LTC Bullet:  My History of Long-Term Care Financing

Friday, July 21, 2017


LTC Comment: When economists and policy wonks get long-term care analysis wrong, we correct the record. Twenty-eight examples follow.



LTC Comment:  Next week we’ll announce publication of “How to Fix Long-Term Care Financing.” This new paper by Stephen Moses, published jointly with the Foundation for Government Accountability, lays to rest once and for all the myth that Medicaid requires impoverishment. More importantly, it explains why economists and policy analysts continue, despite overwhelming evidence, to purvey that fallacy and base poor policy proposals on it. Finally our new report explains how to fix long-term care in ways that will improve access and quality while reducing Medicaid costs substantially.

But first, this week, we give you the back story of the decade of analysis that led up to the new report. In 2005, Congress was considering legislation to prevent abuse of Medicaid long-term care benefits by middle class and affluent people. That year, I spent half time in Washington, DC talking to any interest groups, legislators and policy makers who would listen about how to improve Medicaid for the needy by diverting prosperous people into responsible LTC planning. At the same time, my co-founder of the Center for Long-Term Care Reform, Attorney David Rosenfeld, was staffing a key committee of Congress considering what to do about the Medicaid estate planning problem.

We were having an impact. The issue was in the news. Opposition grew vehement, but in the end we won a big victory. You’ll recall the Deficit Reduction Act of 2005 became law early in 2006. It put the first cap ever on Medicaid’s home equity exemption, lengthened and strengthened asset transfer look-back rules, eliminated the half-a-loaf loophole, reinstated LTCI partnerships, and did a dozen more valuable things to correct Medicaid eligibility problems. But it wasn’t a slam-dunk. The Vice President had to fly home from overseas to cast a tie-breaking vote in the Senate to pass DRA ’05.

Who opposed such good and needed legislation? Well, read on and you’ll find out. From early 2005 on, studies, articles and white papers poured out attacking the mounting evidence and arguments in support of controlling Medicaid LTC eligibility. As each one appeared, we addressed it, answered it and corrected it in a series of LTC Bullets that has continued to the present. These LTC Bullets are listed below. Read them and we believe you’ll receive a pretty good history of long-term care financing over the past twelve years. In any case, you will be fully primed to read and understand our new report when it’s released next week. You’ll see the battle is not yet won, but our goal—to give Medicaid long-term care back to the needy and help everyone else prepare to pay privately—is finally within reach.

LTC Bullet:  Why Does Georgetown Dodge RAMs?, April 12, 2005
LTC Comment:  A new report on home equity conversion from the Georgetown LTC Financing Project downplays the importance of reverse annuity mortgages (RAMs) for financing long-term care.  We present an opposing view from the National Council on the Aging in this
LTC Bullet

LTC Bullet:  Where There's Smoke, There's Fire, May 18, 2005
LTC Comment:  A new report on Medicaid planning by the Georgetown LTC Project tells us more about that organization's research bias than about the critical topic of artificial impoverishment to qualify for publicly financed long-term care.  More in this
LTC Bullet.

LTC Bullet:  LTC Bombshell, June 29, 2005
LTC Comment:  Results from a poll of state Medicaid programs by a Congressional office with subpoena power may blow the lid off a carefully orchestrated cover-up of Medicaid planning abuses.

LTC Bullet:  LTC Doubletalk, January 24, 2006
LTC Comment:  Medicaid planners and their academic and media enablers are talking out of both sides of their mouths:  asset transfers are rare but preventing them will devastate seniors.   Say, what?

LTC Bullet:  Georgetown, GAO and Kaiser:  The Bermuda Triangle of Good LTC Policy, January 25, 2006
LTC Comment:  LTC doubletalk is not the exclusive province of Medicaid planners and AARP lobbyists.  Otherwise often reliable analysts get long-term care policy wrong too.  More in this
LTC Bullet.

LTC Bullet:  Kaiser Cover-Up Continues, April 27, 2006
LTC Comment:  Urban Institute "scholars," aided and abetted by the Kaiser Family Foundation, employed an underhanded straw man argument in the foundation's latest unsuccessful attempt to debunk the impact of Medicaid planning abuse.  

LTC Bullet:  Take Georgetown's Facts With a Big Grain of Salt, February 15, 2007
LTC Comment:  Three new "fact sheets" from the Georgetown LTC Financing Project are spoiled by ideological bias.  Click the link above to read our analysis.

LTC Bullet:  GAO on LTCI Partnerships, June 20, 2007
LTC Comment:  GAO drops the ball again on the issues of Medicaid, long-term care financing and private insurance. 

LTC Bullet: KFF Misfires on LTCI, June 9, 2009
LTC Comment: A new study of private long-term care insurance published by the Kaiser Family Foundation fails in the usual, predictable ways.

LTC Bullet:  The Enemy of LTC Truth, February 8, 2010
LTC Comment:  Albert Einstein said "Unthinking respect for authority is the greatest enemy of truth."  See how this principle applies to long-term care.

