Bipartisan Policy Center Launches Long-Term Care Initiative
April 18, 2014 07:02 AM
Earlier this month, the Bipartisan Policy Center (BPC) held a briefing where it launched its Long-Term Care Initiative (the Initiative). That same day, BPC’s Health Project released a white paper entitled: America’s Long Term Care Crisis: Challenges In Financing and Delivery (the White Paper). The Initiative, according to the White Paper, seeks to find “a sustainable means of financing and delivering long-term services and supports [(LTSS)].” To this end, the Initiative plans to release pragmatic, bipartisan recommendations by late 2014.
After brief opening remarks by Jason Grumet, President of BPC and Dr. Bruce Chernof, President and CEO of the SCAN Foundation, the co-chairs of the Initiative made keynote remarks. The co-chairs are:
Senator Tom Daschle, Former U.S. Senate Majority Leader;
Senator Bill Frist, Former U.S. Senate Majority Leader;
Governor Tommy Thompson, Former Governor of Wisconsin and Former Secretary of the US Department of Health and Human Services; and
Dr. Alice Rivlin, Former Director of the Congressional Budget Office.
Senator Daschle stated that financing and delivery of LTSS has been a challenge. Sen. Daschle believes that a large part of this stems from health care delivery being highly fragmented and not coordinated, and that better LTSS system will come from a combination of private and public, and legislative and regulatory changes.
Senator Frist stated that LTSS financing and delivery must be improved given a coming “tidal wave” of utilization: there will be 27 million people utilizing LTSS in 2050 compared with just 12 million in 2010. Sen. Frist also asserted that in 20 years, baby boomers will have an increased need of these services, and there will be fewer and fewer private insurance options.
Governor Thompson mentioned that states will play a key role in finding solutions, as they currently fund two-thirds of LTSS. He stated that we have made progress in moving people into the home for LTSS, as well as providing community health services, but there will still be a need for skilled nursing facilities (SNFs). A sustainable policy solution will address both the need to keep people in their homes, and the imperative to integrate state and federal budgets. He stressed the importance of a federal and state partnership, as “the states cannot do it alone.”
Dr. Rivlin stated that the country is not any closer to solving the problem of long-term care since she wrote a book on it in 1988. She mentioned that a resolution must be found by forging an ideological compromise between “stereotypical” Democrats that favor a public option and “stereotypical” Republicans who favor a private solution. She echoed Gov. Thompson’s statement that there is consensus that people should be kept in home care as much as possible, but the system must also continue to support some institutions like SNFs. In this vein, she hopes that the Initiative will devise a way to “reconfigure communities and families [to foster efficient LTSS delivery and financing] without bankrupting the country.”
The briefing followed with a panel discussion moderated by Sam Baker, Health Care Correspondent for the National Journal. The panelists included:
Anne Tumlinson, Senior Vice President, Avalere Health;
Marc Cohen, Chief Research and Development Officer, LifePlans, Inc.;
Tom McInerney, CEO, Genworth Financial; and
Diane Rowland, Executive Vice President, The Henry J. Kaiser Family Foundation.
Ms. Tumlinson discussed some of the challenges facing a sound long-term care policy. People needing long-term care are very medically diverse group of all ages. Quantifying the total spend in long-term care is also difficult as the 20-25 million people providing 20 hours per week of uncompensated care while working other jobs, in addition to private duty nursing and home care aides employed by families are not counted in national health expenditures. She also stated that Medicaid LTSS spending as a percentage of total Medicaid spending, is the lowest it has been in the last 20 years, and thus there are fewer dollars to go around. She believes that key to a viable LTSS solution is government policy creating a viable insurance option that has value for and buy-in from consumers and actuaries alike.
Dr. Cohen stated that LTSS expenditures will soon account for an average of 31% of household expenditures where there is an individual in the household aged 65 or older. There are currently 7-8 million people who have private insurance, but there are only about 20 companies that currently provide such insurance. He stated that long term care is an insurable risk, and that paying for premiums makes more sense than paying for the long-term care itself when needed. However, given the exit of companies from the market, consumers are wary to buy in. Therefore, echoing Ms. Tumlinson’s remarks, Dr. Cohen stated a key to sound reform would be to increase consumer appeal and buy-in of long-term care insurance, be it public, private, or both.
Mr. McIerney discussed the significant need of the population to get long term care insurance. He stated that in home care is more economical, and that 70% of long-term care is now conducted in home. According to Mr. McIerney, the inflation rate of in home care is more modest than nursing home inflation, at approximately 1% versus 4%.
Ms. Rowland stressed the importance of Medicaid in any reform discussion, as it is the developer of the home and community-based services (HCBS) model of care. She stated that it is important to look at the innovations of states, and the innovations within the Affordable Care Act. Ms. Rowland also mentioned that states need to better integrate acute and medical services, along with Medicaid and Medicare. Behavioral health needs must also be addressed, as this is frequently neglected and carved-out of managed long-term services and supports (MLTSS). Different settings (like those for Alzheimer’s patients), and the need for funding housing must also be addressed, in addition to better case management strategies including a standardized form of assessment.
The question and answer session was largely focused on how to create a viable private long term care insurance market. Ms. Rowland stressed marketing HCBS services specifically, as that is where the real demand is.
To see BPC’s press release on the briefing, click here. To see the full white paper, click here.
The work of the Initiative is still in its early stages. BPC’s white paper largely sets out the framework for debate on LTSS reform, and highlights key questions that stakeholders should be asking. However, it remains to be seen what the BPC will ultimately recommend. The Council believes that BPC may issue similar recommendations to those stated by the Long Term Commission last September. In that vein, the Council re-iterates its support of state innovations, and programs within the Affordable Care Act, to the extent that they increase HCBS utilization and rebalancing. However, the Council strongly advises BPC to reach consensus on the financing solution of LTSS reform, a most critical aspect of any viable reorganization. NAHC's National Council on Medicaid Home Care hopes that those working in the Initiative do not “punt” on this issue as the Commission did last fall. The Council will continue to update its members on the Initiative’s progress.