House Energy & Commerce Health Subcommittee Members Comment on Incentivizing Home and Community-Based Services in Long-Term Care Financing and Delivery
March 9, 2016 11:53 AM
On March 1, 2016, the U.S. House of Representatives Energy & Commerce Subcommittee on Health held a hearing titled “Examining the Financing and Delivery of Long-Term Care in the U.S.” A statement by the National Association for Home Care & Hospice (NAHC) was submitted for the hearing record recommending that Congress enact a comprehensive, high quality home- and community-based long-term care program (see previous NAHC Report article here).
During the hearing, Representatives discussed the existing problems with individuals facing gaps in long-term care coverage, and that those problems will only increase with the growing aging population. Several Representatives expressed a desire to address issues related to improving long-term care financing and delivery through incentives for the use of home- and community-based services rather than institutional care. Recommendations included simplifying the existing waivers to make it less burdensome for states to expand the availability of Medicaid home- and community-based services, as well as encouraging individuals to enroll in private long-term care insurance, establishing a federal catastrophic plan, and pursuing Medicaid integrity measures.
“Today we are facing a long-term care crisis that is forcing millions of Americans to drain all of their resources before they get any support from the federal government,” Rep. Frank Pallone (D-NJ-6) said. “This crisis is not only affecting those who need long-term care but also their families, sons and daughters who have no other choice but to spend hours every week caring for their parents. This simply cannot continue, and I hope that today’s hearing is the beginning of an ongoing conversation that leads to real action to address this crisis. After all, the crisis is not new. Congress has been discussing a solution for decades.”
“While long-term care largely differs from health coverage or medical care, I know every member of this Committee wants to ensure that frail elderly seniors or disabled individuals across the country receive high-quality care,” stated Chairman Joseph Pitts (R-PA-16). “We want to see each person treated with dignity and respect that they deserve. And we want a long-term care system that empowers each person and respects individuals’ preferences.”
Several Representatives mentioned that those without coverage are often forced to rely on unpaid caregivers who are disproportionately represented by female family members. These unpaid caregivers are forced to forgo their careers and wages in order to care for their ailing family member. Rep. Kathy Castor (D-FL-14) discussed the importance of the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act, of which she is the lead House cosponsor, to support family caregivers (see previous NAHC Report article here). The concerns about burdening unpaid caregivers, particularly women, were echoed by one of the witnesses,Ms. Anne Tumlinson,CEO of Anne Tumlinson Innovations. “We cannot backdoor finance this off of women,” Ms. Tumlinson said.
There was some disagreement among the members of the Subcommittee regarding a public versus private solution to the problem of ensuring people have access to long-term care coverage.
Frank Pallone announced his intention to introduce new legislation that would create a Medicare Part E option to help pay for long-term care services. "Seventy percent of Medicare seniors will someday need long-term care services and support, and they deserve a better option when faced with catastrophic out-of-pocket costs,” he said.
Chairman Pitts, in his opening statement, said he is wary of any proposal that resembles “a new entitlement.” Other Republicans also expressed their desire to help individuals receive coverage through the private insurance market.
Another recommendation presented by one of the witnesses, Dr. Alice Rivlin, Co-Chair of the Long-Term Care Initiative at the Bipartisan Policy Center, was to provide states with more flexibility to offer home- and community-based services under Medicaid. This recommendation was included in a report recently released by the Bipartisan Policy Center (see previous NAHC Report article here).