LTC Bullet: Still Standing Guard
Friday, August 23, 2019
LTC Comment: Private LTC financing is
constantly under attack by scholars representing financially well-endowed
think tanks, advocacy organizations, government agencies and by the media
that broadcast their message. We’ve fought back for 21 years. Here’s how,
after the ***news.***
*** NEW MIDDLE CLASS ENTITLEMENT?
Medicaid for long-term care has operated as a middle-class entitlement for
half a century. Now add acute care to the mix. We can fix both if
policymakers heed this groundbreaking research reported in the Wall
Street Journal on August 14: “ObamaCare’s
Medicaid Deception,” by Brian Blase and Aaron Yelowitz
Excerpt: “ObamaCare wasn’t supposed to give free health
insurance to everybody. The Affordable Care Act’s authors expected the
poor would enroll in Medicaid, while those with higher incomes would buy
coverage through the new insurance exchanges, with subsidies that decrease
as income rises. It isn’t working. A study published
this week by the National Bureau of Economic Research finds that in
several Medicaid-expansion states most people who gained coverage have
enrolled in Medicaid regardless of their income. In practice, ObamaCare
has turned Medicaid into an entitlement program for the middle class. …
These findings should alarm Americans across the political spectrum. They
show that complicated government programs often bear little resemblance to
planners’ designs. ObamaCare has turned out to be a giant welfare program,
with millions of working- and middle-class Americans improperly receiving
Medicaid—a reflection of the unpopularity of the exchange policies and
incompetence of government oversight.”
LTC BULLET: STILL STANDING GUARD
LTC Comment: The Center for Long-Term
Care Reform celebrated our 21th year last April. In those two
decades, we’ve analyzed, criticized and rebutted just about every study,
report, article or commission that attacked private funding or promoted
compulsory government financing of long-term care. We’ve identified
ideological bias by scholars, think tanks, government agencies, advocacy
organizations and the media. We’ve denounced their confirmation bias when
they ignore evidence contradicting their preconceptions. We’ve refuted
fallacies in their logic. Today’s LTC Bullet includes links to 87
LTC Bullets we’ve published taking these groups and individuals to
Consumer Reports, National Public Radio (NPR), Public
Broadcasting System (PBS), New York Times, Wall Street
Journal, Washington Post, Dow Jones MarketWatch,
National Academy of Elder Law Attorneys (NAELA, Medicaid planners’ trade
association), AARP, Alzheimer’s Association, Leading Age (formerly
American Association of Homes and Services for the Aging, LTC provider
Thinktanks or companies:
Kaiser Family Foundation (KFF), Georgetown Long-Term Care Financing
Project, Urban Institute, Avalere, SCAN, Employee Benefit Research
Institute (EBRI), Bipartisan Policy Center (BPC), Center for Retirement
Research at Boston College, LTC Collaborative
Government Agencies and Commissions:
Government Accountability Office (GAO), the Medicaid Commission, the
Long-Term Care Commission, Congressional Research Service (CRS),
Congressional Budget Office (CBO), Medicare Trustees, Centers for Medicare
and Medicaid Services (CMS)
Ellen O'Brien, Peter Kemper, Harriet L. Komisar, Lisa Alecxih, Timothy
Waidmann, Korbin Liu, Judith Feder, Richard W. Johnson, Joshua Wiener,
Mark Merlis, Lee Shirey Thompson, Anne Tumlinson, Christine Aguiar, Molly
O'Malley Watts, Diane Rowland, David G. Stevenson, Marc A. Cohen,
Janemarie Mulvey, Sudipto Banerjee, Richard G. Frank, Neale Mahoney,
Howard Gleckman, Leora Friedberg, Wenliang Hou, Wei Sun, Anthony Webb,
Gretchen Jacobson, Shannon Griffin, Tricia Neuman, Karen Smith, Norma B.
Coe, Melissa M. Favreault, and David C. Grabowski.
