Universal Family Care: Decision Points for States in Improving the Care Infrastructure Through Social Insurance

Abstract

This report presents policy options for a new social insurance program – akin to Social Security or Medicare – that would provide an integrated approach to protecting against the risk of needing to provide or receive care across the lifespan: Universal Family Care. The program would allow individuals and families to access caregiving supports at various points throughout the life course, from the arrival of a child to end-of-life care for a family member or oneself. The program covers three specific caregiving needs: long-term services and supports, paid leave, and early child care and education. This report identifies key design questions for states to consider in crafting a UFC program, outlines a range of vetted approaches, and describes the building blocks and tradeoffs involved. This analysis was developed during a year of deliberations by a Study Panel of 30 experts in care policies from a variety of perspectives.

Restructuring Public Policy for Large Numbers of Elders Living with Disabilities

“…How would elders pay for the first years of needing supportive care? We could save through our working years, we could have large and well‐financed families willing and able to be of help, our communities and organizations could pitch in (as Washington state has done with $36,500 of first‐dollar coverage for workers in that state (Veghte, Bradley, Cohen, & Hartmann, 2019, p. 190), and we could buy long‐term care insurance privately that reflects our situation and willingness to take risks. Insurance companies, freed of the risks of very long durations of long‐term care, would offer a variety of coverage packages to individuals, companies, and organizations to precede and wrap around the government's catastrophic coverage.…”

“…This approach would greatly reduce the number of elderly who spend-down to Medicaid, thus reducing the pressure on Medicaid. Liberal and conservative think tanks alike have suggested frameworks similar to the proposed structure (Calmus, 2013;Veghte, Bradley, Cohen, & Hartmann, 2019).…”