Americans Over 40 Think Medicare Should Pay for Long-Term Care

Growing numbers of Americans think Medicare should bear the cost of long-term care for older adults, one of the most vexing social challenges as this group grows more quickly than the rest of the population.

A new poll by the Associated Press and the NORC Center for Public Affairs Research finds that 56% of Americans over age 40 believe that Medicare should have a significant role in paying for the daily cost of living. Only 39% had this opinion in 2013. What’s more, both Democrats and Republicans now believe Medicare should have at least some role in the covering the cost of care.

The Trump administration apparently does not agree, given the budget introduced this week that makes deep cuts in social programs, including a $610 billion cut in Medicaid on top of more than $800 billion that will be squeezed from the program if the American Health Care Act passes in its current form. The replacement for the Affordable Care Act calls for converting Medicaid into a block grant, per capita program under greater control by states.

While many do not realize it, a large share of Medicaid spending goes toward nursing home care for the elderly who are “dual eligibles,” meaning they receive benefits under both Medicare and Medicaid. Medicare, meanwhile, has been shouldering the cost of prescription drugs since 2006, when Part D was added to the program.

The AP-NORC poll uncovers Americans’ lack of knowledge about what Medicare actually covers, particularly the fact that it does not pay for living assistance. More than half (57%) said they plan to rely on Medicare completely or significantly for ongoing assistance, even though Medicare does not cover most nursing care or home health aides. Only 25% say they plan to rely on Medicaid, which is available only to those with lower incomes or the disabled. Typically, older Americans must “spend down” personal resources on nursing care before they become eligible for help under Medicaid.

Americans increasingly have been unable or unwilling to plan for their retirement, which the poll also revealed. The poll showed those ages 40 and older feel unprepared for the cost of their care.

The survey found that planning for long-term care is woefully inadequate; 67% said they have done only a little or no planning for personal needs. Just 12% feel very well-prepared to provide long-term care, while 56% feel somewhat prepared.

Many see themselves helping a family member or friend with care rather than relying on a paid health aide, and they apparently expect the same in return: two-thirds said they felt confident they could rely on their own families for support as they age.

Income made a difference: those with lower incomes were less confident than those with higher incomes (59% vs 74%). And only 20% of older Americans said family members should have a large responsibility to help older relatives pay for long-term care.

The poll pointed to policy solutions to deal with long-term care:

• Three-fourths favor tax breaks to encourage saving for long-term care, as well as tax breaks to cover the cost of long-term care insurance.
• Support for paid family leave exists, regardless of political affiliation.

The United States is at the start of an explosion in the share of the population over age 65. This group, which numbered 43.1 million in 2012, is projected to grow to 83.7 million by 2050. Baby boomers are responsible for this increase, as they began turning 65 in 2011; by 2050, the surviving baby boomers will be over the age of 85. Most of this group entered retirement healthier than their parents, but faces different health challenges in old age. Deaths from Alzheimer’s are rising, and the CDC expects the number will only increase.