Speaking truth to power is a mostly
thankless job. Please review the efforts we’ve made to correct attacks on
you for supporting responsible long-term care planning. Browse the
following LTC Bullets’ titles and teasers. Pick a few to download
and read in full. Then, if you find value in our work, please support the
Center for Long-Term Care Reform by becoming a member or making a
contribution. Contact Damon at 206-283-7036 or
firstname.lastname@example.org to join our fight for rational long-term care
LTC Bullets Standing Guard
LTC Bullet: More Bad Advice from Consumer Reports,
November 15, 1999
LTC Comment: Individuals and organizations most critical of private
long-term care insurance are usually the ones lining their pockets with
Medicaid estate planning profits.
LTC Bullet: They're Baaaack . . . Medicaid Planners Rise
Again, April 25, 2001
LTC Comment: Ever since Congress and then-President Bill Clinton nailed
them with mandatory estate recovery (OBRA '93), "Throw Granny in Jail" (HIPAA
'96) and "Throw Granny's Lawyer in Jail" (BBA '97), the Medicaid estate
planning attorneys have laid low. No longer.
LTC Bullet: "Nursing Home Care Virtually Free For Life,"
Tuesday, May 7, 2002
LTC Comment: What follows is a transcription of excerpts from a
professionally produced and mass-distributed videotape from a man and his
company who promise lifelong free long-term care.
LTC Bullet: Medicaid Planners Confess,
October 2, 2003
LTC Comment: A survey intended to exonerate Medicaid planners is actually
the strongest indictment of artificial impoverishment yet.
LTC Bullet: Where There's Smoke, There's Fire,
May 18, 2005
LTC Comment: Our critique follows of "Medicaid's coverage of nursing home
costs: Asset shelter for the wealthy or essential safety net?" by Ellen
O'Brien of the Georgetown Long-Term Care Financing Project.
LTC Bullet: LTC Bombshell, June
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. Lists, summarizes and
analyzes studies that pooh-pooh Medicaid planning.
LTC Bullet: Alzheimer's Association Shortsighted on LTC
Financing, July 6, 2005
LTC Comment: The Alzheimer's Association's public position on Medicaid
reform and long-term care financing is a classic example of how good
intentions invite unintended consequences.
LTC Bullet: GAO on TOA Underwhelms,
October 5, 2005
LTC Comment: The Government Accountability Office's new report on Medicaid
asset transfers asks the wrong questions, uses the wrong data, and so
provides few helpful answers.
LTC Bullet: NPR Defends Medicaid Planning, Attacks
Messenger, January 4, 2006
LTC Comment: National Public Radio's "All Things Considered" show
took a slanted swipe at responsible Medicaid reform yesterday while
defending Medicaid planning abuse. Hear the broadcast version, followed by
our side of the story.
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.
LTC Bullet: LTC Victory, February
LTC Comment: The Deficit Reduction Act of 2005 passed yesterday curbing
Medicaid abuse and unleashing LTC Partnerships. Celebrate? Sure. But don't
take a victory lap until you consider what can go wrong.
LTC Bullet: Microsimulate This!,
March 28, 2006
LTC Comment: The fundamental things apply as time goes by--like "garbage
in, garbage out." Take for example a recent Inquiry article that
estimates future public and private LTC costs. Our critique follows.
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
LTC Bullet: Medicaid Commission Errs by Omission,
August 9, 2006
LTC Comment: The national Medicaid Commission, appointed last year to fix
Medicaid (including its dysfunctional LTC component) before the welfare
program implodes financially, is way off track.
LTC Bullet: The DRA Bullets,
January 9, 2007
LTC Comment: Two Medicaid planners lament the DRA we praised and defended
in 21 LTC Bullets last year. Their whining, our replies plus links
to all the DRA Bullets follow.
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. This Bullet critiques
Medicaid's Spousal Impoverishment Protections (February
Medicare and Long-Term Care (February 2007)
National Spending for Long-Term Care (February 2007)
LTC Bullet: GAO AWOL on LTC TOA,
May 2, 2007
LTC Comment: The Government Accountability Office has again displayed
stunning miscomprehension of the Medicaid eligibility, Medicaid planning
and transfer of assets issues.
