WASHINGTON — Long-term care is “the big missing piece in health care reform” Leonard Burman, Ph.D., said during a panel discussion hosted by the Urban Institute.
While Dr. Burman, codirector of the Tax Policy Center, and his fellow panelists said that long-term care should be included in the health reform discussion, home- and nursing-home care are probably too complex for Congress to tackle this year.
“The system of providing long-term care is just broken,” said Dr. Burman. He and several panelists said the system is unsustainable because it bankrupts individuals and, without reform, will eventually do the same for Medicaid and the state and federal governments.
The Urban Institute and the Brookings Institution, which cosponsor the Tax Policy Center, assembled the panel of experts to discuss long-term care issues as Congress began working on health reform bills.
Although the ongoing health care debate is a “wonderful opportunity” to look for solutions to long-term care, that probably won't happen, said Howard Gleckman, a senior research associate at the Urban Institute. In fact, he predicted, “health care won't be resolved this year,” with many issues to be left on the table even if legislation passes. For action on long-term care, Congress is “waiting for Obama,” said Mr. Gleckman, but the president “has frankly said nothing about this.”
Long-term care “makes Congress nervous,” said Bob Rosenblatt, of the National Academy of Social Insurance, because the government costs involved already are enormous and lawmakers don't know how much higher those costs might go in various reform scenarios.
Anne Tumlinson, a vice president and long-term care expert at the consulting company Avalere Health, said that she sees a “silver lining” in long-term care's exclusion from reform so far: The ability to focus more closely on long-term care reform later.
“We have to get [overall health reform] out of the way,” she said. “The way we design health reform could have major implications for the way we design long-term care reform.”
For instance, if a government-run public plan alternative to private health insurance emerges from the process this year, long-term care's mix of coverage by private insurance and Medicaid—or some other government program—could be fundamentally affected, said Ms. Tumlinson.
William Galston, Ph.D., of the Brookings Institution, pointed out that, ironically, long-term care seems to be “a classic insurable event,” with catastrophic costs incurred by a minority within a large population. Yet, he and Richard Johnson, Ph.D., of the Urban Institute ticked off reasons long-term care insurance has been “intractable” including the fact that people don't want to confront the notion of becoming old and frail, care is expensive wherever it's provided, and insurers are doing a poor job of creating and selling long-term care policies.