Support long-term care services in the New York Health Act

Nursing home care.
Nursing home care.
Dmytro Zinkevych/Shutterstock
Nursing home care.

Support long-term care services in the New York Health Act

Medicare doesn’t cover long-term care for the elderly and disabled. The state should.
March 6, 2019

New York’s health care system is failing the people who need it the most. But, with the reintroduction of the New York Health Act this session, Assemblyman Richard Gottfried, state Sen. Gustavo Rivera and advocates statewide have shown how it can be changed. While this bill to implement a single-payer health care system in New York has been around for years, this year’s reintroduction includes a critical new amendment to include comprehensive long-term care services. With this amendment, the state Legislature has an opportunity to protect the health of all New Yorkers and curb costs – especially for seniors and people with disabilities who desperately need the improved long-term care access that the bill would provide.

A patient of one of ours, Samuel (his name has been changed for confidentiality), was a classical music aficionado, an immigrant and a New Yorker. Sitting by his hospital bed, his wife shared stories of their trips to the orchestra but could not conceal worries about what comes next. Bedridden with dementia, he was too ill to continue living at home without professional care. Hiring a home health aide was the preferred option, but a nursing home would have been another medically acceptable choice. Unfortunately, when navigating long-term care services, patients like Samuel frequently choose not what is best medically, but what is most affordable. In his case, neither option was, despite his Medicare coverage and moderate life savings.

Long-term care includes the range of services a person needs if they cannot perform everyday tasks due to a chronic illness, physical or cognitive disability, injury or aging. These services have long been unaffordable, often ignored, challenges for those that need them. The average annual cost of care in a nursing home ranged from $120,816 in Central New York to $160,884 on Long Island in 2017. The cost of hiring a home aide for just four hours a day, five days a week can cost more than $22,000 per year.

While Medicare has served many well since it was introduced, it leaves our middle-class and low-income aging and disabled communities behind. Despite misconceptions, long-term care services are not covered. Medicare will cover “skilled nursing” for brief periods following hospitalizations, but with conditions like dementia that worsen over the years, benefits run out quickly. This forces families to forgo needed support or spend down life savings until they qualify for Medicaid, which will cover some long-term care.

This lack of long-term care coverage also forces loved ones to leave work to provide care. In New York alone, approximately 2.58 million unpaid family caregivers provide 2.4 billion hours of care annually. This burden is distributed inequitably. Two-thirds of the caregivers are women. On average, African-American caregivers spent 34 percent of their annual income providing caregiving services. Hispanic and Latino family caregivers spent 44 percent.

Ultimately, our dismal long-term care system forces a choice – between family and career, between health care and poverty – that nobody should have to make. Other developed countries recognize this and provide long-term care coverage. New York should do the same.

“Health care for all” has become a rallying cry for people in this country. At its heart is the movement for “Medicare for all,” the popular term for a single-payer health insurance program. Thanks to advocates, the “Medicare for all” movement is beginning to respond to calls for improved long-term care services. Like the New York Health Act, H.R. 676, the national single-payer bill sponsored by Rep. Pramila Jayapal of Washington’s 7th Congressional District, also covers universal long-term care.

Of course, covering long-term care nationally, and in New York, would not be free. Coverage funded under the New York Health Act would be covered through a graduated tax on income, based on the ability to pay. These taxes do not represent completely new funding – rather, they replace billions in current private and public spending on insurance premiums, deductibles, out-of-pocket costs, and copays. In addition, a recent study showed that over time, the costs of long-term care would be almost entirely offset by the savings generated by a single-payer health care system.

In addition to providing universal, comprehensive health coverage, the reintroduced New York Health Act would ensure that seniors and New Yorkers with disabilities get the long-term care they need without going bankrupt. By doing so, it would provide New Yorkers the freedom to continue living their lives the way they choose. For Samuel, we imagine that would be at home, surrounded by his wife, kids and the sound of classical music.

Alec Feuerbach
is a medical student in New York City and the 2018-19 student fellow for the Physicians for a National Health Program (PNHP) – New York Metro Chapter.
Winn Periyasamy
is a policy analyst and PNHP – New York Metro Chapter board member. Her writing has appeared in the Guardian, Muftah Magazine and more.
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