1 / 22

The Future of Long-Term Care: What Is Its Place in the Health Reform Debate?

The Future of Long-Term Care: What Is Its Place in the Health Reform Debate?. Howard Gleckman Tax Policy Center June 16, 2009. Remember: This is About People. The Challenge. Deliver the most appropriate care to a highly vulnerable population

ellis
Download Presentation

The Future of Long-Term Care: What Is Its Place in the Health Reform Debate?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Future of Long-Term Care: What Is Its Place in the Health Reform Debate? Howard Gleckman Tax Policy Center June 16, 2009

  2. Remember: This is About People

  3. The Challenge • Deliver the most appropriate care to a highly vulnerable population • Design a financing system to support this care without busting the budget • Make it work for today’s frail elderly and disabled—and for 77 million Boomers

  4. What Is Long-Term Care? • Personal Care for disabled and frail elderly • 10 million need it • 85% is delivered in the community • We spend $230 billion for paid care • And $375 Billion for informal “free” care • Free= financial, emotional, physical burdens

  5. WHO PAYS?

  6. Medicaid • A Vast improvement over pre-1965 • Provides benefits for the low-income elderly and disabled • Targets assistance to those in society who most need it

  7. BUT… • You Pay ‘til you’re broke, then Medicaid • Wide variation in benefits by state • In the bulls eye in economic downturns • Obligated for SNF care only • Home care is optional Underfunded, limited benefits, long waiting lists

  8. Stein’s law

  9. Everyone Into the (Risk) Pool • Private Long-Term Care Insurance • Valuable estate planning tool for some • Not a policy solution

  10. Why? • Too Expensive • Too complicated • Why buy if you’ve got Medicaid?

  11. Health Insurance: 250 million covered LTC insurance: 7 million covered The Real Crisis of the Uninsured

  12. SOLUTIONS • DELIVERY ….BUT HOW? • FINANCING:TIME FOR A MANDATE?

  13. DELIVERY • COORDINATE CARE • MAKE IT AVAILABLE AT HOME • Infrastructure: Not just personal aides, also housing, transportation, food, good medical care • But don’t break the bank

  14. FINANCE • DO WE REALLY NEED MEDICAID? • THREE ALTERNATIVES: • ENHANCE PRIVATE LTCi • CREATE NEW SOCIAL INSURANCE • PUBLIC/PRIVATE MIX

  15. ENHANCED LTCi • Sell like Medigap • Expand tax incentives • Expand Partnership Program • More Government Marketing • EACH MAY HELP, NOT THE ANSWER

  16. Social insurance • International Model: • France, Germany, Japan, Korea • Nearly everyone but the UK & US

  17. Medicare Part E • HOW DO YOU TAX? • Income tax surcharge (Burman/Johnson) • Payroll tax surcharge (ala Germany) • VAT—probably with health reform • BUT…WILL AMERICANS PAY A NEW TAX?

  18. Public/Private • Government as First Payer (CLASS Act) • Government as Secondary/Catastrophic: Galston; Tumlinson & Lambrew; Bishop

  19. CLASS Act • In the HELP bill • Benefit: Cash, $50+ daily for life • Auto enroll w/ an opt-out • A premium, not a tax • $65, or is it? • Plus Private Insurance

  20. Catastrophic • Personal responsibility w/ low-income subsidy • True catastrophic coverage • Mandatory insurance or savings?

  21. MODELS FOR FINANCING REFORM

  22. If not now, when? • HELP bill Will include CLASS Act, home care, workforce • Workforce will pass, limited support for others • Waiting for Obama

More Related