马萨诸塞州考虑征收工资税，为老年居民的长期护理提供资金

【中美创新时报2025年12月10日讯】（记者温友平编译）现在，马萨诸塞州卫生部门领导人正在考虑设立一项公共长期护理保险计划，以帮助人们支付相关费用。与此同时，马萨诸塞州老年人口比例飙升，用于居家护理、医疗设备、专业护理、康复治疗和其他老年人服务的公共支出正使该州预算捉襟见肘，约占马萨诸塞州医疗补助资金的三分之一。《波士顿环球报》记者过凯·拉扎尔对此作了下述报道。

残酷的现实如晴天霹雳般袭来，尼德姆夫妇的当地银行柜员冷冷地告诉他们：他们账户里的余额加起来只够买几周的食品杂货。

迈克尔·布朗一直以来都一丝不苟、谨慎地管理着家里的财务。但他的妻子简却丝毫没有察觉到他已经陷入了早发性阿尔茨海默病的迷雾之中。在他神志不清、健康咨询业务日渐衰败的同时，他悄无声息地挥霍掉了夫妻俩的积蓄和退休金，试图勉强维持生计。

简·布朗很快就体会到自己多么需要这笔钱，因为她在家照顾丈夫的日子十分艰难。在长达十年的时间里，直到三年前丈夫迈克尔去世（享年71岁），布朗一直靠着家人的帮助勉强维持生计，支付迈克尔的部分家庭护理人员费用。最终，迈克尔符合领取长期残疾津贴和医疗补助的条件，得以支付大部分医疗费用。她还抵押了房子，直到两年前72岁高龄才从一家非营利机构的全职工作中退休。

现在，马萨诸塞州卫生部门领导人正在考虑设立一项公共长期护理保险计划，以帮助人们支付相关费用。与此同时，马萨诸塞州老年人口比例飙升，用于居家护理、医疗设备、专业护理、康复治疗和其他老年人服务的公共支出正使该州预算捉襟见肘，约占马萨诸塞州医疗补助资金的三分之一。

与此同时，联邦政府大幅削减医疗补助资金，导致各州未来支付长期护理费用的能力出现不确定性。

今年早些时候发布的一项州政府委托研究设想，一项计划将通过强制性工资税来筹集资金，其方式与目前医疗保险税和社会保障税的自动扣除方式非常相似。根据个人选择的计划，工资税的税率将在0.68%至2.74%之间。对于年收入10万美元的人来说，这意味着每月需缴纳的税款从最便宜的56美元到229美元不等。

该研究探讨了多种潜在方案，但重点关注了三种，其终身福利总额从7.5万美元到最高方案的无限额不等。方案福利将随通货膨胀而增加，并涵盖广泛的服务，包括居家护理、辅助生活和疗养院。

此类服务的费用很容易让家庭不堪重负。据总部位于弗吉尼亚州的长期护理保险和服务公司 Genworth 在 2024 年进行的一项调查显示，在马萨诸塞州，一名家庭护理员的年费用约为 87,000 美元，而辅助生活设施的平均费用约为 109,000 美元，养老院的单人房间费用则高达 186,000 美元。

布朗说：“我真希望当时我能拥有它。或许它能让我消除哪怕一丝一毫的担忧、焦虑和恐惧。”

卫生部门负责人表示，大多数人没有意识到随着年龄增长，他们很可能需要一些照护方面的帮助。但长期护理保险费用高昂——平均每年约3375美元——行业数据显示，马萨诸塞州60岁以上的人群中只有约10%的人购买了此类保险。

“如果你的收入足够低，你就可以申请医疗补助；如果你的收入足够高，你可以自费就医，”马萨诸塞州老年人协会（LeadingAge Massachusetts）主席艾丽莎·谢尔曼（Elissa Sherman）说道，该协会是非营利医疗保健提供商的行业协会。

“但正是不断壮大的中产阶级陷入了困境，”谢尔曼说。“他们不得不依靠家人或让自己变得贫困才能获得医疗补助，我们认为这对家庭和州财政来说都是不可持续的。”

该州的可行性研究估计，公共资助的保险方案有可能在 75 年内为马萨诸塞州的医疗补助长期护理总支出节省 5% 到 45%，因为工人将通过工资税为该计划提供资金，从而减轻医疗补助系统的负担。

由萨默维尔的州参议员帕特里夏·杰伦和沃尔瑟姆的州众议员托马斯·斯坦利共同提出的法案，旨在成立一个由医疗行业领袖、倡导者和政府官员组成的委员会，负责在两年内制定一项公共长期护理计划。该法案目前已进入最后阶段，正在两院的筹款委员会审议中。

