Washington State’s Celebrated Long Term Care Program Is Headed Towards Trouble

A caregiver and her client


Nearly two years ago, social insurance advocates were celebrating the creation of a new long-term care program in the state of Washington. Here, for instance, is what The Nation wrote in May of 2019:

“The Long Term Care Trust Act, which passed the state legislature at the end of April and will be signed into law by Governor Jay Inslee on Monday, establishes the country’s first social-insurance program to pay for long-term care. All residents will pay 58 cents on every $100 of income into the state’s trust. After state residents have paid into the fund for ten years—three if they experience a catastrophic disabling event—they’ll be able to tap $100 a day up to a lifetime cap of $36,500 when they need help with daily activities such as eating, bathing, or dressing. . . .

“The architects of the legislation were trying to find ‘a number adequate enough to meet people’s needs and at the same time not be catastrophic if everybody [made claims] at the same time,’ [AARP vice president Elaine] Ryan explained. ‘To make it actuarially sound so people could be guaranteed a benefit.’

“The policy’s universal structure and funding is also significant. All working people will pay into the fund through a payroll tax and then be able to claim a benefit when they need it. The same structure has ‘stood the test of time’ with Social Security and Medicare, Ryan noted. Politically speaking, ‘it mattered a lot that it was set up as a social-insurance program,’ Caring Across Generations’ [Sarita] Gupta said.”

It sounded great — but too good to be true.

Now officials in Washington are recognizing there are problems with the plan.

In December, Gov. Jay Inslee announced a delay in the start of the payroll tax, so that the legislature could make changes when the new session convenes on January 10th, following a multitude of complaints about the program, in particular because workers who move out of state, or who were less than 10 years away from retirement, would be paying into the system without ever being able to benefit from it. The tax is now planned to begin in April, but if House Bill 1732 passes, the tax would be delayed until July 0f 2023. In addition, House Bill 1733 would allow people working in Washington but residing elsewhere, as well as temporary workers with nonimmigrant visas, and disabled veterans and spouses of active duty military members, to opt out. Neither of these bills, however, would deal with the issues posed by the eligibility requirements themselves.

But these eligibility requirements are in place for a reason, to reduce costs with lower numbers of recipients, and to build up reserves which are spent down as current workers ultimately retire. Here’s what the 2017 feasibility study itself reported:

“We estimate the Base Plan under Option 1 will require a 0.54% payroll surtax rate over the 75-year period 2020 through 2094. We estimate an ultimate tax rate of 0.94% to cover program costs after 2094 once the population receiving benefits has stabilized.” In other words, if all Washington residents were eligible regardless of age and contribution history, the cost of the program would double, because that’s what will ultimately happen when, 75 years into the future, all retirees have paid into the program. In practice, the actuaries consulted for this report anticipated that payroll taxes would be increased well before the 75 year period ends.

In addition, the $100 per day benefit is slated to increase by no more than the inflation rate, and possibly be reduced if it is deemed necessary for solvency purposes, according to the enabling legislation. And that $100 per day benefit is anticipated to be enough for the average individual receiving 96 hours of home care per month, based on Medicaid rates, for one year, according to the legislation’s findings.

One might argue that, however imperfect this legislation might be, its flaws can be remedied in the future. But the law is a mixture of characteristics of programs of social assistance and social insurance, to its detriment. A requirement to have paid into the system is characteristic of a social insurance program, and the 10 year contribution requirement is essentially the same as the eligibility requirement for Old Age benefits in Social Security. However, true social insurance programs pay out benefits to those eligible regardless of residence — again, once you’ve paid into Social Security long enough to have earned your benefit, you can collect regardless of where you live, even if you have moved abroad. In fact, even noncitizens who worked in the United States long enough to have accumulated sufficient Social Security credits, can receive benefits after having moved back to their home countries. What’s more, many social insurance systems provide some sort of refund mechanism for workers who do not accumulate enough contribution years to be eligible.

And this hybrid system will likely prove to be unsustainable politically. Even if ordinary Washingtonians are not well-versed in social insurance concepts and theories, it will not sit right with them that those who retire with 10 years of payroll taxes have “earned” their benefits but those with 9 years have not, and, likewise, that those who have “earned” benefits would lose those “earned” benefits merely by moving out of state. How precisely this will play out over the long term remains to be seen, but the new bills are not likely to be the end of the story.

In any case, these problems will not be easy to remedy.

As always, you’re invited to comment at JaneTheActuary.com!