On the heels of a new SCAN Foundation data-dump (hundreds of long-term care (LTC) studies released at once, sound and fury so far signifying… a paperweight?) the eternal question among industry-watchers remains, "After CLASS, what?"
As I've written before, a private long-term care insurance (LTCi) market which disenfranchises 1 out of 5 invited guests will always have its "viability" questioned, or at the very least, must partner with an entity willing to insure that other 20 percent. Enter public insurance.
In the meantime, our attention has been distracted like a magician by the repeal of CLASS and the tangential ways in which the Affordable Care Act (ACA) intersects with LTC (e.g., creation of The National Plan and a plethora of mostly pilot programs in long-term care supports and services (LTSS) aimed at re-balancing resources from institutions to home care).
But, in the magician's other hand, something very significant has been concealed from view…
Until I attended the ILTCI Conference in Dallas last month and happened upon a presentation entitled, "Financing Framework for Social LTC Security System," I might have never heard of the "LTC Financing Collaborative," nor been sufficiently informed to call it to your attention.
I've not met a single person who has previously heard of it, yet the LTCFC is apparently staffed with a Who's Who of inside the Beltway thought leaders.
On the panel that day were Stuart Butler (distinguished fellow and director, Center for Policy Innovation, The Heritage Foundation), Howard Gleckman (resident fellow, The Urban Institute), and Jonathan Westin (health policy director, The Jewish Federations of North America). Mr. Butler was the first to describe the Collaborative's behind-the-scenes think-tanking.
He began with historical comparisons to both "Welfare Reform" and "Coverage for the Uninsured." Both seemingly-intractable American problems that spanned decades, while attracting opposing, entrenched idealogues. Finally, a watershed moment occurred—a dam burst—and major legislation was passed which ushered in a new era. Why?
It turns out—and this may be news to some of us—that both processes were enabled by professional, skilled mediators. These facilitators used the same techniques as arms control negotiations.
Mr. Butler explained how it was necessary in each case to bring the right people—the top people (those with decision-making authority, not "third or fourth level" in an organization). He stressed the importance of working without a timeline (unlike, for example, the much-maligned National LTC Committee), since trust must be built organically and personal stories must be shared.
When it was Mr. Westin's turn to speak, he outlined in broad strokes the mission of the Collaborative. Explaining that 23 years had passed since the Pepper Commission (the last federal commission to look extensively at long-term care), a new think tank had been assembled of liberals, conservatives, past and present congressional officials, all working with a professional facilitation firm. They intend to produce a report in 2014, which will hopefully result in legislation.
Among the LTC Financing Collaborative's goals are maximizing independence and autonomy for adults in need of both acute and chronic care, providing a safety net for those in our society in need, and preventing the middle class from impoverishing themselves.
Asked about the future of Partnership policies, the panel replied that any designs they develop would have to include a "partnership" between public and private financing. Mr. Gleckman also disabused us of the notion of Congress creating any future tax subsidies for the purchase of LTCi: The experience of the states that had tried that approach has been that it was a windfall for high-income individuals who would have bought coverage anyway, without increasing sales to the "middle-middle." Politically, all the talk whirls around getting rid of tax breaks, not giving out new ones.
Asked why the current National LTC Committee might not be up to the task, the panel wished the members luck, and offered to serve as a resource to them, but also warned that their constraints (e.g., a six-month deadline and a lack of funding) would limit their ability to produce meaningful results, while the Collaborative would take a more "significant, consensus-driven approach."
This author raised two serious questions with the panel following their presentation. First, given the tensions brought to the surface during the CLASS debate, wouldn't it be foolhardy to "give the keys back to the same drivers" and expect different results?
Mr. Butler responded that "the leading stakeholders are the leading stakeholders," and that one cannot simply bring in new people. Rather, the key to success this time around will be the mediator, allowing people who previously failed to try new ideas, and become amenable to compromise.
Second, I wondered whether the elite group chosen for the Collaborative in a schoolyard pick 'em might have left anyone out? Was the panel comfortable that all interests were represented?
To this, Mr. Westin referred only to one "very large stakeholder," whose name he would not reveal, except to say "they do not play well with others." For the sake of the facilitation process, it would be important to choose their representative wisely—to prevent any "flamethrowers" from derailing the think tank—but he was confident this group would end up as a Collaborative member.
If you search for the LTC Financing Collaborative (LTCFC) online, you're not apt to find much yet. This was about the only confirmation I received, but it does describe a partnership among the three organizations represented by the panelists who spoke at the ILTCI.
That could make this the most promising LTC initiative you've never heard of. What do you think? Can it succeed? Will you be watching? Who should be included? Let us know in the comments below.