"The way I see it, [this] is a civil rights issue," said Sen. Tom Harkin, D-Iowa, a member of the Health, Education, Labor and Pensions (HELP) Committee. "As far as I'm concerned, there is no health reform without the Community Choice Act."
Harkin is the sponsor of the Community Choice Act, one of two proposals introduced this year that that would significantly expand federal assistance for people in need of long-term care. Harkin and other advocates of the measures say they must pass this year – tying them to overall health care reform that the president and others have said will be accomplished now or never.
The proposals could face serious opposition, though, as Republicans continue to speak out against the growth of federal programs that come with hefty price tags.
"I think people are starting to get it, (but) they're a little worried about the cost," Harkin said Monday, speaking before a large crowd on Capitol Hill. "We've just got a couple hurdles to get over, and they're tough hurdles. They're like stairs to a person using a wheelchair, but we can overcome it."
The Community Choice Act would reform Medicaid to give recipients eligible for institutional-level care the choice of receiving in-home or community-based assistance rather than nursing home care.
HELP Chairman Ted Kennedy, D-Mass., has sponsored a second bill, the Community Living Assistance Services and Supports (CLASS) Act. This measure would create a new, nationwide insurance program, financed through payroll deductions with opt-out enrollment.
Harkin said the Community Choice Act was the essential first step to ensuring disabled people receive the care they need. The measure, he said is estimated to cost between $2 billion to $4 billion a year.
"That's a lot of money, but we're talking about a $1 trillion health reform bill," he said. "I'm here to tell you, 2 or 3 or 4 or 5 percent is not too much to ask to provide civil rights."
Harkin added that the measure could cost less than expected. By supporting people who currently lack long term care, the government could enable them to get a job, he said. More important, he said, is "the quality of life issue."
Currently, the federal government will pay for institutional-level care through Medicaid, but those who want to receive care in a home or community-based setting must go through a waiver program. Many states have long waiting lists for waiver programs that provide marginal subsidies. In Iowa, for instance, recipients receive what amounts to $22 a day to pay for in-home care.
While the Community Choice Act would strictly address Medicaid, the CLASS Act would create a vast new government fund to insure people in the event they become disabled.
"We need to set up a system so people can pay into a system for that kind of home care in the future," Harkin said. "So we can build up a trust fund in the future."
Under the legislation, employed adults would be automatically enrolled – with the choice to opt-out – into a program that would deduct no more than an estimated average of $65 a month. Full time students or workers below the poverty would make contributions of no more than $5 a month.
Workers would be eligible to receive cash benefits after contributing to the fund for five years.
"The CLASS Act says you shouldn't have to be poor or unemployed to get assistance," said Mike Oxford, executive director of the Topeka Independent Living Resource Center. "It's simply time to force the political will for this happen."
Harkin said President Obama is supportive of the Community Choice Act, though he told the senator the cost of the program must be addressed.
"Now we have a president of the United States on our side," he said.