The WISH Act is a case study in collaboration, compromise, and negotiation.
On April 7, Congressmen Tom Suozzi (D-NY) and John Moolenaar (R-MI) will hold a conference in Washington, D.C. to promote their bipartisan Well-Being Insurance for Seniors to be at Home, or WISH, Act. The WISH Act calls for a federal catastrophic long-term care insurance program for older adults with disabilities, which includes both public- and private-sector components.
This legislation stands out for two reasons. One, the WISH Act proposes a solution to an ongoing crisis that affects millions of older Americans and their families: how to pay for long-term care. Second, it’s championed by both a Democrat and a Republican, making this a rare piece of bipartisan agreement in 2025.
This act didn’t just become a bipartisan effort; it’s been one from the start. Pragmatism and compromise have been part of each step of the process that has led to the WISH Act. Groups and advocates who designed this legislation have spent years building consensus and bridging divides to find practical solutions. One of those people is Marc Cohen, PhD, co-director of the LeadingAge LTSS Center @UMass Boston—part of the Gerontology Institute at UMass Boston—who’s worked toward this legislation with people across the political and philosophical spectrum.
“I’d rather make a difference than make a point,” says Cohen, a self-described “flaming pragmatist.”
Bridging Divides to Ease a Crisis in Care
Currently, many people with functional or cognitive impairments who require care—including in-home care, assisted living, and nursing home care—will exhaust their life savings and then depend upon Medicaid to pay for long-term care. Creating a catastrophic program would offer a new kind of protection, as well as relieve the burden on state Medicaid budgets. A program like this may also incentivize more private insurers to enter the long-term care insurance market, which could create more affordable options for consumers. (Currently, only 3% to 4% of Americans over 50 pay for a long-term care policy.) This act has the potential to create cascading effects that could offer relief in an area that’s long needed it.
Ideas that formed the WISH Act began more than 35 years ago as advocates and policymakers sought creative options to meld different visions for how to pay for long-term care. More recently, the idea was further developed by the Long-Term Care Financing Collaborative, which assembled experts with different points of view. The group began by establishing a shared set of priorities: building a system that works well, that doesn’t bankrupt consumers, and that encourages people to take responsibility for their future. Because the group began from a place of consensus on goals, later discussions and deliberations were productive and respectful. “By then, we had built trust,” Cohen says. “We didn’t question each other’s motives as we sought a path to reaching the goals we had agreed to.”
After the Collaborative created its broad recommendations, Cohen reached out to Judith Feder, PhD to hammer out details. She had put forward this and other ideas in the minority report of the Congressionally mandated Commission on Long-Term Care in 2013. Like Cohen, Feder—a professor of public policy at Georgetown University—has written extensively about the problem of long-term care for decades. However, over their careers, the two often stood at opposite sides of the philosophical continuum regarding the roles of government and the private sector. Cohen didn’t reach out to Feder despite these differences, but because of them. It was their expertise as well as their disagreements that made them productive collaborators.
“Judy and I have great respect for each other,” Cohen says. “We know the issue. We’re not ideologues. We were just two people who were deeply committed to solving a problem.”
Cohen and Feder fine-tuned details that built upon the ideas of the Long-Term Care Financing Collaborative, then collaborated with the Urban Institute, who did financial modeling for them. Then, Cohen and Feder presented their blueprint to the Bipartisan Policy Center.
“What if we have an insurance program where everyone pays in during their working years, and if they later require long-term care, they’re protected?” Cohen says. “We can put in place a complete, comprehensive solution whereby individuals take accountability for the more manageable up-front costs through savings, insurance and/or family help, and the public sector picks up the unmanageable costs, those that are truly catastrophic. It’s so much better than the status quo.”
Joanne Lynn, MD, a former geriatrician and hospice physician who worked in Suozzi’s office, learned about the proposal and became a vocal advocate for it. She connected Cohen with Suozzi, and they all went on to draft the WISH Act in 2021. Although the act didn’t gain much traction then, Suozzi believes the time is right to reintroduce the WISH Act in 2025. This time, he re-introduced the bill with Moolenaar, a Republican colleague, creating a bipartisan solution to a national crisis. (Learn more about the WISH Act: Suozzi to Reintroduce WISH Act to Assist with Long-Term Care.)
A New Chapter for the WISH Act
During the conference on April 7, 2025, Suozzi will discuss the benefits of the WISH Act along with people who recognize its potential to make a positive and meaningful difference, such as private sector professionals who work in the long-term care sector including providers and insurers, advocates for older adults, and labor groups. What happens next is unknown for now, but Cohen is hopeful that more people will see the value in this legislation.
“Pieces of legislation sometimes take on a life all their own, and they attract supporters for all kinds of reasons,” Cohen says. “Even as many other programs are being cut back, I can imagine a scenario where a congressman or senator wants to be seen as solving a problem and shows that they are not blind to the problems faced by older Americans and the challenge of long-term care financing.”
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