The 3in4 Need More bus is continuing its national hunt for long-term care insurance (LTCI) media coverage.
Jonas Roeser, the president of the 3in4 Association, Kirkland, Wash., reports that the roving LTCI awareness bus has had good luck in mountainous states this past week.
A number of TV crews came to greet the bus in Salt Lake City a few days ago, and “to date, we have been on the local news at each stop!” Roeser writes in an e-mail newsletter summarizing the week’s media outreach success stories.
This week, the 3in4 bus will take Marion Somers, the 3in4 campaign’s star geriatrician, to a morning show in Omaha, Neb., and to a caregiver radio program in Minneapolis.
The bus and “Dr. Marion” are promoting the idea that 3 in 4 Americans should do a better job of planning to pay for long-term care (LTC).
That the good news I got in my inbox.
The bad news came in a newsletter from the National Academy of Elder Law Attorneys, Vienna, Va.
Morris Klein, a Bethesda, Md., elder law and estate planning lawyer, wrote an article for NAELA about the sad state of federal support for Medicaid.
Some of my readers don’t think any government, and especially the federal government, should be involved in any kind of health care, except for soldiers wounded while on duty and, possibly, victims of natural disasters.
I think the pure “pay or die” philosophy is elegant, logical, simple, easily implemented, and attractive in many ways, for people who aren't sick, but, in the real world, I think it’s too scary even for most of the Republicans who read this column, let alone the Democrats.
The argument that the government might have a role to play in providing health care for some but provides care for way too many seems a lot more compelling.
About 80% of my readers might agree with that proposition; the rest of my readers, and Morris Klein, might be inclined to say that the government ought to be providing care for more people.
My own philosophy is pretty concrete: Try both approaches and see which works best.
My suspicion is that one common ground principle agree upon is this: Whatever acute health care or LTC services the government says it will provide, the government should provide those services.
If the government promises it will pay poor people’s nursing homes, it should either make good on the promises or publicly cancel the nursing home support program, not try to hide a decision not to pay by paying extremely slowly, processing claims in an erratic way or providing such horrible care the poor people would be better off if they’d been dumped on the sidewalk.
Klein puts the well-known perils facing Medicaid in one neat, depressing package. Klein doesn’t see private LTCI as a practical financing option for most people who will need LTC services.
Today, he notes, about 60% of nursing home residents rely on Medicaid.
But the story Klein tells makes the idea of voluntarily relying on Medicaid to pay future LTC bills seem foolish. House Republicans already are proposing to convert federal Medicaid aid into a fixed block grant, in a way that would, in effect, reduce total federal Medicaid funding by about one-third over 10 years, Klein says.
States are trying to stretch Medicaid money further by making more use of Medicaid managed care, especially for people who need LTC services, but there are no guarantees that managed care plans can safely and effectively serve the people who need LTC services, Klein says.
President Obama’s budget proposal for fiscal year 2013, which starts Oct. 1, does not address the lack of a comprehensive and coordinated LTC program, and it proposes cutting federal health care spending by “blending Medicaid and Children’s Health Insurance Program funding in a way that would reduce spending by $18 billion over 10 years, Klein says.
Obama also is proposing to phase out states’ use of health care provider taxes to generate Medicaid matching funds, and his administration is proposing decrease aid for hospitals that tend to serve a high percentage of low-income, uninsured patients, Klein says.
“Where will the states find the money to replace what the federal government saves with these changes in policy?” Klein asks. “States are already struggling to find ways to reduce Medicaid costs. At some point, services and eligibility will be cut and beneficiaries will be expected to pay more of their modest incomes for health care.”
One answer seems clear: The idea of a family with money protecting assets with Medicaid planning rather than LTCI seems unwise.
The family would be putting its future in the hands of a shaky government program, and siphoning off Medicaid assets that otherwise would be used to pay for care for people who really have no practical ability to buy any kind of insurance.