Fix The Affordable Care Act By Letting People 55-64 Buy Into Medicare

Congressional Republicans seem once again stymied in their efforts to “repeal and replace Obamacare.” So here is a partial solution that can be a winner for both political parties, the insurance industry, and consumers: Allow people 55-64 to buy into Medicare. And enhance the deal by letting Medicare Advantage plans offer some long-term supports and services, such as personal care, as part of their benefit package.

The idea of a Medicare buy-in has been around for years. It was proposed by President Bill Clinton and endorsed again in the recent presidential campaign by Hillary Clinton. About now, you are thinking that the Clinton pedigree is a death sentence in a Republican-controlled government.

What The Trump Presidency Means for Seniors

The election of Donald Trump, along with continued Republican majorities in the House and Senate, will likely result in major cuts in federal programs that benefit older adults and younger people with disabilities.

Some of the programs that could be targeted: Medicaid, important reforms in the way health care is delivered through Medicare, and services funded through the Older Americans Act such as Meals on Wheels, adult day, information assistance. And while Trump vowed throughout his campaign to leave Social Security and Medicare untouched, congressional Republicans have targeted both programs and it is not clear whether the new president would resist their efforts to cut benefits.

A Medicare Long-Term Care Benefit?

Public opinion surveys show that most Americans incorrectly think Medicare pays for long-term supports and services (LTSS). It does not. But should it? Should Congress add a long-term care benefit to the program’s current package of insurance for hospital care, doctor visits, and drugs?

Three highly respected health researchers, Karen Davis, Amber Willink, and Cathy Schoen, think it should. In a blog post for the journal Health Affairs, they’ve proposed Medicare Help at Home. It has three elements:  A limited benefit for support at home, a new health delivery model called an Integrated Care Organization that would provide both medical care and LTSS; and team-based home care.

Yes, We Can Create A Universal Long-Term Care Insurance Program

For three years, I’ve been working with a diverse group of policy experts to create a consensus framework for financing long-term supports and services (LTSS). This morning, the Long-Term Care Financing Collaborative, released its recommendations. And they are built around two major reforms: a new universal catastrophic long-term care insurance program and major improvements to Medicaid’s LTSS benefit.

Our insurance proposal would create an alternative to Medicaid for many middle-income people who now impoverish themselves paying for both long-term care and related medical expenses.

Hawaii Is About To Debate A Public Long-Term Care Insurance Program

 

The state of Hawaii is about to have a fascinating debate over whether to create a first-in-the-nation universal long-term care insurance program. The benefit would be modest—about $70-per-day for a year– but it would be available to all long-term residents of the state and be funded through a broad-based tax.

The measure will be introduced by Senate Commerce, Consumer Protection and Health committee chair Roz Baker, according to a report in the American Prospect magazine. Hawaii has been working on this issue since the 1990s—not surprisingly since the state has a rapidly growing population of those 75 and older and has a cultural traditional of caring for older adults.

Building Better Long-Term Care Insurance

Can the US do a better job of designing long-term care insurance? The answer is yes, according to two important new studies. With hard work and political will, we can develop better ways to help pay the enormous cost of long-term supports and services.

The new research is a big step towards improved financing of these services. It did not find a “magic bullet.” But it did show how various options differed from the current system and from one another: There are big differences between voluntary and mandatory insurance, and smaller, but important, distinctions among the voluntary programs. To learn more about the main study, take a look at this article in the journal Health Affairs (which I helped write) or this more technical paper.

Are Seniors Getting Too Much Medical Treatment?

Older adults are getting too much medical treatment.

No, I am not suggesting we ration treatment for seniors or empower the mythical death panels. Rather, the health system should replace aggressive but ultimately useless medical interventions with more care.

This means rethinking the way we care for older adults with chronic disease. We should organize care around the goal of improving their quality of life rather than on aggressively treating their specific medical conditions. Rather than doing that third scan on the same body part, we could better spend our dollars on home delivered meals or an adult day program for an otherwise homebound senior. Every decision should be based on the answers to two simple questions: Is it what the patient wants? Will it improve her quality of life?

What Are the Chances You’ll Need Long-Term Care And How Much Will It Cost?

What are the odds you’ll need assistance to help with personal activities such as bathing or dressing before you die? For those about to turn 65, it’s about 50/50, according to an important new study. On average, you can expect to need this high level of care for about two years. But one-in-five Americans will need such assistance for less than one year while about one in seven will need extensive help with daily living for five years or more.

A New Vision for Long-Term Care

Today, America’s vision of long-term care is limited and grim. Supports and services for frail elders or younger people with disabilities are delivered in a fragmented, disorganized way that puts recipients of care at risk for serious harm or even death and likely wastes billions of dollars. Indeed, if the goal of supports and services is to provide the best possible quality of life for those who need personal assistance, we are doing almost everything wrong.

How Liberals and Conservatives Are Working Together To Improve Long-Term Care

The number of people needing long-term supports and services is likely to double by mid-century, and there is broad agreement across the political spectrum that our system for delivering and financing that care is, frankly, terrible. But for years, these problems seemed intractable. How could we break the political gridlock that has infected this issue, along with so many others?

In 2012, a small group of policy experts formed what we called The Long-Term Care Financing Collaborative #LTCollaborative to find a way. And today, we are releasing our first report: It describes an integrated model of delivering care that aims to improve the quality of life of those with complex chronic conditions and better support family members and communities that assist them.