title: After CLASS--Is a voluntary public insurance program a realistic way to meet the long-term support and service needs of adults with disabilities?
abstract: BACKGROUND
  The CLASS Act, which was part of the Affordable Care Act of 2010, established a voluntary personal assistance services (PAS) insurance program. However, concerns about enrollment and adverse selection led to repeal of the CLASS Act in 2013.
  
  
  OBJECTIVE
  To estimate the number of middle-aged adults interested in purchasing PAS insurance, the sociodemographic, socioeconomic and disability attributes of this population, and the maximum monthly premium they would be willing to pay for such coverage.
  
  
  METHODS
  A total of 13,384 adults aged 40-65 answered questions about their interest in PAS insurance in the 2011 Sample Adult National Health Interview Survey. We applied survey weights for the U.S. population and conducted logistic regression analyses to identify personal factors associated with interest in paying for the CLASS program.
  
  
  RESULTS
  An estimated 25.8 million adults aged 40-65 (26.7%) said they would be interested in paying for a public insurance program to cover PAS benefits. However, interest in PAS insurance varied by age, race, ethnicity, region, income, disability status, and family experience with ADL assistance. Only 1.6 million adults aged 40-65 (1.8%) said they would be willing to pay $100 per month or more for coverage.
  
  
  CONCLUSIONS
  While more than a quarter of the middle-aged adult population said they were interested in PAS insurance, actual participation would be highly dependent on premium rates. The current lack of publicly subsidized insurance for long-term care and personal assistance services remains a serious gap in the disability service system.
authors.affiliation: Department of Health Policy and Administration, Washington State University, 412 East Spokane Falls Blvd., Spokane, WA 99202, USA. Electronic address: jjkennedy@wsu.edu.
authors.forename: Jae
authors.initials: J
authors.lastname: Kennedy
authors.affiliation: Department of Health Administration and Policy, George Mason University, USA.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Gimm
authors.affiliation: disAbility Research Associates, LLC, USA.
authors.forename: Raymond
authors.initials: R
authors.lastname: Glazier
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D006233:Persons with Disabilities; D005260:Female; D018166:Health Care Reform; D006301:Health Services Needs and Demand; D018576:Home Health Aides / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D016015:Logistic Models; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D035141:Voluntary Programs
keywords: Disability policy; Health reform; Personal assistance services