The passage of the Patient Protection and Affordable Care Act and its companion bill the Health Care and Education Act of 2010 may be the most significant — and also the most controversial and complex — social legislation this country has passed in decades.
The legislation contains several provisions that will impact long-term care and direct-care workers; those provisions are detailed in a PHI summary (pdf).
Overall, when fully enacted in 2014, the law will:
- Ensure coverage for nearly all Americans
- Make significant changes in how care is delivered
- Improve quality
- Hold down overall costs
In fact, according to the Congressional Budget Office, the legislation will reduce the deficit by $124 billion over ten years.
Health Coverage for Families
The legislation passed by Congress will impact coverage for American families as follows:
- Most individuals will be required to have health insurance beginning in 2014.
- Individuals without access to affordable employer coverage will be able to purchase insurance through a health insurance exchange. Premium and cost-sharing credits will be available to some people to help make coverage more affordable. Small businesses will also be able to purchase coverage through a separate exchange, with larger employers having that option over time.
- Medicaid eligibility will be expanded to those earning 133 percent of the federal poverty level ($14,404 for an individual and $29,327 for a family of four in 2009) for all individuals under age 65.
- New standards will be required for all health plans to prevent insurers from denying coverage to people for any reason — including health status — and from charging higher premiums based on health status and gender.
Workers and Long-Term Care Services and Supports
The legislation also includes more options and funding for community-based long-term care services and support, as well as significant investments in the direct-care workforce, including:
- Demonstration grants to develop and pilot competency-based training curricula for personal and home care aides.
- Establishment of a Personal Care Attendant Advisory Panel at the Department of Health and Human Services (HHS) as part of the creation of the new voluntary long-term care insurance program called the CLASS Act.
- Additional demonstration provisions to extend the Money Follows the Person rebalancing demonstration; independence at home program; and community-based collaborative care networks and transition programs.
- Grants for new and incumbent workers to provide career ladders and to states for comprehensive health care workforce development strategies.
Other Resources
Numerous other organizations have created their own detailed and helpful reviews of the new health care law:
- Georgetown University Center for Children and Families — Summary of Medicaid, CHIP, and Low-Income Provisions in Health Care Reform (pdf)
- Kaiser Family Foundation — Side-by-Side Comparison of Major Health Care Reform Proposals (pdf)
- Center on Budget and Policy Priorities — Health Reform Package Represents Historic Chance to Expand Coverage, Improve Insurance Markets, Slow Cost Growth, and Reduce Deficits (pdf)
- Community Catalyst — Quick Wins: Who Will be Helped Right Away by the New Health Care Reform Law? (pdf)
– by Carol Regan
Additionally, if the CLASS Act achieves high participation, it will mean a fairly significant number of new, unrestricted dollars coming into the system. I imagine it could be a boon for the direct-care workforce and for providers. However, it’s really uncertain how many people will participate in the CLASS Act. I’m at the start of my career, and I honestly could not afford to put down $100 a month. That’s y guesstimate of the premium I might have to pay – the Academy of Actuaries estimated an average premium of $160 for everyone assuming 6% of the workforce participates. Age rating of the premiums is allowed, but I still think that affordability is one of the major issues the program will have to address.
Hi Weiwen: I remember meeting you at the NASI conference when we began the discussion of long-term care reform, including the CLASS Act, at our workshop.
I know that staff over at HHS in the Assistant Secretary of Planning and Evaluation’s office have been doing modeling on this and will be taking the lead on the setting premiums and determining benefits. I do know that they are hoping to market the bill to younger folks/early retirees in order to get the upfront investments and build a reserve for the future. There is much to be worked out.
What we are excited about is in fact the understanding that there will need to be workers to provide the supports to those who have the benefit, and so are pleased that within 90 days of the law’s enactment, a Personal Care Attendant Advisory Panel will be established to advise Congress and the Secretary on the adequacy of the number of such workers, the salaries, wages, and benefits of such workers, and access to the services provided by these workers (see page 1977 of the bill)
Stay tuned