LTC Bullet:  What Have You Done for Me Lately? 

Tuesday, October 18, 2005 


LTC Comment:  Six months of two-week trips to DC have concluded.  Here's what we accomplished, after the ***news.*** 

*** QUERY:  Where else do you get the kind of proactive public policy advocacy and constant reportage described in the following LTC Bullet?  If you can't say "from my company" or "from our trade association" or "from so-and-so or such-and-such a news source," then maybe the time is right for you to join the Center for Long-Term Care Reform.  If you do reach that conclusion, the next step is simple.  Just go to and sign up.  Or even easier yet, contact Damon at 206-283-7036 or  He'll have your membership processed, your user name and password set, and your daily LTC E-Alerts on the way in a jiffy.  We can't do it without you.  But anything is possible now with your support.  The LTC dominoes in DC are ready to fall. *** 



LTC Comment:  Two questions every customer should ask every vender are "What have you done for me lately?" and "So what?"  Whether you subscribe to these LTC Bullets for a fee or are among the dwindling number (mostly media and government) we're able to "comp," those are worthwhile queries. 

So, here's our account of what we've been doing over the past half year while commuting half time to Washington, DC.  (Special thanks to the American Health Care Association for making this work possible.) 

A few months ago, there was little hope that long-term care financing and Medicaid reform would make any more progress this year than they have in the past seven.  That is to say, almost none. 

Today, Washington, DC is abuzz with talk about passing LTC Partnerships, closing Medicaid loopholes, tightening asset transfer rules, and extending the LTC awareness campaign.  Last April, when I started making monthly trips to DC, the idea of eliminating or severely reducing Medicaid's wide open home equity exemption was unthinkable.  Now that idea is commonplace and recommended by the National Governors Association.  Nothing else would do more to save Medicaid as a safety net and to unleash the potential of private financing alternatives like LTC insurance and home equity conversion. 

What happened? 

We won't try to take credit.  Many factors are at work.  But let me just lay out for you what your Center for Long-Term Care Reform has been doing for the last several months.  Make your own decision whether you think it's made any difference  . . . and whether you'd like to help our work continue by becoming a dues-paying member of the Center or renewing your membership. 

In April . . . 

I briefed the House Energy and Commerce Health Sub-Committee minority staff on the need for Medicaid reform to save Medicaid for the needy by encouraging private insurance and home equity conversion for others; then I testified before the House Energy and Commerce Health Sub-Committee on Medicaid and LTC financing as the egregious Medicaid planning quotes I supplied to the Committee's majority staff scrolled on a monitor overhead. 

In May . . . 

I briefed Congressman Lee Terry who has introduced a bill to promote LTCi by allowing people to pull the money from their 401-K plans penalty free; I conferred with my former business partner David Rosenfeld who is now Health Counsel for the House E&C Health Sub-Committee and will write the bill to reform Medicaid to encourage private LTC financing; I briefed Tom Miller of the Joint Economic Committee, Senate side; Scott Pattison, Executive Director of the National Association of State Budget Officers; Peter Bell, Executive Director of the National Reverse Mortgage Lenders Association; Jim Baumgartner, a Director at the Congressional Budget Office; Ron Lucchino, a gerontologist and lobbyist for the Alzheimer's Association; Carol O'Shaughnessy, a Director and Julie Stone Axelrad, who testified at two Senate hearings on our issue, of the Congressional Research Service; Kathryn Allen, a Division Director at the Government Accountability Office who leads a team studying Medicaid asset transfers; Jim Frogue, previously of the American Legislative Exchange Council and now with Newt Gingrich's organization; Jim Cantwell of the House Budget Committee staff; and Joby Fortson, Counsel for the House Energy and Commerce Oversight and Investigations Sub-Committee, who is conducting a survey of state Medicaid directors regarding Medicaid planning abuses.  I also briefed the health legislative assistants for Senators Jeff Bingaman (D-NM), George Allen (R-VA), Rick Santorum (R-PA) and Roy Ramthun, Special Assistant to the President for Health Policy. 

Topping off May came nominations from the Directors of the Heritage Foundation and the Cato Institute for me to serve on the Medicaid Commission.  Alas, these nominations were to no avail. 

