Recent efforts to repeal or replace the ACA have been acrimonious from a policy perspective and confusing for the citizen observer. The specifics, key players, and data supporting policy directions changed daily—sometimes hourly. It was a roller coaster.

During this time, LeadingAge's time and attention were focused on preserving the structure and financing of Medicaid and, for now, our efforts have paid off. Beyond the immediate policy victory, the real win is the enhanced understanding of what the Medicaid program is, who it covers, and for what benefits. Prior to the recent policy debate, this was not widely known or understood—altogether surprising for a program that touches 1 in 5 Americans.

Medicaid is essential. It is stretched thin, in large part, because it fills needs that reach beyond its intended purpose. Specifically, it is the payer of last resort for long-term services and supports. People in need of these services, which includes 50% of people over the age of 65 at some point in their later years, pay out of savings and retirement income first. They might then look to family members for financial and other essential support. At some point, all resources are depleted and they turn to Medicaid.

We need a solution to take the pressure off individuals, families, and Medicaid, particularly as we face growing demand resulting from a rapidly increasing aging population. We must acknowledge that personal responsibility needs to be matched by public responsibility.

Two weeks ago, we released a report: A New Vision for Long Term Services and Supports. Our vision includes a more rational, balanced system that is based on the following 3 essential features:

  1. A universal approach to coverage: The mandatory program would spread risk over a large population, thus lowering expenses for individuals, and increasing overall funding for LTSS.

  2. A catastrophic benefit period: The program would finance care for individuals with high needs for LTSS. Benefits would begin after individuals had financed their own care for two years through private long-term care insurance or out-of-pocket spending.

  3. A “managed cash” benefit structure: Beneficiaries would use a cash payment to purchase services and supports related to an LTSS need. This flexible approach would ensure that services and supports were tailored to individual needs and preferences.

We hope this vision will stimulate a national discussion at all levels. And that it will be the first of many discussions to come. It is incumbent upon us to help those who struggle daily to meet their own needs for long-term services and supports.

Abraham Lincoln was once asked what he would do if he had 1 hour to chop wood. He responded that he would spend the first 15 minutes sharpening his axe.

Developing and sharing LeadingAge's vision prepares us for the bigger task ahead. Enacting a fair and rational system to ensure access to quality long-term services and supports for all who need it is imperative.

We have sharpened our axe. Now we begin chopping wood so we can all age with dignity and choice.