By Jane Norman, CQ HealthBeat Associate Editor
March 20, 2013 -- A new federal commission on long-term care faces the formidable task of coming up with workable ideas that also stand a chance of making it from concept into law within five years, a member of the group recently said.
"We have a five-year window to do something substantial," said Bruce Chernof, president and CEO of the SCAN Foundation, which organized a conference on options for transforming what Chernof called the "broken system" of long-term care. The foundation advocates for quality long-term care for seniors.
The five-year period is crucial because the baby boom generation is aging, and while many may not need care when they first retire, those circumstances will change, he said. The Department of Health and Human Services estimates that 70 percent of Americans will need long-term care at some point in their lives, yet there's no national strategy in place.
"As the boomers go through, if we are going to make a difference in their lives, five years is the break point," said Chernof. "What we're really talking about here is triaging the impact on Medicare and Medicaid, because Medicare and Medicaid will bear the brunt of our failure to act."
Medicaid pays for nursing home care for poor people, and Medicare picks up costs associated with doctor visits and hospital stays. Private long-term care insurance is available but few people buy it. Most of the time, long-term care is provided by an unpaid spouse, family member or friend, studies show.
President Barack Obama and Republican and Democratic leaders of Congress have appointed Chernof and 14 other commissioners to a temporary panel that will study how to provide long-term supports and services to seniors and people with disabilities. The commission, which was created in the fiscal cliff law (PL 112-240), is charged with making recommendations to Congress within the next six months.
At the Beginning
In an interview, Chernof said the commissioners are just now getting organized and don't yet have a date for a first meeting. Obama, the last to make appointments, did so a week ago. Chernof also said he's personally committed to making commission deliberations open to the public; similar panels like the Medicare Advisory Payment Commission also meet in public.
The group will convene amid what many experts view as a growing crisis in long-term care. A voluntary long-term care insurance program known as the CLASS Act was created in the health care law (PL 111-48, PL 111-152) but the Obama administration abandoned it when it was determined the program wasn't financially viable. Congress then repealed it. Plus there is little money available for launching a new system for care, and other groups have produced recommendations in the past that were never acted upon.
Chernof said he understands the skepticism that the commission will produce results. "Is there any reason to believe this time will be any different? I don't think we'll know the answer to that question until we go through the work ahead of us," he said. "While it's very hard, very hard for us to make change, I don't think it's impossible."
Other commissioners appointed by Democrats besides Chernof include Judy Feder, a professor of public policy at Georgetown University, and Carol Raphael, vice chairwoman of the AARP Board of Directors. Republican appointees include Grace-Marie Turner, president of the Galen Institute, a right-leaning think tank; and Bruce Greenstein, secretary of the Louisiana Department of Health and Hospitals.
Fresh Research
The conference featured the presentation of summaries of research papers on the current landscape of financing of long-term care as well as policy considerations for the future. Among them:
- Jeremy Pincus, of the Forbes Consulting Group, said that most workers don't have access to private long-term care insurance through their employers, which decreases the possibility they will buy it. Pincus said that 61 percent of employers sponsor health insurance for their workers, but just 0.3 percent sponsor long-term care insurance. He said there is an "enormous untapped market" for long-term care insurance.
- Joshua M. Wiener, who studies health and aging issues for RTI International, looked at the characteristics of people over 50 who between 1996 and 2008 "spent down" all their money and thus qualified for Medicaid coverage. He said his findings contradicted the impression that Medicaid is a "middle class entitlement," and instead found that most of those who became eligible didn't have much money throughout their lives. Those who spend down to Medicaid eligibility tend to be black, Hispanic, unmarried and with lower levels of education, Wiener said.
- Anne Tumlinson of the consultants Avalere Health said that a voluntary system for long-term care insurance wouldn't reach a substantial portion of the population or significantly reduce the number of people who depend on Medicaid to pay for nursing home costs. Tumlinson said that a mandatory program by its 15th year would cover 86.7 million people, save Medicaid $49 billion and cost enrollees $35.26 monthly in its first year. A voluntary program would cover just 8.4 million people in its 15th year and save Medicaid $5.6 billion, she said.
- SCAN Foundation Papers (PDF)