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Long-term care: still a political stepchild?

Even though health care reform is a major item on the Election Year political agenda, proposals addressing long-term care are all but nonexistent.

President George Bush's reform proposal, for example, contrary to helping funding for long-term care, may actually force more Americans to pay for nursing home care from their own resources. In recommending various administrative reforms and tax credits to enhance access to coverage for the uninsured, the Administration attempts to balance this with a lower ceiling on federal contributions to Medicaid. Analysts predict that states already struggling to meet their share of Medicaid costs would respond to the President's proposals by cutting reimbursement rates to nursing homes. Nursing homes would have to respond by some combination of cost-cutting, limiting access by Medicaid patients, and raising prices for self-pay and insured patients.

A White House spokesperson stated that the goal of the President's proposal was to make insurance more affordable rather than address every health care need. She added that volunteerism could reduce the burden of long-term care on individuals and the government. "We look to families to take back some of their role in caring for the elderly," she said.

Democrats Weren't Doing Much Better

Voters would have been equally disappointed if they looked for specific long-term care ideas from other candidates who ran this year. Only Senator Robert Kerrey (D-Nebraska) proposed any specific long-term care financing plan. Kerrey would replace Medicare, Medicaid, and business contributions to private insurance with a single health care fund used to pay premiums on insurance policies selected by individual consumers. This radical restructuring of health care funding would require all insurers participating in the program to provide at least minimum coverage for nursing home care.

More typical of candidates' positions was that of former Senator Paul Tsongas, who supports an unspecified program of universal health care that "must be affordable, must have no |pre-existing conditions' exclusions, and must provide coverage for such items as prescription drugs, home and hospice care. . . ." Senator Thomas Harkin (D-Iowa) and Governor William Clinton of Arkansas also voiced general support for some type of national health program that could include long-term care.

The only other specific long-term care financing proposal expected this year would be from a non-candidate, Senator Edward Kennedy (D-Massachusetts). "I believe the enactment of a national program for long-term care is one of the critical goals of comprehensive health care reform," Kennedy states, but his aides admit that the chances of passage in an election year are virtually nonexistent.

However, Kennedy has already introduced the Long-Term Care Insurance Improvement and Accountability Act to address marketing and sales abuses in private long-term care insurance. This bill or a House version is viewed as having a reasonable chance of passage if only because it would not increase the federal budget deficit. Wait and see, though, would seem to be the order of the day for long-term care Iegislation.

Business Not Carrying The Ball

Ask most politicians who pays for most U.S. health care, and it is a reasonable bet that they'll answer "the employer." The basic premise of our health care system is that health coverage is usually a benefit of employment. Those Americans who pay for health care out of their own pockets or who rely upon government or charities are supposedly in the minority.

That supposition is wrong.

A study released in February by the U.S. Department of Health and Human Services (HHS) found that, of last year's total national health care bill of $622 billion, over one-third ($224 billion) was paid by individuals. National, state and local governments paid out $212 billion. Health care spending by the private sector, including employers, unions, and charities, totalled $186 billion -- less than one-third of the total.
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Title Annotation:health care reform
Author:Stoil, Michael J.
Publication:Nursing Homes
Date:Mar 1, 1992
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