Incorporating Long-Term Services and Supports in Health Care Proposals

Research Report

Incorporating Long-Term Services and Supports in Health Care Proposals

Cost and Distributional Considerations
May 29, 2020


Recent health care reform proposals have included coverage for long-term services and supports (LTSS), reflecting a fundamental change in the way many policymakers discuss health care. To inform broader discussions of these health care reform proposals, we project costs and distributional effects for three stylized proposals for public LTSS benefits. Each proposal would significantly expand the public role in financing LTSS relative to current law. All proposals would have broad eligibility criteria and generous benefit packages, consistent with recent proposals for single-payer health care plans, and would address family burdens and care inadequacies under current law. Our stylized scenarios are intended to represent some proposals’ intentions without exactly matching any specific proposal. Given the lack of precedent for these proposals, we present ranges for our projections to underscore their uncertainty and dependence on assumptions. We find that single-payer LTSS program are likely to significantly expand the availability and use of paid care. Benefits would alleviate caregiver burdens, enabling families to more easily balance paid employment and care responsibilities, and reduce families’ out-of-pocket costs and unmet need. State budgets could benefit from a single-payer LTSS program, which would reduce the substantial inequities that now exist across states. Federal LTSS costs could increase by hundreds of billions of dollars each year.

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