability to perform at least one activity of daily living or instrumental activity of daily living.

“The aging of America has helped bring this issue to the forefront,” David Grabowski, Ph.D., professor of healthcare policy at Harvard Medical School, told McKnight’s Senior Living. “More Americans and their families are facing this issue of how to pay for high-quality long-term care. There are, unfortunately, not easy answers, given the current system. However, we have an emerging crisis in this country, and that is beginning to draw attention from candidates.”

On the surface, Grabowski said, long-term care seems like a perfect issue for a presidential election. “It will affect many of us, it is catastrophically expensive, and most existing long-term care models aren’t working all that well,” he said. “As such, many older Americans have unmet long-term care needs.”

Yet long-term care seldom has emerged as a major issue in a presidential election, Grabowski said. “In many respects, long-term care has been a ‘third rail’ for politicians, given the high price tag of many long-term care reforms,” he said. “Many Americans have viewed long-term care as a family issue and thus haven’t demanded policy attention. As a result, politicians have often ignored this issue.”

It remains to be seen whether the 2020 campaign will be any different, Grabowski said.

“Voters are not yet holding candidates’ feet to the fire on this issue,” he said. “There is still a great deal of uncertainty about the role of government versus families in this area. There is also the fact that long-term care reform would be expensive, and it is unclear whether Americans are willing to pay this high cost.”

Recent Medicare-for-all efforts have been the work of Democrats, but a majority of citizens belonging to both major political parties now support a government-administered long-term care insurance program similar to Medicare, according to Associated Press–NORC research. That support won’t necessarily translate into votes at the polls, however.

“In the abstract, many Americans are quite positive about universal long-term care coverage,” Grabowski said. “However, these same individuals are not quite as positive about having to pay for such a plan. However, I do think more Americans are facing issues with their own parents and beginning to see the value in some type of major long-term care reform.”