Financing ElderCare: The WISH Act HR 4289

This short summary illustrates why the U.S. needs federal catastrophic long-term care insurance and how the WISH Act would meet the need.


  • Average Americans have no way to save, insure, or provide for the costs of supportive care while disabled in our last years.
  • Eldercare causes most spending down to poverty and relying on Medicaid in old age, and family caregivers often lose their own retirement security.
  • The average elder needs supportive services for 2 years, 1 in 7 of us will need more than 5 years.
  • Change is needed now, since current challenges will be dwarfed by nearly doubling the affected population within a decade.

Federal Catastrophic Long-term Care Insurance – the WISH Act, HR4289

  • Federal because elders move from state to state, and catastrophic costs require a large pool of funds
  • Catastrophic because then people can make their own plans for the first period of disability, confident of financial help if the period of disability becomes long
  • Catastrophe varies with different opportunities to save – well-off people can manage a longer period before needing the support of a public insurance plan
  • Long-term care (LTC) here focuses on a period when the person cannot take care of daily tasks without help – either paid or unpaid help is needed every day
  • Insurance because the need for long-term care in old age is both unpredictable and quite varied. Some need many years of around-the-clock care, while a few die suddenly with no long-term care need – but no one can predict.  This is by far the most substantial threat to most family’s finances, making it very desirable to be part of a large insurance pool.

Some Specifics about the proposed WISH Act, HR 4289

  • Fully paid for by a payroll tax of 0.6%, split between employee and employer
  • Cash benefit of about $120/day, tied to inflation, enough for about 6 hours of paid help, including paying family
  • Triggered by cognitive disability requiring constant supervision or functional disability of two or more activities of daily living (which is the HIPAA standard used by LTC insurance)
  • Requires a waiting period of 1 to 5 years living with disability, depending upon lifetime earnings – 40% of the population with the lowest earnings wait one year, average Americans wait less than 2 years
  • Requires paying into the insurance for 10 years for full benefits
  • Creates a strong market for private long-term care insurance, since many workers will want to cover the waiting period
  • Greatly reduces reliance on Medicaid, avoiding substantial challenges for state budgets

Let’s make it possible for most Americans to pay for the supports needed in advanced age – Federal Catastrophic Long-term Care Insurance – the WISH Act

More Info  – for HR 4289, section-by-section, and a Powerpoint presentation 

for the fundamental research shaping the proposal  

for a succinct overview on long-term care financing options 

for an endorsement honoring the fiscal soundness of the proposal

Author: Dr. Joanne Lynn

Dr. Lynn is a geriatrician and hospice physician doing advocacy and research to improve eldercare. She encourages better financing models for long-term care and demonstration projects to improve eldercare in communities. Dr. Lynn has published over 300 peer-reviewed medical research and policy articles.

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