This morning, two subcommittees of the Energy and Commerce Committee hosted a hearing on the CLASS Act.

The CLASS Act (Community Living Assistance Services and Supports Act) was one of the nine titles in the Affordable Care Act, and – if you haven’t been watching the news lately – the program has recently been abandoned because HHS could not produce an actuarial model of the program’s long term sustainability.  Congress doesn’t normally allow an executive department to simply stop implementing a law that’s been passed, but in this case, the law contained a self-test for the program before it could get started.

The two HHS officials who testified this morning – Kathy Greenlee (Asst. Sec. on Aging) and Dr. Sherry Glied (Asst. Sec. for Planning and Evaluation) – were definitely in the hot seat.  Republicans interrogated them about the program’s un-sustainability, and Democrats let them know of their disappointment about the program’s abandonment.

But throughout the morning’s debate, there were a few valuable takeaways:

  1. Long term care is an expensive burden for many Americans and their families.  Medicare provides coverage only for some short-term needs, and then after that, seniors are on their own.  Very few people actually purchase private-market long term care insurance, meaning that when devastating bills do come, many more sick and elderly patients end up on Medicaid, which currently pays for about half of the long term care costs in our country.
  2. To deal with this problem, Congress passed CLASS in March 2010, along with many other reforms to our health care system.  But despite their best efforts, HHS officials have not been able to find an actuarial model that suggests that the CLASS program is workable.  In its current structure, CLASS encourages adverse selection and would end up with costs far exceeding collected premiums.
  3. Changes to CLASS could be made in order for it to work.  These changes involve instituting 15-year waiting periods, adjusting premiums based on risk (underwriting!), or excluding people with preexisting conditions from the program.  But wait, you might say, this is just what happens in the private market!  Exactly.

It’s clear that government isn’t going to be the solution to the problem of expensive long term care.  Perhaps Congress could pass laws that create a better environment for consumers and patients (one Member, Dr. Burgess, suggested Americans be allowed to purchase long term care insurance with pre-tax dollars), but in the end, our government leaders need to eat some humble pie and realize that even government would have to imitate the private sector if economic reality and financial soundness were of first concern (as it is with CLASS, thanks to the Gregg Amendment). 

The problem with programs like CLASS, and indeed the trouble with the entire health reform law, is that they come from an arrogant, power-hungry attitude among our leaders – an attitude that believes government alone can fix all of society’s problems. 

This was clearly illustrated by one comment in today’s hearing that really and rightly ruffled my feathers.  Rep. Dingell said:

“Republicans who want to repeal parts of this bill are trying to strip Americans of rights and opportunities we have given them.”

With all due respect to Rep. Dingell (currently our longest-serving Member of Congress), I must ask, who is this “we?”  Democrats? Congress? Government?  No.  The answer is none of the above.  Government doesn’t give rights.  God gives rights.  If we can’t get this basic founding principle right, then we’ll never get complex issues like health care policy right.

We can debate all day about what actuarial data was available when, or how financially sound or unsound the program might be, but the bottom line is this: It’s not government’s role to provide long term care insurance.  In the words of Thomas Jefferson:

“A government big enough to give you everything you want, is a government big enough to take away everything you have.”