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Add Long-Term Care to Medicare? Experts Say Yes

By Reed Cooley, CQ Staff

July 25, 2008 -- Medicare should include a benefit for long-term care financed by a premium, said nearly four of five health care "opinion leaders"—including professors, researchers, and health industry professionals—participating in a new Commonwealth Fund study.

The report, released Monday, found that 79 percent of health care experts "strongly favored" such a benefit, and 69 percent said that it is either important (28 percent) or very important (41 percent) that presidential candidates address quality and cost of long-term care in their health overhaul proposals.

"Although health care leaders say long-term care is important to include in health care reform plans, the presidential candidates have not yet addressed this issue, which is certain to become an increasing concern for American families," Commonwealth Fund President Karen Davis said in a press release.

Public coverage of long-term care services such as nursing homes currently exists only under Medicaid, the entitlement program for impoverished individuals. Medicare includes a benefit for post-acute care services such as those provided by skilled nursing facilities, but not for services that aid seniors in permanent need of assistance in their day to day lives.

But other analysts believe that a shift to Medicare-covered long-term care would significantly drive up costs.

"Federalizing the cost on long-term care is going to be much more expensive than the current system," Heritage Foundation senior fellow Dennis Smith said in an interview. Smith recently stepped down as the director of the federal Medicaid program.

Robert Helms, a researcher at the American Enterprise Institute, expressed a similar concern but seemed less distressed by the idea that the benefit would be paid for by a premium.

"The extent that you could actually make the premiums pay for it would be far better than putting it on trust funds," he said.

Smith noted progress toward lower costs in existing public long-term care coverage programs as another strike against the Medicare idea. "We're making huge strides in Medicaid by moving long-term care away from institutions. We would lose that momentum if the federal government took it over," he said.

A recent report by the senior lobby AARP found that, although some states are making strides toward replacing more expensive institutional care models such as nursing homes with home- or community-based models, progress in this area is still limited.

Seventy-six percent of respondents to the Commonwealth Fund study said it was urgent or very urgent to develop a "sufficient supply" of home- or community-based models, as opposed to more expensive institutional care models like nursing homes.

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