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Panel Urges More Federal Money for Long-Term Care

NOVEMBER 14, 2005 -- Backed by "surprising" poll findings, a panel convened by the National Academy for Social Insurance (NASI) is making a pitch for greater federal financing of long-term care. Seventy percent of Americans over the age of 50 expressed support for more federal financing, and 53 percent said addressing long-term care costs should be a high priority for the nation, NASI said.

NASI is a nonpartisan organization made up of the nation's leading experts on "social insurance," defined as "broad-based systems for insuring workers and their families against economic insecurity caused by loss of income . . . and the cost of health care."

Chaired by two former top health policy staffers who were on opposite sides of the 1992–1994 debate over universal health coverage, the panel was united on the need for more federal funding, despite warnings by senior federal budget analysts that current Medicare and Medicaid spending is unsustainable.

The panel said however that individual funding and private long-term care insurance also should play a part in funding nursing home care.

"Achieving a system that meets individual needs and distributes costs equitably will require greater federal involvement and financing," said panel co-chairwoman Sheila Burke, who was chief of staff to Robert Dole when the Kansas Republican was Senate majority leader.

Judith Feder, the panel's other co-chairwoman, said at a Monday morning press briefing that the panel did not expect most respondents would view costs as a high priority for policy makers.

Much of the public is unaware that the government doesn't pick up the costs for long-term nursing home care without a patient first becoming impoverished, she said. The panel expected the findings to highlight the need to build national awareness of the costs of long-term care, she said. Feder, who is dean of the Public Policy Institute at Georgetown University, advised President Clinton in the development of his unsuccessful plan to achieve universal health coverage through employer and federal funding.

According to one GOP Hill aide, the survey findings are hardly a surprise since increased federal spending would lower individual costs. He added that the survey was funded by the Service Employees International Union, which represents many nursing home workers. NASI's VP for Health Policy, Paul Van de Water, said that while SEIU paid for the survey, it was carried out jointly by a Democratic pollster and a Republican pollster to give it a "bipartisan cast." He added that the survey accounted for only 10 percent of the costs of the entire NASI project addressing long-term care costs. Other funding was provided by the Robert Wood Johnson Foundation, TIAA-CREF, and GE Financial Assurance, he said.

The panel's report identified two solutions as promising. One, "modeled on Social Security, would provide everyone access to a basic, limited long-term care benefit, supplemented by private insurance for the better-off and enhanced public protection for the low-income population," the panel's report said.

"The Social Security system was designed to provide beneficiaries with a base of income which they can supplement with pensions and savings. Social insurance for long-term care could provide the same kind of basic protection through Medicare, Social Security Disability Insurance, or a new public program."

Another promising approach would be to "establish a national floor of income and asset protection." The floor would replace or revise Medicaid, which picks up long-term nursing homes costs after a patient becomes impoverished.

"The floor could be set to allow people who worked hard all their lives to keep their homes and a modest amount of other assets, while those who are sufficiently well off could purchase private long-term care insurance to protect a larger amount of assets," the report said.

Medicaid is jointly funded by the federal government and the states, but many governors say states must have relief from their share of the long-term care cost burden. Either approach would "provide substantial fiscal relief to states," the panel said.

The survey did not measure support for tax hikes or changed federal spending priorities needed to increase federal funding of long-term care.

While legislation to expand the federal role in long-term care might seem improbable in today's budget climate, Feder said other legislation has recently defied the budget odds when a public need was identified: the Medicare drug law (PL 108-173).

Skillful "policy entrepreneurs" wait for a window to open, and "when political leaders, especially the president, make an issue theirs, the political process moves into high gear," the report says.

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