Making Progress on LTC

By Grace-Marie Turner

The long-term care program – the CLASS Act – contained in ObamaCare was repealed earlier this year after Health and Human Services Secretary Kathleen Sebelius said she was unable to find a way to make the program financially solvent.

But when Congress repealed the program, it created a commission charged with developing recommendations for a new plan.

On Thursday, Sept. 12, a majority of the members of the Long-Term Care Commission voted to approve final recommendations addressing service delivery, workforce, and financing of long-term care services and supports (LTSS).  The report represents a great deal of work by all of the commissioners and represents what I believe is an important and necessary step forward.  While this was not the report any one of us would have written on our own, it does contain good ideas about how to advance solutions that address both immediate problems and the longer challenge of financing long-term care for Americans unprepared for the financial risk.

The surprising aspect of the final vote was that it was truly bi-partisan, with five commissioners appointed by Republican leaders and four by Democrats voting in favor of the final report.  (The commission had 9 Democratic and 6 Republican appointees.) Chairman Bruce Chernof and vice-chair Mark Warshawsky did a superb job in building this consensus.

There were many people on the commission who are extremely knowledgeable about the challenges and opportunities for improvement in the LTSS space, and they brought a sincere desire to improve care, delivery, and financing to all of the hearings and deliberations during the 100-days that the commission worked together.

The commission had a statutory deadline to make recommendations to Congress by Sept. 12.  Because of time pressures and because the commission was still debating details of the report, only the top-line recommendations were delivered and released to the public then.  The full report was released during the final public meeting of the commission on Sept. 18 on Capitol Hill.  Here are links to the final documents to all of the commission’s reports:

  1. The Commission on Long-Term Care’s Report to Congress
  2. The news release about the Sept. 12 vote
  3. A very top-line summary of the recommendations
  4. A link to the commission website with all of the testimonies the commission heard and other documents
  5. A transcript of my speech from the Sept. 18 meeting

In addition, six of us commissioners have written a separate letter to President Obama and the congressional leaders appointing us about the importance of budget neutrality in advancing these initiatives.

A 9-6 majority of commissioners concluded there are many changes we could recommend, with bipartisan support, to make progress in improving long-term care. We worked very hard on those areas of broad agreement, and I think this report represents an important step forward.

Not every report, decision, or vote represents blockbuster improvement. This may be seen as incremental improvement, yet I think it makes significant changes that could benefit people not only in the short term but also in the long term.

One issue that I am particularly passionate about is to allow people to continue to or to begin to work while still receiving long-term services and supports.

I had a beloved niece, Katie, who was born with Downs Syndrome. After high school and community college, she held two different jobs. She loved going to work. It organized her time, her day, and her friendships. Katie was a much more fulfilled young woman when she died at the painful age of 30 because she was able to have the work experience that she did.

I will work to bring together some continued consensus around making progress on a path to work and on many other recommendations in the report, such as allowing states greater flexibility with the Medicaid waiver process.

On financing issues, we couldn’t come to agreement partly because we didn’t have the time, and also because we didn’t have the resources to analyze the costs of some of the proposals that were made. But I do think we have offered some proposals, both in the alternative approaches that were offered as well as the specific recommendations in the financing section, that could make important improvements toward the goals outlined at the beginning of the report.

On the financing question in particular, I believe that, if we are to have a strong safety net for people who have no other options for care, we need to provide new incentives for people who are able to prepare now for their own potential long-term care needs.

If those who can take care of themselves do so, then we will be able to have a stronger safety net in an era of limited government resources. We offered several alternative recommendations that involve giving people new tax incentives to purchase long-term care insurance or other products that the market might offer.  Our alternative recommendations can be found in Chapter 3, Section 3 of the final report.

I look forward to working with my fellow commissioners to advancing positive changes in long-term care service, delivery, and financing.


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