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: Medicaid Estate Recover. . .up,
July 5, 2007
LTC Comment: Medicaid estate recovery could be a major source of non-tax
revenue for the ailing LTC safety net for the poor, but AARP would tie the
program in bureaucratic knots.
LTC Bullet: The NY Compact: Analysis, Conclusions, and
Recommendations, July 31, 2007
LTC Comment: Is the New York Compact the future of long-term care
financing or the last gasp of an old, failed system?
LTC Bullet: Hillary Clinton on LTC,
January 3, 2008
LTC Comment: Presidential candidate Senator Hillary Clinton has promised a
cornucopia of LTC benefits if elected. Would our service delivery and
financing system be better or worse if she delivered? We comment.
LTC Bullet: WSJ Attacks LTCI, We Respond,
February 26, 2008
LTC Comment: Today's front-page Wall Street Journal article
criticizing long-term care insurance was as one-sided and misguided as a
similar piece published by the New York Times also during a major
industry conference. We reply, same day, as follows.
LTC Bullet: NYT Asks Medicaid Planner to Advise on LTCI,
July 18, 2008
LTC Comment: The New York Times added insult to injury by inviting
a notorious Medicaid planner to advise readers on private long-term care
insurance. We respond.
LTC Bullet: We Critique WSJ on Medicaid Planning,
January 16, 2009
LTC Comment: Within 24 hours, we replied to a Wall Street Journal
column that promoted Medicaid planning for long-term care.
LTC Bullet: New LTC Financing Study Uninterpreted or Misinterpreted,
March 24, 2009
LTC Comment: A new report on LTC financing by Avalere Health was reported
uncritically by many and mistakenly by one source.
LTC Bullet: LTC Clueless, May 26,
LTC Comment: Consumers' denial of LTC risk and cost is nothing compared to
the naiveté of professionals who should know better.
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. Details
LTC Bullet: How Much More Wrong Can They Get It?!,
July 21, 2009
LTC Comment: Another "report" from the usual suspects gets long-term care
advice dead wrong.
LTC Bullet: We Reply to Washington Post Blast at
Federal LTCI, August 14, 2009
LTC Comment: Read our reply to the Washington Post's "Federal
Diary" criticism of Federal LTCI's premium increase.
LTC Bullet: CLASS Consciousness,
October 21, 2009
LTC Comment: To hear Kaiser Family Foundation speakers, the CLASS Act is a
no-brainer for passage and implementation. We offer a wake-up call.
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
LTC Bullet: New LTCI Report: Research or Propaganda?,
June 8, 2010
LTC Comment: Is a newly updated report on LTC insurance by the
Congressional Research Service really research, or CLASS Act propaganda?
LTC Bullet: CLASSless Journalism,
September 21, 2010
LTC Comment: Reporting only the CLASS program's dubious benefits and none
of its inevitable detriments is negligent journalism. An example follows.
LTC Bullet: Friendly Fire in the Class War
(LTC Embed Report #6), September 22, 2011
LTC Comment: Steve Moses's Congressional testimony on Wednesday was
well-received except for an ad hominem attack, "friendly fire" in
the class war. An explanation, witness testimonies, and a video of the
LTC Bullet: Moses Replies to Congressman's Questions
(LTC Embed Report #11), October 13, 2011
LTC Comment: House Oversight and Government Reform Healthcare Subcommittee
ranking member Danny Davis (D, IL) asked me some questions in writing
after the 9/21 hearing on "Examining Abuses of Medicaid Eligibility
Rules." His questions and my answers follow.
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
LTC Bullet: SCAN the LTC Possibilities,
April 5, 2013
LTC Comment: SCAN is a fountainhead of ideas about long-term care
financing, but are those ideas potable? We analyze.
LTC Bullet: What Should the LTC Commission Do?,
June 21, 2013
LTC Comment: How should the LTC Commission prioritize its work and
recommendations? Some thoughts follow.
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. We answer who, what, when, where and why.
