Republican Scott Brown’s stunning victory in the Massachusetts Senate race has obviously turned the health reform debate on its head. Without a 60-vote majority in the Senate, Democrats are no longer assured of passing a major health bill. But what will this mean for long-term care reform?
There are three key long-term supports and services issues at stake–expansion of Medicaid home and community based care, new efforts to coordinate care both for Medicare patients and for those eligible for both Medicare and Medicaid, and the CLASS Act, the proposed national long-term care insurance program.
Keep in mind that the fate of all these measures is tied to broader reform. If the big health bill dies this year, so will long-term care reform.There is no chance Congress will pass a long-term care bill on its own this year.
If the House can pass the Senate version of health reform, these proposals will survive, although not necessarily in the best form. If, as President Obama hinted today, he’d like Congress to try to pass a slimmed-down bipartisan health insurance reform bill, the fate of long-term care will be much dicier.
To start, it is not clear that either Republicans or liberal Democrats want to pass a mini-reform bill. But if they do, would long-term care be in the package?
It is hard to imagine that broad expansion of Medicaid home and community care would be included, because that proposal could be very expensive, and lawmakers will be looking to jettison costly provisions. Care coordination has a better chance since it may be sold as a cost-saving measure.
And what about CLASS? It is harder to say. On one hand, CLASS generates substantial revenues in the first ten years, at least on paper, and that has always been it biggest advantage. However, the proposal has also generated a number of important critics, including both Republicans and nearly a dozen moderate Democrats.
CLASS, for all its benefits, is not essential to health insurance reform. And if Obama wants to get something passed quickly, I suspect he’ll dump everything that is at all controversial.
Bottom line: the immediate future of long-term care reform is extremely precarious. But whether it is approved this year or not, the issue has generated more attention than at any time in decades. And as long as millions of us need care, or are caring for our parents or other loved ones, it is not going away.