Tuesday, May 03, 2005
Long-term care issue must be addressed
[Editorial, "Band-Aid not enough," The Atlanta Journal-Constitution, 2 May 2005.] (free registration required)
This editorial points out the urgent need for states to address the problem long-term care provision through Medicaid presents to budgets:
One of the most contentious issues between the states and Washington involves the huge impact Medicaid spending is having on state budgets.
With the annual cost of the health care program for the poor and disabled skyrocketing, Medicaid has begun to challenge elementary and secondary education as the most costly wedge of the state spending pie. At the same time the Bush administration has told Congress it wants to reduce federal spending on Medicaid by as much as $40 billion over the next decade. (Medicaid is jointly funded by the states and the federal government.)
Those budgetary trend lines are not a good omen, and states have already begun scrambling to enact cost-saving measures.
But largely left out of the debate has been the most ominous Medicaid trend line of them all — the issue of long-term care.
Elderly, blind and disabled people represent roughly a quarter of the nation's 50 million Medicaid patients, yet they account for 71 percent of the program's costs. The National Governors Association reports that people with disabilities are the fastest-growing Medicaid eligibility group. Over the next 30 years, the number of Americans aged 65 and older — and the proportion of those individuals 85 and older — is expected to double.
Medicaid, not Medicare, will pick up most of the long-term care services of many of these patients. In order to keep Medicaid sustainable for the basic services it provides for pregnant women and children and other poor and uninsured Americans, the nation will need to come to grips with what role government and private individuals should play in ensuring long-term care.
Among other things, some of the nation's governors want Medicaid to take aim at the common practice of allowing elderly nursing home patients to give away their assets so that Medicaid will pick up their bills. That's why Congress needs to seriously consider incentives for making the purchase of long-term care insurance more affordable.
Similarly, the private sector should step up promotion of innovative long-term care plans, such as those that allow life insurance benefits to be converted for nursing home care. Then Medicaid might have a chance to survive.
While the column correctly identifies the problem, it goes slightly astray in suggesting that the solution to elderly nursing home patients giving away their assets is to bribe them with incentives. Before any incentives are considered, and indeed before a healthy private sector market can develop, policymakers must eliminate the incentives already in place to hide assets and avoid purchasing insurance. Otherwise, it essentially devolves into a game of legislators trying to outbid themselves.
[Editorial, "Band-Aid not enough," The Atlanta Journal-Constitution, 2 May 2005.] (free registration required)
This editorial points out the urgent need for states to address the problem long-term care provision through Medicaid presents to budgets:
One of the most contentious issues between the states and Washington involves the huge impact Medicaid spending is having on state budgets.
With the annual cost of the health care program for the poor and disabled skyrocketing, Medicaid has begun to challenge elementary and secondary education as the most costly wedge of the state spending pie. At the same time the Bush administration has told Congress it wants to reduce federal spending on Medicaid by as much as $40 billion over the next decade. (Medicaid is jointly funded by the states and the federal government.)
Those budgetary trend lines are not a good omen, and states have already begun scrambling to enact cost-saving measures.
But largely left out of the debate has been the most ominous Medicaid trend line of them all — the issue of long-term care.
Elderly, blind and disabled people represent roughly a quarter of the nation's 50 million Medicaid patients, yet they account for 71 percent of the program's costs. The National Governors Association reports that people with disabilities are the fastest-growing Medicaid eligibility group. Over the next 30 years, the number of Americans aged 65 and older — and the proportion of those individuals 85 and older — is expected to double.
Medicaid, not Medicare, will pick up most of the long-term care services of many of these patients. In order to keep Medicaid sustainable for the basic services it provides for pregnant women and children and other poor and uninsured Americans, the nation will need to come to grips with what role government and private individuals should play in ensuring long-term care.
Among other things, some of the nation's governors want Medicaid to take aim at the common practice of allowing elderly nursing home patients to give away their assets so that Medicaid will pick up their bills. That's why Congress needs to seriously consider incentives for making the purchase of long-term care insurance more affordable.
Similarly, the private sector should step up promotion of innovative long-term care plans, such as those that allow life insurance benefits to be converted for nursing home care. Then Medicaid might have a chance to survive.
While the column correctly identifies the problem, it goes slightly astray in suggesting that the solution to elderly nursing home patients giving away their assets is to bribe them with incentives. Before any incentives are considered, and indeed before a healthy private sector market can develop, policymakers must eliminate the incentives already in place to hide assets and avoid purchasing insurance. Otherwise, it essentially devolves into a game of legislators trying to outbid themselves.
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