LTC Bullet:  LTC Embed Report (#8) from the Policy Front in Washington, DC

Friday, September 30, 2011

Washington, DC--

Happy New Year's Eve!  (The 2012 Federal Fiscal New Year begins tomorrow)

LTC Comment:  Polarized political stalemate in Washington leads to a mid-course correction in the Center's DC project.  Details after the ***news.***

*** NPR STORY HIGHLIGHTS LTC INSURANCE AND SALLY LEIMBACH.  "When aging Americans need long-term care, especially in a nursing home, the costs can be enormous. In this part of the program, we're going to talk about those costs and some options for seniors and their families . . .."  That's how yesterday's story begins.  Listen to it here.  Read the transcript here.  Center supporter and LTCI agent/expert Sally Leimbach of FranklinMorris in Baltimore was interviewed for this NPR story. She and her client are quoted.  We have Sally to thank for adding this focus on the solution (LTCI) to a story mostly about the problem (how to finance LTC). ***



LTC Comment:  Center for Long-Term Care Reform president Stephen Moses is in Washington, DC, living in the Silver Bullet of Long-Term Care, and working on a two-month project in coordination with the Cato Institute. 

You can find a description of our project here.  In a nutshell, we set out to assess the potential for major reform of Medicaid and long-term care financing policy as a means to reduce government expenditures while improving LTC access and quality.  We pitched our approach first as a way to pay for the "doc fix" here and then as a way to achieve one-quarter of the $1.2 trillion savings over ten years that the SuperCommittee needs to find, here and here.

The Center's reports on how to "Save Medicaid LTC $30 Billion Per Year AND Improve the Program" plus our state-level studies on LTC financing in California, New York and Pennsylvania--all published this year--explained why Medicaid spends too much without fixing long-term care and what should be done to correct the problem.

With government spending out of control and all eyes on how to tame the debt and deficit by reducing expenditures, we figured the time was right to focus on policy changes aimed at targeting scarce public resources to the neediest while generating substantial government savings and encouraging private sector jobs and tax revenue.

Evidently, we were wrong.  Unlike in 2005, when our efforts contributed to the successful passage of the Deficit Reduction Act (DRA '05), today's politics are so polarized it seems unlikely any worthwhile legislative change can be achieved before next year's Presidential election. 

What's different?  One political party controlled the Presidency and both houses of Congress in 2005.  This year, divided government prevents action even when both parties fundamentally agree.  For example, in the House Oversight and Government Reform Health Subcommittee's hearing last week on Medicaid eligibility abuse--read about it here, watch it here--members from both parties agreed that Medicaid benefits should go to the indigent and that "loopholes" which allow the affluent to hijack limited Medicaid funds should be closed.

But one party has stated it will not cut Medicaid for any reason, no matter how sensible, and the other party says cutting Medicaid eligibility for the well-to-do is not possible this year because the first party refuses to consider any Medicaid cuts.  The Center for Long-Term Care Reform is non-political so we'll just let you guess which party is which in this scenario.

One incident in the hearing really drove home the frustrating hopelessness of meaningful reform any time soon.  No one took issue with the facts and logic Steve Moses laid out in his testimony and elaborated upon in answers to questions.  But when advocates for maintaining Medicaid's dysfunctional status quo questioned him, they asked exclusively about the Center for Long-Term Care Reform's funding sources.  One member of the Committee railed about the Center being a mouthpiece for the insurance industry and then stormed out of the room without allowing Steve to reply.

Steve adamantly refused to disclose any of the Center's funding sources.  He countered by observing that the only thing that matters about the Center's funding is that none of it comes from the federal government.  All of the Center's financial support is clean money earned legitimately in the private sector.  To oppose the Center's analysis and recommendations based on the source of our funding is a logical fallacy called ad hominem.  Such a tactic is baseless and base.  Center supporter and LTCI expert Bob Vandy of New York and National Long-Term Care Brokers asked "does this mean we can't believe what [the Congressman] says because he is simply a mouthpiece for his campaign contributors?"  Well put. 

Unfortunately, the video of the hearing cut off the end of the Q&A period in which Steve responded forcefully to these attacks.  Several of our readers who watched the hearing video complained that the coverage ended just as he was about to respond.  We've asked the committee to post the entire recording.  People who attended the hearing in person agreed that Steve successfully turned the criticism against his critics.

The bottom line is that continuing to pursue consensus and action on Medicaid LTC reform in the current political environment would be spinning our wheels.  Not because consensus is unreachable.  We have consensus.  We simply have no agreement that action, no matter how worthwhile, is possible.

So, when Plan A doesn't work, you shift to Plan B.  What is Plan B?  Instead of preparing legislative recommendations and persuading interest groups to support them, we'll focus on getting the word out more widely through "bullhorn organizations."  These are groups that don't necessarily conduct research or do analysis, but rather publish information and promote ideas to their membership and clientele.  Some examples include the Peterson Foundation, the Concord Coalition, Citizens Against Government Waste and former Comptroller General David Walker's new Comeback America Initiative.  If you have any contacts in such organizations, please make an email introduction to open the door for the Center.

To help get the word out, Steve Moses will prepare a series of "Briefing Papers" on key issues related to Medicaid and LTC financing.  Topics will include "The Sorry History of LTC Financing," "Easy Medicaid Eligibility," "Medicaid Planning or Welfare for the Well-to-Do," "The Mirage of Rebalancing," "Preventing Dual Eligibles," and "Private LTC Financing Alternatives."  We'll add an "overview" paper that shows how all these topics inter-relate and proposes a solution to the problems discussed.

Finally, let's close today's Bullet with this vote of confidence and support from Center for LTC Reform corporate member Stephen D. Forman of Long Term Care Associates.  He writes about the 9/22/11 ProducersWeb article titled "Medicaid planning critic goes to Capitol Hill," a good read in its own right.

"As Steve Moses has said, 'You can't sell apples on one side of the street while the government is giving them away on the other.' As long-term care insurance producers, the biggest obstacle to growth in our industry is the perverse incentive afforded by Medicaid LTC--an entrenched 45-yr old system of nursing-home biased, low-quality, but free health care.

"Bravo to the Center for LTC Reform for traveling to Washington, DC to testify during the 'Examining Abuses of Medicaid Eligibility Rules' Hearing (find the video and transcript here: . . .

"Where is the support, the hurrahs, the interest? Do the LTCI producers-at-large make the connection between the products you sell and Medicaid, and why the latter crowds-out 2/3rds to 90% of our market? Or do you disagree? The work the Center is doing is singular in its purpose--no other organization can perform the mission it can. I'm curious why a story like this seemingly flies under the radar . . .

"One of the future articles I'm writing in my series concerns unity in our industry: showing a united front; trading competition in favor of collaboration; taking responsibility for the attacks we incur and standing up to defend ourselves in the media-- not letting a handful of agents carry the water for us. . . ."


Stephen D. Forman, SVP, LTCA INC

Read the article Steve Forman refers to in the last paragraph above here.