LTC Bullet:  LTC Denouement . . . for Now 

Thursday, December 22, 2005 


LTC Comment:  We warned "don't count your chickens before they're hatched," and now, sure enough they'll be incubating for at least another month and a half.  Details after the ***news.*** 

*** LTC PROVIDER PLEADS FOR PASSAGE.  The following email received by the Center for Long-Term Care Reform yesterday is published with permission from the sender.  We feel it articulates well what is at stake in the current legislative fight for rational LTC policy reform. 

"As the executive of a faith-based, not-for-profit continuing care retirement community, I see way too much inappropriate Medicaid planning going on.  While it's understandable that people want to leave their children some money or support a favorite charity, that is not the purpose of Medicaid.  My 225-bed skilled nursing facility is now over 80-percent Medicaid.  We are losing money and the board has asked us to develop a plan to downsize the nursing home.  Access to high quality nursing homes is going to be a huge challenge in the not-too-distant future as a result of over-reliance on Medicaid funding.  I hope the bill with the proper language is passed and signed into law.  I've contacted each of the Senators.  Thank you for all your efforts to get this legislature this far.  Sincerely, F. Jay Shetler, President and CEO

Glencroft Retirement Community, Glendale, Arizona *** 


LTC Comment:  The Oxford English Dictionary defines denouement as "The unravelling of the complications of a plot, or of a confused situation or mystery; the final resolution of a play, novel, or other narrative." 

The story of Medicaid reform that we've presented to you over the past few days certainly qualifies as a confused situation.  And it's just been resolved UNsatisfactorily, at least for the time being.  Here's the story.   

By some miracle late last week, the House/Senate Conference Committee on the deficit reduction package agreed to authorize LTC Partnerships and place stringent new controls on Medicaid planning.  

Early Monday morning, after a Sunday all-nighter, the House passed the Conference Committee's agreement in toto and referred it to the Senate.  

Yesterday, the Senate passed the Conference Committee's agreement but with a few minor "parliamentary" changes. 

So, as of now, we have strong legislation passed in both houses of Congress that would authorize LTC Partnerships, extend the Medicaid transfer of assets look back period from three to five years, end the "half-a-loaf" divestment strategy, stop millionaires from sheltering their home equity, and restrict numerous other technically legal, but egregiously unethical Medicaid planning tricks. 

Unfortunately, because the bill passed by the Senate is not identical to the bill passed in the House, this legislation cannot be sent to the President to be signed into law unless and until the House of Representatives passes it again, with the slight, substantively almost meaningless changes made by the Senate. 

But, there's the rub.  Members of the House of Representatives are back in their districts all across the country nestled cozily by their fireplaces, Christmas trees, and/or Menorahs.  

That would not have to be a problem.  They could approve the Senate version of this important legislation by unanimous vote right from home.  It could go straight to the President and be signed into law before Christmas or Hanukkah.  And that's exactly what Speaker Denny Hastert asked Minority Leader Nancy Pelosi to allow in an urgent letter yesterday. 

Quoth the Speaker: 

Dear Ms. Pelosi:  I am writing to ask you for unanimous consent to approve the conference report on H.R. 4241, the Deficit Reduction Act of 2005.  As you know, the House approved this measure on December 19, 2005 in a 212-206 vote.  Unfortunately, the Senate has now made minor changes, such as simple reporting requirements, that send the legislation back before the House.  Our members have already returned home to spend the holidays with their families.  By passing these changes through unanimous consent, we can avoid unnecessary disruption in the enactment of important program additions and reforms contained in this legislation. . . .  I don't think any of us wants to see a situation where some of our neediest Americans are denied care and help because of politics.  It is Christmas season, and not the time to engage in partisan squabbles.  So I would ask you respectfully, to put politics aside, agree to unanimous consent of these changes and put the American people first.  Sincerely,

J. Dennis Hastert, Speaker of the House 

Quoth the Minority Leader:   

Bah, Humbug.  Well, not exactly, here's how she actually responded by press release:   

"[W]e will request a recorded vote where all Members return to Washington to make clear their values to the American people.  Democrats will work with our allies to fight for a budget that represents the values and needs of all Americans."  

So, what's the bottom line? 

The important changes to long-term care policy that have been passed by both houses of Congress cannot become law until they're passed again by the House in a form identical to the Senate's version. 

Minority Leader Pelosi refuses to allow a unanimous vote from home as requested by Speaker Hastert. 

Neither Speaker Hastert nor President Bush appears to be willing to call the House back into session immediately for this vote. 

The House of Representatives will not reconvene in Washington, DC under its regular schedule until Tuesday, January 31. 

That gives defenders of the status quo like AARP and the Medicaid planners over a month to mobilize opposition to these critical reforms. 

That process of obstruction has already begun as these quotes from today's news coverage make clear: 

"The House had narrowly passed the bill, 212 to 206, in a predawn vote on Monday, and now, with a new vote in the House coming, opponents of the budget bill -- from organized labor to the powerful seniors lobby AARP -- began gearing up for another fight." 

"A coalition of labor unions and liberal interest groups immediately swung back into gear, drafting a list of 18 House Republicans in hopes of persuading eight to change their vote. 

"'Make no mistake -- we're going to keep on fighting until we permanently derail these reckless budget and tax cuts,' said Gerald W. McEntee, president of the American Federation of State, County and Municipal Employees, the union that has largely bankrolled the fight against the budget measure." 

The opposition's strategy is force consideration of the Administration's budget and tax cut proposals together so as to derail both by arguing that poor people will be hurt in order to deliver tax relief to the rich.  Demagogy?  Sure, but it could succeed and derail responsible LTC reform.   

We'd ask the opposition to consider this.  Giving Medicaid back to the poor by curtailing artificial impoverishment and encouraging private LTC financing alternatives is really a FAIRNESS issue.  Why use scarce public welfare resources to indemnify baby-boomer heirs of well-to-do seniors?  Ironically, most of the affluent beneficiaries of Medicaid planning abuses are likely to be Republicans!  Democrats who think the issue through will realize they're cutting off their noses to spite they faces by obstructing rational LTC policy reform. 

Anyway, for now, everything's been thrown into a cocked hat.  It looks like we won't know the final outcome until well into next year.  In the meantime, keep the faith, enjoy the holidays, and gird your loins for another fight, coming soon in the New Year.