Joe Paduda of Managed Care Matters did an excellent job with the most recent edition of the Health Wonk Review. It includes lots of excellent articles, but I especially recommend John Goodman’s discussion about long term care. Ever since it was announced earlier this month that the long term care portion of the ACA (CLASS) was being axed, I’ve been pondering the looming problem of long term care and how it’s going to be financed as we move forward over the next few decades.
As more and more seniors begin to rely on Medicaid to fund their long term care, the Medicaid system is bound to encounter some serious financial bumps in the road. Medicaid is an essential program to provide health care for those who are unable to afford it. It’s a safety net program, so it makes sense that it should cover long term care for seniors who have no other means of paying for their care.
But Medicaid is also likely funding long term care in situations that perhaps meet the letter of the law but not its spirit. He describes how “an entire cottage industry of lawyers is now helping seniors protect their assets and still get Medicaid long-term care coverage.” That’s not something we should feel good about. Nobody should be relying on Medicaid to pay for long term care and still bequeathing private assets to the next generation.
John’s article includes several long term care reform ideas that would encourage people to purchase long term care insurance or utilize their own assets to pay for care, and make it easier for states to recover assets from the estates of people who have received Medicaid-funded nursing home care. For the most part, I think his ideas are excellent ones that could help to keep Medicaid intact as a “payment plan of last resort” for people who are in need of long term care and genuinely have no way of paying for it. I do have reservations about the problems that go along with allowing long term care insurance carriers to set premiums based on an applicant’s health history and likelihood of needing long term care. That’s the way the private LTC market works now, but it also works to prevent those who most need LTC insurance from purchasing it – either because they can’t afford it, or because they can’t get accepted by a carrier. I can see problem with this a decade or two from now, similar to the issues we’ve seen with the individual health insurance market being castigated for “cherry picking” healthy applicants.
Ideally, I’d love to see a single-payer style long term care insurance program that covers everyone. Maybe an extension of Medicare? Of course, that would require an increase in Medicare premiums and taxes, and judging from the health care reform fight that we’ve seen over the last few years, it would probably take an Act of God.
As long as we’re looking at a fragmented public/private hodge podge of long term care funding that includes Medicaid, private long term care insurance, private assets, and help from family and friends, I think it’s important that we look for ways to make things as fair as possible and also keep Medicaid financially afloat. The CLASS Act got nixed from the ACA, but the problem of funding long term care isn’t going away, and is only going to grow as the baby boomer generation ages. John’s article is a good one to read if you’re interested in possible solutions.