WA Cares is a small lifeline to those workers struggling to pay for long-term care. Voters this fall will decide whether you can opt out

When her elderly father needed 24-hour care, Sam Hatzenbeler could not afford it.

She lived on the West Side, while her father lived alone on his horse ranch outside Medical Lake. Unwilling to leave his home, Butch Hatzenbeler was cared for by a home aide who came during the day.

One night, he fell and did not receive treatment until  he was discovered by a neighbor hours later. The fall was the precipitating event that hastened his decline and ultimately led to his death in 2022.

According to Sam Hatzenbeler, had the two of them been able to afford overnight care, he likely would have lived a longer life and been able to enjoy life more in his final days.

As the larger baby boomer generation grows into old age, long-term care will become  more important – and likely  more expensive. In the future, more and more adult children such as Sam Hatzenbeler will need to take time away from their careers and their family to care for a parent who has no one else.

“He was a stubborn cowboy. He wanted to stay at home,” she said. “I’m an only child and didn’t have any other family support, so just for me alone to figure how he could stay there and still get care was really stressful and really costly.”

After his fall, they sold the farm’s tractor to pay $8,000 for one month at an adult family home.

“His doctor wanted him to have 24-hour care, but that just wasn’t feasible financially,” Sam Hatzenbeler said.

To live somewhere an individual has 24-hour supervision can cost upwards of anywhere between $4,000 and $8,000 a month, according to Judith Bendersky, a retired aging and disabilities specialist at the Washington State Office of the Insurance Commissioner.

“There are some resources for extremely wealthy people to go to a long-term care facility. But most people cannot find the resources to have care in the home or afford a long-term care facility,” Bendersky said.

Less than 10% of the population have private long-term care insurance, which can have monthly premiums in the thousands of dollars, Bendersky added.

In Washington, the program attempting to fill in that gap is WA Cares, a public long-term care insurance that provides a modest one-time benefit when Washington residents need it. Workers are required by the state to pay into the program throughout their lives to receive WA Cares benefits.

The program has long been controversial, and an initiative on the ballot this fall would allow Washingtonians to opt out of the state-run long-term care insurance. Opponents of Initiative 2124 claim making the program optional would render it unsustainable and effectively end WA Cares entirely. Those pushing the initiative say struggling workers need the right to refuse this insurance if they can’t afford it.

Bendersky contends WA Cares benefits could have extended her father’s life. She is a policy expert at the Economic Opportunity Institute, a liberal think tank, and is working with the campaign to defeat the initiative against WA Cares.

Regardless of the measure’s outcome, the need for long-term care will continue to grow.

What is WA Cares?

WA Cares was first passed by the state Legislature and signed by Gov. Jay Inslee in 2019. The program’s implementation was later delayed, and the Legislature passed changes to the long-term care insurance program in 2022.

These updates included allowing those who retire out of state to access benefits and allowing exemptions for those who work in Washington but live elsewhere.

The payroll tax funding WA Cares started being taken out of workers’ pay checks in July 2023, and the first payouts to those needing long-term care will come in July 2026. Until the end of 2022, workers with private long-term care insurance could apply for an exemption,  according to the Office of the State Actuary. But now all those who did not opt out are required to pay.

The payroll tax takes 0.58% of a worker’s income each paycheck. For someone who makes $50,000 a year, they will pay approximately $290 to WA Cares annually. After paying into the program for at least 10 years, those needing long-term care receive a one-time $36,500 benefit.

WA Cares benefits will increase as inflation rises, but those paying into the program longer than 10 years do not get a larger payout. Those who need the benefit before 10 years will get a smaller payout based on how long they paid in.

WA Cares benefits can be used to pay for professional care in-home or at a facility, equipment, and other long-term care needs. The funding can also be paid to a family member who interrupts their career to take care of a loved one full time. These family members must take 30 hours of training and are subject to spot checks by adult protective services.

Initiative 2124

The initiative to make WA Cares optional was put on the ballot through the efforts of Let’s Go Washington, a conservative advocacy group funded by wealthy hedge fund manager Brian Heywood. The group was able to collect enough signatures to get a whole slate of initiatives on the ballot this fall, including about 424,000 signatures for the WA Cares initiative.

When going to the polls in November, a “yes” vote will make WA Cares voluntary and a “no” vote will keep the program as it is.

Speaking to The Spokesman-Review, Heywood called WA Cares a “terribly designed program” meant only to fill the pockets of government.

“The Legislature knew it was flawed and it was unpopular, so they delayed implementation for two years and tried to quietly sneak it back last year and barely gave us any escape period to get out of it,” Heywood said. “And look at who optioned out. Everybody that had a sophisticated HR department got out of the program. But if you were a waitress or you worked at a gas station, you didn’t even know the government was going to take this out of your paycheck.”

Heywood called the 500,000 people who were able to decline WA Cares insurance “very lucky lotto winners.” His initiative is just a way to give everyone the option to not have long-term care insurance if they don’t want it.

“I want to give people a choice. We gave 500,000 people a choice. We trapped 3.5 million. They should have a choice to stay in or get out,” he said.

