NCIL - The National Council on Independent Living

Clinton Proposes Agenda To Help Seniors And Their Families Afford Quality Long-Term Care
December 8, 2007 Source: Press Release, HillaryClinton.com

Today in Winterset, Iowa, Hillary Clinton outlined her long-term care agenda to ensure that seniors and people with disabilities can get the high-quality care they need to live with security and dignity. Clinton's plan includes a $3,000 caregiving tax credit, a doubling of the elderly standard deduction and a long-term care insurance tax credit so that millions of seniors and their families can afford care. She would also end insurance discrimination and focus on the quality of care, tripling the funding for nursing home ombudsmen, creating a national system of background checks for long-term care workers and requiring disclosure of poor-performing nursing homes.
"Our seniors are caught between the soaring costs of care, the desire not to be a burden to their families, and the fear of hurting themselves or others because they are living without the care they need," Clinton said. "It's time for a new beginning - and a new approach to helping Americans grow old with dignity. Our seniors deserve our love, our respect, and our care."

The group most likely to need long-term care - those 85 and older - will grow from 5 million in 2006 to 21 million by 2050, creating a sandwich generation of Americans who are caring for their parents and their children. In Iowa, over 15 percent of the population is 65 or older, and the state ranks second among the states for population above 85. The average out-of-pocket costs facing family caregivers is $5,500 a year, more than most spend on their own health care and entertainment combined. To meet this challenge and support seniors and the army of unpaid caregivers that support them, Clinton's plan provides more choices, greater access, and higher quality.

WHAT THE EXPERTS ARE SAYING ABOUT HILLARY’S PLAN:
John Rother, Director of Policy and Strategy, American Association of Retired Persons (AARP): "Senator Clinton's long-term care initiative is both innovative and responsive to the undeniable burdens chronically ill and disabled Americans of all ages and their families face. By focusing on patients, their family caregivers and the need to train and expand a high quality workforce, she’s prescribing a thoughtful solution to a problem that has gone unaddressed for far too long. We commend the Senator for putting it on the table and hope all other candidates will follow her lead."

Val J. Halamandaris, President, National Association of Home Care and Hospice: "Senator Hillary Clinton is to be commended for offering a bold long-term home care initiative which will help millions of infirm seniors and disabled persons preserve their health, independence and freedom. For too long there has been little help for infirm seniors and disabled persons who suffer from complex medical problems. Her proposal addresses the problems they face every day. It should be obvious to everyone that this is but a harbinger of the great things she will achieve on behalf of the most vulnerable Americans."

Larry Minnix, President and CEO of the American Association of Homes and Services for the Aging: "I applaud Senator Clinton for highlighting the important issue of long-term care during the Presidential campaign. This is an issue that voters overwhelmingly care about and one which deserves serious national dialogue. Family caregivers are the cornerstone of long-term care in our country and greatly need financial assistance to continue providing care. Senator Clinton's proposal to improve the workforce by offering new resources to states to design and implement initiatives aimed at attracting new individuals into the long-term care field and improving their training and performance is essential to ensuring that our country has an adequate workforce that can accommodate the needs of our nation's growing senior population."

HILLARY CLINTON’S LONG-TERM CARE AGENDA
Supporting Seniors With Long-term Care Needs, and The Invisible Army of Caregivers that Support them:

Helping the Elderly Prepare for Long-term Care Needs by Making Long-Term Care Insurance More Secure and Affordable:

DETAILS OF HILLARY CLINTON’S LONG-TERM CARE AGENDA

Supporting Seniors With Long-term Care Needs, and The Invisible Army of Caregivers that Support them:
Enacting a new $3000 Caregiving Tax Credit: Ninety percent of all long-term care received is informal, primarily provided by spouses and adult children. Overall, as many as 52 million Americans are informal, un-paid caregivers. Many are in the so-called sandwich generation, playing dual caregiving roles as "working parents" and "working children" for their own parents as well. According to a new study by the National Association of Caregiving, the average out-of-pocket costs for long-term caregiving, usually by a spouse or a child, is $5,531 - more than double previous estimates. That is more than 10 percent of a typical caregiver’s salary and more than what most Americans spend in a year on their own health care and entertainment combined. Many caregivers meet this financial burden by dipping into their retirement savings or forgoing their own personal health care.
To ease this financial burden, Hillary is proposing a new $3000 Caregiving Tax Credit. This new partially refundable tax credit will be available to any person with substantial long-term care needs or to their caregivers (the credit would be phased out for couples earning more than $150,000). The credit will not require a complex accounting of out-of-pocket costs, but instead would be available directly to any individuals with substantial long-term care needs or their caregivers. The credit will offer generous assistance to more than 3 million seniors and their families, and also to more than a million families with children and young adults with long-term care needs.

