Advocates for Elderly Succeed in Pushing for Nursing Home Insurance

By Nathan Guttman

Published December 23, 2009, issue of January 01, 2010.
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Jewish advocates for the elderly breathed a sigh of relief as both the Senate and the House of Representatives included a provision for creating a voluntary long-term care health insurance program in their respective versions of health care reform legislation.

The Community Living Assistance Services and Support Act, known as the CLASS Act, has been incorporated into the final health care reform bills now before both houses of Congress. It would allow people to buy into an insurance program that covers costs of long-term care and enables them to receive services in their homes and communities, mitigating the need to move to nursing homes.

For organizations that serve the Jewish community — which has a disproportionately large elderly population — the CLASS Act is seen as having great promise. It was a focus of Jewish lobbying efforts in recent months.

“This is the missing piece of health care reform,” said Rachel Goldberg, director of aging policy at B’nai B’rith International.

The CLASS Act, originally introduced by the late senator Edward Kennedy, would create a publicly sponsored national insurance trust that people can voluntarily buy into. The plan would not impose any medical screening, and premiums would be kept at an affordable rate. In case of disability or need for daily assistance, the insured would receive a cash benefit that can be used to pay for in-home care, day programs or nursing homes.

Opponents of the provisions of the CLASS Act have argued that it is yet another entitlement program which eventually would be funded by taxpayer dollars. Senator Kent Conrad, a Democrat from North Dakota, called the act “a Ponzi scheme from the first order.” Senator Lindsey Graham, a South Carolina Republican, criticized the measure and said it was the “most overlooked area” of the health care bill. Critics argue that although the insurance program created by the CLASS Act is fully funded by premiums, costs might balloon in the future, requiring government intervention. The nonpartisan Congressional Budget Office, however, found the plan to be fiscally sound for the next 75 years.

Jewish organizations have advocated vigorously for the inclusion of the CLASS Act in health care reform legislation. Although it drew relatively little attention in the broader reform debate, long-term care was a key lobbying point for service providers in the Jewish community, and specifically for two groups: the Jewish Federations of North America (formerly known as United Jewish Communities), which represents the interests of local federations that support nursing homes and provide services for the elderly, and B’nai B’rith International, which is the largest Jewish contractor for government-funded housing for elderly.

As part of a broader coalition with other elderly-issue advocacy organizations,

both groups have been active in lobbying congressional offices to ensure inclusion of the CLASS Act in the final health care reform legislation.

B’nai B’rith’s Goldberg said that elderly residents of the independent-living buildings run by her organization could benefit significantly from the plan, since it would allow them to receive services in their homes. “Our elderly residents want to stay in their apartments and not move to nursing homes,” she said.

Among the legislators lobbied by Jewish groups on the CLASS Act was Senator Joseph Lieberman of Connecticut. One of the key lawmakers opposed to the CLASS Act, Lieberman heard a plea from his state’s Jewish communal leadership during the November Capitol Hill missions that were part of the Jewish Federations’ General Assembly. Lieberman eventually voted to allow a vote on the Senate version of health care reform, which included the CLASS Act.

Being in both the Senate version and the House version of the health care reform bill gives the CLASS Act a good chance of making it through the conference process in which the two versions will be combined to one final bill. Advocates for the legislation in the Jewish community say that if passed, it will have little immediate impact on elderly members of the community, since the CLASS Act has a five-year waiting period before benefits can be used. The main target demographic of the legislation is baby boomers, who are still healthy enough to buy in and young enough to enjoy the benefits.

At present, according to advocacy groups working on behalf of the elderly, many view the purchase of private long-term care insurance as a luxury. It is low on the priority list for individuals under the age of 40 and unaffordable for older individuals because premiums tend to go up with any pre-existing conditions.

In many states, Medicaid doesn’t cover home care and Medicare has restrictions on use for long-term care at home. So for those without long-term care insurance, even a need for part-time home assistance can be out of reach and force patients to move to nursing homes.

“Rationalizing elder care financing is the single most important thing that can be done to sustain our community,” said Martin Goetz, CEO of the River Garden Hebrew Home, a nursing home in Jacksonville, Fla.

The nursing home run by Goetz houses 180 elderly residents. Goetz said that had the provisions of the CLASS Act been in effect years ago, it might have kept many of his nursing home’s residents out of the facility or postponed their entrance, since they would be able to afford assistance in their own homes. “The longer you can forestall the need to move and potentially avoid it, the better the people are,” he said.

Contact Nathan Guttman at

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