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News / Health

WA at national forefront of battle over long-term care

By Claire Withycombe, The Seattle Times
Published: May 27, 2024, 6:02am

OLYMPIA — Getting older is a fact of life — but how Americans should pay for that care is a matter of opinion.

Experts say Washington voters in November could shape how other states try to figure out how to foot the bill for the costs of an aging population.

That’s because Washington has done something unique: It was the first in the country to set up a publicly funded trust dedicated to long-term care, known as WA Cares.

Since July, most workers in the state have paid a .58% payroll tax out of their wages. That money goes toward WA Cares and is expected to eventually allow beneficiaries to collect up to $36,500 to pay for help like nursing care or in-home help for people who need help with three or more basic activities like bathing and eating. Benefits are scheduled to become available in 2026.

But the program faces a ballot test. Initiative 2124, part of a slate of voter initiatives backed by the GOP and bankrolled by Redmond businessman Brian Heywood, would make the tax optional.

If the requirement to pay the tax survives, proponents say, so would WA Cares. But if Washingtonians decide to make it optional, that could spell doom for the program — and for similar approaches in other states.

“Everybody is looking at Washington state right now,” said Marc Cohen, clinical professor of gerontology and co-director of the LeadingAge LTSS Center at UMass Boston.

The heart of the debate is whether the state should require taxpayers to front part of the bill for future care.

“I think you really have to go back and say ‘What are the responsibilities of state government?’” said Rep. Chris Corry, R-Yakima. “For the most part, yes, we need a social safety net for those who have, you know, no other means. But that should be the last resort, not the first.”

An aging population and a budget crunch

Markos Worku, of Seattle, was 47 and working as a nurse when he had a stroke. He now receives care at home, and said that WA Cares could help people like him.

Benefits aren’t just for care services, but can be used to pay for equipment like a wheelchair, grab bars in showers or ramps like the one Worku relies on enter and exit his home. And it’s not just for older adults.

“Washington’s long-term care benefit will help so many people like me, whether they need help because of a chronic disease, or a sudden event like a stroke or a serious accident,” Worku said last week at an event in support of WA Cares.

While younger adults can also get benefits if they qualify, Ben Veghte, director of WA Cares, points to the growing aging population as one of two trends that drove the creation of the program in 2019. In Washington and across the country, the massive baby boomer generation, generally defined as being born between 1946 and 1964, are entering their 60s and beyond.

In 2023, about 23% of Washington’s population was 60 years old or older, according to the Department of Social and Health Services. In 2050, about 29% will be 60 and up. And as Washingtonians live longer and are healthier, adults ages 85 and up will have the greatest need for care. DSHS projects over the next three decades, that population will increase by more than four times the current amount.

That means the number of potential caregivers for each older person needing care will decline. A 2013 AARP study found that in the state of Washington, the number of potential caregivers ages 45-64 in 2010 was about eight for each person 80 years and older. By 2030 that ratio will fall to roughly 4 to 1, and in 2050 to roughly 3 to 1.

The second trend, Veghte said, is that fewer people now can afford to give up their jobs to be unpaid caregivers for relatives or loved ones needing care.

The idea behind WA Cares is to pre-fund the need for future care and to avoid burdening future generations with the bill.

It does so by generating a new pool of dedicated taxpayer money. Proponents argue it will lessen the strain on Medicaid, the government health care program for low-income people and other qualifying groups, which covers long-term care costs. (Medicare, the government health program for Americans 65 and older, does not cover most long-term care).

Without a program like WA Cares, younger generations will either have to pay higher taxes to cover the ballooning costs of Medicaid, or care will have to be rationed, which could hurt older adults and people with disabilities, Veghte said.

“That’s another reason why many states are looking at programs like WA Cares, is to protect their Medicaid program so it doesn’t collapse under the weight of the age wave,” Veghte said.

Eyes on Washington voters

Other states are watching how the ballot initiative will play out in Washington because they are grappling with the same problem WA Cares was established to try to solve.

“At least once a month, I have a call with someone from another state, whether it’s a legislator or a stakeholder, inquiring about what can be done in this regard,” said Veghte. “All the experts in this field are keenly aware of the need to get ahead of the curve.”

While New York is in the early stages of considering a long-term care social insurance program, voters in Maine rejected a 2018 ballot measure to create one that was designed to be financed by higher-income people and employers. Other states are in various stages of pursuing potentially similar programs to WA Cares, or at least studying them, like Minnesota, Michigan and Massachusetts, according to a Massachusetts Institute of Technology community lab tracking long-term care policies.

Cohen, the professor of gerontology, said that if a greater share of state budgets is devoted to Medicaid costs, that can crowd out other public priorities like schools.

While there are private long-term care insurance plans available, and Washingtonians had the option to buy one until November of 2021 in lieu of participating in WA Cares, Veghte says the plans are unaffordable to most people. Private insurers can also decline to cover a person with a preexisting condition.

That happened to Kim Allen, 60, of Seattle, who was born with a condition called bladder exstrophy. It was corrected by childhood surgeries and hasn’t affected her life since then, so she was surprised to be rejected on the basis of that condition by three different underwriters several years ago.

She was “super relieved” when she learned that the Legislature was considering creating WA Cares, which covers people with preexisting conditions.

Opponents question the program

Elizabeth New, director of the Centers for Health Care and Worker Rights at the Washington Policy Center, agrees that a graying population spells higher costs for Medicaid.

But she says policymakers should respond to that problem by taking a closer look at who qualifies for Medicaid and placing more limits.

“Medicaid is not a long-term care insurance program, but it’s being used like one,” New said.

She said that even people who can afford to pay for long-term care later in life can apply for Medicaid and navigate the guidelines, like asset limits, in order to qualify and to have the public pay for their care.

Now that people are living longer, they need to understand long-term care is a life need they should save for, she said.

Cohen, though, says it’s difficult to know what kind of care an individual will need later in life, or how much, and that simply saving for it isn’t the right approach.

“It’s really hard to save for that kind of a risk because you don’t know, are you going to be the person that never has a need?” he said. “Are you going to be the person that maybe needs three or four years of paid care? You can never quite save the right amount.”

Opponents have also raised criticisms about the program’s individual maximum benefit amount of $36,500.

New points to estimates from the long-term care insurer Genworth, which finds that a year of 20 hours per week of help from an in-home health aide will cost about $48,867 in 2026 in Washington.

The company’s estimates for assisted living facilities that year are higher, ranging from $66,219 for a year in assisted living to $187,457 for a private room in a nursing home.

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Jim Walsh, a state representative from Aberdeen and the chair of the state’s Republican Party, who filed the initiative that would make the tax optional, said the maximum lifetime benefit is “not a meaningful benefit.”

“What it acts as is essentially a deductible, a separately funded deductible to long-term care which ultimately will still be provided by Medicaid,” he said.

To get the maximum benefit, which will be adjusted for inflation, a person has to work 500 hours a year for 10 or more years, without a gap of five or more consecutive years.

That requirement “is going to rule out some of the very caregivers that WA Cares claims it’s there to help,” New said.

Veghte said that lawmakers considered, but did not pass, a bill that would have removed that provision during this year’s legislative session, but there’s a “good chance” it could pass in future years.