LTC Bullet: The LTC Blind,
October 25, 2013
LTC Comment: “There are none so blind as those who will not see.” That
proverb applies perfectly to a recent column about long-term care by the
Urban Institute’s Howard Gleckman.
LTC Bullet: PBS’s 6 LTC Tips Miss the Mark,
November 8, 2013
LTC Comment: What’s wrong with the conventional wisdom about how to
resolve America’s long-term care crisis?
LTC Bullet: WSJ Misfires on LTC Insurance,
February 14, 2014
LTC Comment: We dissect and correct a misbegotten column in the Wall
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
LTC Bullet: 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.
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
LTC Bullet: Entitlement Double Talk,
August 1, 2014
LTC Comment: To read the major media coverage of the 2014 Medicare
Trustees report, you’d think things are looking up for the 49-year-old
mega-program. Think again.
LTC Bullet: CMS Health Expenditure Data Mask LTC Cost
Growth, September 5, 2014
LTC Comment: CMS actuaries’ estimates of health expenditures for 2013-2023
downplay the big story, snowballing LTC costs. We explain.
LTC Bullet: Does Medicaid Solvency Matter?,"
October 31, 2014
LTC Comment: CMS says Medicaid solvency “is not an issue.” We beg to
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. Details follow.
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
LTC Bullet: When Bad Models Happen to Good People,
January 16, 2015, guest Bullet by Stephen D. Forman
LTC Comment: We offer the last word on that Boston College fiasco of poor
scholarship and bad economics.
LTC Bullet: Holding CMS’s Feet to the Fire,
February 6, 2015
LTC Comment: When a federal agency fails to enforce the law hurting the
poor it’s supposed to help and costing tax payers billions of dollars,
bureaucratic heads should roll. Background and details follow.
LTC Bullet: New Data on LTC Incidence, Duration, Cost and
Financing Sources, July 24, 2015 LTC Comment:
New numbers, better than the old numbers, but they require further
clarification and explanation.
LTC Bullet: Pandora Meets Rosy Scenario in CMS Projections,
July 31, 2015
LTC Comment: The aging demographic evils in Pandora’s “box” don’t find
their way into CMS actuaries’ health expenditure estimates for the coming
decade. Quotes and our comments follow.
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? Answers follow.
LTC Bullet: A New Revolution in Long-Term Care Financing .
. . by Government, November 6, 2015
LTC Comment: Radical, disruptive changes in how government pays for
long-term care are advancing rapidly. We provide background.
LTC Bullet: The Future of Long-Term Care Seen Through the
Prism of History, November 13, 2015
LTC Comment: Big changes are afoot in government financing of post-acute
and long-term care--changes that will rattle private LTC financing options
as well. We cover the big picture.
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.
LTC Bullet: 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.
LTC Bullet: LTCI Defeatism,
April 1, 2016
LTC Comment: LTC insurance leaders should not surrender to
government-financed long-term care based on ideologically biased policy
analysis grounded in misleading data and fallacious arguments. We say
LTC Bullet: Losing Principles,
April 29, 2016
LTC Comment: What’s happening to the basic principles of personal
responsibility and self-reliance that validate private insurance? We
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.
LTC Bullet: How the Government Ruined LTC (and We’ll Fix
It), June 10, 2016
LTC Comment: Government interference in the LTC marketplace since 1965
caused harmful unintended consequences that only clear analysis and bold
action can fix.
LTC Bullet: Half a Century of Bad Medicaid LTC Policy,
August 5, 2016
LTC Comment: Medicaid long-term care policy is a classic story of good
intentions leading to unfortunate consequences.
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. Details follow.
LTC Bullet: How Fiscal and Monetary Malfeasance Will Ruin Long-Term Care,
October 7, 2016
LTC Comment: Fiscal malfeasance ($20 trillion federal debt) enabled by
monetary malfeasance (artificially low interest rates) bode ill for the
economy and for Medicaid LTC financing. Here’s why and how.
