Overview
Title
To amend title II of the Social Security Act to provide for long-term care insurance benefits, and for other purposes.
ELI5 AI
H.R. 2082 is a bill to help seniors with serious disabilities pay for care at home so they don't have to use Medicaid as much. It creates a special money fund to manage this, and part of the money will go to teaching the public about these benefits.
Summary AI
H.R. 2082, also known as the "Well-Being Insurance for Seniors to be at Home Act" or the "WISH Act," seeks to amend the Social Security Act to offer long-term care insurance benefits. This bill would provide financial support to seniors with serious disabilities, allowing them to receive care at home and reduce dependence on Medicaid. It establishes a Federal Long-Term Care Insurance Trust Fund to manage the program, appropriating funds for its initial years and for public education about the program. The bill also outlines eligibility criteria for benefits, including retirement age and a serious functional disability, and seeks to educate the public on the necessity of long-term care planning.
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AnalysisAI
To amend title II of the Social Security Act, the proposed "Well-Being Insurance for Seniors to be at Home Act" or "WISH Act" aims to introduce long-term care insurance benefits for older Americans. This legislation targets the financial challenges many seniors face when seeking long-term care due to insufficient insurance coverage and significant out-of-pocket costs. By amending the Social Security Act, the bill seeks to provide relief through a Federal insurance plan specifically designed to cover long-term care expenses, reducing dependency on Medicaid and supporting caregivers.
General Summary of the Bill
The WISH Act's primary objective is to provide financial assistance for long-term care to older adults who meet specific criteria, such as having reached retirement age and suffering from serious disabilities. The bill outlines how benefits will be calculated and distributed, setting up a Federal Long-Term Care Insurance Trust Fund to manage and fund the program. Additionally, education outreach initiatives aim to inform Americans about the importance of planning for long-term care. The bill also mandates regular reporting and evaluation of the program's effectiveness to ensure its goals are met.
Summary of Significant Issues
Several issues arise from the bill's structure and objectives, creating potential obstacles:
Complex Eligibility: The definition of eligibility and benefit calculations rely on complex formulas using indexed earnings and coverage quarters. This complexity may prove difficult for individuals to understand, potentially limiting accessibility.
Residency Restrictions: Limitations on benefits for recipients residing outside the United States for more than five years consecutively may penalize citizens who are legitimately living abroad.
Funding and Expenditure Concerns: The bill allocates substantial funds for program establishment and public education, totaling millions of dollars. Without detailed expenditure guidelines, there is a risk of inefficient use of resources.
Workforce and Wage Compliance: The requirement for individuals to comply with wage and tax laws when hiring caregivers presents potential enforcement difficulties and administrative burdens.
Impact on the Public
Broadly, the WISH Act is likely to provide significant support to seniors facing the high costs of long-term care. By alleviating financial burdens, the bill could enhance the quality of life for older Americans, allowing them to remain in their homes and communities during periods of disability. Moreover, the public's awareness of long-term care planning would likely improve, encouraging proactive financial preparations for aging.
On the downside, the complexity of benefit calculations could create barriers for potential beneficiaries, especially for those with limited understanding of the intricate eligibility criteria. There is also the possibility of public concerns about federal spending, given the large sums allocated without explicit oversight.
Impact on Stakeholders
Positive Impacts: - Seniors and Families: Eligible older adults and their families could see significant financial relief, with reduced dependency on Medicaid and enhanced support for care services. - Caregivers and Workforce: The bill's intent to sustain the workforce providing care could result in better support and stability for caregivers.
Negative Impacts: - Non-Residents: Americans living abroad longer than five years could face unfair restrictions, effectively losing potential benefits. - Fiscal Management: Stakeholders concerned with federal budget allocations might question the effectiveness and necessity of the significant educational funding.
In summary, while the WISH Act represents a promising step towards addressing the financial strain of long-term care for seniors, it must also navigate complex eligibility requirements, ensure effective use of resources, and refine the implementation details to genuinely benefit the intended populations without unnecessary limitations or expenditures.