In addition, Hillary will invest more than $300 million per year in stepped-up state support for unpaid family caregivers. Providing temporary relief for these caregivers helps keep families together and healthy while also saving money that would otherwise be spent on institutionalized long-term care services. As President, Hillary will ensure that caregivers have support by fully funding the Lifespan Respite Caregiver Act at about $60 million per year ($300 million over 5 years), and doubling funding for the National Family Caregiver Support Program to $250 million per year.

Allowing more seniors to access long-term care services where and when they need it, including in their homes: Our current long-term care system is biased towards institutional care, even though many seniors would prefer the opportunity to remain independent and stay in their own homes and communities for as long as they are able. To address this problem, Hillary will:

Doubling the elderly standard deduction to provide additional financial relief for 11 million elderly taxpayers: To help offset the growing financial burden of long-term care—as well as prescription drugs and other health needs—Hillary will provide additional tax benefits to the elderly. She will double the additional standard deduction available to elderly taxpayers, which would provide tax benefits to at least 11 million seniors.

Supporting the Elderly Prepare for Long-term Care Needs by Making Long-Term Care Insurance More Secure and Affordable:
Our long-term care infrastructure affects not only those with long-term care needs, but all Americans who wish to plan ahead for such an eventuality. For some, long-term care insurance can play an important role in safeguarding their future health, well-being, and financial security. But Hillary believes we need to do more to ensure that long-term care insurance provides real security and support, not false hope that falls short when seniors need it most. This issue is particularly important in Iowa, which has the 4th largest market penetration in long-term care insurance, with as many as 124,000 Iowans holding current policies. Therefore, as President, Hillary will take aggressive steps to increase consumer protections for long-term care insurance policies, alongside efforts to increase the affordability and access to high-quality long-term care insurance, by:
Requiring strong new consumer protections for long-term care insurance: When long-term care insurance is revealed as a false promise, it hits seniors at their most vulnerable moments, threatening health crises and financial devastation for entire families. It also increases costs for taxpayers, as the burden is shifted onto Medicaid, which already devotes 40 percent of its spending to long-term care. And it threatens to destabilize nursing homes and hospitals that rely on the stability of revenue from their patients to engage in long-term planning. As President, Hillary will require that all long-term care insurance companies that receive federal tax preferences abide by the National Association of Insurance Commissioners (NAIC) 2006 Model Regulations, including a requirement that insurers offer nonforfeiture benefits and inflation protection. She will also outlaw discrimination based on pre-existing conditions in long-term care insurance policies. Hillary will also:

Allowing consumers to purchase the same secure long-term care insurance policies that members of Congress have access to: Hillary will give all American access to same type of long-term care insurance options that federal employees currently have. This approach will increase choice and offer more secure and affordable options for those who are interested in purchasing long-term care insurance. Plans offered through this option would include a robust set of consumer protections similar to those offered through the existing federal plan. They would also be affordable. The Government Accountability Office recently found that the federal program offered annual premiums that were 46 percent lower for single people and 19 percent lower for married couples than five major private insurance suppliers.

Providing a new Long-Term Care Insurance Tax Credit to make secure insurance plans affordable: Once she has secured strong new consumer protections in the long-term care insurance market, Hillary will offer a new tax credit to help those planning for retirement be able to afford high-quality insurance policies that are right for them. This new tax credit will cover 75 percent of long-term care insurance premiums up to $1500 per year for qualified long-term care insurance policies that would meet the new consumer protection requirements (the credit would be phased out for couples earning more than $150,000). The credit will reward middle-class families who take steps to prepare for their long-term care needs, and put qualified insurance in reach for many middle-class families.

