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Thursday, October 10, 2013

The Long-Term Care Commission: The Good, The Bad, and What’s Next?

Joe Caldwell, National Council on Aging

Howard Bedlin, National Council on Aging

The Long-Term Care Commission faced incredible odds. It originated as a consolation prize for repeal of the CLASS program, struggled to get off the ground, and was charged with solving one of the most challenging issues facing our country—all in less than 100 days. Despite the odds, the Commission managed to generate a lot of buzz about long-term care this summer, at least inside the Beltway. It held four public hearings, gathered nearly 100 outside comments, and delivered a report on time that probably exceeded expectations.

The final report contains 28 recommendations. They are modest but can be viewed as areas of common ground across divided ideological perspectives and interests. Some areas where the Commission agreed include promoting access to home and community-based services, investing in quality measures, supporting family caregivers, and strengthening the direct care workforce. The Commission also offered recommendations to improve access to long-term services and supports for workers with disabilities in Medicaid and improvements in Medicare.

Unfortunately, however, the Commission fell short on its central task—providing direction on financing. Instead of making recommendations, the Commission listed two approaches. The first would strengthen private insurance options and included a laundry list of incentives and a call for public education. The second approach offered two social insurance models: 1) a comprehensive long-term care benefit within Medicare or 2) a limited catastrophic benefit within Medicare or a new public program.

The question now is: Where do we go from here? There are several potential paths forward. One is to package some of the low or no-cost, incremental recommendations (those that can be translated into legislative language) into a bi-partisan bill and use it to garner attention and support by pushing it forward in the near term. In fact, the statutory language establishing the Commission required introduction of bills in the House and Senate. Including the report’s recommendation to establish a formal advisory committee should provide a platform to continue the discussion on financing and hopefully provide resources for necessary actuarial work and analyses of the impact on Medicaid savings.

Another potential path is for members of Congress to pick up pieces of the report and introduce them as bills. In addition to the 28 recommendations, the appendix contains other recommendations put forth by commissioners. A sub-group of commissioners who voted against the final report is drafting an alternative report offering a social insurance approach and more detailed rebalancing proposal. Moreover, the outside comments submitted to the Commission put many good ideas on the table, including NCOA’s recommendations. All of these are fodder for potential legislation. Right now, there are very few, if any, long-term care bills in Congress. Putting competing ideas out there could continue the conversation, debate, and perhaps help elevate the issues headed into the mid-term and 2016 Presidential elections, where seniors are expected to represent up to one-quarter of the vote.

Ultimately, we need bi-partisan Hill champions willing to step up and commit to working on the issue. Sadly, we are losing two of our long-time champions—Sens. Rockefeller and Harkin. Perhaps there is room for them to offer legacy pieces of legislation. There are also many potential new champions on committees with jurisdiction that could make this issue their own. One idea NCOA has proposed is for the Senate Finance and House Energy & Commerce Committees to form Long-Term Services and Supports Sub-Committees. This could promote opportunities for hearings and for Congressional leaders to emerge.    

Despite what some may think, the CLASS program didn’t happen overnight. It also didn’t come from a commission or outside think tanks. It came from dedicated Hill champions and staff willing to roll up their sleeves, regularly convene stakeholders for years, and tackle big issues. There is no shortage of ideas out there on financing—many have existed for decades. The Commission helped put more on the table. Now we need champions on both sides of the aisle (perhaps even a bi-partisan “Gang” on Long-Term Care) who are willing to put in the time; pull in the private sector, actuaries, and the aging and disability communities; find the middle ground; and take some long overdue action.

Posted on October 10, 2013  |  Write the first comment

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