The Hill News

Last week, the Obama administration halted implementation of the new federal long-term care insurance program â€" the Community Living Assistance Services and Supports (CLASS) initiative, which had been tucked into health care reform legislation. It is disappointing, but not surprising that the administration was unable to design a financially self-sustaining, voluntary long-term care insurance program. The unusual legislative journey of the Patient Protection and Affordable Care Act, which had no House-Senate conference to clean up the bill, left CLASS with statutory limits that proved unworkable. Without mandatory participation or some other way of achieving near universal participation, the program did not stand a chance.
 
The administration’s inability to implement CLASS does not endanger the Affordable Care Act (ACA), which will still extend health coverage to 32 million uninsured people by 2016. According to the Congressional Budget Office, the ACA wil! l reduce the deficit by $127 billion even without CLASS. The success of the Affordable Care Act depends more on how HHS uses its broad discretion to formulate rules for accountable care organizations, medical homes and state health insurance exchanges. If the administration was given as much discretion over CLASS as it has over other provisions in the ACA, the news last week would have been quite different.
 
In the absence of CLASS, Medicaid will continue to be our de facto long term care public policy. State Medicaid programs that require near, if not actual, impoverishment are, as others have said, like having an insurance policy with a deductible that is all your wealth.

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