Protecting our Seniors By Improving the Quality of Our Nursing Homes
While the majority of the nation’s nursing homes provide quality care to their residents, when persistent quality violations go unaddressed and when our seniors are subjected to unconscionable neglect, it erodes confidence in the system and makes it more difficult for all operators to function effectively. And sadly, the problem of poor nursing home quality extends far beyond the list of 54 under-performing nursing homes that the Centers for Medicare and Medicaid Services has recently released. In 2006, nearly one in every five nursing homes that received federal funds was cited for serious deficiencies in care. And from 2000-2005, nearly half of the 63 nursing homes that regulators had identified as having an established history of serious medical deficiencies continued to repeatedly fail federal requirements and still receive federal funds.
These severe, and often long-standing, quality violations are more than a regulatory problem. They offend our solemn commitment to ensure that seniors live in dignity and security. Our seniors deserve better. That is why Hillary will take aggressive steps to improve quality in our nation’s long-term care facilities by:

Tripling Federal Support for Nursing Home Ombudsmen Programs to Protect Consumers of Long-Term Care: Effective ombudsmen programs are crucial to combating fraud and abuse in the long-term care industry. Ombudsmen are on-the-ground and act solely on behalf of nursing home residents to monitor quality: identifying and investigating complaints, providing information, monitoring regulations and participating in resident advocacy organizations. However, ombudsmen programs such as Iowa’s are struggling to meet the many new challenges that nursing home residents face. Currently, the Iowa program ranks last among the 50 states in the number of ombudsmen per nursing home facility beds. Yet while Iowa has been making progress in strengthening its ombudsman program, the office still faces many new challenges. As President, Hillary would triple federal support for state ombudsman programs to $50 million per year. The increased resources will strengthen the capacity of ombudsmen to vigorously investigate complaints and offer new training programs on emerging issues like complex insurance fraud and the purchase of nursing homes by private equity firms.

Directing the Department of Justice and the Federal Trade Commission to Assist State Consumer Advocates and Prosecutors to Tackle New Challenges to Long-term Care: For the past year, Hillary has been raising concerns about the new regulatory challenges that we face in long-term care. Earlier this year, Hillary called for the Government Accountability Office to investigate the unconscionable mistreatment of seniors who have purchased long-term care insurance by their insurance providers—many of whom were systematically denying benefits while forcing steep premium increases. And in October, Hillary called for an investigation into whether nursing homes with new hybrid ownership structures—created in many instances by private investment groups—were evading regulators for quality violations and sub-par standards. As President, Hillary will direct the Department of Justice and the Federal Trade Commission to lend their consumer protection prosecution expertise to state regulators who are struggling to tackle these new and complex challenges. State regulators need sufficient information and sophisticated tools to effectively police nursing homes and insurance carriers, and as President, Hillary will ensure they have the support they need.

Reversing CMS’ Inexcusable Policy and Giving Seniors Full Access to Usable Data on Nursing Homes, including Data on Nursing Home Ownership Structures: Choosing a nursing home is one of the most important life decisions a senior and their family makes. When seniors and their families are empowered with information, they become not only effective consumers but effective regulators in the nursing home marketplace. But the federal government needs to do far more to ensure that seniors and their families have the information they need to make informed choices. As President, Hillary will direct CMS to release all information on the designations it makes about the quality of nursing home facilities. CMS’s unwillingness to freely and openly share its full list of 128 underperforming nursing homes is inexcusable, and must be reversed. Hillary will direct CMS to provide on the Nursing Home Compare website accurate, up-to-date data on nursing home staffing levels; the full—not just abridged—reports from inspections and complaint investigations; and any and all information about repeat offenses that CMS compiles. Finally, CMS should compile and post clear information about the ownership structures of long-term care facilities--so seniors can know who is in charge of the facilities they live in.

Strengthening our nursing and direct care workforce with a national system of background checks for long-term care workers and a $125 million in Workforce Improvement Grants: While thousands of long-term care professionals provide admirable care to our elderly every day, abuse and neglect of our seniors in long-term care is on the rise. As President, Hillary will combat this abuse with a nationwide system of state criminal background checks for long-term care workers. In addition to ensuring our long-term care workers are qualified, Hillary will also ensure that we have a strong well-trained long-term care workforce. She will invest an additional $125 million per year to improve recruitment and retention of health and direct-service professionals and provide greater consumer choice. The new investment will: 1) provide grants to states to adopt and expand successful organizational models for workforce tracking and coordination, including the development of worker registries through a new directed spending program; 2) make federal funding available to states, in partnership with local organizations, to develop a credentialing programs for direct support professionals (where as a condition of receipt of grants, states must collaborate with state universities and community colleges to allow credentialing program to count as college credit); 3) provide grants to states to encourage the expansion of successful agency models of care that give seniors and individuals more direct control over the services they receive and the people that provide them.

