Establishing national responsibility for affordable health insurance was a monumental and much debated achievement. But deep within the health-reform legislation it passed last March, Congress also did something else extraordinary with hardly any fanfare: It enacted a new federal long-term-care insurance program called the Community Living Assistance Services and Supports Act.
As a public program directly run by the government, CLASS resembles Social Security and Medicare, yet it differs in critical ways that pose significant challenges for implementation. CLASS is a voluntary program that will need to enroll a broad portion of the population in order to spread its costs as widely as possible. The start-up will therefore demand wide publicity.
It is now an open question whether Medicare will provide adequate health coverage to the baby-boom generation as it begins turning 65 just over a decade from now. The source of uncertainty is not whether America has the resources to sustain the program; we do. The real challenge comes instead from proposals to save Medicare. Far from preserving its benefits, the major restructuring proposals under discussion would radically alter the principles on which Medicare rests and erode the protection it affords.