House hearing tackles LTC financing

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The federal government must be part of the solution to long-term care financing, Rep. Frank Pallone (D-NJ), ex-officio member of the U.S. House of Representatives Energy and Commerce Committee Subcommittee on Health, told attendees of a March 1 subcommittee hearing on long-term services and supports. “We can't afford to wait any longer,” he said.

Finding answers to the issue “is one of America's big challenges,” witness Alice M. Rivlin, Ph.D., co-chair of the Bipartisan Policy Center's Long-Term Care Initiative and senior fellow of the Brookings Institution, told committee members, “but it's an even bigger opportunity for a constructive bipartisan policy process.”

Several hearing participants, including subcommittee Chairman Joe Pitts (R-PA), noted that three recently released reports contain recommendations for financing LTSS. Reps. Doris Matsui (D-CA) and Frank Pallone (D-NJ) both noted that the recommendations from LeadingAge, the Bipartisan Policy Center and the Long-Term Care Financing Collaborative, all based on modeling performed by the Urban Institute and actuarial firm Milliman, had three points in common. Specifically, they all seek to strengthen and simplify Medicaid long-term care, build a more consumer-friendly LTC private insurance market and create a program to cover catastrophic LTC costs.

Rep. Michael Burgess, M.D. (R-TX) said that members of the subcommittee must help people to understand that they need to prepare for potential LTSS expenses. Health policy consultant William J. Scanlon, Ph.D., another hearing witness, agreed in his remarks. “Encouraging personal preparedness should be a priority,” Scanlon said. “While that may be perceived by some as a means of limiting public expenditures, I see it as essential to providing individuals with more choice in how they live their lives when they have a disability and in how their families will be impacted by the disability.”

Cultivating insurer interest in offering LTC policies that have reasonable benefits and premiums also is vital, Scanlon said.

Several subcommittee members mentioned related legislation they have introduced or plan to introduce.

  • Pallone said he plans to introduce legislation to “provide a federal role in long-term care.”
  • Subcommittee Vice Chairman Rep. Brett Guthrie (R-KY) said he has introduced H.R. 1361, the Medicaid HOME Improvement Act, which would allow people to use home equity to finance long-term care.
  • Guthrie also said he has introduced H.R. 2446, which has the goal of reducing fraud by requiring home care providers to electronically verify the delivery of services to Medicaid beneficiaries.
  • Rep. Kurt Schrader (D-OR) said that he and fellow subcommittee member Rep. Leonard Lance (R-NJ), with fellow co-sponsor Rep. Pat Meehan (R-PA) and sponsor Rep. Linda Sanchez (D-CA), have put forth H.R. 4212, the Community-Based Independence for Seniors Act, which would enable budget-neutral demonstration projects to determine whether providing home care before a Medicaid “spend-down” occurs can save the government money.

In a statement entered into the record, the American Health Care Association/National Center for Assisted Living said that five reform-related goals will shape its policy positions on LTC financing:

  1. Promote beneficiary access through better private LTC financing options.
  2. Meet consumer LTC needs and preferences.
  3. Maximize value and cost-effectiveness by ensuring that care is provided in the setting most appropriate to the consumer's needs and preferences.
  4. Preserve and improve the public LTC benefit for low-income individuals.
  5. Better coordinate acute and long-term care.

“Solutions for LTC financing are elusive and challenging,” the organizations said. “Today's ‘long-term care system,' despite efforts such as Aging and Disability Resource Centers and similar specialized care coordination programs, remains fragmented and confusing for older adults and their families and inefficient, as well as often underfunded, for providers struggling to [deliver] critical services.”

Materials related to the hearing are available online.

Watch the committee hearing below (note that the subcommittee may be experiencing volume issues):

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