LTC Bullet: Unique LTC Reform Opportunity

Monday, May 18, 2009

Denver, Colorado--

LTC Comment: We have the greatest chance ever to do LTC financing right. Carpe diem! No ***news*** today. This is too important to delay!



LTC Comment: What if we could do for long-term care what Governor Tommy Thompson (R, WI) and President Bill Clinton did for welfare reform 13 years ago?

Under a federal waiver, Governor Thompson removed perverse incentives in the old AFDC welfare program that trapped generations of young women in poverty. President Clinton and Congress "changed welfare as we know it" in 1996 using Thompson's Wisconsin model. Welfare rolls declined by two-thirds saving millions from impoverishment and misery.

The stars have aligned for a similar opportunity in long-term care reform. I have identified the following:

o A state ideal to be an experimental laboratory for LTC reform.

o A state with legal authorities already in place to enable the needed experimental reforms.

o A state devastated by a budget shortfall drastically exacerbated by Medicaid, especially LTC costs.

o A state with a Governor and Medicaid agency director amenable to experimentation with market-based reforms.

o A state with a legislature dominated by politicians eager to preserve and improve Medicaid as a LTC safety for the needy.

o A state with a well-regarded think tank willing to lead the charge for LTC reform by working closely with the Center for Long-Term Care Reform.

I've dreamed for many years that an opportunity like this would come along some day. This is our chance to show what can happen when a state Medicaid program eliminates perverse public policy incentives that have . . .

o trapped millions in nursing homes on welfare,

o impeded the development of a privately financed home and community-based services infrastructure,

o crowded out up to 90 percent of the potential market for private LTC insurance,

o prevented the use of home equity (seniors biggest asset) to fund quality long-term care at the most appropriate level,

o created our long-term care system's institutional bias,

o caused the serious access and quality problems that plague LTC in America, and

o created a cottage industry of "advisors" who overload Medicaid by artificially impoverishing vulnerable elderly clients.

They say doing what you've always done but expecting a different result is the definition of insanity. What federal law has forced state Medicaid programs to do since 1965 certainly qualifies. Now we have an opening to try something different and get a better result.

What should we try? You've heard it here a thousand times:

Target Medicaid's scarce LTC resources to people truly in need and use some of the savings to incentivize responsible long-term care planning through savings, investment, home equity conversion and/or private insurance. Not exactly "rocket science" as they say in DC. It's simple, straight forward, and it will work. All that's different today is that we have a real opportunity to try this approach.

By now you're probably asking: which state offers us this magnificent opportunity? But I'm not going to tell you . . . yet. Believe it or not, there are people and organizations that would nip our little seedling of reform in the bud if they knew.

Instead, let me tell you how I'd like to proceed. I want to visit State X (X for experimental), interview all the key stakeholders, explain what we have in mind, prepare and publish an action plan, mobilize with the cooperating local think tank, and get the ball rolling. I can accomplish this first step with a one week site visit to State X and another week of research and writing back in Seattle.

The Center needs $5,000 to make this humble start toward a noble goal. So, if you want to know who State X is and why I think the opportunity is so great, pledge $1,000 or more to fund this special project. We'll give you and your company or organization recognition in the report plus first right of refusal to sponsor or co-sponsor the full-fledged project.

This chance is a dream come true for the Center for Long-Term Care Reform's 2009 "Save Medicaid Campaign." I strongly encourage Regional Representatives of the Center to reach out with this appeal to potential sponsoring companies and organizations with whom you do business or have influence. Likewise, I urge all Center members and readers of our publications to forward this LTC Bullet to anyone and everyone you think might be a potential donor. Let's raise the funds and get started!

I'll close with this. Over the years, I've noticed a pervasive problem that impedes progress on long-term care policy reform. People, companies and organizations become so consumed with fighting their operational and budgeting "brush fires" that they don't even notice when the fire truck pulls up.

My friends, this is the fire engine we've been waiting for to fix long-term care. Don't let it sit in the weeds unrecognized. For general queries, please contact Damon first at 206-283-7036 or If you think there is a real possibility you can pledge $1,000 or more, please contact Steve Moses directly at or 425-891-3640.

Get the details, pledge your support, and jump aboard this bandwagon. It's going to be a heckuva ride!