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The U.S. House of Representatives voted last week to repeal the Community Living Assistance Services and Supports (CLASS) Act, a voluntary, federal long-term care insurance program established by the Affordable Care Act (ACA).

The final vote against the CLASS program in the Republican-dominated House was 267-158. All 239 Republicans present for the vote sided with the decision to repeal CLASS.

The bill is expected to be “ignored” by the Democratic-controlled Senate, where it is headed next. Additionally, the White House has said that it does not support repeal.

Nevertheless, the future of the CLASS Act remains very much in doubt. Health and Human Services Secretary Kathleen Sebelius said in October that she did not believe the CLASS program would be financially sustainable.

Congressional Republicans, meanwhile, say they are focused on defeating CLASS as part of their larger goal of dismantling the ACA. House Speaker John Boehner (R, Ohio) told reporters that his party is “committed to repealing and defunding [the ACA], piece by piece if necessary.”

CLASS Advocates Speak Out

Supporters of the CLASS program say that simply casting the program aside would be unproductive and short-sighted.

Larry Minnix, the president and CEO of LeadingAge, told McKnight’s Long Term Care News, “We need to keep CLASS alive because we believe it can be made to work. It is the only alternative so far to Medicaid as the primary means of financing long-term services and supports.”

As currently constructed, the U.S.’s long-term care system cannot possibly meet the needs of the country’s rapidly aging population, supporters say. Sweeping CLASS off the table does nothing to solve that problem.

In an op-ed published on the website Politico, Senator Jay Rockefeller (D, West Virginia), a leading CLASS supporter, wrote:

We should commit to finding solutions that, at a minimum, give people access to long-term services and support, regardless of pre-existing disability, in their homes or communities — and without impoverishing themselves. Rather than repealing CLASS outright, we should all put our ideas on the table. And have the long-overdue debate that the American people deserve.

If CLASS is ultimately repealed, it would take with it a proposed national Personal Care Attendants (PCA) Workforce Advisory Panel, designed to advise Congress on PCAs’ jobs quality as well as consumers’ access to PCA services. The panel is to be run by the CLASS Office.

– by Matthew Ozga

On January 18, the U.S. House of Representatives Committee on Ways & Means voted 23-13 to repeal the Community Living Assistance Services and Supports (CLASS) program, by approving the Fiscal Responsibility and Retirement Security Act (H.R. 1173).

The Committee’s approval clears the bill to be voted on by the full House.

Advocates for older adults and people with disabilities — as well as for direct-care workers — have been supporters of the CLASS program, the voluntary, federal insurance plan created under the Affordable Care Act to help people purchase long-term services and supports (LTSS).

The CLASS program would also establish a national Personal Care Attendants (PCA) Workforce Advisory Panel to advise Congress on the adequacy of the number of PCAs, their wages and benefits, and access to the services that PCAs provide.

Advocates Oppose the Bill

CLASS supporters have organized to oppose the advancement of H.R. 1173 (pdf).

On January 17, more than 50 organizations sent a letter (pdf) to the Ways & Means Committee leadership opposing the bill.

Caring Across Generations also mobilized its supporters, generating hundreds of calls to Committee members opposing repeal.

The Obama Administration halted implementation of the CLASS program in October due to concerns about its viability. However, the Administration also opposes repeal, arguing that CLASS provides a framework for future action to meet the LTSS needs of older Americans and people with disabilities.

Senator Jay Rockefeller (D-WV) is leading efforts to defend CLASS against repeal in the Senate.

– by Gail MacInnes, PHI National Policy Analyst

Sen. Robert Casey (D-PA)

Senator Robert Casey (D-PA) has introduced a bill that would expand the role of direct-care workers across the country.

The Improving Care for Vulnerable Older Citizens through Workforce Advancement Act (pdf) would establish demonstration projects focusing on care coordination and service delivery redesign for older adults with chronic illnesses, or those at risk of institutional placement.

“Direct-care workers are key to providing services that improve the health of older Americans and reduce re-hospitalizations, vastly improving the quality of life for our older citizens and reducing costs and strain on the entire healthcare industry,” Casey said.

“My legislation will help to better train and utilize direct-care workers to lower the cost and improve the quality of healthcare provided to older Americans,” he continued.

Demonstration Projects Detailed

The bill would create six three-year demonstration projects:

• Two would incorporate direct-care workers into interdisciplinary care coordination teams to promote smooth care transitions and prevent unnecessary re-hospitalizations;
• Two would have direct-care workers take on a greater role in monitoring, maintaining, and improving their consumers’ health status; and
• Two would train direct-care workers to care for specific diseases and afflictions, including dementia, diabetes, and congestive heart failure.

