Vol. 41, No. 5

A Note from the Chairman Emeritus

States have been called the laboratories of our democracy. They’re places where policy experiments are carried out. If the experiment is successful, the lessons are often applied nationwide.

A More Perfect Constitution – A Q&A with Larry Sabato

America’s favorite political scientist talks about his new book, “A More Perfect Constitution.”

So Far, So Good

When the Medicare Modernization Act was signed into law in December 2003, there were many predictions of problems implementing the new drug benefit.

Prescribing a Financial Fix for Post-Acute, Long Term Care

As greater numbers of patients and residents enter our nation’s long term care system, it is imperative that our policymakers address America’s entitlement programs.

Entitlement Reform: The 800 pound gorilla that’s being ignored in the 2008 campaign

When asked what they would do about fixing entitlement spending, with just a few exceptions, the current presidential candidates quickly retreat into clichés.

Leading the Way: Health Care Reform

California’s Health Secretary discusses Governor Arnold Schwarzenegger’s plan to reform health care in their state.

It’s Not Just in California

A look at some of the other health care reforms being pushed by Republican Governors around the country.

Schwarzenegger’s Health Care Plan: A Bridge too Far, or a Bridge to Nowhere?

The key question is not whether the Governor’s plan is good politics, but whether it is good policy.

Health Care Reality Check

The goal of any reform plan should be the same as the Hippocratic Oath: First, do no harm.

From Barefoot Doctors to Red Envelopes

China’s health care system is weighed down by a legacy of government control.

Should SCHIP be Expanded?

Yes, the program is working, and America’s families need the coverage.

Should SCHIP be Expanded?

No, it will result in bigger government, not better care for our children.

The Backpage: Above All, Try Something

It is common sense to take a method and try it. If it fails, admit it frankly and try another. But above all, try something.

Ripon Profile of Judy Biggert

We must work very hard to earn back the respect and trust of the American people.

Prescribing a Financial Fix for Post-Acute, Long Term Care

As we head into yet another Presidential race, it seems that every candidate is focusing on the need for health care reform and we have seen many proposals put forth into the court of public opinion. 

While the goals of fixing a troubled and ailing healthcare system are laudable, it is greatly distressing that no candidate has included long term care – no addressing skilled nursing care, assisted living, hospice, or home care – in their reform plans. This is why long term care professionals are actively engaged in bringing long term care issues to the forefront as part of the 2008 presidential debate. 

According to the U.S. Department of Health and Human Services, nearly 40% of all Americans will require nursing home care at some point in their lives. In addition, they estimate that by 2020, 12 million older Americans will need long term care services. These startling facts reveal one very important truth – that it is critical that policymakers address long term care reform now in order to prepare for America’s future long term care needs. 

As greater numbers of patients and residents enter our nation’s long term care system, it is imperative that our policymakers address America’s entitlement programs. Unfortunately, at present, nursing facility care is predominantly funded by the overextended Medicaid and Medicare programs. Currently, 80 percent of the patients and residents receiving care and services in the nearly 1.5 million nursing facilities nationwide rely on funding from one or both of these programs to pay for their long term care. This strain on the system, coupled with the need to care for an ever increasing number of patients, clearly points to the need to address these programs, and soon. 


As greater numbers of patients and residents enter our nation;s long term care system, it is imperative that our policymakers address America’s entitlement programs.

The American Health Care Association (AHCA), the National Center for Assisted Living (NCAL) and our nearly 11,000 member long term care providers believe that a comprehensive long term care system should promote and integrate a comprehensive array of public and private financing options that meet consumer and family needs and respond to their preferences.               

As long term care and post-acute care expenditures are expected to increase dramatically over the next fifty years due to the aging of the baby boom generation, the enormous financial pressure on federal and state budgets will continue to escalate. However, not only do state and federal governments need to plan for the future of long term care, but individuals must take personal responsibility in planning for their future care needs. 

First off, we must clear up misconceptions about how long term care is financed in this nation. Many consumers are under the impression that these services are automatically funded by Medicare, Medicaid or their traditional health care insurance. However, Medicare has a limited benefit for post-acute long term care and in order for Medicaid to fund an individual’s long term care and services, an individual must impoverish themselves. As well, many are unaware that health care insurance has no long term care benefit and that long term care insurance is a completely separate policy required to fund this type of care. 

Personal investment and future planning through the purchase of a long term care insurance policy is one step to take the pressure off Medicare and Medicaid in their role of funding long term care. In order to encourage such personal responsibility, incentives must be built in to the system. 

Through the Deficit Reduction Act of 2005, Congress took initial steps to encourage purchase of long term care insurance policies by expanding the Long Term Care Partnership Program by lifting restrictions that had limited the program to four states. The Long Term Care Partnership Program is a public-private partnership between states and private insurance companies, designed to reduce Medicaid expenditures by delaying or eliminating the need for some people to rely on Medicaid to pay for long term care services. This was a critical first step in the direction of personal investment in long term care and services, but we must do more. 

While this is an important effort to take pressure off the role of Medicaid in financing the long term care for millions of Americans, it must be complemented by efforts that build on the expansion of this laudable program. 

Earlier this year, AHCA, NCAL and the Alliance for Quality Nursing Home Care entered into a partnership to develop real solutions to this long term care financing conundrum. Working in cooperation, these groups have developed a comprehensive plan, the “Long Term Care and Post-Acute Care Financing Reform Proposal.” This includes workable, relevant policy proposals that meet the needs of patients while addressing the looming financing crisis 

AHCA, NCAL and the Alliance propose a new model for both financing and delivery of long term care and post-acute care that is sustainable, patient-centered, and lower cost. The proposal replaces the current patchwork financing with a voluntary federal system, increases private long term care financing, and rationalizes the post-acute and long term care delivery systems. Among other items, this model incorporates a new Medicare post-acute payment system to pay primarily based on the condition, needs and characteristics of the patient regardless of the post-acute care setting in which the patient receives care, and establishes a catastrophic federal long term care benefit which mandates individual commitment to planning and saving for their future long term care needs. A variety of vehicles may be used to meet this commitment including the purchase of an approved long term care insurance policy or investment in an approved savings vehicle dedicated for future long term care costs. 

We challenge the 2008 presidential candidates, as well as Congressional leaders and policymakers nationwide, to investigate the feasibility of such a plan – and look for ways to implement a program that effectively and proactively addresses the impending financing crisis in our nation’s long term care system. 

In these days and years leading up to the time when our Greatest Generation and Baby Boomers alike require critical long term or post-acute care services, it is imperative that providers and policymakers partner together to create real solutions to a real and growing healthcare concern. 

David Hebert is the Senior Vice President of Policy and Government Relations at the American Health Care Association.