Long-term Care

The Senate and House health reform bills would expand Medicaid to 133 percent to 150 percent of the federal poverty level respectively. In both scenarios the federal government would pay virtually all the costs for the newly eligible groups but continue to pay for most current eligibles at current matching rates. This creates significant inequities as well as introduces new administrative complexities. This analysis, however, shows that it is possible to distribute increased federal payments in multiple alternative ways that could avoid the problems, provide fiscal relief to states, and solve existing financing problems as well.

Growing evidence demonstrates that certain approaches to financing and paying for chronic care coordination for patients are effective not only for improving patient well-being but can also reduce health care spending. However, chronic care approaches should vary for different patient populations and can be carried out effectively by diverse organizations and professionals reflecting the heterogeneity of health care delivery throughout the US. The Report considers the different populations in need of care coordination, summarizes current evidence of effectiveness, describes the various entities that can serve as focal points for coordinating care, and details the possible financing and payment options that can support these approaches.

About two-thirds of those over 65 will need some long-term care before they die. Howard Gleckman looks at a key question at the heart of the debate over long-term care insurance: how much will premiums cost?

As many as 10 million older Americans and younger adults with disabilities require long-term care, either at home or in nursing facilities. The United States spends more than $200 billion annually for such care. However, our system for financing this assistance-principally Medicaid and family assets, with a small share funded through private insurance—may be untenable as baby boomers age. TPC's Howard Gleckman looks at the way we deliver and pay for these services in a new book, Caring for Our Parents: Inspiring Stories of Families Seeking New Solutions to America's Most Urgent Health Crisis. He and a panel of top policy experts will discuss how—or whether—long-term care should be included in health reform legislation.

More than 250 million Americans-more than 80 percent of us- have health coverage, usually through employers or Medicare, Howard Gleckman points out in a USA Today commentary. By contrast, just 7 million have long-term care insurance. That, it seems, is the real crisis of the uninsured.