What Biden’s latest rebuilding plan means for the elderly

President Biden’s $ 1.7 trillion social spending and tax plan Build Back Better keeps significant benefit increases for Medicaid long-term care recipients as well as those enrolled in Medicare. But he cuts more ambitious initiatives and abandons an earlier proposal for family and medical leave.

Here are the key elements of the plan, which will likely change as it travels through Congress.

Health Insurance : Senator Bernie Sanders and many progressive Democrats wanted to expand traditional fee-for-service medicare to cover dental, vision and hearing care. But Biden’s new plan would add hearing-only coverage. Combined with recent regulatory changes allowing over-the-counter hearing aids, this step could significantly improve the quality of life for many hearing-impaired seniors, including half of those over 75.

However, abandoning the provision on dental coverage is a missed opportunity. Dental coverage is sometimes available through Medicare Advantage managed care plans, which now cover about 40 percent of Medicare registrants. Adding Medicare dental coverage would be expensive, but about half of seniors have no coverage today and half have not seen a dentist in the past year.

Medicaid: Biden’s new plan would provide about $ 150 billion in new federal funding for Medicaid’s home and community services (HCBS), up from $ 400 billion in his original proposal. It would also make permanent a program called Money Follows the Person which helps nursing home residents return home. While this program primarily benefits young people with disabilities, it also helps some residents of nursing homes for the elderly.

Biden’s plan would also improve quality measures for home care and protect the spouses of those receiving Medicaid HCBS benefits from impoverishment.

An additional $ 150 billion federal contribution to Medicaid’s HCBS program would be significant. This would go a long way from providing Medicaid recipients the level of long-term care they need. Even Biden’s original plan to increase the federal payment by $ 400 billion over eight years would not have done this. But an increase of $ 150 billion would be another big step forward that could increase benefits for current home care recipients or help remove others from home care waiting lists.

Paid family leave. The Biden plan completely abandons this initiative. The president had initially proposed 12 weeks of paid vacation. Faced with opposition from Sen. Joe Manchin (D-WV) and others, lawmakers have tried to cut it down to four weeks. But, ultimately, Biden withdrew the proposal.

The only good news is that a number of states have passed their own paid family leave laws. Some supporters of family leave may count on other states to follow suit, making a federal law less important. But Congress’ failure to pass a national measure would be a huge disappointment for family caregivers.

Workforce Development. Biden’s plan also includes around $ 1.5 billion to support direct care workers and encourage more people to enter the profession.

Child Care and Dependents Tax Credit (CDCTC). The US bailout package that Congress passed in March greatly expanded that credit. It primarily benefits families with young children in day care, but under certain circumstances it can be used by adult children of frail parents. Biden originally wanted to make the more generous credit permanent. But this provision was also removed and the extended credit would expire at the end of the year.

Public long-term care insurance. While a bill was introduced in Congress, this idea was never successful. One reason: Biden has vowed to never raise taxes for those earning $ 400,000 or less, and public insurance would be funded by a small increase in payroll taxes for all workers.

But that leaves a significant gap in federal support for long-term care. While Biden’s proposals would help those on Medicaid, it would do nothing for the millions of older adults and young people with disabilities who are not impoverished enough to become Medicaid eligible, but who do not have the resources to. get the care they need.

Many defenders will be disappointed with Biden’s plan. Yet his proposal would be the biggest boost in federal support for long-term care in decades.

If Congress passes this package, it would only be a first step. The biggest challenge will then be to convince lawmakers that their job is not done. Much more will still need to be done to ensure that seniors and young people with disabilities get the supports and services they need to live the best possible lives. And, no coincidence, to save the system billions of dollars by avoiding costly emergency room visits and hospitalizations.


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