In June . . . 

I briefed Christie Herrera of the American Legislative Exchange Council; Kate Sullivan Hare of the U.S. Chamber of Commerce; Stuart Hagen of the Congressional Budget Office; Elias Papasavvas, Founder and CEO of ElderLife Financial; Joe Lessen, a lobbyist for America's Health Insurance Plans (AHIP); Sandy Cook, a lobbyist for UNUM Provident; Brian McManus, a lobbyist for Golden Rule; Matt Salo of the National Governors Association; and Senator Jim Bunning's (R-KY) health legislative assistant.  I met at length with two important Washington-based reporters who have published before and will write again on our issues:  Marilyn Werber Serafini of the National Journal and Sarah Lueck of the Wall Street Journal.  I attended a conference and policy forum sponsored by the Center for Budget and Policy Priorities and the Council for Affordable Health Insurance, respectively, at which I pressed in questions and comments the importance of reforming Medicaid to spur private long-term care financing alternatives.  I attended Senate Finance Committee Hearings on Medicaid Fraud, Waste and Abuse and took the opportunity to discuss key topics with witnesses and members of the audience. 

In July . . . 

I briefed Jennifer Sincavage, who is a lawyer and Health Policy Analyst with the Senate Republican Policy Council; Don Muse of Muse and Associates and his data maven, Mick Cowles; Paul Klaassen, CEO and Founder of Sunrise Senior Living; Rodney Whitlock, Ph.D., Health Policy Advisor to the Senate Finance Committee; Richard Jackson, Director of the Global Aging Initiative at the Center for Strategic and International Studies; Larry Levitt, Vice President for Communications and Online Information at the Kaiser Family Foundation (KFF); Joshua Wiener, Ph.D., Program Director for Aging, Disability and Long-Term Care at RTI International; Michael Cannon, Health Policy Director at the Cato Institute; Winthrop Cashdollar of AHIP; and Barbara Gay, Director of Communication, for the American Association of Homes and Services for the Aging.  I briefed the health legislative assistants for Senator Craig Thomas (R-WY), Senator Gordon Smith (R, OR), Senator Mel Martinez (R-FL), Senator Kent Conrad (D-ND) and Senator Trent Lott (R-MS).  I briefed a special ad hoc discussion group on Medicaid and long-term care organized by Jim Cantwell of the House Budget Committee staff including himself, Nina Owcharenko of the Heritage Foundation, Joe Moser (staffer for Congresswoman Heather Wilson, R-NM), Tom Miller (Joint Economic Committee) and John Greene of the National Association of Health Underwriters.  I monitored the Senate Aging Committee hearing on "Sound Policy, Smart Solutions:  Saving Money In Medicaid" and followed up with some of the witnesses to hammer home points I didn't think they understood or emphasized sufficiently.  I also attended a small-group, invitation-only Long-Term Care "Think Tank" sponsored by the Society of Actuaries, which to my surprise and satisfaction, endorsed major Medicaid reform as the single most important factor to spur growth in the private long-term care insurance market. 

In August . . . 

I briefed Ken Weinstein, CEO of the Hudson Institute; three staffers at the Congressional Budget Office who wanted to pick my brain for ideas on how to "score," i.e., price, certain legislative proposals; Merrill Matthews and his staff at the Council for Affordable Health Insurance; Bob Helms and Joe Antos, senior fellows at the American Enterprise Institute; Bridgett Taylor of the House Energy and Commerce minority staff; Hunter McKay of the Health and Human Services Department's Assistant Secretary for Planning and Evaluation's Office of Disability, Aging and Long-Term Care Policy; and Joy Wilson, Federal Affairs Counsel for the National Council of State Legislatures and Member of the Medicaid Commission.  I briefed the health legislative assistants for Senator Max Baucus (D-MT), Senator James Jeffords (I-VT), and Senator Blanche Lincoln (D-AR).  I conferred with Rebecca Martin of the Research Triangle Institute and William Bassett, Ph.D. of the Federal Reserve Board about how they might help cull critical data from the National Long-Term Care Survey and the Health and Retirement Survey data bases to document the wealth and home ownership of people on Medicaid in nursing homes. 

