Show some CLASS

by Harold Pollack | October 21, 2009

Harold Pollack is a professor at the University of Chicago School of Social Service Administration and Special Correspondent for The Treatment.

Imagine that you walk outside your home one rainy morning to get your morning paper. You slip and fall on your slippery front steps, breaking your back and suffering irreparable spinal cord damage. Even if you have perfect medical insurance, you would quickly discover that you would need a lot of help. You might need a home health care aid. You might need ramps and equipment for your house, a handicap-accessible van. You might easily deplete your assets buying these goods and services. You might have to, if you end up in an institution or on Medicaid.

If falls and related mishaps such as car crashes don’t scare you, move the film forward a few decades. You are now caring for a spouse experiencing increasing cognitive difficulties, and everything that entails. You are trying to make this work without going crazy or going broke, without depleting the assets of a lifetime you hope to leave for your kids.

Every day, disabled people and their loved ones navigate such financial and logistical challenges. Many of these issues have been neglected in this year’s health reform debate. Candidate Obama supported full-funding for the Community Choice Act (CCA), an important but potentially costly measure. That IOU remains unpaid. Whatever happens in the 2009 health reform, millions of people living with disability will remain subject to the difficulties and indignities that accompany means-tested public aid.

The Senate HELP bill does include one important measure called the Community Living Assistance and Social Support (CLASS) Act. Championed by the current HELP chairman Tom Harkin and by the late Senator Edward Kennedy, CLASS is a voluntary insurance program for adults to address key problems associated with disability. It would be financed through monthly insurance premiums. Qualifying beneficiaries would receive a cash benefit paid into a Life Independence Account. The benefit would vary with disability, but would exceed $50 per day and would be sheltered from Medicaid asset tests. These funds could be used:

to purchase nonmedical services and supports that the beneficiary needs to maintain his or her independence at home or in another residential setting of their choice in the community, including (but not limited to) home modifications, assistive technology, accessible transportation, homemaker services, respite care, personal assistance services, home care aides, and nursing support.

CLASS would make a big difference for many people, maybe for you or someone you love. It would make it easier to stay off Medicaid and out of an institution, and it would cover many expenses that disabled people and their caregivers often bear on their own.

CLASS is now on the chopping block in Senate negotiations. The Finance Committee chose not to include CLASS in their version of health reform. So the outcome remains in doubt. CLASS is contained in the House bill, and has significant political momentum behind it, including support from AARP, disability rights groups, and many others.

Ironically, CLASS also gains a political boost because it improves the 2010-2019 budget numbers, contributing an estimated $58 billion in net revenue over this period. As the Congressional Budget Office explains, this apparent surplus is actually an artifact of a new insurance program. Participants must contribute premiums for five years before they are eligible to collect benefits. That $58 billion will be needed in the following decade to finance benefits once CLASS is operational. There is some poetic justice in this. Arbitrary budget accounting rules hinder many progressive health efforts. This once, anyway, the arcane budget rules have the opposite effect.

Like the Americans with Disabilities Act that came before it, CLASS is an imaginative response to the practical challenges disability poses. It arises from a long history of experiments and policies in home health care, “cash and counseling,” and other approaches to the complicated dilemmas disability can pose. No one can confidently predict CLASS’s full impact, financial or otherwise. Alongside some other unsung pertinent provisions in health reform this year, it is a humane and sensible proposal that promises to keep many people from spending down onto Medicaid, and that promises to help others stay in the family home.

Apparently this Thursday, the Senate will combine the Finance and HELP bills, in preparation for the historic floor debate. CLASS won’t make or break health reform. It won’t markedly change the budget numbers in the final bill. It will make health reform a little bit more worthy of signing. In a season of necessary but unpalatable compromises, this is no small thing.

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