Howard Gleckman, the moderator of a recent Urban Institute panel discussion on “long-term care in an era of shrinking government,” greeted an audience question about private long-term care insurance (LTCI) with a polite but distant stare.
The Urban Institute, Washington, organized the discussion in response to U.S. Health and Human Services Secretary Kathleen Sebelius’s announcement in October that she saw no way to create a viable voluntary worksite LTC benefits program based on the Community Living Assistance and Support Services (CLASS) Act.
The Urban Institute panelists did not seem to think the current Congress would do much about meeting U.S. residents’ LTC needs, in part because of the difficulty of dealing with anti-selection concerns.
“It does seem very difficult to do this on a voluntary basis, and it also seems very unlikely that we’re going to make this mandatory,” said Len Fishman, chief executive officer of Senior Hebrew Life, Boston.
Fishman said one ray of hope is that Medicare will be making hospitals with excessive readmission rates pay penalties starting in 2012. The penalty is having a “stunning” effect on hospitals’ level of interest in what happens to patients after patients leave the hospital, he said.
Later, Fishman suggested that Congress will have to get the money for LTC by shifting resources away from the Medicare acute care budget.
“Increasing spending for long-term care at all is going to be really hard while acute care is driving us toward an unsustainable growth curve,” Fishman said.
Joshua Wiener, director of the program on aging, disability and long-term care at RTI International, Research Triangle Park, N.C., said in response to a question about the possibility of Medicaid getting out of the LTC benefits business that Medicaid has to be in the LTC business.