杰伦说：“人们不仅寿命更长，而且残疾程度也更重。但他们在家里得到的支持也更少，因为即使家里有人照顾他们，照顾他们的人也可能在工作。”

马萨诸塞州的可行性计划大致以华盛顿州的一项计划为基础。华盛顿州于 2019 年通过了一项法律，设立了WA Cares 基金。该基金于 2023 年启动了工资税，第一批福利金预计将于明年夏天发放。

该项目是全国首创，统一征收0.58%的工资税，大多数员工需要等待10年才能符合领取福利的资格。目前，最高终身福利金额仅为36,500美元，但会随通货膨胀而增加。该项目还允许已缴纳至少三年福利但迁居外州的居民继续参与。

但华盛顿州关爱计划（WA Cares）也经历了不少成长的阵痛。最初，华盛顿州允许购买了私人保险的人选择退出该计划，结果近50万人这样做，几乎导致该计划早期就破产。此后，该州堵上了这一漏洞，强制大多数人参加该计划。

华盛顿政策中心（一家自由市场智库）的政策分析师伊丽莎白·纽并不赞同这种做法。

“我对WA Cares最大的不满在于，它向低收入工人征税，用来支付高收入工人的福利，而这些高收入工人本可以负担得起这些福利，”她说。“这项福利将惠及所有人，无论他们是否需要。”

该项目去年经受住了废除的考验。

斯坦利表示，他预计在马萨诸塞州也会遇到阻力。

他说：“任何时候我们向居民要求更多资金，都会引发一些争议。”

斯坦利指出，凯撒家庭基金会2023年的一项全国调查显示，近一半65岁以上的成年人错误地认为联邦医疗保险涵盖长期护理。事实并非如此。

另一项来自“全国健康老龄化民意调查”的调查发现，57%的50岁及以上受访者认为自己永远不需要长期护理。然而，根据联邦政府的数据，70%的人一生中都需要某种形式的长期护理。

简和迈克尔·布朗夫妇认为他们迟早需要长期护理，早在迈克尔57岁被诊断出患有阿尔茨海默病之前几年，他们就申请了私人保险。但简说，他们的申请被拒绝了，因为简是癌症幸存者，并且正在与克罗恩病作斗争，而迈克尔患有严重的睡眠呼吸暂停症。

在布朗努力在家照顾丈夫的十年里，这种否认一直困扰着她。

“我几乎每天晚上醒来都会担心我们的财务状况，”她说。

然而，布朗不好意思地承认，她并没有过多考虑自己未来的照护问题。她说，她仍然住在几十年前和丈夫一起养育四个孩子的那栋简朴的三居室平房里，所以至少她以后还能住在单层楼里。

“我不想显得天真，因为我已经经历过现实的残酷，”布朗说。“但我还没有完全走出困境。”

题图：简·布朗（右）与她的律师凯瑟琳·林奇·蒙卡塔（一位老年法律师）坐在一起。布朗的丈夫三年前因阿尔茨海默病去世，他所需的护理费用几乎让她破产。州卫生部门负责人正在考虑设立一项公共长期护理保险计划，以帮助人们支付随着年龄增长而需要更多帮助的护理费用。《波士顿环球报》记者苏珊娜·克雷特。

附原英文报道：

Mass. considers payroll tax to fund long-term care for aging residents

By Kay Lazar Globe Staff,Updated December 8, 2025, 6:00 a.m.

Jane Brown (right) sat with her attorney, Kathleen Lynch Moncata, who is an elder law attorney. Brown’s husband died three years ago from Alzheimer’s, and the care he needed nearly bankrupted her. State health leaders are considering creating a public long-term care insurance program to help people pay for care as they age and need more help. Suzanne Kreiter/Globe Staff

Reality came in a gut punch, delivered matter-of-factly by the Needham couple’s local bank teller. The total balance in their accounts was barely enough to buy a few weeks of groceries.

Michael Brown had always been meticulous and careful in managing the family’s finances. But his wife, Jane, hadn’t realized he had slipped into the fog of early-onset Alzheimer’s. Amid his confusion and the erosion of his health consulting business, he had quietly burned through the couple’s savings and his retirement accounts, trying to keep ahead of the bills.

Jane Brown would soon discover how much she needed that money as she struggled to care for her husband at home. For a decade, until her husband’s death three years ago at age 71, Brown patched together assistance from family to help pay for some of Michael’s home health aides. Eventually, he qualified for long-term disability payments and for Medicaid to cover many of the health care bills. She also took a reverse mortgage on their house and didn’t retire from her full-time job at a nonprofit until two years ago, at age 72.

Now, state health leaders are considering creating a public long-term care insurance program to help people pay for such costs. It comes as the percentage of older adults in Massachusetts is soaring, and public spending on home care, medical equipment, skilled nursing, therapy, and other services to help people as they age is swamping the state’s budget, eating up roughly a third of Massachusetts’ Medicaid money.