In September . . . 

The Cato Institute published my monograph titled "Aging America's Achilles' Heel:  Medicaid Long-Term Care" (; I debated New York Medicaid planner Vincent Russo at the Cato Institute (viewable at; I was quoted in the Wall Street Journal and interviewed by the Baltimore Sun; I briefed Grace-Marie Turner of the Galen Institute who is a Medicaid Commission member; I presented a briefing titled "The Trouble with Medicaid" for Hill staffers in the Rayburn Building (viewable at; I briefed Founder and CEO Paul Klaassen and the executive staff of Sunrise Senior Living; I met one-on-one for 30 minutes with Chairman Bill Thomas of the House Ways and Means Committee at his "hideaway" office in the Capitol Building; I made a presentation to the Long-Term Care Discussion Group; I briefed the Majority Staff Director of the Senate Special Committee on Aging and two Senator's Health Legislative Assistants. 

In October . . . 

I made three presentations on Medicaid and LTC financing with the Chairman of the Kansas House Appropriations Committee in three Kansas cities to excellent media coverage; I met with Wataru Sakata, Resident Director of the Japan Center for International Finance and with Director Hiromi Nakaoji and members of the Japanese Association of Administrators and Directors of Long-Term Care to discuss, compare and contrast the U.S. long-term care service delivery and financing system with Japan's; I conferred with Michael Cannon, Director of Health Policy, and Jagadeesh Gokhale, Senior Fellow and economist, of the Cato Institute to discuss ideas for a study to provide evidence of Medicaid asset transfers and spend down; I discussed LTC policy with Dr. Mark Meiners, Director of the Center for Health Policy, Research and Ethics at the George Mason University; I met with Kirk A. Johnson, Ph.D., Senior Policy Analyst, Center for Data Analysis at the Heritage Foundation who recently published an excellent piece on Medicaid and long-term care; USA Today published my letter to the editor criticizing their articles and editorial on fire safety in nursing homes and defending nursing homes; I met with Mark Warshawsky, Assistant Secretary for Economic Policy at the Treasury Department, to discuss new Nancy Johnson bill encouraging the use of annuities for long-term care financing; I briefed Dan Elling, Health Policy Aide, and Douglas Lathrop, Ph.D., Legislative Director, in Congresswoman Nancy Johnson's office regarding interest at the Treasury Department in their new annuity and LTC bill and about Medicaid eligibility and how it inhibits the market for all kinds of private LTC financing alternatives; I conferred with Kay James, former Director of the U.S. Office of Personnel Management and current member of the Medicaid Commission, regarding strategies to implement policy reform in Medicaid and long-term care; I met with John Whitman, a professor at the Wharton School of Business who has roots in the long-term care profession; I briefed Dr. William H. Dow, Senior Economist for the Council of Economic Advisors in the White House; and I met with a dozen or so representatives of AARP to seek common ground on long-term care public policy. 


In the meantime, over these past six months, I gave my usual interviews with national, regional and local print and media reporters who call frequently when they are doing stories on Medicaid, long-term care insurance or home equity conversion.  The Center also continued its daily LTC E-Alerts, including the popular LTC Embed series, faithfully. 

That brings us current.  What's next? 

Administrative Coordinator Damon Moses and I are getting ready for an 18-day trip to Japan beginning this Sunday.  Our objective is to research the Japanese long-term care service delivery and financing system.  We have appointments with key academics, an official of the Ministry of Health, Labor and Welfare, and several long-term care facilities.  I'll report on these visits after we return in mid-November. 

From November through at least the end of January, there will be less travel and more research and writing.  I have a book manuscript, tentatively titled "The Unnecessary Tragedy of Long-Term Care," due to the Cato Institute by January 31.  

Nevertheless, we will continue to follow developments on the LTC policy front and report them to you in our weekly LTC Bullets.  But if you want the down and dirty, nitty gritty details on a day-to-day basis, join the Center for Long-Term Care Reform.  We'll send you daily updates that go into much greater detail than you'll receive in the LTC Bullets. 

We can win this fight for rational long-term care policy!  But not without your help and support.