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.
From a pure bean counting perspective, shutting down the program promptly probably makes good actuarial sense. Program managers want to make sure whatever funding they have lasts until the end of the year. This is not a great time to be assuming that someone somewhere in the government will come up with more cash to rescue the program.
On the other hand, from a consumer protection perspective: What would the people who bill themselves as being nonprofit consumer advocates do if suppliers of important commercial safety net insurance products were actively marketing their products one hour, then up and suspended sales the next? I think those consumer advocates would scream bloody murder and insist that someone, somewhere, come up for the money for a transition program, to give consumers time to adapt to a major change in the market.
As far as I can tell, as tough as these times are, the Obama administration has made no visible effort to warn the public that it was going to suspend the federal PCIP program overnight or to make any serious effort to raise emergency funding for the program. It has given far more attention to the possibility that detention centers might release some nonviolent undocumented aliens than to the idea of creating a transition for sick Americans who were counting on the government to live up to its commitment to provide access to health insurance for people with health problems up until the new Patient Protection and Affordable Care Act (PPACA) guarantee-issue rules take effect Jan. 1, 2014.
Plenty of consumer advocates still talk wistfully about the idea of the federal government offering bigger, more generous LTC programs. They seem to regard private LTCI providers as a silly nuisance.
But — possibly in part because of innate kindness and good sense, and possibly in part because of the pressure brought to bear in the past by regulators and consumer advocates — private LTCI carriers phase in major changes in their programs, such as rate hikes, over a two-month period. Many avoid making any changes at all for the oldest insureds.
Any readers who have gotten to this point who think the idea of goverrnment involvement in LTC is ludicrous are now hoarse because they’ve been screaming, “I told you so. Bozos!!!” so loudly for so long.
I think that any readers who believe that the government should, or, in their eyes, sadly, must have a role in paying for LTC need to figure out how to build program cancellation and change safeguards into any current government LTC programs and any government LTC programs to be created in the future.
The government has to be able to respond to financial problems and shifts in conditions by changing programs, but it ought to do so in an orderly, public fashion, after giving the affected consumers some reasonable level of notice and ability to apply for exceptions, not by slamming the application door shut during a Friday afternoon teleconference.