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Health reform, long-term

Though unnerved by uncertainties about what Washington is offering, Americans are still demanding healthcare reform.

If one little-discussed element of reform is missing, however, Americans will be surprised, and even distraught, while the country will be ensnared in another kind of healthcare crisis in the near future.

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Most Americans believe healthcare reform will provide coverage for a variety of long-term care services. In a survey we conducted for the American Associating of Homes and Services for the Aging, majorities expected that care for people with Alzheimer’s disease (61 percent), in assisted living (57 percent) and assistance for an older or disabled person in taking their medications (64 percent) will all be covered when healthcare reform is enacted.

If the Senate HELP Committee’s bill, or that reported out by the House’s Energy and Commerce Committee, reflect the ultimate shape of what is passed into law, voters’ expectations will be met. Those versions of healthcare reform create a voluntary insurance program where, for premium payments of just a couple of dollars a day, the elderly, the disabled or anyone who needs assistance caring for themselves will receive a benefit of up to about $37,000 a year.

Constituents are expecting reform to provide some mechanism for long-term care, and they will be sorely disappointed if healthcare reform fails to deliver in this arena. More important, the country will be far worse off for having squandered the opportunity to avert an impending crisis.

As I have noted here before, America is on the verge of a long-term care crisis about which it is barely conscious.

Some 60 percent of those over 65 will need at least some long-term care services during their lifetime. That need should come as little surprise to most Americans, as 40 percent in our survey expect a close family member to require long-term care during the next 10 years.

However, despite clearheaded recognition of what lies ahead, 70 percent of Americans have done no planning whatsoever for long-term care. In fact, more than two-thirds of those who expect to need such care for a family member in the next five years have made no plans of any kind, and 81 percent are unprepared for the financial demands soon to be forced upon them.

Many Americans spend more time and money planning for their next Super Bowl party than for their family’s long-term care needs, in part because they vastly underestimate the costs involved. Perhaps more important, the public misunderstands who will pay. According to an AARP survey, 59 percent of Americans over 45 years old believe Medicare will pay for nursing home care, despite unambiguous denials by the Department of Health and Human Services — “Medicare does not pay for what comprises the majority of long-term care services … ” Still others believe their health insurance policy will pay for nursing home care. Wrong again.

Medicaid does pay for long-term care — by some accounts, two-thirds of nursing home residents are Medicaid beneficiaries, and the program is paying almost half the cost of long-term care in America. Despite the fact that it was never designed for that purpose, nearly one-third of Medicaid dollars go to long-term care.

However, Medicaid itself only finances long-term care for those who are impoverished.

As 77 million baby boomers start to require long-term care, mostly for temporary rehabilitation, they are going to suddenly find out they have no way to pay for it without giving up all of their assets, and the government is going to be hard-pressed to pay for their care through Medicaid once they become impoverished.

Dealing with long-term care in healthcare reform will help keep both our families and our government solvent, while meeting voters’ clear expectations.



Mellman is president of The Mellman Group and has worked for Democratic candidates and causes since 1982. Current clients include the majority leaders of both the House and Senate.

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