Compare Policy Proposals
Review and compare proposals for financing long-term services and supports (LTSS).
Review and Compare Policy Proposals by Category
By providing a consistent framework for analysis, this feature supports informed decision-making and evidence-based policy development.
You can:
- Browse proposals by category: from public coverage reforms to private market approaches and commission reports.
- Examine structured details: including funding mechanisms, eligibility rules, scope of coverage, and projected impacts.
- Compare side-by-side: evaluate how proposals differ across key policy dimensions such as cost, sustainability, administrative feasibility, and equity.
- Gain context: with timelines, supporting evidence, and summaries of implementation challenges.
Legislative Proposals for Public LTSS Coverage Reform
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| Proposal Name | LTC Assistance Act | Medicare for All | WISH | CLASS Act | Health Security Act | Health Security Act | Comprehensive Care Act | LTC Family Security Act | Secure Choice Act | Medi-Plan Long-Term Care Act | Universal Health Care Act | Lifecare LTC Protection Act | Amend Title XIX of the Social Security Act | Better Care Better Jobs | HCBS Access Act |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LEGISLATION NUMBER | S 2305 | H.R. 3421 | H.R. 4289 | S 697 | S. 2357 | S. 1757 | H.R. 6063 | H.R. 6076 | H.R. 1668 | H.R. 651 | H.R.1300 | S. 2163 | H.R. 8106 | S 100/H.R 547 | S 762/H.R. 1493 |
| YEAR | 1988 | 2023 | 2021 | 2009 | 1994 | 1993 | 1992 | 1992 | 1991 | 1991 | 1991 | 1990 | 2024 | 2023 | 2023 |
| PROGRAM STRUCTURE | |||||||||||||||
| Add-on to Medicare | X | X | X | X | |||||||||||
| Medicaid enhancement | X | X | X | ||||||||||||
| New program/separate administration | X | X | X | X | X | X | |||||||||
| Transforming Healthcare Structures | X | X | |||||||||||||
| POPULATION SERVED | |||||||||||||||
| All adults (18+) | X | ||||||||||||||
| Older adults (65+) | X | X | X | X | |||||||||||
| Other age limits | X | X | X | X | |||||||||||
| No age limits | X | X | X | X | X | X | X | ||||||||
| Excludes persons with disabilities | |||||||||||||||
| COVERED SERVICES | |||||||||||||||
| Facility care only | |||||||||||||||
| Home and community care only | X | X | X | X | X | X | |||||||||
| Comprehensive | X | X | X | X | X | X | X | ||||||||
| Cash benefit – no services defined | X | X | |||||||||||||
| FINANCING | |||||||||||||||
| Dedicated/earmarked source (e.g., Social Security/ Medicare tax) | X | X | |||||||||||||
| General appropriations (e.g. income tax) | X | ||||||||||||||
| Other | X | X | X | ||||||||||||
| None specified | X | X | X | X | X | X | X | X | X | X | X | X | |||
| PROGRAM PARTICIPATION | |||||||||||||||
| Mandatory/universal | X | X | X | X | X | X | X | X | X | X | X | X | X | X | |
| Voluntary | X | ||||||||||||||
| ADMINISTRATION OF PROGRAM BENEFITS | |||||||||||||||
| Largely state role | |||||||||||||||
| Largely federal role | X | X | X | X | X | X | |||||||||
| Both federal and state | X | X | X | X | X | X | X | X | X | ||||||
| COST ESTIMATE | |||||||||||||||
| CBO estimate | X | X | X | ||||||||||||
| Legislation estimate | X | X | X | X | X | X | X | ||||||||
| None | X | X | X | X | X | X | X | X | |||||||
| COVERAGE DURATION/TYPE | |||||||||||||||
| Front-end | X | X | |||||||||||||
| Back-end/Catatrophic | X | ||||||||||||||
| Comprehensive | X | X | |||||||||||||
| Not Specified (See below) | X | X | X | X | X | X | X | X | X | X | |||||
| In some cases, the coverage duration is not specified because the program structure is meant to be determined by the states. Also Medicare-expansion type finance reform proposals often do not specify this level of detail. | |||||||||||||||
*Estimate of impact on deficit reduction – due to vesting period when premiums are collected but no benefits paid. No other program cost estimates provided.