“With adequate training, compensation, and support, a newly created ‘advanced aide’ position could support health promotion, better chronic care management, and care transitions, resulting in less institutionalization and fewer re-hospitalizations,” PHI President Steven Dawson said.

Partnerships of health service providers, including at least one long-term care facility or home and personal care service provider, are encouraged to apply for demonstration funding if the bill passes into law.

PHI has published a one-page backgrounder (pdf) capturing the highlights of Casey’s bill.

– by Matthew Ozga

Senator Al Franken (D-MN)

With the support of three of his colleagues from the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP), Senator Al Franken (D-MN) introduced the Home Care Consumer Bill of Rights Act (S. 1750) on October 20.

Franken plans to incorporate the bill (pdf) into the upcoming reauthorization of the Older Americans Act (OAA).

The bill aims to guarantee basic rights, including protection from abuse and neglect, to older Americans who receive long-term services and supports in their homes and communities.

Specifically, the Act would:

• direct states to develop a Home Care Consumer Bill of Rights;
• establish a voluntary Home Care Ombudsman Program to support states that choose to provide ombudsman services to resolve the concerns and complaints of older adults who receive home and community-based services; and
• develop quality standards for home and community-based services so that older adults and their families can make more informed decisions about who provides their services.

Remaining at Home a Top Priority

“It became very clear to me after meeting with seniors from Moorhead to Winona that remaining independent and at home is a top priority for our seniors,” Franken said.

According to a May 2010 environmental scan (pdf) of Medicaid-funded long-term services and supports by the Center for Health Care Strategies, 41 percent of Medicaid expenditures for long-term services and supports are for home and community-based services.

The increasing number of older Americans in need of long-term services and supports who choose to receive services in their homes and communities rather than in nursing homes makes Franken’s bill particularly relevant.

These rights, protections, and standards are already available for nursing home residents.

– by Gail MacInnes, PHI National Policy Analyst

PHI Massachusetts, a new section of the PHI PolicyWorks website, will provide news, facts, and other resources about the state’s direct-care workforce.

The site also contains information on several state-focused priorities, including educating policymakers about the direct-care workforce, transforming care environments, and building skills for workers.

Visitors can sign up for e-mails alerting them to new Massachusetts content at the PHI Massachusetts homepage.

The PHI Massachusetts page is the third state-focused page that PHI has introduced this year, following PHI New York and PHI Michigan.

“We are thrilled to have this platform to speak out about the unique challenges and opportunities facing Massachusetts’s largest occupational group,” said PHI Massachusetts State Director Amy Robins.

Task Force Bill Would Help Workers

One of those unique opportunities is “An Act to Establish a Task Force Relative to the Direct-Care Workforce,” a bill recently introduced to the Massachusetts legislature by State Senator Pat Jehlen (D).

If passed into law, the task force bill would require the state to take steps to ensure that it has an adequate workforce and infrastructure to meet the rising demand for long-term care services and supports.

The bill (S45) is covered in depth at the new PHI Massachusetts site.

A public hearing for the bill will take place on November 15 at 10:30 am at the Massachusetts State House.

On January 19, while members of the House of Representatives debated and passed a bill (H.R. 2) to repeal health care reform, PHI and other advocates representing 150 national organizations (pdf) gathered elsewhere on Capitol Hill to voice ardent support for the Affordable Care Act.

Led by Families USA, the event featured speakers from the American Nurses Association, National Committee to Preserve Social Security and Medicare, United Spinal Association, and Catholic Health Association.

Particularly compelling were messages delivered by organizations representing older adults and people living with disabilities, which noted important benefits the law provides, including:

• a 50 percent discount on brand-name prescription drugs in the Medicare Part D “doughnut hole”;
• full coverage of preventive services such as diabetes tests and prostate cancer screenings for people with Medicare;
• protection from denial of health care coverage due to pre-existing conditions; and
• the elimination of annual or lifetime caps on coverage.

Kimball Gray, speaking from his wheelchair on behalf of the United Spinal Association and National Spinal Cord Injury Association, expressed support for the law’s protections for individuals with pre-existing conditions, telling those assembled, “I am a pre-existing condition.”

Move Forward, Not in Reverse

Gray called for movement forward toward more accessible and better quality health care for all, rather than reversal of what has already been achieved.

Because the repeal effort is unlikely to progress past the House, the challenge for advocates and government officials continues to be effective implementation of the Affordable Care Act.

The Direct Care Alliance has issued a new brief (pdf) on advocacy strategies, outlining what’s at stake for direct-care workers in the Affordable Care Act implementation.

– by Gail MacInnes, PHI National Policy Analyst