JoAnne Clager is an 81-year-old retiree who lives independently at Rockwood Retirement in Spokane. While acknowledging long-term care is a serious issue for her and many others her age, she thinks it would be “a lot more fair if younger Washingtonians had a choice in signing up for a “very ineffective” insurance.

“(The) $36,500 might get you two months here at Rockwood. If somebody is paying into it for 15 or 20 years and all they get is that. Well, that isn’t going to go very far to help them with what they need,” Clager said.

The benefits are tied to inflation, so WA Cares payouts will be higher in two decades.

WA Cares Director Ben Veghte admits $36,500 is not a lot of money for long-term care.

“The scope of the program is modest. It’s a modest premium for modest benefit,” he said, calling WA Cares a “foundation” to expand upon.

“If someone wants larger payouts, they also want the premium to be greater. That is a political choice,” he said. “There’s no appetite in the legislature to increase the premiums right now. And I don’t know if there ever will be. We still think that the benefit is absolutely critical, and it’s a useful benefit to people.”

If the program stays in place, Veghte in the coming years hopes to strike a deal with private insurance companies for cheaper supplemental plans that can expand WA Cares insurance.

Long-term care can be temporary

Though it is long-term care insurance, Bendersky said WA Cares’ benefit is not intended to last long.

“Suddenly needing full-time or part-time professional care for a loved one can be highly disorienting. WA Cares will be a stopgap to cover services and supports while an individual and their family figure out where to move and how to navigate the very confusing systems of long-term care,” she said.

Less than $40,000 can bring a professional into the home for a couple hours of intermittent care but will not cover 24-hour supervision for very long, Bendersky added.

WA Cares is not only meant to cover the elderly who need permanent and intensive treatment. Long-term care is also needed on a more temporary basis for those recovering from surgery, an accident or many other conditions.

“If I am 50 years old and have a very bad bike or car accident and I can’t work and need long-term care for a few months while I recover, WA Cares can be a really wonderful benefit,” Bendersky said.

Spokane resident Julie Sparkman was diagnosed with breast cancer in 2021 and underwent major surgery that left her unable to complete basic tasks for months.

“I couldn’t wash my own hair. I couldn’t brush my hair. I couldn’t lift my coffee pot. There were times I couldn’t brush my own teeth,” she said.

For Sparkman, the need for long-term care was temporary, but the single mother could not afford it for even that relatively short period. Instead, her minor children took care of her in ways that Sparkman now regrets.

At the time, her eldest daughter Sam had just begun her freshman year of high school. According to the teenager, she was “utterly afraid” of losing her mother and felt a “heavy obligation” to care for her.

“The world felt like it was falling apart beneath my feet while I did everything for her. I couldn’t focus on school, and it ultimately led to mishaps for me. My life was totally derailed from it all,” Sam Sparkman said. “I wish things hadn’t gone the way they did for her or myself, but I really don’t regret throwing my life away like that for her, even though I know she wishes I hadn’t.”

Julie Sparkman believes the $36,500 from WA Cares would have been a “lifesaver” after her surgery. And as a result, she is telling her story to help defeat Initiative 2124 and volunteering with the pro-WA Cares campaign.

“If I had had WA Cares, I would have just hired someone. My children wouldn’t have felt afraid that I would go without something I needed because they couldn’t provide it. And they would have been able to concentrate more on their school and their emotional wellbeing,” she said. “That’s why I support WA Cares. I am happy to do my part to know that someone else’s daughter isn’t going to throw away their high school diploma trying to save their mother.”

Why is WA Cares not voluntary?

Opponents of the referendum argue that its passage would mean an effective end to the program. In a 2024 report, the Office of the State Actuary found making WA Cares voluntary could “lead to an unsustainable program.”

When an insurance program is voluntary, those who make the least and are in the best health are likely to opt out. Those remaining in the program would likely have a higher risk of needing long-term care, so a higher premium may be needed to cover payouts. When that higher premium is introduced, another round of those in the program at a higher income bracket will likely decide to opt out, and the process begins again.

This “insurance rate spiral” would eventually lead to failure when collected premiums are not enough to cover payouts, according to the report.

According to Bendersky, members of the public underestimate their personal risk for needing long-term care.

“Just like any insurance, WA Cares is dependent upon a large number of people contributing into an insurance pool. The more people that opt out, the smaller that pool, the greater the risk, and over time it would collapse,” she said.

While Veghte acknowledged WA Cares is an insufficient solution, he believes its collapse would not help those in need of long-term care.

“Anyone who wants to get rid of WA Cares, my question is, ‘What’s your solution?’ And I don’t think there is one,” he said.

But proponents of the initiative argue that creating a government system where the only way it can work is if citizens are required to participate is unethical.

“If you have to put a gun to someone’s head to get them to stay in a program, it’s not a good program to begin with,” Heywood said. “If their program depends on dishonesty, that’s more a reflection of the people that wrote the bill than of anything that I’m trying to do. They designed something that was so dishonest it can’t stand on its own. I’m not trying to make it fail. I’m giving people a choice.”

Asked if there could be a government program to address the issue of long-term care, Heywood said such health insurance should not be the domain of the state.

“I don’t think the government has the capability or the competency to administer this type of thing,” he said. “That’s the problem. The state could do a lot better if it decreased the regulation on the type of plans that could be offered in the state.”