Financial Assessment
The Well-Being Insurance for Seniors to be at Home Act (WISH Act) aims to amend the Social Security Act to create a long-term care insurance benefits program. This commentary will highlight the financial details and concerns associated with the bill.
Financial Allocations and Spending
The WISH Act lays out several financial provisions. A primary element is the creation of the Federal Long-Term Care Insurance Trust Fund, which serves as a reservoir for managing the funding needed to support the program. The bill specifies an appropriation of $12,000,000 for each of the fiscal years 2026, 2027, and 2028. This allocation is intended to establish the Long-Term Care Insurance program and cover the commencement of benefit payments during these years.
Additionally, the bill allocates $50,000,000 for public education regarding the program. This funding is designed to help raise awareness among the public about long-term care insurance, the necessity of long-term care planning, and the available benefits under the act.
Issues Related to Financial Allocations
Appropriations and Oversight
One of the prominent issues identified in the bill involves the potential for inefficient allocation of the funds appropriated for the Trust Fund's establishment and public education initiatives. The substantial financial commitment of $50,000,000 to public education raises the possibility of inefficiencies or wasteful spending. The lack of detailed guidance on how these funds will be used or what specific outcomes are expected may prompt debates around federal spending priorities. Without stringent oversight and management, there is a risk that these funds may not be used effectively.
Complexity and Accessibility
The bill introduces complex eligibility criteria for beneficiaries, particularly concerning the definition of a "substantial period of time" and "indexed earnings." This complexity could hinder public understanding and accessibility to the program benefits. The effort to inform and educate the population on these intricacies will draw from the $50,000,000 public education fund. However, ensuring clarity and comprehension across such a broad audience could challenge the sufficiency and efficiency of the allocated resources.
Investment Practices
The bill's language allows the Managing Trustee of the Trust Fund to invest in "conservative market securities," but it lacks clear definitions of what constitutes such securities. This ambiguity can lead to potential financial risk, as the absence of stringent regulatory definitions might result in investments that do not align with the Trust Fund's financial security goals.
Management and Oversight of Funds
Given the overall financial stakes, the substantial amounts of money dedicated to various aspects of the program reflect a need for clear budgeting frameworks. The absence of detailed explanations of how financial resources will be managed increases the risk of overspending. This concern is especially significant given the considerable sums involved across different sections of the bill, predominantly in Sections 4 and 5.
In summary, while the WISH Act endeavors to provide valuable benefits for long-term care, its financial provisions pose several challenges and require careful oversight to ensure funds are deployed effectively, efficiently, and in a manner that maximizes their intended impacts.
Issues
The requirement for beneficiaries hiring non-family member caregivers to comply with wage and tax laws introduces potential complexity, as this might be difficult to enforce and assess compliance effectively. This is particularly relevant as it influences the administrative burden on individuals managing personal care, particularly under Section 3, subsection (i).
The restriction on benefits for individuals who report a country of residence outside the United States for five consecutive years may unfairly impact citizens who are validly residing abroad. This issue is highlighted in Section 3, subsection (i)(3), where nonresidents might face undue limitations.
The appropriation of significant funds for the establishment and education of the Long-Term Care Insurance Trust Fund, as mentioned in Sections 4 and 5, may lead to inefficiencies and wasteful spending without proper oversight and specific guidelines on fund allocation and expected outcomes.
The complexity of definitions and eligibility criteria, particularly for 'substantial period of time' and indexed earnings in Section 3, subsection (e), introduces potential challenges for the general public to understand and apply for benefits, raising accessibility issues.
The allocation of $50,000,000 for public education relating to the Long-Term Care Insurance program in Section 4 may appear excessive without detailed breakdowns and justification of costs, potentially leading to debates about federal spending priorities.
The language regarding investment practices of the trust fund, allowing investments in 'conservative market securities,' lacks clarity in what qualifies as such, potentially leading to financial risk without stringent regulatory definitions. This is highlighted in Section 4, subsection (c).
