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Illustration: Aïda Amer/Axios

Taking care of the aging population is a crisis in the making, and no one — not families, not government programs and not the health care workforce — is prepared for it.

The big picture: Providing health care to aging Baby Boomers will strain Medicare’s finances, but the problem is even bigger than that.

Long-term care — the kind of services typically performed in a nursing home or by a home health aide — largely falls through the cracks of both public and private health insurance, saddling seniors and their families with financial and emotional burdens they often didn’t anticipate or plan for.

  • “It’s a problem nobody’s talking about,” said David Grabowski, a health policy professor at Harvard who studies long-term care. “Part of that’s just, these are hard issues to think about. Nobody wants to think about getting old and needing care. But part of it is that these are really hard problems.”

By the numbers: Estimates differ on the specifics, but they generally agree that somewhere between half and two-thirds of seniors will need at least some long-term care.

  • Today’s seniors will incur an average of $138,000 in long-term care bills, according to one federal study.
  • Even middle-class seniors are largely unable to cover those costs, according to a study published earlier this year, which Grabowski co-wrote.

How it works: Medicare doesn’t cover most long-term care services. The market for private long-term care insurance is tiny and fraught with failure.

  • That leaves three real options: Be rich enough to pay out of pocket, be poor enough to quality for Medicaid, or lean on family and volunteer caregivers.
  • In many cases, seniors must do all three: They begin paying out of pocket, then quickly spend everything they have, making them Medicaid-eligible, but still rely on family members for at least some additional help.

Medicaid is already the biggest line item in most states’ budgets — so as the need for long-term care grows, it will cost seniors, families, states and the federal government all at the same time.

The intrigue: A lot of long-term care has recently shifted away from nursing homes and toward home care or community-based options like assisted-living facilities.

  • That’s a good thing for seniors, but “the challenge with it is it sort of widens this gap between the haves and the have-nots,” Grabowski said.
  • Medicaid is still structurally tilted toward nursing homes, and when it does pay for home care, it doesn’t pay home care workers very well.

That leads to yet another problem — high turnover among nurses and caregivers, which isn’t great for patients.

  • Home care workers are also predominantly immigrants, tying this issue up with yet another charged political debate.

The bottom line: I asked Richard Johnson, who leads the Urban Institute’s program on retirement, why there isn’t a bigger political constituency to change this system.

  • “If you provided this benefit, lets say you made paid home care more affordable, there’s always a concern that it could lead to less family care,” he said.
  • “Look at child care,” he said. “We don’t have much of that, either.”

Go deeper: The unofficial health care system

Go deeper

Justice Department drops insider trading inquiry against Sen. Richard Burr

Sen. Richard Burr (R-N.C.) walking through the Senate Subway in the U.S. Capitol in December 2020. Photo: Stefani Reynolds/Getty Images

The Department of Justice told Sen. Richard Burr (R-N.C.) on Tuesday that it will not move forward with insider trading charges against him.

Why it matters: The decision, first reported by the New York Times, effectively ends the DOJ's investigation into the senator's stock sell-off that occurred after multiple lawmakers were briefed about the coronavirus' potential economic toll. Burr subsequently stepped down as chair of the Senate Intelligence Committee.

Netflix tops 200 million global subscribers

Illustration: Rebecca Zisser/Axios

Netflix said that it added another 8.5 million global subscribers last quarter, bringing its total number of paid subscribers globally to more than 200 million.

The big picture: Positive fourth-quarter results show Netflix's resiliency, despite increased competition and pandemic-related production headwinds.

Janet Yellen plays down debt, tax hike concerns in confirmation hearing

Treasury Secretary nominee Janet Yellen at an event in December. Photo: Alex Wong via Getty Images

Janet Yellen, Biden's pick to lead the Treasury Department, pushed back against two key concerns from Republican senators at her confirmation hearing on Tuesday: the country's debt and the incoming administration's plans to eventually raise taxes.

Driving the news: Yellen — who's expected to win confirmation — said spending big now will prevent the U.S. from having to dig out of a deeper hole later. She also said the Biden administration's priority right now is coronavirus relief, not raising taxes.