Congress and President Obama say they want to pass a massive health reform bill this year. But will they include desperately-needed changes in the way we deliver and pay for long-term care services for the frail elderly and those with disabilities?

Right now, that is an open question. Some key lawmakers are pushing for major reform, but others are reluctant to tackle what is sure to be a controversial issue. And the White House has, so far, shown little interest in major long-term care reform.

Senator Ted Kennedy (D-MA) favors dramatic changes, especially in financing. Kennedy understands that the current system, where nearly half of all costs are paid by the welfare-based Medicaid system, less than 10 percent by private long-term care insurance, and much of the rest out-of-pocket by hard-pressed families, is not sustainable. Families  caring for parents and other loved ones cannot afford it. And in the long-run neither can Medicaid, funded jointly by the federal government and the states.

Kennedy would largely replace that system with government long-term care insurance. Under his plan, called the Class Act, people could begin buying insurance as young as age 18. Premiums would be less than $100 per month and provide a benefit of between $50 and $100 a day for life. He is about to propose an updated version and one key question is whether everyone will have to buy, or whether they will be able to opt-out. When you think about this, remember a key rule about insurance: The more people buy, the less costly the premiums.

Others favor more modest, but still very important changes. Most are focused on the way we deliver care. For instance, Senate Aging Committee Chairman Herb Kohl (D-Wisc.) would like to improve the quality of health care workers and personal aides. The powerful seniors lobby AARP is backing a package of changes that would make more people eligible for Medicaid long-term care coverage, and make it easier for beneficiaries to get the help they need at home, rather than in a nursing home.

Some physicians groups and patient advocates also support improving the critical moves patients make from hospitals to nursing facilities to homes. These transitions are especially important for the frail elderly and those with disabilities, but key for anyone with a chronic disease.

This battle will be fought out on Capitol Hill over the next six months. It would be a tragedy if Washington ignores the needs of millions of families caring for parents and other loved ones.