long term care reform: July 2009 Archives

A new poll suggests the public would like to see long-term care reform included in any congressional remake of the health system. While many respondents were concerned about their ability to pay for care, their biggest interest was in better coverage for home and community supports that could keep them out of nursing homes.

The survey, done by Lake Research Partners for the California-based SCAN Foundation, reported that 92 percent felt it was important to improve home-based services, and 80 percent said they'd be more likely to back a health reform bill that did that. 

More than two-thirds said it is important to improve insurance coverage for home-based services. However, they did not say whether that coverage should be provided by private carriers or government insurance.

Whether, and how, the public is willing to pay for better home and community services will be critical to the future of any congressional debate over long-term care. Americans have made it clear they want more acute medical care at no extra cost--an impossible demand. If they feel the same way about long-term care, it is hard to see lawmakers making much progress toward reform.   

For those interested in long-term care, the House Democrats' consensus health reform bill is pretty disappointing. Unlike the Senate Health, Education, Labor, and Pensions Committee version, it includes no proposal for national long-term care insurance. And it largely ignores efforts to expand access to home care for those on Medicaid, who now often can only get care in nursing facilities, or to better coordinate care for those receiving both Medicaid and Medicare benefits.

Key House Democrats, including Representative Frank Pallone (D-N.J.), are long-time supporters of Sen. Ted Kennedy's plan to provide national long-term care insurance (the CLASS Act). Still, the draft is silent on the issue. Similarly, despite strong Democratic support for efforts to enhance Medicaid home care, the proposal calls for little more than studies. Better than nothing, I suppose, but not by much. 

I expect lawmakers will attempt to add some long-term care provisions to the House draft, which will be considered by three committees over the next few weeks, For those of us looking for help caring for our parents, it will be interesting to see how they fare.   

The Obama Administration has given a boost to Senator Ted Kennedy's national long-term care insurance program, the CLASS Act. In a July 6 letter to Kennedy, Health and Human Services Secretary Kathleen Sibelius said President Obama believes "it is appropriate to include the CLASS Act as part of health reform." Obama co-sponsored the bill when he was in the Senate, but has been silent on the issue since he was elected President.

While Obama's endorsement is a major step forward for the plan, it by no means assures its passage. Senate Finance Committee Chairman Max Baucus (D-MT) has been reluctant to include the proposal in his bill. White House aides have said Obama will not get deeply involved in a final health reform measure until after the House and Senate have passed their versions of reform--probably sometime this fall.

The CLASS Act would provide access to government long-term care insurance to every worker. It would provide a benefit of at least $50 a day for life. Kennedy is aiming for an average premium of $65 per month, although the HHS Secretary would have broad discretion to set both benefits and premiums. Workers would be automatically enrolled, but could opt out of coverage should they choose.