Letter in Support of Home and Community-based services for Long-term Care by the ISPC People with Disabilities Committee

January 2024

Dear Medicare for All Supporters:

The People with Disabilities Committee of the Illinois Single Payer Coalition is sharing our concerns by circulating this open letter to the supporters of Medicare for All.

We have been very vocal about the need for all universal single-payer bills to include the universal support of all necessary long-term care services. To be clear, we strongly advocate for a preference for Home and Community-Based Services as the best option to serve most seniors and people with disabilities who need long-term care over institutional placement. Home Care is the preferred option for a high percentage of seniors and people with disabilities who need personal care.

We see significant differences in what the current House of Representatives bill [1] and the Senate bill [2] cover in long-term care.  The Senate bill leaves out funding for most nursing home care. It gives that responsibility to state-operated Medicaid programs to fund this care. All other Medicaid services would be moved to the national Medicare for All program with this glaring exception.  Medicaid does not have a good history of quality care in nursing homes. Medicaid has gaps in long-term care coverage that vary by state.  We believe all long-term care needs must be included in a Medicare for All bill.  We support the House bill as the one that will address all long-term care needs and that recognizes long-term care as essential health care. 

Here are some reasons that our universal health care system should cover all medically necessary care.

1. Aging population: The United States has an aging population, with the number of elderly individuals projected to nearly double by 2050.  There are large gaps in the provision of adequate paid home care services for people with disabilities by states. As people age, they usually require more long-term care services, such as assistance with daily living activities, home health visits, or community health care.  Universal coverage for long-term care ensures that the growing elderly population and people with disabilities have access to the care they need without facing financial hardships.

2. Financial burden: Long-term care services are extremely expensive, particularly for lower-income individuals or those without sufficient insurance coverage. Many Americans have exhausted their savings to pay for long-term care services, leaving them financially vulnerable. Universal coverage mitigates this burden by ensuring that everyone has access to these services without facing exorbitant costs.

3. Improved quality of life: Long-term care services play a crucial role in supporting individuals' health and overall quality of life. By providing universal coverage you provide consumer choice to meet the diverse needs that may fall under long-term care and thus better meet individual needs.  We know many people have died due to low quality of care and abuse particularly in for-profit nursing homes before and during COVID.  Federal funding could be a way to better regulate and monitor these settings.  We know that a significant majority of individuals support home and community services and independent living over institutions but we see the need to cover the entire spectrum of care needs. 

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1. The Medicare for All Act 2023, House, H.R. 3421;
2. The Medicare for All Act 2023, Senate, S. 1655.