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An LTC planner's guide to the presidential candidates

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Dementia and long-term care (LTC) finance have not yet become major presidential campaign issues, but Brenda Bouchard, a caregiver, has done her best to make that happen.

Bouchard is a New Hampshire resident whose husband has early-onset Alzheimer’s.

See also: Moore’s Oscar win puts Alzheimer’s film in spotlight

Because New Hampshire holds the first presidential nomination primaries in the country, residents of the state have many chances to ask presidential candidates questions at in-person forums or town halls.

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Bouchard went to the forums to ask the candidates about their views on Alzheimer’s disease, the burdens facing family caregivers, and the financial impact of dementia on families, Medicare and Medicaid.

Some of the candidates who are still in the race have issued proposals related to those issues. Most had some kind of involvement with LTC issues before they began running for president.

See also: LTCI Watch: Candidates

For a look at what Hillary Clinton, Ted Cruz, John Kasich, Marco Rubio, Bernie Sanders and Donald Trump have said and done that might be of interest to the LTC planning community, read on.

1. Hillary Clinton

Long before, Clinton began running for president, she led the effort to develop a major 1993 health policy bill: H.R. 3600, the Health Security Act bill.

One section of the bill would have encouraged states to provide home and community-based services to people of all ages who had disabilities.

Another section would have created a National Long-Term Care Insurance Advisory Council. The council would have been responsible for developing national standards for private LTCI benefits, premiums, sales practices, solvency, rates and rate increases.

Last year, in Exeter, N.H., when Bouchard challenged Clinton, Clinton said that her own mother had lived with her in her later years.

“She was, thankfully, in good health, but she had the beginnings of some real deterioration,” Clinton said. “So, I’m well aware of how important this is.”

Clinton said she believes the country should respond to dementia by spending more on medical research; providing more general support for family caregivers; increasing family caregivers’ access to respite care; and, possibly, by organizing a “Care Corps” that would mobilize volunteers from the community to support family caregivers.

Clinton has put a caregiver support proposal in the issues section on her campaign website.

See also: Hillary Clinton latches on to caregiver support issue

2. Ted Cruz

When Bouchard spoke to Cruz in Portsmouth, N.H., in February, he said he had seen the ravages of Alzheimer’s affect his own family.

“My grandmother had Alzheimer’s disease,” Cruz said. “She lived with it for 10 years. It’s a tragic disease, a heart-breaking disease.”

Cruz said that his grandmother had been a school teacher with a photographic memory. In some ways, the early years — when she understood how she was slipping — were the toughest, he said.

Cruz said he thinks one answer is to invest more money in research on cures for Alzheimer’s, cancer, heart disease and diabetes.

“A few dollars on the front end curing those diseases have the potential to save trillions of dollars on the back end,” Cruz said.

Another measure would be to streamline the U.S. Food and Drug Administration (FDA) drug approval process, to help new drugs get to market more quickly, Cruz said. 

See also: South Carolina focus group praises Cruz but sees Trump win

3. John Kasich

As a long-time member of Congress, and the current governor of Ohio, Kasich has been working on legislation and programs related to LTC services and long-term care insurance (LTCI) for many years.

See also: Coalition Forms To Promote LTC Awareness

In 1999, for example, Kasich was one of the five original cosponsors of a bill that would have let consumers deduct LTCI premiums from their income taxes.

When Bouchard told Kasich her story in Greenland, N.H., in July 2015, he walked into the audience and hugged her.

“That’s really hard,” Kasich said. “That’s really, really hard.”

Kasich said that he knows that the country has to save money, but that he also believes in the need to spend more money on basic medical research at the National Institutes of Health (NIH). He said he thinks there’s bipartisan support for increasing NIH research budgets.

“I really think we need to have some incentives so people begin to buy long-term care [insurance],” Kasich added. “Right now, it’s really, really expensive. My wife and I have it. We bought it years ago. There’s very little incentive for us to buy long-term care.”

If Bouchard had private LTCI, the benefits could help her to pay to have someone else in the house, Kasich said.

Kasich said that, in Ohio, the state has also tried to improve support for home health workers without turning them into government employees.

“Recently, since they can get on the [Patient Protection and Affordable Care Act] exchange, they can get their health care, and they’re protected,” Kasich said.

Supporting and respecting caregivers is critical, because the ability to provide care “is a gift,” Kasich said. “The Lord gave you a gift to be able to care for people. 

4. Marco Rubio

In 2013, Rubio teamed up with Sen. Orrin Hatch, R-Utah, to introduce the Family and Retirement Health Investment Act bill. One section of the bill would have let consumers use the cash in health savings accounts to pay for LTCI premiums.

See also: GOP senators push bill to expand access to HSAs, FSAs

Recently, Rubio put a proposal on his website that calls for the country to create a 25 percent, non-refundable tax credit that a business could choose to use to pay for providing up to four to 12 weeks of paid family leave per year. 

Workers could use paid leave to look after sick spouses or parents as well as to recover from their own illnesses or look after sick children, according to the proposal summary.

When Bouchard taped Rubio in Londonderry, N.H., in August 2015, he said that his aunt struggled with Alzheimer’s for 14 years, and that the period before she entered an institution was particularly difficult on her daughter.

Workers need more flex time to handle caregiving needs, and the country needs to give Alzheimer’s research the same kind of funding priority it gave HIV/AIDS, Rubio said.

“It’s the only way we’re going to have any kind of solution to this,” Rubio said.

5. Bernie Sanders

Sanders has introduced several American Health Security Act (AHSA) bills that would replace the current Medicaid nursing home benefits system and private LTCI with a public LTC finance program.

See also: How might ‘Berniecare’ work?

In August, in Exeter, N.H., Sanders emphasized the importance of increasing funding for research.

Sanders said his Republican colleagues in Washington are eager to give more tax breaks to billionaires while they cut back on funding for the NIH and other scientific organizations.

The Republican leadership has cut back so much on research funding that many leading U.S. researchers are leaving to work in labs in other countries, Sanders said.

“They can’t get the grants they need to do their work,” Sanders said.

6. Donald Trump

When Bouchard asked Trump about Alzheimer’s and caregiving in Hampton, N.H., in August, he said of Alzheimer’s, “Tough. Tough.”

“It’s a total top priority for me,” Trump said. “I have so many friends whose families have been devastated by Alzheimer’s.”

In 2010, Trump appeared as a celebrity guest on the Together for Care Telethon that was organized by the Alzheimer’s Foundation of America.

Trump asked viewers to contribute generously to the foundation’s efforts to run a toll-free helpline, provide educational materials, support hands-on care programs, and help families pay for respite care.

See also:

Sally Pipes proposes PPACA replacement plan

Trump’s health plan includes PPACA repeal, drug re-importation


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