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If not LTCI, then what?

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Just how cold was the room for private long-term care insurance (LTCI) at a recent panel discussion on aging organized by the Altarum Institute?

So cold that even the economist from the American Enterprise Institute sounded skeptical about the idea of private LTCI doing much to help the United States cope with the baby boomers’ likely coming need for long-term care (services).

Joseph Antos, a health care analyst at the institute, argued that using private, voluntary insurance to meet the nation’s LTC planning needs would be difficult.

When people buy insurance for acute care, they know the services used might be needed soon and would probably make them feel better, Antos said.

“There’s a light at the end of a very short tunnel,” he said.

When consumers are thinking about buying LTCI, they assume the insurance would pay for care when their lives are, essentially, “over.”

“Why pay for that?” Antos asked.

Another problem, Antos said, is that private LTCI arrangements trap both the issuer and the policyholder.

“Everyone is making a bet on what there will be 20 or 30 years out.”

Antos said he thinks combining LTC benefits with an annuity makes more sense.

“But it’s really painting lipstick on that pig,” Antos said.

Another panelist, John Rother, president of the National Coalition on Health Care — a group that includes many traditionally liberal groups but also includes the Blue Cross and Blue Shield Association and the International Foundation for Employee Benefit Plans — was tougher on private LTCI.

When an audience maker asked about ways to encourage people to take personal responsibility for insuring against LTC risk, Rother said he disagrees with that idea.

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“People have other demands,” Rother said. “Who knows what the world is going to look like 20 years from now?

Earlier, Rother said, “Private insurance has failed. There’s no future for private insurance.”

The country still needs to think in terms of insurance, because there’s no other affordable way to deal with the problem, policymakers need to think in terms of something other than stand-alone, private LTCI coverage, he said.

Panelists were more eloquent when talking about why no big, comprehensive solution would be coming any time soon than when talking about possible solutions.

John Feather, chief executive of Grantmakers in Aging, said LTC programs need to start with small, local projects.

“This is not going to be about rainbows and unicorns,” Feather said. “We cannot look to the federal or state governments for the solution for the problems.”

But Suzanne Burke, chief executive of the Council on Aging of Southwestern Ohio, pointed out during her presentation that voters in her area have agreed to pay extra property taxes to support programs that help older residents stay in their homes.

About 75 percent of the voters have been voting to support the stay-at-home services levy. Burke said.

In addition to persuading taxpayers to provide dedicating sources of tax revenue for LTC services, panelists suggested that the government and private grantmakers could help by doing more to support research focusing on fighting the conditions that push many people in long-term care: Dementia, incontinence and broken hips.

Rother recommended that policymakers considering adding some long-term care benefits to the “essential health benefits” package that the Patient Protection and Affordable Care Act (PPACA) now requires all individual and small-group acute health insurance plans to cover.

Several speakers agreed local governments could help by simply doing more to adopt and enforce building codes that make buildings more accessible for all people, including older people with disabilities that limit their “activities of daily life.”

Burke wondered why any builder in the country can get away with building a new shower without a grab bar.

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