**Provides some benefits but primarily emphasizes other services indicated.
***Only individuals with qualified disabilities are included
****Limited facility care
Legislative Proposals for the Private Long-Term Care Insurance Market
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| Proposal Name | Improving Access to Long-Term Care Insurance Act | Amends Internal Revenue Code of 1986 | LTC Affordability Act | LTC Affordability Act | Health Savings Freedom Act of 2022 | HELPS Retirees Improvement Act of 2022 | LTC Affordability Act | LTC Retirement and Security Act | Simple Cafeteria Plan Act | Tax Relief for LTC Act | LTC Family Accessibility Act | LLTC and Retirement Security Act of 2008 | Alzheimer’s Family Assistance Act of 2007 | Qualified LTC Fairness Act of 2007 | LTC Trust Account Act | LTC Trust Account Act | LTC Affordability and Security Act | Simple Cafeteria Plan Act | Healthcare Enhancement for Local Public Safety Retirees Act | Amends the IRC of 1986 | LTC and Retirement Security Act of 2005 | LTC Support and Incentive Act | LTC Tax Reduction Act | LTC Support and Incentive Act | LTC Act of 2005 | Long-Term Care Improvement Act of 2006 | Improving Long‑Term Care Choices Act of 2005 | LTC and Retirement Security Act, 2003 | LTC and Retirement Security Act | Ronald Reagan Alzheimer’s Breakthrough Act of 2004 |
|
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
LEGISLATION NUMBER | HR 8820 | HR 5774 | HR 7107 | S 2415 | HR 6474 | HR 7203 | S 4820 | HR 6005 | S 988 | HR 6237 | S3365 | HR 5559 | S 897 | HR2582 | S 504 | S 1809 | HR 3363 | S723 | HR 2177 | HR1150 | HR 2682 | HR 2935 | HR 4220 | HR 6221 | HR 976 | HR 6405 | s 1602 | HR 2096 | S 1335 | S 2533 | |
| CONGRESS | 118th | 118th | 117th | 117th | 117th | 117th | 116th | 112th | 111th | 110th | 110th | 110th | 110th | 110th | 110th | 110th | 110th | 109th | 109th | 109th | 109th | 109th | 109th | 109th | 109th | 109th | 109th | 109th | 109th | 109th | |
| YEAR | 2023-2025 | 2023-2025 | 2021-2023 | 2021-2023 | 2021-2023 | 2021-2023 | 2019-2021 | 2011-2013 | 2009-2011 | 2007-2009 | 2007-2009 | 2007-2009 | 2007-2009 | 2007-2009 | 2007-2009 | 2007-2009 | 2007-2009 | 2005-2007 | 2005-2007 | 2005-2007 | 2005-2007 | 2005-2007 | 2005-2007 | 2005-2007 | 2005-2007 | 2005-2007 | 2005-2007 | 2005-2007 | 2005-2007 | 2005-2007 |
|
| CATEGORIES | |||||||||||||||||||||||||||||||
| Tax deductions: Remove requirement to itemize | X | X | X | X | X | X | X | X | X | X | X | X | X | X | |||||||||||||||||
| Allow use of pre-tax HSA funds | X | X | X | ||||||||||||||||||||||||||||
| Allow use of pre-tax retirement funds | X | X | X | X | X | X | X | X | |||||||||||||||||||||||
| Allow tax-free exchange of retirement funds | X | ||||||||||||||||||||||||||||||
| Allow LTCI inside cafeteria plans or FSAs | X | X | X | X | X | X | X | X | X | X | X | X | |||||||||||||||||||
| Allow LTC within HSA account w/o High Deductible Plan | X | ||||||||||||||||||||||||||||||
| Create new type of LTC savings account w/ tax free growth | X | ||||||||||||||||||||||||||||||
| Allow tax/penalty free withdrawls from retirement accounts | X | ||||||||||||||||||||||||||||||
| Allow tax free withdrawals from retirement accounts | |||||||||||||||||||||||||||||||
| Allow penalty free withdrawals from retirement acocunts | |||||||||||||||||||||||||||||||
| Gov't public awareness education website | X | X | |||||||||||||||||||||||||||||
| Tax credit for LTC Premiumds | X | X | X | X | X | X | |||||||||||||||||||||||||
| OTHER PROPOSALS | OWN YOUR FUTURE | LTC CLEARINGHOUSE | PARTNERSHIP | ||||||||||||||||||||||||||||
| Gov't public awareness education website | X | X | |||||||||||||||||||||||||||||
| Medicaid eligibility with modified spend-down requirements; allows individual who has a PQ LTCI policy to keep additional assets equal to benefits they received from their PQ policy. All other Medicaid eligibility rules still apply. | X | ||||||||||||||||||||||||||||||
| None of the other criteria above apply to these other proposals |
*Estimate of impact on deficit reduction – due to vesting period when premiums are collected but no benefits paid. No other program cost estimates provided.
