Here’s How Not to Reform Long Term Care

It’s looking increasingly unlikely that the Senate will pass President Biden’s Build Back Better social spending plan before the end of the year. Since the House version passed last month, there has been heightened scrutiny on the bill’s largest spending provisions, such as universal child care, green energy, and paid family leave, all government expansions that will grow ad infinitum once passed and signed into law. In fact, the Congressional Budget Office recently released the true effect of the bill’s provisions if they are all made permanent: $3 trillion added to the deficit over 10 years, rather than adding $365 billion to the deficit if all programs are allowed to lapse as written.

There are other provisions in the bill that are destructive in their own right, even if they have received less attention. While establishing the aforementioned programs would place additional stress on the government balance sheet, it has always been the growth in health care spending—especially in Medicare and Medicaid—that represents the greatest threat to America’s bottom line. 

The most overlooked but consequential piece of the bill’s $1.85 trillion price tag is a $150 billion outlay for long-term care (LTC)—most of which is earmarked for bolstering home- and community-based services (HCBS) in Medicaid.

What’s worse, BBB also has two unfunded mandates related to long-term care staffing levels that will have far-reaching implications for the industry and ultimately, what taxpayers will have to pay.