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.
While our primary focus is on financing, we needed to agree on what delivery system we wanted before we could find a way to pay for it. I’ll talk in more detail about that new framework for care in a forthcoming blog post. In this post, I’d like to focus on the Collaborative itself.
We formed a group of strange bedfellows—people with little in common except a commitment to work together to solve these difficult problems. We represent providers, consumers, and the insurance industry, as well as policy analysts from across the political spectrum. Some of us are health care experts, others focus on long-term care.
There are about two dozen of us, including Stuart Butler and Bill Galston of the Brookings Institution; Shelia Burke of the Kennedy School (and former chief of staff to Senate Majority Leader Bob Dole); Paul Van de Water of the Center on Budget and Policy Priorities; Deb Whitman of AARP; Jennie Chin Hansen, who just retired as CEO of the American Geriatrics Society; John Rother of the National Coalition on Health Care; Ron Pollack of Families USA; and Lee Goldberg of the National Academy of Social Insurance. We have two former senior state health officials, Mike Fogarty of Oklahoma and Dennis Smith of Wisconsin. Gail Wilensky is a former director of the federal Medicare and Medicaid programs. Audrey Weiner, Jonathan Westin, and John Erikson were among those bringing a provider perspective, and Susan Coronel of America’s Health Insurance Plans, Marc Cohen of Lifeplans, and Al Schmitz of Milliman Inc. helped us understand the perspective of the insurance industry.
To help a group of people with strong opinions get to “yes,” we worked with the Convergence Center for Policy Resolution, a non-profit that facilitates consensus-building on complex policy matters.
The Collaborative is only one of many groups tackling long-term care. Others include the Bipartisan Policy Center, Leading Age (a trade group representing non-profit senior service providers), and AARP. While we each have our own ideas, we communicate regularly and cooperate on some important issues.
The most important is an effort to model a series of policy options. All of us agreed that we wanted a common tool to measure the effects of potential financing alternatives. While we might disagree on specific solutions, we could avoid battles—and confusion– over how to calculate how much proposals would cost, who they’d benefit, and what they’d mean for government programs.
To solve that problem, my colleagues at the Urban Institute, along with the actuarial firm Milliman, are calculating whether and for how long people over 65 can expect to need long-term care, and whether they are likely to require Medicaid assistance. With that baseline information, these analysts can predict what a specific policy option would cost, and how it would benefit people by income, gender, and other characteristics.
We’ll have their results in the fall and hope to release our final report soon after that. We are considering a broad range of alternatives, including several forms of public and private insurance, and reforms to Medicaid and Medicare. Finding consensus won’t be easy but we’ve already accomplished much more than many expected.
Long-term supports and services is a difficult issue. We’ve understood the problems for years but little has changed since I described them in my book Caring for Our Parents. As the population ages, and younger people with disabilities live longer, it is essential that we develop workable, consensus improvements in both delivery and finance. The Collaborative is taking a big step in that direction.