The mention of 'methods to responsibly support the workforce' without outlining any specific strategies or programs creates ambiguity, leaving gaps in workforce planning and potentially affecting the quality of care and services. This concern arises in Section 2.
The overall financial management of the program, with substantial amounts dedicated to various aspects without clear budgets or frameworks, raises concerns about potential overspending, as evidenced by sections related to funding allocations, particularly in Sections 4 and 5.
Sections
Sections are presented as they are annotated in the original legislative text. Any missing headers, numbers, or non-consecutive order is due to the original text.
1. Short title Read Opens in new tab
Summary AI
The section introduces the "Well-Being Insurance for Seniors to be at Home Act," abbreviated as the “WISH Act,” and allows it to be referred to by this short title.
2. Findings; purpose Read Opens in new tab
Summary AI
Congress has found that many older Americans will need long-term care, which is very expensive and often not covered by insurance, leaving them to rely on Medicaid after depleting their savings. This bill aims to help Americans plan for their future care by creating a Federal insurance plan to cover long-term care needs while reducing Medicaid dependency and supporting the workers who provide care services.
Money References
- (a) Findings.—Congress finds the following: (1) More than half of Americans entering old age today will have a long-term services and supports (in this section referred to as “LTSS”) need, averaging $298,000 costs per person for about 2 years of serious self-care disability, and more than half will be out-of-pocket, according to the U.S. Department of Health and Human Services (in this section referred to as “HHS”).
3. Long-term care insurance benefits Read Opens in new tab
Summary AI
The bill proposes an amendment to the Social Security Act to provide long-term care insurance benefits to people who meet specific criteria, such as having a serious functional disability and having reached retirement age. It also outlines how the benefit amount will be calculated, the requirements for maintaining eligibility, and assurances that these benefits will not affect eligibility for other federal or state assistance programs.
Money References
- “(e) Definition of substantial period.— “(1) IN GENERAL.—For purposes of subsection (a), a substantial period of time means— “(A) in the case of an individual who, at the time described in paragraph (3), has average indexed monthly earnings for long-term care equal to or less than the dollar amount representing the 40th percentile in the table established under subsection (f) for such calendar year, 12 months; and “(B) in the case of an individual who, at such time, has average indexed monthly earnings for long-term care greater than such dollar amount, 12 months plus 1 additional month for each 1.25 percentile interval above the 40th percentile for which the individual’s average indexed monthly earnings for long-term care would attain (as specified in such table).
- “(2) TABLE OF EARNINGS.— “(A) IN GENERAL.—The Commissioner of Social Security shall establish a table, for each calendar year beginning with calendar year 2026, setting forth— “(i) the dollar amount representing the 40th percentile among the average indexed monthly earnings for long-term care (as determined under subparagraph (B)) of each individual who has attained age 62 and whose primary insurance amount is first computed during such calendar year (or, for calendar year 2036, during any previous calendar year); and “(ii) the dollar amounts representing percentiles over 40 (increasing linearly from 40 in intervals of 1.25) among the average indexed monthly earnings for long-term care (as so determined) of each such individual.
235. Long-term care insurance benefits Read Opens in new tab
Summary AI
The section outlines who qualifies for long-term care insurance benefits, detailing requirements like age, disability duration, and insured status. It sets the monthly benefit amount calculation, defines important terms, and specifies rules for the treatment and reporting of these benefits, which are not considered income for eligibility in other federal programs.
Money References
- (e) Definition of substantial period.— (1) IN GENERAL.—For purposes of subsection (a), a substantial period of time means— (A) in the case of an individual who, at the time described in paragraph (3), has average indexed monthly earnings for long-term care equal to or less than the dollar amount representing the 40th percentile in the table established under subsection (f) for such calendar year, 12 months; and (B) in the case of an individual who, at such time, has average indexed monthly earnings for long-term care greater than such dollar amount, 12 months plus 1 additional month for each 1.25 percentile interval above the 40th percentile for which the individual’s average indexed monthly earnings for long-term care would attain (as specified in such table).
