OPINION: Thinking of Opting Out of 'WA Cares'? Think Again

by Nina Valerio

Last year, we heard a lot about how people wanted to opt out of the new WA Cares Fund program and how the program isn't perfect. Well, now our legislators are moving quickly to pass two bills that will strengthen and improve this program — the first of its kind in the nation — to provide flexible, affordable benefits to help workers pay for long-term care when the time comes that they need it.

"The WA Cares Fund^sm is a new fund to which we all contribute while we are working, and through which we can access long-term care when we need it."

—WA Cares Fund website

It is concerning me greatly to hear opponents of the program point to private insurance policies as the better alternative. As someone fighting tooth and nail to get the benefits we paid for from our corporate long-term care policy, I strongly urge my fellow Washingtonians to take a "buyer beware" attitude when relying on corporate long-term care policies to be there when you need benefits.

No matter what your age or circumstance, we should all accept the truth that there's a good chance we will need help at some point in our lives with daily living tasks like getting dressed, bathing, doing errands, and managing medication. Or we may want the option to get paid when we have to take time off or quit a job to take care of a family member who needs us.

For those who choose to opt out of the WA Cares Fund, I can tell you that the private market is not reliable. Long-term care insurance companies often take advantage of vulnerable people: They use scare tactics, raise premiums by exorbitant amounts, deny or delay benefits, cancel policies, and keep the thousands of dollars consumers paid in premiums for their policies.

My husband and I are retired professors who bought MetLife policies over 20 years ago and continue to pay into them today. Joseph is gravely ill (multiple myeloma, sudden right-eye blindness, cognitive impairment with memory loss, prostate cancer) and I am his caregiver. We don't know how much time we have left. MetLife has denied or delayed our benefits at every turn. They limit home care aides to no more than four hours (less than $150) a day. My husband's benefits total over $323,000. He automatically pays for his annual, ever-increasing premium without lapses. I have the same insurance myself. Joe's illnesses are tragic, and our lives have been turned upside down. A caregiver's responsibilities are enormous, and the way MetLife has treated us makes us feel completely overwhelmed, angry, and powerless.

We learned from an S&P Global Market Intelligence report that the CEO of MetLife has an annual salary of $14 million, while policyholders like us are facing the need to sell our home and downsize in order to pay for the care we need and while the company holds onto the thousands of dollars in premiums we paid into our policy. If we miss even one payment, I was told by our client case coordinator, our policy will be permanently canceled, and all the premiums they have collected will stay with the insurance company.

A recent analysis found more than 800 complaints were filed against long-term care insurance companies with the Washington State Office of the Insurance Commissioner in just the past few years. Almost half were for delaying or denying benefits like in-home care and nursing home stays. Another third were for premium hikes of 30%, 90%, even 300%. Consumers need a way to hold these companies accountable now. That's why I am joining with fellow consumers who have been wronged by insurance companies to ask our State Attorney General Bob Ferguson to investigate the practices of these companies.

The State's new public long-term care benefit is sure to be more reliable and affordable than corporate insurance companies that can deny or cancel coverage for no reason, jack up premiums, or just go out of business with no notice. Experts, including our own Insurance Commissioner Mike Kreidler, are warning it's not a matter of if but when the big long-term care insurance carriers will go insolvent. Consumers may well find themselves without benefits when they need them most, even if they did everything right.

The WA Cares Fund will ensure workers have a safety net to tap into when they need care, which I can promise, most of us will need at one time or another. Just as we pay into Medicare and Social Security so it's there for us when we need it, it's smart for workers to pay into a program that will be there for them when they need help caring for themselves or their loved ones — whether they have dementia, diabetes, or a broken hip. This kind of longer-term personal care is not covered by health insurance or Medicare and is denied by many private long-term care insurance policies.

I wish a reliable, affordable, public option like WA Cares had been around when Joe and I were still working. Washington can be a model for the nation, creating a universal long-term care coverage system and fixing a broken long-term-care insurance industry.

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Featured Image: Nina L. Valerio and Joseph W. Scott. Photo courtesy of Nina Valerio.