We reported in a recent In Essence item about a Health Affairs article whose authors found that when people learned through genetic testing that they were likely to develop a debilitating disease (the authors looked at Alzheimer’s), they were more likely to enroll in long-term care insurance plans.  The spread of genetic testing, the authors said, will likely increase the number of high-risk enrollees and could undermine the financial foundation of the plans.

The passage of health-care reform, however, may alter this distressing equation.  Buried within the 2,000 pages of legislation that President Barack Obama signed into law on March 23 is the little-discussed Community Living Assistance Services and Supports (CLASS) Act, which lays out a national program for long-term care insurance.  According to the Congressional Budget Office, under the CLASS Act, workers will automatically make monthly contributions of around $65 to a national plan (though they can opt out), and become eligible to receive benefits after five years of roughly $75 a day or more depending on need.  Such sums aren’t sufficient to completely cover nursing home care, but they should pay for a big part of the cost of various home care services. Ideally, a much greater number of Americans will buy insurance (fewer than 10 percent over 50 do now), spreading risk, and lowering costs.

Reached by phone, Donald H. Taylor, Jr., an assistant professor of public policy at Duke University and one of the authors of the Health Affairs article, was cautiously optimistic about the new law.  “There are a lot of uncertainties,” he said, noting that rather than ending the policy-making process, the bill’s passage only starts the conversation about how the law’s myriad programs, including CLASS, will operate.  The stipulation that long-term care be self-financing poses a tremendous challenge, Taylor said, given that it’s hard to judge what kind of care workers paying into the system today will need 30 or 40 years down the line.  (Read more from Taylor on CLASS here.)  Yet there is no doubt that CLASS will significant expand security for the aging.   “The goal of the program is to make planning for long-term care a normal part of being a young adult,” Taylor observed.  If enough people end up becoming part of the system, “this could work really well.”