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Americans Want Government To Help Them Age At Home, Buttressing Biden’s Medicaid Long-Term Care Agenda

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A new public opinion survey shows broad bipartisan backing for more public support for long-term care, especially at home, even as congressional Republicans appear to be lining up against the idea.

According a  new survey by The Associated Press-NORC Center for Public Affairs Research, 63 percent of respondents say government should support programs to help low income people receive supports and services at home. At least in concept, this idea is similar to the $400 billion expansion of Medicaid home-based long-term care recently proposed by President Biden.

But other forms of government support for long-term care also have strong public backing. Seventy percent of respondents favor government long-term care coverage through Medicare and 60% favor a government-administered long-term care insurance program.

Even some support among Republicans

While each of these ideas has overwhelming support among Democrats and majority backing of independents, even many Republicans favor a larger government role. Sixty-five percent support a Medicare long-term care benefit, either through Medicare Advantage managed care plans or though Medicare Supplement (Medigap) policies. Forty-nine percent  favor government  support for low-income people getting long-term care at home, and, remarkably, 42 percent of Republicans back a public long-term care insurance program.  

The survey finds that Americans overwhelmingly want to age at home. Consistent with prior surveys, nearly nine of every 10 people questioned want to get care in their own homes. And due in part to the pandemic, respondents continue to be wary about long-term care facilities. A third would be very or extremely concerned about a loved one receiving short-term rehabilitation in a nursing home and an even higher 44% worry about long term care in a nursing home

This actually is good news for facilities: Those fears have dropped significantly since last September, when 81 percent worried about a short stay and 87 percent were concerned about long-term care in a nursing home.

Despite the strong desire of respondents to age at home and despite the public’s strong support for government assistance, congressional Republicans seem to be lining up against Biden’s plan to increase Medicaid funding for home-based long-term care.

McConnell: “No.”

Senate Republican Leader Mitch McConnell says “no” Senate Republicans will back Biden’s massive $2.2 trillion infrastructure bill that includes the Medicaid provision. While McConnell did not specifically criticize Biden’s long-term care plan, he made it clear that his focus is on roads and bridges, not government support for families.

“We’re open to doing a roughly $600 billion package which deals with what all of us agree is infrastructure,” McConnell said. “If it’s going to be about infrastructure, let’s make it about infrastructure.”  

This puts some Senate Republicans in an awkward spot. For example, Maine’s Susan Collins represents a state that has the oldest average age in the country and the third largest share of residents over age 65. About 29 percent of those older residents are low-income.  Yet Collins, a long-time member of the Senate Aging Committee, McConnell appears to be including her among the no votes.

How far will Biden go?

Biden has been counting on this split between Republicans in Congress and voters—even GOP voters—to get some bipartisan traction for this ambitious domestic policy. Yet McConnell remains resistant—not only to expanding Medicaid long-term care but other Biden proposals such as paid leave for family members caring for older adults and younger people with disabilities, and increased funding for Older Americans Act programs such as Meals on Wheels.

Many congressional Democrats want to go even beyond Biden’s agenda. For example, Senate Aging Committee Chair Bob Casey (D-PA) and Rep. Debbie Dingell (D-MI) are circulating a bill that would make Medicaid home-based long term care a federal entitlement.

But it is not clear how far Biden will go. He could try to reach agreement with the GOP on a bipartisan infrastructure  bill that almost certainly would exclude the Medicaid long-term care provisions. If he does, he could either drop the Medicaid reform entirely or, more likely, try to include it in a second bill that would have to pass with only Democratic votes.

A key vote in that scenario would be West Virginia Democrat Joe Manchin. West Virginia has the second largest share of residents over age 65, about 45 percent of them have a disability, and one-third are receiving Medicaid assistance for long-term care.

The AP-NORC survey, funded by the SCAN Foundation, is an important snapshot of attitudes of older adults about long-term care. Given the priority that Biden is giving to aging issues, the results may be especially critical this year.

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