Hawaii Long-Term Health-Care Bill Serves as National Model

(AP Photo/Eric Risberg)

Families at this assisted living facility in Santa Rosa, Calif., and around the country, are grappling with the high cost of long term health care, which a path-breaking Hawaii bill sets out to remedy.

Hawaii may soon become the first state in the union to offer universal long-term care for seniors, as state legislators prepare to roll out a bill that would tackle the nation’s elder care crisis head-on.

Slated for introduction in the 2016 legislative session, Hawaii’s innovative bill could become a national model for states looking for ways to help families afford the high costs of elder care. Across the country, as millions of baby boomers hit retirement age, they are beginning to feel the strain of paying for health care. A full 10,000 Americans have turned 65 every single day since 2011, and will continue to do so until 2030—a trend that is dramatically altering the demographic landscape of the United States.

“There's an important role for government to play,” says Kevin Simowitz, the political director for Caring Across Generations, a national organization that aims to help people age with dignity and independence. “Most people simply don’t have the individual means to pay for the care they need.”

These population trends have been particularly marked in Hawaii. While the number of seniors aged 75 and older increased by 47 percent nationally between 1990 and 2012, Hawaii saw a 116 percent increase in that age cohort during this same period.

A coalition of retiree groups, labor unions, and religious organizations in Hawaii has been leading the public campaign for Hawaii’s new health care program.

“I think if we have enough push from the public we can make it happen because the will of the people, I would hope, will supersede all potential barriers,” says Clementina Ceria-Ulep, the chair of the Nursing Department at University of Hawaii at Manoa, and a leader with Faith Action for Community Equity, a faith-based community organization.

Aloha State residents boast a distinct cultural tradition of caring for and cherishing their “kupuna”—a Hawaiian word that refers to the elderly. Indeed, Hawaiian leaders have been reckoning with the challenges of elderly care for far longer than most states on the U.S. mainland.

Now, after decades of debates, state audits, and legislative campaigns, Hawaii residents and lawmakers say the time is right for action on the proposed universal care benefit. Supporters of the bill argue that it would not only help ease the financial burden on families caring for seniors, but also create more high-quality home care jobs for the mostly women and immigrant workers who tend to shoulder these responsibilities.

“Hawaii has a tradition of being at the forefront of health care policy,” says Simowitz, of Caring Across Generations. “Long before the Affordable Care Act, Hawaiians had a plan to make sure that workers had quality affordable health care. This would not be the first time they’ve done something a little bit provocative and groundbreaking.”

Simowitz says that the idea of a universal long-term care program could spread to other states, in the same way that grassroots movements to promote paid sick leave and increase the minimum wage have taken off.

“It is a breakthrough to have legislators move this conversation from kitchen tables in peoples’ houses to conference tables at the legislature,” he says. “We need this to be a public policy conversation.”

Hawaii’s program would work like this: Every person who files a Hawaii state income tax for ten years would be eligible to receive $70 a day, for a total of 365 days. The benefit would be underwritten by a slight increase in the state’s General Excise Tax, a tax on all businesses’ gross income. Hawaii’s thriving tourist industry would help boost the fund. That’s because tourists, who also pay the General Excise Tax, would fund roughly 35 percent of the long-term care program but would never claim the benefit themselves.

“Our target was to look at what it would cost to help someone get four hours of home or community care,” explains Dr. Lawrence Nitz, a political science professor at the University of Hawaii at Mānoa, who conducted research on long-term care financing for the state. “Seventy dollars means you could plan to go to work, you could take time to meet your child’s teacher. It’s enough to help people avoid losing their jobs, while still balancing care responsibilities.”

Most people need some form of long-term care as they get older. Long-term care refers to assistance with activities of daily living, such as bathing, eating, using the toilet, and getting dressed. It also includes help with tasks like shopping, cooking, and cleaning. Despite a common misconception, Medicare does not cover the cost of long-term care services, meaning that the majority of Americans must pay out of pocket.

Hawaii’s proposed social insurance program would not cover the cost of nursing homes or assisted living facilities, which can easily reach $100,000 per year. However, it would offer more money and flexibility to families that are already providing long-term care.

In 2011, the AARP’s Public Policy Institute found that the average caregiver is a 49-year-old woman who works outside the home and spends nearly 20 hours per week providing unpaid care to a parent over nearly five years. The report found that two-thirds of family caregivers are women, and that the total economic value for all this unpaid work was an estimated $450 billion annually.

Hawaii State Senator Roslyn Baker plans to introduce the long-term care bill in the upcoming legislative session. It’s not the first time that Baker, who has been active in elderly care issues since the 1990s, has introduced long term care legislation. But now, due to growing political support and a string of research studies supporting the program’s the feasibility, Baker predicts that the bill has a good chance of passing.

“We think the timing is right, even though it’s an election year,” Baker told The American Prospect. “We're going to work to help people understand exactly what the funding mechanism is, how small a tax burden it is, and just how it will help lots and lots of people afford the care they need.”

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