LTC Bullet:  New LTCI Report:  Research or Propaganda?, Tuesday, June 8, 2010
LTC Comment:  Is a newly updated report on LTC insurance by the Congressional Research Service really research, or CLASS Act propaganda?  You decide. 

LTC Bullet:  Nursing Home Spend Down Misunderstood and Late-Breaking LTCI Industry News, July 20, 2012
LTC Comment:  A recent EBRI study that claims nursing home stays are wiping out Americans’ savings is based on a fallacy and mistaken.  What’s really happening?

LTC Bullet:  Medicaid Spend Down that Isn’t and Why it Matters, July 19, 2013
LTC Comment:  Claiming “transitions” to Medicaid are evidence of catastrophic LTC asset “spend down” misrepresents the truth and should be publicly recanted.  Click the link above to find out who, what, when, where and why. 

LTC Bullet:  Do the Rich Benefit from Medicaid?, August 23, 2013
LTC Comment:  Biased reporting by AARP suggests the answer to the title question is “no,” but solider peer-reviewed scholarship says “yes.”  Who’s right?

LTC Bullet:  Who Gets Medicaid LTC?, March 28, 2014
LTC Comment:  Is Medicaid a long-term care safety net for the poor, the middle class, even the affluent, all of the above?  Questions remain, but answers abound.

Will Bipartisan LTC Policy Be Better?, April 11, 2014
LTC Comment:  Heads up!  Consensus is coalescing around a bipartisan long-term care financing solution.  Let’s be hopeful, but wary in this
LTC Bullet

LTC Bullet:  GAO Punts on Medicaid Planning, July 3, 2014
LTC Comment:  Another GAO report underplays dramatic findings about the role, methods and extent of Medicaid planning and loose LTC eligibility rules. 

LTC Bullet:  IG Report Reveals Costly Medicaid Enforcement Failures, November 21, 2014
LTC Comment--The USDHHS Inspector General reports that many states failed to implement mandatory provisions in OBRA ’93 and/or DRA ’05 designed to discourage abuse of Medicaid LTC benefits. 

LTC Bullet:  IG Report Reveals Medicaid Estate Recovery Weakness, December 5, 2014
LTC Comment—A newly released USDHHS Inspector General report shows few states do Medicaid estate recoveries well resulting in a potential annual loss, we infer, of $2.5 billion.  Details, numbers, and why it matters.

LTC Bullet:  How Careless Economists Boosted LTC Risk, December 12, 2014
LTC Comment:  We explain how Boston College economists generated poor long-term care planning advice that national media unfortunately amplified in this
LTC Bullet.

LTC Bullet:  Another LTCI Hit Job?, October 9, 2015
LTC Comment:  What shall we make of this new attack on private long-term care insurance?

LTC Bullet:  The Arrogance of LTC Analysts’ Elitism, December 4, 2015
LTC Comment:  Arrogance, ideological bias and elitism spoil the recent research of abundantly endowed LTC analysts.  We explain.

Three Cheers (But Two From the Bronx) for New BPC-LTC Recommendations, February 5, 2016
LTC Comment: The Bipartisan Policy Center’s new report on long-term care leads with LTCI (hear, hear!), but makes Medicaid even more tempting (boo!) and adds a new, expensive, mandatory government program (boo!) based on faulty premises.  Our analysis and critique follow in this
LTC Bullet.

LTC Bullet:  LTC at a Crossroads, June 3, 2016
LTC Comment:  Long-term care financing policy is at a critical crossroads and may take a wrong turn.  We explain in this
LTC Bullet.

LTC Bullet:  Behind AHEAD, September 2, 2016
LTC Comment:  The people and organizations advocating a new, compulsory, payroll-financed government program to fund catastrophic LTC expenses base their arguments on dubious sources and reasoning. 

LTC Bullet:  Who Isn’t Covered by Private Long-Term Care Insurance?, October 21, 2016
LTC Comment:  Who is not covered by private LTCI is a much more interesting question, and harder to answer, than who is covered as we’ll explain in this
LTC Bullet.

LTC Bullet: The LTC Wars (shawsky), February 24, 2017
LTC Comment: The self-styled conservative LTC Commission co-chair has declared war on government-financed long-term care proposing private sector solutions that mirror our own.

LTC Bullet: Home Equity and LTCI Demand, June 30, 2017
LTC Comment: We affirm and confirm Professor Thomas Davidoff’s observations on the connection between home equity and LTC insurance demand in this
LTC Bullet.

LTC Bullet: Medicaid, Home Ownership and Long-Term Care Financing, July 7, 2017
LTC Comment: Medicaid’s estate recovery requirement induces aging Americans to reduce home ownership and decrease home equity in order to qualify for Medicaid long-term care benefits: we explore how this occurs and to what extent in this
LTC Bullet.

LTC Bullet: Is it Spend Down or Medicaid Planning?, July 14, 2017
LTC Comment: A lot of what passes for Medicaid “spend down” in the scholarly literature is really Medicaid planning. We explain and give examples in this
LTC Bullet.

LTC Comment:  That’s it for now, folks. See how we put it all together in our new report next week.