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February 27, 2013 at 09:51 AM
LifeHealthPro has some great producer readers and avid commenters who probably think of themselves as dogged consumer advocates who hate the idea of the government having anything to do with providing long-term care (LTC) for anyone.
We have, I think, many more readers who accept the idea that some government involvement in LTC finance is a necessary evil, and some who think the government should do much more than it already does to make sure frail Americans and Americans with serious disabilities have access to whatever home health care, community-based care or nursing home care benefits they happen to me.
For the people in both of those camps — the necessary evil camp and the more more more camp — the main concerns about government involvement in LTC have to do with the quality and efficiency of the care, not so much arguments about whether it’s all right for the government to get involved with care in the first place.
Claude Thau, a long-term care insurance (LTCI) actuary, has argued that keeping LTCI providers and LTCI supervisors separate provides much needed checks and balances. Maybe one side will co-opt the other, but at least they will be (or, could be) separate groups of people who look at LTCI situations from different perspectives.
Now the sudden shutdown of the federal Pre-existingCondition Insurance Plan (PCIP) program has raised serious questions about how well-prepared the agency that oversaw the PCIP program, the Centers for Medicare & Medicaid Services (CMS) — the agency that oversees the existing Medicaid nursing home benefits program for the poor and the short-term skilled nursing care benefit for Medicare — really is to protect the interests of consumers.
The PCIP program charges market rates for coverage for people with serious health problems who have been uninsured for at least six months.
Program managers, are, understandably, worried about the fact that annual medical costs for the average PCIP enrollee are more than $32,000 per year, and that costs for the most expensive enrollees — the 4.4 percent of the enrollees would account for half of the program claims costs — average $225,000 each.
OK, that’s a tough program to run.
But the program managers announced Feb. 15 that they were suspending acceptance of new applications Feb. 15 and requiring states to phase out accepting applications for state-level programs by March 2.
