Niskanen Senior Fellow Robert Saldin authored this piece for the Winter 2022 edition of National Affairs, an American Enterprise Institute publication. Read the full piece here.
In recent years, reform-minded Republicans have started recognizing and responding to the challenges facing middle- and working-class American families. In 2017, a GOP-led Congress passed a law that doubled the amount of the child tax credit as a means of supporting parents and reducing childhood poverty. And in February 2021, Senator Mitt Romney put forth a child-allowance proposal that would increase those payments and make them universal.
While these reformers should be praised for focusing on the needs of families with children, many continue to ignore a problem plaguing the American middle class from the other end of the age spectrum: the cost of long-term care (LTC) for the elderly. Though often overlooked, reforming LTC presents a unique opportunity for Republicans to fill what is arguably the biggest hole in the American social safety net and relieve the pressures that this broken system places on the middle class and state budgets.
“LTC” refers to the services and support that over 14 million chronically ill or disabled Americans require to complete “activities of daily living,” such as eating, bathing, and dressing. For those requiring this form of assistance, there is considerable variation in the level of need, the type of services necessary, and the location where this care takes place. At one extreme are individuals with relatively modest limitations who may only require in-home visits by a family member or aide for a few hours a week. At the other extreme are individuals residing in nursing homes who require round-the-clock support.
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