At the same time, substantial federal funding cuts to Medicaid have created uncertainty about states’ abilities to pay for long-term care going forward.

A state-commissioned study released earlier this year envisioned a program to be funded by a mandatory payroll tax, in much the same way Medicare and Social Security taxes are automatically deducted now. The payroll tax, depending on the plan a person chose, would range from 0.68 percent to 2.74 percent. For a person earning $100,000 a year, that translates to a monthly tax ranging from $56 for the cheapest option to $229.

The study explored many potential plans, but focused on three, with total lifetime benefits ranging from $75,000 to unlimited coverage for the most expensive. Plan benefits would increase with inflation and would cover a wide range of services, including home care, assisted living, and nursing homes.

The costs of such services can easily overwhelm families. A home health aide in Massachusetts costs about $87,000 a year, while assisted living averages roughly $109,000, and a private room in a nursing home $186,000, according to a 2024 survey by Genworth, a Virginia-based long-term care insurance and services company.

“I so wish it was something I had had at my disposal,” Brown said. “Maybe it could have taken away even a modicum of concern and worry and fear.”

Health leaders say most people don’t realize they will likely need at least some help with care as they age. But long-term care insurance is so expensive — averaging about $3,375 a year — only about 10 percent of people in Massachusetts over age 60 have such a policy, industry figures show.

“If you have a low enough income, you can qualify for Medicaid, and if you have enough, you can pay privately,” said Elissa Sherman, president of LeadingAge Massachusetts, a trade association of nonprofit health care providers.

“But it’s that growing middle that is stuck,” Sherman said. “They have to rely on family or impoverish themselves to qualify [for Medicaid], and we see that as not sustainable for families or for the state budget.”

The state’s feasibility study estimated the publicly funded insurance options have the potential to save between 5 percent and 45 percent on Massachusetts’ total Medicaid long-term-care spending over 75 years, because workers would be funding this program through the payroll tax, easing the burden on the Medicaid system.

Legislation sponsored by state Senator Patricia Jehlen of Somerville and Representative Thomas Stanley of Waltham would create a commission composed of health industry leaders, advocates, and government officials to design a public long-term-care program within two years. The legislation is in its final stages, under consideration by both chambers’ Ways and Means committees.

“Not only are people living longer, they’re surviving with more disabilities,” Jehlen said. “But they also have fewer supports at home, because even if they have somebody at home, they might be working.”

Massachusetts’ feasibility plan is loosely based on a program in Washington state, which passed a law creating its WA Cares Fund in 2019. It launched its payroll tax in 2023, and the first benefits are slated to be paid out next summer.

The program, the first of its kind in the country, charges a flat 0.58 percent payroll tax, and most workers must wait 10 years to qualify for benefits. The maximum lifetime benefit, at this point, is modest, just $36,500, which will increase with inflation. The program also allows residents who have contributed for at least three years, but who move out of state, to continue in the program.

But WA Cares had substantial growing pains. Initially, Washington allowed people to opt out of the program if they purchased private insurance, and almost 500,000 did that, nearly bankrupting it early on. The state has since closed that loophole, making the program mandatory for most people.

Elizabeth New, a policy analyst at the Washington Policy Center, a free market think tank, is not a fan.

“My biggest complaint with WA Cares is it is taxing low-income workers to pay for benefits of higher-income workers, who could afford their care,” she said. “It will go to all people, regardless of need.”

The program survived a repeal effort last year.

Stanley said he expects there will be pushback in Massachusetts as well.

“Any time we are asking for more money from residents, there will be some controversy,” he said.

Stanley noted that a 2023 KFF national survey revealed that nearly half of adults over 65 mistakenly believe Medicare covers long-term care. It does not.

Another survey, from the National Poll on Healthy Aging, found 57 percent of respondents age 50 or older did not believe they would ever need long-term care. Yet 70 percent of people can expect to use some form of long-term care during their lives, according to the federal government.

Jane and Michael Brown believed they would need long-term care at some point and had applied for private insurance coverage several years before Michael was diagnosed with Alzheimer’s at age 57. But they were turned down because Jane was a cancer survivor and battling Crohn’s disease, while Michael had severe sleep apnea, she said.

That denial would haunt Brown over the decade she struggled to care for her husband at home.

“There was rarely a night or day I didn’t wake up not worried about our finances,” she said.

And yet, Brown sheepishly admitted she has not thought much about her own care going forward. She still lives in the same modest three-bedroom ranch house where the couple raised four children decades ago, so at least she will have single-floor living, she said.

“I don’t want to sound naive because I have had reality flashed in front of me,” Brown said. “But I am not there, yet.”