I think it’s great that President Biden is including “human infrastructure” in his infrastructure bill and that long-term care services and support (LTSS) is included in his proposal. But I am disappointed that the funding is limited to Medicaid. His proposal is important as he is addressing the issue of low wages for caregivers and is providing money for the expansion of HCBS. But, I would like to see a proposal for Medicare LTSS as well so services can reach people in the middle class.
Bernie Sanders has a proposal for Medicare expansion that he wants included in the infrastructure bill. Sanders’ proposal includes lowering the age for Medicare, lowering drug prices by Medicare negotiations with drug companies and an increase in dental, vision and hearing benefits. But, LTSS is not included in his proposal for Medicare expansion.
The critics of the Medicaid-based long-term care policy expansion acknowledge that long-term care expansion in Medicare would cost more than the current Medicaid proposal. But without an expansion of LTSS in Medicare, middle-class Americans will continue to be in a position where they cannot afford care as they age. Since negotiation of these bills is inevitable, I wish Biden started with the inclusion of a long-term care benefit within Medicare.
Lastly, I have read some interesting articles about redefining the term infrastructure. In the NPR report, “What is Infrastructure? It’s A Gender Issue, For Starters” (Kurtzleben, 2021), Senator Kirsten Gillibrand’s tweet is quoted. Senator Gillibrand tweeted that, “Paid leave is infrastructure. Childcare is infrastructure. Caregiving is infrastructure” (Gillibrand, 2021). I agree that defining infrastructure merely as roads, bridges and the like is a male-oriented definition of infrastructure. Human infrastructure is a part of physical infrastructure. In the 21stcentury, infrastructure’s definition should include social support for the people and families that work in this country.
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