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Piece by piece, will Obama's health-care reform law be dismantled?

The administration itself has abandoned a long-term health-care provision for seniors, and the Supreme Court will decide soon whether to take up the law. Critics see beginning of the end for Obama's health-care reforms.

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At least 2 in 3 seniors will need help with daily activities at some point in their remaining years, estimates HHS. But fewer than 10 percent of those age 50 or older have private insurance to help pay for it, according to the Congressional Research Service. Options include a nursing home at a median annual cost in 2010 of $75,000, assisted living at $37,500, or a home-care attendant at $19 an hour to help with basics such as eating and getting into bed. But Medicare covers only limited long-term care services, meaning individuals pay for them mostly out of pocket. Medicaid does cover such services, but beneficiaries must have nearly depleted all resources before they are eligible.

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"There needs to be a mechanism by which people can insure themselves against being bankrupted by medical expenses later in their life," says Jared Bernstein, a senior fellow at the Center on Budget and Policy Priorities.

The CLASS program would have allowed people to buy insurance to cover in-home care; after paying into it for five years, they would be eligible for, say, a $50-a-day benefit to subsidize an attendant's salary, so they could afford to live at home rather than in a more expensive institutional setting.

But HHS documents reviewed by a House and Senate GOP CLASS Act working group showed that HHS officials were concerned as early as May 2009 that CLASS could not be sustained without billions in taxpayer subsidies by the third decade, when claims would be spiking.

Is this the end of the issue? Not likely. Republicans and some business groups say it's not enough that HHS says it is scrapping plans for the CLASS program. They want Congress to repeal it.

"CLASS is not gone – not yet," said Rep. Denny Rehberg (R) of Montana, a member of the CLASS Act working group, at an Oct. 26 hearing. "The secretary can claim she has the authority to, in effect, rewrite it."

The US Chamber of Commerce, which backed the overall health-care reform law, is also calling on law-makers to repeal CLASS, saying it will never benefit taxpayers and could yet be revived by regulators. Democrats, though, still want to find a way to make the CLASS Act work.

"Cheering the suspension of CLASS does nothing for the working families in my district who are already under the enormous stress that comes when a parent falls seriously ill and who have no way of paying for the around-the-clock care their loved one needs," said Rep. Ted Deutch (D) of Florida, at the Oct. 26 hearing.

According to updated estimates from the Congressional Budget Office, the Affordable Care Act will cut federal deficits by $127 billion over 10 years, even now that CLASS is excluded.

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