- (2) TABLE OF EARNINGS.— (A) IN GENERAL.—The Commissioner of Social Security shall establish a table, for each calendar year beginning with calendar year 2026, setting forth— (i) the dollar amount representing the 40th percentile among the average indexed monthly earnings for long-term care (as determined under subparagraph (B)) of each individual who has attained age 62 and whose primary insurance amount is first computed during such calendar year (or, for calendar year 2036, during any previous calendar year); and (ii) the dollar amounts representing percentiles over 40 (increasing linearly from 40 in intervals of 1.25) among the average indexed monthly earnings for long-term care (as so determined) of each such individual.
4. Establishment of Federal Long-Term Care Insurance Trust Fund Read Opens in new tab
Summary AI
The section establishes a Federal Long-Term Care Insurance Trust Fund, detailing its funding, management, and administration. It appropriates specific amounts for program establishment and public education, allows for gift contributions, and requires regular reporting to Congress on the insurance program's impact and recommendations for adjustments.
Money References
- The Federal Long-Term Care Insurance Trust Fund shall consist of such gifts and bequests as may be made as provided in section 201(i)(1) of the Social Security Act (42 U.S.C. 401(i)(1)) and such amounts as may be appropriated to, or deposited in, the Federal Long-Term Care Insurance Trust Fund as provided in this section. (b) Appropriation.—There is appropriated to the Federal Long-Term Care Insurance Trust Fund out of moneys in the Treasury not otherwise appropriated— (1) for each of fiscal years 2026, 2027, and 2028, $12,000,000 for the initial establishment of the Long-Term Care Insurance program and payment of benefits during such fiscal years; and (2) $50,000,000 for public education relating to the Long-Term Care Insurance program as described in section 6(a).
5. Education and outreach Read Opens in new tab
Summary AI
The bill requires the Secretary of Health and Human Services to create a 10-year plan to educate the public about long-term care and its related costs, which will be funded with $50 million. Additionally, the Social Security Commissioner must provide personalized notices to eligible individuals about their potential long-term care benefits and earnings, with these notices being updated annually and accessible online for those over age 35.
Money References
- (2) FUNDING.—There are appropriated, out of the Federal Long-Term Care Insurance Trust Fund, to the Secretary of Health and Human Services $50,000,000 to carry out paragraph (1). (b) Individual notices.— (1) IN GENERAL.—Beginning 1 year after the date of enactment of this Act and in accordance with paragraph (2), the Commissioner of Social Security shall provide to each eligible individual a notice that specifies— (A)(i) the average indexed monthly earnings for long-term care that would be calculated for the individual under paragraph (2)(B) of section 235(e) of the Social Security Act if such average indexed monthly earnings for long-term care were calculated in the month before the month such notice is provided; and (ii) for purposes of applying such section to the individual, the percentile in which such average indexed monthly earnings for long-term care of the individual would fall among the average indexed monthly earnings for long-term care (as determined under such paragraph (2)(B)) of each individual whose average indexed monthly earnings for long-term care are calculated in such month; (B) the number of quarters of coverage the individual has in the month before the month such notice is provided for purposes of attaining insured status for long-term care insurance benefits under such Act; and (C) in any case in which the individual has a continual serious functional disability (as defined in section 235(d) of such Act), the date on which such disability began.
6. GAO Report on Performance of the WISH Program Read Opens in new tab
Summary AI
The GAO is required to report to Congress on the WISH Program's performance within five years after the law is enacted and every three years following. The report must cover potential manipulation of eligibility rules, risks of financial exploitation of beneficiaries, and how well people understand long-term insurance, along with recommendations for improvements in these areas.
7. Report on remaining long-term supports and services needs Read Opens in new tab
Summary AI
The Secretary of Health and Human Services is required to report to Congress every three years on the long-term support needs of people who aren't eligible for certain Social Security benefits, like those who became disabled as children, have disabilities before retirement, or aren't insured for these benefits. The report should also suggest strategies and costs to address the unmet needs of these individuals.