Harkin — A Step Toward Health Reform

Circa 2010
3 face pictures of Senator Harkin
Senator Harkin


The President’s directive for health reform in his State of the Union address was clear: do not walk away. I am glad that he reaffirmed his commitment to enacting strong and comprehensive health reform this year and delivered a message the country urgently needed to hear.

For individuals with disabilities, it is an especially important message. In December, when the Senate passed the Patient Protection and Affordable Choices Act, we were on the verge of major reforms to longterm care programs that would give people with disabilities greater opportunities to remain in their homes and communities.

As readers of ABILITY Magazine know, I have fought hard for many years to pass the Community Choice Act. Ten years ago, in the Olmstead decision, the United States Supreme Court held that the American Disabilities Act guarantees individuals with disabilities the right to live in the most integrated settings possible. Yet state Medicaid programs, which by law must provide care in nursing homes to eligible individuals with disabilities, are not required to pay for the same individual to receive that care in his or her own home. The Community Choice Act would change Medicaid law to make clear that all individuals with a disability who are eligible for nursing home care are also eligible for personal, in-home care services.

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For the first time, the health reform bill that passed the Senate on Christmas Eve begins to make the Community Choice Act a reality, through the Community First Choice option. The bill offers states a significant amount of additional federal funding if those states agree to provide personal care services to all Medicaid-eligble people with an institutional level of need. This is a huge change from our current system, in which personal care services may or may not be available depending on the state in which a person lives, how long he has been waiting and whether his disability meets the criteria of the current waiver programs that pay for personal care services in many states.

While this program is critical for people with the most significant disabilities and for those already receiving Medicaid, I am also proud to have played a role in including in the health reform bill the CLASS Act, a new voluntary, long-term care insurance program that for the first time allows middle-class people a realistic and affordable method to plan for the possibility of becoming a person with a disability or for the possibility of suffering from a chronic illness.

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Unlike current long-term care insurance programs, which are prohibitively expensive and subject to impossibly stringent health criteria, the CLASS Act will allow anyone who is employed to pay into the program and to vest after five years of contributions. Like the Community First Choice option, the CLASS Act is designed to pay for the types of services that are critical to allowing people to remain in their homes rather than be forced into an institutional setting.

In addition to helping individuals with a disabilities, both of these programs lift some of the burden off of family members who currently struggle to provide the necessary care that stands between their loved one living in the community and living in a nursing home.

The inclusion of these two initiatives in the health care bill is a big reason why I am committed, as Chairman of the Senate’s health committee, to work with my colleagues to pass a comprehensive health reform bill this year. Far too much is at stake for America’s families and for people with disabilities.

We will not give up!


Senator Tom Harkin

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