A COMMTIMENT TO FISCAL RESPONSIBILITY: The total cost of Hillary Clinton’s long-term care agenda is approximately $5 billion per year. Hillary will finance this cost without increasing the deficit by dedicating the revenue from closing two ineffective provisions in our tax code. First, Hillary will close the loophole that allows hedge fund managers to use offshore tax havens to defer paying taxes on their compensation. Second, Hillary will repeal the provision in the 2004 JOBS Act which allows U.S. Corporations to gain tax benefits from their foreign assets by allocating interest on a worldwide basis. (Enacted in 2004, this provision has yet to take effect.)

Hillary Clinton Statement on Backlogs in the Social Security Disability Insurance System

"Today’s front-page New York Times story highlighting the human toll of the growing backlogs in our Social Security Disability Insurance system is a stark reminder that Congress and the President must act immediately to address this problem. I have for several years been calling on this Administration to adequately fund the Social Security Administration to ensure that people with disabilities and retirees can access the benefits they deserve. But the President has been more interested in spending $10 billion a month on a misguided war in Iraq and tens of billions each year in tax cuts for the wealthiest Americans than in funding key services for our most vulnerable citizens. As a result, the average delay for individuals seeking an appeal from a disability determination has doubled since 2000 to more than 500 days.

"The President’s recent veto of additional funding for the Social Security Administration signals an unacceptable willingness to let this problem continue to grow. His veto will leave hundreds of thousands of Americans with disabilities to suffer and even die without our support. That’s why today I wrote the President urging him to reconsider his veto threat. I asked the President to make immediately clear that he will support the needed funding increase for SSA, and will sign it into law. I hope the President heeds this advice. But if he fails to act, then as President I will act immediately to address these growing backlogs, and ensure that the SSA has adequate support to serve Americans in need. People with disabilities and retirees deserve a President willing to stand up for their interests and ensure that government is delivering "not denying" them the support they need. I intend to be that President."

On the eve of the 17th Anniversary of the Americans with Disabilities Act (ADA), Hillary Clinton wanted to celebrate the significant progress that has been made since this landmark law was enacted. The nation has dramatically improved the accessibility of the built environment and the telecommunications infrastructure. But there is still have a long way to go. That is why today Hillary Clinton is unveiling a new set of proposals to empower people with disabilities for the jobs, work and careers they aspire to.

The United States will only reach its economic potential if it ensures that people with disabilities have the full opportunity to reach their potential. Americans with disabilities have half the employment rate and double the poverty rate of individuals who do not have disabilities. Even those people with disabilities who graduated college work at only two-thirds the rate of college graduates without disabilities. Hillary Clinton believes we must shift our orientation towards a new approach that helps those with disabilities thrive and reach their potential in the workplace, community and nation.

This agenda builds on Hillary Clinton’s record on issues important to people with disabilities. From her support for programs that promote access to long-term support services to providing universal health care, Hillary Clinton has been a longtime champion of policies and programs that help people with disabilities live full and rewarding lives.

Hillary Clinton’s work opportunity agenda for persons with disabilities is the start of an ongoing dialogue with the disability community. This dialogue will continue on campaign trail and when she’s in the White House. She wants to reach a point so that on future anniversaries of the ADA instead of lamenting the lack of progress on employment and economic opportunity, we can celebrate together the vast strides we’ve made together. The ADA’s promise of full and meaningful participation is not going to be realized as long as we have a bias towards institutionalizing people. That is why Hillary is a proud co-sponsor of the Community Choice Act and why today - in honor of the 17th anniversary of the ADA - she is proposing an economic opportunity agenda for all persons with disabilities. As President, Hillary Clinton will:

