2020 Election
By Jay Newton-Small
June 26, 2019

Gracyn Robinson is a single mom of three. The 48-year-old worries about putting her kids through school, paying her rent and maintaining her job security as an interior designer for senior centers. But, on top of that already considerable load, she’s most worried these days about her parents.

They’re in Kennebunkport, Maine, a 90-minute drive from where she lives in Lexington, Mass. They missed putting their names down for an independent living community in the early years of their retirement, and are now 79 and 80, too far along in their care to qualify for a continuing care retirement community. Robinson fears that her mom, who has already had three bad falls, is one fall away from needing full-time care, and her parents are already burning through much of their retirement savings paying for part-time, in-home care, subsidized by their Medicare Advantage Plan. She worries that they’ll need to come and live with her soon, or that she’ll have to help them pay for care just as her 16-, 14- or 12-year-old is heading to college.

Like most Americans, Robinson was shocked to discover that Medicare doesn’t pay for long-term care. “These days we have paid assisted fertility, paid parental leave,” says Robinson. “But we really need paid senior help, paid senior leave. How can anyone maintain job security if they can’t maintain their parents’ health?”

Robinson is one of the 45% of Americans who worry that a healthcare event could soon bankrupt them. But, like many, she doesn’t hear any of the Democratic candidates addressing her issues. As Democratic presidential hopefuls gather this week for the first primary debates, all the buzz about health has been about Medicare-for-all. While nice sounding, such a program would do nothing for the most pressing health crisis facing the nation: the millions of Baby Boomers who are in need of, or soon will need, long-term care. As many as 70% of Boomers over retirement age will eventually need long-term care, yet only 30% have saved anything in preparation for such care, according to estimates from the Employee Benefit Research Institute, which tracks retirement data.

“With aging parents and still needing childcare for my children while I’m at work as a single mother, the pressure on both ends is extreme,” Robinson says. “A lot of this is driven by immigration—there’s no one left for care at either end—but a lot is also driven by government and politicians lacking policies to address the issues.” As the Trump Administration has moved to limit the number of immigrants, this has exacerbated a market already short on workers. On average, senior living communities in the U.S see a 75% percent staff turnover annually, as frontline staff is lured away to better paying, or easier jobs in retail or the gig economy.

Every day, an estimated 10,000 Baby Boomers turn 65, the traditional retirement age. America is already short more than 1 million family caregivers—family members caring for those in need versus paid caregivers— and as the Boomers age, that shortage is estimated to grow to 4 million by 2030. So just as the need for care will be the greatest, the supply and, likely, quality of it will be the lowest. This will lead to a ballooning of the cost of care, threatening to bankrupt most middle-class Americans by 2050, unless something is done to change the system.

And yet long-term care is not central to any of the candidates’ Medicare-for-all plans and few ever mention on the campaign trail the largest driver of long-term care expenses: Alzheimer’s and dementia. Only one candidate’s plan, Bernie Sanders’, even addresses long-term care; a plan that outside analysts estimate could cost $30 trillion over a decade and only has 14 cosponsors in Congress—a virtual non-starter, legislatively-speaking. “Medicare was never designed to finance long-term care, the cost of which would instantly bankrupt an already underfunded program,” says Dr. Marty Makary, a professor at Johns Hopkins University and the author of The Price We Pay, to be published later this year. “Medicare for all may sound attractive but in reality, it’s a futile whack-a-mole approach to the real issues driving up the cost of health care.”

Though polls show health care consistently is one of the top concerns for most American voters, including Democratic primary voters, they don’t seem as interested in getting into the details of policy. A recent Kaiser Family Foundation poll found that only 4% of Democratic primary voters were interested the candidates discussing Medicare-for-all in the first primary debates. And, according to that same poll, voters showed a very poor understanding of what the term even means. In particular, they seemed to not understand that it implies transitioning away from private health insurance and towards a single-payer system.

With Medicare’s key Hospital Fund, which finances Medicare services for beneficiaries through a payroll tax, set to go bankrupt by 2026 and states to start seeing Medicaid funds dry up by next year as they are no longer able to afford their share of care as the sheer numbers of those in need overwhelm the system, the crisis is looming—even if it’s not at the forefront of candidates’ minds. “You don’t want to be elected office at the time when those funds start to run out,” says Bob Kramer, founder of the National Investment Center for Seniors Housing & Care. “That will be a game of musical chairs which won’t be pretty.” Yet the cliff is still a few years away, and without immediate impetus, the debate remains focused on other issues. This, Kramer laments, is shortsighted. “The shorter the runway the tougher this will be to do, and the runway keeps getting shorter,” he says.

Which is why, in part, states have begun to take up the slack. Hawaii and Washington State have become the first two states to pass long-term care plans of their own. Maine tried and failed last year, but will try again in 2020. Last year, Congress passed the RAISE Act, which promised to study the issue and look for solutions, but the CLASS Act, which would’ve started a similar scheme on a federal level fell out of the Affordable Care Act during the Senate debate, deemed too expensive.

Still, the debate of Medicare-for-all could be productive, argues Anne Tumlinson, founder of Daughterhood, a blog and social platform for daughters caring for their parents, and a respected consultant in the senior space. ““There’s no reason that [long-term care] can’t be integrated into a Medicare-for-all program,” says Tumlinson. “It’s completely doable and there are many options to pay for it.”

But, like with all legislation, seeing a reasonable end game doesn’t mean easy passage—especially though Congress in this political climate.

“Long-term care is the hidden issue no one talks about. That’s because, while it affects nearly every family, it doesn’t affect them all at the same time,” Tumlinson says. “We don’t have a critical-enough mass of folks in this situation at the same time to elevate this pain politically, in my view.”

Certainly, that was the case for Robinson. Senior care wasn’t her top issue until suddenly it needed to be. But the sad reality is that most families in America are heading to that inflection point sooner rather than later.

Contact us at editors@time.com.

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