LTC Commission Ducks Financing Issue, While Minority Calls for New Social Insurance Program

Judith Stein

The Commission on Long-Term Care has issued its recommendations for reforming the way long-term care services are funded and delivered to seniors and people with disabilities.  Unable to agree on changes to the fragmented and frayed system of financing long-term care, the Commission left that crucial area largely untouched.  But five Commission members who voted against the majority’s proposals confronted the question of financing head on, calling for a public insurance program to cover long-term care needs.

Created as a substitute for the canceled CLASS Act in the “fiscal cliff” budget deal, the bi-partisan Commission was charged with voting on its recommendations by September 12, 2013, giving its 15 members only six months to come up with a plan to establish, implement, and finance a comprehensive set of long-term care services for seniors and people with disabilities. Nine of the 15 Commissioners voted in favor of a package of recommendations to be submitted to Congress. The Commission’s package will be included in its Final Report on long-term services and supports to be published by September 30. 

The Commission's recommendations are grouped into three areas: service delivery, workforce and finance.  On the question of how to finance long-term care services, the Commission’s summary of recommendations presents two alternative approaches without taking a position on which one it prefers: strengthening long-term care financing through private options for financial protection, or achieving this objective through a social insurance program.

The Commission’s majority was, however, able to agree that Medicare’s three-day hospital stay requirement for skilled nursing facility coverage should be eliminated and that Medicare should reconsider its “homebound” requirement for receiving home health services.

The group’s final report also will call for the creation of a national advisory committee to continue its work and ask the President to address these issues through a White House conference on aging. Congress is not required to vote on the Commission’s recommendations.

Minority Says Social Insurance Is Only Solution

Five members of the Commission who voted against the majority’s recommendations declared in a separate statement that a public social insurance program must be at the core of any truly comprehensive system. The five Commissioners -- Judith Stein, Founder and Executive Director of the Center for Medicare Advocacy, Inc.; Henry Claypool, executive vice president of the American Association of People with Disabilities; Laphonza Butler, President of SEIU-ULTCW; Lynnae Ruttledge of the National Council on Disability (NCD) ; and Judy Feder, an Urban Institute Fellow and Professor, Georgetown Public Policy Institute – were not joined in their call for a new public program by a sixth dissenting Commissioner, Christopher Jacobs of the Heritage Foundation

“We are convinced that no real improvements to the current insufficient, disjointed array of LTSS and financing can be expected without committing significant resources, instituting federal requirements, and developing social insurance financing,” said Stein. “The people I represent are crying out for a real LTSS system now.”

“The need for extensive and expensive long-term services is a catastrophic risk for people both under and over age 65.  Today, neither private insurance nor public programs protects us against that risk.  Private insurance has demonstrated it can't, by itself, do the job,” added Feder. “A public program has to be the bedrock on which we build an effective LTSS financing system.”

The five Commissioners said that such a social insurance program could provide either comprehensive benefits or a more limited package, and it “would not eliminate the roles of private insurance or of family financing or caregiving. Rather it would make them more manageable.” The Commission was created after Congress canceled an attempt at just such an insurance program, the Class Act.  

The minority group of Commissioners also issued recommendations regarding compensation and training for direct-care workers and addressing the needs of family caregivers.

To download the Commission's final report, click here.

For the alternative recommendations of five of the dissenting Commissioners, click here.

For Forbes columnist Howard Gleckman’s assessment of the Commission’s conclusions, click here.

For Kaiser Health News coverage of the Commission's recommendations, click here.