Promote innovative employment strategies for people with disabilities
Too many people with disabilities are being held back from obtaining good, high-paying jobs in our economy because employers are unwilling or unaccustomed to work with them. In addition, while states and cities throughout the United States have pioneered programs that help individuals with disabilities connect to high-paying jobs, these programs remain localized and poorly funded. As President, Hillary will help individuals acquire work-enabling technology and work with employers to ensure they recognize the economic potential of providing more accommodating work environments. She will dedicate $100 million towards innovative initiatives that increase the proportion of people with disabilities in the workforce by:
- Doubling Funding for Assistive Technology Loan Programs. Assistive technologies should be affordable to all people with disabilities who need them. Expensive loans that weigh down people already struggling are not the answer. Hillary will double loan programs that enable people to purchase assistive technologies and support state initiatives like the Virginia Assistive Technology Loan Fund Authority, which has helped Virginians of all income levels (including SSI and SSDI recipients) to access low-interest loans to purchase equipment like wheelchairs, Braille equipment, hearing aids, low vision aids, and communication systems. To ensure that financing such technology is never an undue burden on the work aspirations of people with disabilities, Hillary Clinton will require an income-contingent option that never requires more than a modest percentage of one’s income for repayment.
- Providing More Technical Assistance for Employers. Many employers are hesitant to hire people with disabilities because they are unsure about the accommodations necessary to enable successful work. President Bush has not kept his promises to fund programs that remove employment barriers that keep people with disabilities from work. He has cut funding for the Office of Disability Employment Policy by 41%, and his current budget proposes to cut the Office by an additional 34%. As President, Hillary Clinton will restore funding to the Office of Disability Employment Policy, with an emphasis on giving employers the tools to effectively employ people with disabilities. She will establish a new technical assistance resource center to provide real-time support for employers and help them link with local resources to implement workplace accommodations.
- Expanding Innovative State and Local Job Connection Strategies Hillary Clinton will bolster employment for people with disabilities by providing federal challenge grants to expand and replicate innovative state and local strategies such as Maryland’s Reach Independence Through Self-Employment (RISE) program that has trained over 1,000 people with disabilities on developing business plans and has supported the launch of over 30 businesses across the state of Maryland with loans of up to $15,000.
Re-establish the Clinton Administration executive order to hire 100,000 qualified employees and make the federal government a model of accessibility
During the Bush administration, the federal government has failed to make jobs or information technologies fully accessible for people with disabilities. In her first month in office, Hillary Clinton will review all federal websites to ensure they are accessible. She will also re-establish Executive Order 13163 to hire 100,000 qualified employees with disabilities to federal employment over five years.
Enact a $1,000 refundable worker with disabilities tax credit
Workers with disabilities face extra costs for accessible technologies, transportation, and support service workers. These additional expenses amount to a regressive tax for workers with disabilities, so the federal government must work to offset these costs. Hillary Clinton proposes a $1,000 refundable tax credit to help offset additional expenses for workers with serious disabilities and moderate incomes.
Reduce disincentives to work in federal benefits programs
People with disabilities can lose their Social Security Disability Insurance, Supplemental Security Income, Medicare, and Medicaid benefits when they work for even a meager income. The Clinton administration took important steps to address this problem by enacting the Ticket to Work and Work Incentives Improvement Act. As a result, 31 states have enacted policies to reduce the disincentives to work. That represents significant progress, but state policies are still uneven. Some states place limits on unearned income with respect to enrollment. Others require persons with incomes above specified levels to pay premiums. And still others fail to provide enrollment protections for individuals who lose employment while participating in the Medicaid Buy-In program. In addition, when an individual who is covered by the buy-in is moves to another state that has not taken up the buy-in option, they lose their coverage and incentive to stay employed. As President, Hillary will further break down the disincentives to work in our public programs by:
- Equalizing Cost Sharing Treatment by Applying More Favorable SCHIP Cost Protections to Medicaid Buy In. States frequently charge burdensome premiums and co-pays for coverage under the Medicaid buy-in for working individuals with disabilities. The cost of tStates frequently charge burdensome premiums and co-pays for coverage under the Medicaid buy-in program for working individuals with disabilities. The cost of that coverage can be unaffordable for working individuals with disabilities. To make health care more affordable for working parents of children, the federal government has limited the premium and cost-sharing amounts under the State Child Health Insurance Program (SCHIP) to 5 percent of family income. This proposal would limit premiums and cost-sharing for individuals buying into Medicaid to the same percentage of family income - creating parity between the two programs.
- Eliminating Medicare Eligibility Time Limit. An individual with disabilities who is eligible for Medicare can continue working and retain Medicare coverage for a time-limited 8½ years. Hillary would eliminate the time-limit, allowing individuals to continue to work as long as they are able, and still retain Medicare eligibility.
- Conducting a National Review. Hillary will also ask top government officials to work with health, retirement and disability experts to review and make recommendations on how work disincentives can be eliminated from major federal programs such as SSDI, SSI, Medicare, and Medicaid eligibility. This review will develop recommendations to eliminate inconsistencies across states and will require HHS to release a best practice report that will make explicit recommendations to reduce disincentives to work.