LTC Bullet: Medicaid LTC Data Insights,
October 14, 2016
LTC Comment: What’s happening with Medicaid LTC financing and why it
LTC Bullet: What’s Wrong with Bundled and Value-Based LTC
Payments? January 20, 2017 LTC Comment: Big
changes are afoot in government financing of post-acute and long-term
care--changes that will rattle private LTC financing options as well. We
present the big picture.
LTC Bullet: Hoist with its Own Petard
, April 28, 2017
LTC Comment: This Kaiser Family Foundation “Issue Brief” blows up its own
argument. We explain.
LTC Bullet: The Broken Rhythm of Long-Term Care Reform,
May 19, 2017
LTC Comment: Why did Medicaid long-term care eligibility reforms quickly
follow economic recessions until the year 2000, but no longer? The answer
LTC Bullet: Is it Really Hopeless to Reduce Medicaid LTC
Costs?, June 23, 2017
LTC Comment: Kaiser Family Foundation researchers despair of reducing
Medicaid LTC expenditures, but their “literature review” is incomplete,
misleading and risky.
LTC Bullet: Home Equity and LTCI Demand,
June 30, 2017
LTC Comment: We explore the Professor Thomas Davidoff’s thesis that home
equity “substitutes” for long-term care insurance demand and suggested
instead that Medicaid’s large home equity exemption obviates LTCI demand
by eliminating home equity’s liability for long-term care costs.
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, decrease home equity and set up trusts
in order to qualify for Medicaid long-term care benefits.
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
LTC Bullet: Have Your Cake Until It Eats You,
March 23, 2018
LTC Comment: Americans want to have their cake (entitlements) and eat it
too, but trends show this cake will eat our economy first. Scary evidence
LTC Bullet: Retirement Confidence and Asset Spend Down,
April 27, 2018
LTC Comment: Two new EBRI studies shed light on how workers/retirees’
expectations and behavior differ.
Feder Fantasy Fatally Flawed (Cohen Contribution
Notwithstanding), May 4, 2018
LTC Comment: A new Feder/Cohen proposal would
take long-term care out of the frying pan into the fire.
LTC Evasion, May 11, 2018
LTC Comment: We explain what LTC scholars evade and why.
Feder/Cohen Proposal Ignores LTC Problems’ Cause,
May 18, 2018
LTC Comment: We explain how government intervention caused the
dysfunctions in long-term care that Feder/Cohen seek to correct with more
government intervention, including institutional bias, poor access and
quality, excessive dependency on family caregiving, inadequate financing,
and lack of insurance.
LTC Policy Blinders, May 25, 2018
LTC Comment: We explain why and how LTC policy analysts evade facts that
contradict their predisposed positions in favor of compulsory government
LTC Bullet: The New Fallacy of Impoverishment,
June 29, 2018
LTC Comment: Government should declare success in the War on Poverty and
eliminate policies that discourage personal responsibility and work.
LTC Bullet: How and How Much Medicaid Reduces Lifetime
Medical Spending for Affluent Retirees, October
LTC Comment: Medicaid is welfare, so of course it reduces lifetime medical
spending of the poor. But here’s evidence Medicaid radically reduces
medical spending by the affluent, especially for those savvy enough to
maximize “Medicaid planning.”
LTC Bullet: Amplify LTC Sanity,
February 13, 2019
LTC Comment: In today’s echo chamber of irresponsible fiscal and monetary
advocacy, a voice for responsible LTC planning and policy is more critical
than ever. Join us!
LTC Bullet: Remember the Middle,
Friday, May 10, 2019
LTC Comment: A recent Health Affairs article accurately assessed
the plight of middle-income seniors whose resources will be inadequate to
fund their senior living and long-term care. But the article proposed
interventions that would exacerbate the problem.
LTC Bullet: Middle Market Mayhem,
June 7, 2019
LTC Comment: LTC analysts, advocates, and providers are wringing their
hands about the middle market’s future inability to afford senior living.
We mitigate the problem and re-offer a 25-year-old solution.
LTC Bullet: Why Too Little Home Care?,
June 28, 2019
LTC Comment: Why is home care so unaffordable and hence unavailable to so
many? Two views follow.