**Provides some benefits but primarily emphasizes other services indicated.
***Only individuals with qualified disabilities are included
****Limited facility care
Commission Reports and Research Papers
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| Proposal Name | Brookings Institution | National Academy for Social Insurance | Leading Age | Urban Institute | Georgetown University LTC Financing Project | The Pepper Commisson | American LTC Insurance program | Mark Warshawsky | Bipartisan Policy Center | Milken Institute | LTC Financing Collaborative | US Senate Commission on LTC: Option A | US Senate Commission on LTC : Option B | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NAME | Home Care Benefit for Medicare | Designing a State-Based Social Insurance Program for LTSS | A New Vision for LTSS | Microsimulation Analysis of Financing Options for LTSS | A Trade-Off Proposal for Fudning LTC | A Call for Action: Blueprint for Health Care Reform | A Solution to Reduce Cost and Provide Stability | National Affairs, Financing LTC | An Updated Policy Roadmap: Caring for those with Complex Needs | New Approaches to LTC Access for Middle-Income Households | Principles for Improving Financing and Delivery of LTSS | Report to Congress | Report to Congress | ||
| YEAR | 2024 | 2019 | 2017 | 2015 | 2007 | 1991 | 2017 | 2024 | 2022 | 2021 | 2015 | 2013 | 2013 | ||
| PROGRAM STRUCTURE | |||||||||||||||
| Add-on to Medicare | X | X | X | X | |||||||||||
| Add-on to Social Security | |||||||||||||||
| Medicaid reform | X | X | X | ||||||||||||
| Private market incentives | X | X | X | X | X | X | X | ||||||||
| Transforming structures | X | X | X | ||||||||||||
| New program/separate admi | X | X | X | X | X | X | X | X | |||||||
| POPULATION SERVED | |||||||||||||||
| All adults 18+ | |||||||||||||||
| Older adults 65+ | X | X | X | X | X | X | |||||||||
| Other age limits | |||||||||||||||
| No age limits | X | X | X | ||||||||||||
| Not specified/other | X | X | X | ||||||||||||
| Other criteria | X | ||||||||||||||
| Include disabled | X | ||||||||||||||
| Excludes persons w/ disabiity | |||||||||||||||
| COVERED SERVICES | |||||||||||||||
| facility care only | |||||||||||||||
| Home care and CC only | X | X | X | ||||||||||||
| Comprehensive | X | X | X | X | X | X | X | ||||||||
| Not specified/other | X | X | |||||||||||||
| Cash benefit - no service defined | X | X | |||||||||||||
| FINANCING | X | X | |||||||||||||
| Dedicated/earmarked source | X | X | X | X | |||||||||||
| General appropriations | |||||||||||||||
| Other | X | X | X | X | X | ||||||||||
| None specified | X | X | X | ||||||||||||
| PARTICIPATION | X | X | x | ||||||||||||
| Mandatory/universal | X | X | X | X | X | X | X | X | |||||||
| Voluntary | X | X | |||||||||||||
| Not specified/other | X | ||||||||||||||
| ADMINISTRATION | X | ||||||||||||||
| Largely state role | X | ||||||||||||||
| Largely federal role | X | X | X | ||||||||||||
| Both state and federal | X | X | X | ||||||||||||
| Not specified/other | X | X | X | X | X | X | |||||||||
| COST ESTIMATE | |||||||||||||||
| CBO | |||||||||||||||
| In proposal | X | X | X | X | X | X | |||||||||
| None specified | X | X | X | X | X | X | |||||||||
| PRIVATE SECTOR INCENTIVES | x | ||||||||||||||
| Not specified/other | X | X | X | X | X | X | |||||||||
| Tax clarification | X | X | X | X | |||||||||||
| Federally regulated exchange | X | X | X | ||||||||||||
| Tighten Medicaid | X | X | X | X | |||||||||||
| Regulation change/new product | X | X | X | ||||||||||||
| Awareness campaign | X | X | |||||||||||||
| Reinsurance | X | ||||||||||||||
| Subsidy for Medicaid opt-out | X | ||||||||||||||
| Standardize policies | X | ||||||||||||||
| Lower distribution cost | X | ||||||||||||||
| COVERAGE DURATION | |||||||||||||||
| Front-end | X | X | X | ||||||||||||
| Catastrophic | X | X | X | X | X | ||||||||||
| Comprehensive | X | X | |||||||||||||
| Not specified/other | X |