Legislation To Transform American Elder Care, Create Federal Long-Term Care Insurance Program

September 21st, 2021

The legislation would allow Americans to age at home, financially protect themselves and their families, and not become dependent on Medicaid

Today, Congressman Tom Suozzi (D-Long Island, Queens) introduced the Well-Being Insurance for Seniors to be at Home (WISH) Act, legislation that would address one of our nation’s most pressing challenges: financing long-term care for elderly Americans.

Every day, roughly 10 thousand Americans turn 65. By 2050, the population over 65 will almost double and the population over 85 will triple. At the same time, the number of family members available to care for these aging Americans is decreasing because families are smaller and more spread out than they used to be.

These demographic challenges have been exacerbated by the fact that the United States has not prioritized long-term care. Medicare does not cover it, Medicaid only covers nursing home care for elderly Americans who have become impoverished, and the private long-term care insurance market has failed. Without legislative action, millions of older Americans will face financial ruin and Medicaid costs will skyrocket.

“Growing up, all four of my grandparents lived in our house. Three of them were very sick. We all cared for them, with my mom, a former operating room nurse, providing the bulk of the caregiving. Both of my parents passed away a few years ago. My mom was 93 and my dad was 95. Fortunately, both were able to age comfortably at home with the assistance of home health aides,” said Suozzi. “We have a storm coming, with the number of disabled elders expected to double in the coming years.

Fewer family caregivers are available for these aging Americans and the market for long-term care insurance is not currently sufficient to address these demographic challenges. The WISH Actwould save the Medicaid program and millions of Americans from financial ruin, would allow people to age at home with dignity, and would create millions of good-paying, middle-class jobs in the home health care industry.”

The WISH Act would create a public-private partnership to provide long-term care insurance for older Americans so they can age at home if they wish instead of needing to spend down their life savings and enter Medicaid-funded nursing homes. Specifically, the bill:

  • Would create a new federal Long-Term Care Insurance Trust Fund that would pay for the “catastrophic” period of long-term care for those who need many years of it

  • Would enable private insurance companies to offer affordable coverage plans for elderly Americans’ initial years of potential disability

  • Would be fully paid for by social insurance contributions made by workers and their employers (Each would make a contribution equal to 0.3% of wages)

“This legislation recognizes a simple reality: we're all growing older. Each of us, if we’re lucky, will live well into our eighth or ninth decade of life. And the fact is many Americans from all walks of life across this country will need some kind of help beyond what our families can provide. It’s time for our policy makers to recognize these realities, and provide critical long-overdue support,” said Katie Smith Sloan, President and CEO of LeadingAge. “The WISH Act takes an important step forward toward ensuring that long-term care and services do not impoverish families.

Mr. Suozzi wisely devised a public-private partnership that generates funding for federal catastrophic long-term care coverage. The result is a much-needed, public-private partnership and an important step toward more equitable access to long-term services and supports for all.”

U.S. Congressman, Tom Suozzi (NY), introduces legislation that would allow Americans to age at home, financially protect themselves and their families, and not become dependent on Medicaid. For many older adults, the plan would shift public support for long-term care from Medicaid, a program limited to the poor, to social insurance available regardless of income. The cash benefit would give beneficiaries substantial flexibility in how they spend the assistance, in contrast to Medicaid where benefits are limited by state and federal rules. It also may make it less likely they’d have to move to a nursing home, the only setting where Medicaid is required to provide long-term care benefits.

“The nation’s long-term care system is broken. We appreciate Representative Suozzi for proposing a fiscally responsible fix,” said Maya MacGuineas, President of the Committee for a Responsible Federal Budget. “The WISH Act’s new spending is paid for with a payroll tax, and may even reduce deficits by lifting some of the burden of long-term care costs currently imposed on the Medicaid program. We commend Rep. Suozzi for not passing costs on to the next generation.”

“The WISH Act is a major step towards tackling the crushing personal cost of care during old age,” said Stuart Butler, Senior Fellow of Economic Studies at the Brookings Institution. “It would help revive the private long-term care insurance industry and make policies more affordable, thus protecting the savings of millions of hardworking Americans. It would slow Medicaid costs for states. And it would do this in a fiscally responsible way.”

“The WISH Act is quintessentially an American approach for dealing with a complex social policy issue: harness the best of what the public and private sectors have to offer in order to solve a problem that neither can solve on its own, namely, how to finance long-term services and supports for the growing number of Americans with such needs,” said Marc Cohen, Co-Director of the LeadingAge LTSS Center @UMass Boston. “This innovative and consequential program represents a great stride forward in making aging in place an attainable reality for all.”

More information on the WISH Act can be found here: